Alimentary constitutional obesity of the 1st degree. Causes of exogenous-constitutional obesity

Obesity is the excess deposition of fat in the human body. It can develop from the initial stage into the last - the fourth, which will cause the most serious consequences. Why obesity occurs and how to treat, you can find out further.

Degrees of obesity by body mass index

Depending on how much excess fat deposits in the body more muscle mass, distinguish 4 degrees of obesity by body mass index.

Body mass index (BMI) is a calculated value that helps to assess whether you are overweight or underweight. It is calculated by dividing the body weight (kg) of a person by the square of his height (m).

If the BMI is in the range of 20.0–25.9, then a person over 25 years of age has a normal weight. When the BMI is 26–27.9, this indicates that the person is overweight.

The following degrees of obesity are distinguished.

BMI will be for people over 25 years old in the range of 28.0–30.9, for 18–25 year olds - 27.5–29.9.

2 degree

Appears, pain in the spine and joints, profuse sweating. Lipid metabolism is disturbed, which provokes heart disease. Body fat makes up 30-50% of the lean body mass, and BMI for people over 25 years old is 31.0-35.9, for younger people (from 18 to 25 years old) - 30.0-34.9, respectively.

With obesity of the second stage, the risk of endocrine and metabolic disorders increases.

3 degree

Body weight exceeds normal values by 50% or more. Obesity is difficult to tolerate, a person suffers from shortness of breath, and does not tolerate physical activity. There are complications - arthrosis of the joints, strokes, heart attacks.

BMI corresponds to 36.0-40.9 for people aged 25 and over, and 35.0-39.9 for younger people (18-25 years).

Normal body weight is the weight that corresponds to a certain height of a person, given his physique.

4 degree

Weight more than normal 2 times or more. This stage is rare, because patients simply do not live up to it. They usually do not leave the bed, they cannot move, they suffer from shortness of breath even at rest. Often the shape of the body takes on a monstrous character, a person resembles a monster with a shapeless body, consisting of mountains of fat.

BMI will show 40.0 and above for 18-25 year olds and 41.0 and above for older people.

Causes of obesity

There are many reasons that cause this disease, from overeating to hormonal disorders. Therefore, there are two main groups of obesity:

exogenous

Types of exogenous obesity:

Alimentary-constitutional obesity. The main reasons are physical inactivity, the cult of food (overeating, malnutrition, passion for fast food), stress, depression. It belongs to family diseases. In these families, usually all households have one of the degrees of obesity. And also this species is typical for the female, especially women who have crossed the 40-year mark. Violation occurs energy balance. All the energy that enters the body is not completely consumed, but is deposited in the form of adipose tissue.
Exogenous constitutional obesity. Has a progressive character. It affects people with sedentary work and fast food lovers. But it differs from the previous one in that it is not hereditary and is not the result of any disease.
Visceral obesity. Adipose tissue is not deposited in the subcutaneous layer, but is localized around internal organs. It affects both men and women. "Beer belly" refers to this type. It is more difficult to treat and provokes diabetes, as it is associated with a violation of metabolic processes in the body.

You can determine visceral obesity by measuring the waist circumference. The norm is the waist circumference for women up to 80 cm, for men - no more than 95 cm. If the figures are higher than these values, then it's time to take action.

endogenous

Endogenous types of obesity are as follows:

Cerebral obesity. It occurs as a result of trauma, inflammation and neoplasms (malignant and benign) of the brain. It is not a hereditary disease.
endocrine obesity. Occurs against the background of dysfunction of the hormonal system, with diseases of the pituitary gland, hypofunction of the thyroid and gonads. It is also not hereditary.

These two obesity are difficult to cure, because it must be treated along with the underlying disease that causes this ailment.

obesity treatment

The approach to treating obesity depends on the degree of the disease.

Obesity 1 degree

For the treatment of obesity of the 1st degree, a set of measures is used:

Diet. Reduce the daily calorie content of the diet, reduce the consumption of carbohydrates and lipids. They eat fractionally, replace animal fats with vegetable oil.
Physical exercise. Regularity is important here - you can’t let yourself be lazy. They select a set of exercises and start with 3-5 repetitions, gradually increasing the number of repetitions and exercises. The process of losing weight will take a long time, for quick result hopefully not worth it.
Ethnoscience. Traditional medicine will also help restore normal weight. For example, they drink an infusion of ginger every day. Take 50 g of fresh ginger root, grind it and pour 1 liter of boiling water. Half a lemon, cut into slices, and a little fresh mint are also added there. Leave to brew and drink 1 glass before meals.

It is important to note that in case of obesity it is prescribed by a doctor therapeutic diet- table number 8, which can be found from the video:

Obesity 2 degrees

With 2 degrees of obesity are also prescribed:

Diet therapy, but it will be more strict. A nutritionist will select a low-calorie diet in which vegetables and fruits will be the main products.
Daily exercise, a specialist can direct to physiotherapy exercises taking into account the age and health status of the patient.
Phytotherapy. Herbs are used that create a satiety effect and reduce appetite, as they swell in the stomach. These are flax seeds or angelica officinalis. Diuretics are also effective - lingonberry leaf, parsley root.

In advanced cases, medications are prescribed that are aimed at reducing appetite and removing excess fluid from the body. Preparations are selected by the doctor for each patient individually.

Obesity 3 degrees

With 3 degrees of obesity, they first undergo an examination - donate blood for hormones and sugar, and with the help of a doctor, they identify the cause that provokes weight gain. Apply:

diet and fasting days limit carbohydrates and sugar in the diet. They eat fractionally, reducing portions.
Physical exercise. They are performed at a moderate pace for initial stage. They start with morning exercises, walking short distances. They are more actively engaged when weight is significantly lost.
Medical treatment. Drug treatment is prescribed only by a specialist.

With the 3rd degree of obesity, the patient cannot cope on his own and only in tandem with the doctor will achieve a positive effect from the treatment.

Obesity 4 degrees

At grade 4, treatment is carried out under the supervision of the attending physician. In addition to diet exercise, treatment of concomitant diseases, use surgical intervention:

Liposuction- remove excess adipose tissue if a threat hangs over the patient's life. As a result of the operation, the load on the vital organs is reduced.
Vertical gastroplasty- vertically divide the stomach into two parts. After the operation, the upper part of the stomach becomes smaller in volume, and therefore, it fills up with food faster and satiety occurs sooner.
gastro bypass, in which a small part of the stomach is isolated. As a result, the patient receives less food, but after the operation it is necessary to consume vitamins and minerals throughout life.
Biliopancreatic shunting. Remove part of the stomach. And just like in the previous case, you need to take vitamins and minerals all your life.

A drug treatment for grade 4 is rarely prescribed, since the body is in a serious condition. A person with this stage is considered seriously ill, in whom all vital organs are affected.

Fatty liver and its treatment

Fatty hepatosis is one of the most common diseases of this type, in which the degeneration of liver tissue into fatty tissue occurs.

Causes

The main reasons are:

abuse of fatty foods and alcohol;
violation of metabolic processes;
lack of vitamins and proteins in the diet;
chronic substance poisoning.

Development of hepatosis

In the early stages of development, the disease, especially caused by endocrine disorders, may not manifest itself for a long time. Patients usually complain of indigestion, nausea, and vomiting. With a progressive disease, jaundice is observed, which is accompanied by itching of the skin. Patients have an enlarged liver.

Since the initial symptoms are characteristic of a variety of diseases of the gastrointestinal tract, you should definitely visit a specialist and undergo an examination to establish an accurate diagnosis and prescribe the best treatment option.

The main task is to find the factor that provoked fatty hepatosis. Therefore, the patient must be ready to refuse bad habits or leave harmful production.

During treatment, as well as after it, a person must adhere to strict diet. Eliminate everything from the diet fatty foods- meat, fish, dairy, as well as canned food, smoked meats, pastries and fried foods. And, of course, you should forget about any use of alcoholic beverages.

In addition to diet, the doctor may prescribe a vitamin course or drug therapy. In some cases, take medicines will have until the end of life. They also pay special attention to lipid metabolism, if necessary, correct it with anti-cholesterol drugs.

With untimely treatment, hepatosis can go into the form of chronic hepatitis or cirrhosis of the liver.

