Obesity and metabolism

Journal "Obesity and Metabolism" is a multidisciplinary forum for clinical and applied research in the field of biochemistry, physiology, pathophysiology, genetics, nutrition, as well as molecular, metabolic, psychological and epidemiological aspects of obesity and metabolism.

The main subject "Metabolism" reviewed in the journal, includes fat, carbohydrate, protein, bone, fluid and electrolyte and other types of metabolism in the spectrum of pathology of the endocrine system.

The priority direction of Journal "Obesity and Metabolism" is publishing modern high-quality original research on the effectiveness of new and existing treatments in any aspect of metabolic and endocrine diseases.

Pre-clinical pharmacology, pharmacokinetics studies, meta-analyzes, addressed to drug safety and tolerance are also welcome for publication in the journal "Obesity and metabolism." Journal "Obesity and Metabolism" announces review articles that are balanced, clear and offer the reader a modern and critical analysis of the literature on the subject of the magazine. Case reports, and lecture materials are also published for highlighting for practitioners new approaches to diagnosis and treatment of patients with metabolic disorders and obesity.

Journal "Obesity and Metabolism" is designed for scientists, diabetologists, endocrinologists, bariatric surgeons and specialists in all related areas of internal medicine, including physicians, general practitioners, family practitioners, pediatricians.

Journal "Obesity and Metabolism" is included into the  “List of leading scientific journals under review, where principal data of applicants for scientific degree has to be published”, as decreed by Russia’s State Commission for Academic Degrees and Titles in Bulletin №2 of 2003 and revised in 2010.

Information on published articles is transmitted to the Russian Scientific Citation Index on the regular basis.

Federal Supervision Agency for Information Technologies and Communications registration ПИ № 77 – 17119 от 26.12.2003

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Vol 17, No 2 (2020)

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Review
Efficacy of interventions for prevention and correction of overweight and obesity in children 7–8 years old: a meta-analysis
Fediaeva V.K., Bogova E.A., Peterkova V.A., Rebrova O.Y.
Abstract

The rapid increase in overweight and obesity in children is a global public health problem. Interventions to reduce the prevalence of obesity before puberty are considered to be the most effective, but the results of trials are not consistent enough. We performed a meta-analysis of the efficacy of interventions to prevent or correct overweight and obesity in pre-pubertal children. Thirty-one Cochrane systematic reviews were analyzed, the results of 10 RCTs and two prospective comparative studies were extracted. All trials had an moderate or high risk of bias. According to the results of meta-analyzes, the prevention of overweight and obesity through recommendations of lifestyle modification is effective, the difference in a BMI decrease is -0.19, 95% CI [-0.35; -0.03], compared with the absence of intervention, in children 7–8 years old if applied within 2–4 years, but not within one year or less. The effect of non-drug interventions in children with overweight or obesity was not revealed.

Obesity and metabolism. 2020;17(2):115-124
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The evaluation of chromosome telomere length change as a criterion of life expectancy in bariatric practice
Bekmurzinova F.K., Ospanov O.B., Akilzhanova A.R., Kozhamkulov U.A., Rakhimova S.E.
Abstract

In recent decades, the prevalence of obesity has been steadily increasing in most countries of the world. Overweight is a risk factor for a wide range of endocrine, cardiovascular, gastrointestinal, metabolic, neoplastic and musculoskeletal disorders and diseases. As you know, obesity is a state of chronic inflammation and severe oxidative stress, which will certainly affect the length of the chromosome telomeres. The dynamics of telomere length changes plays a decisive role in the regulation of cellular processes and cellular changes. Damage to telomeres, chromatin structures that help maintain the stability of the genome, leads to cell death or aging. However, information on how telomere length changes after weight loss through bariatric surgery remains limited to date. There are several types of bariatric surgery, each of which has its advantages and disadvantages. Based on this, it is possible that the restoration of the telomere length will differ depending on the technique used. This review describes the mechanisms for shortening leukocyte telomeres, and how bariatric surgery can affect this. The review also includes an analysis of evidence linking obesity and accelerated aging processes, as they are regulated by telomeres.

