[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.

[The role of magnesium and potassium in preventive and therapeutic nutrition].

Due to the versatility of its functions and participation in all types of metabolism, magnesium can be considered the main cation in the human organism. Equally important is the role of the main intracellular ion - potassium, which is a synergist of magnesium, especially with regard to the effect on cardiovascular system function. In Russia, there is insufficient consumption of magnesium and potassium by the population. The purpose of the work was to assess the role of magnesium and potassium in ensuring public health. Material and methods. Literature search was carried out using PubMed, Google Scholar, ResearchGate, RISC systems mainly over the past 10 years, with the exception of works of fundamental importance, according to the keywords "magnesium", "bioavailability", "potassium", "efficiency". Results. Chronic hypomagnesemia and hypokalemia are involved in the pathogenesis of various metabolic disorders (metabolic syndrome, insulin resistance and type 2 diabetes mellitus, hypertension, hyperlipidemia and sluggish inflammation). Magnesium deficiency increases the risk of cardiovascular (arrhythmia, hypertension, heart failure), neurological diseases (stroke) and depression, as well as diseases of the respiratory system (bronchial asthma, chronic obstructive pulmonary disease). Potassium deficiency is also associated with pathology of the cardiovascular system. Adequate intake of magnesium and potassium with food and/or dietary supplements prevents the development of chronic metabolic complications. Various magnesium compounds used to correct its deficiency, have different bioavailability. Conclusion. The expediency of compensating for magnesium and potassium deficiency in nutrition has been proven both for preventive purposes in a healthy person and as part of diet therapy in a patient. Enrichment of the diet with magnesium and potassium is a reliable non-drug, economical and safe prevention of chronic deficiency and associated metabolic disorders.

[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.

[Basic principles of dietary therapy in type 2 diabetes mellitus: focus on antioxidant protection and endothelial dysfunction].

Oxidative stress and endothelial dysfunction have been identified as the most important pathogenetic pathways for the development and progression of vascular complications in type 2 diabetes (T2DM). Objective. To evaluate the effect of individual dietary components on oxidative stress and endothelial dysfunction in patients with 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 keywords "type 2 diabetes mellitus", "endothelial dysfunction", "polyphenols", "antioxidants", "diet". Results. It has been shown that despite the progress in the development of drugs for the correction of clinical and metabolic disorders in T2DM, diet therapy is an important therapeutic factor influencing the main mechanisms of development and progression of cardiovascular complications in T2DM, including hyperglycemia, dyslipidemia, arterial hypertension, subclinical inflammation, endothelial dysfunction. Properly organized and built on modern scientific principles, clinical nutrition improves glycemic control, correction of arterial hypertension, dyslipidemia and overweight/obesity. Influencing the mechanisms of development of oxidative stress, therapeutic nutrition can serve as a preventive approach to protect against the occurrence of endothelial dysfunction and subsequent complications, primarily atherosclerotic origin. Conclusion. The review presents current data on the effect of diet therapy on the main clinical and metabolic parameters in T2DM, endothelial function and oxidative stress, as the most significant factors in the development of systemic vascular complications.

[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.

[Role of calcium in health and reducing the risk of non-communicable diseases].

Calcium as an essential mineral is involved in many processes in the body, being the main one in the mineral matrix of bones and teeth. It is necessary for conducting nerve impulses, blood coagulation, muscle contraction, regulation of the transport of various ions through the cell membrane, glycogenolysis and gluconeogenesis, and the activity of many enzymes. In Russia, insufficient calcium intake is noted. The purpose of the work was to assess the role of calcium of various origins in meeting the needs and health of the population. Material and methods. Literature search was carried out using the PubMed, Google Scholar, ResearchGate, RSCI, CyberLeninka systems, mainly for the last 10 years, with the exception of research of fundamental importance, using the keywords "calcium", "milk", "bioavailability". Results. Dairy consumption is associated with an overall reduction in the risk of noncommunicable diseases, including cardiovascular disease, type 2 diabetes mellitus, and some types of cancer. Calcium in natural milk and dairy products, as well as calcium of milk origin, has a higher bioavailability and absorption than from other sources of synthetic or natural mineral origin. The recommendation to reduce dairy consumption may be counterproductive to health and therefore may increase health care costs. Conclusion. Milk and dairy products are the optimal source of calcium. The high bioavailability of calcium of milk origin justifies the expediency of its preferred use in dietary nutrition, both as part of therapeutic diets in hospitals and nutrition in social service institutions, and in outpatient practice. Additional studies, including randomized controlled trials, may be needed to explore in more detail the optimal consumption of milk and dairy products, as well as the use of calcium-containing pharmaceutical products and dietary supplements.