Treatment of fatty liver folk remedies

IN folk medicine There are several recipes that help the liver get rid of adipose tissue:

Rosehip infusion. 100 g of dry rose hips are poured into a thermos and poured with boiling water, insisted for 8 hours. Drink an infusion of 200 ml 3 times a day.
apricot kernels. No more than 6 apricot kernels are eaten per day, they prevent the accumulation of fat in the liver. However, you should not get carried away with them, as they contain a small amount of cyanide.
lemon pips. Contribute to the restoration of liver cells. To do this, they must be crushed and mixed with an equal amount of honey. Take 1 teaspoon on an empty stomach.

Prevention of obesity

Obesity is a dangerous disease, so it is better to prevent it than to fight it for a long time. This is especially true for people at risk. This:

people whose parents suffer from overweight;
people leading an inactive lifestyle due to their profession;
lovers of good food;
people with diseases of the endocrine system and gastrointestinal tract;
people taking medications - hormonal, contraceptives and psychotropic drugs.

Preventive measures:

Limit the intake of salt, easily digestible carbohydrates. Keep track of the amount of food you eat.
Limit consumption of alcoholic beverages, which stimulate appetite and reduce satiety sensitivity.
Lead an active lifestyle that helps burn calories.
Improve psycho-emotional state. Since stress, depression, negative emotions, a person usually "seizes" with food.
Promptly treat comorbidities diabetes, thyroid dysfunction.

Dissertation abstractin medicine on the topic Functional changes in the cardiovascular system in individuals with an extreme degree of alimentary-constitutional obesity who underwent surgery to form a small ventricle

R G B O

"^MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

MOSCOW MEDICAL ACADEMY them. I. M. SECHENOVA

KOZLITINA Tatyana Viktorovna

FUNCTIONAL CHANGES IN THE CARDIOVASCULAR SYSTEM IN PERSONS WITH EXTREME DEGREE OF NUTRITIONAL CONSTITUTIONAL OBESITY UNDER SURVEYING SMALL VENTRICULAR FORMATION

dissertations for the degree of candidate of medical sciences

x 7 Moscow - ¡994

As a manuscript UDC 616.1:613.24:616-089

The work was done in the Moscow medical academy them. I. M. Sechenov.

Scientific adviser: Doctor of Medical Sciences, Professor A.I. Ivanov.

Official opponents: MD,

Professor A. L. Syrkin Doctor of Medical Sciences, Professor B. Ya. Bart

Leading institution: Central Institute for the Improvement of Doctors of the Ministry of Health of the Russian Federation.

Thesis defense will take place ""_1994

in _hours at a meeting of a specialized Scientist

Council D.074.05.01 at the Moscow Medical Academy. I. M. Sechenov (Moscow, B. Pirogovskaya st., house 2).

The dissertation can be found in the library of the academy (Zubovskaya sq., building 1).

Scientific Secretary of the Specialized Academic Council,

Candidate of Medical Sciences, Associate Professor

V. I. PODZOL KOV

GENERAL DESCRIPTION OF WORK

Relevance of the topic. The data available in the literature indicate that a significant part of the adult population of economically developed countries is overweight. According to average data, the number of obese people is 20-30%. A steady increase in this indicator is noted (Samsonov M. A. et al., 1979, Beyul E. A. et al., 1986, Kuzin M. I. et al., 1988, Alexander J. et al. 1978).

Among various forms obesity, the most common is alimentary-constitutional obesity (ACO) according to the classification of D. Ya. Shurygin et al., 1980. Extreme degrees of ACO attract especially close attention of researchers: degree III (excess body weight (BMI) more than 50%) and degree IV ( BMI over 100%).

With obesity - are created extremely unfavourable conditions the vital activity of the organism, primarily for the functioning of cardio-vascular system(CCS). Patients have a persistent increase blood pressure(AD), atherosclerosis of the aorta (AO) and coronary arteries, hypertrophy and dilatation of the left ventricle (LV), changes in contractility and electrical activity of the myocardium. However, among researchers there is no unambiguous assessment of such changes and their mechanisms (Barret-Connor E. L., 1985, Grossman E. et al., 1991, Messerli F. H „ 1982, Nath A. et al., 1988, Zarioh S. W. et al., 1991). Overweight is one of the main risk factors in the development of sudden death in coronary heart disease (Alexander J. K. et al., 1962, Pelkonen R. et al., 1977). Obesity - reduces the efficiency of patients and often causes early disability (Beyul E. A. et al., 1986, Alexander J. K., 1980).

In this regard, the intensive search various methods obesity treatment. Widespread conservative therapy, which gives certain results in the early stages or in mild to moderate obesity, is not effective in patients with extreme ACH.

IN last years surgical methods for the treatment of obesity are gaining popularity. Under certain conditions, they are the most effective way stable weight loss in patients with extreme ACO (Lebedev L. V. and Sedletsky Yu. I., 1987, Gomez O. A., 1980, Mason E. E., 1981). Among the proposed operations, the operation of the formation of a small ventricle (FMZH) using synthetic

vascular prosthesis is becoming widespread and attracting more and more supporters due to its technical simplicity and the achieved positive results(Kuzin M. I. et al., 1987, 1988, 1991), The consequences of the operation can be manifested by a change in the functioning of various body systems, primarily the CCC. Accurate estimate CVS status before and after surgery FMF is extremely important for excluding independent CVS pathology, differentiated preoperative preparation, timely prevention of complications in the postoperative period and subsequent rehabilitation of patients.

The purpose of the study was to evaluate functional changes in the cardiovascular system in patients with extreme ACH before and after FMF surgery in order to clarify the indications for surgical treatment, predict its results, and improve the implementation of more effective rehabilitation measures.

Research objectives.

1. To study the effect of overweight in extreme ACH on the CVS function.

2. To develop objective echocardiographic criteria to distinguish true circulatory failure (NC) from circulatory disorders in extreme ACH.

3. Evaluate the results of the FMF operation and the change in CVS function after weight loss.

4. Clarify the indications for surgical treatment of extreme ACH.

5. To determine the diagnostic capabilities of non-invasive methods for studying the cardiovascular system (echocardiography (EchoCG), Doppler echocardiography (DCH), electrocardiography (ECG) and differentiated ECG (ECGdif)) in patients with extreme ACH and give recommendations for their use.

Scientific novelty. No works devoted to a comprehensive study of the function of the cardiovascular system in patients with an extreme degree of ACH who underwent FMF surgery were found in the literature available to us.

The study of CVS function in patients with ACH is associated with the use of various surgical interventions for obesity. Publications on this topic reflect only narrow cardiological problems, and the study of the function of the cardiovascular system often occurs using invasive research methods (Alexan-

der J. K., 1980, Kaltman A. J. et al., 1976, Murrey G. L. et al., 1991), which does not allow their multiple reproduction. Single works on the use of EchoCG can be evaluated as preliminary data (Messerli F. H., 1982, Alpert M. A. et al., 1985, Terry B. E., 1987). Data on the state of the cardiovascular system after weight loss are contradictory (Alpert M. A., 1985, Mac Mahon S. W. et al., 1986, Murrey G. L "1991), so they cannot serve as a key to accurate preoperative diagnosis, be used for prediction of the results of the operation.

This work was carried out using a unique clinical material (most patients had a BMI of more than 100%, and some patients had a BMI of more than 200%), the patients underwent a new effective method treatment with stable results, for the first time in our country, repeated studies were carried out three years after FMF surgery, which made it possible to objectively assess changes in CVS function.

Practical significance. The obtained data on CVS functional changes in patients with an extreme degree of ACH before and after FMF surgery made it possible to clarify the indications for surgery, improve the possibilities of postoperative management of patients, the results of rehabilitation, and objectify the process of rehabilitation. Recommendations are given for examining patients before and after surgery using echocardiography, DCG, ECG, and ECGdif as the most accessible, informative, and safe non-invasive methods for studying CVS.

Implementation. The technique was introduced into practice in the clinic of faculty surgery named after. H. N. Burdenko MMA them. I. M. Sechenov.

Approbation of the dissertation. The materials of the dissertation were reported and discussed at the interdepartmental scientific conference Department of Therapy FOU; Department of Surgery No. 1 of the 1st Faculty of Medicine, MMA named after. I. M. Sechenov and the Department of Cardiology Central Institute improvement of doctors of the Ministry of Health of the Russian Federation on February 8, 1993; the main provisions of the work were presented at the conference of young scientists of the MMA im. I. M. Sechenov on May 25, 1993 and at a meeting of the Moscow City Scientific Society of Therapists on April 27, 1994

The structure and scope of the dissertation. The dissertation consists of an introduction, 4 chapters containing a review of the literature, own research, conclusions, conclusions, practical advice, bibliography. References contains

46 domestic and 157 foreign sources. The dissertation is presented on 169 pages of typewritten text, illustrated with 10 figures, 20 tables.