Obesity and metabolism. 2020;17(2):125-129
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Gastric bypass in modern bariatric surgery
Ospanov O.B., Yeleuov G.A., Bekmurzinova F.K.
Abstract

The Roux-en-Y Gastric bypass surgery has long been considered as the «gold standard» method for the surgical treatment of obesity and its complications. But at present, this position is disputed by supporters of one-anastomotic gastric bypass and sleeve gastrectomy. The decrease in the share of gastric bypass in the structure of bariatric operations is explained by technical complexity, surgical and malabsorption complications. This review reflects the main role of gastric bypass as a bariatric surgery in the treatment of obesity and metabolic syndrome, and discloses various options for the technical implementation of gastric bypass surgery according to Roux-en-Y and alternative one-anastomotic gastric bypass surgery. The advantages and disadvantages of the stapler-use and stapleless method for performing bariatric operations are shown. In our opinion, one of the promising alternative concepts for the surgical treatment of obesity is stapleless one-anastomotic direction in gastric bypass surgery, but the known stapleless methods are imperfect and unsafe. Thus, based on the presented literature review, we can conclude that the imperfection of not only the stapler gastric bypass methods, but also the stapleless method. Therefore, a further research is needed for alternative surgical methods that would reduce the likelihood of surgical complications, reduce the cost of bariatric surgery and increase the accessibility of surgical treatment of obesity for the population.

Obesity and metabolism. 2020;17(2):130-137
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The effect of bariatric surgery on purine metabolism and gout
Panevin T.S., Eliseev M.S., Shestakova M.V.
Abstract

Gout is an auto-inflammatory tophaceous disease characterized by the deposition of crystals of monosodium urate and developing in connection with this inflammation in people with hyperuricemia (HU). Except to genetic factors, risk factors for the development of HU and gout are many modifiable factors, including metabolic syndrome and obesity, and their correction is the most important component of successful disease control. Obesity can change the clinical picture of gout, characterized by an earlier onset, a large number of affected joints. Weight loss helps reduce uric acid (UA) serum levels. Bariatric / metabolic surgery significantly reduces the incidence of comorbid obesity and mortality, and is by far the most effective way to combat obesity. In addition to improving health, an important goal of bariatric surgery is to improve the quality of life. Bariatric surgery can prevent the development of HU in subjects with an initially normal level of serum UA before surgery. The dynamics of the concentration of UA in serum can be a predictor of successful bariatric surgery and help in predicting the severity of postoperative weight loss. The decrease in body weight after bariatric surgery leads to a decrease in UA in the long-term postoperative period, however, there is a high frequency of acute gout attacks in the early postoperative period. Thus, bariatric surgery has a significant effect on HU and gout and can be an effective treatment for this disease.

Obesity and metabolism. 2020;17(2):138-146
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The relationship of obesity and prostate cancer (review)
Peshkov M.N., Peshkova G.P., Reshetov I.V.
Abstract

Obesity is a critical risk factor for prostate cancer (PCa). Adipose tissue plays an important role in tumor development, including growth, invasion, and metastasis. Diet and dietary components affect the progression of prostate cancer; however, the mechanisms underlying these associations remain unclear. Extraprostatic prostate tumor cells form a new microenvironment in the periprostatic adipose tissue, which alters these interactions and promotes tumor progression.

Hyperinsulinemia leads to an increase in the level of free or biologically active insulin-like growth factor (IGF-1) due to a decrease in the production of IGF-binding proteins. Hypoandrogenism promotes the development of a more aggressive type of prostate cancer (higher Gleason scores). Adipokines of adipose tissue and cytokines (for example, interleukin-6 (IL-6) and tumor necrosis factor (TNF-α), angiogenic factors (for example, vascular endothelial growth factor (VEGF), apelin (AGTRL1) and other factors (for example, leptin and adiponectin) have multiple effects on prostate cancer cells. Tumor cells interact directly or indirectly with adipocytes.

Yellow (inactive) bone marrow is adipose tissue with separate islands of reticular tissue. It is located in the medullary canals of the tubular bones and in parts of the cells of the cancellous bone. Bone tissue is the object of the most frequent metastasis in prostate cancer, and with age, the content of fat cells in it increases. Bone marrow adipose tissue interacts with tumor cells, osteoblasts and other stromal cells and participates in the organization of the tumor microenvironment. Adipokines are key molecules in the interaction between tumor cells and adipose tissue, which is carried out through various mechanisms. A better understanding of the role of adipose tissue in the induction and progression of prostate cancer will lead to effective therapeutic strategies for this disease.

