[Adipomyokines in children with obesity].

BACKGROUND: Adipomyokines are synthesized and secreted into the bloodstream by cells of both muscle and adipose tissue. They can have both a negative metabolic effect, acting as pro-inflammatory adipokines in obesity, and a positive one, increasing in response to physical exertion in the form of myokines. AIM: To study the features of adipocytokine secretion in children with constitutionally exogenous obesity. MATERIALS AND METHODS: The study included 80 patients: 60 adolescents aged 15 [13; 16] years with constitutionally exogenous obesity SDS BMI: 3.0 [2.6; 3.3] and 20 control group children aged 16 [15; 17] years without excess weight SDS BMI: -0.3 [-1.25; 0.33]. Commercial enzyme immunoassay kits were used to determine the level of adipomyokines. The compositional composition of the body was evaluated by bioimpedance analysis (InBody 770 analyzer, South Korea) in the morning, on an empty stomach. Statistical processing was carried out using STATISTICA v.12.0 (StatSoft Inc., USA). The results are presented in the form of median (Me) and quartiles (Q1; Q3) corresponding to 25 and 75 percentiles. The critical significance level (p) was assumed to be <0.05. RESULTS: Levels of IL-6 and irisin are statistically significantly higher in obese adolescents compared to the control group: 0.55 [0.226; 1.35] pg/ml vs 0.202 [0.128; 0.652] pg/ml (p=0.041) and 11.16 [6.6; 22.76] mcg/ml vs 7.36 [6.48; 9.68] mcg/ml (p=0.043), respectively. Concentrations of IL-6, myostatin and decorin increase with an increase in the degree of obesity: grade I vs III: 0.226 [0.224; 0.398] vs 0.80 [0.36; 1.81] pg/ml (p=0,0197), 25,85 [21,53; 28,23] vs 31.41 [24.36; 35.06] ng/ml (p=0.03), 4065.3 [3244.9; 5245.5] vs 5322.5 [4199.8; 7702.4] pg/ml (p=0.0376), respectively. In obese children, IL-6 levels positively correlate with BMI, SDS BMI and the amount of adipose tissue, and myostatin - with BMI and SDS BMI. The concentration of irisin in the blood serum is significantly higher in obese girls than in obese boys and healthy girls. Obese patients, compared with lean peers, are characterized by a statistically significantly higher content of both fat and lean mass. With the progression of obesity, there is a statistically significant increase in the ratio of fat to lean mass (I degree - 0.66 [0.56; 0.7], III - 0.78 [0.68; 0.98] (p=0.0073). CONCLUSION: Patients with obesity and normal body weight have different levels of adipomyokines. An increase in the level of IL-6 with the progression of obesity is directly related to an increase in the content of adipose tissue. Further study of the features of adipocytokine secretion, their relationship with the features of the body composition and metabolic complications in obesity is required.

[The causes of obesity relapse after weight loss].

The main problem of obesity treatment is the difficulty of long-term weight maintenance. From one point of view, it can easily be explained by patients' low compliance and absence of self-control. From another point of view, body weight is regulated not only by persons will, but also by multiple physiological mechanisms. Moreover, studies demonstrate that the attempts to reduce body weight stimulate the activation of adaptive biological process that block weight reduction.Despite the variety of obesity treatment methods, only few patients are able to achieve significant (at least 5-7%) weight loss and maintain the result. In most cases people return to the initial weight in about 3-5 years. Therefore it is relevant to study weight regain mechanisms in order to identify new effective obesity treatment strategies.The objective of this review is to summarize the information about the main issues of central, peripheral and behavioral pathogenic mechanisms which lead to disease relapse after obesity treatment and ideas for future strategies to resolve them.

[Myokines in obese adolescents with aerobic exercise].