CHARACTERISTICS OF THE MATERIAL AND RESEARCH METHODS

In order to fulfill the tasks set, 120 patients with extreme ACH were examined and followed up before FMF surgery and in the period from 1 to 3 years after surgical treatment.

The clinical form and degree of obesity in each case were established on the basis of anamnesis, clinical data, laboratory and instrumental methods of research in order to exclude obesity of another origin. In parallel (with this, an independent pathology from the CCC was excluded. All patients were diagnosed with grade III and IV ACH according to the classification of D. Ya. Shurygin et al. (1980). The proper body weight was calculated using the Brock method, taking into account the correction factor.

The age of the subjects ranged from 19 to 57 years (average 36.6 ± 1.33 years). 89 people (74%) of the examined were female, 31 people (26%) were male. The body weight of patients ranged from 100 to 280 kg, the average total body weight (GWB) of the examined was 150.6 ± 6.3 gk (BMI - 120 ± 4.01%).

All patients underwent an ECG study in conventional leads, a recording of the first derivative, and an echocardiographic study. However, in some of the subjects (37.5%), it was impossible to conduct ultrasound research methods due to anatomical features and limited technical capabilities of ultrasound equipment.

In the remaining 75 patients, the study was carried out in full. The average age of the examined group was 36.6+ 1.82 years. OMT of the examined -145 ± 7.56 kg (BMI-115.0 ± 4.9%), average height 166.7 + 1.92 cm. 55 (73.3%) of the examined were female, 20 (26.7 %) - male. The duration of obesity m averaged 16 + 0.4 years. The group of fully surveyed is representative of the total group of 120 people, therefore, further development was carried out using data obtained from the survey of this group.

Depending on the degree of obesity, groups were distinguished: with ACH III degree in the amount of 26 people (35%) and with ACH

IV degree in the amount of 49 people (65%). Patients were divided into groups depending on the duration of obesity. The first group included patients with a duration of obesity not exceeding 10 years (18 people or 24%), the second group included patients suffering from ACH from 11 to 20 years (40 people or 53.3%), the third group consisted of patients with ACH more than 21 years (17 people or 22.7%). Also, all the subjects were divided into groups depending on age. The age group under 30 included 18 people (24%), the group 30-39 years old included 28 people (37.4%), the group 40-49 years old included 22 people (29.3%), the group 50 years old and older included 7 people (9.3%).

The most common complication of extreme ACH was arterial hypertension (AH) - (60%), the second most common pathology was deforming osteoarthritis (58.7%). Among other diseases that significantly worsen the course of the main one, it is necessary to note Pickwick's syndrome (SP) (21.3%), diabetes mellitus (12%), cholelithiasis (16%).

Of particular interest were symptoms such as shortness of breath with physical activity, noted in 63 patients (84%), edema of the legs, occurring in 45 people (60%) and tachycardia, registered in 40 patients (53.3%), which are signs of NK in patients with normal body weight. Patients with extreme ACH have some difficulties in differential diagnosis NK and similar symptoms caused by obesity itself (the presence of the so-called circulatory stagnation).

In order to identify differences in the genesis and course of AH, 20 patients with stage II hypertension (AH) with normal body weight were examined. Average age was 39.4 ± 2.38 years, the average OMT was 74.7 ± 2.08 kg.

The control group included 30 healthy people with normal body weight. The average age is 40.6 + 2.25 years, the average GMT is 65.3 ± 2.08 kg.

CCC function was assessed using M-mode echocardiography using the recommendations of the American Society for Echocardiography using the MK-500 apparatus manufactured by AT (USA). The following indicators were determined: LV end diastolic size (Dd), LV end systolic size (Ds), LV posterior wall myocardial thickness in diastole (Tmd), interventricular septal thickness in diastole (IVD), LV posterior wall motion amplitude (aZS) and IVS (aVZHP), anteroposterior size of the left atrium (LA), size of the right ventricle (RV), aortic diameter (Yes).

Based on the data obtained, the calculation of evidence-based central hemodynamics was performed: end-diastolic volume (EDV) and end-systolic volume (ESV) of the LV, stroke volume of the left ventricle (SV), cardiac output (MO), cardiac index (CI), stroke index (SI), total peripheral resistance (OPS), the degree of shortening of the anteroposterior size of the left ventricle in systole (AS), the rate of circular shortening of myocardial fibers (Vcf), ejection fraction (EF), the mass of the LV myocardium (Mm) was calculated. Based on the measurements of systolic blood pressure (SBP) and diastolic blood pressure (BPd), the mean blood pressure (MAP) was calculated.

With the help of DCG in a pulsed mode (the sensor was located in the jugular fossa (determined: maximum flow rate (vmax)> ejection time (VI), flow rate integral (FSI), calculated VODkg

The ECG study was performed on a polygraph "Mingo-graph-82" company "Elema" (Sweden)¡ in 12 conventional leads. To standardize the ECG waves, a millivolt (mV) equal to 10 mm was recorded. The tape drive speed was 50 mm/s. ECG signs of LV, RV and LA hypertrophy were revealed. The QT interval was calculated in s; for comparison, tables of the maximum duration of the QT interval were used in normal conditions at different heart rates (HR). Based on the data obtained, the relative electrical systole was calculated.

Recording of the first derivative of the ECG was carried out using a differentiator at a time constant of 5 ml/sec. Differentiation of leads V5 and Ve was performed. Using the first derivative, we determined the ratio maximum speeds(OMS) and the duration of the QT interval in s.

A re-examination of patients with ACO was carried out 3 years after the FMF operation and the loss of most of the excess body weight. The most intensive decrease in excess body weight was observed during the first year after surgery (on average 38.9 ± 3.48 kg or 27.8% of body weight from the initial one). Three years after the operation, patients lost from 28 to 90 kg, on average 49.8 ± 4.15 gk or 34% of body weight from the initial one. OMT was completely normalized or ACO of the I degree was preserved, maximum of the II degree.

Statistical data processing was carried out using standard programs on an IBM personal computer - PC/AT.

MAIN RESULTS OF THE RESEARCH

Fig. 1. The state of the myocardium and central hemodynamics in patients with extreme ACO according to EchoCG in the M-mode and DCG in the pulsed mode before FMF surgery

The examination revealed in all patients, regardless of the degree of obesity, in all age groups and with different duration of extreme ACH, moderate LV myocardial hypertrophy, confirmed by increased Mm. These changes are more pronounced with an increase in OMT (see table 1).

No relationship was found between the duration of obesity and the magnitude of LV myocardial hypertrophy, so the maximum values (TM1=1.1±0.5 cm, IVS n= 1.03±0.04 cm, Mm=-192.8±12.28 g ) were detected in the group with a duration of obesity up to 10 years. In the same patients, LV dilatapia is maximally pronounced. These changes in patients with relatively short periods of ACH can be explained by the fact that surgical methods of treatment have to be addressed in cases of unsuccessful conservative treatment. Most often, this contingent of patients is patients with complications and comorbidities, who have a progressive course of ACH, which explains their early appeal to surgeons and more pronounced changes in the CVS obtained during the examination.

LV myocardial hypertrophy was insignificant in the age group up to 30 years (Tid = 1.06 + 0.03 cm, the difference with the control group was significant, p< 0,005, МЖПД = 0,95 ± ±0,03 см, различие с контрольной группой недостоверно, р >0.05), with age there was a tendency to increase.

In addition to LV myocardial hypertrophy, dilatation of the heart chambers (LV, RV, LA) was revealed in patients with extreme ACH. These changes also become more pronounced with increasing OMT (see table #1). The dependence of dilatation, mainly of the left parts of the heart, on age was revealed. After 30 years there is an increase in these indicators, especially pronounced changes were noted in patients after 50 years of age (Dd = 5.7 ± 0.29 cm, Ds = 4.3 ± 0.3 cm, RV = 2.3 ± 0.11 cm). The dynamics of changes in extreme ACH with age is similar to changes in myocardial thickness h of the internal dimensions of the heart chambers in healthy people who also showed their increase in older age groups.

Reliable increase Yes (on average up to 3.5 + 0.1 cm, p< 0,05 по сравнению с контрольной группой и пациентами до 30 лет) и уплотнение стенок А0 у пациентов после 50 лет, мы склонны расценивать как ее атеросклеротическое поражение.