Obesity and metabolism. 2020;17(2):147-155
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Original paper
The features of psychological state, eating behavior, hormonal and adipokine regulation of metabolism in men with subcutaneous and abdominal fat distribution
Mokhova I.G., Pinkhasov B.B., Shilina N.I., Yankovskaya S.V., Selyatitskaya V.G.
Abstract

BACKGROUND: development of obesity and obesity related conditions are directly associated with eating disorders and psychological state. There is increasing focus on the assessment the characteristics of these indicators in men with subcutaneous and central fat distribution, which are associated with various hormonal and adipokine mechanisms that effect on parameters of metabolism and eating behavior.

AIMS: to study the characteristics of the psychologycal state, eating behavior and their relationship with hormonal and adipokine status in men with different fat distribution.

MATERIALS AND METHODS: a single-center, cross-sectional study of 99 men aged 27 to 68 years was performed. 4 groups of men were formed after anthropometric examination. Group 1 (comparison) consisted of men with normal body weight. Group 2 consisted of overweight men, class I obesity and lower subcutaneous fat distribution (SFD). Group 3 consisted of overweight men, men with class I obesity and abdominal fat distribution (AFD); group 4 - men with class II obesity and class III obesity AFD. Eating behavior were determined with DEBQ questionnaire, severity of anxiety-depressive disorders were investigated with the Hospital Anxiety and Depression Scale; body image satisfaction was assessed with body image questionnaire. Serum glucose, triglycerides, insulin, leptin and adiponectin were estimated.

RESULTS: it was shown, that men with AFD had severe metabolic disorders: hyperglycemia, hypertriglyceridemia, hyperinsulinemia and insulin resistance, hyperleptinemia and hypoadiponectinemia, than men with SFD. Men with AFD had an external type of eating behavior, with sever expressed depressive disorders and body image dissatisfaction. Men with SFD had an emotional type of eating behavior and higher body image satisfaction. A comparative analysis between men from 3 and 4 groups with AFD showed that in group 4 in men had higher hyperleptinemia and insulin resistance and there are no differences in severity of eating disorders, anxiety and depression between the groups.

CONCLUSIONS: adipose tissue topography is associated with the psychophysiological, metabolic, hormonal and adipokine characteristics that underlie the development of primary obesity in men.

Obesity and metabolism. 2020;17(2):156-163
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Prevalence of overweight and obesity among the adult population of the Yaroslavl region
Tyatenkova N.N., Uvarova I.E.
Abstract

BACKGROUND: Obesity is one of the most common non–communicable diseases. Overweight and obesity negatively affect all spheres of human activity, leading to the development of related diseases and disability.

AIMS: to estimate the prevalence of overweight and obesity among the adult population of the Yaroslavl region according to sex and age.

MATERIALS AND METHODS: The research included results of comprehensive medical examinations of 13948 persons of both sexes aged from 20 to 79 permanently residing in the Yaroslavl region. Anthropometric examination was performed by standard methods with the measurement of body weight and body length and calculation of body mass index. Overweight was defined as having a BMI to 25.0–29.9 kg/m2, obesity was defined as having BMI grater or equal to 30 kg/m2. The fat compound of body mass was determined by bioimpedancemetry.

RESULTS: The prevalence of overweight among the adult population of the Yaroslavl region was 34.2%, obesity was 31.6%. Overweight in men of all ages was at least 1.5 times more prevalent than women, obesity in women was 1.3 times more prevalent than in men. The prevalence of first–degree obesity was 20.9%, grade II and III – 7.9% and 2.8%, respectively. The proportion of overweight and obesity increased with age, reaching a maximum of 50–59 years for men and 60–69 years for women. The gradient of age changes is more pronounced in women. Patients with normal body mass index had excessive fat deposition in 38% of cases.

CONCLUSIONS: The study showed a high prevalence of overweight and obesity among adults in the Yaroslavl region.

Obesity and metabolism. 2020;17(2):164-170
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The frequency of obesity in patients with acute pancreatitis, chronic pancreatitis and pancreatic cancer
Grigor’eva I.N., Efimova O.V., Suvorova T.S.
Abstract

BACKGROUND: In the XXI century, the frequency of pancreas diseases increased 2–3 times. The expectation that causes a pandemic lead to the development of a number of diseases. The results of studies on the relationship of overweight, obesity with the risk of developing pancreas diseases (acute pancreatitis (AP), chronic pancreatitis (CP) and pancreas cancer (PC)) are very heterogeneous (for AP and PC) and not numerous (for CP).

