[Characteristics of the Renin-Angiotensin-Aldosterone System in Carriers of Polymorphic Variants of the VDR Gene With Arterial Hypertension and Obesity].

AIM: to study the renin-angiotensin-aldosterone-system (RAAS) in patients with polymorphic variants of the vitamin D receptor gene (VDR), arterial hypertension (AH) and obesity. MATERIALS AND METHODS: We included in this study 98 patients with stage II-III AH and obesity (33 men, 65 women, mean age 61.1±9.9 years and BMI 43.3±5.0 kg/m2). The VDR gene study included genotypes TaqI, BsmI, FokI. After identification of TaqI, BsmI, FokI VDR gene sites we carried out measurements of levels of RAAS markers. RESULTS: We revealed an associative relationship between the presence of allele G of the BsmI site, C/C homozygosity of FokI site of VDR gene and presence of AH in patients with obesity. An increase of renin level was noted only in the homozygous T/T genotype of FokI, no differences in the concentration of aldosterone and angiotensin were detected between any of the studied genotypes. CONCLUSION: Polymorphic alleles and genotypes of the VDR gene can be used as predictors of AH development in obese patients with subsequent characterization of the state of the RAAS system.

[Diet optimization in patients with obesity and diastolic heart failure based on the assessment of indicators of metabolism during physical exertion].

The objective of the work was to examine the performance of basal metabolism and body composition in obese patients with diastolic heart failure (DHF) to identify optimal needs of these patients in the nutrients and energy. We studied 222 patients with obesity, that were divided into four groups depending on the degree of obesity and the presence or absence of DHF with preserved systolic function of the left ventricle (2 groups of obese patients with an initial degree I-II, 2 groups - a pronounced degree of obesity III). Basal metabolism by indirect respiratory calorimetry, physical activity at home and cardiorespiratory exercise testing were evaluated in these groups of patients. It has been shown that patients with obesity and secondary DHF have significantly lower physical activity during the day, resulting in the reduction of the overall length of the active time of day to 18.5-26.9%, and in the decrease of the proportion of time performing heavy and moderate work to 27.6-80.3%. Anaerobic threshold in obese patients I-II degree was 62.9% of maximum oxygen consumption (VO2pik) (rate is more than 60%), in patients with obesity III degree - 77.6% of VO2pik. Alveolar gas exchange also was not broken - the CO2 ventilation equivalent was equal respectively 23.4±2.8 and 28.9±1.5 (rate is less than 32). Thus, cardiopulmonary exercise testing have demonstrated that cardiopulmonary causes of dyspnea in obese patients without DHF were absent; and the reason for the decrease of exercise tolerance in patients with obesity III degree was the detraining. The reason for inactivity in patients with obesity and DHF was a marked reduction in exercise capacity due to violations of alveolar ventilation and reducing aerobic capacity of muscles. It was found that accustomed physical activity of patients at home didn't allow patients with obesity and DHF to carry out effective fat oxidation, due to the rapid achievement of the anaerobic threshold. It has been suggested that this effect may be the cause of metabolic progression of obesity in patients with DHF. It was found that patients with obesity and secondary DHF were characterized by a more pronounced oxidation of the protein, compared with similar patients without DHF, which made actual the muscle mass patronage under diet therapy management of patients. The optimum performance of the chemical composition and energy value of the diet have been calculated for patients with obesity of varying severity in conjunction with SDS.

[Low calorie diet influence optimization on body composition at obese patients with secondary diastolic heart failure].

In open prospective monocentric study in 3 parallel groups we studied the effectiveness of correction of body composition using low calorie diet therapy with inclusion of specialized food products (SFP)--sources of polyphenols and iridoids made on the basis of the juice of Morinda citrifolia L. fruits. We studied 90 patients aged from 30 to 50 years old with grade III obesity and clinically expressed secondary diastolic heart failure. The duration of diet therapy was 42 days. It was shown that low-calorie diet has non-optimal effect on the body composition in morbidly obese patients with secondary diastolic heart failure, namely leading to the expressed loss of body fatless (7.2%, p=0.00008) and muscle mass (by 16.6%, p=0.00004); at the same time the reduction of total body weight is noted only by 2.3% (p=0.053), reduction of waist measurement by 1.3% (p=0.028) and reduction of hips measurement by 1.3% (p=0.09), accompanied by the reduction of body fat by 8.5% (p=0.000017) and of liquid by 7.3% (p=0.0018). The introduction of the SFP into the diet optimizes the effect of low calorie diet therapy on the anthropometric parameters and body composition. The most important effect of the SFP is the ability to prevent the excess loss of muscle mass in patients, and this effect is being dose-dependent. The loss of muscle mass in two groups of patients was 3.1-4.1% after 6 weeks of diet therapy, while in the control group it was 8.5% (p=0.0051). We have concluded that the inclusion of the SFP, manufactured on the basis Morinda citrifolia L. (noni) juice to the low calorie diet allows to initiate mainly the loss of the body fat with the simultaneous protection of active cellular mass, which is without doubt can be considered as the advantage compared to the standard low calorie diet.