LV myocardial hypertrophy, confirmed by increased Mm. in patients with extreme ACH cannot be explained by fatty infiltration alone. We are of the opinion that explains the development of LV myocardial hypertrophy and dilatation of the heart chambers by compensatory mechanisms. In obesity, excess adipose tissue and increased metabolism lead to an increase in blood MO. According to our observations, an increased MR is the result of an increased VR, since no changes in resting heart rate were detected in our patients. This conclusion confirms other works (Bakshap L. e! a!., 1973, \Voodard S. V. a1., 1978) and contradicts those studies in which tachycardia is considered an important factor that increases MO in obesity (Kaitap A. L. , Gostlint, I. M., 1976). Our studies have shown an increase in EDV, ESV, as well as SV and MO in proportion to the increase in OMT and with age (in patients over 40 years of age). Cardiac output in patients with ACH increased regardless of the level of blood pressure.

Thus, the compensation mechanisms due to increased LV work, mainly during volume overload, lead to compensatory LV hypertrophy. LA dilatation can also be explained by chronic volume overload and increased afterload due to stretching and increased stress in the LV wall. Changes are more noticeable with an increase in OMT.

The average values of aZS, and especially aVZHP, exceeding aZS and increasing after 50 years with an ACH duration of more than 2! years, confirm the presence of LV dilagation and its volume overload, especially with a long course of the disease and in middle age.

On the basis of the obtained data, we came to the conclusion that changes in the heart in extreme ACH can be considered as eccentric myocardial hypertrophy.

Prolonged LV volume overload and increased workload ultimately lead to deterioration in LV systolic function. The SI and CI values remained within normal limits in the age group under 30 years and in patients with normal BP values. In other groups, we found a slight decrease in SI and SI, In some

In works, the authors do not find a change in these indicators during ACO (Alexander J. K., 1978, 1985), but we are closer to the opinion of Messerli F. H., 1982, who considers these results to be false positive, and SI - reduced, calculating this indicator per kg of mass body.

A decrease in myocardial contractility in extreme ACH is confirmed by reduced Vcf, EF, AS. To a greater extent, these changes are expressed after 30 years and with an increase in OMT. Thus, with an increase in BMT, patients are at an increased risk of developing congestive heart failure.

Separately, data concerning patients with "over-obesity" were studied. The mean age of the group was 40 ± 4.22 years, the duration of obesity was only 10.5 ± 1.97 years, weight loss was 228 ± 13.2 kg, BMI was 223.8 ± 15.7%. The results of the study of this group of patients are similar to those in ACO grades III and IV, but in patients with "superobesity" the heart rate was on average significantly higher than in the control group (82±4.78 beats per minute and 71.1+2 ,19 beats per minute, respectively, p< 0,05), более выражены дилатация левых отделов сердца (в среднем Дд = 6,4±0,48 см, Дс = 5,1 ±0,56 ем, ЛП = 4,75 ± 0,45 см) и гипертрофия миокарда ЛЖ Тыд = = 1,23 ± 0,14 см и МЖПЛ= 1,1 ±0,08 см), Мм увеличена до 233,9± 31,22 г в среднем. Не выявлено увеличения УО и МО. При «сверхожирении» снижается -сократительная функция миокарда, что выражается в снижении СИ и УИ (2,25 ± ± 0,34 л/мин/м2 и 27,5 ± 4,67 мл/м2 соответственно) и таких показателей как Vcf- ФВ, AS (0,57 ± 0,25 С"1, 40,5 ±6,09% и 20,5 + 3,74% в среднем соответственно).

Severe dilatation of the left heart, LV myocardial hypertrophy, decreased VR and MO, a tendency to increase heart rate, a decrease in SI and SI values, sharply reduced values of Av, EF, AS, suggest the presence of true NC in patients with excess body weight of more than 200% of due. This is also confirmed by clinical manifestations.

All of the above CVS disorders in patients with extreme ACH without independent heart pathology can be explained as congestive heart failure due to obesity cardiomyopagia. This term is still controversial, but in our opinion, it fully reflects the pathogenesis of the disease. A number of researchers use it in their work (Alexander J.K., 1985, Braunwald E., 1980).

It is also necessary to address changes in the cardiovascular system in ACH of an extreme degree of complicated course. In our studies, 45 people (60%) of patients with extreme ACH were diagnosed with AH.

Table 2. BP values in different groups (M±m).

BP, mmHg Art. Group I Group II Group III

AKO cr. sg. with AH (n = 45) GB II stage (n = 210) Control gr. (n = 30)

BP 141.1 ± 2.02*** 154.3+ 2.48* 1:13.5 ± 2.25

BPd 91.0 + 1.74* 92.0 + 0.68* 68.0 ±0.9

ADer 107.7 ± 1.95* ** 112.8 ±0.93* 88.0 ± 1.44

* - 1 asterisk indicates significant differences between groups with ACH, HD and the control group (p< 0,00(1) .

** - 2 asterisks indicate significant differences between groups with ACH and HD (p<0,05).

As follows from Table 2, with extreme ACH, there is an increase in blood pressure, mainly ADS, but in comparison with the indicators of patients with stage II hypertension, it is moderate.

AH is more often recorded in patients with grade IV ACO, that is, it is directly dependent on OMT. In addition, hypertension is a more frequent complication with an increase in the duration of ACH. Mean BP mean values in all age groups are increased compared to the control group, but BP tends to increase with age.

To clarify the mechanisms of BP increase in ACH, the results of a study of a group of patients with GB were used as a comparison. In hypertensive patients, pronounced hypertrophy of the LV myocardium, the absence of dilatation of the heart chambers (concentric type of hypertrophy) and a significantly increased TVR were revealed. SV and MO in these patients did not differ from normal values, myocardial contractility did not change. Based on the data obtained, it was concluded that the leading mechanism for increasing blood pressure in GB is an increased TPS.

In the group of patients with extreme ACH and AH, LV myocardial hypertrophy was less pronounced than in patients with

GB (Tmd = 1.08 ± 0.02 cm and Tmd = 1.26+ 0.05 cm, respectively, p<0,05) н не отличалась от показателей в группе АКО без АГ. Мм также меньше, чем при ГБ (186 + 6,48 г) и 190,1 + ±10,85 г соответственно, р<0,05). Однако дилатация камер сердца и увеличенные КДО, КСО, УО и МО были значительно выражены. ЧСС не отличалась от нормальных "показателен. ОПС у пациентов с АГ было несколько выше, чем у пациентов без АГ, но не отличалось от показателей в контрольной группе. Следовательно, повышение АД при АКО крайней степени происходит преимущественно за счет увеличения сердечного выброса при гиперкинетическом типе кровообращения. В пашем исследовании в отдельных случаях МО достигал 11,8 л/мин. Учитывая некоторое увеличение ОПС, при этом, .следует отметить увеличение постнагрузки за счет увеличения ОПС у пациентов с АКО и АГ. Таким образом, сочетание АКО и АГ, за счет различных механизмов, создает высокую пред- и постнагрузку на сердце, увеличивая работу ЛЖ. Это ухудшает сократительную способность миокарда ( сниженные показатели Vcf >EF and AS) and increases the risk of developing NK.

A serious complication of extreme ACH is SP. We did not find any dependence of the occurrence of SP on age, duration of obesity, OMT or BMI. Due to the complexity of visualization of the anterior wall of the pancreas, we cannot speak with full certainty about the nature of hypertrophy of the myocardium of the pancreas. RV dilatation in SP in our work did not differ from RV dilatation in extreme ACH without SP. In the left heart, changes in SP were of the same nature as in extreme ACH. However, these patients showed a significant increase in DD, EDV and MO, that is, the load of the LV volume is even more pronounced and the contractility of the LV myocardium is significantly reduced. Therefore, it can be assumed that in patients with extreme ACH with SP there is no "pure" right ventricular failure and isolated damage to the pancreas.

Examination of patients with extreme ACH is not always possible with the M-method of echocardiography. In this regard, conducting DCG in a pulsed mode and calculating, based on the obtained data, VODkg and other indicators of central hemodynamics, was of particular interest. In parallel with the M-method EchoCG, DCG study in a pulsed mode showed that the SV determined by various methods does not differ significantly.

In addition, according to the blood flow in the ascending section of A0, an indirect assessment of myocardial contractility is possible. With a decrease in myocardial contractility, Vmax decreased. Our work shows the relationship between Vmax and AS. Thus, in cases where visualization of the heart with parasternal access is not possible, pulsed DCG should be recommended.

