Keywords
How to Cite
Abstract
The article summarizes and analyzes the material devoted to the study of pathogenetic links in the development of obesity to improve the methods of early prevention and treatment. The purpose of the work: to optimize the identification of risk factors for the development of obesity in patients to prevent its progression and develop the methods of prevention and treatment. Subject: obesity, type 2 diabetes (T2D), insulin resistance, diabetic retinopathy, leptin levels, retinol binding protein-4 (RBP-4), glucagon-like peptide (GLP-1), peptide tyrosine-tyrosine (PYY), degree of 25-OH-D deficiency. Material and methods: biochemical, immunoenzymatic, instrumental, statistical. The results. The levels and relationships of incretins, namely GLP-1, leptin and RBP-4 adipokines, neurotransmitters (PYY) in overweight patients against the background of carbohydrate metabolism disorders were studied. For T2D patients with increased body weight and obesity, the predominance of the abdominal type of adipose tissue distribution has been established. It has been proven that this category of patients is characterized by an increase in leptin levels and a decrease in 25-OH-D levels against the background of increased insulin resistance, regardless of the obesit degree. It has been proven that the level of leptin and 25-OH-D in the blood serum depends on the compensation of the underlying disease; these figures are likely to decrease in patients with decompensated diabetes mellitus — with an HbA1c level > 8.5%. A decrease in PYY and GLP-1 levels was established for patients with T2D on the background of obesity, which can be a prognostic negative factor for eating disorders and weight gain. A relationship between 25-OH-D and PYY indicators was established (r=0.67; p<0.001). In the study of the intestinal microbiota, it was shown that patients with obesity had a lower microbiota diversity, a decrease in the Firmicutes/Bacteroidetes ratio, and an increase in anaerobic flora. Therefore, changes in the microbiota can be an important factor in the development and progression of obesity. A high prevalence of diabetes-associated osteoarthritis with dominant localization in the upper limbs was established: in 74.5% of patients with type 1 diabetes — mainly in the form of oligoarthritis, in 78.2% of patients with type 2 diabetes (T2D) — in the form of polyarthritis. The risk factors for the development of diabetes-associated osteoarthritis were identified and substantiated: patient age, HbA1c level, body mass index, and duration of the underlying disease. Conclusions. Thus, the predominance of the abdominal type of adipose tissue distribution with an increase in the level of leptin and a decrease in 25-OH-D against the background of increased indicators of insulin resistance, regardless of the obesity degree, was established in patients with T2D. A decrease in PYY and a significant decrease in GLP-1 levels may be negative predictors of eating disorders and weight gain. The presence of a high prevalence of diabetes-associated osteoarthritis in patients with diabetes mellitus has been established. Modifying factors in the development of arthropathy for patients with both types of diabetes mellitus are the levels of HbA1c and body mass index, therefore, measures to prevent diabetes-associated osteoarthritis should be based on maintaining optimal levels of these indicators to compensate for diabetes mellitus. It has been shown that metabolic disorders are a significant factor that negatively affecting the course of the COVID-19 infection and its possible complications. The consequences are especially dangerous for people with newly diagnosed and untreated diabetes, overweight and obesity. It has been established that T2D can be considered a risk factor for post-Covid syndrome in patients who have recovered from COVID-19. Therefore, weight gain in patients with diabetes mellitus is an important aggravating factor in the course of the underlying disease and its complications and requires a special approach in the complex treatment of such patients.
References
Alharbi TA, Ryan J, Freak-Poli R, Gasevic D, Scali J, Ritchie K, et al. The association of weight loss, weight status, and abdominal obesity with all-cause mortality in older adults. Gerontology. 2022;68(12):1366-74. doi: 10.1159/000522040.
Zheng R, Zhou D, Zhu Y. The long-term prognosis of cardiovascular disease and all-cause mortality for metabolically healthy obesity: a systematic review and meta-analysis. J Epidemiol Community Health. 2016 Oct;70(10):1024-31. doi: 10.1136/jech-2015-206948.
