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ОРИГИНАЛЬНЫЕ
СТАТЬИ
UDC: 616-056.52-06:616.33-072.1-089
Nazirov Feruz Gafurovich
Doctor of Medical Sciences, Professor, Academician of the Academy
of Sciences of Uzbekistan, director of State Institution “Republican
Specialized Sciense-Practical Medical Center of Surgery,
named after academician V.Vakhidov”, Tashkent, Uzbekistan.
https://orcid.org/0000-0002-2772-3984
Khaybullina Zarina Ruslanovna
DSc, the chief of biochemistry department of State Institution
“Republican Specialized Sciense-Practical Medical Center of Surgery,
named after academician V.Vakhidov”, Tashkent, Uzbekistan.
Khashimov Shukhrat Khurshidovich
DSc, the chief of endovisual surgery department of State
Institution “Republican Specialized Sciense-Practical Medical Center
of Surgery, named after academician V.Vakhidov”, Tashkent, Uzbekistan.
Sharapov Nodir Utkurovich
DSc, the chief of functional diagnostics department
of State Institution “Republican Specialized Sciense-
Practical Medical Center of Surgery, named after
academician V.Vakhidov”, Tashkent, Uzbekistan.
Makhmudov Ulugbek Marufjanovich
PhD, endovisual surgery department of State Institution
“Republican Specialized Sciense-Practical
Medical Center of Surgery, named
after academician V.Vakhidov”, Tashkent, Uzbekistan.
Abdullaeva Saodat Daniyarovna
a doctor of biochemistry department of
State Institution “Republican Specialized Sciense-
Practical Medical Center of Surgery,
named after academician V.Vakhidov”, Tashkent, Uzbekistan.
CARDIOMETABOLIC RISK REDUCTION AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
For citation:
Nazirov F. G. Khaybullina Z. R., Khashimov Sh.t Kh., Sharapov N. U., Makhmudov U. M. Abdullaeva S.D.
Cardiometabolic risk reduction after laparoscopic sleeve gasterectomy. Journal of cardiorespiratory research. 2020, vol. 1, issue 1,
pp.54-58
http://dx.doi.org/10.26739/2181-0974-2020-1-7
ABSTRACT
According to statistical data, published in New England Journal of Medicine, Republic of Uzbekistan is leading among the countries
of the Central Asia by number of people with excessive weight – they are 44,5 %, and 20,4 % of them are with superobesity. Surgical
bariatric treatment of obesity is the unique method which has proved stable efficiency in reduction of excessive weight at patients with
morbid obesity for a long time. The purpose of this study was evaluation of cardiometabolic risk regression after laparoscopic sleeve
gasterectomy (LSG). There were observed 35 women with morbid obesity. It was established that cardiometabolic risk reduced after
LSG because number of women with average risk by CMDS is reduced in 2 times, with low risk is increased in 1,6 times 12 month
after surgery. Level of proinflammatory cytokine IL-6 and CRP start declining at earlier period after LSG. Volumetric - linear
parameters of heart change synchronously with reduction of excessive weight and is proportional to changes of a surface of a div.
Key words:
morbid obesity, cardiometabolic risk, laparoscopic sleeve gastrectomy
Назиров
Феруз
Гафурович
доктор
медицинских
наук
,
профессор
,
академик
АН
РУз
,
директор
ГУ
«
Республиканского
специализированного
научно
-
практического
медицинского
центра
хирургии
им
.
академика
В
.
Вахидова
»,
г
.
Ташкент
,
Узбекистан
.
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55
https://orcid.org/0000-0002-2772-3984
Хайбуллина
Зарина
Руслановна
доктор
медицинских
наук
,
руководитель
отдела
биохимии
ГУ
«
Республиканского
специализированного
научно
-
практического
медицинского
центра
хирургии
им
.
академика
В
.
Вахидова
»,
г
.
Ташкент
,
Узбекистан
.