2. The state of the electrical activity of the myocardium

according to ECG data in conventional leads and differentiated ECG in patients with extreme ACH before FMF surgery

A study of the electrical activity of the myocardium, performed in 120 patients with extreme ACH in the preoperative period, led to the conclusion that the ECG in this pathology in most cases does not differ from the ECG of healthy people, we did not find a significant decrease in the ECG voltage, as noted in some studies (Lebedev L. V. and Sedletsky Yu. N., 1987, Eisenstein I. et al., 1982). In our work, low voltage was detected in 6 people (5%), while normal voltage was found in 114 people (or 95%). All patients had sinus rhythm, and only in 2.5% of cases (in 3 people) rhythm disturbances were detected. In two cases it was a single atrial extrasystole, in one patient - a single ventricular extrasystole. Thus, we cannot state that in patients with extreme ACH, a regular ECG study reveals frequent arrhythmias, as Messerli F. H. et al., 1987 claims. Holter 24 hour monitoring.

The location of the electrical axis of the heart (EOS) in extreme ACH is presented in Table 3. The horizontal position of the EOS and the deviation of the EOS to the left occurred in 70% of cases. This can be explained by the presence of LV hypertrophy, which occurs in 53.3% of patients with ACH, as well as the horizontal position of the heart in the chest cavity, when the dome of the diaphragm rises due to excessive obesity.

The heart rate did not differ significantly from the normal values, but with "super-obesity" there was a tendency to increase.

It should be noted that with normal average values of the duration of the RO interval, the width of the P wave and the complex (¡^B, the values of the last two were significantly higher (p< 0,001), чем аналогичные в контрольной группе, причем с увеличением ОМТ отмечена тенденция к их росту.

Conduction disturbance is also more common with increasing OMT. Of the 36 people (30%) with impaired conduction, 1 patient had incomplete blockade of the right bundle branch of His, 19 patients had blockade of the anterior left branch of the His bundle, 7 patients had incomplete atrioventricular blockade of the 1st degree, and 9 patients had nonspecific changes , expressed in the serration of the ventricular complex in various ECG leads.

Signs of LA hypertrophy were registered in 24 patients with ACH (20%). An echocardiographic study in all cases showed an increase in the internal dimensions of the LA, therefore, we can talk about either hypertrophy of the LA myocardium, or an overload of the LA. However, an increase in the LA was observed in an echocardiographic study in 93.3% of cases, that is, the information content of the ECG is low .

Signs of LV hypertrophy based on quantitative criteria were found in 10 out of 120 patients with extreme ACH, which is only 8.3%. Signs of pancreatic hypertrophy were not found in any of the patients. The possibilities of diagnosing hypertrophy of various departments are limited, which may be due to their moderate severity, as well as changes in the electrical conductivity of surrounding tissues due to excessive development of subcutaneous fat.

The average duration of the OT interval, determined by ECG sbypon, did not differ from the indicators in the control group. In most cases, the duration of the WC interval corresponded to the heart rate, as evidenced by the normal WC (see Table 3).

Since in our work, when analyzing a conventional ECG, we did not reveal an increase in the duration of the interval (^T), we analyzed 1 derivatives of the ECG in the same patients. The average duration of the OT interval, determined by this method, also corresponded to normal values (see Table 3). In 18 people (15%), the WC interval was increased to an average of 0.39 ± 0.007 s with an average heart rate of 79.9 ± 1.7 beats per minute and significantly higher than normal values (p< 0,001), показатель ОТ в среднем равнялся 1,12±0,01, что превышало норму. Среди этих пациентов у 13 человек (72,2%) при ЭхоКГ-исследоваяни выявлена гипертрофия миокарда ЛЖ.

However, out of 75 patients with extreme ACH who underwent echocardiography, 40 patients (53.3%) had left ventricular hypertrophy and only 13 of them (32.5%) had an increased QT interval. At the same time, the average values of the duration of the QT interval in patients with LV hypertrophy were 0.38 ± 0.006 s and did not differ from the data in the control group. The QT index was also within normal limits, averaging 1.06 ± 0.02. Thus, an increase in the duration of the QT interval occurs in about 1/3 of patients with extreme ACH and LV hypertrophy.

In our work, no increase in VMS was found in ACH, no differences were found in the mean values of VMS in ACH of extreme degree and concomitant hypertension. Separately, the mean values of VMS were calculated in patients with proven LV hypertrophy, but, with an upward trend no significant differences were found compared with the control group.

The use of the ECGdif method is justified due to its higher sensitivity (determining the duration of the QT interval), despite the fact that the velocity parameters (VMS) in moderate LV myocardial hypertrophy turned out to be uninformative.

Fig. 3. The state of the myocardium and central hemodynamics in patients with extreme ACH after FMF surgery according to EchoCG in M-mode and DCG in pulsed mode

The literature provides data on changes in the function of the cardiovascular system after weight loss in patients with ACH in terms of 4 to 34 months, but some of the studies were performed using invasive methods, and the other concerns radiographic methods of research, moreover, the decrease in body weight was not always significant and “e has always been associated with surgical treatment (Alexander J. K., 1985, Alport M. A., 1985, Mac Mahon S. W. et al., 1986). The researchers 'e came to an I-: unanimous opinion about the changes in the CCC.

In our work, a repeated study of CVS in patients with extreme ACH was carried out in 18 patients (25%) 3 years after FMF surgery, which allows us to draw certain conclusions.

The needs of an organism that has significantly reduced metabolism as a result of a decrease in OMT are sharply reduced and this is reflected in hemodynamics. All patients have

SV and MO are correctly reduced. The decrease in MO is directly proportional to the decrease in OMT. To maintain adequate blood flow, less costs are required, which explains the decrease in heart rate in the postoperative period, and although we did not find a significant decrease in heart rate in these patients, the tendency to bradycardia is beyond doubt (heart rate in some patients was 50 beats per minute).

In all patients, Dd, Ds, LP, RV significantly decreased, which reflects a decrease in volume load. This is also confirmed by the significantly reduced EDV and ESV, therefore, we can talk about a decrease in the filling pressure of the LV. We cannot agree with the conclusions of Alexander J. K., 1972, which reports a decrease in the size of the LV only in 7% of cases. A decrease in LV size occurs in all cases with a decrease in BMT, however, this decrease depends on the initial body weight (i.e., the degree of ACH) and the duration of obesity. Our work shows that in patients with grade III ACH and obesity duration of up to 10 years, LV dimensions return to normal, while in patients with grade IV ACH and obesity duration of more than 10 years, they only approach them. This fully applies to the size of the pancreas. The dimensions of the LP do not differ from normal in all cases.

No changes in Tmd and MZhPd were found even 3 years after surgery and weight loss. Increased Mm, which significantly differs from normal values, confirms the persisting moderate hypertrophy of the LV myocardium. The only exception was the group of patients with grade III ACH, whose postoperative data did not differ from the norm (see Table 1).

There was a decrease in aVZHP and an increase in aZS after weight loss, which, together with a decrease in the size of the LA, suggests a decrease in diastolic dysfunction. There is no doubt about the improvement in LV systolic function in all patients. Vcf. > EF and AS after weight loss practically did not differ from those in the control group. SI and IA also did not significantly differ from normal. In patients with obesity for more than 10 years, systolic function recovered worse. When re-examined, Vcf, EF and AS in these patients tend to decrease.

The study of blood flow in the ascending AO showed that Vma increased in both groups after surgery. In the case of grade IV ACH, the indicators do not differ from normal

(78.5±2.6 cm/s), and in the group with grade III ACH they even exceed the normal values (91.8±4.23 cm/s, p<0,05).

In all cases, with a decrease in OMT in patients, there is a decrease in blood pressure, both APS, and ABP and ABP. BP normalizes in almost all patients, and this is due to a decrease in MR, and hence SV. A small role in this is played by a decrease in heart rate. At the same time, OPS slightly increases and does not differ from the values in the control group. It should be noted that the decrease in blood pressure with a decrease in BMT occurred without salt restriction in the diet.

4. The state of the electrical activity of the myocardium

according to ECG data in common leads and differentiated ECG in patients with extreme ACH after FMF surgery

An ECG performed after weight loss showed a significant decrease in heart rate compared with the group of patients before surgery and the control group, which may be one of the mechanisms for reducing MO.

