In this literature review, an attempt is made to analyze the interrelationships of the main sex hormones with the processes of development and progression of insulin resistance as a fundamental pathogenetic component of insulin-glucose homeostasis. In the evaluation of sex steroids, a complex approach was used - the associations of both androgens and estrogens in males and females are described in detail, a great deal of attention is paid to the violation of the secretion and effectiveness of the main adipocytokines - leptin and adiponectin in the sex hormone-insulin-glucose interaction chain. At the end of the review, new data on the expression of sodium-dependent glucose cotransporter (SGLT) and glucose transporters (GLUT) in animals, depending on sex, are presented.

The present review considers modern concepts of the physiological mechanisms of the formation of food behavior in a norm at several levels, beginning with the cellular level and ending with the level of functional systems. Neuroimaging methods used for both the study of the pathophysiological foundations of eating disorders and for determining the target for neurostimulation techniques are described. Methods of non-invasive brain stimulation such as transcranial magnetic stimulation and transcranial electrical stimulation, the mechanisms of their influence and aspects of safety of application are reviewed, the latest data on the results of studies on the use of the above methods in the therapy of obesity are summarized.

Aims. To study of the polymorphisms of the TPN2 and GNB3 genes in obese patients and their effect on weight loss in patients on sibutramine therapy.

Materials and methods. The research study included 118 patients with exogenous-constitutional obesity who received Reduxin (sibutramine + CMC) at the dose of 10 mg. Term follow-up was 3 months. A genetic study was performed to assess ТРН2 and GNB3 gene polymorphisms. The response to the therapy was evaluated after 3 months by the dynamics of body weight.

Results. In the study the G703T polymorphism of the GNB3 gene showed that during 3 months of observation, carriers of the TT genotype had a greater decrease in body weight in comparison with carriers of the allele C – -8 kg (-12; -5) vs. -5 kg (-8; -3), p = 0.018. In carriers of different variants of the genotype of the TPH2 gene (polymorphism C825T), there was no difference in body weight dynamics with sibutramine therapy. There was no correlation between the foresaid polymorphisms of the TPH2 and GNB3 genes with the indices of blood pressure and heart rate.

Conclusions. 1. The result of sibutramin therapy may depend on genetic factors: in carriers of the TT-genotype C825T of the GNB3 gene the body weight loss was higher than among the carriers of the C allele. 2. Changes in blood pressure and heart rate did not show any statistically significant relationship with polymorphisms of the TPH2 and GNB3 genes.

Hypophosphatemic rickets (HR) - a group of diseases characterized by the development of ricketic changes in bone tissue due to increased excretion of phosphorus from the body. This form of rickets is the most common among variants of genetically determined forms of disturbances in mineral metabolism. HR is an actual medical and social problem, requiring constant updating of knowledge of both endocrinologists and doctors of other profile. This is due to the fact that the clinical picture of HR has a significant heterogeneity and can manifest as severe deformations of the skeleton, delay in physical development, severe muscle hypotension, frequent fractures, tooth abscesses, which in some cases leads to disability of the patient and, accordingly, reduces the quality of life. Timely diagnosis and adequate therapy of HR is extremely important for preventing the development of severe complications. Currently, more than 10 candidate genes are known, the defects in which lead to the development of congenital forms of GFR. Genetic diagnostics of the HR is of great importance for determining the form of the HR, and for carrying out genetic counseling of families when planning pregnancy.

Pseudohypoparathyroidism is a rare group of clinically and genetically heterogeneous diseases caused by the inactivation of the PTH-signaling pathway. The main component of the disease is resistance to PTH, causing a disturbance of calcium-phosphorus metabolism. With pseudohypoparathyroidism, there may also be a development of insensitivity to thyrotropic and gonadotropic hormones of the pituitary gland and the formation of characteristic clinical features in the form of subcutaneous calcifications, brachidactyly, obesity, stuntedness, mental retardation. This article describes the clinical case of pseudohypoparathyroidism in a 35-year-old woman with classic phenotypic hypoparathyroidism with hereditary Albright osteodystrophy and a proven mutation in the GNAS gene, and discusses the spectrum of metabolic disorders of the disease.

We do not recommend population screening for diabetes insipidus (DI) (B3). We recommend to perform diagnostic testing for central diabetes insipidus (CDI) in patients who underwent neurosurgery, after skull and brain trauma, subarchnoid hemorrhage (B3). We recommend excluding thirst impairment during all stages of diagnostic assessment (С3).

