[Bone mineral density in vegetarians and vegans].

The number of vegetarians and vegans is increasing each year. In this regard, studies of the quality of diets that exclude slaughter foods, as well as their impact on human health, are becoming more and more relevant. The main purpose of the study was to assess the bone mineral density (BMD) in Russian vegetarians and vegans, as well as in omnivores. Material and methods. Design - cross-sectional study. On an outpatient basis, we examined 103 conditionally healthy people aged 18 to 77 years with different diets: 36 vegans, 38 vegetarians and 29 omnivores. X-ray two energy absorptiometry was used to assess BMD. The density of the lumbar vertebrae (LI-LIV) and femoral neck was measured. Results. Osteopenia in the lumbar spine was diagnosed in 27.8% of vegans, 39.5% of vegetarians, and 31.0% of omnivores. In the femoral neck, BMD corresponding to osteopenia was detected in 19.4, 26.3, and 17.2% of cases, respectively. 18.4% of vegetarians and 6.9% of omnivores had BMD corresponding to osteoporosis in the lumbar spine. Osteoporosis was not diagnosed in the femoral neck. No significant differences were observed after exclusion of people over 50 years of age. This was probably due primarily to the fact that the largest number of peri and postmenopausal women were in the vegetarian group. Excluding people who had took vitamin D supplements regularly did not drastically change the results of the study. When taking into account both exclusion criteria, no significant differences were observed. Conclusion. The findings suggest that BMD in vegans and vegetarians in Russia does not differ from that in omnivores. However, further larger studies are required.

[Efficiency estimation of diet therapy with protein component modification in patients with obesity and purine metabolism disorder].

The development of a personalized nutritional approach to diet therapy for patients with obesity and hyperuricemia, aimed at increasing the treatment effectiveness of these patients, is an urgent task. The aim: to assess the impact of nutritional approach with a modification of the protein component on body composition and biochemical parameters in patients with obesity and purine metabolism disorder. Material and methods. A randomized controlled trial was conducted, and included 50 patients (average age 46.9±2.5 years) with obesity and purine metabolism disorder. All patients were divided into two groups of 25 people. Within 2 weeks patients of group 1 received the main version of a standard low-calorie diet (1730 kcal, protein - 87.4 g, fat - 61.4 g, carbohydrates - 207 g). Group 2 received a personalized version of the diet (2125 kcal, protein - 100.2 g, fat - 75.9 g, carbohydrate - 260 g) with the modification of the protein component: protein content of at least 90 g per day, restriction of animal products containing a high purine load. Results and discussion. During diet therapy the decrease in fat mass in group 1 patients averaged 4.4%, visceral fat area - 8.6% (p<0.05) and in patients of group 2 - 6.9 and 9.1% respectively (p<0.05). During treatment a significant decrease in muscle mass was observed in group 1 at average 3.9% (p<0.05), and in group 2 on the basis of personal nutritional approach there was a slight decrease in muscle mass at average of 1.5%. After treatment patients of the two groups showed improvement in a number of indicators of lipid and carbohydrate metabolism: a significant decrease (p<0.05) of glucose, total cholesterol, LDL cholesterol and triglycerides in blood serum by 18.2-19.1, 23.2-23.6, 24.2-25.0 и 28.5-30.4%. However, patients in group 1 showed a slight decrease in uric acid in blood serum at average 7.6%, and patients in group 2 who received a personal nutritional approach with a modification of the protein component showed a significant decrease in uric acid at average of 12.5% (p<0.05). Conclusion. The obtained data indicate the need for a personal nutritional approach with a modification of the protein component in patients with obesity and purine metabolism disorder, which will prevent the development and progression of complications associated with obesity.

[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.

[Current trends in nutrigenomics of obesity].