AIMS: to identify the frequency of obesity in AP patients (APр), CP patients (СPр) and PC patients (PCр) and compare these parameters.

MATERIALS AND METHODS: at the observational multicenter clinical cross-sectional uncontrolled case-study 44 APp, 97 CPp and 45 PCp were examined; the groups were comparable by sex/age. Informed consent form for participate in the study was obtained from all patients. The main outcome of the study: the frequency of obesity in APp, CPp; PCp.

RESULTS: The frequency of obesity in APp (13,6%), CPp (24,7%) and PCp (20,0%) did not differ significantly. Among the examined patients, the lowest average BMI (24,2±0,7 kg/m2) was observed in APp (p=0,049). BMI ≥22,5 kg/m2 was found to be associated with AP (OR=0,398; 95%CI 0,195–0,812; p=0,011). An inverse relationship was shown between the BMI and “definite” CP (Exp (B)=0,772; 95%CI 0,632–0,942; p=0,011). In men with CP and in CPp alcoholic etiology, weight deficit was observed significantly more often than in women with CP and in CPp biliary etiology, respectively. Earlier (a year before the present survey), obesity was more common in PCp (55,6%) than in APp (13,6%, χ2=3,3; p=0,000) and CPp (25,8%, χ2=12,0; p=0,001). A history of obesity (in our study one year before PC detection) and PC (OR=4,435; 95% CI 2,180–9,025; p=0,000) direct relationship was shown.

CONCLUSIONS: the frequency of obesity in APp, CPp and PCp was similar. The average BMI was higher in APp, than in CPp and PCp. BMI≥22,5 kg/m2 was a protective factor for AP. BMI was inversely associated with “defined” CP. A history of obesity was directly associated with PC.

Obesity and metabolism. 2020;17(2):171-178
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Range of values for lipid accumulation product (LAP) in healthy residents of the European north of Russia
Kaneva A.M., Potolitsyna N.N., Bojko E.R.
Abstract

BACKGROUND: Obesity is a major health problem in modern society and its prevalence throughout the world has reached the epidemic level. The unfavorable outcomes of obesity are associated with a high risk of numerous diseases due to metabolic disorders. Finding of diagnostic criteria for early detection of obesity is a priority in biomedical research. Therefore, of particular interest is the new visceral obesity marker – lipid accumulation product (LAP). Meanwhile, to date, the reference values for LAP are not defined, and data on sex- and age-related changes are contradictory.

AIMS: The aim of this study was to determine the variation range, sex and age differences in LAP values in healthy subjects.

MATERIALS AND METHODS: The study was conducted on apparently healthy subjects (455 men and 286 women) aged 20–59 years selected at routine examinations at the base of the central clinic in Arkhangelsk. Examination of subjects consisted of physical examination with measurement of anthropometric and clinical parameters, filling out a questionnaire, and evaluation of serum lipid levels.

RESULTS: The LAP values in the subjects varied in a wide range (0.5–156.5 cm×mmol/l in men; 0.4 to 116.2 cm×mmol/l in women), but at the same they in 75% of the participants did not exceed 30 cm×mmol/l. Sex differences in LAP with the prevalence of values in men were observed in the age groups up to 40 years old, later they disappeared. LAP in men and women increased with age, but these changes were unequal. The LAP values increased to reach a plateau in men up to 30 years of age and in women up to 40 years of age.

CONCLUSIONS: LAP is a combined index that simultaneously reflects distribution of adipose tissue and changes in blood lipids, and is considered a marker of obesity associated with the risk of metabolic disorders. This study was the first to determine the variation range, sex differences and age dynamics for LAP in the apparently healthy subjects.

Obesity and metabolism. 2020;17(2):179-186
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Thyroid-stimulating hormone, leptin and insulin resistance in patients with obesity after bariatric surgery
Volkova A.R., Fishman M.B., Semikova G.V.
Abstract

BACKGROUND: The function of the thyroid gland effects on obesity and comorbidities. It has been proven for bariatric surgery to be the most effective in obesity treatment.

AIM: to evaluate the dynamics of body weight, thyroid status, leptin and insulin resistance in obese patients after bariatric surgery.

MATERIALS AND METHODS: 74 obese patients were observed after bariatric surgery (sleeve gastrectomy – 42, gastric bypass - 32); initial body mass index (BMI), thyroid stimulating hormone, free T4, fasting plasma leptin, insulin and glucose were estimated; the insulin resistance index HOMA-IR was calculated. The dynamics of body weight was estimated by BMI and the excess BMI loss (% EBMIL). After 3 years of follow-up, 48 patients were examined.

