[Diet therapy program for weight loss and assessment of its effectiveness in overweight and obese persons].

The basic method of obesity treatment is diet therapy aimed at long-term maintenance of negative energy balance by restricting the caloric intake of the diet. The aim - to evaluate the effectiveness of the diet therapy program for weight loss with the use of a complex of amino acids and glucomannan. Material and methods. To conduct the study, in accordance with the inclusion and exclusion criteria, a sample of 33 overweight or obese people was formed, of which 30 people (16 men and 14 women) took part in the study. The age of the persons included in the study ranged from 20 to 59 years (average 41.0±1.73 years), body mass index- from 26.4 to 45.5 kg/m2 (average 35.5±0.8 kg/m2), waist circumference as a criterion for abdominal obesity - 110.4±2.4 cm. Participants three times a day (7.00-9.00, 12.00-14.00 and 16.00-18.00) received within 14 days 15 g of powder dissolved in 200 ml of water containing whey protein concentrate, potassium (618 mg in the form of citrate), glucomannan, taurine (290 mg), zinc (2.5 mg in the form of sulfate), vitamins B6 (1.4 mg) and B12 (3 mcg), and 2 capsules containing L-isoleucine (340 mg), L-ornithine-alpha-ketoglutarate (290 mg), L-citrulline-DL-malate (290 mg) and L-tryptophan (80 mg). In the evening, the main meal was dinner, which included a protein dish with vegetables and herbs. The energy value of the evening meal was 400 kcal (1675 kJ), the proportion of protein, fat and carbohydrates was 40, 30 and 30%, respectively, of the calorie content of the evening meal. Results. It was shown that the use of a 14-day course of the diet therapy program to reduce body weight was accompanied by a statistically significant decrease in body weight on average 6.3% of the initial level, an improvement in body composition indicators (a rather pronounced decrease in body fat mass by 9.2%, p<0.001, with a smaller decrease in lean body mass and skeletal muscle mass, respectively by 3.9 and 4.1%, p<0.001) and metabolic blood parameters (a decrease in serum glucose concentration, total cholesterol, triglycerides, total bilirubin and gamma-glutamyltransferase by 12.5, 15.0, 35.0, 22.8 and 34.6% respectively). Conclusion. Application of the diet therapy program for weight loss «Non-invasive liposuction¼ allows us to recommend its use in obese patients in order to increase the effectiveness of therapeutic and prophylactic measures in correcting excess body weight, improving the parameters of carbohydrate and lipid metabolism, and the functional state of the biliary system.

[Assessment of efficiency of the personalized therapy of patients with obesity and diabetes mellitus 2 types appointed on the basis of studying rs5219 polymorphism of KCNJ11 gene].

The aim of the study was to develop and evaluate the effectiveness of personalized therapy forpatients with diabetes mellitus type 2 (DM) and obesity based on the study of rs5219 polymorphism of KCNJ11gene. The study involved 120 women with DM and obesity I-II degree. Genotyping was performed in patients using allele-specific amplification with the detection in real time. Depending on the genotype of KCNJ11 gene patients with DM and obesity received different treatment and were divided into 2 groups (40 patients in each): group A (C/T genotype) received standard low-calorie diet + metformin 2000 mg/day and group B (T/T genotype) received a personalized diet + vitamin-mineral complex (VMC) + metformin 2000 mg/day. Results of the study of rs5219 polymorphism of KCNJII gene in patients with,DM and obesity have shown that 49% of them were carriers of the mutated T allele in the heterozygous form and 37% - in the homozygous variant. It has been found that reducing of calories in a diet promoted weight loss in patients with DM and obesity mainly due to lean body mass in Group A and in Group B - mainly due to the fat component. A significant decrease in blood glucose under complex therapy was observed in both groups. However, after treatment in group B blood glucose levels were significantly lower than in group A. Thus, personalized therapy of patients with DM and obesity should be based on molecular genetic studies that will allow to improve the efficiency of therapeutic measures in these diseases.

Assessment of efficacy of specialized food products with modified carbohydrate profile in patients with type 2 diabetes.

Objective - To evaluate the effect of diet therapy with the inclusion of specialized food product with a modified carbohydrate profile (fruit jelly) on glycemic and metabolic parameters in patients with type 2 diabetes mellitus. The study included 45 patients (aged 35 to 69 years) with type 2 diabetes with concomitant obesity I-III degree. The study was conducted in two stages. The first phase evaluated the effect of jelly intake on postprandial glycemia with determination of blood glucose levels on an empty stomach and 30, 60, 120 and 180 minutes after consumption of fruit jelly with maltitol, pectin and sublimated raspberry juice and traditional marmalade with fructose (control), containing 25 g of digestible carbohydrates. In the second phase the effectiveness of combination therapy during 2 weeks of the inclusion of fruit jelly with a modified carbohydrate profile in a standard hypocaloric diet (1550 kcal/day) has been assessed. It has been shown that the dynamics of postprandial glycemia in patients with type 2 diabetes after the consumption of fruit jelly with a modified carbohydrate profile was comparable to the dynamics of blood glucose after eating traditional marmalade with fructose. Inclusion of fruit jelly with a modified carbohydrate profile in the standard diet therapy of patients with type 2 diabetes during 2 weeks was accompanied by positive dynamics of carbohydrate and lipid metabolism, as well as a decrease in the content of lipid peroxidation products in blood plasma: reducing the level of conjugated dienes and malondialdehyde averaged 15.2 and 17.4% from baseline (p<0.05), respectively, while content of lipid peroxidation products in blood plasma did not changed in patients from the control group.