We recommend excluding DI in cases of persistent hypotonic polyuria: excretion of more than 3 L. or more than 40 mL/kg of urine daily; urine osmolality less than 300 mOsm/kg or urinary specific gravity less than 1004 g/L in all urine samples or during Zimnitsky test (В3). After hypotonic polyuria is confirmed, we recommend excluding of the main causes of nephrogenic diabetes insipidus (NDI) (B3). We recommend simultaneous measurement of urine osmolality and blood osmolality/sodium level in order to confirm DI. Blood hyperosmolality (more than 300 mOsm/kg) and/or hypernatremia with low urine osmolality (less than 300 mOsm/kg) confirms DI (B2). If testing does not reveal these findings, we recommend performing a fluid deprivation test to exclude primary polydipsia (PP) (B2). Desmopressin test is recommended to distinguish CDI and NDI (B2).

In cases of CDI we recommend to perform head MRI with contrast (B3). In cases of NDI we recommend assessing renal structure and function and possible electrolyte disturbances (C3). In cases of PP we recommend to refer a patient to psychiatrist (B3).

We recommend treating CDI with synthetic vasopressin analogue – desmopressin (B1). We recommend an individual approach in choosing desmopressin dosage form (B2). As the initial dose is difficult to predict when starting desmopressin treatment, we recommend titrating the dosage using two approaches: “the average dose” and “as required” (C4). We recommend educating the patients to ensure knowledge of the features of various desmopressin dosage forms (C4). To decrease the risk of water intoxication, we recommend educating the patients to the water intake regimen adherence (С4). When CDI is accompanied by thirst impairment, we recommend titrating the dose in a clinical setting, with assessment of blood sodium, bodyweight and/or urine volume (C4).

Background. Obesity by prevalence is equated to non-infectious epidemic. Conduction of epidemiological studies in different regions allows to assess the scale of the problem, to form and implement a program aimed at reducing this risk factor.

Aim. To determine the prevalence of overweight and obesity in the adult population of the city of Irkutsk depending on gender and age.

Matherials and methods. The data of the survey of a representative sample of the adult population of Irkutsk, consisting of 3510 people, are analyzed. Based on the calculated BMI, a group of respondents with an overweight and obesity was identified.

Results. The average age of respondents with a BMI over 25 kg/m2 was higher than average age in the population – 48 and 40 years. The prevalence of BMI over 25 kg/m2 was diagnosed in 1551 respondents (44,2%): women 47.2% of men and 40.3% of the. Overweight was found in 27.8 %, obesity at 16.4%. While being overweight were more often registered in men, 29.8% and 26.2% and obesity in women is 21% and 10.5%.

Conclusions. In the adult population of Irkutsk, we found a significant prevalence of overweight and obesity and determined its sex and age characteristics.

Background. When choosing foods rich in carbohydrates, it is important to consider not only their chemical composition, but also the ability to influence the level of postprandial blood glucose (glycemic response). A qualitative indicator of this ability is the glycemic index (GI) of a carbohydrate-containing product. Recently, there have been some evidences that control of GI nutrition can be important for prevention and nutrition therapy of metabolic disorders.

Aim. To determine of the magnitude of the glycemic index (GI) of actual nutrition in women in Novosibirsk, and the study of the connection with metabolism and obesity.

Material and methods. The study was designed as cross-sectional research and was carried out within the framework of the international HAPIEE project on a random representative sample of the unorganized population of Novosibirsk, 4397 women, the average age was 57.7 ± 7.1, without diabetes. For the calculation of GI nutrition, the International Table of Glycemic Index and Glycemic Load (2008) were used. The frequency method was used to evaluate the actual nutrition. Metabolic Syndrome (MS) criteria were used in accordance with the Russian National Recommendations of the GEF (2009), as well as with the international recommendations of NCEP ATP III (2001) and JIS (2009). Statistical processing of data was carried out using the SPSS 13.0 software package (Bonferroni criterion in the GLM procedure). The odds ratio (OR) was estimated using binary logistic regression in quartiles of the glycemic index. Differences were considered statistically significant at p <0.05.