[Age-dependent characteristics of nutritional status and resting metabolism in overweight and obese children].

The age-dependent nutritional status and resting metabolism in overweight and obese children have been examined. The study included 625 children of 2.5-17 years old. Patients were divided into three groups: 1st--2.5-7 years old (n = 49), 2nd--8-12 years old (n = 204), 3rd--13-17 years old (n = 372). The diagnosis of overweight and obesity was based on CDC criteria: children with 85-94 BMI percentile according to age and gender had overweight, BMI 295 percentile--obesity. Anthropometry, bioelectric impedance analysis and indirect respiratory calorimetry were performed; lipid and carbohydrate parameters were measured. The fat mass percentages in children of studed groups were 41.3 ± 1.9, 39.8 ± 0.7 and 42.3 ± 0.4%, the mean percent of fat mass excess--163.6 ± 26.2, 113.7 ± 8.3 and 134.9 ± 8.2% respectively, p > 0.05. Prevalence of dyslipidemia in children increased with age: lipid metabolism disorders were revealed in 28.6, 49.0 u 53.2% children of the 1st, 2nd and 3rd groups respectively. The mean HDL level in the 1st and 2nd groups was significantly higher, and triglycerides--lower than in the 3rd group. The correlation of HDL level and breastfeeding duration (r1 = 0.94, p < 0.05) was found in the 1st group of children. Increased insulin level was revealed in 38.8% children in the 1st group (mean 12.8 ± 1.4 µIU/ml), 62.2% children in the 2nd group (21.1 ± 0.7 µIU/ml) and 64.8% children in the 3rd group (25.1 ± 0.9 µIU/ml); increased HOMA--in 36.7% (4.32 ± 0.6), 62.2% (4.65 ± 0.17) and 59.1% (5.56 ± 0.21) respectively. The negative correlation of insulin and HOMA level with breastfeeding duration (r1 = -0.38 and -0.37, respectively, p < 0.05) was found in the 1st group of children. Prevalence of hyperuricemia increased from 13% in the 1st group to 21.1% in the 2nd and 44.1% in the 3rd group. Prevalence and degree of resting metabolism changes increased with age and had tendency to the shift of proportion of energy-intensive substrates (fats and carbohydrates) to deceleration of carbohydrate oxidation (in 32, 50, 55.1% of children) and compensatory fat oxidation acceleration (8, 28.4 and 34.7% respectively). Mean fat oxidation rate levels significantly differed between groups and increased with age (48.38 ± 7.14, 54.29 ± 3.06 and 78.43 ± 2.89 g/day in children of the 1st, 2nd and 3rd groups respectively, p < 0.001). The mean level of carbohydrate oxidation rate in the 3rd group of children was lower than normal value (p < 0.01). Resting energy expenditure was lower in the 2nd and 3rd groups of children.

[Evaluating the effectiveness of dietary management of patients with varying degrees of obesity].

The purpose of the research is to study the efficiency of a low-calorie diet in treatment of patients with various degree of expressiveness of obesity. 605 patients (188 men and 417 women) with a body mass index > 25 kg/m2 at age 18-79 years have been examined. All patients underwent a complex clinical and instrumental and laboratory examination on the "Nutritest IP-2" system, including studying of clinical status dynamics, anthopometrical indicators, composite structure of a body, parameters of a power exchange and the laboratory indicators characterizing a condition of lipid, carbohydrate and protein metabolism. It has been revealed that low-calorie diet in combination with traditional curative measures ("Nutrikor IP-2") in obese patients significantly improved clinical status, central hemodynamics (blood pressure and heart rate), anthropometric parameters and body composition, lipid profile and parameters of metabolic status. In particular, systolic arterial pressure decreased authentically by 18- 19% (p < 0.00I), diastolic arterial pressure--was reliable for 16-17% (p < 0.001), heart rate authentically decreased by 7-12% (p < 0.001). Concentration of blood glucose authentically decreased at patients with obesity of I and II degrees--by 6% (p < 0.01), at patients with obesity of the III degrees--for 8% (p < 0.001). The reduction of fatty body weight in patients without obesity was 2.3%, in patients with I degree of obesity--3.1% (p < 0.001), in patients with II degree of obesity--3.4% (p < 0.001), and in patients with III degree of obesity--4% (p < 0.001). It has been shown that the effectiveness of therapeutic interventions reduced according to the severity of obesity, that requires changes in the approach to the treatment of these patients, the search for new methods of drug and dietary management of this pathology.

[Influence of dietotherapy enriched with conjugated linoleic acid on anthropometrical indicators and body composite structure in patients with an overweight].

