[Empirical dietary patterns and their influence on health in epidemiological studies].

The last two or three decades in the epidemiology of nutrition empirical approaches to assessing the diet of the population are increasingly being used. However, in Russian studies, these approaches are used extremely rarely, which may be due to insufficient knowledge of the essence, methodological aspects and the field of application of posterior dietary patterns. In this regard, the aim of this review was to highlight the essence, methods and main results of using empirical approaches to assessing the diet of the population. Results. This review discusses the main methodological features of multivariate analysis methods - factor analysis (principal component analysis) and cluster analysis. The main trends of dietary patterns characteristic of the epidemiology of nutrition, and various in different countries and regions are shown. The results of studies of the impact of dietary patterns on some indicators of health status (cardiovascular and oncological diseases, diseases of the musculoskeletal system, diabetes mellitus, metabolic syndrome and its components, mortality) are considered. A brief description of the few Russian studies that used the principal component method in identifying empirical dietary patterns of population is given. In general, this review indicates that the use of multidimensional statistics to highlight population dietary patterns as part of an empirical assessment is nowadays one of the most important components of nutrition epidemiology in different countries. An empirical assessment allows us to consider the diets of the population from a factual point of view and significantly supplements the scientific knowledge obtained using other epidemiological approaches. Currently, considerable experience in the development of methodological approaches to dietary patterns, as well as in the analysis of their associations with various indicators of health status has been accumulated. Conclusion. All this testifies to the high relevance of the considered epidemiological approaches and the need for their testing in Russian conditions, which, perhaps, will give new knowledge about the dietary patterns formation and its impact on the health status of Russians.

[Empirical dietary patterns in the Russian population and the risk factors of chronic non-infectious diseases (Research ECVD-RF)].

Currently, in the epidemiology of nutrition, methodological approaches to the empirical assessment of the diets of the population and their relationship to health indicators are actively using. In Russia, these approaches have been used in a number of cohort and regional studies, however, such studies are not available for the entire Russian population. Aim. Identification of empirical dietary patterns in the Russian population and analysis of their associations with risk factors for chronic non-communicable diseases. Material and methods. The work was carried out as part of a multicenter epidemiological study "Epidemiology of cardiovascular diseases in the regions of the Russian Federation" (ECVD-RF) in 2013-2014. The final sample size was 19 520 people aged 25- 64 years. Arterial hypertension, general and abdominal obesity, hypercholesterolemia, hypertriglyceridemia, low HDL, high LDL, and hyperglycemia were observed as risk factors for chronic non-infectious diseases. The data on the frequency of consumption of 13 food groups, which were grouped into 10 groups by combining dairy products into one were collected by interviewing. The identification of dietary patterns and assessment of their sustainability was performed using factor analysis (principal component analysis). In accordance with the individual commitment of the participants to the selected dietary patterns the sample was grouped into quartiles for each of the patterns. In order to ensure associations between patterns commitment and risk factors, a logistic regression analysis was used adjusted for the socio-demographic characteristics of the participants. Results and discussion. Four stable dietary patterns with a total specific gravity of the explained variance of 55.9% were identified and conventionally designated as "Reasonable" (milk, sweets and confectionery, fresh fruits and vegetables, cereals and pasta), "Salt" (sausages, pickles and pickled products), "Meat" (meat, fish and seafood, poultry meat) and "Mixed" (beans, pickles and pickled products, fish and seafood). The set of products of the "Reasonable" patterns mainly corresponds to the "Healthy" or "Balanced" patterns in foreign studies, the combination of the "Salt" and "Meat" patterns - the "Western Salt". Adherence to a "Reasonable" pattern was associated with a decrease in the likelihood of risk factors for chronic non-communicable diseases, and to a "Salt" and "Meat" patterns, on the contrary, with an increase. The associations obtained generally correspond to the results of similar foreign studies. A "Mixed" dietary pattern was associated with a few risk factors, which did not allow an unambiguous assessment of the pattern in terms of its impact on health. Conclusion. The study identified empirical dietary patterns of the Russian population and characterized them in terms of associations with the state of health of risk factors for chronic non-communicable diseases.