One of the most general chronic illness in the world is obesity, which lead to progression of cardiovascular diseases, diabetes mellitus type 2, metabolic syndrome and other diseases. Slow body weight gain, that leads to overweight, is a long-term aftereffect of a long-term positive energy balance, which occurs as a result of physical activity reduction and calorie intake increasing. Trend in the reduction of physical activity and increasing the caloric value of food intake is probably the main reason of increasing patients with obesity, but it's necessary to mention that this tendency occurs because of genetic variation in population. The volume of scientific information, relevant to the problem of genetic predisposition testing to obesity, is highly increasing. This article provides an overview of recent data on the genetics of obesity and the role of genetic testing of candidate genes polymorphisms, as well as genes associated with carbohydrate and lipid metabolism disorders (FTO, ADRB2, ADRB3, PPARG and a number of others). The role of nutrigenomics in personalization of diet treatment for obesity.

[Genomic, proteomic and metabolomic predictors of atherosclerosis in obese patients. Part II].

Currently there is no extensive research of metabolic disorders in obese patients with atherosclerosis, including the study of genomic, biochemical, immune and other markers. Therefore, the aim of the study was to identify the genomic, proteomic and metabolic predictors of atherosclerosis in obese patients. We evaluated condition of the cardiovascular system of the 100 obese patients aged 18 to 66 years, which were divided in two groups of patients: Group 1 consisted of 50 obese patients without vascular pathology, 2nd group consisted of 50 patients with obesity, complicated by atherosclerosis. We carried out a study of the lipid metabolism and analysis of polymorphic alleles ε2, ε3, ε4 of the ApoE gene by PCR. Our data showed that clinically significant predictors of atherosclerosis in obese patients are homozygous genotypes ε2/ε2 of the ApoE gene, increased blood serum level of triglycerides, oxidated LDL, interleukin-6, adhesion molecules SICAM, L-FABP and adiponectin reduction.

[Comparative assessment of efficiency of the low-calorie diets modified by proteinaceous and vitamin cocktails].

The aim of the work is comparative assessment of efficiency of a hypocaloric diet with inclusion of proteinaceous and vitamin cocktails at obesity. 90 patients with obesity of the II­III degree at the age of 18­65 years by the principle of casual selection were divided into three groups. Control group (30 patients) received a standard low-calorie diet with an energy value of 1600 kcal/day. The diet of the 1st group (30 patients) was modified by the inclusion of protein-vitamin-mineral cocktail (16 g of dry mixture with the addition of 250 ml of yogurt 1.0% fat) twice a day, diet of the 2nd group (30 patients) ­ the inclusion of a protein cocktail (16 g of dry mixture with the addition of 250 ml of yogurt 1.0% fat), while excluding from the diet equivalent caloric meals. The 1st group of patients had a decrease in fat mass by 4.2±0.7 kg (p<0.02), in active lean mass by 1.1±0.1 kg, in total fluid volume by 2.2±0.3 kg (p<0.02). The 2nd group of patients had a decrease in fat mass by 3.8±0.9 kg (p<0.01), in lean mass by 1.4±0.3 kg and in the total fluid volume by 3.1±0.9 l (p<0.02). In the control group attention should be paid to a decrease in lean mass by 1.9±0.6 kg, while fat mass decreased by 3.0±0.4 kg (p<0.02) and the total fluid volume by 3.1±0.9 l (p<0.02). Evaluation of the changes of serum biochemical parameters after treatment demonstrated that the 1st group of patients had significant favorable dynamics of reduction of serum level of total cholesterol, uric acid and glucose (17.7, 28.2 and 18.3%, respectively), which was more pronounced compared with the dynamics in the control group (the decrease by 15, 19.2 and 8.2%, respectively). In the 2nd group of patients the decrease rate of the observed parameters was less pronounced (15, 19.2 and 8.2%, respectively). More appreciable favorable dynamics of biochemical parameters and reduction in body weight in the 1st and 2nd groups in relation to the control group allow to reasonably apply the protein-vitamin cocktails in a diet therapy at obesity.

[Genomic, proteomic and metabolomic predictors of nonalcoholic fatty liver disease development in obese patients. Part I].