Хашимов
Шухрат
Хуршидович
доктор
медицинских
наук
,
руководитель
отдела
эндовизуальной
хирургии
ГУ
«
Республиканского
специализированного
научно
-
практического
медицинского
центра
хирургии
им
.
академика
В
.
Вахидова
»,
г
.
Ташкент
,
Узбекистан
.
Шарапов
Нодир
Уткурович
доктор
медицинских
наук
,
руководитель
отдела
функциональной
диагностики
ГУ
«
Республиканского
специализированного
научно
-
практического
медицинского
центра
хирургии
им
.
академика
В
.
Вахидова
»,
г
.
Ташкент
,
Узбекистан
.
Махмудов
Улугбек
Маъруфжанович
кандидат
медицинских
наук
,
заведующий
отделением
ГУ
«
Республиканского
специализированного
научно
-
практического
медицинского
центра
хирургии
им
.
академика
В
.
Вахидова
»,
г
.
Ташкент
,
Узбекистан
.
Абдуллаева
Саодат
Данияровна
врач
-
биохимик
отдела
биохимии
ГУ
«
Республиканского
специализированного
научно
-
практического
медицинского
центра
хирургии
им
.
академика
В
.
Вахидова
»,
г
.
Ташкент
,
Узбекистан
.
СНИЖЕНИЕ
КАРДИОМЕТАБОЛИЧЕСКОГО
РИСКА
ПОСЛЕ
ЛАПАРОСКОПИЧЕСКОЙ
РУКАВНОЙ
РЕЗЕКЦИИ
ЖЕЛУДКА
РЕЗЮМЕ
Республика
Узбекистан
лидирует
среди
стран
Центральной
Азии
по
количеству
людей
с
излишним
весом
–
их
44,5%,
причем
у
20,4% -
сверхожирение
.
Хирургическое
лечение
является
наиболее
эффективным
методом
лечения
морбидного
ожирения
(
МО
)
в
аспекте
долгосрочного
эффекта
снижения
избыточной
массы
тела
.
Целью
исследования
было
изучение
регресса
кардиометаболического
риска
после
лапароскопической
рукавной
резекции
желудка
(
ЛРРЖ
).
Обследовано
35
женщин
с
МО
.
Установлено
,
что
после
ЛРРЖ
кардиометаболический
риск
статистически
значимо
снижается
:
число
женщин
со
средним
риском
по
CMDS
снижается
в
2
раза
,
с
низким
риском
-
увеличивается
в
1,6
раза
.
После
ЛРРЖ
снижается
уровень
провоспалительных
факторов
–
С
-
реактивного
белка
и
интерлейкина
-6.
Объемно
-
линейные
параметры
сердца
через
12
месяцев
после
ЛРРЖ
изменяются
синхронно
со
снижением
избыточной
массы
тела
и
пропорционально
изменениям
поверхности
тела
.
Ключевые
слова
:
морбидное
ожирение
,
кардиометаболический
риск
,
лапароскопическая
рукавная
резекция
желудка
.
Nazirov Feruz Gafurovich
tibbiyot fanlari doktori, akademik, DK “akad. V.Voxidov nomli
Respublika ixtisoslashtirilgan ilmiy-amaliy tibbiet
xirurgiya markazi” direktori, Toshkent sh., O’zbekiston.
https://orcid.org/0000-0002-2772-3984
Xaybullina Zarina Ruslanovna
tibbiyot fanlari doktori, professor, O'zbekiston Respublikasi
Fanlar akademiyasi akademigi, DK “akad. V.Voxidov nomli
Respublika ixtisoslashtirilgan ilmiy-amaliy tibbiyot xirurgiya
markazi” biokimyo bo’limi boshlig’i, Toshkent, O'zbekiston.
Xashimov Shuxrat Xurshidovich
tibbiyot fanlari doktori, DK “akad. V.Voxidov nomli
Respublika ixtisoslashtirilgan ilmiy-amaliy tibbiet xirurgiya
markazi” endovizual jarroxlik bulimi boshligi, Toshkent, O'zbekiston.