[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.

[Optimization of dietary support for patients with diabetic nephropathy].

The article presents modern approaches to dietary support for patients with diabetic nephropathy (DN). The possibility of using the developed specialized products (SP), modified by protein, fat and carbohydrate composition, containing food ingredients with hypoglycemic, hypolipidemic and antioxidant effects is presented. The aim - development of a formulation and technology for producing SP with modified chemical composition and energy value, intended for inclusion in a low-protein diet for patients with DN. Material and methods. When developing the SP formulation, soy protein isolate, monoand polyunsaturated fatty acids, soluble dietary fiber, fat- and water-soluble vitamins, tracelements, curcumin, taurine, flavoring and aromatic additives were used. Results. The chemical composition and organoleptic characteristics of two SPs have been determined. A technology has been developed for producing SP in the form of instant drinks, which consists in stage-by-stage mixing of prescription ingredients, which ensures uniform distribution of minor biologically active substances. The conducted studies of the organoleptic parameters of the developed SPs showed an average overall score of 4.8 and 4.9 on a 5-point scale. Conclusion. Taking into account the technological and organoleptic compatibility of the selected ingredients, formulations and technologies for preparing SP have been developed, which are powdery multicomponent mixtures for preparing drinks for use in the complex therapy of patients with DN.

[Obesity as a global challenge of the 21st century: clinical medical nutrition, prevention and therapy].

The article presents modern data on the prevalence of overweight and obesity, provides updated information on personalized programs for managing body weight, individual recommendations for a healthy diet, adequate physical activity and long-term lifestyle changes. It is shown that dietary therapy is the basic treatment method in weight loss programs and is aimed at long-term maintenance of a negative energy balance in the patient's organism by limiting the calorie intake. A significant place in the article is devoted to the use of diets modified by calorie value and macronutrient content which are recommended for obese patients. A strategy for the prevention of obesity and its associated diseases is presented.

[Effect of specialized product with modified carbohydrate profile on clinical and metabolic parameters in patients with type 2 diabetes].

The prevalence of type 2 diabetes mellitus (DM2) determines the need to develop evidence-based methods for preventing this disease, including personalized approaches to the dietary correction of metabolic disorders in DM2, including the use of specialized foods. Aim. To evaluate the effect of a low-calorie diet with the inclusion of a specialized product (SP) with a modified carbohydrate profile (dry instant mixture) on the glycemic and metabolic control indicators in patients with DM2. Material and methods. The study included 30 patients with DM2 with concomitant obesity, grade I-III, who were on oral sugar-lowering therapy. Within 2 weeks, patients of the main group received a low- calorie diet (1550 kcal/day) with the inclusion of SP with a modified carbohydrate profile (based on maltitol and with sweeteners) with strawberry flavor in the form of a drink (30 g dry mix per 150 ml of water) for the second breakfast instead of a carbohydrate-containing dish, which provided the intake of 7.8 g of protein, 6.1 g of fat, 1.8 g of carbohydrates, 5.6 g of maltitol. The comparison group received a low-calorie diet (1550 kcal/day) without the inclusion of SP. In all patients, on the background of complex therapy, anthropometric indices, body composition, parameters of carbohydrate, lipid and protein metabolism, liver function, and lipid peroxidation were assessed. Results and discussion. It was shown that SP inclusion into the hypocaloric diet was accompanied by a significant decrease in the level of basal glycemia by an average of 17.4% from the initial level (p<0.05), serum total cholesterol (TC) and low density lipoproteins cholesterol (LDL-C) on average by 26.9 and 36.2% of baseline, respectively, p<0.05, while in patients of the comparison group, the change in fasting blood glucose was not statistically significant (a decrease of 8.1%), and the decrease in TC and LDL-C was on average 22.1 and 21.0%, respectively (p<0.05). At the same time, against the background of complex therapy, positive dynamic in lipid peroxidation in the main group was observed: the level of blood serum malondialdehyde decreased on average by 25.3% from the baseline values (p<0.05). Conclusion. The inclusion of SP with a modified carbohydrate profile in a low-calorie diet is accompanied by an improvement in glycemic control, lipid metabolism and antioxidant status of patients with DM2, helping to reduce the risk of developing systemic vascular complications in this disease.

Vitamins in diet of patients with metabolic syndrome.

