HOMA Index Research Articles

Effectiveness of Motivational Counseling for Lifestyle Modification in Obese Patients Using a Patient-centered Approach

Obesity is a predictor of a significant number of non-communicable diseases. Reduction of body weight by 5–10 % in 6 months, has a positive effect on the prognosis of life and is one of the goals of treatment. To achieve such goals, there is a need for a patient-oriented approach, where the degree of individualization corresponds to the personal risks and needs of the patient with his involvement in the process of choosing a treatment strategy and forming new flexible life habits through the use of motivational counseling. The objective: is to determine the effectiveness of motivational counseling for lifestyle modification in obese patients of prime working age using a patient-oriented approach. Materials and methods. 37 patients with obesity I (27 people) and II (10 people) degree, aged 38.03±1.27 years (20 women and 17 men) were examined. Patients were given motivational counseling according to the «5 As» system, the patient-oriented approach included recommendations regarding the regime and caloric content of food, physical activity (monitoring with a pedometer), compliance with sleep hygiene, correction of psycho-emotional disorders. Clinical laboratory examination in dynamics after 1 month, 3 months and 6 months included measurements of BMI, waist and hip circumference, body surface area, waist/hip ratio, conicity index, body shape index, abdominal volume index, blood pressure, levels of blood glucose, insulin, HOMA index, cholesterol, lipidogram indicators, serotonin and leptin. In addition, surveys were conducted using the HADS hospital anxiety and depression scale, Beck’s scale, Hamilton scale, Dutch Eating Behavior Questionnaire, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Questionnaire, SF-36, The International Physical Activity Questionnaire, The Finnish Diabetes Risk Score. Statistical analysis was performed using IBM SPSS Statistics, Statistica 12, descriptive statistics Excel 2010. Results. During 6 months of observation, patients lost more than 5 % of their body weight (p<0.05), which was accompanied by a significant decrease in BMI (p<0.01) and an increase in the level of physical activity (p<0.001). The levels of lipid and carbohydrate metabolism exceeded the recommended values and had a positive tendency to decrease during treatment (p>0.05). Assessments of the manifestations of anxiety and depression according to the HADS depression and Hamilton scales, eating disorders, serotonin and leptin levels, quality of sleep, quality of life of patients improved. The prediction of the risk of developing diabetes had significant positive dynamics (p<0.05). Conclusions. The obtained results make prove that the application of of motivational counseling according to the step-bystep system «5 As» with a patient-oriented approach in patients of working age with obesity is an effective method, which is confirmed by reliable positive results and allows to reduce body weight by more than 5 % in 6 months, reduce levels of metabolic disorders, blood pressure, increase physical activity, reduce the manifestations of depression and anxiety, eating disorders, improve the quality of sleep and life of patients, improve the prognosis and reduce the risk of non-infectious diseases. If it is necessary to achieve stricter targets of indicators in obese patients and/or in a shorter time, it is necessary to carry out a further search for effective measures and consider the additional use of pharmaceutical products in prevention.

Analysis of the effect of hashimoto's thyroiditis and insulin resistance on ovarian volume in patients with polycystic ovary syndrome

ObjectiveIn this study, patients were divided into two groups. Patients with polycystic ovary syndrome (PCOS) and patients with polycystic ovary syndrome + Hashimoto's Thyroid (PCOS + HT). The effect of insulin resistance on ovarian volume in patients divided into two groups and the change in ovarian volume with the addition of HT to PCOS will be investigated.Material and methods46 PCOS patients and 46 PCOS patients diagnosed with HT were included in this study. A detailed medical history was taken from all participants. Polycystic ovary image was evaluated as below or above 10 ml and antral follicles were counted by transvaginal ultrasound. Insulin resistance of the patients was evaluated according to the fasting insulin (HOMA) index.ResultsInsulin resistance was found to be associated with fasting insulin, HOMA index, body mass index and right ovarian volume in patients diagnosed with PCOS. Among the patients diagnosed with PCOS + HT, insulin resistance was found to be significantly correlated with fasting insulin, HOMA index, (BMI), (SHBG) and left ovarian volume. An increase in right ovarian volume was found in 37.5% of patients with PCOS without insulin resistance and in 76.3% of patients with insulin resistance. An increase in left ovarian volume was found in 35.7% of patients without insulin resistance diagnosed with PCOS + HT and in 68.8% of patients with insulin resistance.ConclusionsThis study shows that ovarian volume should be evaluated in every PCOS patient in order to predict insulin resistance, which causes long-term metabolic diseases, and that all PCOS patients with increased ovarian volume should be investigated for insulin resistance. In addition, it has been observed that insulin resistance affects left ovarian volume in patients with PCOS + HT, whereas insulin resistance affects the volume of the right ovary more in patients with PCOS. At least one ovary has been found to be affected by long-term metabolic diseases. While there was a greater increase in ovarian volume with the addition of insulin resistance, no significant change was observed in the number of patients with increased ovarian volume (PCOS-58, PCOS + HT-57) with the addition of HT finding.

