Vol 16, No 2 (2019)

Obesity and infection. Another comorbidity?
Dvoretskii L.I.


A literature review is devoted to the problem of comorbidity of obesity (Ob) and infections. At present, extensive material has been accumulated about the increased propensity of patients with Ob to various infections (respiratory, urinary, viral, nosocomial, postoperative). One of the pathogenetic mechanisms of infection development in patients with Ob is dysfunction of cellular and humoral immunity, induced by adipose tissue production of cytokines (adipokines), which have an immunomodulating effect in various directions. Further research is needed in the field of epidemiology, mechanisms of development and course of infections in patients with Ob, as well as developing tactics for conducting this category of patients (diagnosis, antibiotic therapy, preoperative preparation, etc.).

Obesity and metabolism. 2019;16(2):3-8
Obesity and reproductive function of women: epigenetic and somato-psychological features
Andreeva E.N., Absatarova Y.S., Sheremetyeva E.V., Fursenko V.A.


The review article presents data on the effects of obesity on the female reproductive system and offspring of mothers with overweight or obesity, such as infertility, miscarriages, premature birth, stillbirth, congenital anomalies and prematurity, as well as a high risk of cesarean section. Obesity accompanies polycystic ovary syndrome, worsening the metabolic profile and increasing the risk of developing depression and eating disorders. Maternal obesity and hyperglycemia are able to influence the formation of the fetus by epigenetic mechanisms without affecting the nucleotide sequences. Subsequently, the metabolic and cardiovascular risks increase in the descendants of obese or overweight mothers and gestational diabetes. Patients with obesity are characterized by a folic acid deficiency and a deficiency of the luteal phase. Exogenous administration of these substances improves pregnancy outcomes and prevents congenital malformations.

Obesity and metabolism. 2019;16(2):9-15
Ovarian reserve and autoimmune thyroid diseases
Grigoryan O.R., Krasnovskaya N.S., Mikheev R.K., Yarovaya I.S., Andreeva E.N., Dedov I.I.


Present literature review provides information about clinical trials that evaluated the association of the carriage of antithyroid antibodies (ATA) and the reduction of the ovarian reserve, as well as the effectiveness of assisted reproductive technologies. The ambiguity and sometimes the opposite of the conclusions of different authors, makes it possible to recommend a balanced attitude to the advisability of screening for ATA in women with a reproductive dysfunction as well as the therapeutic measures proposed in some guidelines based on the results of such examination.

Obesity and metabolism. 2019;16(2):16-21
Original paper
Effect of MC4R gene polymorphism on food intake in adolescents with overweight and obesity
Ievleva K.D., Bairova T.A., Sheneman E.A., Balzhieva V.V., Ayurova Z.G., Rychkova L.V., Kolesnikova L.I.


BACKGROUND: The melanocortin 4 receptor gene (MC4R) codes the receptor expressed in the hypothalamus and involved in the regulation of body mass and height. Data on the association of polymorphism MC4R rs17782313 with anthropometric parameters are contradictory.

AIMS: to study the influence of the carrier of polymorphism MC4R rs17782313 on the anthropometric parameters in adolescents of different ethnic groups: caucasians and mongoloids living in the Siberia.

MATERIALS AND METHODS: The study included 179 caucasian adolescents (by the example of russians, average age is 15.07 ± 1.25 years) and 182 mongoloid adolescents (by the example of the buryats, the average age is 14.71 ± 1.28 years), 89 and 92 adolescents were included in groups with overweight and obesity (standard deviation (SDS) BMI> 1), in the control groups (SDS BMI from -1 to + 1) also 90 and 90 adolescents were included in the control groups (SDS BMI from -1 to + 1) (russian and buryat, respectively). Anthropometric measurements included height, weight with the calculation of BMI and SDS BMI, WC (waist circumference), HC (hip circumference ). Genotyping was performed by real-time PCR. Statistical analysis of the results of the study was carried out using the software «STATISTICA 8.0».

RESULTS: We showed no association of the risky C-allele of polymorphism rs17782313 with overweight and obesity in russian adolescents (22.5% vs 17.9% OR = 1.34 (p> 0.05)) and in the buryat (29.8% vs 24.1%, OR = 1.43 (p> 0.05)). It was revealed that adolescent carriers of the C-allele in buryat showed higher growth in both groups (control: 162.19 cm vs 157.26 cm (p = 0.019)), the main group: 165.24 cm vs 164.91 cm (p = 0.041)), as well as weight gain in the control group (52.29 kg vs 48.05 kg (p = 0.028)).

