Polycystic ovary syndrome (PCOS) is a common endocrine disease in women of reproductive age. The prevalence of this pathology is approximately 15-20%. PCOS is characterized by hyperandrogenism, hirsutism, menstrual irregularities, and polycystic ovaries. More than half of patients with PCOS have a metabolic syndrome, the main component of which is visceral obesity and insulin resistance, which play an important role in the pathophysiology of PCOS. Insulin resistance is a marker of cardiometabolic risk and can lead to cardiovascular disease and carbohydrate metabolism disorders up to type 2 diabetes mellitus (DM2). Therefore, in the treatment of patients with PCOS, an important aspect is the impact on insulin sensitivity and body weight. This review focuses on various groups of drugs that can potentially have a positive effect on metabolic disorders in PCOS. Among them are metformin, drugs with an incretin effect, as well as drugs for weight loss. Given the similarity of the metabolic and pathological features of PCOS and DM2, as well as the diversity of therapeutic options, there is a potential for expanding the strategy for the treatment of metabolic disorders in PCOS, including through antidiabetic drugs, which, however, requires further study. It should be noted that surgical treatment of obesity also has a beneficial effect and contributes to the normalization of the menstrual cycle and the normalization of the hormonal and metabolic profile in patients with PCOS and severe obesity.

The decrease in female sex hormones with age causes a decrease in muscle mass, a change in the contractile properties of muscles, as well as the infiltration of adipose tissue into muscle. This leads to a subsequent decrease in muscle strength, functional disorders, and disability. In this regard, the development of simple screening techniques to detect low muscle mass is relevant. Aim of the study: to determine the threshold values of anthropometric obesity indices for detecting low muscle mass in elderly women. Materials and methods: the study included 593 elderly women (average age 63.19 ± 2.11 years). All participants were measured anthropometric indicators (height, weight, body mass index (BMI, kg/m2), waist circumference (WC), hip circumference (HC), the ratio of OT to height (OTR), triglyceride levels (TL), high density lipoproteins (HDL), body composition using bioimpedance analysis. Results: The study participants had a BMI of 28.49±5.17 kg/m2 and WC 95.35±10.39 cm, the prevalence of low muscle mass was 19.4%. The threshold values of anthropometric obesity indices for screening low muscle mass in elderly women for BMI were 29.4 kg/m2, for WC - 94.3 cm, for WC/HC - 0.91, for OTR - 0.64, for IR - 1.34, for IOT - 39.1, for INL - 51.4. Logistic regression analysis showed that that age over 60 years (OR = 3.8; CI 95%: 2.2-6.8), WC (OR = 6.2; CI 95%: 1.4-28.1), WC/HC (OR = 1.8; CI 95%: 1.0-3.4), OTR (OR = 5.0; 95% CI: 1.0-23.7) and IOT (OR = 14.5; 95% CI: 6.6-31.7) were associated with low muscle mass (p<0.05). Conclusions: in this study, the threshold values of anthropometric obesity indices for screening low muscle mass in elderly women were determined, which is of great practical importance for early diagnosis of sarcopenia, its monitoring during therapeutic and preventive measures.

Objective: to study and clinically substantiate the relationship between overweight and the dynamics of CKD progression in patients with type 2 diabetes of different age groups using the diagnostic parameter Index of glomerular filtration rate reduction. Material and methods: a single-stage cross-sectional observational study of clinical indicators in a population sample of patients with type 2 diabetes of different age groups was performed, patterns of relationships, significance of differences in mean values and measures of influence (OR (95%CI)) were studied between the indicators of BMI, the stage of obesity and the presence of a diagnosis of obesity in the anamnesis and the original calculated diagnostic parameter, the Index of glomerular filtration rate reduction (RI_GFR), which allows to give an objective quantitative characteristic of the rate of progression of CKD. Results: significant correlations were established between RI_GFR and indicators of age, BMI, DM experience and duration of insulin therapy, a significant inverse relationship with BMI was noted only in the older group; when analyzing differences in the average values of clinical indicators in the groups of rapid and slow progression of CKD, divided by the threshold value of RI_GFR, significant factors affecting the rate of progression were determined CKD: DM experience, duration of insulin therapy, BMI; the logistic regression analysis determined the measure of the influence of the above factors on the dynamics of GFR reduction, confirmed its significance; when analyzing the factors of drug treatment in the elderly group, it was revealed that an integrated approach to the appointment of antihypertensive therapy (prescribing drugs of three or more groups) significantly reduces the risk of rapid progression of CKD. Conclusions: the most significant risk factors for the high rate of progression of CKD in patients with type 2 diabetes and overweight in the general sample and in patients of the older age group are the length of diabetes and duration of insulin therapy; the dynamics of GFR reduction in patients with type 2 diabetes of different age groups is interrelated with BMI, and in patients with overweight CKD progresses more slowly; an integrated approach to prescribing antihypertensive therapy (prescribing drugs of three or more groups) in elderly patients with type 2 diabetes significantly reduces the risk of rapid progression of CKD.

