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ALGORITHM OF DIAGNOSIS EATING DISORDERS AND
NUTRITIONAL STATUS IN PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE, OBESITY AND
HYPERTENSION
Dm. G. D. Fadieienko Ya. V. Nikiforova
Ukraine, Kharkiv, SI «L.T. Mala National Therapy Institute of NAMS of Ukraine»
Abstract. Eating behaviour disturbance is the long-term process. Various factors can result in changes of EB and its disturbances. The study of the contribution of the EB in the etiopathogenesis of nutrition-related pandemics of the XXI century as non-alcoholic fatty liver disease, obesity, hypertension is relevant. At the present stage is being actively seeking screening methods timely diagnosis of EB and NS, that would constitute a non-invasive, inexpensive, with a minimum of contraindications and allow objectively and accurately assess the presence or absence of disturbances in the power supply and if available - to conduct timely and adequate their correction.
Keywords: eating behavior, nutritional status, non-alcoholic fatty liver disease, obesity, hypertension, Bioimpedance.
Introduction. Eating behaviour (EB), including a preference for the consumption of certain types of products, methods of their preparation, the mode and frequency of food intake plays a significant role in changing the nutritional status (NS) - a set of indicators that reflect the actual value of the preceding actual supply the body's needs. Long-term eating disorders lead to violations in the NS, which clinically manifested in the development of chronic non-communicable diseases (CHND). The study of the contribution of the EB in the etiopathogenesis of nutrition-related pandemics of the XXI century as non-alcoholic fatty liver disease (NAFLD), obesity, hypertension (H) is relevant, not only because of the medical, but also a socio-economic factor (marked increase in the population of diseases of working age). [4] Therefore, at the present stage is being actively seeking screening methods timely diagnosis of EB and NS, that would constitute a non-invasive, inexpensive, with a minimum of contraindications and allow objectively and accurately assess the presence or absence of disturbances in the power supply and if available - to conduct timely and adequate their correction.
Among the study NS methods are the most common measurement of anthropometric parameters (body mass index (BMI), waist circumference (WC), hip circumference (HC), the ratio of WC/HC), the measurement of subcutaneous fat folds. Determination of BMI to diagnose overweight (IMT>25kg/m2) or obese (IMT>30kg/m2), the definition of WC/HC allows you to diagnose abdominal obesity. This, in turn, allows you to determine the prognosis for an individual patient regarding CHND development risks (the ratio of WC/HC > 0.85 increased risk of insulin resistance
(IR), NAFLD, H, diabetes, and others.) [5]. Measurement of subcutaneous fat folds is very informative and objective indicator of health status, and is used in health care facilities during the screening.
The above diagnostic methods allow to calculate basal metabolic rate (BMR) patients - the intensity of the metabolic processes in the absence of exercise, when energy consumption is aimed only at the basic needs: to maintain body temperature, breathing and heartbeat. The advantage of the above research methods of the NS is that they are available to use at all levels of care for patients with obesity or comorbidity pathology. However, their use is limited only by the identification of overweight and obesity as indicators of violations of the NS.
More informative and modern method to study the characteristics of the individual NS is Bioimpedance (Bioelectrical impedance analysis, BIA), or Bioimpedance analysis - a common method of determining the composition of the human body by measuring the electrical resistance in the tissues. Bioimpedance is considered a more accurate method than the BMI calculation, WC/HC, so it takes into account not only the height and weight, but also the ratio of fat and lean mass. The method allows to differentiate the presence of adipose tissue (both general and visceral adipose tissue (VAT)) and big-boned body structure. It is an advantage of the method makes it possible to diagnose the metabolic risks in patients with BMI<25kg/m2, in contrast to the above methods of diagnostics of violations of the NS.
Specially designed computer program, which is equipped with a Bioimpedance device, quantifies the prevalence of a particular type of tissue in the human body, expects BMR, excluding errors in the calculation of the possible BMR mathematical method manually. Additionally, BIA allows to determine the water content in the body, located in a bound (cell) and free (extracellular) state (blood, lymph, etc.). The method helps reveal excess fluid in the body in the form of edema and local accumulation of fluid (ascites, pleural effusion, bursitis, etc). This is another advantage of the method for patients with comorbid disorders NAFLD, obesity and H, which allows you to diagnose fluid retention in the body at the preclinical stage and to conduct a timely correction of therapy.