Comparable Hemodilution with Hypertonic Glucose in Patients with and without Type-2 Diabetes Mellitus during Hemodialysis.

(1) Background: It was examined whether glucose-induced changes in the relative blood volume are suitable to identify subjects with and without type-2 diabetes mellitus (T2D) during hemodialysis. (2) Methods: The relative blood volume was continuously recorded during hemodialysis and perturbed by the infusion of glucose comparable to the dose used for intravenous glucose tolerance tests. Indices of glucose metabolism were determined by the homeostatic model assessment (HOMA). Body composition was measured by a bioimpedance analysis. The magnitude and the time course of hemodilution were described by a modified gamma variate model and five model parameters. (3) Results: A total of 34 subjects were studied, 14 with and 20 without T2D. The magnitude of the hemodilution and the selected model parameters correlated with measures of anthropometry, body mass index, absolute and relative fat mass, volume excess, baseline insulin concentration, and HOMA indices such as insulin resistance and glucose disposition in a continuous analysis, but were not different in a dichotomous analysis of patients with and without T2D. (4) Conclusions: Even though the parameters of the hemodilution curve were correlated with measures of impaired glucose metabolism and body composition, the distinction between subjects with and without T2D was not possible using glucose-induced changes in the relative blood volume during hemodialysis.

Índice de masa triponderal y marcadores de riesgo metabólico en niños y adolescentes con obesidad

Background and objectiveTriponderal mass index (TMI) would estimate excess adiposity better than body mass index (BMI), maintaining stable values during childhood. This work aims to determine the correlation between TMI and markers of metabolic risk as well as set values of TMI that are related to an increase of metabolic risk. Material and methodsMulticenter, observational, cross-sectional and prospective study in children under 14 years of age with obesity. Variables: age, sex, pubertal stage, weight, height, abdominal circumference, BMI, TMI, basal glucose and insulin, HOMA index, blood pressure, lipoprotein profile, transaminases and uric acid. BMI and TMI were expressed according to the values of the Barcelona longitudinal study. Statistical analysis was performed with the SPSS* program. ResultsOne hundred and ninety-nine patients (50.3% male), age 11.08 (2.48) years, TMI 19.68 (2.36)kg/m3. Correlation between TMI and abdominal circumference (r=0.571; p=0), insulin (r=0.198; p=0.005), HOMA index (r=0.189; p=0.008) and HDL-c (r=−0.188; p=0.008) was observed. IMT>20.15kg/m3 was associated with insulin≥15mIU/ml (p=0.029) and IMT>20.36kg/m3 with HDL-c<40mg/dl (p=0.023). ConclusionsTMI was correlated with increase of abdominal circumference, insulin and HOMA index and decrease of HDL-c. IMT>20kg/m3 can be associated with increased insulin and decreased HDL-c. Therefore, the IMT seems to be a useful parameter in the assessment of pediatric patients with obesity.

The effects of phthalate exposure on metabolic parameters in polycystic ovary syndrome

Background-aimPhthalates are known as endocrine disrupting chemicals which are present in wide-range of products. The objective of the study was to investigate whether phthalate exposure may attribute to the metabolic syndrome development in women with polycystic ovary syndrome (PCOS). MethodThe cross-sectional study involved 60 women in reproductive age with confirmed PCOS. Anthropometric and biochemical measurements were examined together with detected levels of ten phthalate metabolites measured by GC–MS in morning urine samples. ResultsIn this study at least one phthalate metabolite was detected in 51.7% of samples. Total phthalate metabolites urine concentrations were positively associated with BMI, waist circumference, waist-to-height-ratio (WtHR), leptin serum levels as well as lipid accumulation product (LAP) and visceral adiposity index (VAI). Mono-methyl-phthalate (MMP) levels was significantly correlated with WtHR, LAP and VAI. Additionally, total phthalate metabolites levels were significantly linked with fasting plasma glucose and HOMA index, whereas MMP concentrations were associated with fasting plasma glucose and insulin levels. Total cholesterol (TC) level was statistically significantly higher among PCOS women with detected phthalate metabolites compared to those without phthalates. The sum of all phthalates was correlated with LDL and triglyceride levels as well as TC/HDL. MMP concentrations were linked positively with TC, LDL and triglyceride levels as well as with TC/HDL. It is noteworthy that MMP concentrations were positively associated with testosterone serum levels while the total phthalate metabolites concentrations were also linked but with moderate significance. ConclusionsThe increased phthalate metabolites concentrations may interfere with obesity, glucose and lipid impairment in PCOS women. Additionally, testosterone serum levels can be disrupted by MMP.

