[Features of the metabolism of polyunsaturated fatty acids in type 2 diabetes mellitus].

Type 2 diabetes mellitus (T2DM) is a widespread disease with a high risk of cardiovascular complications, disability and mortality. The progression of T2DM is closely related to lipid metabolism disorders, caused both by insufficient intake of polyunsaturated fatty acids (PUFAs), and by a violation of their endogenous metabolism. Desaturase enzymes, FADS1/2, are involved in the regulation of PUFA metabolism. Violation of the functioning of FADS1/2 and their genes leads to a change in the biosynthesis of PUFAs and the fatty acid composition of cell membranes. The purpose of this research was to summarize the data of modern literature on the metabolism of PUFAs and the effect of FADS genetic variants on the fatty acid composition of cell membranes in T2DM. Material and methods. The search and analysis of publications was carried out using the PubMed, MEDLINE, Web of Science databases, mainly for the last 10 years, using the search keywords: polyunsaturated fatty acids, fatty acid desaturases, desaturase genes, type 2 diabetes mellitus. Results. In the pathogenesis of T2DM and its complications, many factors play a role, including impaired PUFA metabolism. A large evidence base has been accumulated on the effect of PUFAs on cardiometabolic risk factors in T2DM. The effect of desaturase activity on the fatty acid composition of cells was identified as the most important link in the metabolism of PUFAs. Focusing on the modulation of desaturase activity and studying the polymorphism of fatty acid desaturase genes may be a useful therapeutic option in the treatment of patients with T2DM and its complications. Conclusion. A promising direction of scientific research in the treatment and prevention of T2DM and its complications is the study of genetic mechanisms associated with the metabolism of PUFAs and their metabolites.

[Dietary correction of metabolic disorders in patients with diabetic nephropathy].

One of the ways to optimize the complex treatment of patients with diabetic nephropathy (DN) is the use of therapeutic nutrition with the inclusion of foods for special dietary use (FSDU) that correct carbohydrate and lipid metabolism disorders and have antioxidant and anti-inflammatory, properties. The aim of the research was to study the effect of a low-protein diet with the inclusion of FSDU on some clinical and biochemical parameters in patients with DN. Material and methods. 30 patients with DN and concomitant obesity of I-III stages were examined, which were divided into two groups of 15 people each. Patients of the main group received a low-protein diet for 14 days (protein 62.4 g/day, energy value 1360 kcal/day) with the inclusion of FSDU (124 kcal per portion), modified by protein, fat and carbohydrate profile (dry instant mixture), and the comparison group - a low-protein diet without the inclusion of FSDU. In blood serum, the content of glucose, glycated hemoglobin (HbA1c), total cholesterol (CH), triglycerides, cholesterol of low and high density lipoproteins (LDL, HDL), urea, creatinine, total protein, albumin, total bilirubin, alanine and aspartate aminotransferase activity, levels of potassium, phosphorus, calcium. Glomerular filtration rate was calculated and body composition indicators were studied using the bioimpedancemetry. Results. Patients of the main group showed a statistically significant decrease in fat mass by an average of 5.5% (p=0.0001) and a tendency to increase muscle mass by 1.7% (p>0.05) from the initial level. Among the patients of the comparison group, the decrease in fat mass was 4.9% (p=0.0001) against the background of a decrease in lean body mass by 2.5% (p>0.05). When comparing biochemical parameters, positive dynamics of glycemic control indicators was noted in both groups: the level of glucose in blood serum decreased (p<0.005) by 10.9 and 9.3% from the initial level in the main group and the comparison group. A more pronounced decrease in LDL and triglycerides was noted in patients of the main group (29.4 and 26.2%, respectively, p=0.005), in the comparison group the decrease in these indicators was less pronounced and statistically insignificant. Conclusion. The results obtained indicate an increase in the effectiveness of therapeutic nutrition in patients with DN and concomitant obesity when an FSDU with a modified protein, fat and carbohydrate profile is included in a low-protein diet.

[Clinical aspects of the effectiveness of metformin therapy in combination with a low-calorie diet in patients with type 2 diabetes mellitus with various variants of the TCF7L2 gene polymorphism].