Sharapov Nodir Utkurovich
tibbiyot fanlari doktori, DK “akad. V.Voxidov nomli
Respublika ixtisoslashtirilgan ilmiy-amaliy tibbiyot xirurgiya
markazi” funktsional diagnostika bo’limi boshlig’I, Toshkent, O'zbekiston.
Maxmudov Ulug’bek Ma
ʼ
rufjanovich
tibbiyot fanlari nomzodi, DK “akad. V.Voxidov nomli
Respublika ixtisoslashtirilgan ilmiy-amaliy tibbiyot xirurgiya
markazi” endovizual jarroxlik bo’limi jarrox, Toshkent, O'zbekiston.
А
bdullaeva Saodat Daniyarovna
DK “akad. V.Voxidov nomli Respublika ixtisoslashtirilgan
ilmiy-amaliy tibbiyot xirurgiya markazi” biokimyo
bo’limi shifokor-bioximik, Toshkent, O'zbekiston.
OSHQOZONNING L
А
P
А
ROSKOPIK QISM
А
REZEKTSIYASID
А
N KEYINGI K
А
RDIOMET
А
BOLIK X
А
VFNING
K
А
M
А
YISHI
А
NNOTATSIYA
O
ʼ
rta Osiyo bo
ʼ
yicha O
ʼ
zbekiston Respublikasi og
ʼ
ir vaznli, ya
ʼ
ni semizlikning ko
ʼ
rsatkichlari yuqoriligi bilan - 44.5% ni, shuningdek
o
ʼ
ta semizlikning - 20,4% ko
ʼ
rsatkichlari bilan yetakchi o
ʼ
rinni egallaydi. Uzoq muddat davomida tananing ortiqcha vaznini yetarlicha
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kamaytirishdan ko
ʼ
ra xirurgik jarrohlik morbid semirishni (MS) davolashda eng samarali usul hisoblanadi. Tadqiqot maqsadi
oshqozonni laporoskopik qismi rezektsiyadan (OLQR) keyingi kardiometabolik xavfning pasayishini o
ʼ
rganish. Morbid semirgan 35
nafar ayol ko
ʼ
rib chiqilgan. OLQR dan so
ʼ
ng kardiometabolik xavf statistik jihatdan sezilarli darajada pasaygani aniqlandi: CMDS
bo’yicha aniklanganida o
ʼ
rtacha xavfga moyil ayollar soni 2 barobarga kamaydi, past xavfga moyilliklari esa 1,6 marotaba oshdi.
OLQR so
ʼ
ng yallig
ʼ
lanishga moyil faktorlar - S reaktiv oqsili va interleykin – 6 miqdorlari pasaydi. Yurakning hajmli-chiziqli
parametrlari OLQR dan 12 oydan keyin ortiqcha vaznning kamayishi bilan birgalikda sinxron ravishda tana yuzasi proportsional
o
ʼ
zgarib borishi kuzatildi.
Kalit so’zlari:
morbid semirishi, kardiometabolik xavf, oshqozonning laparoskopik qismi rezektsiyasi.
Introduction.