Interrelation of cardiovascular risk factors with high albuminury among patients with arterial hypertension living in Mountain Shoriya.

AIM: To evaluate the association of a complex of cardiovascular risk factors and genetic markers with the development of high albuminuria among patients with arterial hypertension in the population of Mountain Shoriya, taking into account ethnicity. MATERIALS AND METHODS: A clinical epidemiological study of a compactly residing population in remote areas of Mountain Shoria was carried out. 1409 people were examined [901 people - representatives of the indigenous nationality (Shorians), 508 people - representatives of non-indigenous nationality (90% of them are Caucasians)]. Hypertension was diagnosed according to the National Guidelines of the Russian Society of Cardiology/the Russian Medical Society on Arterial Hypertension (2010). All patients underwent clinical, laboratory and instrumental investigation. To study the state of the kidneys, the concentration (the presence of elevated levels) of albumin (albuminuria) in the morning portion of urine by an immunoturbidimetric method was analyzed. Polymorphisms of genes ACE (I/D, rs4340), АGT (c.803T>C, rs699), AGTR1 (А1166С, rs5186), ADRB1 (с.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c.677С>Т, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a) were tested using PCR. RESULTS: In the group of shors with arterial hypertension, high albuminuria was associated with polymorphisms of the ACE genes (OR=2.05), ADRA2B (OR=6.00), elevated triglyceride level (OR=2.86), decreased index of cholesterol of high density lipoproteins (OR=5.57) and increased index of low density lipoproteins (OR=2.49); in the new population - with polymorphisms of the AGTR1 genes (OR=8.66), ADRA2B (OR=6.53), MTHFR (OR=7.16), obesity (OR=2.72), and abdominal obesity (OR=3.14). CONCLUSION: The primary predictors determining the development of high albuminuria among patients with arterial hypertension in both ethnic groups were genetic ones. In addition to them, non-genetic risk factors also contributed to the development of this organ damage to the kidneys: age and lipid metabolism disorders in representatives of indigenous nationality; age and abdominal obesity in the examined patients non-indigenous nationality.

Population Risk of Ischemic Heart Disease Depending on the Volume of Alcohol Consumption by the Population (ЭССЕ-РФ Study in the Kemerovo Region).

PURPOSE: to assess relationship between the prevalence of cardiovascular risk factors and associated population risk of ischemic heart disease (IHD) alcohol consumption in the Siberian region (Kemerovo Region). MATERIALS AND METHODS: This work was carried out within the framework of a multicenter epidemiological study "Epidemiology of CardioVascular Diseases in the regions of the Russian Federation" (ЭССЕ-РФ in the Kemerovo region) in 2013. In the final form, the sample size was 1628 individuals aged 25-64 years. We analyzed data on frequency, volume, and type of consumed alcoholic beverages, as well as on the presence of a number of risk factors of cardiovascular diseases and IHD. Alcohol consumption was estimated by the original method, volume of alcohol consumed in a year was categorized as absent (non-drinkers), moderate, medium, and strong. The calculation of the population risk of IHD was carried out according to the author's methodology, taking into account the prevalence of risk factors and their contribution to the development of IHD. RESULTS: Prevalence of several risk factors among non-drinkers was significantly different (p<0.05) compared with drinkers with varying degrees of alcohol consumption. In men, there were differences in low physical activity, hypertriglyceridemia, excess weight, education, in women - in anxiety, low physical activity, hypertriglyceridemia, educational qualifications, smoking. In nondrinking men, the additional risk of IHD associated with risk factors was slightly reduced (-1.1 %). In groups of moderate, moderate, and strong alcohol consumption, risk of IHD was higher than the population risk by 2.2 %, 0.7 % and 6.5 %, respectively. In non-drinking women high burden of risk factors accounted for additional risk of IHD (4.5 %). In women with moderate and medium alcohol consumption the risk of IHD was 2.5 and 1.9 %, respectively, lower compared with population risk. Abuse of alcohol in women caused significant increase in the burden of risk factors and, accordingly, was associated with high additional risk of IHD (18.7 %). CONCLUSION: Predominantly linear in men and J-shaped in women relationship between prevalence of risk factors and volume of alcohol consumption accounted for analogous tendencies in population IHD risk. Specific for men is close to linear dependence of additional IHD risk on population IHD risk with insignificant variability in non-drinkers, moderate and medial consumers, and with significant growth in alcohol abusers. Women have a J-shaped relationship: in extreme categories (non-drinkiers and alcohol abusers), the risk of IHD is higher than the population risk, while in the middle categories (moderate and medial consumers) it is lower than the population risk.

