[Dynamics of epidemiological indicators of thyroid pathology in the population of the Russian Federation: analytical report for the period 2009-2018]

ОБОСНОВАНИЕ. Уровень потребления йода населением во многом определяет спектр тиреоидной патологии. На сегодняшний день в РФ йододефицитные заболевания (ЙДЗ) занимают лидирующие позиции в структуре всех заболеваний щитовидной железы (ЩЖ). Хронический дефицит йода (ЙД) приводит к неблагоприятным последствиям для здоровья и существенным экономическим затратам на их устранение в масштабах страны. Кроме того, спектр тиреоидной патологии в условиях ЙД не ограничивается проблемой ЙД, и изучение остальных заболеваний ЩЖ также представляет интерес.ЦЕЛЬ. Проанализировать динамику основных эпидемиологических показателей ЙДЗ и других заболеваний ЩЖ у всего населения РФ за период 2009–2018 гг., используя данные официальной государственной статистики.МЕТОДЫ. Проанализированы заболеваемость и распространенность заболеваний ЩЖ у всего населения РФ с использованием данных официальной государственной статистики. Использованы статистические формы №63 МЗ СР РФ «Сведения о заболеваниях, связанных с микронутриентной недостаточностью» и №12 «Сведения о числе заболеваний, зарегистрированных у больных, проживающих в районе обслуживания лечебного учреждения, РОССТАТ». Анализируемый период — 2009–2018 гг. Для оценки динамики распространенности и заболеваемости были построены линейные регрессионные модели.РЕЗУЛЬТАТЫ. Данные проанализированы в соответствии с представленной в статистической отчетности структурой заболеваний: зоб, тиреоидит, гипотиреоз, тиреотоксикоз, синдром врожденной йодной недостаточности. За десятилетний период 2009–2018 гг. отмечается статистически значимый рост распространенности различных форм зоба, тиреотоксикоза, синдрома врожденной йодной недостаточности у всего населения РФ. В течение периода наблюдения выявлен рост заболеваемости тиреотоксикозом. В отношении заболеваемости синдромом врожденной йодной недостаточности выявлена лишь тенденция к росту. Несмотря на то что в течение периода наблюдения число новых случаев различных форм зоба уменьшилось, распространенность зоба среди населения РФ остается высокой: 1,2% населения к 1 января 2019 г. В отношении тиреоидита выявлен статистически значимый рост распространенности и заболеваемости, что может быть связано с ростом аутоиммунной патологии, совершенствованием уровня диагностики, а также, в некоторых случаях, с гипердиагностикой (например, при постановке диагноза аутоиммунного тиреоидита у лиц с бессимптомным носительством антитиреоидных антител). Существующие на сегодняшний день подходы к йодной профилактике недостаточно эффективны.ЗАКЛЮЧЕНИЕ. Результаты проведенного анализа свидетельствуют преимущественно о росте распространенности тиреоидной патологии среди населения РФ на фоне проводимых региональных мероприятий. Проблема ЙДЗ остается нерешенной, что диктует необходимость внедрения всеобщего обязательного йодирования соли на территории РФ.

Draft of the clinical practice guidelines “Adrenal incidentaloma”

The wider application and technical improvement of abdominal imaging procedures in recent years has led to an increasingly frequent detection of adrenal gland masses — adrenal incidentaloma, which have become a common clinical problem and need to be investigated for evidence of hormonal hypersecretion and/or malignancy. Clinical guidelines are the main working tool of a practicing physician. Laconic, structured information about a specific nosology, methods of its diagnosis and treatment, based on the principles of evidence-based medicine, make it possible to give answers to questions in a short time, to achieve maximum efficiency and personalization of treatment. These clinical guidelines include data on the prevalence, etiology, radiological features and assessment of hormonal status of adrenal incidentalomas. In addition, this clinical practice guideline provides information on indications for surgery, postoperative rehabilitation and follow-up.

Postprandial hypoglycemia after upper gastrointestinal tract surgery: prevalence and pathophysiology (part 1)

Nowadays obesity is a major health problem worldwide. Surgery is the most promising treatment for morbid obesity. There are two types of bariatric procedures, one to reduce the food intake volume and the other to limit the absorption of nutrients. Despite the indisputable advantages of bariatric surgery for weight loss, it is necessary to remember the potential risk of severe complications, such as hypoglycemic syndrome at 2 to 3 hours after ingestion of rapidly absorbable carbohydrates manifested by adrenergic and neuroglycopenic symptoms. According to the literature, the prevalence of post-bariatric postprandial hyperinsulinemic hypoglycemia (PHH) varies from 10% to 75%. PHH in post-bariatric patients should be differentiated from the syndrome of non-insulinoma pancreatogenic hypoglycemia and from insulinoma; however, these diseases are described also in patients after bariatric surgery.

