Background: Obesity is one of the most significant risk factors for type 2 diabetes (T2D), but a large number of patients with morbid obesity maintain normal glycemia for a long time. There are no definite easy-to-measure clinical features that distinguish severely obese people who will or will not develop T2D. These features may be useful in clinical practice to predict T2D development in obese patients.

Aims: We aimed to identify clinical features (lifestyle factors, obesity history, concomitant diseases) that may be associated with T2D in obese patients.

Materials and methods: The study was conducted at single center during 2002 and 2017 and recruited patients with BMI≥30 kg/m2 who attended bariatric surgeon. Patients weight and height were assessed by the doctor, other features were obtained from the questionnaire: overweight and obesity history (age of onset, duration, family history of obesity), lifestyle factors, T2D and concomitant diseases medical history. Patients were divided into 2 groups with regard to the presence of T2D. Data analysis was performed with Statistica 13.3.

Results: The study included 170 patients with known T2D and 528 patients without history of T2D and prediabetes. Both groups had similar gender structure, as well as current and peak BMI. There were no significant differences in overweight/obesity duration, obesity family history, lifestyle factors and smoking status of patients. Obese patients without T2D were younger than T2D patients at the time of T2D onset (median age 40 and 45 years respectively). Patients without T2D started to gain weight earlier than those with T2D (median age 17 and 25 years respectively) and reached their peak BMI during 1 year before study entry, while patients with T2D went through maximum weight previously. The frequencies of concomitant diseases didn’t differ between the groups with the exception of hypertension that started later in patients with T2D (median age 51 and 47 years in patients with and without T2D respectively); also patients with T2D had gastroesophageal reflux disease (GERD) and chronic back pain less often than patients without T2D with regard to age.

Conclusions: Clinical features that distinguished obese patients with and without T2D were age at the start of overweight/ obesity and concomitant disease profile (hypertension, GERD, chronic back pain) at corresponding age.

Background: Considering the negative impact of visceral obesity on fertility, it is important to study semen quality indicators associated with reduced body weight.

Aims: Evaluation of semen quality indicators associated with reduced body weight in patients with infertility, postpubertal visceral obesity and normal andrological history.

Materials and methods: 33 infertile men under 30 years with post-pubertal and alimentary visceral obesity were included into retrospective case-control study. All patients have been followed through a six month weight loss program (hypocaloric diet, daily aerobic physical activity). The waist circumference, blood lipid levels, seminal antioxidant capacity and scanning electron microscopy analysis were determined before and after weight loss program. At the end of the study, patients were divided into two groups according to weight loss. The first group reduced their body weight by 5% or more (n=16), second group didn’t achieve the goal (n=17).

Results: Statistically significant differences were identified in the ejaculate parameters between patients of two groups. Though at the time of initiation of medical intervention two groups were comparable except for body mass, after six months in the first group the number of sperm in 1 ml ejaculate, morphologically normal forms and the total antioxidant capacity of ejaculate increased while the number of sperm DNA integrity decreased.

Conclusion: In young men with postpubertal visceral obesity and normal andrological history clinically significant body weight reduction is associated with improved semen quality indicators.

Background: An in-depth study of dismetabolic mechanisms in the genesis of pre-eclampsia (PE) has been updated because pregnancy is considered as a natural model of metabolic syndrome (MS), as well as the metabolic disorders are important in development of essential hypertension.

Aims: to reveal clinical and laboratory parallels in pregnancy complicated by PE without MS and pregnancy proceeding on the background of MS to assess the role of metabolic disturbances in the development of PE.

Materials and methods: 82 women with MS were examined in the dynamics of pregnancy and were divided into 2 groups depending on the implementation of PE: group I consisted of 50 women with PE on the background of MS, group II 32 women with MS without PE. We formed group III consisting of 44 pregnant women with PE without accompanying diseases to assess the pathogenetic value of metabolic disorders in the development of PE. The IV (control) group consisted of 30 healthy women with physiological pregnancy. Metabolic, hematological parameters, hormones, markers of the proinflammatory state, endothelial hemostasiological dysfunction, decidualization and placental angiogenesis, accumulation dynamics and distribution loci of adipose tissue were determined in all pregnant women.

Results: In the groups of pregnant women with PE, changes similar to MS were revealed: pronounced diabetic and atherogenic disorders with the development of pathological insulin resistance, hyperinsulinemia and leptinemia, endothelial-platelet link hyperactivation, thrombotic and inflammatory status, visceral type of fat deposition, hyperuricemia, hypersympathicotonia. It is proved that in the hierarchy of mechanisms of PE formation, placental dysfunction is a secondary alteration factor, which additionally potentiates the insulin resistance increase and the effects of structural and functional destabilization of the vascular endothelium.

Conclusions: The direction of metabolic changes during pregnancy, the common development of PE and MS indicate the important role of dismetabolic mechanisms in the formation of PE.

