The physiological mechanisms controlling reproduction are closely linked to energy balance. In the recent years, accumulating evidence suggests that prolactin regulates metabolic functions, besides regulating breast development and stimulating milk formation. Hyperprolactinemia is associated with obesity and treatment with dopamine agonists results in weight loss. We discuss the integrated effects of prolactin in the metabolic control and reproductive function, the role of prolactin in the pathogenesis of obesity. The present review also describes the effects of treatment with cabergoline on body weight and cardiovascular risk markers.

The article presents data on new possible mechanisms of pathogenesis of polycystic ovary syndrome. In the past years there have been a lot of studies on the effect of vitamin D on the development of insulin resistance and hyperandrogenism. The amount of evidence for of the correlation between vitamin D deficiency and obesity is growing. The search for genetic markers predisposing to polycystic ovary syndrome among vitamin D receptor gene polymorphisms seems quite premising. Considering of detected connections, therapy with vitamin D may be an effective treatment for this disease. In addition to the influence on reproductive function vitamin D is involved in the regulation of circadian rhythm, and it’s disturbance may lead to the development of anovulation. Another important factor in control of sleep and wakefulness cycles is melatonin. It’s participation in development and maturation of follicles by inhibiting of oxidative stress was proved, and the use of melatonin in women as a treatment for infertility helped to improve reproductive function. Thus, further studies of the role of vitamin D and melatonin may allow developing principally new approaches and medical guidelines for clinical practice.

We’ve studied a carbohydrate metabolism in morbidly obese (MO) patients and the patients after bariatric surgery. The patients of the 1st group had BMI>40 (n=22) and no history of diabetes mellitus. Patients after biliopancreatic diversion (BPD) performed for MO were included in the 2nd group (n=23). The 3rd group was a control group of normal weight healthy subjects (n=22). Blood glucose levels, insulin, GLP-1, GIP and glucagon during the OGTT (with 75 g of glucose) at 0, 30, 60 and 120 minutes were measured in all patients. In MO group fasting glucose levels were the highest. Impaired glucose metabolism was revealed in 68.2% of patients (n=10). Impaired fasting glucose (IFG) was diagnosed in 4 cases (18.2%), impaired glucose tolerance (IGT) in 11 patients (50%). In the BPD postprandial blood glucose levels (120 min) were lower if compared to the other groups. In 4 individuals (17.4%) we found postprandial hypoglycemia (<2.8 mmol/l). Patients of the MO group had the highest fasting insulin levels and HOMA-IR (p<0.001). The maximum of insulin concentration was seen on minute 30 of the OGTT in the 2nd and 3rd groups, and it was significantly higher in the post-bariatric patients (p=0.026). In MO group the maximum of the plasma insulin levels were on the 60th minute and were still elevated after 120 minutes. Fasting and stimulated (on the 30th minute) levels of GLP-1 were significantly higher after BPD (р=0.037 and p=0.022 at 0 and 30 min, respectively). Morbidly obese patients had higher fasting and stimulated GIP. Fasting glucagon concentrations were similar in the surgical and control groups, while the people with MO had higher initial levels of glucagon (p=0.013) and it was not suppressed during the OGTT (p=0.076). Glucose intolerance and insulin resistance incidence was higher in MO patients. Hyperglucagonemia, increased GIP and decreased GLP-1 levels are observed in MO patients. Stimulated plasma insulin and GLP-1 concentrations were significantly increased in patients who underwent BPD, and may cause postprandial hypoglycemia.

The Goal of this study was to investigate the efficacy of the integrated approach for the treatment of metabolic syndrome (MS) aiming to correct all of its components versus standard therapy using clinical outcomes (BMI, waist circumference, blood pressure, lipid levels), assessment of psychological status (Beck Depression Inventory), and quality of life (SF-36). Methods: A total of 60 patients with MS were included in the study. The study group (30 subjects mean age 41.0±11 years, women - 23 (76.7%), men - 7 (23.3%)) received the complex therapy of MS - pharmacotherapy of obesity (orlistat) and insulin resistance (metformin), lipid-lowering therapy (statins or fibrates), antihypertensive therapy. Control group (30 patients mean age 43.4±9.5 years, women - 26 (86.7%), men - 4 (13.3%)) was treated with statins or fibrates and received antihypertensive therapy when needed. At the inclusion in the study and after 6 months of therapy all patients underwent clinical and laboratory investigation, assessment of depression and quality of life. Results: We found a more significant reduction of all clinical outcomes (body weight, blood pressure, improvement in glucose and lipid metabolism), a significant decrease in the prevalence and severity of the depression, and an improvement in the quality of life in patients of study group compared with standard therapy. Conclusion: Complex treatment of the MS, including pharmacotherapy of obesity (orlistat, Xenical) and insulin resistance (metformin, Glucophage) is characterized by a greater clinical efficacy compared with standard therapy.

The goal of our study was to assess the prevalence and characteristics of lipid metabolism disorders in children Krasnodar region of Russia. Overall 6,000 children 10-17 years were included in the study. Lipid disorders were observed in 11.3 %, excess body weight in 6.3%, and obesity in 5.0% of children. The above pathologies were more common in boys (14%) than girls (8.8%). The study revealed that hormonal disorders were the cause of every second obesity as an increased thyroid-stimulating hormone was observed in 9.5 %, increased prolactin - in 38.8 %, and hyperinsulinemia - in 22.0 % of children. Metabolic disorders that were observed were: hypercholesterolemia - in 24.0 % of children with obesity, impaired glucose tolerance - in 13.0%, and the presence of three or four components of the metabolic syndrome in various combinations, identified in 18.0 % of children with obesity.

Hyperinsulinism and insulin resistance, hypogonadism in men and women are often associated with obesity and may be its consequences and to be a primary preceding the development of overweight. A characteristic feature of the endocrine obesity is an increase in body weight due to visceral fat with redistribution on central type, accompanied by the development of the metabolic and endocrine disorders. Mechanisms of obesity in various hormonal disturbances are different. In general in the vast majority approaches of obesity treatment do not differ from generally accepted. Adequate correction of hormonal disorders can reduce body weight and contribute to the improvement of endocrine-metabolic parameters.

Obstructive sleep apnea (OSA) and obesity are mutually burdening clinical conditions. Weight loss is quite effective for the control of breathing disorders during sleep, but the impact of OSA treatment on the dynamics of body weight in obese patients remains poorly studied. Presented clinical case features a significant reduction in body weight in a patient with morbid obesity complicated by severe OSA with contemporary approach and without CPAP therapy due to high patient adherence to therapy and absence of comorbidities.

Russian safe weight loss program "Primavera". Results of the first year.