The mechanisms of PHH as an outcome of shunting bariatric procedures are currently not fully clear. According to the recent studies, incretin hypersecretion in response to the accelerated flow of carbohydrates into the small intestine plays a leading role in the inappropriate excess production of insulin by the pancreas. In addition, there are hypotheses on a slower normalization of insulin production during more rapid bodyweight decrease and regression of insulin resistance, the role of alpha-cell dysfunction, disturbed negative feedback between insulin and ghrelin, compensatory hyperplasia and hypertrophy of the remaining enterocytes (including L-cells), changes in gut microflora, bile acids level and composition. A number of other mechanisms have also been proposed that require further studies.

[Primary hyperaldosteronism: difficulties in diagnosis]

Primary hyperaldosteronism (PA) - is the clinical syndrome, results from autonomous of the major regulators of secretion, aldosterone overproduction by a tumorous or hyperplastic tissue in adrenal cortex. Being the most frequent cause of secondary hypertension, PA may be represented by disorders with unilateral or bilateral aldosterone overproduction and differential diagnosis between them is crucial for choosing a right therapeutic approache: lifelong medical therapy with mineralocorticoid receptor antagonists or unilateral adrenalectomy. Adrenal venous sampling (AVS) is currently the «gold standard» test for identifying laterality of excess hormone production, unlike imaging tests, sensitivity and specificity of which is not enough, due to inability to evaluate functional activity with confidence, and also to limitations in detecting tiny abnormalities of adrenals, such as microadenoma or hyperplasia. Excluding certain cases, AVS is recommended to patients with confirmed PA, planning surgical treatment, to determine the lateralization of aldosterone hypersecretion. Described clinical case of patient with confirmed lateralization from adrenal without any detected lesions on CT-imaging and nonfunctioning tumour on contralateral side, highlights the importance of using AVS for decision to refer patients for surgery.

[Clinical practice guidelines "Management of iodine deficiency disorders"]

Iodine deficiency disorders is a sweeping term that includes structural and functional impairment of the thyroid gland.These clinical guidelines include algorithms for the diagnosis and treatment of euthyroid goiter and nodular/ multinodular goiter in adults and children. In addition, these clinical guidelines contain information on methods for an adequate epidemiological assessment of iodine deficiency disorders using such markers as the percentage of goiter in schoolchildren, the median urinary iodine concentration, the level of neonatal TSH, the median thyroglobulin in children and adults. As well from these clinical guidelines, you can get to know the main methods and groups of epidemiological studies of iodine deficiency disorders.

[Vitamin D and pregnancy: current state of the problem in the central regions of the Russian Federation]

BACKGROUND

It has been proven that vitamin D plays an important role in pregnancy. Deficiency of this element may be associated with the risk of developing gestational diabetes mellitus, preeclampsia, placentar insufficiency, low birth weight and premature birth.

AIMS

To conduct an epidemiological analysis of vitamin D supply in women at different stages of pregnancy, living in Russia.

MATERIALS AND METHODS

We included 1198 pregnant women living in 3 regions of Russia in the observational, multicenter, cross-sectional, continuous study. All pregnant women were tested for serum 25(OH)D levels. We collected biomaterial from August 2018 to December 2019. The end point of the study was the indicator of vitamin D supply in pregnant women and its level depending on the trimester of pregnancy and region of Russia. Statistical analysis included counting and grouping according to vitamin D levels, and calculating the median vitamin D concentration in each region.

RESULTS

We confirmed vitamin D deficiency in all regions. The optimum level of this element is present in less than 7% of women. Insufficiency of this element is present in 20,62% of all women. The largest percentage of them is in a deficit of this element - 46,66%. We found that the lowest rates are in Smolensk, where the median was 12,75 ng/ml. In addition, we found changes in vitamin D concentration: with an increase in gestational age revealed a decrease in its level.

CONCLUSIONS

In our study, we confirmed the presence of a 25(OH)D deficiency in most of the examined pregnant women, which is consistent with international epidemiological data. We should remember about these both at the stage of pre-gravid preparation and at the stage of pregnancy itself in order to achieve the optimal level of vitamin D.