The clinical efficiency of dietotherapy enriched with conjugated linoleic acid (3 g per day) in patients, suffering from the excess mass of a body and obesity of I and II degrees has been investigated. Dynamics of anthropometrical indicators and body composite structure before and after the treatment of patients from the main (n = 20) and control groups were estimated. Studied parameters were fixed in day 0, 14 and 28. Statistically significant reduction of the weight, body mass index (BMI), anthropometrical parameters (volumes of a waist, hips, a shoulder), indicators of body composite structure (fatty weight, area of splanchnic fat, muscular weight) has been revealed as a result of the carried-out course of treatment, and they were more expressed in patients of the main group. In particular, the waist size authentically decreased by 6.5% in patients from the main group, while in patients from the group of comparison the decrease reached only 4.2%. Average change of waist volume was--7.0 cm in the main group and--4.5 cm in the control group. The grasp of hips in the main group decreased by 4.2%, in the group of comparison for 2.8%. Absolute change of hips volume in the main group 1.67 fold exceeded that in the group of comparison (p < 0.005). The shin grasp in the main group decreased by 9.7%, while in the control group remained invariable. BMI decreased by 7.2% and 5%, respectively. Thus, the reduction of body fatty weight was 10% in patients from the main group and 4% in patients from the group of comparison. The body total liquid decreased by 1.4 l in the main group, and only by 0.3 l in the group of comparison. The received intergroup distinctions are statistically reliable (p < 0.05).

[Effect of diet enriched with selenium on the psycho-emotional and adaptive capacity of patients with cardiovascular diseases and obesity].

It was studied the effect of diet enriched with selenium on the clinical and biochemical status, psycho-emotional and adaptive capacity of the organism in patients with diseases of the cardiovascular system. We examined 59 patients with cardiovascular disease and obesity, treated for 3 weeks antiatherogenic reduced calorie diet. Of these 36 patients from the index group took on the back of ground diet selenium containing diet product (part of alimentotherapy). Patients underwent clinical examination, biochemical parameters and the availability of selenium were measured. To assess the adaptive capacity of the organism we used Program Apparatus Complex. Quality of life of patients, overall health, level of anxiety and the dynamics of mental processes were assessed using SAS procedures, Spielberger-Hanin anxiety test, Serdyuk Quality of Life Questionnaire, Kraepelin's counting test. The results indicate positive changes in clinical and biochemical status, availability of selenium, adaptive capacity, psycho-emotional state of patients with cardiovascular disease and obesity because of the diet enriched with organic form of selenium. We revealed increase in activity, improvement of overall health and cognitive functions, mood stabilization, reduction of anxiety and emotional lability. The main differences observed between the groups identified in the leveling of the anxiety radical in psycho-emotional status of patients.

[Functional performance of the cardiovascular system in patients with overweight and obesity].

Was investigated 471 patients with obesity and cardiovascular diseases. Direct dependence between degree of expressiveness of obesity and the clinical status, severity of infringement of a functional condition of cardiovascular system, frequency of development of complications is revealed.

[The cell immunity in patients with arterial hypertension and obesity].

In the present study 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 arterial hypertension and obesity in comparison with the healthy persons was determined. 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 increase the percentages of T-helper and decrease the cytotoxic T-lymphocytes in patients with arterial hypertension and obesity in comparison with the healthy persons. In the peripheral blood of patients with arterial hypertension and obesity were observed a greater level of activated T-lymphocytes (CD3+CD25+, CD3+HLA-DR+), that reflect the increase activity of T-cell immunity. In these patients a greater level of NKT-cells (CD3+CD16+CD56+) and lymphocytes expression of CD95-antigen in comparison with the healthy persons also was noted. The direct correlation between the increased quantity of T-helper lymphocytes, activated T-lymphocytes, NKT-cells, lymphocytes expression of CD95-antigen, and index of body mass in patients with arterial hypertension and obesity was found.

[The system of multilevel diagnostics and corrections of nutrition status disorders in the patients with cardiovascular diseases].

As is known, the pathology of cardiovascular systems depends on nutrition and occupies leading positions in structure general morbidity and mortality of the population of Russian Federation. The system of nutritional and medical aids--"Nutritest" and "Nutricor", represent the technology of diagnostics of infringements the status of nutrition, estimations of risk of development of cardiovascular diseases, and ways of their high-grade correction.

[Dietary correction of nutrition status in patients with metabolic syndrome].

Effectivity was studied of a low-caloric diet in patients with metabolic syndrome. Results of the study show that enrichment of a low-caloric diets in patients with metabolic syndrome improved clinic status, antropometric levels, metabolism and lipid spectrum of blood.

[Energy metabolic in patients with ischemic heart disease before and after heart surgery].

The study involved 85 patients with coronary heart disease (CHD). The parameters of metabolic status the actual food intake with the help of a new computer program, based on frequency method were investigated from patients with cardiovascular diseases. It was found a disbalanse of intake main food components and low physical activity in of patients.

[The assessment of clinical efficiency of the diet therapy in cardiosurgery patients].

A total of 82 patients aged 47 to 78 years who had undergone myocardial revascularization were examined. A control group comprised 41 patients who had postoperative routine dietic therapy. The experimental group consisted of 41 patients who had postoperative modified dietic therapy. A complex laboratory blood test was made, cardiovascular system were evaluated. It was shown to normalize the major parameters of to increase cardiac contractility, and to improve the outcomes of the early rehabilitative period in patients undergone myocardial revascularization.