The article substantiates the need for adequate fixed combination therapy for metabolic syndrome and arterial hypertension (AH). The issues of inflammation in the initiation and stabilization of arterial hypertension in patients with metabolic syndrome (MS) are considered. Taking into account the results of international and Russian studies, a differentiated approach is proposed to select a fixed combination of antihypertensive drugs for the treatment of hypertension and prevention of cardiovascular complications in patients with MS.

It is known that metabolic syndrome is currently the leading cause of the development of cardiovascular pathology, which occupies a leading position in the structure of mortality not only in the Russian population, but also in the world. The prevalence of MS is growing, which is associated with stressful professions, eating disorders. The presence of MS is associated with arterial hypertension and atherosclerosis of the arteries of any localization. In this regard, the purpose of our study was to study the quality of life in patients with MS, depending on the severity of coronary atherosclerosis. Materials and methods: The study included 239 patients (142 men, 97 women) with MS with atherosclerosis of the coronary and carotid arteries. The number of subjects in group 1 (n=141), of which 101 were men and 40 were women. The second group consisted of 84 male and 14 female patients (n=98). The control group consisted of 70 people (27 men, 43 women) with grade 1-3 hypertension. The age of the subjects was 31-56 years. All patients underwent: collection of complaints and anamnesis, assessment of body mass index (BMI); determination of the lipid spectrum, blood glucose, glycated hemoglobin. Microalbuminuria and glomerular filtration rate were determined. Instrumental studies were carried out: ultrasound examination of brachiocephalic vessels with determination of the thickness of the intima-media complex and the percentage of carotid artery stenosis; coronary angiography on the General Electric Innova 3100 angiographic complex. Based on the results of coronary angiography, the patients were divided into two subgroups: group 1 - with coronary artery stenosis of less than 50% (n=141), group 2 - with stenosis of 50% or more (n=98), group 3 (control) without stenotic lesions of the coronary arteries. A non-specific questionnaire “SF-36 Health Status Survey” was used to assess the quality of life. Results: assessing physical functioning and mental health, there was a significant decrease in these indicators in patients of group 2, in whom, according to coronary angiography, hemodynamically significant coronary artery stenoses were diagnosed, a strong correlation (r=0.730; p=0.005) was revealed between deterioration in quality of life and hemodynamically significant stenosis of the carotid and coronary arteries. Restriction of physical activity and reduction of daily activities were more significant in group 2 compared to groups 1 and 3. The feeling of uncertainty with restless expectation and fears, as well as a feeling of depression prevailed in men. However, patients after percutaneous coronary intervention, as well as with lipidogram correction, assessed the quality of life with some restriction of physical activity, but with significant social functioning. Conclusions: hemodynamically significant atherosclerosis of the carotid and coronary arteries is a predictor of deterioration in the quality of life, especially in men. The use of the international questionnaire “SF-36 Health Status Survey” is appropriate for assessing the health and vital activity in patients with MS and hypertension, with signs of atherosclerosis. The interaction of a cardiologist, an endocrinologist and a psychotherapist are justified for the most optimal management of patients with comorbid pathology.

Relevance. Metabolic disorders in non-alcoholic fatty liver disease play a significant role in the development and progression of cardiovascular diseases, accelerating their occurrence, aggravating their course and outcomes. The occurrence and maintenance of a chronic staged course (from fatty hepatosis and non-alcoholic steatohepatitis to progressive liver fibrosis) of the disease is associated with quantitative and qualitative changes in the composition of the intestinal microflora. At the same time, outpatients may consider themselves healthy, which makes it difficult to implement a comprehensive treatment program. The peculiarities of the combination of clinical, laboratory and microbiological characteristics of patients with hepatic steatosis require detailed study for the earliest identification of therapeutic targets, diagnostic and prognostic tools and their effective correction. Purpose of the study: to determine the clinical, laboratory and microbiological characteristics of patients with non-alcoholic fatty liver disease. Material and methods: clinical, laboratory and microbiological data of outpatients were collected, anthropometric indicators were calculated. Statistical analysis: Microsoft Excel 2010 and StatTech v.3.1.8 (Russia) with assessment for normality of distribution and chi-square test. Differences were assessed by nonparametric analysis at a significance level of p<0.05. Results. Patients were assigned to the observation group if they had NAFLD or to the comparison group in it absence. Many patients in the observation group were found to have metabolic syndrome and/or abdominal obesity, accompanied by asthenic syndrome, functional disorders of the biliary tract, and disorders of lipid and carbohydrate metabolism. In the luminal microflora of the intestines of patients in the observation group, the presence of representatives of Pseudomonas spp. was significantly more often detected. Correction of microbiological disorders by adding dietary fiber to the diet provided clinical improvement. Conclusion. In addition to clinical and laboratory data, microbiological characteristics of patients can be used for the earliest diagnosis and effective correction of disorders that occur during the development of NAFLD.