[Aldosterone- and cortisol-co-secreting adrenal tumors: an uneasy sum of well-known parts (review)]

Primary aldosteronism (PA) is the most common form of secondary arterial hypertension. In patients with PA, more so than in the general population, there is a prevalence of insulin resistance, diabetes mellitus, metabolic syndrome, osteoporosis, and symptoms of depression; these conditions are more likely to manifest a gluco- rather than mineralocorticoid excess. This fact is of particular importance in light of recent studies that have shown that PA is often associated with glucocorticoid excess. Since the first reports of cases of combined secretion of aldosterone and cortisol in 1979, the number of cases of so-called Connshing syndrome has increased. An analysis of data from recent studies suggests that hypercortisolism in PA is closely associated with an increased risk of cardiovascular complications, metabolic disorders and post-surgical adrenal insufficiency. The most important diagnostic problem in adenomas with combined secretion is the risk of false interpretation of the results of adrenal venous sampling (AVS). The indications that suggest aldosterone-and-cortisol-co-producing adenoma are the lack of suppression of cortisol levels following a night test with 1mg of dexamethasone, and an adrenal tumo of over 2.5cm. As an alternative test capable of differentiating this type of tumor, a number of researchers have proposed measuring the level of so-called hybrid steroids in the peripheral plasma and urine. Taking into account the high prevalence and potential risks, ruling out of excess corisol secretion is obligatory in all cases of PA before AVS and when planning surgery.

[Amiodarone-associated thyroid dysfunction: prevalence and possibilities of correction]

During 1 year of amiodarone intake development of amiodarone-associated thyroid dysfunction was observed in 25% of patients (hypothyroidism and thyrotoxicosis in 19.2 and 5.8%, respectively). Development of hypothyroidism was not accompanied with loss of antiarrhythmic efficacy of amiodarone and therapy with L-thyroxin was conducted at the background of continued amiodarone intake. In all patients with clinical and in less than one half (47.6%) of patients with subclinical forms of hypothyroidism replacement therapy with L-thyroxin was carried out. Development of amiodarone-associated thyrotoxicosis was accompanied with loss of antiarrhythmic efficacy of amiodarone in all cases. In all patients with thyrotoxicosis which developed during amiodarone intake thyrostatic therapy with mercasolil was carried out and in case of its inefficacy prednisolone was added. In 87.5% of patients with thyrotoxicosis correction of the thyroid status was conducted under conditions of continued amiodarone intake as this drug had been prescribed because of life saving indications. Achievement of euthyroid state was followed by restoration of antiarrhythmic efficacy of amiodarone. Amiodarone was discontinued just in 1 patient with ventricular extrasystole as correction of thyroid status and restoration of euthyroidosis enabled effective use of other antiarrhythmic drugs.

[Thyroid dysfunction and the hemostatic system]

Whether there is a link between thyroid dysfunction and different impairments in the hemostatic system is discussed. The level of thyroid hormones is an essential factor that influences the coagulation system. Thyroid dysfunction affects the balance between coagulation and fibrinolysis, by increasing the risk of thrombosis and hemorrhage in hyperthyroidism. However, there is no consensus of opinion regarding the mechanisms of the described hemostatic changes in the literature.

Atypical and typical course of neurofibromatosis type 1 in combination with pheochromocytoma

Neurofibromatosis type 1 is a hereditary disease that has a multisystem character of organism damage, a wide variability of clinical manifestations, up to the almost complete absence of typical symptoms. Phenotypic manifestations, their expressiveness and heaviness can be varied even among members of the same family with identical mutations. One of the possible clinical manifestations of this pathology is pheochromocytoma, the development of which is associated with a high risk of developing life-threatening conditions. Timely diagnosis of the disease, the choice of treatment tactics for the patient, genetic testing of blood relatives can significantly improve the survival rate and prognosis of the disease. In this article, on the presented clinical examples of patients with a typical and atypical course of type 1 neurofibromatosis in combination with pheochromocytoma, the issues of managing patients with this pathology are outlined.