Атерогенные нарушения у подростков с ультразвуковыми признаками жирового гепатоза и гиперурикемией

The purpose — to study the features and relationship of blood uric acid and metabolic atherogenic disorders in adolescents with fatty hepatosis. Material and methods. The study of atherogenic disorders included the following groups: 1 — adolescents with fatty hepatosis and hyperuricemia (n = 44), 2 — adolescents with fatty hepatosis and normal blood uric acid levels (n = 76), 3 (comparison group) — adolescents without acute and chronic diseases (n = 220). The study results showed higher values of average body mass index, waist circumference, triglycerides, total lipid peroxidation, glucose, HOMA index, insulin, C-reactive protein, and lower values of high-density lipoprotein cholesterol and 25-hydroxyvitamin D in the group of adolescents with fatty hepatosis and hyperuricemia, compared to the group with fatty hepatosis and normal blood uric acid levels and the comparison group. A correlation analysis in a group of adolescents with ultrasound signs of fatty hepatosis revealed a positive correlation of the uric acid level in the blood with the HOMA index (r = 0.45; p &lt; 0.001), waist circumference (r = 0.45; p &lt; 0.001), body mass index (r = 0.35; p &lt; 0.001), insulin (r = 0.34; p = 0.007), glucose (r = 0.31; p &lt; 0.024), total lipid peroxidation (r = 0.41; p &lt; 0.015), triglycerides (r = 0.36; p = 0.014), and C-reactive protein (r = 0.31; p = 0.007), and a negative correlation with the 25-hydroxyvitamin D level (r = — 0.38; p = 0.001). Conclusions. The study showed the possibility to use blood uric acid levels in fatty hepatosis in adolescents as an indicator of atherogenic metabolic disorders: insulin resistance, lipid peroxidation, dyslipidemia, chronic inflammation, and 25(OH)D insufficiency.

COMPARATIVE ANALYSIS OF EFFECTIVENESS OF OBESITY TREATMENT IN PRIMARY CARE USING PATIENT-ORIENTED APPROACH WITH MOTIVATIONAL COUNSELING FOR LIFESTYLE CORRECTION AND ITS COMBINATION WITH ARMODAFINIL THERAPY IN PATIENTS WITH CONCOMITANT SHIFT WORK SLEEP DISORDER

Aim: Conduct a comparative analysis of effectiveness of obesity treatment in primary care using patient-oriented approach with motivational counseling for lifestyle correction and its combination with armodafinil therapy in patients with concomitant shift work sleep disorder. Materials and Methods: 75 patients with obesity were studied, 38 patients had shift work disorder. Patients were divided into 2 groups: I (37 patients with obesity treated with motivational counseling) and II (38 patients with obesity and shift work disorder treated additionally with armodafinil 150 mg daily). The examination was at baseline, after 1st, 3th and 6th months. Statistical analysis was provided. Results: After 1 month of treatment, there were improvement of eating behavior, level of anxiety and depression, prognosis of diabetes development. At 3rd month, more pronounced changes were observed in 2nd group: 10% body weight loss, changes in eating behavior, sleep quality, anxiety level (p&lt;0.05). After 6 months, examined indicators in both groups normalized, but dynamics in 2nd group was more significant; armodafinil-treated group had significantly better results in body weight loss, BMI, WC, HC, ConI, AVI, BPs, HOMA index, serotonin, leptin, levels of anxiety and depression, eating behavior, daytime dysfunction, level of sleepiness, quality of life and risk of developing diabetes. Conclusions: The use of armofafinil in addition to patientoriented motivational counseling in lifestyle correction (“5 As” and “5R”) in patients with obesity connected with shift work disorder and excessive daytime sleepiness allows to reduce body weight by more than 16,52%, in contrast to isolated use of the same technique of motivational counseling in obese patients without sleep disorder (only 5,51%).

The efficacy of diet modification in improving of both elevated low-density lipoprotein cholesterol (LDL-C) and HOMA index

The efficacy of diet modification in improving of both elevated low-density lipoprotein cholesterol (LDL-C) and HOMA index

The Relationship Between Oxidative Stress, Selenium, and Cumulative Risk in Metabolic Syndrome.