The increase in the prevalence of obesity in recent decades is an urgent medical and social problem for all countries, increasing the cost of medical care and worsening the quality of life of patients. Obesity is an independent risk factor for the development of a number of chronic non-infectious diseases, including respiratory diseases. The presence of excess body weight not only provokes the development of bronchopulmonary pathology, but also aggravates its course. The article discusses the mechanisms of the impact of obesity on the pathogenesis of diseases such as bronchial asthma, chronic obstructive pulmonary disease and coronavirus infection.

Objective: To compare the efficacy of continuous controlled attenuation parameter (CAPc) compatible with vibration-controlled transient elastography (VCTE) versus standard controlled attenuation parameter (CAP) in a population of patients with non-alcoholic fatty liver disease (NAFLD). Materials and methods: A retrospective analysis of the database of patients (n = 582), divided into two groups: NAFLD group (n = 342) and control group (n = 240), was performed. The database was formed in the period from 2021 to 2023. The assessment of VCTE with CAP was carried out using two elastographs (FibroScan 530® and FibroScan 630 Expert®). The indicators of biochemical blood test, lipid and carbohydrate metabolism were evaluated. Statistical calculations were performed using STATISTICA13.0 (StatSoftInc., USA). Results: When comparing CAP with CAPc, statistical differences between CAP (264.7 ± 61.2) and CAPc (260.1 ± 57.4) (P < 0.0001), IQRCAP (36.4 ± 21.7) and IQR CAPc (13 ± 7.8) (P<0.0001) were found. When considering the stages of liver steatosis, no differences were found (p=0.32). A high degree of correlation was found between CAP and CAPc (R²=0,87). The analysis showed high sensitivity and specificity of CAPc compared to CAP for S0 (85.2% and 88.5%) and S3 (81.2% and 91.2%) stages vs S1 (41.4% and 91.0%) and S2 (25.0% and 93.7%) stages. When analyzing mismatches, it was shown that the main share of mismatches falls within the interval between two adjacent stages (one for S0 and one for S3): S0: 10.7%, S1: 42.8%, S26 62.5% and S3: 10.0%. Conclusion: Since IQR CAPc is 3 times less than IQR CAP, CAPc has high diagnostic efficiency. On the other hand, CAPc and CAP scores are highly correlated, and the stages of liver steatosis calculated with CAPc and CAP are not statistically different, which indicates the equivalence of the results of two elastographs.

Non-communicable diseases, among which arterial hypertension and ischemic heart disease are the predominant contributors to disability and mortality, have long been identified as a strategic target of preventive intervention in our country. The situation is aggravated by covid-19 associated mortality, which is characterized by delayed dynamics and is largely related to cardiovascular. Excess mortality, in the structure of which cardiovascular diseases are leading, requires new solutions. One of them is population pharmacoprevention, based on the use of complex fixed combinations of drugs targeting different risk factors, as arterial hypertension and dyslipidemia, as most important. This concept, which logically follows from modern realities, is in contradiction with the existing approach of personalized therapy in high/very high risk groups, because of its complexity, leading to patients noncompliance. The new system of cardiovascular risk stratification SCORE 2 introduced in the Russian Federation significantly contributes to the spread of the concept of polypills as a unified approach primarily in the most vulnerable population of males 50 years and older.

This article highlights the pharmacological activity of licorice metabolites of significant interest in the context of the treatment of cancer, cardiovascular, and respiratory diseases. The review details the diversity and efficacy of lichalocone, isoliquiritigenin, liquiritigenin, and other licorice metabolites that exhibit anti-inflammatory, antimicrobial, and antioxidant effects. These effects are based on the ability of licorice metabolites to regulate molecular cascades responsible for apoptosis, cell cycle, cell proliferation and many other processes. The article discusses in detail the prospects for the use of licorice metabolites in oncology, cardiology, their potential in the development of new drugs and the need for further research to determine their full therapeutic potential.

Aging is associated with a change in body composition, which is an increase in the proportion of fat mass, usually against with decrease in muscle mass. In addition, obesity is often associated with metabolic syndrome, type 2 diabetes mellitus (DM2), and cardiovascular diseases. Visceral obesity is more dangerous than excessive accumulation of subcutaneous fat. An accurate assessment of body composition can provide useful information about the health and functions of the body. However, it can be difficult to determine the exact content of musculoskeletal and adipose tissue in the body of geriatric patients. Anthropometric methods are easy to use and do not require complex and expensive equipment, but they are uninformative and have low accuracy. The issue of timely diagnosis of the compositional composition of the body in older age groups is relevant for predicting the risk of developing chronic non-communicable diseases, disability.