According to statistical data, published
in New England Journal of Medicine, Republic of Uzbekistan is
leading among the countries of the Central Asia by number of
people with excessive weight – they are 44,5 %, and 20,4 % of
them are with superobesity [10]. Surgical bariatric treatment of
obesity is the unique method which has proved stable efficiency
in reduction of excessive weight at patients with morbid obesity
for a long time [4,12]. Weight loss is associated with reduction
of comorbidity, because reduction of cardiovascular diseases
(CVD) observed in 80% of patients [15], number of patients with
arterial hypertension (AG) decreased on 52-92%, with
dyslipidemia - on 63%; reduction degree of hepatosis observed
in 82% of patients after bariatric surgery. Liver fibroses at
nonalcoholic fatty liver disease patients decreased in 20% of
cases; 83% of patients achieved remission of diabetes mellitus 2
type (DM2), in 95% of patients the quality of life became
improved after bariatric surgery [2,4,6]. Taking into account
importance of the problem of obesity, in 1997 the International
federation of surgery of obesity (IFSO) was formed. Its annually
publishes the report about bariatric operations worldwide in the
Global Register of IFSO. According to this data, women are
73,7% (50-93 %) of bariatric surgeon patients [7], most of
operations - 99,3% performed by laparoscopy technique [11]. In
view of close link of obesity with arterial hypertension and
disturbances in carbohydrate and lipid metabolism, WHO (2014)
offered to expand diagnostic criteria of obesity with accentuation
of its metabolically healthy (MHP) and metabolically unhealthy
(MUHP) phenotypes. MUHP characterizes with increase visceral
adipose tissue depots (abdominal, epicardial, perivascular) and
laboratory markers such as hyperglycemia, hypertriglyceridemia,
insulin resistance, dyslipidemia, C-reactive protein (CRP)
increasing in combination with arterial hypertension [14].
Besides, it is recommended to estimate "global
cardiometabolic risk", which represents absolute risk of
development of cardiovascular diseases and DM-2 for patients
with morbid obesity (MO) [8,13]. For this purpose it is offered to
use as classical risk factors of CVD - smoking, high cholesterol,
AG, hyperglicemia and the factors directly associated with
obesity (insulin resistance, a low level of high density
lipoproteins (HDL-C), hypertriglyceridemia (TG) and
proinflammatory markers [1,3]. The TG/HDL-C index is an
independent predictor for coronary heart disease and can identify
cardiometabolic risk [9]. Data of echocardiography (Echo-KG) at
patients with obesity can approve cardiac function disturbances.
The purpose
of this study was evaluation of
cardiometabolic risk regression after laparoscopic sleeve
gasterectomy (LSG).
Material and Methods.
There were observed 35
women with morbid obesity, treated in State Institution
“Republican Specialized Science-Practical Medical Center of
Surgery, named after academician V.Vakhidov” in 2015-2020
years. Inclusion criteria were sex (only women), age (only 18-44
years), morbid obesity (BMI>40,0 kg/m
2
), non smoking. An
average age was 33,2±0,9 years ; BMI = 44,4 ±1,0 kg/m2. 10
controls were women - volunteer at age 38,4±1,9 years old
without obesity, BMI=23,4±0,3kg/m2, WC = 76,1±1,0sm.
Phenotype of obesity determined according S.V. Nedogoda
(2016) [3], criteria of MUHP were waist circumference (WC)
more 88 sm, fast glucose level more 5,6 mmol/l, TG level more
1,7 mmol/l, dyslipidemia – HDL-C less 1,3 mmol/l, systolic
blood pressure more 130/80 mm Hg [3]. Laboratory tests
included CRP and routine biochemical tests (lipidomic panel,
total protein, albumin, glucose, which were made in automatic
biochemical
analyzer
“VITROS-350”
(Ortho
Clinical
Diagnostics, USA). IL-6 were measured in the blood serum using
commercially available ELISA kits (VECTOR-BEST, Russia) in
immunoassay analyzer ST-360, (China). Cardiometabolic
Disease Staging (CMDS) evaluated according Guo F. et al.
(2015) recommendations [8]. Laparoscopic sleeve gasterectomy
(LSG) was performed on laparoscopic track (Karl Storz, GMBH
& CoKG, Germany) with energy platform Force Triad and
technology Liger Sure (USA). Duration of observation was 12
months after LSG. For each patient up to 10 controls were
matched by pre-surgery BMI, WC, age, laboratory tests. The
results are presented as the M ± m. Echo-KG was performed
on “Sonos 2500”.
Results and Discussion.