Oxidative stress in association with metabolic syndrome represents a complex disease entity that has emerged as a significant public health challenge, and it is closely linked to an elevated risk of cardiovascular disease, type 2 diabetes, and even cancer. The objective of this study was to investigate the effectiveness of selenium supplementation in managing oxidative stress while considering a well-balanced diet based on a healthy lifestyle and diet therapy. The study included a total of 206 participants divided into three groups: the control group consisting of 35 individuals (17.0%) named LC, the diet therapy group comprising 119 individuals (57.8%) named LD, and the diet therapy group supplemented with selenium consisting of 52 individuals (25.2%) named LD+Se. Various clinical parameters such as body mass index (BMI), weight status, fat mass, visceral fat, and sarcopenia index, as well as paraclinical parameters including the HOMA index, cholesterol, triglycerides, C-reactive protein, and HGZ, were evaluated. Additionally, oxidative stress parameters using the FORD, FORT and MIXT tests were measured. Selenium supplementation, along with FORD and FORT tests, demonstrated effectiveness in individuals with chronic venous disease, with a significantly greater decrease observed in those with chronic venous disease in the LD+Se group. Physiological aging has an important role in triggering or aggravating oxidative stress, and the use of antioxidant products such as selenium can reduce this process.

Korelacija FLI indeksa masne jetre sa indeksima insulinske rezistencije kod pacijenata sa metaboličkim sindromom

Introduction: Metabolic syndrome includes insulin resistance, visceral obesity, hypertension and dyslipidemia, which together lead to an increased risk of atherosclerosis, cardiovascular diseases, and diabetes mellitus. Insulin resistance is considered a pathophysiological mechanism underlying metabolic syndrome, characterized by inadequate glucose metabolism, hyperinsulinemia and lipid imbalance. Non-alcoholic fatty liver disease is a chronic disease characterized by microvesicular steatosis and isn't a consequence of the use of drugs, alcohol, or inherited diseases and is a hepatic manifestation of metabolic syndrome. Aim: Since insulin resistance is pathophysiologically related to metabolic liver diseases, the aim of this study was to investigate the correlation of the FLI index with insulin resistance indices HOMA and QUICKI, but also a comparison of the insulin resistance index HOMA, Quicki and Tyg and the FLI index of fatty liver in the complete sample and in the groups of overweight and obese patients with characteristics of the metabolic syndrome. Material and methods: The study included 70 patients who met the criteria for the diagnosis of metabolic syndrome and who were selected by reviewing the medical documentation. Patients were divided into two groups. Group A were overweight patients (BMI 25 - 29.9 kg/m2). Group B were obese patients (BMI &gt; 30 kg/m2). Insulin resistance index values were compared between groups and then correlated by statistical analysis with FLI index within groups and in a complete sample. Results: Statistical analysis found a correlation between the FLI index and the insulin resistance index HOMA (p = 0.03) in a complete sample. A statistically significant difference in the values of the FLI index between the examined groups was proved (p = 0.001). Conclusion: The positive correlation between the FLI index with the HOMA index speaks in favor of the interrelationship between insulin resistance and fatty liver in patients with metabolic syndrome. In this case, insulin resistance can be a predictor for the development of non-alcoholic fatty liver disease, steatosis, steatohepatitis, hepatocellular carcinoma and cardiovascular diseases.

Düşük serum meteorin benzeri/subfatin seviyesi, obezite ve insülin direnci ile ilişkilidir

Introduction: Meteorin-like (Metrnl), also known as subfatin is a newly discovered adipokine of adipocyte origin that may play a role in obesity and insulin resistance. The current study aimed to investigate the association between subfatin and biochemical values, demographic characteristics, and insulin resistance in obese patients and healthy controls.Methods: This cross-sectional study included 59 obese patients with sex and age-matched group of 41 healthy controls. An enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of Subfatin (Metrnl), and the correlations of Metrnl level with anthropometric parameters, HOMA index, and biochemical measurements were assessed.Results: The levels of BMI (p&amp;lt;0.001), insulin (p=0.002), and HOMA-IR score (p&amp;lt;0.001) were significantly higher in obese patients than controls. The serum levels of Subfatin were found to be lower in obese patients (1.85 [1.35–5.51] ng/ml) compared to the healthy controls (21.82 [12.61–27.76] ng/ml) (p&amp;lt;0.001). Subfatin had a significantly negative relationship with age (r =-0.250, p=0.012), weight (r =-0.373, p=0.001), BMI (r =-0.492, p=0.001), HbA1c (r =-0.209, p=0.037), LDL (r =-0.264, p=0.008), HOMA-IR (r =-0.223, p=0.026), and glucose (r =-0.376, p&amp;lt;0.001). There was a significantly positive correlation between subfatin and height (r=0.321, p=0.001).Conclusion: These results show that levels of subfatin were decreased in obese patients. There is a relationship between circulating amounts of subfatin hormone and age, weight, height, LDL-cholesterol, glucose, hbA1c, and HOMA-IR. Subfatin might be a new biomarker of obesity and insulin resistance.Keywords: Meteorin-like/subfatin, adiposity, insulin resistance, adipokines, biomarkers, diabetes mellitus type 2