The most common and affordable method for studying the characteristics of EB is questioning. Dutch questionnaire DEBQ (Dutch Eating Behavior Questionnair) identifies three types of violations EB: externalities, the emotion and the restrictive and degree severity. Despite the availability and simplicity of the method of diagnosis, only a few studies conducted EB obese patients [1,3] and H [2]. Research EB and its connection with the changes in the NS patients with NAFLD, H and obesity have been conducted.
On the basis of SI «L.T. Mala National Therapy Institute of NAMS of Ukraine» in the framework of the research work №0113U001139 we conducted a survey whose purpose was: to study features of EB, NS in patients with NAFLD and H in combination with abdominal obesity with the help of non-invasive diagnostic methods.
Materials and methods. A total of 90 patients (42 men and 48 women) with NAFLD, H and obesity that the main group. Patient age averaged (52,4 + 0,96) years. The control group consisted of 35 healthy people. All patients underwent a survey using the questionnaire DEBQ to determine the type of EB and further developed for the purposes of this study, a questionnaire study on the NS. All patients were determined by anthropometric measures: height, weight, BMI ((kg)/height m2), WC and HC (cm), WC/HC, carried out on the unit Bioimpedance OMRONBF-511 and NS score according to WHO recommendations.
Results and discussion. It was found that patients with NAFLD in combination with H and obesity there are three types of violations EB: externalities, the emotion and the restrictive with a significant prevalence of externalities such as EB and emotion and restrictive (52%, 28,8% and 19,2%, respectively). The degree of externalities such as EB also significantly higher at 4,9 (3,9;5,0) points compared to the severity of the emotion and restrictive (2,9 (2,6;3,9) and 1,2 (1,0;1,2) points, respectively). Moreover, women severity externalities type EB was significantly higher (p = 0,001) than in men, whereas in men the greatest degree of severity has a restrictive type of EB (p = 0,043). It was revealed that externalities type of EB is the most unfavorable regarding violations in the NS.
In the group of patients who use fat more than 100 g/day significantly higher degree of externalities such as EB, compared with patients who ate less fat 100 g/day (P<0,05). Similar exponents of externalities such as the severity of the EB obtained in respect of fruit consumption. Patients who consume sugary drinks and salt more than 5 g/day had significantly higher severity of externalities and the emotion of EB in comparison with patients who do not drink sugary drinks (p <0,05).
When comparing the dietary habits in males and females revealed differences in the amount of use of different kinds of products: fats, carbohydrates, vegetables and fruits (p = 0,047). Men who consume large amounts of fat (n = 36), compared with men with a lower consumption of (n = 6) showed a significant increase in BMI - 31,8 ± 0,6 and 25,4 ± 2,9, respectively (p = 0,004), an increase
WC - 100,4 ± 9,9 and 93,9 ± 9,9 cm (p = 0,034) and an increase HC - 104,8 ± 6,4 and 101,4 ± 4,6 cm (p = 0,045). In men, the relationship obtained with the use of fat average force BMI: r = 0,445 (p = 0,04) and the relationship with the use of fat WC and HC was r = 0,330 (p = 0,03) and r = 0,296 (p = 0,05), respectively. In women, the amount of fat intake had no effect on BMI, WC, HC, WC/HC. Men ate less fruit and vegetables than women (p = 0,042), the amount of consumed fruits and vegetables did not affect the index of BMI in men. Women who consumed up to 100 g/day of vegetables and fruits (n = 28), BMI was lower in comparison with women who consumed fruits and vegetables to 400 g/day (n = 20) - 26,9 ± 4,6 and 34,9 ± 5,4 (p = 0,044), respectively.
Patients in the control group (n = 35) revealed externalities type EB (n = 6) in 17.1%, whereas 82.9% (n = 29) EB violations have been identified. Patients in the control group with the type of externality EB often did not use the breakfast, we had a 2-3 - one-time meal and a more than 6-hour interval between meals, which is a risk factor violations of the NS in the future with the possible subsequent development of metabolic disorders and CHND.