Aim - analysis of data on the role of vitamin and carotenoid deficiency in the development of metabolic syndrome (MS), the consumption of individual vitamins and vitamin supplements, as well as estimation of the effectiveness of the use of vitamins in patients with MS. A review of the existing literature has been carried out in the databases of RINC, CyberLeninka, Google Scholar, Pubmed. The lack of vitamins is a risk factor for MS and its components. The diet of people with MS is characterized by excessive caloric content and at the same time contains an inadequate amount of most vitamins. The most frequent in patients with MS is the deficiency (blood level) of vitamin D, E, B vitamins, carotenoids. Among patients with MS, individuals with a reduced concentration of vitamins in the blood plasma are often found. In turn, among those with a deficiency of vitamins, MS is more often found. Low concentrations of 25(OH)D in the serum are associated with an increased risk of MS. An inverse association between the concentration of the hormonal form of vitamin 1.25(OH)2D3 in the serum and the development of MC has been found. In patients with MS, the α-tocopherol concentration associated with lipids is lower than in healthy individuals, and γ-tocopherol, on the contrary, is higher. Taking high doses of one of the vitamin E homologues shifts the balance between tocopherols in the blood plasma. Sufficient supply of the body with all vitamins involved in the formation of metabolically active forms of vitamins (D, B6, PP) is a necessary condition for the exercise of these biological functions by these vitamins. The lack of vitamins is a risk factor for MS and its components. Enrichment of the diet of patients with MS should be considered as a necessary favorable background for its treatment. Since the body has functional connections between vitamins, it is advisable to use not individual vitamins, but their complexes.

[Metabolic effects of egg white enzymatic hydrolyzates: prospects of use in persons with metabolic syndrome (short review)].

The metabolic syndrome (MS), which is characterized by significant prevalence, constant growth of patients' number and high rate of cardiovascular complications, is one of actual problems of modern medicine. A way for optimization of the dietary status of patients with MS is the use of specialized foods with optimized chemical composition in their complex treatment. These products allow to correct hyperglycemia, dyslipidemia and antioxidant status disorders. The publications of the last decade show high interest of scientists to the problem of use of enzymatic hydrolysates of food proteins in dietary preventive products for people with metabolic disorders. High biological value of chicken egg protein and its enzymatic hydrolysates define the prospects of their use in specialized foods aimed at correction and/or prevention of MS clinical implications. The hydrolysis of chicken egg protein leads to the formation of biologically active peptides with antioxidant, hypotensive, anticoagulant and some other effects. As functional food ingredient, the enzymatic hydrolysate of chicken egg protein has some advantages over native protein - higher water solubility, digestibility and absorption in gastrointestinal tract. The results of preclinical in vitro and in vivo studies on evaluation of hypolipidemic effects of chicken egg protein and its enzymatic hydrolysates are discussed in this review. The analysis of the presented publications shows, that introduction of chicken egg protein and its enzymatic hydrolysates into the diet of animals with induced metabolic syndrome had hypolipidemic and antihypertensive effects. The main mechanisms of hypolipidemic action of protein hydrolysates and peptides in gastrointestinal tract are briefly discussed in this review. The prospects of the production of enzymatic hydrolysates of chicken egg protein with defined hypolipidemic properties for their inclusion into dietary products for prevention and treatment of MS are proved in the review.

[Modern approaches to dietary support for patients with diabetic nephropathy].

The article presents modern approaches to dietary support of patients with diabetic nephropathy (DN) characterized by gradual sclerosis of the renal tissue, leading to a loss of filtration and nitrogen excretory function of the kidneys. An analysis of publications of domestic and foreign authors indicates a slowdown in the progression of chronic kidney disease against the background of low-protein diets. However, the role of protein restriction and its qualitative composition in the diet of patients with DN is the subject of comprehensive discussion. KDOQI (2007) Clinical Practice Guidelines and Clinical Practice Guidelines for Kidney Disease determine the target level of protein intake in individuals with diabetes and chronic kidney disease 1-4 stages at the level of 0.8 g/kg of body weight per day. In the recommendations on nutrition for patients with DN, along with a controlled reduction in protein content, great importance is attached to reducing sodium intake from food to 1.5-2.3 g per day. In recent years, close attention has been paid to the use of highly active natural antioxidants for the treatment and prevention of type 2 diabetes, including DN, which was determined by the results of studies demonstrating their beneficial effects on DN patterns. It has been shown that one of the ways to optimize the nutrition of patients with DN is the use of specialized foods modified by protein, fat and carbohydrate composition, including food ingredients with hypoglycemic, hypolipidemic and antioxidant effects.

[Specialized food products with modified carbohydrate profile for dietary correction of diet of patients with type 2 diabetes].