In 2 patients, a change in the EOS from a horizontal to a normal position was noted, which can be explained by a change in the topography of the heart relative to the chest and diaphragm with a decrease in the OMT and a decrease in the size of the heart.

Conduction disorders in the postoperative period were noted in 23.3% of cases: in 5 patients (16.7%) - blockade of the anterior left branch of the His bundle, in 2 patients (6.6%) - nonspecific changes.

The duration of the PQ interval and the width of the P wave did not change. Signs of LA hypertrophy were noted in 4 patients (13.3%), in 11 patients (36.6%) the width of the P wave decreased compared to the preoperative period, and the "bihump" disappeared. The width of the QRS complex in comparison with preoperative parameters did not change. Signs of LV hypertrophy were not detected in any of the patients either before or after surgery. The duration of the QT interval tended to increase, but did not differ significantly from the values in the control group. The QT index, on the contrary, significantly decreased compared to preoperative data, which also did not allow us to state that the QT interval increased significantly. When recording the first derivative of ECGl„f, we obtained the values<ЗТДНф не отличающиеся от средних значений в дооперационной группе (см. таблицу 3).

The postoperative study revealed a significant decrease in the mean values of the BMR compared with the preoperative group (p<0,05), в то же время эти показатели не отличались от данных в контрольной группе. Для уточнения подобных изменений были вычислены значения ОМС у этих пациентов до операции. Средние значения ОМС до операции в этой группе составили 0,98 ± 0,05, что позволило расценить эти изменения, как «первичные» нарушения репо-ляризации, вызванные кардиомиопатией олшрения и, возможно, атеросклерозом, так как возраст пациентов этой группы в 50% случаях превышал 40 лет. После операции у этих больных выявлено достоверное увеличение ОМС до 1,1 ±0,03 в среднем (р<0,01). Следовательно, в действительности можно говорить не об уменьшении показателей ОМС, а об их увеличении после снижения ОМТ, а также об обратимости кардиомиопатии ожирения если предположить, что снижение ОМС при АКО крайней степени вызвано именно этой причиной.

1. With alimentary-constitutional obesity of extreme degree, obesity cardiomyopathy occurs, characterized by moderate hypertrophy of the left ventricular myocardium, dilatation of the heart chambers and a decrease in myocardial contractility, with an increase in body weight, age and duration of obesity, these changes are more pronounced.

2. Changes in central hemodynamics are associated with an increase in stroke volume and cardiac output, which increase the preload on the heart and are the main mechanism for increasing blood pressure in extreme alimentary-constitutional obesity.

3. In true circulatory insufficiency, echocardiography reveals a decrease in stroke volume and minute volume and a sharp decrease in myocardial contractility, which distinguishes this pathology from circulatory disorders in extreme alimentary-constitutional obesity.

4. With a decrease in body weight as a result of the operation of the formation of a small ventricle, the stroke volume and minute volume, the internal dimensions of the chambers of the heart decrease, myocardial contractility is restored, blood pressure normalizes, but left ventricular myocardial hypertrophy remains. Improving the function of the cardiovascular system up to full normal

malization was noted in patients with alimentary-constitutional obesity of the III degree, a short history of the disease and under the age of 40 years.

5. Methods of EchoCG and DCG in pulsed mode allow you to safely, repeatedly and accurately conduct a study of the cardiovascular system, while ECG and ECGDIf did not reveal specific changes, which suggests their low information content compared to ultrasound methods.

1. The selection of patients with extreme alimentary-constitutional obesity for surgical treatment must be carried out with the obligatory use of EchoCG and ECG, which makes it possible to exclude an independent pathology from the cardiovascular system and identify functional changes caused by the underlying disease.

2. When selecting for surgery, preference should be given to patients with alimentary-constitutional obesity of the III degree under the age of 40 years and the duration of the disease up to 10 years, since in this group in the postoperative period the function of the cardiovascular system completely returns to normal.

3. In the diagnosis of hypertrophy of various parts of the heart, the EchoCG method in M-mode should be used, as the most informative in comparison with ECG.

4. The M-mode EchoCG method and the indicators of central hemodynamics obtained on its basis make it possible to distinguish true circulatory failure from circulatory disorders caused by extreme alimentary-constitutional obesity. With true circulatory failure, the stroke volume and minute volume of blood decrease, the contractility of the left ventricular myocardium is sharply disturbed (decrease in the ejection fraction of the left ventricle, the degree of shortening of the anteroposterior size of the left ventricle, shock and cardiac indices).

5. The use of Doppler echocardiography in pulse mode with the location of the sensor in the jugular fossa is advisable when it is impossible to conduct echocardiography in the M-mode due to the anatomical features encountered. The indicators of central hemodynamics obtained on the basis of Doppler echocardiography closely correlate with the indicators obtained by the M-method EchoCG.

b. Donplerechocardiography in a pulsed mode is recommended to be used to calculate central hemodynamic parameters in severe dilatation of the heart chambers and associated regurgitation, as the most accurate method.

1. Functional changes in the cardiovascular system in patients with alimentary-copstigudial! extreme obesity after surgical treatment.- Dep. in GTsNB, D-24105, 30.03.94 (together with M. M. Romanov, L. Yu. Churganovop, N. M. Kuzin, V. K. Marko, Vym, A. I. Ivanov).

2. The duration of the ECG OT interval in patients with extreme alimentary-constitutional obesity before and after surgical treatment, Dep. in the State Central Center for National Library of Science, D-24106, 30.03.94 (together with L. Yu. Churganova, M. M. Romanov, N. M. Kuzin, A. I. Ivanov).

Table 1. Dependences of echocardiogram parameters on the degree of ACH (M ± m)

(asterisk - significance of differences with the control group, p< 0,05)

ACH grade III (Group 1) ACH grade IV (Group 2) Control group (n = 30)

Parameters before FMF after FMF before FMF after FMF

(n = 26) (n = 7) (n = 49) (n = 1.1)

WMT, kg 129.6 ±3.54* 78.0 ± 4.53* 154.1 ±4.33* 88.1 + 6.0* 65.3 ± 2.08

BMI, %" 77.4 ± 2.56* 13.0 ± 6.06* 134.9 ±5.32* 33.0 ± 5.3* -

Tmd, cm 1.05 ± 0.02* 1.0 ±0.02* 1.1 ±0.02* 1.1 ±0.06* 0.9 + 0.02

IVAD, cm 1.0 ±0.03* 1.0 ±0.04* 1.03 ±0.03* 1.0 + 0.04* 0.9 ± 0.03

mm, g 170.9 ±5.47* 127.6 ± 11.3 189.3 ±5.88* 176.9 ±15.83* 123.4 ± 3.88

DD, cm 5.57 ±0.11* 4.9 ±0.15 5.9 ±0.09* 5.2 ±0.19* 4.8 + 0.06

Ds" cm 3.9 ±0.12* 3.1 ±0.11 4.2 + 0.12* 3.4 ± 0.12* 2.9 ± 0.06

EDV, ml 153.8 ± 6.82* 119.9 + 8.51 175.9 ±6.1* 138.3 ± 10.58* 105.3 ± 3.37

CSD, ml 71.4 ±5.05* 48.5 ± 7.53 84.6 ±5.58* 65.3+9.99* 334.5 ± 1.52

LA, cm 3.98 ± 0.09* 3.4 ±0.15 4.28 ± 0.07* 3.6 ±0.14 3.3 ± 0.08

RV, cm 2.38 ± 0.09 1.9 ± 0.08 2.39 ± 0.08* 2.2 ± 0.11* 1.9 ± 0.07

OPS, dyn. cm-6 1639.5 ±161.7 1691.5 ± 158.3 1348.8 ± 56.63 1709.0 ± 112.6 1499.1 ± 79.44

SV, ml 78.6 ± 6.21 67.0 ± 7.9 91.4 ± 3.54* 73.1 ± 7.1 70.9 ± 2.61

MO, l/min 5.82 ±0.45 4.4 ± 0.25 6.82 ± 0.28* 4.5 ±0.40 5.06 ± 0.26

EF, % 53.2 ±2.69* 63.7 ±4.11 53.3 ± 1.93* 61.9 ±3.0 . 67.6±1.07

Av, s-1 1.04 ± 0.08* 1.4 ±0.19 1.07 + 0.06* 1.1 ±0.03* 1.3 + 0.05

DB, % 28.4 + 1.83* 32.5 ± 2.78 28.9 ± 1.29* 33.9 ± 2.0 37.7 ±0.78

SI, l/min/m2 2.43 ±0.19* 2.9 ± 0.8 2.72 ±0.11* 2.6 + 0.4 3.16 ±0.18

AI, ml/m2 34.3 ±2.19* 41.0 + 3.3 36.4 ± 1.29* 40.4 ± 2.42 44.1 + 1.72

Table 3. Results of ECG examination after FMF surgery (M±m)