INFLUENCE OF ROSUVASTATIN ON VASCULAR ENDOTHELIUM FUNCTIONAL STATE AND SYSTEMIC INFLAMMATION IN PATIENTS WITH ISCHEMIC HEART DISEASE AND DIABETES MELLITUS

Purpose of the study. The goal of the present study was to evaluate the effect of low dosed statins (rosuvastatin 10 mg/day) on the state of lipid and carbohydrate metabolism, insulin levels, vascular endothelial function, and markers of systemic inflammation in patients with ischemic heart disease in combination with diabetes mellitus.&#x0D; Materials and research methods. We examined 83 patients with ischemic heart disease and type 2 diabetes mellitus aged 44 to 78 years (mean age was (56,8 ± 3,4) years). For all patients, the fasting glucose level was determined, the HOMA index, the levels of total cholesterol, low density lipoproteins, very low density lipoproteins, high density lipoproteins and triglycerides in the blood, the concentration of C-reactive protein, and the content of pro-inflammatory cytokines in the blood serum were calculated. To study the function of the endothelium, dopplerography of the brachial artery was used according to the D.S. Celermajer. All patients received IHD therapy according to generally accepted standards. The drugs were used against the background of stable oral hypoglycemic therapy. As cholesterol-lowering therapy, rosuvastatin was prescribed at a dose of 10 mg/day for 3 months.&#x0D; Results. During the study, it was noted that in patients with coronary artery disease in combination with type 2 diabetes mellitus on the background of hyperand dyslipidemia, elevated levels of insulin and glucose, dysfunction of the vascular endothelium was revealed. Vascular endothelial dysfunction had a close correlation with markers of systemic inflammation, which was exacerbated by the presence of insulin resistance. While taking rosuvastatin at a dose of 10 mg/day, in addition to a sufficient lipid-correcting effect, there was a decrease in the level of IR, activity of systemic inflammation and improvement in the function of the vascular endothelium, which ensures the correction of additional risk factors in patients with coronary artery disease in combination with type 2 diabetes.&#x0D; Conclusions. In patients with ischemic heart disease in combination with type 2 diabetes mellitus on the background of hyperand dyslipidemia, elevated levels of insulin and glucose, dysfunction of the vascular endothelium was revealed. Dysfunction of the vascular endothelium is closely correlated with markers of systemic inflammation, which is exacerbated by the presence of insulin resistance. Against the background of taking rosuvastatin at a dose of 10 mg/day, in addition to a sufficient lipid-correcting effect, a decrease in the level of IR, activity of systemic inflammation and an improvement in the function of the vascular endothelium were noted, which ensures the correction of additional risk factors in patients with coronary artery disease in combination with type 2 diabetes.

Mental Health and Sleep Disorders in Obese Patients, Their Relationship with Clinical and Pathogenetic Changes in the Organism and Impact on Quality of Life

In the world the problem of obesity is an important aspect in the non-infectious diseases progression. It is known, that 95% of the pathogenic factor for the obesity development depends on the changes caused by neurochemical, hormonal and metabolic mechanisms that occur by depression, anxiety, eating disorders, circadian rhythms and sleepiness. The objective: to determine the psychosocial features and their relationship with clinical and pathogenetic changes in obese patients of working age. Materials and methods. 75 patients with obesity of the 1st and 2d degrees (39.03±0.93 years old) and 75 practically healthy persons of the corresponding age (36.84±0.96 years old) were examined. Waist circumference (WC), hip circumference (HC), body surface area (BSA), waist/hip ratio (WHR), conicity index (ConI), a body shape index (ABSI), abdominal volume index (AVI), blood pressure, blood levels of glucose, insulin, index HOMA, cholesterol, lipidogram indicators, serotonin, and leptin were determined in the patients. The psychological status was assessed by Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Scale (HAM-A), the Dutch Eating Behavior Questionnaire (DEBQ), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), the patient’s quality of life – by 36-Item Short Form Survey (SF-36). The statistical analysis was conducted by IBM SPSS Statistics, Statistica 12, descriptive statistics Excel 2010. Results. The patients of the studied group, unlike the control group, had significantly higher indices of WC, HC, BMI, WHR, ConI, ABSI, AVI, HOMA index, blood pressure, glucose, insulin, total cholesterol, lipidogram, leptin and the lower level of serotonin. This was accompanied with clinically expressed anxiety of depression which led to eating disorders (a tendency “to eat emotions”, to overeat when food is available, a habit to eat without restrictions), sleep disorders (excessive day time sleepiness, low quality of sleep) and reduced quality of life. The results of correlation analysis indicate a strong or moderate positive correlation between obesity indices, glucose level, lipidogram, atherogenicity index, HOMA index, scores of depression and anxiety scales, as well as strong negative correlation with ABSI index, high density lipoproteins, serotonin. In addition, a positive correlation was found between leptin level and scores of depression and anxiety scales, scores of eating behavior, sleepiness, and a negative correlation was determined between these indices and serotonin level. Conclusions. The patients of the studied group (100.0 %) had abdominal obesity. Among the anthropometric indices ABSI and AVI ones were the most significant and informative for determination of abdominal obesity in gender aspect, this can be an alternative for MRI diagnosis of visceral obesity at the level of primary medical care. A close relationship between abdominal obesity with psycho-emotional disorders, disorders of sleep and eat behavior, metabolic disorders, leptin and serotonin levels was determined. Taking into account these interrelationships in a patient-centered management in persons with obesity will improve the quality of medical care.