[Diagnostics, treatment, and prevention of iatrogenic iodine-induced thyroid gland diseases]

The authors of the study investigated the effects of pharmacological doses of iodine as an ingredient of amiodaron, an anti-arrhythmic agent, and iodine radiopaque contrast agents (RCA), on the thyroid gland (TG) function. The subjects were 133 patients aged 60.5 +/- 8.5 years, who had been taking amiodaron for 12 to 164 months, and 164 patients aged 59.4 +/- 9.1 years, who were examined before coronarography (CAG) with RCA, and 1, 3, 6, and 12 months after the procedure. Serum levels of TSH, FT4, FT3, TG antibodies, TPO antibodies, and urine iodine level were measured; TG ultrasonography was performed. Forty-nine (51.9%) out of the 133 patients on amiodaron therapy developed thyroid disfunction. Subclinical hypothyroidism (24 cases; 18%) and manifest thyrotoxicosis (21 case; 15.8%) prevailed among functional TG disorders. Thirty-one per cent of the patients with thyrotoxicosis had preceding TG diseases; 70% of the thyrotoxicosis patients had a cardiac arrhythmia relapse. The concentration of thyroid antibodies did not change in patients with normal TG. The patients who underwent CAG displayed elevated renal iodine excretion 1, 3, and 6 months after RCA administration. Thyroid disfunction (thyrotoxicosis in 7.6% of the cases; hypothyroidism in 15.8% of cases) was revealed in 23.4% of the patients with preceding TG diseases one month after CAG. Cardial pathology exacerbation was observed in patients with thyrotoxicosis.

[Thyroid dysfunction in long-term amiodarone administration. Correlation of the antiarrhythmic activity of amiodarone with its effect on thyroid function]

Relationship between amiodarone-associated thyroid dysfunction and antiarrhythmic activity of amiodarone was studied in 27 patients (13 with hypothyroidism, 8 with hyperthyroidism, 6 with euthyroid hyperthyroxinemia). Amiodarone-associated hypothyroidism and euthyroid hyperthyroxinemia were not associated with loss of antiarrhythmic efficacy of amiodarone. Hypothyroidism did not require amiodarone withdrawal and therapy with L-thyroxin was conducted at the background of continued amiodarone intake. Achievement of euthyroid state was not followed by recurrence of heart rhythm disturbances. Development of amiodarone-associated thyrotoxicosis was accompanied with loss of antiarrhythmic efficacy of amiodarone in all cases. In 87.5% of patients with thyrotoxicosis correction of the thyroid status was conducted under conditions of continued amiodarone intake as this drug had been given because of life threatening arrhythmias or proven resistance to other antiarrhythmic therapy. In 12.5% of patients it was possible to substitute other drugs for amiodarone. Correction of thyroid status and achievement of euthyroidosis in these patients was associated with restoration of amiodarone antiarrhythmic activity.

[Thyroid functional features after diagnostic studies with iodine-containing X-ray contrast substances]

Iodine-containing radiopaque preparations have been widely used for diagnostic purposes. The absolute amount of iodine introduced in this case is 200,000 to 350,000 times the daily requirement for the element. Throughout life, a person consumes only about 3-5 g of iodine, while during coronary angiography the dose of parenterally administered iodine is about 25-52 g. In this regard, the possibility of development should be taken into account when conducting diagnostic studies using radiopaque drugs iodine-induced conditions, especially in people of an older age group, among which the prevalence of thyroid pathology is especially high. The presence of autonomous formations in the thyroid gland (thyroid gland), often unrecognized, can lead to the development of iodine-induced thyrotoxicosis (IIT) after the introduction of pharmacological doses of iodine, which in turn can lead to deterioration in the course of IHD and the development of arrhythmic complications. We continue discussion the need for screening for the detection of functional thyroid dysfunctions and an ultrasound of the thyroid gland before the introduction of iodine-containing radiopaque drugs. The controversial issue remains the need for preventive treatment with thyreostatic drugs of people at risk of developing IIT.

[The specific features of hypothyroidism developing with the use of cordorone]

Hypothyroidism (HT) is one of the thyroid dysfunctions occurring with the use ofcordorone. The authors examined the clinical features of this condition in 26 patients living in Moscow and its region (mild and moderate iodine deficiency areas). The blood levels of thyrotropic hormone (TTH), free thyroxine (Т4) free triiodothyronine (T3), thyroid peroxidase antibodies, and lipid spectrum were estimated. Thyroid ultrasound study and Holler ECG monitoring were performed. HT was found to develop in the presence of the abnormally changed (66%) and intact (34%) thyroid. Examining the course of cardiac arrhythmias (CA) as HT progresses has ascertained that this condition does not lead to their recurrences. As compared with the controls, the patients were found to have higher frequencies of dyslipidemias (p < 0.05). Blood lipid changes appeared as the higher levels of total and LDL cholesterol (p < 0.05); a positive correlation was also established between these parameters and the levels of TTH. The use of L-thyroxine replacement therapy, as indicated on an individual basis, during ongoing cordorone intake did not result in relapses of prior CA and it contributed to blood lipid spectrum parameters. Thus, HT is a condition that does not cause a loss of the antiarrhythmic effects ofcordarone manifests itself as the impaired blood lipid spectrum. L-thyroxine replacement therapy may be, if required, performed during the ongoing use of an antiarrhythmic agent.