The prevention, diagnosis and treatment of diseases associated to obesity require a qualitative increase of efficiency. There are still disputable questions about diagnostic significance of some molecules, including genomic, proteomic and metabolomic biomarkers. We observed 72 obese patients (20 men and 52 women, mean age--41.3 +/- 2.5) and performed ultrasound elastography and ultrasound of liver. We have identified two groups of patients: Group 1 consisted of 50 obese patients without complications (BMI 43.2 +/- 0.6), group 2 consisted of 22 patients with obesity complicated with nonalcoholic fatty liver disease (BMI 45.8 +/- 2.3). Determination of the adipokines (adiponectin, ghrelin, resistin, visfatin, and apelin), cytokine (interleukin--6, TNFalpha) oxidized lipoproteins (oxLDL), adhesion molecule sICAM (soluble intercellular cell adhesion molecule), fatty acid transporter L-FABP in serum was performed by ELISA. The study of the lipid metabolism involved determination of the concentration of total cholesterols, triglycerides, low and high density lipoproteins (LDL and HDL) by turbidimetry and spectrophotometry by analyzer. In addition, we conducted analysis of polymorphic alleles epsilon2, epsilon3, episolon4 of ApoE gene using polymerase chain reaction. Our data indicate that reducing the concentration of adiponectin (0.46-1.71 mcg/ml), increasing the level of glucose (5.57-6.25 mmol/l), triglycerides (2.06-3.94 mmol/l), TNFalpha (5.07-16.68 pg/ml) and L-FABP (11.62-23.76 pg/ml) are predictors of nonalcoholic fatty liver disease in obese patients, and the presence of genotype epsilon3/epsilon4 of ApoE gene is a poor prognostic marker of severity of nonalcoholic fatty liver disease.

[Adipokines and the metabolism of key nutrients in patients with obesity].

AIM: To study the effect of adipokines on the metabolism of key nutrients in patients with obesity. SUBJECTS AND METHODS: Ninety patients aged 18 to 66 years old who were treated at the Department of Preventive and Rehabilitative Nutrition, Research Institute of Nutrition, Russian Academy of Medical Sciences, were examined. Carbohydrate and lipid metabolisms were assessed by turbidimetry and spectrophotometry. The levels of adipokines, insulin, and oxidized low-density lipoproteins (LDL) were measured by ELISA. Insulin resistance was assessed with HOMA-IR in all the patients. RESULTS: It was found that there were discoordinated changes in the content of adipokines. The patients with Grade 1 obesity, as compared to the control group, had a statistically significant decrease in the serum concentrations of adiponectin (5.94 +/- 0.90 and 15.34 +/- 0.45 microg/ml; p < 0.05) and ghrelin (215.50 +/- 104.50 and 540.67 +/- 0.76 pg/ml; (p < 0.05) and resistin levels above the normal values (7.34 +/- 1.24 and 5.12 +/- 0.22 ng/ml; p < 0.05; respectively). There was an inverse correlation between the content of adiponectin and ghrelin, and body mass index in obese patients (r1 = -0.25, r2 = -0.15; p < 0.05). There was evidence that there was also an inverse correlation between the levels of adiponectin, triglycerides, LDL, particularly oxidized LDL (p < 0.05). Adipokine-induced insulin resistance appeared as increases in the concentrations of glucose, insulin, and HOMA-IR, as compared to those in the control group. CONCLUSION: A comprehensive approach to evaluating metabolic disorders and adipokine synthesis in obese patients makes it possible to optimize the diagnosis of type 2 diabetes mellitus and cardiovascular diseases and to personalize diet therapy.

[Polymorphisms Ser447Ter of lipoprotein-lipase gene, Cys112Arg and Arg158Cys of apolipoprotein E gene in patients with obesity].

