Association of Polymorphic Variants of TCF7L2 and PPARG Genes with Metabolic Markers in Patients with Early Disorders of Carbohydrate Metabolism.

We performed complex analysis of the association of polymorphic variants rs7903146 of the TCF7L2 gene and rs1801282 of the PPARG gene with metabolic parameters, insulin resistance, and ß-cell function in a group of patients with early signs of carbohydrate metabolism disturbances in a sample of Tyumen citizens. The study group consisted of 64 people (39 women, 25 men) aged 40-70 years. The distribution of frequencies of alleles and genotypes of the polymorphic markers rs7903146 and rs1801282 was analyzed and associations of carriage of major homozygous polymorphisms with various phenotypic traits were identified. Genotyping for polymorphic variants of TCF7L2 and PPARG genes was performed using allele-specific PCR with primers provided by Synthol company. Carriers of homozygotes for allele C of the polymorphic marker rs7903146 significantly differed from other respondents by a higher level of C-peptide, as well as by the presence of associations with waist circumference, elevated level of glycated hemoglobin, and arterial hypertension. Carriers of homozygotes for the allele C of the rs1801282 polymorphism of the PPARG gene differed from the group of carriers of homozygotes for the allele G and the group of heterozygote carriers by higher levels of triglycerides, as well as the presence of associations with waist circumference and the level of glycated hemoglobin.

[The role of nutritional factors in the formation of cardiovascular risk in patients with type 2 diabetes mellitus].

Cardiovascular diseases are the most common complications of type 2 diabetes mellitus (T2DM) and remain the main cause of mortality in this category of patients. Currently, there is more and more data that confirm the influence of nutritional factors not only on the achievement of target values of metabolic parameters in diabetes, but also on predictors of cardiovascular risk, and also demonstrate their role as independent predictors. In this regard, the study of the role of nutritional factors in the formation of high cardiovascular risk in patients with T2DM is of high practical importance and relevance. The aim was to assess the role of nutritional factors in the formation of high total cardiovascular risk in patients with T2DM. Material and methods. An open clinical controlled prospective observation was carried out for one year in 110 patients with T2DM (87 women and 23 men, mean age 56.7±8.6 years). The average value of glycated hemoglobin (HbA1c) in the group was 8.95±2.09%, the av erage value of the body mass index was 32.3±6.2 kg/m2. All patients were assessed for traditional cardiovascular risk factors, markers of systemic inflammation and endothelial dysfunction, nutritional status was assessed by analyzing the frequency of consumption and a general semi-quantitative assessment of the intake of nutrients, food groups, and energy. During a one-year prospective follow-up, total cardiovascular endpoints were recorded and the effect of patient education on metabolic parameters, nutritional factors, and cardiovascular risk was assessed. Results. In patients with T2DM who had various clinical forms of cardiovascular diseases, the diet had an increased level of fats, which exceeded the intake in individuals without complications (p=0.013), and saturated fatty acids (SFA) (p=0.003). The risk of developing cardiovascular events in patients with T2DM increased by 5 times under excessive consumption of products containing SFA (meat, animal fats, sausages) (OR 5.34; CI 3.05-10.22, p=0.001). The decrease in body weight in the target range (by 7-10% during the year) was characterized by a decrease in the HbA1c by 11.9%, postprandial glycemia by 25.7%, total cholesterol by 20.4%, atherogenic coefficient by 25.0%, plasminogen activator inhibitor-1 by 8.5%, highly sensitive C-reactive protein by 27.4%, systolic blood pressure by 6.9%, and also was accompanied by significant decrease in unfavorable total cardiovascular events during the year (p=0.024). In addition, in the group of patients who underwent training, there was a decrease in the total amount of calories consumed (p=0.018), consumption of SFA (p=0.021) and mono- and disaccharides (p=0.001), an increase in dietary fiber in the diet (p=0.015). Conclusion. In the course of the study, an imbalance in the nutritional components of the diet in patients with T2DM was revealed. The significant role of alimentary factors in the formation of high cardiovascular risk has been demonstrated, as well as the effectiveness of therapeutic education of patients in terms of managing behavioral risk factors.

Personified strategy for the correction of cardiometabolic risk factors in the alien population of the Arctic.

Aim. To estimate the efficacy and prognostic value of individual consulting in Far North inhabitants during a 5 year survey. Materials and methods. 125 patients with metabolic syndrome were included in the study (24.8% women, 24.8% men, age median 45 years (39-48); p > 0.05). All the participants were divided into 2 groups dependence on the consulting frequency in the framework of the non-surgical body mass reduction programs (group 1 - single consulting, group 2 - repeated consultings in 12 months). Results. Individual consulting of patients with MS within 3 months after the onset of the study allowed the target body mass to be achieved in 50% of the patients in association with the reduction of atherogenic lipid fractions (p < 0,05), insulin resistance (p < 0,05), inflammation markers, hemostasis disorders markers (p < 0,05) and decrease in the number of patients with behavioral risk factors. Repeated educational module increased the relative probability 1,9 (95% CI 1,03-3,6) and odds ratio - 2.4 (95% CI 1,01-5,4) of body mass maintenance within 24 months and also reduced the risk of type 2 DM development (Cox's F-Test: F = 2,7; p = 0,041) and atherogenicity of lipid profile after 5 year observations. Conclusion. Our results proves the necessity of active utilization of educational modules at least as often as once a year. For the successful use of these modules based at outpatient facilities of the Far North it is necessary to include a dietologist in the staff of prophylactic departments which encounters difficulty under the modern funding mode.

