МЕТАБОЛИЧЕСКИЙ СИНДРОМ: АКТУАЛЬНЫЕ ВОПРОСЫ, ОСОБЕННОСТИ ПРОЯВЛЕНИЙ В РАЗНЫХ ЭТНИЧЕСКИХ ГРУППАХ

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Ражабова, Г., & Джумаев, К. (2022). МЕТАБОЛИЧЕСКИЙ СИНДРОМ: АКТУАЛЬНЫЕ ВОПРОСЫ, ОСОБЕННОСТИ ПРОЯВЛЕНИЙ В РАЗНЫХ ЭТНИЧЕСКИХ ГРУППАХ. Журнал вестник врача, 1(2), 159–162. https://doi.org/10.38095/2181-466X-2020942-158-161
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Аннотация

Метаболический синдром - полиэтиологическое патологическое состояние, способствующее развитию многих заболеваний, являющихся основной причиной инвалидизации и высокой смертности населения на сегодняшний лень. Проблемы патогенеза, диагностики и лечения метаболического синдрома активно дискутируются. Ежегодный рост заболеваемости требует совершенствования подходов в профилактике, диагностике. и немедикаментозном лечении данного патологического состояния. Согласно данным эпидемиологических исследований, около 300 миллионов людей в мире имеют метаболический синдром, и, по мнению экспертов ВОЗ. в ближайшие 20 лет ожидается увеличение числа больных на 50%.

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Доктор ахборотномаси № 2 (94)—2020

158

DOI: 10.38095/2181-466X-2020942-158-161 УДК: 616-008:615.225+616-088

METABOLIC SYNDROME: CURRENT ISSUES, THE CHARACTERISTICS OF

MANIFESTATIONS IN DIFFERENT ETHNIC GROUPS

G. H. Rajabova, K. Sh. Djumayev

Bukhara state medical institute, Bukhara, Uzbekistan

Key words:

metabolic syndrome, ethnic characteristics, abdominal obesity, hypertension, dyslipidemia, hyperglyce-

mia.

Таянч сўзлар:

метаболик синдром, этник хусусиятлар, абдоминал семизлик, артериал гипертензия,

дислипидемия, гипергликемия.

Ключевые слова:

метаболический синдром, этнические особенности, абдоминальное ожирение,

артериальная гипертензия, дислипидемия, гипергликемия.

Metabolic syndrome is a polyetiologic pathological state, promoting the development of many diseases that are

the major causes of morbidity and mortality of the population today. Problems of pathogenesis, diagnosis, and treat-
ment of metabolic syndrome are actively discussed. The annual increase in the incidence requires improved approach-
es to prevention, diagnosis, and drug-free treatment of this pathological condition. According to epidemiological stud-
ies, about 300 million people in the world have a metabolic syndrome and according to WHO experts, an increase in
the number of patients by 50% is expected in the next 20 years.

МЕТAБОЛИК СИНДРОМНИНГ ДОЛЗAРБ МУAММОЛAРИ,

ТУРЛИ ХИЛ ЭТНИК ГУРУҲЛAРДA ХОС ХУСУСИЯТЛAРИ

Г. Х. Ражабова, К. Ш. Джумаев

Бухоро давлат тиббиѐт институти, Бухоро, Ўзбекистон

Метаболик синдром – бугунги кунда ногиронлик ва юқори ўлимнинг асосий сабаби бўлган кўплаб

касалликларнинг ривожланишига ҳисса қўшадиган полиэтологик патологик ҳолат. Метаболик синдромнинг
патогенези, ташҳиси ва даволаш муаммолари фаол муҳокама қилинмоқда. Касалликнинг ҳар йили кўпайиши
ушбу патологик ҳолатнинг олдини олиш, ташҳис қўйиш ва номедикаментоз даволаш усулларини
такомиллаштиришни талаб қилади. Эпидемиологик изланишларга кўра, дунѐда 300 миллионга яқин одам
метаболик синдромга эга ва ЖССТ экспертларининг фикрига кўра, кейинги 20 йил ичида беморларнинг сони
50 %га кўпайиши кутилмоқда.