[Subacute thyroiditis]

Subacute thyroiditis (de Kerven's thyroiditis, giant cell thyroiditis, granulomatous thyroiditis) - a self-limiting inflammatory disease of the thyroid gland (thyroid gland), presumably of viral etiology, is the most common cause of pain in the thyroid gland. The disease (probably without an autoimmune component) is characterized by a 4-phase course (thyrotoxicosis, euthyroidism, hypothyroidism and restoration of normal functioning of the thyroid gland), its duration is from several weeks to several months. The subacute thyroiditis was first described by de Kerven in 1904. In most cases, if the disease has a characteristic clinical picture, the diagnosis of subacute thyroiditis is not difficult and, with adequate treatment, the patient will recover completely.

[Disorder of eating behavior and comorbid syndromes in obesity and methods of their correction]

Eating behavior and comorbid syndromes were investigated in 40 women with obesity. A frequent combination of obesity with disorders of eating behavior, with emotional-personality, psychoautonomic and algesic disorders as well as with appearance of affective disorders during dietetic nutrition ("dietetic depression") required their correction. As a result of insufficiency of serotoninergic system of brain in pathogenesis of such disorders, fluoxetine (prozac)-a selective inhibitor of serotonine reuptake--was used for treatment of eating disorders. Heterogeneity in the structure of the obesity is shown. Disorders of eating behavior were combined with pronounced anxiety, depression, algesic and psychoautonomic syndromes. Therapy with prozac during 3 months in dose of 20 mg daily resulted in decrease of weight. Normalization of eating pattern, decrease of anxiety, depression, reaction to the external stimuli, increase of stress-resistance of patients, alterations in eating liking, decrease of severity of disorders comorbid to obesity were observed. A conclusion is made that prozac is indicated for patients in whom pathology of eating behavior plays a significant role in pathogenesis of obesity.

[Incidence and predictors of thyroid dysfunction caused by long-term intake of amiodaron]

AIM

To analyze occurrence of thyroid dysfunction due to regular long-term intake of amiodaron (for one year), to search for predictors of amiodaron-induced hypothyroidism and thyrotoxicosis.

MATERIAL AND METHODS

Sixty two patients with different types of arrhythmia have undergone examination including tests for TTH (once in three months), free T3 and T4 (once in 6 months), ultrasound thyroid investigation, general clinical and physical check-up, resting ECG in 12 leads, echocardiography, chest x-ray, biochemical blood tests, blood count, urinalysis.

RESULTS

Amiodaron intake for 1 year was associated with amiodaron-induced thyroid dysfunction in 25% patients: 19.2% developed hypothyroidism, 5.8%--thyrotoxicosis. Organic pathology of cardiovascular system, cardiac failure, left ventricular aneurysms, low global myocardial contractility, organic thyroid pathology, elevated levels of antithyroid antibodies predicted hypothyroidism. Thyrotoxicosis was associated with a young age and male sex.

CONCLUSION

Amiodaron may cause thyroid dysfunction in patients with arrhythmia.

Somatic Mutations in the BRAF, KRAS, NRAS, EIF1AX, and TERT Genes: Diagnostic Value in Thyroid Neoplasms

The feasibility of using molecular genetic markers associated with thyroid neoplasms and more aggressive course of the disease is now actively studied. We analyzed the diagnostic value of somatic mutations in the hot spots of BRAF, KRAS, KRAS, EIF1AX, and TERT genes in histological material from 153 patients with thyroid gland neoplasms. BRAF mutations (exon 15, codon area 600-601) were found in 54 patients, NRAS mutations (exon 3, codon 61) were detected in 12 patients; mutations KRAS, TERT, and EIF1AX genes were not detected.

[Disturbances of thyroid function after coronary angiography]

Frequency of thyroid gland functional disturbances after introduction of iodine-containing radiographic contrast agents during coronary angiography was studied in 146 patients, residents of the zone of borderline iodine deficit. Frequency of thyroid pathology was high at baseline (39%). Functional state of the thyroid gland was assessed before and 1, 3, 6, 12 months after investigation. During first month after coronary angiography there were several new cases of thyrotoxicosis and hypothyroidism, as well as deterioration of preexisting functional disturbances of the thyroid. Patients with baseline pathology and functional disturbances of thyroid gland before conduction of coronary angiography should be included into risk group of development of iodine induced states.