When calculating the BMR patients using the formulas recommended by the WHO, the following data: BMR in the study group was 1670 (1450; 1800) kcal, in the control group - 2200 (1880; 2860) kcal. According to BIA BMR patients of the main group (n = 80) - 1460 (1300; 1720) kcal. These rates are lower than in the calculation of the BMR WHO formulas. Middle calorie actual power (AP) according to the questionnaire for the study of the NS core group exceeded 3,000 kcal (for externalities such as EB - 3400 (2958; 3850) kcal, for the emotion-type EB - 3200 (2800; 3950) kcal for restrictive - 3100 ( 2600; 3730) kcal). Patients control without violating EB calorie AP group corresponded to daily energy expenditure (1880 (1780; 3220) kcal and 1890 (1700; 3020) kcal, respectively) according to the WHO formula, the corresponding figures were obtained during the BIA (1860 (1800; 3100) kcal and 1900 (1860; 2890) kcal, respectively).
Conclusions. Studied types of EB violations, including in patients with NAFLD, H and obesity externalities type predominates significantly. In all groups with three types of violations detected EB most patients (86%, 80% and 76%, respectively), which are abused fats, salt and sweet drinks. The study of the NS patients with NAFLD, H and obesity showed that eating large amounts of fat in men is associated with an increase in BMI (p = 0,004), WC (p = 0,034) and HC (p = 0,045) index WC/HC (p = 0,03).
The prevalence of externalities such as EB in the study group correlated with abdominal obesity and is more commonly associated with disturbances in the NS. That confirms the need for greater use of DEBQ questionnaire in clinical practice for early diagnosis of EB and its correction for primary and secondary prevention of NAFLD, and associated diseases.
The results of our study showed that the use of BIA is more informative and reliable for the study of the NS patients with NAFLD, H and obese or overweight (BMI >25 kg / m2), while for patients with BMI <25 kg/m2 in the absence of the possibility of BIA BMR can be calculated according to the WHO recommendations.
Nowadays EB is estimated not only as lifestyle component, directed to the satisfaction of physiological and psychologic needs including: choice, ways of cooking, meal, nutritional condition and food influence for whole organism, but also as a weighable independent component of risk factors of chronic noninfectious diseases. In the future, we plan to continue investigating the relationship of different types of EB with metabolic indicators, as well as learning correction value of EB in patients with comorbid pathology of the patients.
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ИЗУЧЕНИЕ ФИЗИКО-ХИМИЧЕСКИХ СВОЙСТВ ГЕЛЯ ПОД УСЛОВНЫМ НАЗВАНИЕМ "АНТИКАНДИД"
1Дербисбекова У. Б.
1Датхаев У. М.
2Журавель И. А.
1 Казахстан, гАлматы, Казахский Национальный Медицинский Университет им. С. Д. Асфендиярова 2Украина, г. Харьков, Национальный Фармацевтический Университет,
Аннотация. В данной работе приведены результаты изучения набухающей способности высокомолекулярных соединений (ВМС), а так же изучения расторимости активного фармацевтического ингредиента (АФИ). При этом доказана необходимость разработки новых лекарственных форм с наиболее удовлетворительными технологическими свойствами.
Ключевые слова: структурообразователь, растворимость, карбопол марки Ultrez 20, димексид, пропиленгликоль, высокомолекулярные соединения, редкосшитые акриловые полимеры, метод термогравиметрического анализа (ТГА), Na-карбоксиметилцеллюлоза, набухающая способность.
Введение
В последнее десятилетие в технологии лекарственных форм стали широко применяться редкосшитые акриловые полимеры (РАП), многие из которых под названием Карбомеры, включены в зарубежные фармакопеи [1, 21.
Большой интерес к РАП обусловлен ценными свойствами их гелей: высокой вязкостью при низких концентрациях, значительной эмульгирующей и суспендирующей способностью, обеспечением высокой биодоступности и пролонгирующего эффекта, возможностью использования в большинстве видов лекарственных форм, значительной биоадгезией, отсутствием раздражающих свойств, микробиологической устойчивостью, удобством применения, совместимостью со многими группами лекарственных веществ и др. Важное значение играет и низкая стоимость РАП по сравнению с другими основообразующими вспомогателными веществами [1, 3, 4].
В настоящее время РАП используют при производстве гелей, эмульсий, суспензий, таблеток, офтальмологических препаратов и др. [5-10].
Весьма актуальной и перспективной областью применения мазей РАП может явиться использование их при изготовлении дерматологических гелей, широко встречающихся в рецептуре большинства производственных аптек Казахстана [11]. Наиболее часто при этом используются основы содержащие метилцеллюлозу и Na-карбоксиметилцеллюлозу обладающие рядом отрицательных свойств: нарушением многих функций кожи, аллергизирующим и сенсибилизирующим действием [12 - 14].