МЕТАБОЛИЧЕСКИЙ СИНДРОМ: АКТУАЛЬНЫЕ ВОПРОСЫ,

ОСОБЕННОСТИ ПРОЯВЛЕНИЙ В РАЗНЫХ ЭТНИЧЕСКИХ ГРУППАХ

Г. Х. Ражабова, К. Ш. Джумаев

Бухарский государственный медицинский институт, Бухара, Узбекистан

Метаболический синдром – полиэтиологическое патологическое состояние, способствующее развитию

многих заболеваний, являющихся основной причиной инвалидизации и высокой смертности населения на
сегодняшний день. Проблемы патогенеза, диагностики и лечения метаболического синдрома активно дис-
кутируются. Ежегодный рост заболеваемости требует совершенствования подходов в профилактике, диа-
гностике, и немедикаментозном лечении данного патологического состояния. Согласно данным эпидемиоло-
гических исследований, около 300 миллионов людей в мире имеют метаболический синдром, и, по мнению
экспертов ВОЗ, в ближайшие 20 лет ожидается увеличение числа больных на 50%.

Metabolic syndrome (MS) is a complex of metabolic disorders (abdominal obesity, arterial

hypertension, dyslipidemia, impaired carbohydrate tolerance, impaired system hemostasis, chronic
subclinical inflammation), etiopathogenetically interconnected and accelerating the development
and progression of atherosclerotic cardiovascular diseases, type 2 diabetes. According to WHO
experts, ―... we are facing a new pandemic of the 21st century, covering industrialized countries.
This could be a demographic disaster for developing countries. The prevalence of the metabolic
syndrome is 2 times higher than the prevalence of diabetes mellitus, and its growth rate is expected
to increase by 50% in the next 25 years. ‖ The concept of metabolic syndrome X appeared in 1966
in the work of J. Camus. The final definition of metabolic syndrome was presented in a well-
known Bunting lecture given by G. Reaven and published in the journal Diabetes in 1988. At his
suggestion, this syndrome complex includes: insulin resistance (IR), impaired glucose tolerance
(NTG), hyperinsulinemia, elevated levels low density lipoproteins (LDL) and triglycerides (TG),

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arterial hypertension (AH). Kaplan coined the term ―deadly quartet‖ and first introduced obesity
into the insulin resistance syndrome. Over the past 3 years, more than 3,600 articles on various as-
pects of the metabolic syndrome have been published. In the adult population (30-69 years), meta-
bolic syndrome is detected in 15-25% of cases, in people older than 70 years - detectability 40-
45% in the age group from 20 to 30 years in 5-10%. As you know, metabolic syndrome increases
the risk of type 2 diabetes, atherosclerosis, arterial hypertension and other diseases. In patients
with metabolic syndrome, the frequency of development of life-threatening cardiovascular diseas-
es increases by about 4 times. At scientific sessions of the American College of Cardiology (2007)
it became known that the losses of the world community from cardiovascular diseases amount to
more than 400 million a year. The main diagnostic criterion for the metabolic syndrome is insulin
resistance, which is not included in the classifications proposed later (ATR III, ACE, etc.). In
addition to identifying insulin resistance for the diagnosis of metabolic syndrome, according to
WHO criteria, two or more of the following symptoms are necessary: arterial hypertension (blood
pressure level ≥140 / 90 mm Hg, and / or taking antihypertensive drugs); hypertriglyceridemia>
1.7 mmol/l (150 mg/dl); low HDL cholesterol <0.9 mmol/L (35 mg/dl) in men and <1 (39 mg/dl)
in women); a div mass index of more than 30 kg/m² or a ratio of waist circumference to hip
circumference> 0.9 in men and> 0.85 in women; urinary albumin excretion of more than 20

