The National Consensus statement on the management of adult patients with non-alcoholic fatty liver disease and main comorbidities

The National Consensus was prepared with the participation of the National Medical Association for the Study of the Multimorbidity, Russian Scientific Liver Society, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians, National Society for Preventive Cardiology, Professional Foundation for the Promotion of Medicine Fund PROFMEDFORUM. The aim of the multidisciplinary consensus is a detailed analysis of the course of non-alcoholic fatty liver disease (NAFLD) and the main associated conditions. The definition of NAFLD is given, its prevalence is described, methods for diagnosing its components such as steatosis, inflammation and fibrosis are described. The association of NAFLD with a number of cardio-metabolic diseases (arterial hypertension, atherosclerosis, thrombotic complications, type 2 diabetes mellitus (T2DM), obesity, dyslipidemia, etc.), chronic kidney disease (CKD) and the risk of developing hepatocellular cancer (HCC) were analyzed. The review of non-drug methods of treatment of NAFLD and modern opportunities of pharmacotherapy are presented. The possibilities of new molecules in the treatment of NAFLD are considered: agonists of nuclear receptors, antagonists of pro-inflammatory molecules, etc. The positive properties and disadvantages of currently used drugs (vitamin E, thiazolidinediones, etc.) are described. Special attention is paid to the multi-target ursodeoxycholic acid (UDCA) molecule in the complex treatment of NAFLD as a multifactorial disease. Its anti-inflammatory, anti-oxidant and cytoprotective properties, the ability to reduce steatosis an independent risk factor for the development of cardiovascular pathology, reduce inflammation and hepatic fibrosis through the modulation of autophagy are considered. The ability of UDCA to influence glucose and lipid homeostasis and to have an anticarcinogenic effect has been demonstrated. The Consensus statement has advanced provisions for practitioners to optimize the diagnosis and treatment of NAFLD and related common pathogenetic links of cardio-metabolic diseases.

Assessment of Vitamin D Metabolism in Patients with Cushing's Disease in Response to 150,000 IU Cholecalciferol Treatment

In this study we aimed to assess vitamin D metabolism in patients with Cushing’s disease (CD) compared to healthy individuals in the setting of bolus cholecalciferol treatment. The study group included 30 adults with active CD and the control group included 30 apparently healthy adults with similar age, sex and BMI. All participants received a single dose (150,000 IU) of cholecalciferol aqueous solution orally. Laboratory assessments including serum vitamin D metabolites (25(OH)D₃, 25(OH)D₂, 1,25(OH)₂D₃, 3-epi-25(OH)D₃ and 24,25(OH)₂D₃), free 25(OH)D, vitamin D-binding protein (DBP) and parathyroid hormone (PTH) as well as serum and urine biochemical parameters were performed before the intake and on Days 1, 3 and 7 after the administration. All data were analyzed with non-parametric statistics. Patients with CD had similar to healthy controls 25(OH)D₃ levels (p > 0.05) and higher 25(OH)D₃/24,25(OH)₂D₃ ratios (p < 0.05) throughout the study. They also had lower baseline free 25(OH)D levels (p < 0.05) despite similar DBP levels (p > 0.05) and lower albumin levels (p < 0.05); 24-h urinary free cortisol showed significant correlation with baseline 25(OH)D₃/24,25(OH)₂D₃ ratio (r = 0.36, p < 0.05). The increase in 25(OH)D₃ after cholecalciferol intake was similar in obese and non-obese states and lacked correlation with BMI (p > 0.05) among patients with CD, as opposed to the control group. Overall, patients with CD have a consistently higher 25(OH)D₃/24,25(OH)₂D₃ ratio, which is indicative of a decrease in 24-hydroxylase activity. This altered activity of the principal vitamin D catabolism might influence the effectiveness of cholecalciferol treatment. The observed difference in baseline free 25(OH)D levels is not entirely clear and requires further study.

[Characteristics of geriatric and somatic status in patients with osteoporosis]

BACKGROUND

Older adults with osteoporosis (OP) and high risk of falls are the most vulnerable group of patients with respect to the development of fractures. Falls and fractures in elderly patients with OP are associated with geriatric syndromes and worse functional status.

AIM

To аssess comorbidity and geriatric status in elderly and senile patients with and without OP.

MATERIALS AND METHODS

The study included 607 patients over 60 years of age hospitalized in the geriatric department. According to the presence of OP, the patients were divided into 2 groups: group 1 - patients with OP (n=178, 29.3%), group 2 - patients without OP (n=429, 70.7%). All patients underwent a general clinical study, an assessment of comorbidity -according to the Charlson index, and a comprehensive geriatric score.