Adrenal insufficiency (AI) is a syndrome caused by disturbance in the synthesis and secretion of hormones of the adrenal cortex, which ensure the vital activity, energy and water-salt homeostasis. The widest hormonal deficiency is observed in primary hypocorticism, when the synthesis of not only glucocorticoids (GC) and adrenal androgens, but also mineralocorticoids is disrupted. Lifelong replacement therapy with GCs for this pathology may be associated with a risk of bone loss and osteoporosis. However, at present, there are no clear guidelines for diagnosis of bone condition, including and bone mineral density (BMD) monitoring during treatment with GCs in patients with AI. This review summarizes collected data on the key pathogenetic links of glucocorticoid-induced osteoporosis, incidence of decreased BMD and fractures in patients with AI. In this review factors that influence bone metabolism in this cohort of patients are considered: the type and the dose of prescribed GCs, the type (primary, secondary, HH in congenital adrenal cortex dysfunction) and the duration of AI, age, gender, and the presence of concomitant endocrine disorders (hypogonadism, growth hormone (GH) deficiency). In addition, the review presents data on the effect of adrenal androgen replacement therapy and recombinant GH therapy on bone metabolism in secondary AI.

Psoriasis is the most common chronic dermatosis and affects 1–2% of the population of developed countries. In Russia, psoriasis incidence rate has increased by 11% since 2011. Psoriasis is a chronic inflammatory and immune-mediated skin disease and it is often associated with metabolic syndrome and its components such as obesity, arterial hypertension, insulin resistance and dyslipidemia. The risk of developing metabolic syndrome in patients with psoriasis is 40% higher than in the general population. Psoriasis and metabolic syndrome share some pathogenic mechanisms such as chronic low-grade systemic inflammation and an increased level of pro-inflammatory cytokines. Systemic inflammation causes obesity, cardiovascular diseases, diabetes. These conditions increase the risk of mortality among patients. There is a link between the severity of psoriasis and metabolic syndrome and associated with severe rash, reduction of the remission and higher risk of psoriatic arthritis development. The carriers of the risk allele of FTO gene are associated with severe psoriasis, presence of psoriatic arthritis and obesity. The article presents the issues of epidemiology, etiology and pathogenesis of psoriasis and metabolic syndrome.

Treatment difficulties of COVID-19 have determined the need to identify predictive risk factors for the development of a complicated disease course, critical conditions and death. Endocrine and metabolic abnormalities associated with obesity, including impaired insulin sensitivity, chronic inflammation and impaired lipid and fatty acid metabolism, increase immunological dysregulation and make these patients more susceptible to developing infectious diseases. Research data allows us to single out obesity as a risk factor for the aggravated course of COVID-19, as well as a longer period before the virus elimination, and, therefore, the risk of virus transmission. Potentiation of cardiovascular risk factors, an increase in the production of pro-inflammatory cytokines, coagulopathy are factors in the development of unfavorable outcomes in such patients.This review presents literature data on the features of the course and the mechanisms of development of complications in patients with new coronavirus infection and obesity. Taking into account the need to restore metabolic health to increase the adaptive and resistant capacities of the body in the face of the threat of a new increase in the prevalence of COVID-19, the possibilities of treating obesity using a combined preparation containing sibutramine and metformin in one tablet, are discussed.

Patients with type 1 diabetes mellitus (T1DM) have many benefits from regular exercise, including improved quality of life, lower blood pressure, improved lipid profile, increased insulin sensitivity, decreased insulin dose requirements, improved endothelial function, and reduced risk of micro- and macrovascular complications, as well as overall mortality. Despite these benefits, T1DM patients often do not get enough physical activity (PA) and are less physically active than their non-diabetic peers. The main reason for the low PA in patients with T1DM is the difficulty of glycemic management and the fear of developing hypoglycemia during exercise. Different types of training, such as moderate to high intensity exercise, high intensity interval training, have different effects on glycemic activity during exercise, which can be used to prevent the development of hypoglycemic reactions during and after exercise, along with carbohydrate intake and insulin dose adjustment. Higher-intensity exercise, as well as greater frequency and duration, are associated with a greater reduction in the risk of overall and cardiovascular mortality. Regular physical activity has a positive effect on reducing the risk of micro- and macrovascular complications, general and cardiovascular mortality in patients with type 1 diabetes, regardless of the quality of glycemic control, which can be used for prevention of T1DM complications.

The nature of human nutrition has become increasingly important as an effective element in the prevention and treatment of many pathologies, especially obesity, type 2 diabetes and cardiovascular diseases. High protein diets are some of the most popular eating patterns and the Dukan diet has taken the lead in popularity among the diets of this type. An increase of protein in the diet is effective in reducing body weight, primarily due to the loss of adipose tissue, without a significant effect on muscle mass. Another advantage of a high-protein diet is earlier and longer satiety compared to other diets, which makes it comfortable for use. Besides obesity, high protein diets are presumably effective for treating such diseases as nonalcoholic fatty liver disease, diabetes mellitus and cardiovascular diseases However, despite the important advantages, this nutritional model is not universal and is contraindicated in patients with diseases of liver, kidneys and osteoporosis. Besides, the prolonged use of a high protein diet may increase the risks of urolithiasis and reduced mineral bone density even for healthy individuals. Thus, the increase in the proportion of protein in the diet should take place exclusively under the supervision of a physician.