μ

g/

min or albumin to creatinine ratio of more than 30. These criteria are not widely used in practical
medicine due to the difficulty of conducting special studies of the state of carbohydrate
metabolism. According to the authors, to identify metabolic in practical conditions, it is advisable
to use the criteria adopted by experts of the US National Cholesterol Committee with some
amendments in 2001: abdominal obesity (waist circumference for men > 102 cm, for women > 88
cm); hypertriglyceridemia (triglycerides> 1,69 mmol/l); low HDL cholesterol (<1.04 mmol/L for
men and <1.29 for women); arterial hypertension (blood pressure> 130/85 mm Hg);
hyperglycemia (plasma sugar > 6.1 mmol/L). Metabolic syndrome is diagnosed in the presence of
any three or more of the five symptoms. In 2005, the International Diabetes Federation changed
the criteria for the metabolic syndrome: abdominal obesity with rather rigid cut-off points (waist
circumference in Europeans > 94cm for men and > 80cm for women) is considered as the main
component in combination with two or more other factors - hyperglycemia> 5, 6 mmol/L,
hypertriglyceridemia> 1.7 mmol/L, HDL cholesterol <1 mmol/L for men and <1.3 for women,
arterial hypertension> 130/85 mm Hg. Today scientific literature offers various e options of the
pathogenesis of the metabolic syndrome. According to most authors, the key link in the metabolic
syndrome is abdominal obesity, followed by the development of insulin resistance in individuals
with a genetic predisposition to the disease. Moreover, a decrease in the activity of lipolytic
processes, i.e. a decrease in the activity of hormone-sensitive lipase, which is activated by the
action of catecholamines through cyclic adenosine monophosphate - dependent phosphorylation
(cAMP). Insulin, causing hydrolysis of cAMP, increases the activity of lipogenetic processes.
However, it has been proven that obesity is not caused by insulin resistance and hyperinsulinemia.
Environmental and genetic factors seem to play a leading role in the development of nutritional
obesity: eating disorders with a predominance of animal fats and easily digestible carbohydrates, a
sedentary lifestyle, frequent psycho-emotional stresses, depression, combined dysfunction of the
nutritional nerve center and secondary dysfunctions endocrine glands. In visceral obesity,
predominantly hypertrophy of fat cells and the distribution of fat in the abdominal region are
observed. Abdominal fat includes visceral, intraperitoneal (omental and mesenteric) fat and
retroperitoneal fat masses, which are deposited along the dorsal surface of the intestine and ventral
surface of the kidneys. In this case, there is an increase in the degree of insulin resistance, which is
compensated by hyperinsulinemia.

It should be noted that there are a number of methodological problems in the study of the

epidemiology of MS, which are associated with the lack of a unified definition of this condition.
Currently, at least 10 definitions (criteria) of MS have been proposed, but none of them are
generally accepted today. The lack of consistency in the various definitions introduces controversy

G. H. Rajabova, K. Sh. Djumayev


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Доктор ахборотномаси № 2 (94)—2020

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in the interpretation of epidemiological studies. So, in the work of L. Guize et al., Where MS was
determined by three criteria: NCEP (2001), revised criteria of NCEP-R (2005) and IDF (2005), its
prevalence increased from 10.3% (NCEP) to 17.7% (NCEP-R) and 23.4% (IDF). At the same
time, regardless of the criteria for assessing the metabolic syndrome, its prevalence increases
significantly with age and has gender, ethnic and regional differences, with age and ethnicity
playing a crucial role. The IDF Declaration (2005) emphasizes the relevance of the study of
manifestations of MS in various ethnic groups in order to further complement and clarify the
criteria for this condition. In addition to the high prevalence of MS, in contrast to the European
population, the presence of insulin resistance is also characteristic of the Asian population with
lower div mass index (BMI) and RT and a genetic predisposition to diabetes.