Laboratory tests data shows
that mean level of total cholesterol (TC), TG, HDL-C levels were
increased in obese women versus to the control in 1,17 (p>0,05);
2,9 (p<0,05) and 1,67 (p<0,05) times respectively; TG/HDL-C
ratio was increased in 3,7 times (p<0,05). Before LSG
distribution of MUHP components of obesity at women has
shown, that the increase the systolic blood pressure (SBP) had 24
(68,6%) patients, increase of glucose more than 5,6 mmol/l - had
20 (57,1%), hypertriglyceridemia more than 1,7 mmol/l - had 6
(17,1%) women, decrease HDL-C less than 1,3 mmol/l – had 29
(82,8%) patients. Proinflammatory cytokine IL-6 and CRP level
were increased exactly versus to the control (p<0,05) in 2,7 and
3,5 times respectively.
The estimation of cardiometabolic risk by CMDS has shown, that
before bariatric surgery increase of WC, without pathological
changes in markers of carbohydrate and lipid metabolism was at
5 patients (14,3%). A combination of increase of SBP with
dyslipidemia (1 stage on CMDS) is revealed at 7 (20 %); a
combination of increase of SBP with hyperglycemia and
disturbances of one of the lipidomic profile markers (2 stage on
CMDS) - at 11 (31,4 %); increase WC, hyperglycemia and
pathological changes of two and more parameters of lipidomic
profile (3 stage on CMDS) - at 3 (8,6 %), and 4 stage on CMDS
was at 9 (25,7 %) patients at whom was DM-2 (n=8) and ischemic
heart disease (IHD) (n=1).
Early postoperative period after LSG (7-th day) characterized by
significant decreasing TG (from 2,4±0,3 before surgery to
1,8±0,2 mmol/l after LSG), TC (from 5,3±0,2 to 4,4±0,2 mmol/l
and TG/HDL-C ratio (from 2,8±0,1 to 1,9±0,2) (p<0,05) versus
pre-surgery level. This changes took place long before weight
loss and may be caused by positive changes in adipose tissue (AT)
metabolism after LSG due to decreasing of inflammation and TG
accumulation in AT. This hypotheses is confirmed by IL-6 and
CRP concentrations decreasing exactly on the 7-th day after LSG.
IL-6 level decreased from 24,7±2,2 to 17,9 ±3,0 pg/ml; CRP
decreased from 16,1± 0,3 to 10.2 ±0,3 mg/l at 7-th day after LSG.
12 months after LSG BMI was 33,2 ±0,7 kg/m2, that
demonstrates high restrictive effect of this method of bariatric
surgery. The estimation of metabolic efficiency of LSG in 12
months after surgery has shown, that number of patients with
hyperglycemia decreased in 2,9 times, with AG- in 3,5 times.
Mechanism of hypoglycemic efficacy of LSG may include not
only restriction of food intake, but incretines secretion change.
LSG does not cause malabsorbtion and digestive tract
reconstruction, but it can causes elevation of incretines secretion
and may have positive effect on insulin resistance. Incretines
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provides insulinocytes activation and early secretion of the
insulin as a response to hit of the food in gastrointestinal tract.
Some of incretines, such as glucagon-like peptide -1 (GPP-1) can
inhibited gluconeogenesis and glycogen degradation in liver,
raises the consumption and salvaging the glucose in skeletal
musculature. Hypothalamus and pituitary gland have receptor to
GPP-1 too, stimulation of these receptors decreased appetite [5].
The estimation of CMDS has shown, that 1 year after
LSG the number of patients with III and IV stages authentically
has not decreased, because IHD and DM-2 have only regression
but not total recovery. However, there was a clinical
improvement of IHD and DM-2 that was showed in transition of
disease in easier stage. The amount of patients with II stage on
CMDS has decreased in 2,8 times, and with I a stage - has
increased, due to change of ratio of patients with low and high
cardiometabolic risk. In comparative aspect the diagram of
distribution of patients with low and high cardiometabolic risk
according CMDS 12 months after LSG is shown on fig. 1,2.
Fig.1. Distribution of women with
МО
depending on
a degree of CMDS (number of patients).
Fig.2. Distribution of women with
МО
depending
on a degree of CMDS (%).