[Assessment of efficiency of dietotherapy with addition of a vitamin-mineral complex in patients with diabetes mellitus type 2].

The influence of diet inclusion of vitamin and mineral complex (VMC), potassium and magnesium in the form of asparaginate on micronutrient status, body composition and biochemical parameters in patients with diabetes mellitus type 2 (DM2) has been investigated. 120 female patients with DM2 and obesity of I-III degree (mean age - 58 +/- 6 years) have been included in the study. The patients were divided into two groups: main group (n = 60) and control group (n = 60). For 3 weeks patients of both groups received a low-calorie diet (1600 kcal/day). Patients of the main group received VMC, providing an additional intake of vitamins C and E (100-120% RDA), beta-carotene (40% RDA), nicotinamide (38% RDA), pantothenic acid and biotin (60% RDA), vitamins B12, B2 and folic acid (75-83% RDA), vitamins B1 and B6 (160-300% RDA), zinc (100% RDA) and chromium (400% RDA), and also received magnesium (17.7% RDA) and potassium (9.4% RDA) in the form of asparaginate. Body composition, biochemical parameters and micronutrient status (blood serum level of vitamins C, D, B6, B12, folate, potassium, calcium, magnesium, zinc, phosphorus) were evaluated in all patients before and after the 3-week course of diet therapy. After the low-calorie diet therapy average body weight reduction was 4.2 +/- 0.2 kg in the main group, and 4.4 +/- 0.1 kg in the control group, without statistically significant differences between groups. Statistically significant decrease of total cholesterol, triglycerides, and glucose concentration in blood serum was registered in both groups. It should be noted that in the control group glycemia decreased on 1.2 +/- 0.1 mmol/l, while the main group showed a decrease on 1.8 +/- 0.1 (p < 0.05) to normal values (5.4 +/- 0.1 mmol/l). Initial assessment of vitamin and mineral status revealed that most patients were optimal supplied with vitamins and minerals. After the dietotherapy significant increase of vitamin C, 25-hydroxyvitamin D, vitamin B6, folate, vitamin B12, potassium, magnesium, calcium, zinc and phosphorus concentration in blood serum was observed in patients receiving VMC. While in the control group statistically significant decrease of vitamin C, magnesium, zinc and phosphorus concentration in blood serum after the treatment was revealed. The obtained data shows the necessity of addition of the vitamin-mineral complex to the diet of patients with DM2 and obesity.

[The analysis of disability of adult population of the Perm kray owing to stroke].

The study of general contingent of disabled persons owing to stroke in adult population of the Perm kray during five-year period was carried out. The materials of digital data base of the chief bureau of medical social expertise were used. The evaluation of demand in measures of complex rehabilitation is provided. The applied analysis demonstrated that every tenth out of persons primary recognized as disabled and every fifteenth out of persons secondary recognized as disabled is a disabled person owing to stroke. The level of disability has a tendency to decrease except primary disability in rural population and patients who underwent hemorrhagic stroke and disabled persons of group I as well. Predominantly, in more than half of all cases the severe disability of group I and II is determined without indication of date of reexamination. Under this pathology, urban males are more often recognized as disabled persons. The primary determination of disability is more often concerned persons of retirement age. The secondary determination of disability is more often concerned the able-bodied contingents. Among persons disabled owing to stroke, a higher demand in different types of rehabilitation is established. This need is to be taken into account in development of infrastructure of rehabilitation services in health and social care institutions.

[Assessment of nutritional status of patients in the later period after renal transplantation].

This article summarizes the modern approach for estimation of nutritional status (medical history, anthropometric, clinical and biochemical measures) in patients in the late period after kidney transplantation. It is showed that main complications in the late posttransplant period (cardiovascular diseases, diabetes, obesity, malnutrition) determine the need of complex assessment of nutritional status in these patients with the object of improve outcomes after transplantation.

[The potentials of indirect calorimetry in the differential assessment of the metabolic status of obese patients with insulin-independent diabetes mellitus]. / Vozmozhnosti nepriamoi kalorimetrii v differentsirovannoi otsenke metabolicheskogo statusa bol'nykh insulinnezavisimym sakharnym diabetom tuchnykh.

Twenty-one obese patients with non-insulin dependent diabetes mellitus, 16 female and 5 male ones, were fed similar isocaloric rations, differing only by the share of substitution of the traditional protein products (0%, 60%, 30%, 45%) in the Danpro-S, Danpro-Fibre soybean protein concentrate. The parameters tested were daily glycemia, C-peptides, blood hydrocortisone, and urinary excretion of nitrous metabolites. Indirect calorimetry was used to assess the protein, fat, and carbohydrate oxidation rates at rest. Addition of proteins of a plant origin to the diets of such patients was associated with significant changes of the energy metabolism at rest at the expense of increased oxidation of carbohydrates and reduced protein catabolism, that may be regarded as a favorable effect. In this patient population a 30% soybean diet brings about an almost maximal positive effect in patients with the first degree of obesity, whereas in those with the second degree of obesity such effect is attained by the 45% soybean diet.