Obesity is an important medical and social problem, it occupies one of the leading places among cardiovascular risk factors. Obesity is a major component of the metabolic syndrome. It has a close pathogenetic relationship with its other manifestations, as a result of which a portrait of a comorbid patient is formed. The article presents data on the prevalence, criteria for diagnosing obesity, the relationship of obesity with other components of the metabolic syndrome is shown. The role of adipose tissue dysfunction in obesity on the development and progression of insulin resistance, atherosclerosis, as well as its relationship with non-alcoholic fatty liver disease and arterial hypertension is discussed. It is shown that obesity is a comorbidity factor and the basis of the metabolic syndrome, the leading pathogenetic mechanism in the formation and progression of its components, preceding their occurrence. This allows us to conclude that weight loss can reduce cardiovascular risks, reduce the manifestations of the metabolic syndrome, and in some cases even eliminate them completely.

One of the risk factors for the development of sarcopenia is malnutrition. Impairment of the energy value of the diet, the balance of proteins, fats and carbohydrates, a decrease in the protein-amino acid component of the nutritional diet - all this can lead to the development of sarcopenia. The intestinal microflora plays an important role in the process of growth and development of muscle tissue, in preventing its degradation with age. Fatty hepatosis and cirrhosis of the liver can also cause the development of sarcopenia. The problem is urgent and modern, and needs to be studied, which is what this literature review is dedicated to.

The literature review examines the role of nutrition in the development of skeletal muscles. The pathogenesis of the development of sarcopenia and modern aspects of its diagnosis are outlined. Possible options for the influence of drugs on the state of skeletal muscles and its functional activity are presented. The relationship between sarcopenia and non-alcoholic fatty liver disease with proposed approaches to the treatment of these comorbid diseases is considered.

Currently, special attention is drawn to the phenomenon of comorbidity of chronic non-infectious diseases. The emergence of comorbidity is facilitated by the high incidence of coexisting diseases. One such combination is GERD and metabolic syndrome (MS). GERD and MS are multifactorial diseases, the pathogenesis of which is intertwined and mutually aggravates each other. Every year throughout the world and the Russian Federation, there is a clear trend towards an increase in the incidence of pathology of the upper gastrointestinal tract, namely gastroesophageal reflux disease (GERD). The prevalence of obesity in Russia over 40 years of observation has increased 4 times among men and 1.5 times among women. Despite the high incidence, to date there is no diagnosis of “metabolic syndrome” (MS) in ICD-10. MS is coded based on its constituent pathologies (obesity, dyslipidemia, insulin resistance, arterial hypertension). Treatment of this comorbid pathology requires a multidisciplinary approach, thereby placing a high burden on the healthcare system. This article displays the features of the pathogenesis and clinical picture of GERD, as well as the combination of this pathology with the components of MS.

Sarcopenia is a chronic age-associated disease, the prevalence of which increases with aging. The primary form is associated with aging, when no other causes have been identified, the cause of secondary sarcopenia may be various diseases, including type 2 diabetes mellitus (DM2). One of the common links in the pathogenesis of DM2 and sarcopenia is insulin resistance. A combination of sarcopenia and obesity is often observed. The interrelation of these pathological processes, etiology and pathogenesis are presented in this literature review.

Adipose tissue is an active endocrine organ that regulates energy homeostasis throughout the body by releasing hundreds of biologically active substances called adipokines. Dysregulation of adipokines is a key feature of insulin resistance with the development of metabolic syndrome and type 2 diabetes mellitus, which is an age-dependent pathology. In turn, dysregulation of adipokines and insulin resistance are associated with the development of metabolic deficiency and senile asthenia syndrome in older age groups. Previous studies have shown that the absence of insulin resistance and low prevalence of diabetes among centenarians are metabolic prerequisites for increased lifespan, suggesting a possible role for adipokine homeostasis in healthy longevity. Among numerous adipokines, adiponectin is considered a protective factor, showing a negative correlation with major metabolic disorders associated with age and obesity, and a positive association with life expectancy and insulin sensitivity among centenarians. Despite all the apparent protective effects of adiponectin, large-scale epidemiological studies have revealed the opposite aspect of adiponectin as a predictor of all-cause mortality and cardiovascular disease in patients with heart failure as well as kidney disease. In this review, the clinical significance of adiponectin is considered in centenarians from the point of view of the development of the main geriatric syndrome - senile asthenia, as well as cardiovascular risk and mortality.