Effectiveness of Differentiated Hepatotrophic Therapy in Complex Management of Patients with Comorbidity of Chronic Pancreatitis and Chronic Viral Hepatitis С

An important problem of the combined course of chronic pancreatitis (CP) and chronic hepatitis C virus (HCV) is the study of the effects of chronic HCV, even after the treatment, in particular for the condition of the pancreas and liver in patients with CP. Often hepatotrophic therapy is used for this purpose, which should be differentiated depending on the needs of patients with comorbidity of CP and chronic HCV. The objective: to analyze the functional and structural condition of the pancreas and liver in patients with CP after the chronic HCV treatment by the proposed complex treatment with additional inclusion of hepatotrophic drugs. Materials and methods. 80 patients with a combined course of CP and chronic HCV were examined. According to the methods of treatment the patients were divided into three groups. The 1st group included 20 patients with CP and chronic HCV, who received a common complex for treatment (CCT) by protocol for 3 months. In the 2d group 25 patients with CP and chronic HCV received CCT with additional inclusion of hepatotrophic agent for 3 months. The 3d group included 35 patients with CP and chronic HCV with CAGE≥2.0, who took CTC with additional inclusion of hepatotrophic agent for 3 months and metadoxine for 3 months. Results. The more significant level of efficiency of therapeutic complex with the additional inclusion of hepatotrophic agent was determined when metadoxine was prescribed. It was found that the content of fecal α-elastase increased by 19.6 %, 37.5 % and 66.9 %, glucose level decreased by 13.4 %, 11.0 % and 28.4 %, glyconized hemoglobin – by 12.3 %, 22.1 % and 25.8 %, HOMA index – by 16.3 %, 21.9 % and 56.0 %, coprogram score – by 12.8 %, 18.3 % and 88.7 %, the total index of the pancreas structure – by 7.2 %, 15.1 % and 85.7 %, and the total indicator of liver structure – by 11.7 %, 17.5 % and 44.7 %, respectively in groups (p&lt;0.05). It was established that the inclusion of the hepatotrophic medicine in the standard therapy of CP with chronic HCV improved the results of treatment for the restoration of the functional and structural condition of the pancreas. Conclusions. The additional prescription of the hepatotrophic agents combination significantly increased the effectiveness of treatment according to the dynamics of the functional capacity of pancreas and restoration of its structure (p&lt;0.05). It was confirmed that a complex medical program with additional use of polysubstrate hepatoprotector exceeded the efficiency of the protocol treatment for the structural condition of the liver by 36.0 %, and with a combination of hepatotrophic agents – by 51.9 %; regarding the pancreas condition – by 22.3 % and 38.3 %, respectively (p&lt;0.05). The combined use of hepatotrophic agents was also more effective than monotherapy with one drug.

Pathogenetic role of fetuin-A in formation of metabolic disorders and systemic inflammation in patients with non-alcoholic fatty liver disease