Results. The GI of women's nutrition was on average low and amounted to 53.1 units. In the quartiles of the GI OR, the MS for all the criteria used was not significantly different. In the quartiles of the body mass index (BMI) in women with GI in the group with normal body weight (BMI = 23.3 kg/m2) was significantly higher by 0.9 units (p <0.001) compared with the obese group (BMI = 37.3 kg/m2). The diet was unbalanced and did not meet the recommendation in all groups of women studied. It was noted a significant reduction in the group with obesity 1.6 times the value of total caloric intake per 1 kg of body weight.

Conclusions. Nutrition of women in Novosibirsk is unbalanced, with increased consumption of fat and inadequate intake of carbohydrates. The GI value is close to the GI nutrition of the population of European countries. The presence of a connection between the GI nutrition of women with a metabolic disorder in the sample of the population was not established.

Aims. On the basis of echocardiography to evaluate the thickness of epicardial fat (TEF) in patients with metabolic syndrome (MS) and to establish a connection with the main indicators of laboratory and instrumental methods of research.

Materials and methods. The study included 76 patients, 43 patients with MS and 33 without MS. The average age of patients in the MS group at the time of inclusion in the study was 62.7±10.3 years in the control group (without MS) – 60±14.7 years. All patients underwent a comprehensive examination that included the collection of complaints, study of history, physical examination, anthropometric measurements, laboratory (including the study of the levels of caspase – 8, leptin in blood plasma enzyme-linked immunosorbent assay using kits «Platinum ELISA») and instrumental examination (echocardiography, ultrasound examination of organs of small pelvis). TEF was determined using transthoracic echocardiography on the machine Acuson Sequoia 512.

Results. According transthoracic echocardiography was significantly higher in the group of patients with MS and was 4.67±1.7 mm, as compared to 2.66±1.15 mm in the control group (p<0.001). Identified moderate and strong correlation between TEF and weight of the patients, waist circumference, ratio of waist circumference to hip circumference, body mass index, glucose levels in the blood plasma, the presence of diabetes mellitus type 2, ultrasonic signs of steatosis of the liver and pancreas, increased aminotransferases, the level of caspase-8 concentration in plasma leptin. Patients the MS group with increased TEF increases the risk of developing hypertension, ischemic heart disease, left ventricular hypertrophy, diastolic dysfunction of the left ventricle type 2, level of caspase-8 and concentration in plasma leptin.

Conclusion. Based on the obtained data, the measurement of TEF is justified in patients with MS in everyday clinical practice. The correlations between the TEF and the clinical and metabolic parameters of the CVD and MS make it possible to consider the TEF as a new marker of the risk of developing MS and cardiovascular diseases.

Background. In recent years, clinical work, discovered a correlation between the violations of quantitative and/or qualitative composition of the intestinal microbiota and the development of various dysmetabolic disorders, including obesity.

Aims. To evaluate the effect of the additional inclusion in the diet program of foods with a high content of dietary fibers and microbiotics on anthropometric indicators of obesity.

Materials and methods. The dynamic 6-month observation study included 50 people with 2–3 degrees of obesity (BMI≥35 kg/m2) according to WHO criteria, divided depending on the method of exposure (the traditional scheme of rational diet/or additionally enriched diet with fiber) into two comparable groups. Among the methods of the study were allocated anthropometry, the actual nutritional analysis and chromatographic study of short-chain fatty acids in the feces.

Results. Analysis of anthropometric data (body weight, BMI, waist circumference) using the Wilcoxon test showed a more pronounced dynamics of basic anthropometric data in the group with additional enrichment diet dietary fiber (p<0.01). The data of chromatographic studies showed more significant changes in the total concentration of short chain fatty acids (p<0.01) and in their profile (p<0.05) in the group with additional enrichment diet dietary fiber. Clinically normalization of symbiotic digestion in the intestine in the group with additional enrichment diet dietary fiber was confirmed by reducing the frequency of presented complaints, for flatulence and flatulence from 38.3% to 13.7% (p<0.05), abdominal discomfort from 63.4% to 25.5% (p<0.05), constipation from 44.5% to 13.8% (p<0.05), rumbling in the abdomen on palpation from 50.4% to 18.8% (p<0.05).

Conclusions. Complex effect of dietary fiber within the food products of functional purpose on the processes and symbiotic digestion in the gastrointestinal tract leads to improved clinical and metabolic (normalization of functional activity of the intestinal microbiota) and anthropometric parameters (lower values of body weight, waist circumference), which predetermines the possibility of using dietary fiber in programmes for the treatment and prevention of obesity.