BACKGROUND: Myokines are synthesized by myocytes and released into the bloodstream in response to muscle fiber contraction. They have a positive effect on carbohydrate and lipid metabolism, muscle mass growth, osteogenesis, increase tissue sensitivity to insulin, counteract inflammation of adipose tissue. The study of their secretion in response to physical activity (FA) can help to personalize the therapy of obesity. AIM: to study the features of the secretion of myokines in children with constitutionally exogenous obesity during physical activity of different duration and intensity and to evaluate their relationship with the parameters of the body composition. MATERIALS AND METHODS: 26 children (10 boys and 16 girls) were included in the study 15 [13; 16] years old, SDS BMI: +2.91 [2.24; 3.29], with sexual development according to Tanner 4-5. Two groups of 13 people were formed by random distribution. Group I performed FA (walking on a treadmill under the control of heart rate) of different duration: 30 and 60 minutes at the same intensity (less than 3 metabolic equivalents (MET)). Group II - FA of different intensity: low - less than 3 METH and moderate - 3-6 METH with the same duration of 45 minutes. Commercial kits for enzyme immunoassay were used to determine the level of myokines. The assessment of the compositional composition of the body was carried out by bioimpedance analysis (analyzer In Body 770, South Korea) in the morning, on an empty stomach. Statistical processing was carried out using STATISTICA v.12.0 (StatSoftInc., USA). The results are presented in the form of median (Me) and quartiles (Q1; Q3) corresponding to 25 and 75 percentiles. The critical significance level (p) was assumed to be <0.05. RESULTS: moderate intensity FA leads to a maximum increase in the level of myokines: interleukin-6 (IL-6) by 215.7% and decorin by 34.3%, a decrease in the level of irisin by 16.5%. An hour-long low-intensity workout leads to a moderate increase in the level of IL-6 by 80.5%, to a decrease in the level of irisin by 31.1%. Myostatin increases equally both after 60-minute FA and after moderate intensity FA by 30.9% and 31.8%, respectively. Short low-intensity FA (lasting 30 minutes) it is not accompanied by a significant increase in the expression of myokines. The relationship between the amount of muscle (r=0.65), lean (r=0.62), fat-free mass (r=0.64) and the level of decorin after FA was noted. There was no statistically significant relationship between the parameters of the body composition and the levels of IL-6, myostatin, and irisin. There were no gender differences in both basal and stimulated myokine secretion. CONCLUSION: Moderate intensity FA and low intensity 60-minute FA are most effective for obese children. A 30-minute low-intensity FN is insufficient to increase the secretion of myokines by skeletal muscles.

[Modern strategies for the treatment of childhood obesity].

The prevalence of obesity and related metabolic disorders in children and adolescents in the Russian Federation is steadily increasing, which requires healthcare professionals to search for new methods of treatment and prevention. The treatment of childhood obesity should be based on a comprehensive approach, including diet therapy, increased physical activity, behavioral therapy and psychological support. To increase the effectiveness of the formation of new eating habits and proper eating behavior, as well as to increase the adherence of children and adolescents to treatment, drug therapy of obesity is used, aimed primarily at reducing appetite. Considering the efficacy and safety of glucagon-like peptide 1 analog (Liraglutide) in adolescents, as well as a small number of gastrointestinal side effects, this drug is promising in the complex treatment of childhood obesity. This review presents an analysis of the literature on non-medicated and drug-based methods of treatment of childhood obesity.

[Resolution on the results of the interdisciplinary expert council "Prevention and treatment of obesity. How to Achieve a Healthy Metabolic Balance].

On September 30, 2022, a meeting of the interdisciplinary expert council "Prevention and treatment of obesity. How to Achieve a Healthy Metabolic Balance. To reduce the social and economic burden of obesity and its consequences in the Russian Federation, it is necessary to introduce socially significant initiatives to prevent obesity and increase its detection rate, as well as to update modern approaches to the treatment of this chronic disease, taking into account its multifactorial pathogenesis, comorbidity, risk of complications and patient disability. Based on the results of the scientific reports and discussions held during the expert council, the experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity.

[Energy exchange: how we can personalize obesity therapy].

Obesity is a consequence of chronic energy imbalance when energy intake constantly exceeds expenditure, which leads to excess white adipose tissue accumulation. Effective treatment of obesity requires accurate measure of calories intake and expenditure, as well as related behavior to understand how energy homeostasis is regulated and evaluate the effectiveness of the measures taken. The greatest interest is to study features of energy metabolism in various forms of obesity. It is necessary to create an evidence-based, personalized approach to diet therapy and to increase the effectiveness of weight loss measures. Modern studies have shown that the use of indirect calorimetry in obesity treatment programs leads to greater weight loss compared to traditional diet therapy planning based on calculated formulas.

[Clinical guidelines «Obesity in children¼].