CONCLUSIONS: Thus, the study revealed the relationship of MC4R rs17782313 polymorphism with height and weight in adolescents of buryat ethnic group.

Obesity and metabolism. 2019;16(2):22-28
Predictors of visceral obesity in normal weight obstructive sleep apnea patients
Brodovskaya T.O., Kovin E.A., Bazhenova O.V., Grishina I.F., Peretolchina T.F.


BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is epidemiologically related to adverse cardiovascular outcomes. The pathophysiology clues are metabolic changes and obesity. The most studied anthropometric predictors of obesity, such as body mass index (BMI), waist circumference (WC), are influenced by various factors such as sex, type of constitution, hydration balance. The normal range of BMI and WC limits the diagnostic search for metabolic disturbances and visceral obesity in patients with respiratory sleep distress and can lead to increased cardiovascular risks.

AIMS: to investigate the visceral obesity predictors in normal weight patients with obstructive sleep apnea syndrome.

MATERIALS AND METHODS: We had performed а cross-sectional study, 68 patients were examined with mean age of 38.24 ± 7.4 years. The main group (38 individuals) was represented by patients with OSAS. The control group consisted of healthy individuals without OSAS. Alternative markers of visceral obesity, such as lipid accumulation products, visceral obesity index, conicity index have been studied.

RESULTS: In the main group we found different disorders of lipid metabolism such as the increase in triglyceride levels by 94%, low-density lipids by 32%, total cholesterol by 10% compared with the control group. Anthropometric evidence was obtained for excessive fat accumulation in patients with normal body weight and OSAS: WC was 89.6 ± 5.7 cm in the main group and was higher than in the control group 83.7 ± 6.3 cm (p = 0.024) due to an increase in the visceral fat compartment, as evidenced by the conicity index (67.2 ± 7.0 and 59.3 ± 6.2 respectively, p = 0.032) and waist to height ratio (0.58 ± 0.05 and 0.53 ± 0.04 in the main and control groups, respectively, p = 0.041). Correlation relationships between the severity of sleep apnea syndrome and visceral obesity indicators were revealed.

CONCLUSIONS: Normal weight patients with breathing disorders are at risk of visceral fat obesity and, thereby, increased cardiovascular risk. Assessment of additional markers of visceral obesity in patients with normal body weight and sleep apnea is recommended to include in the dynamic observation programms.

Obesity and metabolism. 2019;16(2):29-35
Correlation between body weight and postural control in healthy individuals using sway meter
G T., M G V., C V S., G M., K K.


BACKGROUND: Postural control is critical for ensuring a safety activity of daily living. Individuals with poor stability are more prone to fall while doing activities of daily living. A certain level of sway is essentially present due to small perturbation within the body during shifting body weight from one to other foot, breathing, etc. The purpose of this study was to analyze the correlation between body mass and postural control in normal, lean and obese individual.

AIMS: to analyze the correlation between body mass and postural control in healthy individuals using sway meter.

MATERIALS AND METHODS: This is an observational study done with 75 participants. Both male and female healthy individuals between 18-23 years were included in this study. Individuals with any musculoskeletal injuries, neurological conditions, peripheral artery disease and pregnant women were excluded from the study. BMI of each participant was calculated and assigned into three groups. Group A-lean, group B-normal and group C-obese. Postural control was analyzed for each group by using sway meter; level of postural sway was compared between groups A, B & C.

RESULTS: On comparing mean values of groups A, B and C there was a positive association and strong correlation between body mass index and postural control with eye open and eye closed in anterior, posterior and postural sway towards left between the groups at (P ≤ 0.05). However, there was a negative association and weak correlation between BMI and postural control with eye open & eye closed in postural sway towards right between the groups at (P ≥ 0.05).

CONCLUSIONS: This study reveals that there is strong correlation between BMI and postural control. Subjects in eyes closed and eyes opened conditions showed sway in anterior, posterior and left directions but there was less sway towards right side direction.

Obesity and metabolism. 2019;16(2):36-41
The experience of sibutramine administration in patients with obesity and controlled arterial hypertension
Shupenina E.Y., Yushchuk E.N., Vasyuk Y.A., Yureneva S.V., Dubrovina A.V.