In recent years, the incidence of diabetes mellitus (DM) in the world is growing steadily. According to the international diabetes Federation (IDF), the number of DM patients in the world in 2015 was 415 million, of them more than 90% - patients with type 2 diabetes. According to forecasts, in 2040 their number will increase to 642 million. Russia ranks fifth among the ten countries with the largest number of the adult population with diabetes. Dietary correction of the diet of patients with type 2 DM is carried out by the inclusion of specialized foods with a modified carbohydrate profile containing ingredients with hypoglycemic action. The purpose of the study - the development of composition and technology of specialized foods and assessment of the possibility of their use in the therapy of patients with type 2 diabetes. Taking into account the medical requirements for diet therapy for type 2 diabetes, composition and technology of two specialized foods in the form of beverage concentrates have been developed. The technology of step-bystep mixing contributed to the uniform distribution of biologically active substances in the mass of the product. The absence of sucrose and digestible polysaccharides in the composition of the developed products was established, the presence of about 1% lactose was due to its content in the protein component. Humidity didn't exceed the standard values for similar products, the values water activity were typical for products with low humidity, which justified the prediction of the microbiological stability of the developed products during storage. The osmolality of the beverages restored in accordance with the method of preparation was 310 and 258 mOsm/kg, which characterized them as isotonic. The products were balanced in amino acid composition, had a high score of essential amino acids due to the introduction of a combination of proteins. The consumption of one serving (30 g) of the product in the form of a drink (200 ml) provided an average daily requirement for essential amino acids by 15-22%, polyunsaturated fatty acids ω-3 - by 10%, ω-6 - by 15%, soluble dietary fibers - by 50-55%, vitamins groups B - by 14-81%, C - by 46%, A, D3, E, K1 - by 17-46%, minerals and trace elements - by 10- 33%. The content of polyphenols was about a half of its adequate level of consumption. The inclusion of specialized foods with a modified carbohydrate profile in the composition of the low-calorie diet lead to the stabilization of postprandial blood glucose levels in patients with type 2 DM.

[Specialized foods with a modified carbohydrate profile in the correction of metabolic disorders in type 2 diabetes].

The review of the literature is devoted to the analysis of scientific publications concerning the optimization of nutrition of patients with diabetes mellitus (DM) type 2 due to inclusion in the ration of specialized foods with a modified carbohydrate profile. Modification of the carbohydrate profile of specialized foods can be achieved by excluding quickly absorbed refined sugars, by using a mixture of slowly digestible and slowly absorbed carbohydrates, enrichment with fructooligosaccharides and soluble dietary fibers. Purposeful introduction of food ingredients with favorable metabolic effects into the composition of the products makes it possible to effectively correct the disorders of carbohydrate and lipid metabolism in patients with type 2 diabetes.

[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.

Criteria of Glycemic Control in Type 2 Diabetes Mellitus.

The paper presents the basic criteria for glycemic control in type 2 diabetes mellitus, the data on the relationship between postprandial glycemia and the development of the late vascular complications, and methods for evaluating the glycemic index of foodstuffs and dishes in order to optimize the diets and improve the efficiency of therapeutic measures in this disease.

[Influence of cookies with a modified carbohydrate profile on postprandial glycemia in patients with type 2 diabetes].

The aim of the study was assessment of influence of cookies with a modified carbohydrate profile on postprandial glycemia in patients with type 2 diabetes. The study included 20 patients 35­69 years old, with type 2 diabetes and obesity II­III degrees (BMI=40.2±1.1 kg/m2) treated with standard hypoglycemic therapy. At the time of the initial evaluation all patients were determined at the stage of metabolic subcompensation: glucose basal level in venous blood was 6.8±0.3 mmol/l; in capillary blood ­ 6.5±0.5 mmol/l; the level of glycated hemoglobin ­ 7.2±0.2%. Glucose blood plasma level on an empty stomach and within 3 hours after the consumption of biscuits with modified carbohydrate profile (25 g digestible carbohydrates) and wheat bread containing 25 g digestible carbohydrates (control) was determined. Calculation of the area under the glycemic curve was conducted by standard technique. Portability of cookies with a modified carbohydrate profile (replacement of wheat flour to the mixture of buckwheat, oat and barley flour and the use of maltitol) was good, with no side effects or signs of intolerance were observed. It has been shown that consumption of biscuits with a modified carbohydrate profile was accompanied by a significantly smaller rise in blood glucose level after 30 min from the start of the study, compared with the standard food load (an average of 19.1% and 42.4%, respectively, from baseline, p<0.05). After 120 and 180 min after the test food loads glycemia changed equally, without significant differences between foodstuffs. Area under the glycemic curve in the consumption of cookies with a modified carbohydrate profile was significantly less than under the standard food load (184.6±16.7 vs. 236.9±21.2 mmol/l×min, p<0.05). Consumption of biscuits with modified carbohydrate profile was accompanied by less severe postprandial glycemic response in patients with type 2 diabetes in comparison with that at a standard load food containing 25 g digestible carbohydrates.