Клинические рекомендации уже давно вошли в число рабочих инструментов современного врача, помогая ему быстро ориентироваться в наиболее эффективных доказанных методах лечения и профилактики различных заболеваний, а также адаптировать эти методы к конкретным задачам своих больных и добиваться максимальной персонализации лечения. Клинические рекомендации составляются профессиональными некоммерческими ассоциациями и одобряются научным советом МЗ РФ, при этом нередко одна рекомендация готовится двумя или даже тремя ассоциациями. Особенность предлагаемых вашему вниманию рекомендаций в том, что в профилактику и лечение ожирения вовлекаются не только эндокринологи, но и терапевты, кардиологи, гинекологи, гастроэнтерологи и врачи многих других специальностей. Мультидисциплинарная рабочая группа представляет этот проект в многопрофильном журнале с целью объединения усилий нескольких профессиональных ассоциаций, что связано с необходимостью уделить внимание не только самому ожирению, но и коморбидным состояниям. Мы надеемся на конструктивную критику и разностороннее обсуждение проблемы на страницах нашего журнала.

Objectives The aim of the study was to compare food patterns in patients with simple steatosis (SS) and non-alcoholic steatohepatitis (NASH). Methods Prospective study was approved by LEC and enrolled subjects with confirmed non-alcoholic fatty liver disease (SS or NASH group). Nutrilogic software (Nutrilogic, Russia) was used for diet assessment. Dietary patterns were assessed according to the Healthy Eating Index (HEI): amounts of the major groups of foods and food products (grains, fruits, vegetables, dairy products, meats, fats and confectioneries) consumption were compared to the levels described in the HEI, and individual deviation rates were obtained. Nonparametric statistics (Mann-Whitney U test) was used to compare deviation rates found in subjects of SS and NASH groups. Results Subjects in NASH group (n = 22) were younger (Mean ± SD: 48.6 ± 13.4 y.o.) than those in SS group (n = 156; 56.5 ± 12.3 y.o., P = 0.008). Main macronutrients consumption did not differ between the groups. Although dietary patterns of major groups of foods consumption did not differ between SS and NASH groups, analysis of the foods subgroups revealed dissimilarity in the structure of vegetables and fats consumption. Patients with NASH consumed larger amounts of potatoes (0.14 ± 0.08 vs 0.11 ± 0.15, P = 0.006), and lower – of onions (0.02 ± 0.03 vs 0.07 ± 0.1, P = 0.006); they also consumed lower amounts of dairy butter (0.14 ± 0.44 vs 0.15 ± 0.21, P = 0.009) compared to subjects with simple steatosis. No other difference in the structure of vegetables (beans, root crops, leafy and other vegetables), fats (animal fats, vegetable oils, margarines) and other major groups of foods consumption was revealed. Conclusions Dietary patterns of patients with non-alcoholic steatohepatitis and simple steatosis differ. The obtained results may help in diet modification in patients with NAFLD in case of confirmation in larger multicenter trials. Funding Sources Russian Science Foundation, grant #1976-30014.

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Aim. To evaluate nutritional patterns in patients with gastroesophageal reflux disease (GERD) compared to the control group without GERD. Materials and methods. The data of complex examination of patients referred to perform esophageal pH-impedance recording and who gave written informed consent to participate in the study served as a source data. All the participants underwent complex examination, including clinical data (presence of heartburn and acid regurgitation), symptom evaluation (GERD-Q questionnaire), esophagogastroscopy, esophageal pH-impedance recordings and food frequency questionnaire. Diagnosis of GERD was based on GERD-Q score 8, acid exposure time 6%, number of gastroesophageal refluxes 80/day by 24-hrs esophageal pH-impedance recordings. Nutritional patterns were assessed with the use of healthy eating pyramid principles. Results. Overall 165 patients were enrolled and the data of 150 of them (34 with confirmed GERD and 116 of the control group) were available for the final analysis. The patients of the both groups consumed lower compared to the recommended amounts of dairy and higher amounts of meat. Those with GERD consumed larger amounts of fruits (0.910.68 compared to the values of healthy eating pyramid vs 0.520.57 in the control group, p=0.001), and fats (0.690.55 vs 0.490.55, p=0.001). Compared to the controls, patients with GERD consumed lower amounts of vegetables (0.860.46 of the healthy eating pyramid vs 0.940.63 in the control group, р=0.004) and sugars confectionaries (0.380.39 vs 1.930.98, p=0.0001). Conclusion. Nutritional patterns of patients with gastroesophageal reflux disease significantly differ compared to the control group. The obtained data may be used for diet modification in patients with arterial hypertension.

Objectives The aim of the study was to assess efficacy and safety of newly developed specialized food product “SPP1” in patients with NASH. Methods New specialized food product for clinical use (SPP1) consisted of (% of the RDAs): protein 8%; fat 7% (including ω-3 PUFA 40%); soluble dietary fiber 160%; phospholipids 25%; alpha-lipoic acid 33%; betaine 10%; minerals 13%–44%; vitamins (A, E, D3, K1, C, B1, B2, B6, B12, PP, Folic acid, Pantothenic acid, Biotin) 24%–140%. The study (NCT04308980) was approved by LEC and enrolled patients with diagnosis of NASH. Subjects were randomized to the following groups: those received iso-calorie diet (according to REE, by indirect calorimetry (Quarck RMR, Italy) alone (ICD) and iso-calorie diet + SPP1 (2 portions of SPP1 a day, 14 days)(ICD + SPP1 group). Safety was assessed based on clinical and laboratory data. Repeated measurements (baseline vs those on the 15th day of the study) of body composition (InBody, South Korea), and blood chemistry were compared. Non-parametric statistics (StatSoft, USA) was used for the analysis. Results The results of complex examination of 20 subjects (12 in ICD + SPP1 and 8 in ICD group) served as a source for the study. Initially, groups did not differ by age, sex, and BMI. The product was well tolerated. In contrast to ICD group, those in ICD + SPP1 group demonstrated greater decrease of weight: BMI initially (BMI0), Mean ± SD: 38.7 ± 5.4 kg/m2 vs BMI at the end-point (BMIEOT) 37.7 ± 5.1 kg/m2, P = 0.003 in ICD + SPP1 group, whereas in the ICD group BMI0 38.9 ± 7.2 kg/m2 vs BMIEOT 37.9 ± 7.3 kg/m2, P = 0.08. These results were reached predominantly by a decrease of the weight of fat: body fat weight (BFW)0 50.2 ± 10.7 kg vs BFWEOT 48.5 ± 10.8 kg, P = 0.002 in ICD + SPP1 group, whereas BFW0 48.9 ± 11.4 kg vs BFWEOT 46.8 ± 11.6 kg, P = 0.07 in ICD group. ALT and AST levels decreased in both groups, but in neither of them was statistically significant. Conclusions The new specialized food product “SPP1” is safe, and well tolerated by patients with NASH. In combination with iso-calorie diet, it may increase efficacy of weight loss, predominantly by fat. Funding Sources Ministry of Science and Higher Education, #0529–2019-0055.