[The Social Economic Factors and Models of Forecasting Mortality Because of Cardiovascular Diseases].

The purpose of the study is modeling and analysis of effect of social economic characteristics of regions on population mortality of cardiovascular diseases. The official data of the Federal service of state statistics of the Russian Federation were used concerning social economic indices and mortality of cardiovascular diseases in the regions of Russia in 2012. The selection of social economic indices included percentage of males in population structure, percentage of individuals of retirement age, percentage of urban population, percentage of individuals with income lower that living wage, percentage of the unemployed individuals, Gini coefficient, percentage of individuals with university education, atmosphere air pollution with emissions of permanent sources, average per capita consumption of vodka and liqueurs, criminality, percentage of regional budget for social cultural expenses, percentage of workers involved in unhealthy labor conditions from total number of population of region. The selection of indices of mortality of cardiovascular diseases included class of diseases of blood circulation system in general, ischemic heart disease and class of cerebrovascular diseases. The mortality was evaluated in overall by population and separately on able-bodied age. The modeling of dependence of mortality from social economic indices was implemented using regression analysis. The calculated ?-coefficients and coefficients of determination were applied to determine approximate input of each predictor into alteration of levels of mortality. The statistically significant mathematical models of dependence of mortality on number of social economic indices were derived. The values explain on 40-75% spreading of regional indices of mortality. The percentage of input of age factor into regional differences of mortality reaches 13-35% in various classes of cardiovascular mortality. Besides, in able-bodied age the average per capita consumption of hard alcoholic beverages (vodka and liqueurs) can be considered as a stable predictor of cardiovascular mortality with corresponding input of 5-7% in the regional differences. The other social economic indices demonstrate a statistically significant relationship only in certain indices of mortality that permits to surmise about only supposed cause-and-effect relationships.

Psychological and social factors of adherence to treatment in patients with myocardial infarction.

AIM: The aim of the study was to assess the impact of psychological and social factors on adherence to treatment in patients with primary and repeated myocardial infarction (MI). MATERIALS AND METHODS: Patients with primary (n=61) and repeated (n=72) ST-segment elevation MI were enrolled in the study. State and trait anxiety, accentuation of personality traits, patient awareness, and adherence to treatment, represented by adherence rate to treatment were evaluated. RESULTS: There were no statistically significant differences found in adherence to treatment between the study groups. Patients' adherence to treatment in the whole cohort was low positive. Patients with primary MI demonstrated higher state anxiety than patients with repeated MI (p=0.0173). The following accentuation of personality traits were determined: hypertimity, emotivity, anxiety, dysthymia and cyclothymic. They were comparable in their severity in primary and repeated MI patients. The regression analysis revealed that the higher the level of education, the higher (by 0.40 scores) adherence rate to treatment (p=0.0210). Higher patients' awareness resulted in increased adherence rate by 0.54 scores (p=0.0010). CONCLUSION: The main factors contributing to increased adherence rate in patients with MI were the level of education and awareness on the issues of preventing an unfavorable cardiovascular prognosis.