BACKGROUND: Obesity is a metabolic disorder that becomes epidemic. Visceral adiposity increases the risk of arterial hypertension, diabetes mellitus and other comorbidities. According to this, the main aim of obesity treatment is not only a weight loss but also a decrease of the risk of comorbidities.

AIMS: to assess the efficiency and safety of sibutramine in patients with obesity and arterial hypertension, to evaluate the drug influence on epicardial fat thickness.

MATERIALS AND METHODS: 57 patients aged 35-60 with obesity and arterial hypertension were included in the study. All patients at the beginning and after 7 months of follow-up underwent complex examination including anthropometric measurement, ECG, office and ambulatory blood pressure measurement, echocardiography. Patients with controlled arterial hypertension were included. During the first month of follow-up patients were given general weight loss recommendations. Then sibutramine was added. Control visits to assess efficiency and safety of drug treatment were held after 1 and 6 months of follow-up.

RESULTS: Women predominated among the study participants. Visceral adiposity was approved by anthropometric measurements among all patients. Most patients had impaired left ventricle geometry: concentric remodeling or hypertrophy. During the first month of follow-up the weight loss was mild: 2 kg (less than 2%) in average. Sibutramine for 1 month the weight loss increased: 3.7 kg (more than 2%) in average. After 6 months of drug administration the weight loss of patients consisted 8.6 kg (6.2%) in average. According to echocardiography results indexed mass of LV myocardium decreased in all patients more significantly in women. Also in this group of patients significant decrease of epicardial fat thickness was revealed. Adverse events of sibutramine were revealed in 26.3% of patients. The most frequent were constipation (12.3%) and dry mouth (10.6%). The severity of symptoms persisted for 1 month and then decreased, additional therapy was not required.

CONCLUSIONS: Sibutramine treatment of obesity promotes effective weight loss, influences the adipose tissue distribution, decreases the progress of associated comorbidities. Sibutramine is an effective and safe drug that can be used in patients with visceral adiposity and controlled arterial hypertension.

Obesity and metabolism. 2019;16(2):42-48
T/A polymorphism of the FTO gene and lifestyle are associated with fat accumulation in different age groups of men
Bondareva E.A., Zadorozhnaya L.V., Khomyakova I.A.


BACKGROUND: Adiposity development and its complications are determined by lifestyle, genetic mechanisms and their interactions. Among the obesity-related genes, polymorphisms in the fat mass and obesity associated (FTO) gene are strongly associated with body fat estimates in different populations.

AIMS: to examine the association between the FTO polymorphism (T/A, rs9939609) and fat accumulation in adult russian males.

MATERIALS AND METHODS: The study engaged 205 participants; the age ranged from 17 to 52 years. Samples of buccal smears were collected and genomic DNA was isolated for T/A polymorphism genotyping. Anthropometric measurements were conducted with caliperometry and body composition was estimated by bioimpedance analysis.

RESULTS: Genotype frequencies in the whole studied sample were as follows FTO*TT 14%, FTO*AT 52,6%, FTO*AA 33,4% (χ2HW = 1,65 p=0,193). The minor A allele was significantly associated with increased fat accumulation and abdominal adiposity.

CONCLUSIONS: Among different lifestyle modifications regular and consistent programmes of exercise are most efficient strategy to reduce abdominal fat deposits significantly, independent of FTO genotype.

Obesity and metabolism. 2019;16(2):49-53
Comparison of the accuracy of resting metabolic rate in children with simple obesity using calculation formulas and indirect respiratory calorimetry
Okorokov P.L., Vasyukova O.V., Shiryaeva T.Y.


BACKGROUND: A prerequisite for planning a diet for weight loss in obese children is to determine the level of resting metabolic rate (RMR). The gold standard for estimating the daily energy consumption of rest is indirect respiratory calorimetry. However, given its high cost and labor intensity, various calculation formulas are widely used in clinical practice.

AIMS: to determine the accuracy of resting metabolic rate estimated by calculation formulas and indirect respiratory calorimetry in children with simple obesity.

MATERIALS AND METHODS: The study included 100 children aged 9 to 18 years, with a «simple» constitutional-exogenous obesity, which assessed the resting metabolic rate estimated by calculation formulas and indirect respiratory calorimetry.