Extreme ACH rates before VMF (n = 120) Patients after VMF (n = 30) Control group (n = 30)

Heart rate, beats per min 76 ± 1.04 63 ± 1.13%* 71 ± 2.19

normally located 36 (30%) 12 (40%) 20 (66.6%)

horizontal 61 (50.8%) 12 (40%) 5 (16.7%)

deviated to the left 4 (3.3%) 1 (3.3%) -

sharply deviated to the left 19 (15.9%) 5 (16.7%) -

vertical - 5 (16.7%)

R<Э, с 0,16 ±0,002 0,16 ±0,03 0,16 ±0,02

P, s 0.09 ± 0.01 0.09 ± 0.003 ** 0.08 ± 0.001

Sda, s 0.07 ± 0.001 0.07 ± 0.002 "" 0.06 ± 0.002

<ЭТ с 0а36 ±0,03 0,37 ± 0,04* 0,36 ± 0,004

display.<ЗТ 1,01 ±0,007 0,98 ±0,01* 0,96 ± 0,004

Signs of hypertrophy

LP 24 (20%) 4 (13.3%) -

Signs of LV hypertrophy 10 (8.3%) _ _

C-T diff., s 0.38 ± 0.003 0.38 ± 0.004 0.36 ± 0.004

OMS 1.2 ±0.03 i 1.1 ± 0.03* 1.2 ±0.05

*-1 asterisk indicates significant differences between patients with extreme AK.0 before FMF surgery and patients after FMF surgery (p< 0,05).

¡¡i-2 asterisks indicate significant differences between post-FMF patients and controls (p<0,05).

Many women are faced with the problem of excess weight, considering it just an external disadvantage. But at the time of planning and the course of pregnancy, special attention must be paid to this factor. A little extra weight is not a serious problem or threat to the proper development of the child. Dangerous is the moment when simply being overweight turns into an NZhO of 1 or more degrees.

In medicine, this term stands for a violation of fat metabolism in the body, to put it simply, obesity. This problem is becoming more common among people from different countries, preventing them from leading a normal healthy lifestyle. Obesity during pregnancy leads to many problems and complications.

The rise of obesity

This pathology occurs for various reasons and can develop even in childhood. The main problem is that the majority of people suffering from NZhO do not consider it necessary to take measures to get rid of excess weight. Obesity can occur for the following reasons:

The most common cause of weight gain is a sedentary lifestyle, junk food, frequent drinking of alcoholic beverages, smoking and overeating. In such cases, the person himself admits the occurrence of a health problem due to a negligent attitude.

To avoid overeating, you need to listen to your body. The part of the brain - the hypothalamus, gives a signal when the body needs food and also at the moment of saturation. With a normal diet, a person stops eating when they feel they are full. With systematic overeating, this part of the brain ceases to give signals to the body about a sufficient amount of food, and also causes a person to feel hungry much more often. This leads to the fact that the body constantly receives more and more calories that it does not require. It is impossible to spend such an amount in a short period of time even with physical exertion, if any. So a person gets used to taking the amount that far exceeds the required rate, which leads to the deposition of fatty tissues. If you are overweight from overeating, you can quickly get a Grade 1 NZhO, especially during pregnancy, when your appetite is increased.

During pregnancy, women who are overweight and predisposed to obesity need strict weight control and an individual diet. During this period, it is important to provide the body with the right amount of nutrients, limiting the amount of simple carbohydrates and fats. When following the recommendations of a specialist for the period of bearing a child, you can gain a minimum weight or, conversely, even get rid of excess. You can not sit on strict diets and load yourself with physical exercises. In order not to aggravate the problem of obesity, it is enough to eat right and not overeat.

The impact of obesity on the human body

Violation of fat metabolism is a pathology due to which an excessive amount of fat deposits accumulate in the body. This leads to increased work of all organs, as they experience an increased load.

Obesity causes both physical and psychological problems. Excess weight disrupts the normal functioning of most organs, leading to pain, shortness of breath, problems with blood pressure, swelling, disruption of the cardiovascular system and other more serious consequences. Also, self-esteem of a person suffers from obesity even of 1 degree, complexes and depression appear, which very often interferes with personal life, professional career and normal development.

This pathology has a negative impact on the reproductive function of a person, so an obese woman may have problems conceiving a child. Doctors draw a direct link between obesity and infertility, because due to a violation of the normal functioning of the body, various pathologies of internal organs occur. Being overweight can lead to problems with conceiving a child, but if they are avoided, then complications may arise during the period of gestation or childbirth.

At the time of pregnancy, a woman's hormonal background changes greatly, the hormone progesterone and gonadotropin are produced in excess in the body. They provide a favorable environment in the body for increased deposition of fatty tissues. This process is inevitable in all women, even if they were not overweight before pregnancy. Fat deposits are necessary as protection for the fetus, so their largest accumulation occurs in the chest and abdomen, as well as the buttocks and thighs.

In the presence of obesity in a woman, it is necessary to reduce the increase in body weight as much as possible so that the body uses the already existing fat deposits. This requires the preparation of an individual nutrition plan, which can only be done by a specialist. Diet can be detrimental to fetal development if it does not include all the necessary nutrients.

Carrying a child with 1 or more degrees of obesity

If a woman is obese of the 1st degree, then this practically eliminates the risk of pathologies and problems with the development of the fetus. It is necessary to carefully monitor your well-being and nutrition, take tests in a timely manner and undergo an examination with a doctor. With grade 1 NJO during pregnancy, as a rule, there are no problems with the woman's health. Childbearing and childbirth most often pass without complications. Also, the pathology of a woman's body weight is not the cause of any defects in a child.

In the presence of obesity of 2 or more degrees, the risk of complications increases greatly. First of all, this refers to the health and condition of the expectant mother. During pregnancy, the organs perform work 2 or more times more actively than in the normal rhythm of life.

Obesity increases the load even more, which can cause such complications:

Preeclampsia is a severe form of preeclampsia that occurs in late pregnancy. This is a very common complication in obesity of 2 or more degrees. At the time of development of this pathology, the fetus does not receive all the necessary nutrients and oxygen, which leads to serious consequences. It is manifested by a high protein content in the urine of a pregnant woman, an increase in blood pressure, rapid weight gain and edema.

Obesity can also cause other complications. The state of health of the mother directly affects the well-being and development of the fetus. Often, VVT leads to the fact that the child is already born with overweight. Which is a serious complication for the mother at the time of labor and for the child himself. Most often, with such a pathology, it is necessary to resort to surgical intervention, as well as to constant monitoring of the child's condition by specialists.

A lack of folic acid can also be a consequence of obesity, more precisely, impaired metabolism. Even when taking special preparations, this substance may not be absorbed in the body of a woman, which leads to its deficiency for the normal development of the child's nervous system.

Childbirth in obesity and disease prevention

Women with overweight and 1 degree of obesity most often give birth on their own, without experiencing any difficulties. This is possible with proper management of pregnancy and the size of the fetus and pelvis of the woman for natural childbirth. At this stage, labor activity is not significantly reduced, which allows a woman to cope with the process on her own, avoiding surgical intervention.

If a woman in labor has a degree of pathology of 2 or more, then there is a risk of a caesarean section and forceps to improve the process. This is due to the fact that obesity disrupts the functioning of the part of the brain that is responsible for labor. It is because of this that one can be afraid of overcarrying the child, as well as very low labor activity. With such complications, the fetus experiences oxygen starvation, which requires urgent medical attention.

When giving birth naturally, heavy bleeding can occur, which is also a consequence of being overweight. In addition, there is a high risk of developing diabetes in the mother immediately after childbirth. That is why women with overweight problems need to examine the blood for sugar after childbirth and also after stopping breastfeeding.

Caesarean section in such cases is the safest way to have a baby. When it is carried out, there is no risk to the fetus, and it is possible to avoid most complications for the woman herself. But when suturing and healing, inflammation can occur due to an excess amount of adipose tissue.

If a woman suffers from NJO, it is necessary to constantly be under the supervision of a specialist. Pregnancy during this period is not contraindicated, but you need to be responsible for your well-being and health.