The estimation of factors of an inflammation after LSG
has shown, that IL-6 decreased in 1,6 time versus level before
surgery (p<0,05), CRP was 4,9±0,3 mg/l, that not differ from the
control (p > 0,05).
Studying of volumetric - straight-line characteristics
of heart according to Echo – KG data has shown, that at women
with
МО
end diastolic volume (EDV), end systolic volume (ESV)
l parameters are necessary for estimating extremely in
recalculation on the area of a surface of a div. The threshold of
values for an establishment high cardiometabolic risk at women
with BMI more 40 kg/m2 according ROC analysis were more
than 55,0 ml for EDV (AUC= 0,719, Sensitivity- 60,5%) and less
than 22 ml for ESV (AUC= 0,724, Sensitivity- 62,5%) (fig.3).
Fig.3. AUC for EDV and ESV in obese women.
Measurement of output fraction of left ventricular (OF) have not different from reference value both before and after LSG. Data of
Echo-KG in women with MO before and after LSG shown in the table 1.
Table 1.
Data of Echo-KG in women with MO before and after LSG
Period of estimation
ESV/m2 (ml)
EDV/m2 (ml)
OF, (%)
Before LSG,
р
1
24,9±0,8
62,0±1,6
60,3±0,4
12 months after LSG,
р
2
23,5±1,1
57,4±1,0
58,8±0,4
р
1:
р
2
>0,05
>0,05
>0,05
This data suggests that changes of geometry of heart and its
constrictive function in dynamics of weight reduction occur
synchronously to decrease of excessive weight and is
proportional to changes of a surface of a div.
Conclusions.
1. Cardiometabolic risk reduced after LSG because
number of women with average risk is reduced in 2
times, with low risk is increased in 1,6 times 12 month
after surgery.
2. Level of proinflammatory cytokine IL-6 and CRP start
declining at earlier period after LSG.
3. Volumetric - linear parameters of heart change
synchronously with reduction of excessive weight and
is proportional to changes of a surface of a div.
low risk
middle risk
high risk
12
14
9
19
8
8
before LSG
12 month
after LSG
before LSG
12 month after LSG
34
54
40
23
26
23
low risk
middle risk
high risk
0
20
40
60
80
100
0
20
40
60
80
100
100-Specificity
S
en
sit
iv
ity
КДО
_
ППТ
КСО
_
ППТ
---- EDV/m2
-----ECV/m2
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References /
Список
литературы
/Iqriboslar
1.
Дедов
И
.
И
.,
Мельниченко
Г
.
А
.,
Шестакова
М
.
В
.,
Трошина
Е
.
А
.,
Мазурина
Н
.
В
.,
Шестакова
Е
.
А
.,
Яшков
Ю
.
И
.,
Неймарк
А
.
Е
.,
Бирюкова
Е
.
В
.,
Бондаренко
И
.
З
.,
Бордан
Н
.
С
.,
Дзгоева
Ф
.
Х
.,
Ершова
Е
.
В
.,
Комшилова
К
.
А
.,
Мкртумян
А
.
М
.,
Петунина
Н
.
А
.,
Романцова
Т
.
И
.,
Старостина
Е
.
Г
.,
Стронгин
Л
.
Г
.,
Суплотова
Л
.
А
.,
Фадеев
В
.
В
.
Национальные
клинические
рекомендации
по
лечению
морбидного
ожирения
у
взрослых
, 3-
ий
пересмотр
(
Лечение
морбидного
ожирения
у
взрослых
) //
Ожирение
и
метаболизм
. -2018.-
№
15(1).-
С
.53-70. doi: 10.14341/OMET2018153-70.
2.
Назиров
Ф
.
Г
.,
Хашимов
Ш
.
Х
.,
Махмудов
У
.
М
.,
Хайбуллина
З
.
Р
.,
Шарапов
Н
.
У
.,
Ходжаева
Э
.
М
.
Комплексная
оценка
соматического
статуса
у
больных
с
морбидным
ожирением
до
и
после
бариатрического
вмешательства
//
Хирургия
Узбекистана
, 2020.-
№
1.-
С
.3-13.