Childhood obesity is an urgent problem of pediatric endocrinology due to the widespread occurrence, the development of metabolic complications and their steady tracking into adulthood. The developed clinical guidelines are the main working tool of the practitioner. They briefly and structurally present the main information about the epidemiology and modern classification of obesity, methods of its diagnosis and treatment based on the principles of evidence-based medicine.

[Myokines and adipomyokines: inflammatory mediators or unique molecules of targeted therapy for obesity?]

Skeletal muscles make up about 25% of the total mass in children and more than 40% in adults. Studies of the last twenty years have shown that along with the main functions, muscle tissue has hormonal activity. It was found that myocytes are able to release signaling molecules-myokines. They act auto-and paracrine within the muscle, and at a high level-through the systemic circulation, carrying out interactions between skeletal muscles and various organs and tissues, such as the liver, bone and adipose tissue, the brain. It is proved that the key factor in the expression of myokines is physical activity, and their level largely depends on physical fitness, the amount of skeletal muscle mass and its composition (the ratio of fast and slow fibers), on the intensity and duration of physical activity. Myokines have a wide range of physiological effects: myostatin suppresses the growth and differentiation of muscle tissue, and decorin, acting as its antagonist, promotes muscle hypertrophy. Interleukin 6 provides an energy substrate for contracting muscle fibers, fibroblast growth factor 21 activates the mechanisms of energy production during fasting and improves tissue sensitivity to insulin; irisin stimulates thermogenesis, glucose uptake by myocytes, and also contributes to an increase in bone mineral density. The study of myokines is one of the key links in understanding the mechanisms underlying obesity and metabolic complications, the consequences of a sedentary lifestyle, as well as the implementation of the action of physical activity. Taking into account the physiological effects of myokines in the body, in the future they can become therapeutic targets for the treatment of these conditions.

[Insulin resistance in obese children: debate on assessment].

No age- and gender-adjusted criteria remain to be a main problem the investigators face when studying insulin resistance in children. This paper compares insulin resistance (IR) indices in 63 children and adolescents with simple (constitutionally exogenous) obesity. The authors demonstrated a low reproducibility of individual baseline values of insulin (not more than 26% as shown by Pearsons correlation analysis). Estimation of IR by means of the design indices calculated from the fasting concentration of immunoreactive insulin and glucose: 40% of obese children and adolescents had no fit of baseline IR indices with the results of an oral glucose tolerance test (OGTT), which may result in a diagnostic error - both hyperdiagnosis (in 12% of patients) and hypodiagnosis (18% of children). According to the results of this study, the values of stimulated insulin release and the Matsuda index, which were determined from the OGTT data, are of the highest diagnostic value in the assessment of insulin resistance in obesity in children and adolescents.

[New evidence for the pathogenesis of obesity: adipokines are adipose tissue hormone].

In recent years, the independent role of adipose tissue in the pathogenesis of obesity and related complications has been actively discussed. Adipose tissue is also a key factor in the development and progression of insulin resistance. Among adipokines secreted by adipose tissue and influencing the development of insulin resistance and metabolic disorders, the most studied are leptin, adiponectin, resistin, visfatin. These adipokines are dedicated to this review.

[Non-immune thyrotoxicosis caused by thyroid-stimulating hormone receptor activating gene mutation (the first description in Russia)].

Thyrotoxicosis of newborns, observed in less than 1% of pregnant women with Graves disease, is due to transplacental transfer of stimulating antibodies to the thyroid stimulating hormone receptor (rTSH). The clinical picture manifests itself in the first days of a child's life, is transient in nature and, as a rule, ends with a full recovery as the maternal antibodies to rTSH disappear from the bloodstream of the newborn. However, in addition to the "classic" autoimmune thyrotoxicosis, cases of congenital and familial non-autoimmune thyrotoxicosis, which are caused by inherited activating mutations of the gene encoding rTSH - TSHR, have been described. This article presents its own observation.

[Diagnosis of insulin resistance in children and adolescents].

The high prevalence of obesity in children is one of the factors contributing to an increase in the frequency of development of the metabolic syndrome and related diseases. A key role in the development of the metabolic syndrome in both children and adults is played by insulin resistance - a violation of the biological effect of insulin and the reaction of insulin-sensitive tissues to it at the pre-, post- and receptor levels.