[IDENTIFICATION OF OCCUPATIONAL RISK FOR ARTERIAL HYPERTENSION. REPORT II: ELIMINATION OF THE MODIFYNG INFLUENCE OF FACTORS OF CARDIOVASCULAR RISK].

This study is a continuation of (Report I) identification of the occupational risk of arterial hypertension (AH) in 13 occupational groups (3842 workers, men). In previous work there was eliminated the influence of traditional factors of the cardiovascular risk, in this study there was implemented the identification of the components of a healthy worker effect (HWE) and the elimination of their influence on the occupational risks of hypertension. Identification and removal of components HWE--the effect of a healthy recruitment (EHR) and the effect of the healthy worker persisting to work (EHWPW--was carried out by the analytic rearranging of the standardized for age and obesity prevalence rate of arterial hypertension with the use of own methodological approaches. For the determination of the presence and severity of EHR there was performed an analysis of the initial prevalence rate of arterial hypertension in the youngest age groups (under 31 years). To overcome HER standardized for age and obesity indices of the arterial hypertension prevalence rate were adjusted by the ratio of the frequency of arterial hypertension in the most young occupational and reference comparable groups. Identification of HWPW was executed by comparing the frequency of AH among workers retiring within 3 years from the occupational groups when compared to the whole sample. Then on the additional risk value there was adjusted the overall prevalence rate of AH in the occupation profession to overcome EHWPW. As a result of the consistent correction and elimination of the influence of HWE components on the prevalence rate of AH, there were obtained risks values, primarily reflecting the impact of occupational factors which can be considered as true occupational risks. Factors of the cardiovascular risk and HWE significantly modified true occupational risks for AH in a number of occupational groups up to inversion. At the same time, the pronouncement of EHR has a paramount importance in the modifying effect.

[IDENTIFICATION OF OCCUPATIONAL RISK FOR ARTERIAL HYPERTENSION. 1: ELIMINATION OF THE MODIFYNG INFLUENCE OF FACTORS OF CARDIOVASCULAR RISK].

On results of research in 13 occupational groups (3842 workers, men) there were performed an analysis of a contribution of non-occupational factors of cardiovascular risk (FCVRs) and the elimination of their modifying influence on risks for the development of the arterial hypertension (AH). In the capacity of non-occupational FCVRs there were considered 16 predictors of AH. There were calculated the relative risk of AH and 95% the confidential interval (CI) in occupational groups on benchmark data of the prevalence rate of AH and after the elimination of the modifying influence of FCVRs. Reference group was the general sample, that is, all the occupations. Modifying influence of FCVR was eliminated by means of direct standardization. With the aid of trees of classifcation from the number of FCVRs in occupational groups the presence of obesity and age of the worker (respectively, 100 and 78 conditional points) was shown to have the maximum impact on the development of AH. Elimination of the influence of data of FCVRs led to the change of benchmark values of occupational risks of AH in the average for 10%, in four occupations level of the statistical importance of risks of AH changed. In top-managers, and also in operating personnel and technical workers the risk for AH from the high decreased to not significant, respectively to 1,00 at 95%, CI: 0.74-1.36 and 1.20 at 95%, CI: 0.97-1.49. On the contrary, the risk for AH increased from low to statistically not significant in underground equipment operators (0.85 at 95%, CI: 0.71-1.01) and labourers (0.89 at 95%, CI: 0.69-1.14).

[A rank-order method for the integrated assessment of trends in all-cause and cardiovascular mortality rates in the subjects of the Russian Federation in 2006-2012].