3.
Недогода
С
.
В
.,
Вёрткин
А
.
Л
.,
Наумов
А
.
В
.,
Барыкина
И
.
Н
.,
Саласюк
А
.
С
..
Ожирение
:
критерии
,
причины
,
диета
,
медикаментозное
и
хирургическое
лечение
(
определение
,
диагностика
;
немедикаментозное
лечение
;
лечение
ожирения
и
коморбидной
патологии
) //
Амбулаторный
приём
.- 2016.-
Том
2.-
№
1 (4).-
С
. 4-33.
4.
ChiappettaS., deParvezikbal P., Stier C., Vincenzo Bottino, Rudolf A. Weiner, Runkel N. The role of C-reactive protein
after surgery for obesity and metabolic disorders // Surgery for Obesity and Related Diseases.- 2019.-Vol. 11 (16). //
doi.org/10.1016/j.soard.2019.10.007.
5.
Dedov I.I., Iashkov Yu.I., Ershova E.V. Incretins and its influence on diabetes mellitus 2 type in patients with morbid obesity
after bariatric surgery // Obesity and Metabolism.-2012.-
№
2.-
С
.3-10.
6.
du Plessis J
1
, van Pelt J, Korf H, Mathieu C, van der Schueren B. Association of Adipose Tissue Inflammation With
Histological Severity of Non-alcoholic Fatty Liver Disease // Gastroenterology. -2015.-
№
S0016-5085(15).-
Р
.00771-4. doi:
10.1053/j.gastro.2015.05.044.
7.
Fifth IFSO Global Registry Report 2019 // Prepared by Ramos A., Kow L., Brown W., Welbourn R. // IFSO Global Registry.
2019.
8.
Guo F, Garvey WT. Development of a Weighted Cardiometabolic Disease Staging (CMDS) System for the prediction of
future diabetes // J. Clin. Endocrinol. Metab. -2015. Vol. 100. N 10. P. 3871–3877.
9.
Hadaegh F, Khalili D, Ghasemi A, Tohidi M, Sheikholeslami F, Azizi F. Triglyceride/HDL-cholesterol ratio is an
independent predictor for coronary heart disease in a population of Iranian men // Nutr Metab Cardiovasc Dis.-2008.-
№
19(6).-
Р
.401-8. doi: 10.1016/j.numecd.2008.09.003.
10. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. The GBD 2015 Obesity Collaborators // N Engl
J Med 2017.-
№
377.-
Р
.13-27. DOI: 10.1056/NEJMoa1614362
11. Jakobsen G.S., Småstuen M.C.,Sandbu R., NordstrandN., Lindberg M., Jens K.H., Hjelmesæth J. Association of Bariatric
Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities// JAMA.
2018.-
№
319(3).-
Р
.291-301. doi:10.1001/jama.2017.21055.
12. Li P., Ma B., Gong S. Efficacy and safety of endoscopic sleeve gastroplasty for obesity patients: a meta-analysis // Surg
Endosc.-2019. / doi: 10.1007 / s00464-019-06889-6.
13. Mancini M.C. Bariatric surgery - An update for the endocrinologist. // Arq Bras Endocrinol Metabol. 2014 .-
№
58(9).-
Р
.875-
88. doi: 10.1590/0004-2730000003413.
14. Marquez M.F., Ayza M.F., Lozano R.B., Morales M.M, Diez J.M., Poujoulet R.B. Gastric Leak After Laparoscopic Sleeve
Gastrectomy // Obes Surg .-2010.-
№
20.-
Р
.1306-1311.
15. Salminen P, Helmiö M, Ovaska J, Juuti A, Leivonen M, Peromaa-Haavisto P, Hurme S, Soinio M, Nuutila P,Victorzon M.
Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric BypassonWeight Loss at 5 Years Among
Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial // JAMA. 2018.-
№
16;319(3).-
Р
.241-254. doi:
10.1001/jama.2017.20313.