Results and discussion In Bishkek, a study was conducted to study the characteristics of MS

in two ethnic groups: people of Russian (55 people) and Kyrgyz nationalities (59 people) aged 38
to 67 years. According to the frequency of occurrence of the criteria for MS, differences between
the Kyrgyz and Russian ethnic groups were not identified. In Kyrgyz men, compared with Kyrgyz
women, statistically significantly more common was hyperTG. There was no difference in the
frequency of occurrence of MS components between Russian men and Russian women. According
to the frequency of occurrence of the MS criteria, the first place is taken by the three-component,
then the four-component and five-component MS. In Kyrgyz with a three-component MS, the
combination of hypertension, low the level of HDL-C and obesity, with a four-component
hyperTG joins, with a five-component - a violation of carbohydrate metabolism (NUO). In
Russians with a three-component MS, with the same frequency of hypertension and low levels of
HDL-C and HDT, with four-component obesity joins, with five-component - NUO. The main
factors affecting the severity of atherosclerotic lesions of the extracranial carotid arteries in
multivariate regression analysis taking into account the ethnic index among Russian patients are
diabetes, the level of total cholesterol, BMI and aggravated heredity, and in the Kyrgyz people -
obesity, apo-B, DBP, age and TG. So, from 2001 to 2004 in the city of Ulan-Ude M.N. Shedoeva
conducted a one-stage study, which included 804 indigenous people (Buryats, Evenks) and 1,608
non-indigenous people (Russians, Tatars, Ukrainians) of Ulan-Ude ethnic groups aged 49 to 79
years. In the course of this study, it was found that the prevalence of GB in the population as a
whole was equal among men and women (37.4%). Indigenous women had less frequent GB
(28.3%) than men (41.1%), while non-indigenous women had GB more often (41.6%) than men
(36.6%). When identifying ethnic subgroups, it turned out that the Buryats, Tatars, and Russians
had a relatively equal frequency of GB, while the Evenks showed a lower incidence of the disease.
The prevalence of dyslipoproteinemia (DLP) in the population as a whole was high (67%), equal
among men and women. When studying the differences, it was found that women of indigenous
ethnic groups, DLP is relatively less common than women of non-indigenous ethnic groups, with a
relatively equal frequency of DLP among men. The level of atherogenic lipoproteins was
significantly higher in the non-indigenous population, and the level of HDL cholesterol was found
in the indigenous ethnic group, and among Buryat women, the level of HDL cholesterol was the
highest. It was also revealed that representatives of the Tatar ethnic group showed a significant
excess of fasting blood glucose compared with representatives of other ethnic groups. In addition,
a significantly higher blood uric acid content was found in representatives of non-indigenous
populations with a higher degree of reliability in Russians.

Conclusion Given that the metabolic syndrome underlies the diseases most often leading to

disability and high mortality, the issue of optimizing the non-drug approach in the treatment of this
condition remains relevant. Establishing the ethnic characteristics of MS will help to improve the
treatment of patients and the prevention of severe complications of metabolic syndrome.




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with metabolic syndrome // Cardiovascular therapy and prevention. 2007. No6 (3). S. 33-37.

G. H. Rajabova, K. Sh. Djumayev

Библиографические ссылки

Abilova S.S. Clinical and functional features of the metabolic syndrome in two ethnic groups (Kyrgyz, Russian), depending on the number of its components: Abstract, diss.... cand. honey, sciences. - Bishkek, 2006. -Hip.

Arkhipova NS. Popova EK. Grigoryeva LV. Afyeva AL Features of the lipid profile of the indigenous and non-root population of the Republic of Sakha (Yakutia) of older age groups with coronary heart disease // Successes in Gerontology. - 2010. - T. 23. No.4. - S.606-610.

Chazova I.E.. Mychka V.B. The prevalence of metabolic syndrome and its individual components in patients with arterial hypertension and obesity // Cardiovascular therapy and prevention. - 2005. - T. 4. No. 6. - S. 51 -61.

Filatova E.G. Anxiety in somatic practice // Therapeutic archive. 2007. No. 5. S. 72-78.

Kireeva VV Ethnic features of risk factors for coronary heart disease in the Baikal region: Diss. ... cand. honey, sciences. - Irkutsk. 2007.- 138 p.

Koziolova N.V., Konradi A.O. Optimization of the criteria for metabolic syndrome. Russian Institute of Metabolic Syndrome - Consistent Position // Arterial Hypertension. - 2007. - T. 13. No. 3. - C.l-2.