[Group preventive consulting influence on body mass correction and nutrition disorders. 5-year prospective survey].

The aim of the work was to analyze education technologies efficacy using group methods of prevention (body mass correction school) in patients with overweight and obesity, living in Extreme North, according to a 5-year prospective survey. 181 Extreme North alien inhabitants have been investigated (23.2% men, 76.8% women) with overweight and obesity. 144 of them were surveyed during 5 years. Age median was 37 (29-49) years, including men - 33 (29-43) and women - 39.5 (27.5-48) (p=0.123). All participants were divided into 2 groups depending on preventive group education compliance. Group 1 received brief recommendations for the inspection, Group 2 was trained with the group of preventive counseling. Within 3 months of surveillance target body mass reduction was achieved by 11.3% of patients of the group 1 and 31.5% of patients of the group 2 (p=0.0018). By the end of the first year these parameters proved to be 7% and 16.4% (p=0.0453). After that there was no significant difference between groups, although about 5-6% of responders kept the achieved target of BM reduction even in group 1. Group prevention consulting is associated with short time reduction of such risk factors prevalence as low physical activity (from 86.3 to 61.1% during 3 months, p<0.005), insufficient fruits and vegetables consumption and violation of macro- and micronutrient composition of the daily diet. It is also accompanied with lower cumulative proportion of patients without all metabolic syndrome components (Cox's F-Test: F=2.61; p=0.0178) and a significant reduction of percent of patients having SCORE-risk >5% (p=0.0461) after 5 years of surveillance. Thus, group preventive consulting raises awareness of patients about their health status, leads to daily meal ratio impairment reduction, decreases prevalence of obesity and low physical activity in short time period and reduces MS - risk. During 3 months after consulting body mass reduction (of 5% or more) was observed in 30% of patients. Achieved result is stable within following 12 months in less than 16% of patients. In the longer term, education is accompanied by a decrease in MS risk and some reduction in SCORE-risk.

[Proinflammatory cytokine levels depending on the stage of hepatic fibrosis in patients with metabolic syndrome and non-alcoholic fatty liver disease].

AIM: To study levels of systemic inflammation markers and plasminogen activator inhibitor-1 (PAL-1) in patients with metabolic syndrome (MS) and establish their relationship with the progress of selected stages of non-alcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS: 129 patients aged 18-59 yr with abdominal obesity and MS underwent elastometry for the assessment of the degree of fibrosis depending on concomitant metabolic disorders and measurement of proinflammatory cytokine levels. RESULTS: Disorders of carbohydrate metabolism in MS patients are associated with the high levels of systemic inflammation markers (CRP, TNF-α, IL-6) and a two-fold rise in the PAI-1 level. The progress of fibrosis is associated with the increase of cytokine levels. CONCLUSION: Patients with MS and NAFLD associated with disorders of carbohydrate metabolism need to be examined by elastometry for the detection of fibrosis with simultaneous measurement of IL-6 and PAI-1 levels as cardiovascular risk factors.

[A course of acute respiratory virus infections in patients with metabolic syndrome].

AIM: To determine specific features of a course of acute respiratory viral infections (ARVI) and changes in immunological status in patients with metabolic syndrome (MS). MATERIAL AND METHODS: Body mass index (BMI), waist circumference, levels of cholesterol, lipoproteins, triglycerides, cytokines and immunoglobulins were measured and glucose tolerance test was made in 120 patients with MS. Registration of ARVI during a year was verified by the presence of antigens in immunofluorescence reaction. RESULTS: MS patients have obesity of an abdominal type and immunoresistance. Concentration of proinflammatory cytokines and leukocyte count in blood increased proportionally to an increase in fat tissue mass, immunoglobulins content went down. ARVI in most evident MS were characterized by a sluggish and areactive onset, longer course, more frequent respiratory and cardiovascular complications. CONCLUSION: MS is a factor of risk of a sluggish and complicated course of ARVI.

[Changes in the hormone profile, central hemodynamics and tissue blood flow in patients with thyrotoxic goiter during treatment with lithium carbonate]. / Izmeneniia gormonal'nogo profilia, tsentral'noi gemodinamiki i ; tkanevogo krovotoka u bol'nykh tireotoksicheskim zobom vo vremia lecheniia karbonatom litiia.

The nature of hemocirculatory and hormonal changes were studied in 68 patients with toxic goiter during lithium carbonate therapy. Thyroxine (T4), triiodothyronine (T3) and thyrotropin (TTH) levels, function of the cardiovascular system, tissue blood flow and vascular permeability were investigated. A significant decrease in T4 and TTH levels in the hemocirculation was observed in thyrotoxicosis patients under the influence of lithium carbonate prompting the return of disturbed myocardial function to normal and rapid restoration of microcirculatory disorders (the isotonic nature of cardiac activity turned into isometric).