AIM: To rank the subjects of the Russian Federation by the trend direction in all-cause and cardiovascular mortality (including mortality from coronary heart disease and cerebrovascular diseases) as a whole and at able-bodied age. SUBJECTS AND METHODS: The investigation used mortality rates from to the 2006 and 2012 data available in the Federal State Statistics Service on 81 subjects of the Russian Federation. According to mortality rates, each region was assigned a rank in 2006 and 2012. Trends in rank changes in the Russian Federation's regions were analyzed. A cluster analysis was used to group the subjects of the Russian Federation by trends in rank changes. RESULTS: The cluster analysis of rank changes from 2006 to 2012 could combine the Russian Federation's regions into 10 groups showing the similar trends in all-cause and circulatory disease mortality rates. Overall, the results of the ranking and further clusterization of the regions of the Russian Federation correspond to the trends in all-cause and cardiovascular mortality rates according to the data of other Russian investigations, by qualitatively complementing them. CONCLUSION: The trend rank-order method permits a comprehensive comparative analysis of changes in all-cause and cardiovascular mortality in the subjects of the Russian Federation both as a whole and at able-bodied age, which provides qualitatively new information complementing the universally accepted approaches to studying the population's mortality.

[HEALTH LOSSES FROM MYOCARDIAL INFARCTION CAUSED BY AIR CHEMICAL POLLUTION OF THE INDUSTRIAL CENTRE].

Losses of health from myocardial infarction in the city of Kemerovo were estimated accordingly to the disability-adjusted life year (DALY) index, as well as its compartments: YLL (years lost due to premature death) and YLD (years lost disability). When ranking districts of the city of Kemerovo both in terms of chemicals exposure and the value of the DALY index there was revealed the opposite direction of these indices. The performance of the correlation analysis of health losses with concentrations of chemical contaminants allowed to reveal a feedback between them among the elderly patients (60 years and older) and direct--in young (up to 45 years old) cases. This fact probably may attest to the significant contribution of the environmental pollution in the process of development and progression of atherosclerotic changes in the young population.

[HEPATIC ENCEPHALOPATHY AND TISSUE ZINC LEVELS IN LIVER DISEASE, DIAGNOSIS AND TREATMENT].

UNLABELLED: THE PURPOSE OF THE REVIEW: Description One of the complications of liver disease--hepatic encephalopathy as well as its relationship with the content of zinc in the body. THE MAIN PROVISIONS: The review provides the key moments of the pathophysiology and clinical hepatic encephalopathy. The basic drugs and treatment regimens of hepatic encephalopathy. Data are considered the original author's research on the relationship of gravity of hepatic encephalopathy and tissue zinc levels in patients with hepatitis and cirrhosis of viral etiology. The data of modern meta-analyzes of complex treatment of hepatic encephalopathy and the role of L-ornithine-L-aspartate. CONCLUSION: Understanding the pharmacological mechanisms of action of L-ornithine-L-aspartate allow gastroenterologist physicians and general practitioners to adequately apply the drug, select the required readings and prioritize the treatment of patients with liver diseases at different stages of the disease. Should be included in the treatment regimen of hepatic encephalopathy zinc supplements.

[The dependence of the prevalence of hypertension on the severity of the professional aging].

On the example of 5437 employees of enterprises and institutions of the Kemerovo region, compiled into 14 occupational groups, an analysis of the relationship between age structure and the frequency of arterial hypertension due to the working conditions has been performed At high levels of hardness of employment and the impact of physical factors, a shift in the age structure toward younger age is seen, which is considered as a demographic consequence of professional ageing. In turn, expressed professional ageing causes the reduction in the prevalence of hypertension, which is, probably is implemented by the effect of "healthy worker".

[Effect of an educational program on effectiveness and safety of anticoagulant therapy in patients with prostheses of cardiac valves].

We analyzed effectiveness and safety of anticoagulant therapy in patients with prostheses of cardiac valves at the background of educational program and without special training. We revealed positive effect of educational program during participation in which in 80 cases (67.8%) patients determined international normalized ratio every month and in 50 of them (62,5%) level of hypocoagulation corresponded to target range (p=0.001). At the background of educational program rate of thrombotic complications was 2.73% per patient year, at the background of no educational program - 4.90% per patient year (p=0.040) while rates of hemorrhagic complications were 2.73 and 7.20% per patient year, respectively (p=0.002).