RESULTS: The Molnar formula most accurately estimates resting metabolic rate, comparable to the results of indirect respiratory calorimetry in 64% of cases. The Harris-Benedict and IOM formulas yield an accurate result in 53 and 51% of the cases, respectively. The least accurate result is shown by WHO formula (22%). The minimum mean difference between the calculated and actual basal metabolic rate in obese boys for the Molnar formula is 18 kcal (CI: -53 to 90, 95% LOA from -490 to 527), in girls: -0.7 kcal (CI) : -65 - 63, 95% LOA from -435 to 434). Attention is drawn to the large mean difference and wide spread of the boundaries of the agreement of the studied indicators in obese children. In the evaluation, depending on the degree of obesity, it is shown that the formula Molnar has the highest accuracy, however, in children with morbid obesity, the accuracy of the evaluation is significantly reduced.

CONCLUSIONS: Indirect respiratory calorimetry is the preferred method of assessing resting metabolic rate in children with simple obesity.

Obesity and metabolism. 2019;16(2):54-59
National survey of doctors on hypo-and hypernatremia in the context of real clinical practice
Pigarova E.A., Dzeranova L.K., Zhukov A.Y., Dedov I.I.


BACKGROUND: The prevalence of dysnatremia varies widely (from 1 to 63%), and depends on comorbidities, the effects of more than 18 hormones and hormone-like substances, which confirms the importance of maintaining blood sodium levels in the tight physiologic range and makes it possible to consider its deviations as an endocrine pathology. Both hypo- and hypernatraemia are associated with a multiple increase in mortality, risk of fractures, and gross balance disturbances. At the same time, the clinical manifestations of dysnatremia are not specific, reflect an osmotically mediated decrease in brain function, which potentially may be missed in clinical practice.

AIMS: to study the specifics of diagnosis, differential diagnosis and treatment of dysnatremia states by specialist doctors using a sociological survey method.

MATERIALS AND METHODS: A cross-sectional sociological uncontrolled study was conducted by questioning doctors about hypo- and hypernatremia using the online questionnaire “Questionnaire on hypo-and hypernatremia in clinical practice” created on the Google forms platform. The invitation to fill in the questionnaire was sent to the email addresses included in the database of the Russian Association of Endocrinologists. A total of 353 completed questionnaires were received.

RESULTS: The poll demonstrated a low frequency of determining blood sodium levels - less than 38% of specialists prescribe sodium in more than half of the cases, including the cases of diseases associated with dysnatremia, which correlates with less practical experience of doctors. The overwhelming majority of endocrinologists (82%) in their clinical practice encounters deviations of the sodium levels in patients, but only 6% recognize the possession of the competence of managing patients with dysnatremia. The discrepancy between the lower limit of normal range to 135-136 mmol/l was observed in 22% (62/278), the inconsistency of the upper normal limit to 145-146 mmol/l - in 47% (131/278) of laboratories, and in 33% (41/278) laboratories, which are used by doctors, there was a discrepancy along both limits of the reference interval. The presence of a hypertonic solution (3%) of sodium chloride in a hospital was noted only by 38% of respondents.

Conclusions: There is an unphysiological variation in reference intervals for blood sodium concentration in 55% of laboratories, a low frequency of sodium levels evaluation in the blood (in more than half of clinical situations only 38.2% of doctors prescribe the estimation of blood sodium level) and the lack of educational competence in managing patients with syndromes of hypo- and hypernatremia in 94% of endocrinologists.

Obesity and metabolism. 2019;16(2):60-68
Vitamin D status in residents of Tyumen region
Suplotova L.A., Avdeeva V.A., Rozhinskaya L.Y.


BACKGROUND: The high prevalence of vitamin D deficiency worldwide is often associated with the region of residence.

AIMS: to study the level of vitamin D in serum of residents living in Tyumen region, to assess the frequency of occurrence of insufficiency and deficiency of vitamin D in the region.

MATERIALS AND METHODS: Observational, single-site, transverse, selective, uncontrolled study of the prevalence of vitamin D deficiency among adults in Tyumen region, conducted from November 2017 to March 2018.

RESULTS: Optimal levels of 25(OH)D in the residents of the Tyumen region were found in 7.3% of patients, its insufficiency was registered in 22.0% of cases, and defficiency – in 70.7%. There was a weak correlation relationship between lower values of 25(OH)D in those examined with obesity according to body mass index (r = -0.104, p <0.05) and waist circumference (r = -0.239, p <0.05), and with greater body mass (r = -0.130, p <0.05).