RESULTS

OPs had 178 (29.3%) patients, more often these were women. 55.6% of patients with OP were disabled. Age--related diseases such as Alzheimer's disease, Parkinson's disease, osteoarthritis, anemia, thyroid disease, varicose veins were significantly more common in patients with OP. With almost all of these diseases, a univariate analysis revealed an association with OP. Geriatric syndromes such as frailty, hypodynamia, malnutrition, polypharmacy, urinary incontinence were significantly more common in group 1 patients. Patients with OP were more likely to live alone and use mobility aids compared to patients without OP.The univariate analysis demonstrated that OP is associated (OR 1.54 to 2.00) with frailty, hypodynamia, the use of aids in movement, sleep disorders, sensory vision deficiency, urinary incontinence. The Functional status of patients with OP was worse compared to patients without OP. Patients with OP suffered more fractures, and vertebral fractures were significantly more frequent.

CONCLUSION

Patients with OP have a high comorbidity, a burdened geriatric status. In elderly patients, it is necessary not only to screen and diagnose OP, to assess the risk of 10-years probability of major pathological fractures using the FRAX algorithm, but also to conduct a comprehensive geriatric assessment to diagnose geriatric syndromes that weaken the course of OP and lead to more serious consequences.

[Study of the psycho-emotional disorders' severity in patients with osteoporotic vertebral fractures and factors affecting them]

There are convincing data on the association of psycho-emotional disorders with the degree of bone mineral density (BMD) loss and the risk of fractures on the basis of osteoporosis (OP) but the nature of the causal relationship has not yet been clearly established. The study of this issue is important to substantiate the need and nature of psychological correction within the framework of comprehensive rehabilitation programs in patients with osteoporotic fractures.

OBJECTIVE

Study of the severity of symptoms of depression and anxiety in patients who have suffered compression fractures of the vertebrae (VF) of osteoporotic genesis who entered the II stage of medical rehabilitation, as well as the contribution to the development of psycho-emotional age disorders, the severity of OP, pain syndrome and the use of orthotics.

MATERIAL AND METHODS

The study sample consisted of 120 women 50 to 80 years old with an established diagnosis of OP based on the results of bone densitometry. The main group included 60 patients with OP complicated by at least one VF. The control group included 60 patients with OP without a history of osteoporotic fractures comparable in age, body mass index and BMD in the spine with the main group. The complex of examination included the collection of complaints, anamnesis of OP, previous fractures, assessment of pain syndrome according to VAS, BMD study and verification of VF by X-ray methods. To assess the level of depression (DL) we used the Tsung depression scale modified by T.I. Balashova, situational (SA) and personal anxiety (PA) - Spielberger-Khanin questionnaire.

RESULTS

In the main group in comparison with the control group the proportion of patients without symptoms of depression was lower (66.7 and 88.3%, respectively; p=0.042), as well as the frequency of detection of high degree of SA was higher (85.0 and 73.4%, respectively; p=0.039). In patients with VF it was higher than in the control, DL - 46.0 [42.0; 54.5] (27-70) and 43.0 [38.0; 47.5] (25-65) points, respectively (p=0.0009), as well as the SA degree - 61.5 [54.0; 71.0] (20-75) and 52.5 [43.5; 64.0] (20-68) points, respectively (p=0.0006). Statistically significant direct correlation dependences of DL on age (r=0.317; p=0.00042), the duration of the postmenopausal period (r=0.325; p=0.0003), the number of VFs (g= -0.245; p=0.00013) were established. Moreover, the intensity of pain syndrome (g= -0.234; p=0.00034), as well as feedbacks of this indicator with BMD in the spine (r= -0.342; p=0.00017) and the duration of the use of thoracolumbar orthoses (r = -0.504; p = 0.00016). There were direct dependence of the SA degree on age (r=0.281; p=0.0019) and the intensity of pain syndrome (g=0.258; p=0.0044). Negative correlation of SA with body weight (r= -0.183; p=0.045), BMD in the spine (r= -0.207; p=0.026), duration of orthosis application (r= -0.327; p=0.0095) and the amount of VF in the lumbar spine (g= -0.214; p=0.044) were detected. There was a significant correlation between the degree of PA and BMD in the lumbar vertebrae (r= -0.18; p=0.046) and the intensity of pain syndrome (g=0.137; p=0.039).

CONCLUSION

The results obtained indicate the need for psychological correction in the framework of the complex rehabilitation of women who underwent VF based on OP due to increased DL and SA especially in older age groups.