The distribution of allele Ser447Ter of lipoprotein lipase gene (LPL) and polymorphic markers E2 and E4 of the apolipoprotein E gene (ApoE) were examined in 100 obese patients at the age of 18-66 years (28 men and 72 women, 40.6 +/- 2.1 years old). The first group included patients with I degree of obesity (n = 26, BMI = 32.5 +/- 0.2), the second group--patients with II degree of obesity (n = 33, BMI = 37.1 +/- 0.2), the third group--patients with grade III obesity (n = 41, BMI = 46.3-1.1) and control group were 18 healthy individuals aged from 22 to 55 years (7 men and 11 women, 36.5 +/- 0.9 years old, BMI = 22.4 +/- 1.8). Maximal frequency of allelic polymorphism epsilon2 has been revealed in patients with I degree of obesity, and allele epsilon4--in patients with III degree of obesity. The most common genotype of ApoE gene was epsilon3/epsilon3 in all three groups of patients with obesity. In a comparative analysis of allelic variants of the Apo E gene occurrence it has been found that the frequency of a polymorphic variant epsilon2/epsilon2 tended to decrease with BMI increasing, whereas a higher rate of detection of genotypes epsilon4/epsilon3, epsilon4/epsilon4 and epsilon2/epsilon4 was found in patients with III degree of obesity. The data obtained suggest that the epsilon4 allele of the Apo E gene is associated with the development of morbid obesity, rather than allele epsilon2. This phenomenon can be explained by the fact that apoE4 isoform has reduced affinity for LDL in comparison with apolipoprotein E3. The maximum concentration of cholesterol, triglycerides and LDL cholesterol has been observed in patients with epsilon2/epsilon4 genotype of ApoE gene, and it was significantly higher than in the control group (p < 0.05). The content of blood lipid fractions in patients with epsilon3/epsilon4 genotype of ApoE gene, in contrast, was the lowest among obese and did not exceed the values of the control group (p > 0.05). These data indicates a small contribution of epsilon4 polymorphism in heterozygous form to the development of dyslipidemia in obesity. The most positive effect of diet treatment was achieved in patients with genotype epsilon3/epsilon3 and epsilon3/epsilon4. An integrated approach to the assessment of lipid metabolism in patients with obesity, including the analysis of polymorphic genetic loci, can optimize and personalize the diet therapy.

[The mineral composition of the carbohydrate-electrolyte drinks, vitamin-mineral complexes and dietary supplements for athletes].

In the article analyzes the macro- and trace element composition of sports drinks, vitamin-mineral complexes and biologically active additives (BAA). The estimation of the mineral collection of these products compared with the recommended standards. Established mineral composition many of the carbohydrate-electrolyte solutions, vitamin-mineral complexes and biologically active additives corresponds the physiology standards. However in some vitamin-mineral complexes and especially biologically active additives a number of minerals can be either unreasonably low or unreasonably high. Furthermore during labeling, mainly in the category D, a number of errors were revealed. Particularly there were lack of instructions about the number of declared ingredients, inaccuracies in the calculations of the daily requirement of mineral elements etc. Providing of an athlete organism with minerals should be carried out not only by carbohydrate-electrolyte solutions, vitamin-mineral complexes and specialized BAA, but mainly through basal ration. Utilising of carbohydrate-electrolyte solutions, vitamin-mineral complexes and biologically active additives can be justified only by the recommendations of experts. This is true not only in pro sports, but for the mass sports, as well as for individual physical training, in order to maintain physically fit.

[Status of nutrition and cell immunity in sportsmen-weightlifters].