Non‑alcoholic fatty liver disease (NAFLD) remains the leading nosology among hepatic diseases around the world. Its complex pathogenesis is not still clearly understood. Besides metabolic changes one of potential mechanisms of NAFLD development is changes in hepatokines, fetuin‑A in particular, secretion and metabolism.&#x0D; Objective — to determine the role of fetuin‑A in the development and progression of NAFLD.&#x0D; Materials and methods. The study enrolled 78 NAFLD patients with metabolic disorders and 30 volunteers as a control group. Additionally to routine examination serum concentration of fetuin‑A was determined. Statistical processing was carried out using SPSS 21.&#x0D; Results. The results showed a statistically significant increase in fetuin‑A concentrations in NAFLD patients with concomitant MS (p &lt; 0.05). There was a direct correlation between fetuin‑A levels and parameters of abdominal (WC and WHR, p &lt; 0.05) and visceral obesity (VAT %, p &lt; 0.05). Concentrations of fetuin‑A were higher in polymorbid patients, especially in the combination of NAFLD with type 2 diabetes mellitus and obesity. Fetuin‑A levels was associated with changes in carbohydrates and lipids parameters. Fetuin‑A positively correlated with glycated hemoglobin (r = 0.32, p &lt; 0.05) and index HOMA (r = 0.36, p &lt; 0.05). There was a positive correlation between fetuin‑A level and TG (r = 0.44, p &lt; 0.05) and LDL cholesterol (r = 0.37, p &lt; 0.05). Furthermore, an increase in fetuin‑A was associated with an increase in activity of ALT (r = 0.39, p &lt; 0.05) and elevation of the level of TNF‑a (r = 0.33, p &lt; 0.05). NAFLD patients with advanced stages of steatosis and fibrosis also demonstrated higher levels of fetuin‑A (p &lt; 0.05).&#x0D; Conclusions. The obtained data indicate a significant pathogenetic role of fetuin‑A in the development and progression of NAFLD.&#x0D;

In-Season Consumption of Locally Produced Tomatoes Decreases Cardiovascular Risk Indices

Tomatoes are widely consumed worldwide at any time of the year. However, depending on the variety, they have a characteristic season. We evaluated the consequences metabolic of consumption of Ekstasis tomatoes from different geographical origin and in different seasons in Fischer 344 rats. The hepatic gene expression of key enzymes in lipid metabolism was also evaluated. Animals were classified in three photoperiods (L6, L12, and L18) and in three treatments (vehicle: VH; local tomato: LT; and non-local tomato: nLT). We measured serum metabolic parameters and the gene expression of liver enzymes related to lipid metabolism (Acc1, Cpt1a, Had, Fas1, Srebp-1c, Fatp5, Cd36). LT consumption in season decreased cardiovascular risk 1 and coefficient atherogenic by 1.81 (p = 0.031) and in L6 decreased TAG and glucose (p = 0.046; p = 0.024). The L18-LT animals had decreased total cholesterol (p = 0.029) and gene expression of Srebp1-c (p = 0.022) but increased expression of Acc1 (p = 0.032). The treatments significantly affected the expression of Acc1 and Fas1 in the liver and the levels of serum TAG and glucose. A significant effect of photoperiod on serum concentration of glucose, insulin, HOMA index, and on the hepatic expression of Srep1-c, Fas1, and Acc1 was observed.

Results of a Russian multicenter open prospective study of the efficacy and safety of Telmista® and Telmista® H in patients with arterial hypertension 1 and 2 degrees

Relevance. The proportion of angiotensin receptor blockers has increased significantly among prescribed antihypertensive agents. To a large extent, this is facilitated by the emergence of new high-quality generic drugs available to the widest range of patients.Study objectives. Evaluation of effectiveness and safety of Telmista® (Telmisartan 40 mg, 80 mg, tablets, JSC Krka, d.d., Novo Mesto, Slovenia) and Telmista® H (hydrochlorothiazide + telmisartan 12.5 mg + 40 mg , 12.5 mg + 80 mg, 25 mg + 80 mg, tablets, JSC «Krka, dd, Novo Mesto», Slovenia) in patients with arterial hypertension of 1 and 2 degrees.Materials and methods. The study included 50 patients, 25 men and 25 women with arterial hypertension of 1–2 degrees. All patients underwent office blood pressure assessment, 24-hour blood pressure monitoring (ABPM), total cholesterol, HDL cholesterol, LDL cholesterol, TG, creatinine, glucose, insulin and glycated hemoglobin levels, HOMA index was calculated, urine microalbumin was determined, LV myocardial mass and LVMI were assessed according to ECHOCG at baseline and throughout the study. BP was re-measured after 4, 8, 12, 16, 20, 24 weeks of therapy, ABPM - after 16 weeks, the rest of the listed examinations - after 24 weeks.Results. During therapy with Telmista® and Telmista® H, 89% of patients with grade 1–2 AH achieved the target BP level, which was accompanied by an improvement in the metabolic profile, a decrease in LVMI and urinary microalbumin (in 50% of patients), alongside with an improvement in the quality of life after 24 weeks treatment. Thus, due to high antihypertensive and organoprotective efficacy, excellent tolerability and availability, Telmista® and Telmista® can be the drugs of choice in hypertensive patients, especially those with metabolic disorders, to maximize the reduction of cardiovascular risk in this category of patients.

The effect of positive pressure ventilation on serum ischemia-modified albumin levels in obese patients with obstructive sleep apnea syndrome.