CONCLUSIONS: There is a high prevalence of insufficiency and deficiency of vitamin D among the adult population living in Tyumen region has been revealed. Additionally, it has been established that the level of vitamin D is not associated with gender and age, but is associated with BMI, waist circumference and body weight of patients.

Obesity and metabolism. 2019;16(2):69-74
New ideas about the pathogenesis of osteoarthritis, the role of metabolic disorders
Alekseeva L.I.


The article highlights the current data on the prevalence and pathogenesis of osteoarthritis (OA), presents a new definition of the disease, research results on the heterogeneity of OA, its relationship with obesity and metabolic syndrome. Obesity is one of the main factors in the development and more rapid progression of OA, and the presence of metabolic syndrome not only increases the risk of developing the disease, but also determines its severity. It is noted that with an increase of the components of the metabolic syndrome, the severity of OA increases. Therefore, hyperuricemia is associated with the presence of osteophytes and the progression of osteoarthritis, hyperglycemia - with the severity of the clinical manifestations and radiological progression. Much attention is given to the treatment of patients with OA and The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) recommendations for the treatment of knee joints OA updated in 2019. In which for the first time a symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) are assigned as the basis in the treatment of OA. The data on the effectiveness of some drugs from this group are presented. The glycosaminoglycan-peptide complex, which contains pharmacologically high-quality chondroitin sulfate when administered intramuscularly, has a significant effect on the symptoms, and in case of continued use, slows the progression of OA. The multicenter open-label prospective study of diacerein in patients with knee-joint OA combined with metabolic syndrome showed that during therapy pain syndrome and stiffness are reduced, and functional condition of the joints and quality of life of patients improves quickly and significantly. In addition, the positive effect of the drug on some components of the metabolic syndrome was demonstrated: a significant decrease in body mass index, low density lipoproteins, triglycerides, glucose and uric acid.

Obesity and metabolism. 2019;16(2):75-82
Case Report
The state of erection in a patient with craniopharyngioma, panhypopituitarism and diencephalic obesity
Sidneva Y.G., Astafyeva L.I., Kadashev B.A., Kalinin P.L., Kutin M.A., Dzeranova L.K.


The article presents a clinical case from the practice of a patient with craniopharyngioma. The man of reproductive age with diencephalic obesity (BMI 35 kg/m2), recurrent craniopharyngioma, a long history of endocrine disorders (panhypopituitarism, including secondary hypogonadism, with the corresponding sexual function disorders and the lack of sexual activity), with visual disorders and psychiatric symptoms in the early postoperative period after shunting surgery and reducing the volume of the craniopharyngioma cyst, erection conditions arose against the background of episodes of disorders of consciousness within the framework of sleep dissociation.

After the operation (installation of the Ommaya system), the patient had a state of «spontaneous» erection lasting up to 30 minutes against the background of dream-oneiric states of impaired consciousness with erotic experiences. These states were observed for 3 nights, the patient remembered the experiences and events that occurred to him «in a dream», and could tell about them to others on the next morning. The identity of the patient remained intact, he was active in the department, ordered in behavior; memory for current events and new information was intact. These disorders in the patient did not require specialized treatment, regressed independently on the 6th day of the postoperative period.

Obesity and metabolism. 2019;16(2):83-88
The efficacy of high-dose cabergoline treatment of prolactinomas resistant to standard doses: a clinical observation
Kalmykova Z.A., Vorotnikova S.Y., Fedorova N.S., Dzeranova L.K., Pigarova E.A., Vorontsov A.V.


Hyperprolactinemia (HP) is one of the most common neuroendocrine disorders. In 60% of cases, pathological HP is caused by pituitary prolactin-secreting adenoma. Therapy with agonists of dopamine type 2 receptors (D2 receptor agonists) is a method of choice for the treatment of pathological HP which allows to achieve prolactin normalization and reduction of pituitary adenoma in most cases. However, 15-20% of patients are resistant to D2 receptor agonists, and the question of overcoming this resistance is highly relevant. Different approaches are considered to solve this problem, one - is to increase the dose of D2 receptor agonists up to the maximally tolerated. In this article, we present a clinical observation of a patient with a partial resistance to D2 receptor agonists who demonstrated a good response to treatment with high doses of cabergoline.

Obesity and metabolism. 2019;16(2):89-94

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