The analysis of average daily nutrient intake, indexes of lipids metabolism parameters of cell immunity on 30 weightlifters and 14 individuals, who does not be engaged in sport, are carried out. Results of the present research show the imbalance in athletes diet with unfavourable ratio of proteins, fats, carbohydrates as 1:1,7:3--in women and 1:1,4:2,9--in men. Lipid storage disease include the rise of low-density lipoproteins level (in women-- 3,2 +/- 0,2; in men--3,4 +/- 0,2 (p < 0,05); in control group--2,2 +/- 0,3 mmol/l) and the fall--of high-density lipoproteins (in women--1,3 +/- 0,1; in men--0,9 +/- 0,1; p < 0,05); in control group--1,7 +/- 0,2 mmol/l). Result of disbalance in sportsmen immune system was statistically authentic decrease in an immunoregulatory index of CD4/CD8 (in women--0,89 +/- 0,08, in men--0,77 +/- 0,11; p < 0,05) at the expense of increase of the relative maintenance of cytotoxic CD3+CD8+ T-killers (in women--39,42 +/- 4,0; in men--41,28 +/- 3,28%; p < 0,05) and reduction of the T-helpers CD3+CD4+ content in peripheral blood (32,48 +/- 1,06 and 31,33 +/- 2,95%; p < 0,05) at 17% of women and 42% of male athletes owing to intense physical activities. This suggests that athletes engaging in longer periods of intensified training can exhibit an inefficiency of cell immunity. The cause of immune response decreasing can be metabolic disorders. The imbalance in athletes' diet leads to dislipoproteinemia, which play a pathogenetic role in cell immunosuppression.

[Medical-biological approach to development of feeding ration for sportswomen--members of Russia weight lifting team].

Physical status of 12 sportswomen - member of Russia weight lifting team during training period was analiysed. Anthropometric, bioimpedance methods with analyzer ABC-01 "Medass" in observation [body weight Index (index Ketle-2), waist circle/hip circle index] and body compositions were used (adipose, bone and muscle tissues masse). Data obtained when bioimpedance method was used indicated: normal body weight and relative adipose mass to body weight - in 92%, surplus - in 8% of cases; body weight Index and normal level of adipose mass - in 75%, surplus - in 25%; active cellular mass and bone mass and general body liquid were found to be normal. 14-day feeding ration for sportswomen were analysed and 3 times per day food intakes was found to be not optimal. Data obtained let to recommend set of daily food products to compose optimal ration for present sportswomen group when energetic value of 4500 kKal and high nutritional value would be provided.

[The clinical and immunological manifestations of food intolerance in obese patients].

The clinical and immunological manifestations of food intolerance in obese patients were studied. Food intolerance was diagnosed in 32.6 and 33.4% in obese patients stage 2 and stage 3 respectively, and was basically determined by 13 proteinaceous food products. The changes in immune status in obese patients created conditions for development of food intolerance. The timely diagnose food intolerance allows to personalize the diet therapy.

[Body composition in patients with different degree of obesity before and after dietetic correction].

The study included 400 patients with I-III obesity degree. All patients were tested before and after hypocaloric diet with energy value of 1600 kcal/day within 2 weeks. The bioimpedance analysis was spent on device "Inbody 720". The application of the hypocaloric diet is accompanied by clinically significant decrease in body weight in patients with obesity mainly due to the fatty component and visceral fat area and positive dynamics of clinical and biochemical parameters.

[Food status peculiarities, anthropometric, clinica and biochemical indices at professional sportsmen].

Under steady state conditions in 66 athletes involved in weightlifting, bodybuilding, judo and taekwondo have studied features of the metabolic status. Data on matter-of-fact nutrition, body weight content within the inter-competition period, energy exchange, clinical and biochemical indices and physical acceptability indices were analyzed. As a result, the decrease indexes of metabolism at all the sportsmen and high-level caloric value at sportsmen who are engaged in weightlifting, which corresponds their energy expenditures, was revealed.

[Evaluation of dietary therapy efficiency, based on clinical and biochemical parameters in patients with cardiovascular disease and osteopenia].

Aim of investigation was to analysis of dietary intake in patients with cardiovascular diseases (CVD) and osteopenia. We studied 13 patients with CDV and osteopenia and 117 control subjects with CDV. Analysis of dietary intake in all patients showed high level consumption of fat, excessive consumption of phosphorus and deficiency in consumption of vitamins A, B1, B2. It was shown that diet-therapy has promoted the most positive changes of the clinical, biochemical and immunological parameters of patients had osteopenia less then control group.