The TCF7L2 gene is one of the new markers associated with the development of type 2 diabetes mellitus (DM). Evaluation of the effect of TCF7L2 gene polymorphisms on the effectiveness of hypoglycemic therapy will allow an individual approach to the choice of methods for treating type 2 DM in their carriers. The aim of the research was to study the effect of carriage of TCF7L2 gene polymorphisms on glycemic control parameters in patients with type 2 DM receiving metformin glucose-lowering therapy in combination with a low-calorie version of the standard diet. Material and methods. The study included 55 patients with type 2 DM (mean age 59.9±6.9, BMI 44.3±8.2 kg/m2) receiving metformin monotherapy at a dosage of 1500-2000 mg/day in combination with a low-calorie variant of the standard diet (1730±130 kcal/day). The frequency of occurrence of polymorphisms rs7903146/rs12255372 of the TCF7L2 gene was studied. The indicators of glycemic and metabolic control, anthropometric parameters and body composition were evaluated. Results. The frequency of occurrence of the T-allele of both single nucleotide polymorphisms rs7903146 and rs12255372 of the TCF7L2 gene among patients was 38.2%. Among carriers of the T-allele rs7903146 of the TCF7L2 gene, 72% of patients responded to therapy, showing a statistically significant decrease in the level of fasting glycemia by an average of 16.2±1.6% from the baseline, while among carriers of the CC genotype - 10.5±1.5% (p=0.017). There were no statistically significant changes in glycemic control indicators on hypoglycemic therapy during 7 months of observation, both in the group of T allele and CC genotype carriers. Conclusionss. An improvement in glycemic control was established in patients with type 2 DM among carriers of the T allele rs7903146 of the TCF7L2 gene during metformin therapy in combination with a low-calorie standard diet. The study of TCF7L2 gene polymorphism in combination with indicators of glucose metabolism makes it possible to predict the effectiveness of hypoglycemic therapy with great accuracy.

[Vitamin supply of patients with type 2 diabetes mellitus complicated by nephropathy].

Insufficient vitamin content in the diet is a risk factor for the development of various diseases and their progression, and drug therapy can also contribute to the development of a deficiency of these micronutrients. Data on vitamin sufficiency of patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN) are needed to develop measures to improve it. The aim of the research was to compare vitamin status of patients with T2DM without DN and those with T2DM complicated by nephropathy by assessing vitamin blood level and urinary excretion. Material and methods. In a single-stage research, 57 patients with T2DM and concomitant obesity (14 men, 43 women aged 42-75 years) have been examined. The 1st group included 26 patients with T2DM (7 men and 19 women, BMI 41.5±1.7 kg/m2) with glycated hemoglobin (HbA1c) - 8.0±1.4%, blood serum glucose level 8.1±0.6 mmol/l, glomerular filtration rate (GFR) - 86.7±3.0 ml/min per 1.73 m2, microalbuminuria - 18.0±2.0 mg/day. The 2nd group included 31 patients with T2DM complicated by DN (7 men and 24 women, BMI 42.5±1.3 kg/m2), with an HbA1c level of 6.4±0.2%, blood serum glucose level 6.8±0.3 mmol/l, GFR - 62.8±2.7 ml/min per 1.73 m2, microalbuminuria - 59.5±22.5 mg/day. The determination of vitamins С (ascorbic acid), A (retinol), E (α- and γ-tocopherols), D [25(OH)D], B2 (riboflavin) and ß-carotene in blood serum and vitamins C (ascorbic acid), B1 (thiamine), B2 (riboflavin) and B6 (4-pyridoxic acid) in the morning portion of urine collected on an empty stomach within 40-120 min was carried out. The vitamin status was assessed based on the concentration of vitamins in blood serum and urinary excretion relative to the lower limit of the norm, as well as using the criteria for the optimal supply and 2 molar ratios. Results. Compared to patients with T2DM without nephropathy, patients with DN were better provided with vitamins B2, A and ß-carotene: vitamin B2 deficiency was found 3.2 fold less often (in 9.7%), ß-carotene - 1.8 fold less often (in 35.5%), nonoptimal retinol level occurred twice less often (in 41.9%). At the same time, serum α-tocopherol level below the optimal level was found in 67.7% of individuals versus 50% among patients with T2DM without nephropathy, with a significantly reduced urinary excretion of vitamins B1 and B2. With the exception of one man, the rest of the DN patients had a deficiency or lack of vitamin D. The characteristic features of the vitamin status of patients in both groups were the complete absence of individuals who were simultaneously optimally provided with all the studied vitamins and ß-carotene (when assessing the vitamin status using both the absolute serum vitamer levels and 2 additional molar ratios), and a high frequency of detection of several simultaneously non-optimal vitamin status indicators. A negative correlation was found between blood serum level of ß-carotene and glycemia (ρ=-0.359, p=0.006), as well as GFR (ρ=-0.289, р=0.029) and positive with high-density lipoprotein cholesterol (ρ=0.423, р=0.001), that indicated the need to increase this antioxidant blood level in patients with T2DM. The presence of a negative correlation between the concentration ratio of vitamins C and E and glucosuria (ρ=-0.288, p=0.033) and postprandial glycemia (ρ=-0.313, p=0.031) indicated the need to maintain it at an optimal level. Conclusion. For patients with T2DM and concomitant obesity, vitamin D and ß-carotene turned out to be the most problematic, since their reduced levels are detected more often than other vitamins. In addition to the optimal blood level of vitamins C and E, it is extremely important for them to maintain the blood molar ratio of ascorbic acid and α-tocopherol at an optimal level. The purposefully development of specialized vitamin complexes containing effective doses is necessary for patients with DN.