Proper nutrition, a moderately active lifestyle, giving up bad habits and taking the necessary vitamin complexes will help to avoid complications and gain fat mass. Being overweight is a very common problem, but having it does not mean that a woman cannot become pregnant and give birth.

In the article we discuss obesity of the 1st degree. We list the causes of weight gain, types, stages of the disease. You will learn how to calculate BMI, recognize pathology at the initial stages. We will also pay attention to prevention methods and a special diet.

Obesity of the 1st degree is the accumulation of excess body weight in the form of subcutaneous fat. This pathology is diagnosed with an increase in weight by 20% of the average. According to medical statistics, women are more susceptible to it by 50% than the representatives of the stronger sex. The peak of pathology development falls on the age from 30 to 60 years.

Treatment should include changes in eating behavior

The main reason for the formation of the disease is an imbalance between the number of calories entering the body and their consumption. The excess amount of fats, carbohydrates is converted into fat cells, which are deposited in the subcutaneous layer.

Overeating, disturbed eating behavior leads to alimentary obesity. Excessive, systematic consumption of large amounts of food provokes the replenishment of the fat depot. Also, the cause of the disease is impaired metabolism (5% of cases). At the same time, metabolism decreases, hormonal disorders occur.

Genetic predisposition, disruption of the endocrine system (insulinoma, hypothyroidism, Itsenko-Cushing's disease) can provoke weight gain.

Disorders of the nervous system can also give impetus to the development of the disease: stress, depression, insomnia make psychological discomfort "jam".

Types and stages of pathology

According to the nature of body fat, their localization, the following types of obesity are distinguished:

femoral-gluteal- fat cells are formed mainly in the lower part of the body. This type is more common in women. The body becomes pear-shaped. Accompanied by disorders of the veins of the lower extremities, joints, spine.
Abdominal- characterized by accumulation of fat in the upper body. The abdominal region suffers the most. The figure takes on a spherical shape. This type of obesity is more common in men. Pathology is associated with the development of diabetes mellitus, stroke, arterial hypertension.
Intermediate (mixed) type- characterized by an even distribution of body fat throughout the body.

According to the rate of growth of the layer, progressive and gradually increasing obesity are distinguished. There are stable and residual stages of the disease. In the stable phase, the primary weight gain occurs, in the residual phase, this is the result of a sharp weight loss.

Allocate primary, secondary, endocrine species. The primary include pathologies caused by eating disorders, the secondary - based on genetic, hereditary diseases. The endocrine type is formed due to violations of the endocrine glands.

How to calculate BMI

Body mass index (BMI) is used to classify the degree of obesity. To calculate it, you need to divide the patient's weight (kg) by the square of height.

First signs and symptoms

The main symptom of the disease is a change in the patient's appearance. Typical places for putting off extra pounds are the stomach, hips, buttocks, neck, shoulders. Excess weight begins to cause dissatisfaction with their own appearance in patients. Against this background, depressive disorders, increased irritability, and apathy are often formed.

Due to the increased load on the internal organs, failures of most body systems occur. Most often, the gastrointestinal tract suffers. There are heaviness in the abdomen, nausea, constipation.

Strongly increased weight provokes disorders of the musculoskeletal system. The patient may feel pain in the muscles, joints. Peripheral edema appears.

For women, menstrual irregularities are typical. In later stages, this can lead to amenorrhea.

Due to endocrine disorders, the condition of the skin and hair worsens. Severe sweating appears, oiliness of the skin increases, the risk of developing skin diseases (eczema, furunculosis, pyoderma) increases.

Diagnostics

If you notice something is wrong, you will need to consult various specialists (therapist, nutritionist, endocrinologist). It also does not hurt to go to a psychologist.

When diagnosing, a complete anamnesis is collected. The doctor draws up a genetic map, determines the minimum / maximum BMI, the duration of the period of weight gain. Particular attention is paid to the lifestyle, nutrition of the patient.

For successful diagnosis with the subsequent choice of treatment, important attention is paid to the calculation of the body weight index. Among the necessary characteristics, the coefficient of distribution of adipose tissue is used. It is calculated based on the ratio of the circumference of the waist to the circumference of the hips. The abdominal type of the disease is indicated by indicators exceeding 0.8 units for women and 1 for men.

Additionally, ultrasound, MRI, CT are prescribed. Studies allow you to more accurately determine the location and size of body fat. By means of a blood test, the level of triglycerides, uric acid, cholesterol, lipoproteins is determined. Be sure to determine glucose tolerance in order to exclude the development of diabetes.

Treatment Methods

A nutritionist can help you create the right diet

The success of treatment directly depends on the desire of the patient. Therefore, the competent work of a psychologist is important. A nutritionist develops an optimal nutrition system for the patient, an exercise therapy instructor selects physical exercises to keep the body in good shape.

If the diet is ineffective for 12 days, they resort to medical intervention. Patients are prescribed drugs from the amphetamine group. They contribute to the rapid appearance of a feeling of satiety after eating.

If necessary, the doctor may prescribe fat-mobilizing drugs in combination with antidepressants (Adiposin, Fluoxetine). Drugs regulate eating behavior, help facilitate the process of weight loss.

Diet

Diet food is to reduce the calorie content of food by 300-500 Kcal. The main restriction falls on carbohydrate foods, animal fats. Preference is given to boiled, steamed or stewed food. At the same time, it is important to consume a sufficient amount of clean water - at least 1.5 l / day. Food is taken in small portions 5-6 times a day.

The basis of dietary nutrition is non-starchy vegetables, lean meats and poultry, cereals, fruits. Spicy, fried, salty foods, alcohol fall under a strict ban.

Prevention

To successfully prevent obesity, it is enough to monitor the balance of calories consumed and expended. To do this, you should adhere to proper nutrition, observe minimal physical activity (sports).

With a predisposition to the disease, special attention must be paid to nutrition. Simple carbohydrates and fats should be excluded or limited. The emphasis in nutrition is best done on fiber, protein, plant foods.

For the prevention of the disease, the control of specialists is important. Once a year it is necessary to visit an endocrinologist and a nutritionist.

What to remember

If obesity of the 1st degree is suspected, the patient needs to consult a therapist, nutritionist, endocrinologist, psychologist.
Due to the increased load on the internal organs, failures of most body systems occur.
For successful prevention, it is enough to monitor the balance of calories consumed and expended.

In modern medicine, it is customary to classify obesity into primary (simple or alimentary-constitutional, exogenous-constitutional) and secondary, which occurs as a result of hormonal imbalance and lesions of the central nervous system. The most common alimentary-constitutional form (primary, simple), it accounts for more than 75% of cases of obesity. The mechanism of the occurrence of primary obesity is the excess caloric content of the food consumed, which causes a violation of all stages of metabolism in the body.

Allocate age periods, the most critical in terms of the development of alimentary obesity- early childhood, adolescence, pregnancy and breastfeeding (lactation), menopause. But it's not so much about age, but about excess calorie intake with low physical activity. This understanding of the cause of obesity leads us to the natural conclusion that its prevention lies in rational nutrition and increased physical activity. In Russia, overweight is detected in 50% of the population, and true obesity in 26%. Obesity progresses in urban and rural residents of all ages. The diet is dominated by animal fats and carbohydrates with a deficiency of fiber and vegetable oil.

Alimentary-constitutional obesity should be considered as a disease with serious changes in metabolic and enzymatic processes that change the ratio between the synthesis and breakdown of fat due to the constant supply of excess energy to the body. With this type of obesity in women, fat is deposited in the chest, pelvis and hips, in men - on the stomach. With severe obesity, these differences disappear.

There are four degrees of obesity

I degree - overweight from 15 to 29%
II degree - overweight from 30 to 49%
III degree - overweight from 50 to 100%
IV degree - overweight over 100%

The condition and complaints of obese patients depend on the degree and duration of obesity, on the degree of violation of the functional state of organs and systems. Initially, these are complaints of weakness, malaise, headaches, palpitations, shortness of breath, sweating, bloating, constipation, swelling, joint pain. In the future, arterial hypertension, atherosclerosis, coronary heart disease, sleep apnea syndrome, reproductive dysfunction, type 2 diabetes mellitus, diseases of the musculoskeletal system.

In recent years, studies have been conducted confirming that satiety triggers complex hormonal processes associated with positive emotions. With a lack of positive emotions in everyday life, people use food as a compensatory way to create pleasure. Regular overeating has become a source of positive emotions for many.

The presence of obesity and its degree can be assessed by