[The use of factor analysis in determining the dietary patterns in the population].

The possibilities of using one of the methods of multivariate statistics, factor analysis, in the study of the frequency of consumption of food categories for the population are considered. Comparison of the results with the results of other statistical methods (cluster and variance analysis) showed the adequacy of factor analysis in the study purposes.

[Occupational aspects of epidemiology of overweight: contemporary tendencies and prospects of prophylaxis (review of literature)].

The review article covers occupational aspects of overweight as one of the major behavioral risk factors in many diseases. As this topic is undercovered by the national studies, the review considers the foreign works more. The authors present main concepts of work process influence on overweight and of prophylactic leverages on this influence.

[Several medical and social factors which may influence in-hospital mortality in patients with myocardial infarction].

AIM: To study the medical and social aspects of in-hospital mortality after myocardial infarction (MI) in the cardiology center of a major industrial city in Western Siberia. PATIENTS AND METHODS: The material of the study was the database of patients with acute coronary syndrome (19 283 patients), formed by a continuous method retrospectively. The volume of the study were 6463 patients with MI for 2006-2011. RESULTS: In-hospital mortality of patients with MI was 11.8%, with MI complicated by cardiogenic shock--87.4%, in the primary MI--7.4%, during the second MI--22.1%. In-hospital mortality in MI depends on the age of the patients: in group of patients of working age mortality was 4.7%, the retirement age--12.4%, old age--22.7%. In the working-age group mortality in men is almost three times higher than in women. The mortality of patients with MI without reperfusion was 13.4%, in the case of reperfusion therapy--9.2%. CONCLUSIONS: Hospital mortality depends on the patient's age, type of MI (primary or repeated), the severity of the condition, applied treatments.

[Importance of occupational selection in prevalence of hypertension: effects of healthy and unhealthy worker].

The importance of occupational selection in prevalence of arterial hypertension in researches of professional cohorts is considered in the article. Because arterial hypertension represents not only the independent disease, but also one of the most important indexes of the functional status of a human body, prevalence of arterial hypertension in professional groups can be substantially caused by occupational selection. As an epidemiological phenomenon of occupational selection "healthy worker effect", known of scientific literature from the middle of last century is considered. Besides, it is offered to consider the regularities of professional selection opposite to "healthy worker effects", as "unhealthy worker effect". The professional conditionality of arterial hypertension considered from epidemiological line items can be distorted by occupational selection. Thus existence of "healthy worker effect" makes impression of absence of direct link between level of occupational influence and frequency of arterial hypertension. At the same time, the increase in prevalence of arterial hypertension not always testifies to its professional conditionality, and can be connected to "unhealthy worker effects". Possible solutions of problems associated with identification of relationships between occupational factors and prevalence of hypertension in the presence of "effects of the healthy" and "unhealthy worker" are discussed. The challenge of considered problem in occupational medicine despite the numerous offered methodological approaches of elimination or decrease in influence of occupational selection is noted.

[The environment as a risk factor of coronary heart disease in urbanized region with developed chemical industry].

Tendency to growth of prevalence of ischemic heart disease (IHD) occurring in Russian Federation despite application of preventive measures designates necessity of search for novel nontraditional factors of risk. Among other studied factors of genesis of cardiovascular diseases in general and of IHD in particular is the role of xenobiotics - chemical pollutants, substances foreign to the body. In this paper we present results of a number of epidemiological studies on the problem of xenobiotics and IHD. Special attention is given to the difficulty of isolation of the leading chemical pollutant and as a consequence of pathogenetic link what leads to underestimation of pathological states caused by ecological factors especially in such urbanized region with developed chemical industry as Kusbass.

[Work intensity and arterial hypertension].

The authors presented dependence of arterial hypertension on work intensity, exemplified by two occupational groups--teachers and electricians, and demonstrated modifying influence of occupation on prevalence of traditional cardiovascular risk factors.