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.

[Markers of immune inflammation in patients with type 2 diabetes and obesity].

AIM: to investigate cytokine profile in patients with type 2 diabetes mellitus (DM) with different degree of obesity. 154 patients with type 2 DM were examined (55.2% women, 44.8% men). All patients received standard antihyperglycemic therapy; mean age was 46.1 +/- 0.82 years, mean duration of disease was 7.2 +/- 1.43 years. The patients were divided into the following groups according to their degree of obesity: grade I obesity (n = 50), grade II obesity (n = 51), grade III obesity (n = 53). 18 healthy volunteers (38.9% men, 61.1% women, mean age 41.2 +/- 3.2 years, BMI - 22.1 +/- 1.8 kg/m2). The patients and healthy volunteers were underwent biochemical analysis, determination of the cytokine profile and estimation of TNF-alpha, IL-1, IL-4, TGF-beta1 by enzyme-linked immunosorbent assay. It has been shown that increase of the body weight excess in patients with type 2 DM and obesity is accompanied with elevation of proinflammatory cytokines (TNF-alpha, IL-1, TGF-beta1) along with the reduction of inflammatory cytokines (IL-4). The TNF-alpha concentration in patients with grade I obesity was 2,8 fold higher than in the comparison group, in patients with grade II and III - 4 and 5,7 fold respectively. A similar trend occurred in TGF-beta1 level: 2 fold increase--when I obesity, 3,3 and 4 fold--respectively for grade II and III. Unidirectional dynamic changes of IL-1 in patients with type 2 diabetes reflects 1,3 fold increase in its level under obesity I grade, 1,7 fold--under II degree and 2,2 fold--under III degree compared to the level in the comparison group. IL-4 level in patients with diabetes and obesity is strikingly contrasted with the index of the comparison group and progressively reduced: 1,7 fold--when grade I obesity, 3,6 fold- with grade II, 7,7 fold--in the grade III. The data obtained indicates that cytokine profile play a critical part in pathogenesis of type 2 DM in association with obesity.

[Features of hormone metabolism in reproductive age women with metabolic syndrome].

Aim of this study was the investigation of feature of hormonal status in patients with metabolic syndrome (MetS). 111 reproductive age women were included in the study. According to diagnostic criteria for MetS of Society of Cardiology of the Russian Federation (2009) they were divided into two groups--study group (n=52) and control group (n=59). It was studied composition of body (fat mass, skeletal mass, lean mass, total, intracellular and extracellular fluid), parameter of lipid and carbohydrate metabolism, parameter of hormonal status. Study of hormonal status in reproductive age women with MetS showed a higher level of fasting and postprandial levels of insulin and C-peptide, hyperleptinemia and a reduced level of sex hormone-binding globulinn (SHBG). We suggest that serum leptin and SHBG levels may be used as an additional diagnostic criteria in these patients.