[The specific features of thyrotoxicosis and euthyroid hyperthyroxinemia developed due to the use of cordarone]

Thyrotoxicosis (TT) is one of the thyroid (T) dysfunctions occurring with the use of cordarone. The clinical features of TT were studied in cordarone-treated patients living in Moscow and its regions (mild and moderate iodine deficiency regions). The patients were examined by using currently available procedures for measuring thyroid-stimulating hormone, free thyroxine, free triiodothyronine, antibodies to TH, TPO, interleukin-6 (IL-6), and C-reactive protein (CRP), and by employing T ultrasound study, Holter ECG monitoring. TT was ascertained to develop in the presence of both the pathologically altered (16/23, 69%) and intact T (7/23, 31%). Examining the course of cardiac arrhythmias (CA) in developed TT has established that this condition gives rise to their recurrence. As compared with the control group, the patients with TT were not found to have higher levels of IL-6 and CRP (p > 0.05; Mann-Whitney test). Therapy with thyrostatic agents alone or in combination with glucocorticosteroids normalizes the levels of thyroid hormonesfollowing, on the average, 2-3 months. Euthyroid hyperthyxinemia (EHT) is frequently recorded with the use of cordarone. Examination of 20 patients with EHT has revealed organic pathology in 13 (65%) patients and its absence in 7 (35%). Recurrences of prior CA have not been found in EHT (p < 0.05; McNemar test). The confidence interval for the difference of relative frequencies of signs did not include 0). Thus, TT is a condition that leads to the fact that cordarone loses its antiarrhythmic effects and TT requires compulsory treatment. If required, therapy should be performed during the continued administration of the drug. EHT is not thyrotoxicosis, which is to be followed up.

[Results of epidemiological surveys for iodine-deficiency diseases within the framework of the Thyromobile project]

In the Russian Federation, there are virtually all areas whose population is at risk for iodine-deficiency disorders. During 2003, we made epidemiological studies of iodine-deficiency disorders within the framework of the Thyromobile project supported by the pharmaceutical company "Nycomed"in 12 regions of the Russian Federation. A total of 2673 individuals were examined. According to the WHO recommendations, the study covered prepubescent children aged 8 to 11 years. It involved physical examination, thyroid ultrasound study, blood sampling for ioduria, intelligence test, and sodium chloride iodine assay. The findings indicated that the tension of goiter endemia corresponded to the level of iodine deficiency, which was in the range of mild iodine deficiency, in most regions other than some districts of the Volgograd, Astrakhan, Nizhni Novgorod regions where the median of ioduria in schoolchildren corresponded severe iodine deficiency. The studies indicated that the population's use ofiodinated salt is not up to the recommendations of international expert organizations. Intelligence tests revealed an 11-18% IQ decrease in children from virtually all study areas. According to the strategy of iodine deficiency control in the Russian Federation, it is advisable to use iodinated salt for mass prevention and drugs containing a physicological dose of iodine for group and individual prevention.

[Adiponectin and parameters of glucose and lipid metabolism at different clinical and morphological stages of non-alcoholic fatty liver disease in patients with abdominal obesity]

AIM

To compare clinical, laboratory, and morphological parameters in patients with abdominal obesity and non-alcoholic fatty liver disease (NAFLD) and to assess the relationship between the degree and stage of the disease and the cardiometabolic risk factors of type 2 diabetes mellitus and cardiovascular diseases.

SUBJECTS AND METHODS

Eighty patients aged 30 to 50 years with abdominal obesity were examined. NAFLD was diagnosed after liver puncture biopsy. The parameters of carbohydrate and lipid metabolism and the activity of hepatic transaminases and the protective adipocytokine adiponectin were investigated.

RESULTS

NAFLD was verified in 77 examinees. Metabolic disturbances were found in the majority of the examinees with abdominal obesity and NAFLD; they were concurrent and increased in their rate and degree with the progression of NAFLD, obesity, and insulin resistance. The patients with NAFLD had a significantly decreased adiponectin level that got worse as NAFLD progressed.

CONCLUSION

The investigation has revealed that NAFLD is associated with cardiometabolic disorders (dyslipidemia, carbohydrate metabolic disturbances, and insulin resistance) increasing in their rate and degree with the progression of NAFLD and the lower adiponectin level reducing as NAFLD worsens.