[Influence of bioactive dietary supplement--dietary unsaturated fats--on immune status of patients with myocardial ischemia and impaired glucose tolerance]. / Vliianie biologicheski aktivnoi dobavki k pishche--istochnika PNZhK-- na immunnyi status bol'nykh ishchemicheskoi bolezn'iu serdtsa s narushennoi tolerantnost'iu k uglevodam.

Immune status measured by the flow cytrometric analysis under the ischemic heart disease and IHD with impaired glucose tolerance has been found to be altered in B cells as well as in T lymphocytes in some cases. Having received the diet supplemented by PUFA "Eicolen", IHD patients present with the restored immune status. Patients with IHD and impaired glucose tolerance did not present with any significant modifications in immune status after PUFA "Eicolen" supplementation.

[The effect of an antiatherosclerotic diet including omega-3 polyunsaturated fatty acids of marine and plant origins on the indices of cellular and humoral immunity in patients with ischemic heart disease and a disordered carbohydrate tolerance]. / Vliianie antiateroskleroticheskoi diety s vkliucheniem polinenasyshchennykh zhirnykh kislot omega-3 morskogo i rastitel'nogo proiskhozhdeniia na pokazateli kletochnogo i gumoral'nogo immuniteta u bol'nykh ishemicheskoi bolezn'iu serdtsa s narushennoi tolerantnost'iu k uglevodam.

The dynamic of natural antibodies against catecholamines and alpha-2-macroglobulin, thrombin, antithrombin III and parameters of cellular immunity in 92 patients with ischemic heart disease and ischemic heart disease complicated by impaired glucose tolerance was studied of influence of antiatherosclerotic diet with fish and vegetable PUFA omega-3 from "Eicolen". Besides favorable influence to a clinical picture of the disease universal normalizing influence of antiatherosclerotic diet with addition Eicolen on parameters of humoral a cellular immunity.

[Effects of omega-3 polyunsaturated fatty acids of vegetable and animal origin on clinical and metabolic indicators and the intensity of lipid peroxidation in patients with ischemic heart disease and impaired carbohydrate tolerance]. / Vliianie kompleksa polinenasyshchennykh zhirnykh kislot omega-3 rastitel'nogo i zhivotnogo proiskhozhdeniia na kliniko-metabolicheskie pokazateli i intensivnost' protsessov perekisnogo okisleniia lipidov u bol'nykh ishemicheskoi bolezn'iu serdtsa s narushennoi tolerantnost'iu k uglevodam.

Use fish and vegetable PUFA omega-3 from "Eicolen" in diet of patients with ischemic heart disease and ischemic heart disease complicated by impaired glucose tolerance resulted in positive dynamic of clinical manifestation, blood lipids and coagulograms of the patients, and did not influence significantly on lipid peroxidation.

[Evaluation of the effects of fish and vegetable omega-3 PUFA complex on the erythrocyte fatty acid composition in patients with ischemic heart disease and impaired glucose tolerance]. / Otsenka vliianiia kompleksa polinenasyshchennykh zhirnykh kislot semeistva omega-3 morskogo i rastitel'nogo proiskhozhdeniia na sostav zhirnykh kislot lipidov éritrotsitov u bol'nykh ishemicheskoi bolezn'iu serdtsa s narushennoi tolerantnost'iu k uglevodom.

Anti-atherogenic diet supplemented with "Eicolen" (30% linseed oil, and 70% cod-liver oil, 9 grams per day) has been analyzed in 10 cases of ischemic heart disease, and in 11 cases of ischemic heart disease complicated by impaired glucose tolerance. The fish and vegetable PUFA omega-3 from "Eicolen" have been found to improve clinical condition as well as to modify erythrocyte membrane fatty acid composition. The ratio omega-6/omega-3 decreased in both groups in different grade.