Liu L, Simon B, Shi J, Mallhi AK, Eisen HJ. Impact of diabetes mellitus on risk of cardiovascular disease and all-cause mortality: evidence on health outcomes and antidiabetic treatment in United States adults. World J Diabetes. 2016 Oct 15;7(18):449-61. doi: 10.4239/wjd.v7.i18.449.
Орленко ВЛ, Іваськіва КЮ, Добровинська ОВ, Гончар ІВ. Дослідження особливостей функціонального стану ендотелію, структурного ураження магістральних артерій голови, стану вуглеводного та ліпідного обміну у хворих на цукровий діабет 2 типу з надлишковою масою тіла. Проблеми ендокринної патології. 2020;(1):41-48 (Orlenko VL, Ivaskiva KYu, Dobrovynska OV, Gonchar IV. Investigation of the functional state of endothelia, structural damage of main brachiocephalic arteries, carbohydrate and lipid exchange in overweight patients with diabetes mellitus 2 type. Problems of Endocrine Pathology. 2020;(1):41-48. Ukrainian). doi: 10.21856/j-PEP.2020.1.06.
Kim SH, Chung JH, Song SW, Jung WS, Lee YA, Kim HN. Relationship between deep subcutaneous abdominal adipose tissue and metabolic syndrome: a case control study. Diabetol Metab Syndr. 2016 Feb 12;8:10. doi: 10.1186/s13098-016-0127-7.
World Health Organization. Obesity and Overweight. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight [Accessed 7th November 2020].
Hall KD, Sacks G, Chandramohan D, Chow CC, Wang YC, Gortmaker SL, Swinburn BA. Quantification of the effect of energy imbalance on bodyweight. Lancet. 2011 Aug 27;378(9793):826-37. doi: 10.1016/S0140-6736(11)60812-X.
American Diabetes Association. 3. Prevention or delay of type 2 diabetes: standards of medical care in diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S34-S39. doi: 10.2337/dc21-S003.
Bays HE, McCarthy W, Burridge K, Tondt J, Karjoo S, Christensen S, et al. Obesity Algorithm 2021. Available from: https://obesitymedicine.org/wp-content/uploads/2021/01/2021-Obesity-Algorithm.pdf [Accessed 7th August 2021].
Bray MS, Loos RJ, McCaffery JM, Ling C, Franks PW, Weinstock GM, et al. NIH working group report-using genomic information to guide weight management: From universal to precision treatment. Obesity (Silver Spring). 2016 Jan;24(1):14-22. doi: 10.1002/oby.21381.
Elks CE, den Hoed M, Zhao JH, Sharp SJ, Wareham NJ, Loos RJ, et al. Variability in the heritability of body mass index: a systematic review and meta-regression. Front Endocrinol (Lausanne). 2012 Feb 28;3:29. doi: 10.3389/fendo.2012.00029.
Locke AE, Kahali B, Berndt SI, Justice AE, Pers TH, Day FR, et al. Genetic studies of body mass index yield new insights for obesity biology. Nature. 2015 Feb 12;518(7538):197-206. doi: 10.1038/nature14177.
van der Klaauw AA, Farooqi IS. The hunger genes: pathways to obesity. Cell. 2015 Mar 26;161(1):119-32. doi: 10.1016/j. cell.2015.03.008.
Boulenouar S, Michelet X, Duquette D, Alvarez D, Hogan AE, Dold C, et al. Adipose type one innate lymphoid cells regulate macrophage homeostasis through targeted cytotoxicity. Immunity. 2017 Feb 21;46(2):273-86. doi: 10.1016/j.immuni.2017.01.008.
Zak KP, Popova VV, Orlenko VL, Furmanova OV, Tronko ND. Cytokines in the blood of patients with type 2 diabetes mellitus depending on the level of overweight/obesity (literature review and own data). Mìžnarodnij endokrinologìčnij žurnal. 2021;17(7):113-30. Russian. doi: 10.22141/2224-0721.17.7.2021.244969.