RESULTS: Subclinical hypothyroidism (SH) was detected in 36.5% of patients with high degrees of obesity. A correlation was found between BMI and TSH level (R=0.5; p=0.01). HOMA-IR was increased in most patients with obesity of the II and III degree (4.8±1.9 ng / ml). In the SH group, the leptin level was significantly higher than in the group with a normal TSH level of 43.0±7.3 ng / ml and 33.2±4.6 ng / ml (p=0.004). Among patients with initial SH, spontaneous reduction of TSH levels occurred in 45% patients 3 years after surgery.

CONCLUSIONS: Postoperatively, the BMI decrease was associated with the decrease of TSH, leptin and HOMA-IR. The data obtained may reflect the effect of adipose tissue on the functional state of the thyroid gland in patients with high degrees of obesity after bariatric surgery. This seems to be extremely important for maintaining body weight.

Obesity and metabolism. 2020;17(2):187-192
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Clinical effect of thiazolidinediones in subjects with disorders of carbohydrate metabolism in case of polymorphism rs1801282
Eremenko T.V., Matsievskiy N.A., Vorokhobina N.V., Matesius I.Y., Abramashvili I.N.
Abstract

BACKGROUND: The polymorphism rs1801282 (Pro12Ala) may be one of the reasons for the heterogeneous response of patients with carbohydrate metabolism disorders to thiazolidinedione therapy. Studies of this polymorphism in patients with metabolic syndrome (MS) will help identify a group of patients in whom the use of thiazolidinedione is advisable.

AIMS: To assess the clinical effect of thiazolidinediones in patients with metabolic syndrome, depending on the presence of polymorphism rs1801282.

MATERIALS AND METHODS: All patients with newly diagnosed MS with impaired carbohydrate metabolism were included in the open cohort study. All patients were recommended a diet, expansion of physical activity and pioglitazone at a dose of 30 mg per day. After the appointment of the therapy, the patients come to the center back at 12 weeks.

The main outcome in the study assessed in patients with impaired glucose tolerance (IGT) was fasting glycemia and 2 hours after glucose tolerance test, in patients with type 2 diabetes — HbA1c.

RESULTS: 109 patients were included in the study. Of these, 14 were carriers of rs1801282, the other 95 had a typical PPARγ genotype. After the appointment of therapy in the groups of IGT and type 2 diabetes, improvement of glycemic control was observed. The degree of decrease in fasting plasma glucose and after glucose tolerance test was more pronounced with IGT in patients with polymorphism rs1801282 compared with the rest (plasma fasting plasma glucose level was -0.7 [-0.9, -0.7] vs. -0, 4 [-0.5, -0.3] mmol/L, p=0.001; plasma glucose level 2 hours after glucose tolerance test was -1.1 [-1.8, -0.3] vs. -0.5 [-0.7, -0.1] mmol/L, p=0.031). In patients with type 2 diabetes, no data were obtained for the statistically significant effect of rs1801282 polymorphism on the results of pioglitazone, but there was a tendency for a greater decrease in fasting plasma glucose in the case of carrying the polymorphic gene (-1.9 [-2.2, -1.8] against -1,5 [-1,7, -1,2] mmol/l, p=0,073).

CONCLUSIONS: The study shows the effect of polymorphism rs1801282 on the results of pioglitazone in patients with MS, both in IGT and in type 2 diabetes. Carrying polymorphism leads to a significant decrease in fasting glycemia and after glucose tolerance test in patients with IGT. The tendency to improve the parameters of carbohydrate metabolism (fasting glycemia, HbA1c) was noted in a subgroup of patients with type 2 diabetes.

Obesity and metabolism. 2020;17(2):193-199
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Serum nesfatin in overweight and obese children
Bazarnyi V.V., Anufrieva E.V., Maksimova A.Y., Polushina L.G., Kovtun O.P.
Abstract

BACKGROUND: Obesity is one of the most common children diseases. In present time it is being actively studied the natural hormones role in the pathogenesis of obesity.

AIMS: To determine the relationship between serum nesfatin level with impaired lipid metabolism in school age children with overweight and obesity.

MATERIALS AND METHODS: The study included children with overweight and obesity («case») and healthy children with normal body mass («control») aged 9 to 15 years. All children were determined by concentration in cholesterol blood and its factions, apoA-1, apoB. Enzyme-linked immunosorbent assay (Bio Human Nesfatin Enzyme Immunoassay Kit).