[Influence of a low-calorie diet with inclusion of probiotic product containing bacterias Lactobacillus plantarum Tensia DSM 21380 on clinical and metabolic characteristics in patients with obesity and arterial hypertension].

In a number of studies it is shown that regular use of the probiotic products containing Lactobacillus plantarum Tensia DSM 21380 in complex dietary treatment, not only modulates intestinal microflora, but also has a positive influence on a functional condition of cardiovascular system including levelels of systolic and diastolic blood pressure. The aim of this research was to study the influence of dietotherapy with inclusion of the probiotic product containing Lactobacillus plantarum Tensia DSM 21380, on clinical and metabolic characteristics in patients with obesity and accompanying arterial hypertension (AH).

[Subpopulation content of lymphocytes in peripheral blood in patients with diabetes mellitus type 2 and obesity].

In the present study was determined the relative quantity subpopulations of lymphocytes, activated T-lymphocytes and CD95-antigen (Fas/APO-1) expression on lymphocytes in the peripheral blood of patients with diabetes mellitus type 2 (DM 2) and obesity in comparison with the healthy persons. The cells were analyzed by the method of flow cytometry using Beckman Coulter FC 500 cytometer. The following of cells subsets: CD19+, CD3+, CD3+CD4+, CD3+CD8+, CD3-CD16+CD56+, CD3+CD16+CD56+, CD3+CD25+, CD3+HLA-DR+, CD45+CD95+ were investigated. In this research was establish the rise of immunoregulatory index (CD3+CD4+/CD3+CD8+) in consequence of decrease the percentages of cytotoxic T-lymphocytes in patients with DM2 and obesity in comparison with the healthy persons. In the peripheral blood of patients with DM2 and obesity were observed a greater level of activated T-lymphocytes (CD3+HLA-DR+), that reflect the increase activity of T-cell immunity. The direct correlation was found between the increased quantity of NKT-cells (CD3+CD16+CD56+) and contain of triglicerides in the peripheral blood of patients with DM2. In these patients also was noted a greater level of lymphocytes expression of CD95-antigen in comparison with the patients with obesity and healthy persons. These results suggest that immune mechanisms play the important role in pathogenesesis of DM2 and obesity.

[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.

[Influence of hypocaloric diet with supplemented biologically active substances with antioxidant activity on clinicometabolic parameters in type 2 diabetes mellitus patients].

It was investigated the influence of a diet with supplemented biologically active substances (catechins, flavanols and other) with antioxidant activity on dinamics clinicometabolic parameters in type 2 diabetes mellitus patients. It was shown that inclusion of biologically active addition as the source of catechins, flavanols and other polyphenols in complex of treatment in type 2 diabetes mellitus contributes to increase hypotensive, hypoglycemic, hypolipidemic and antioxidant efficacy dietary therapy.

[Principles of dietotherapy in patients with long-term renal transplantation].

In this review role of clinical nutrition of the some components of dietotherapy in correction metabolic parameters and in decrease of complication risk (cardiovascular disease, type 2 diabetes, osteoporosis and other) in patients with long-term renal transplantation is discussed.

[Estimation of efficacy use of the dietary therapy in patients with type 2 diabetes with supplemented biologically active addition containing the extract of kurilsky tea].

It was investigated the influence of a diet with supplemented biologically active addition containing the extract of kurilsky tea on dynamics of the clinical and metabolic parameters in type 2 diabetes. It was shown that the inclusion of biologically active addition "Extralife" in dietary treatment of type 2 diabetes allows to decrease the hyperlipidemia and to improve the antioxidative state and thus to decrease the risk of vascular complications in this disease.

[Modern strategy of nutrition management in type 2 diabetes].

In the review the current state of nutrition management for patients with type 2 diabetes is given. On the basis of literature data analysis it was showed that optimally balance diet in type 2 diabetes must be based in principles of the strict control of energy value, quantity and quality of protein, fat, carbohydrates, fiber, adequate contents of vitamin, macro- and micronutrients according the needs for every patient.