Konradi AO Change in the concept of treatment of arterial hypertension in the metabolic syndrome: from drugs of choice to the optimal drug combination // Arterial hypertension. - 2008. - T. 14. No. 1. - S.65-70.

Malakshinova Z.Kh. Coronary heart disease and risk factors among the indigenous and non-indigenous population of the city of Ulan-Ude based on materials from a simultaneous and prospective study: Abstract, diss.... cand. honey, sciences. - St. Petersburg, 1997.- 18 p.

Mamedov M.N. Metabolic syndrome in Russia: prevalence, clinical features and treatment - M .: FSUE Izvestia Publishing House of the Presidential Administration. 2011. - 160 p.

Mamedov M.N. Metabolic syndrome: practical aspects of diagnosis and treatment on an outpatient basis: A manual for doctors. - M.: FAS-media. 2005.- 33 p.

Metabolic syndrome / Alexandrov OV (et al.] // Russian Medical Journal. 2006. No. 6. S. 50-55.

Metabolic syndrome: a manual for therapists and cardiologists / cd. E.I. Sokolova. M.: RCT Sovcro Press, 2005.48 p.

Nevzorova VA. Abramova EL Features of the manifestations of the metabolic syndrome in women of different ethnic affiliations // Problems of Women's Health. - 2007. - T. 2. No. I. - S.20-29.

Ogarkov M.Yu., Barbarash O. L.. Kazachek Y. V. et al. Prevalence of the components of metabolic syndrome X in the indigenous and non-indigenous populations of Mountain Shoria // Bulletin SB RAMS. - 2004. - No. 1. -S.108-111.

Obesity: guidelines for general practitioners - students of the Federal Law, clinical residents, interns / comp.: S.A. Pavlishchuk (et al.]. Krasnodar: Kuban Medical Academy. 2002.S. 7.

Perova N.V., Metelskaya V.A. Obesity leads to atherosclerosis // Disease prevention and health promotion. 2004. No 1. S. 40-45.

Romanova AN A comparative characteristic of coronary atherosclerosis and its risk factors in indigenous and

non-indigenous men of Yakutia: Diss.... cand. honey, sciences. - Novosibirsk, 2007 154 p.

Scientific and organizational approaches in the field of promoting knowledge of good nutrition / E.N. Lobykina [et al.] IS Healthcare of the Russian Federation. 2007. Nol. S. 32-36.

Shedoeva MN Features of risk factors for ischemic heart disease and hypertension among the indigenous and non-indigenous population of Ulan-Ude: Diss.... cand. honey, sciences. - SPb., 2005.- 179 p.

Shlyakhto E.V.. Konradi A.O. Epidemiology of metabolic syndrome in various regions. Dependence on the criteria used and prognostic value // Arterial hypertension. - 2007. - T. 13. No. 2. - S.95-112.

Sofronova S.l. Characterization of lipid-metabolic disorders in Dolgans and Evenks with arterial hypertension in the Republic of Sakha: Diss.... cand. honey, sciences. - Novosibirsk. 2010.- 92 s.

Starostina E. Principles of treatment of eating disorders accompanied by Obesity .7 Doctor. 2005. No4. S. 58-61.

Susekov A.V. New advances in the treatment of hypercholesterolemia and atherosclerosis // Farmateka. 2007. No. 8/9. S. 16-22.

Svaykina EV Epidemiology of metabolic syndrome in the Far North: Diss.... cand. honey, sciences. - M., 2008. - 112 s.

Tokareva Z.N. The prevalence and characteristics of the manifestation of the metabolic syndrome in the adult population of Cheboksary: Diss.... cand. honey, sciences. - M.. 2010.- 95p.

Unloading and dietary therapy: a guide for doctors / ed. A.N. Kokosova. St. Petersburg: SpetsLit, 2007.327 s.

Uspensky Yu.P., Balukova E.V. Depressive disorders and their correction in the complex treatment of patients with metabolic syndrome Si Cardiovascular therapy and prevention. 2007. No6 (3). S. 33-37.

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