Respiratory abnormalities in obstructive sleep apnea syndrome (OSAS) are corrected with positive pressure ventilation treatments. We investigated the effect of positive airway pressure (PAP) treatment on the serum level of ischemia-modified albumin (IMA), an oxidative stress product, in OSAS patients with higher body mass index (BMI) and indication for PAP treatment. Seven consecutive female and 23 male patients with a BMI of ≥30 kg/m2 who were diagnosed as having OSAS according to ICSD3 criteria and were planned for PAP, were included. The Epworth Sleepiness Scale and STOP-Bang Questionnaire were performed. Morning arterial blood gas, hemogram, biochemistry, insulin, and IMA were measured after polysomnography and after three months of PAP. There were no significant changes in lactate, CRP, and serum electrolyte levels measured before and after PAP, except for potassium. When 30 patients were compared in terms of serum IMA levels at baseline and after treatment, the mean baseline value was 0.56 absorbance units (ABSU), and the 3rd-month follow-up IMA value was 0.53 ABSU (p= 0.537). The mean serum fasting insulin level was 15.85 µIU/mL and 11.6 (p= 0.002) and the mean HOMA index was 4.4 and 3.0 (p= 0.001), respectively. Serum IMA levels seem not to be an appropriate marker for the evaluation of PAP treatment in OSAS patients with higher BMI. PAP is associated with a decrease in the fasting insulin level, HOMA index, and hematocrit, but not with serum electrolytes except potassium.

Increased levels of plasma neudesin in adult growth hormone deficiency and their relationship with plasma liver-expressed antimicrobial peptide-2 levels: a cross-sectional study.

Adult growth hormone deficiency (aGHD) is characterized by an altered metabolic profile and increased cardiovascular risk. Neudesin is a newly discovered protein mainly secreted from adipose tissue and brain, under evaluation for its possible activity as a negative regulator of energy expenditure. Liver-expressed antimicrobial peptide (LEAP)-2 is a competitive antagonist of ghrelin on its receptor. An observational cross-sectional study was performed to test the hypothesis that plasma neudesin levels may be modified in aGHD. Given the role played in the energy balance, any possible relationships between neudesin, LEAP-2 and metabolic and anthropometric parameters were evaluated. Thirty-eight patients were included: 18 aGHD patients (7 females and 11 males, aged 59.7 ± 2.6years, BMI 30.2 ± 2.2kg/m2); 20 healthy controls (12 females and 8 males, aged 47.1 ± 2.5years, BMI 24.1 ± 0.9kg/m2). All patients were evaluated for glucose, insulin, HOMA and QUICKI index, total/LDL/HDL cholesterol, triglycerides, uric acid, and IGF-1. Plasma neudesin, LEAP-2, and ghrelin were measured by ELISA. Fat mass was evaluated by DEXA. Neudesin levels were significantly higher in aGHD versus controls. We confirmed the finding of significantly lower ghrelin levels and significantly higher LEAP-2/ghrelin ratio in aGHD patients and found a significant direct correlation between neudesin and LEAP-2 levels. A significant direct correlation between neudesin and fat mass percentage was found in the whole population. These results suggest the onset of adaptive responses to an altered metabolic picture in aGHD. The changes in two distinct pathways that modulate food intake and the still limited knowledge about neudesin suggest future developments in this field.

The significance of overweight and visceral obesity in the detection of pregestational diabetes in the population of women of reproductive age in Dushanbe

Materials and research methods. We examined 1,500 women living in the city of Dushanbe for the period 2020-2021. The examination was carried out at the bases of medical health centers in the city of Dushanbe. In the course of the study, in order to clarify the risk factors in the development of pregestational diabetes, we measured the weight, height of patients, waist circumference (WC), hip circumference (OB), calculated the ratio OT / OB, and also conducted a survey of all examined women.Results of the study and their discussion. In particular, 8 cases of type 1 diabetes mellitus, 92 cases of type 2 diabetes mellitus and 2 cases with suspected MODY diabetes. In the course of the study, it should also be noted that the leading risk factor for the development of type 2 diabetes mellitus in particular (in 60% of cases) was overweight and, in particular, visceral obesity. The average level of glycated hemoglobin in the group of identified patients with type 1 diabetes mellitus was 7.7±0.8%. The age of the examined is 35.7±4.1 years. The average level of glycated hemoglobin in the group of patients with type 2 diabetes was 7.5±0.9%. In addition, during the study, an increase in the level of insulin in the blood of overweight and obese patients by an average of 15.2 mIU / l was found. When calculating the HOMA index, a significant (p&lt;0.01) increase was noted, mainly in the group of patients with overweight and obesity.Conclusion. Taking into account the obtained results, the leading role of overweight and visceral obesity in the detection of pregestational diabetes is shown.