[Effect of diet therapy on status of hemocoagulation and fibrinolysis in type 2 diabetes patients]. / Vliianie dietoterapii na sostoianie gemokoaguliatsii i fibrinoliz u bol'nykh sakharnym diabetom 2 tipa.

The changes in parameters of blood coagulation and the fibrinolytic system in 60 patients with type 2 diabetes mellitus was studied. We conclude what the non insulin depended diabetes mellitus is associated with disturbances in hemostatic and fibrinolytic systems that could contribute to the development of diabetic vascular disease. Besides favorable influence to a clinical picture of disease universal normalizing influence of traditional diet therapy on parameters of coagulation and the fibrinolytic system. Our results show that diet therapy improve metabolic control in type 2 diabetic patients could reflect a reduces thrombotic potential and decreased cardiovascular risk.

[Effect of a monounsaturated fatty acids-enriched diet on the clinical and metabolic parameters in type 2 diabetic patients]. / Vlianie diety, obogashchennoi mononenasyshchennymi zhirnymi kislotami, na kliniko-metabolicheskie pokazateli u bol'nykh sakharnym diabetom 2 tipa.

It was investigated the influence of a diet supplemented with monounsaturated fatty acids (MUFA) on dynamic of glycaemia, lipid profile, blood pressure and composition of fatty acids of erythrocytes in type 2 diabetic patients. Traditional 9 diet was supplemented with olive oil (30 grams per day). The results investigations indicated that a MUFA-enriched diet has beneficial effects on glycaemia, lipid metabolism and blood pressure. It was noted the tendency to increase of content of MUFA in membrane of erythrocytes under the influence of a MUFA-enriched diet.

[Comparative study of effects of diet therapy including eiconol or linseed oil on several parameters of lipid metabolism in patients with type 2 diabetes mellitus]. / Sravnitel'naia otsenka vliianiia dietoterapii s vkliucheniem éikonola ili l'nianogo masla na nekotorye pokazateli lipidnogo obmena u bol'nykh sakharnym diabetom 2 tipa.

It was investigated the influence of a diet supplemented with polyunsaturated fatty acids (PUFA) omega-3 on dynamic of basal glycaemia, lipid profile and composition of fatty acids of erythrocytes in type 2 diabetic patients. Traditional 9 diet was supplemented with fish ("Eiconol", 8 grams per day) or vegetable (linseed oil, 17.5 grams per day) PUFA omega-3. The results investigations indicated that a omega-3 PUFA-enriched diet has a beneficial effects on lipid metabolism. But dietary administration of PUFA omega-3 may be used differently for correction of dislipoproteinemia in diabetic patients.

[Effects of diet therapy including eiconol on clinical and metabolic parameters in patients with type 2 diabetes mellitus]. / Vliianie dietoterapii s vkliucheniem "Eikonola" na kliniko-metabolicheskie pokazateli u bol'nykh sakharnym diabetom 2 tipa.

It was investigated the influence of a diet supplemented with PUFA omega-3 ("Eiconol") on dynamic of basal and postprandial glycemia, blood pressure, lipid levels, parameters of lipid peroxidation in 60 patients with non-insulin-dependent diabetes mellitus. Fish oil ("Eiconol") was used as a dietary supplement of PUFA omega-3. The results of investigations indicated that a diet supplemented with "Eiconol" (8 g/day) increased the effect of dietary therapy in correction of essential hypertension and atherogenic lipids. It was not the worsening of the glycemia and activation of lipid peroxidation.

[Effects of a diet including linseed oil on clinical and metabolic parameters in patients with type 2 diabetes mellitus]. / Vliianie diety s vkliucheniem l'nianogo masla na kliniko-metabolicheskie pokazateli u bol'nykh sakharnym diabetom 2 tipa.

It was investigated the influence of a diet supplemented with PUFA omega-3 (linseed oil) on dynamic of basal and postprandial glycemia, blood pressure, lipid levels, parameters of lipid peroxidation in 60 patients with non-insulin-dependent diabetes mellitus. Linseed oil was used as a dietary supplement of PUFA omega-3. The results indicated that a diet supplemented with linseed oil (17.5 g/day) did not increase the effect of dietary therapy in correction of glycemia, hypertension and atherogenic lipid levels. It was not the activation of lipid peroxidation.