RESULTS: Groups of patients with overweight and obesity (n = 53) and healthy children (n = 31) were comparable by age and sex. In obese children, a significant decrease in the level of nesfatin-1 was revealed compared with the group with normal body weight. In cases of children obesity there is a marked decrease in the concentration of nesfatin-1 in serum, especially expressed in the dyslipidemia presence. The nesfatin-1 level are negatively correlated to BMI and body fat content.

CONCLUSIONS: The obtained data suggest that along with the known key role of nesfatin in the regulation of eating behavior and appetite, it also affects anthropometric indicators, primarily associated with the accumulation of excess fat mass. Based on the data obtained, nesfatin-1 should be considered as a possible marker for the development of obesity in children.

Obesity and metabolism. 2020;17(2):200-207
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Comparative analysis of cardiovascular system morphofunctional disorders’ correction in a simulated metabolic syndrome
Tarimov C.O., Subbotkin M.V., Kulanova A.A., Petrenko V.I., Kubyshkin A.V., Fomochkina I.I., Makalish T.P., Zyablitskaya Y.Y., Shramko I.I.
Abstract

BACKGROUND: Metabolic syndrome (MS) causes the risk of serious diseases development e.g. type 2 diabetes mellitus and cardiovascular disasters. Timely and adequate correction of MS can reduce the risk of heart disease and diabetes

AIM: To investigate the development of MS and drugs for its correction on the morphofunctional state of the heart muscle and large blood vessels.

MATERIALS AND METODS: A comparative analysis of morphofunctional disorders in the cardiovascular system on the fructose model of MS and its correction in adult (n=32) and young (n=50) Wistar rats was performed. The duration of fructose feeding was 24 weeks for young animals and 16 weeks for Mature animals due to their different resistance to the development of the MS model. To correct MS, the following drugs were used: resveratrol, Stilbene concentrate in a dose of 2 mg/kg, Fenokor – 1 ml/kg, azilsartan – 1 mg/kg. During the experiment, blood pressure (BP), body weight, and heart rate (HR) were measured in experimental animals. Then, after euthanasia, sections of the heart and aorta of experimental rats were examined using light microscopy.

RESULTS: In MS, adult male rats developed morphological changes in the heart wall, which were primary vascular damage, and secondary – myocardial injury. In the aorta, signs of endothelial damage, lipid imbibition, and fibroelastic scaffolding were revealed. A specificity of young animals’ response to MS was functional compensation with pronounced changes in the structure of large vessels. The greatest effect of normalization of morphofunctional indicators in mature animals is provided by preparations of polyphenols. When MS was corrected with Resveratrol and Fenocor, there was no obese fibrous stroma of the heart, and there was also a normalization of the structure of the middle layer of the aortic wall. In young animals, the use of Azilsartan and Stilbene concentrate from 14th week of the experiment also led to compensation of vascular damage and hemodynamic disorders.

CONCLUSION: To correct the manifestations of MS in the cardiovascular system in mature rats, the most effective drugs are resveratrol and Fenocor, and in young rats – azilsartan and Stilbene concentrate in the case of early use.

Obesity and metabolism. 2020;17(2):208-219
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Case Report
The case of oncogenic hypophosphatemic osteomalacia
Eremkina A.K., Mirnaya S.S., Gorbacheva A.M., Panevin T.S., Voronkova I.A., Mokrysheva N.G.
Abstract

Osteomalacia is a systemic bone disease, characterized by an excessive accumulation of non-mineralized osteoid and an imbalance in the organic matrix formation and mineralization. A rare cause of disease is tumor-induced osteomalacia, most often due to phosphaturic mesenchymal tumors (PMT). Usually there are benign small tumors, affecting the soft tissues and bones of any location. The basic pathogenesis of underlying oncogenic osteomalacia is a decreased renal tubular reabsorption of phosphate consequent to hyperproduction of fibroblast growth factor 23 in PMT. Clinical features are nonspecific, the average period from the symptoms onset to diagnosis reaches 3 years and at least 5 years before surgical treatment. Finding the tumour is crucial, as complete removal is curative. We present a clinical case of tumor-induced osteomalacia due to PMT required the complex differential diagnosis with other rare diseases.

Obesity and metabolism. 2020;17(2):220-227
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