cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-2165Research ArticleМЕТАБОЛИЧЕСКИЙ СИНДРОМ И САХАРНЫЙ ДИАБЕТMETABOLIC SYNDROME AND DIABETES MELLITUSПсихосоматический аспект ожирения как фактора риска метаболического синдромаPsychosomatic aspects of obesity as a risk factor of metabolic syndromeБабинА. Г.BabinA. G.

руководитель лаборатории профилактики психосоциальных факторов

EBalyasova@gnicpm.ruЧечеткинаЕ. А.ChechetkinaE. A.

м.н.с. лаборатории профилактики психосоциальных факторов

КолтуновИ. Е.KoltunovI. E.

первый заместитель директора, руководитель отдела эпидемиологии хронических неинфекционных заболеваний

Государственный научно-исследовательский центр профилактической медицины. МоскваState Research Centre for Preventive Medicine. Moscow201001011970977178Copyright © Бабин А.Г., Чечеткина Е.А., Колтунов И.Е., 19701970Бабин А.Г., Чечеткина Е.А., Колтунов И.Е.Babin A.G., Chechetkina E.A., Koltunov I.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2165

Цель. Уточнить роль ожирения (Ож) в развитии метаболического синдрома (МС), основываясь на психопатологической природе Ож; оценить эффективность привлечения врача-психотерапевта для профилактики и лечения МС. Материал и методы. Наличие и степень Ож количественно оценивались по индексу массы тела (ИМТ). В исследовании участвовали 3 группы (гр.): I –пациенты с нервной булимией и Ож (n=64), в т.ч. подгруппа с сердечно-сосудистой патологией (n=12); II – кардиологические пациенты без Ож и психопатологии (n=28); III – кардиологические пациенты с наличием или отсутствием коморбидных Ож, МС и сахарного диабета (СД) (n=78). Последняя гр. была разделена на четыре подгруппы в соответствии с тяжестью симптоматики. Психологические особенности пациентов I и II гр. оценивались по результатам клинического интервью и с помощью теста MMPI; для III гр. измерены все компоненты МС, включая показатели липидного и углеводного обменов. Результаты. Кардиологические больные гр. I и II, вне зависимости от наличия Ож, имеют близкие усредненные профили MMPI с максимумом на шкале 1 (ипохондрия), отличные от профиля общей булимической гр. I. Различие наблюдается также на корреляции ИМТ-возраст: для гр. II, в отличие от гр. I и подгруппы с ССЗ, наблюдается тенденция снижения веса с возрастом пациента; эта же тенденция наблюдается в трех подгруппах гр. III, причем особенно сильно в самой тяжелой подгруппе (МС + СД). Для всех четырех подгрупп гр. III проведен анализ корреляционных связей между ИМТ и остальными параметрами МС; результаты свидетельствуют что Ож как особый компонент МС предшествует развитию комплекса остальных симптомов, но при наличии МС существует независимо от них. Заключение. Единственным эффективным средством профилактики МС является психотерапевтическая диагностика и лечение Ож на стадии, предшествующей развитию метаболических нарушений. При лечении больных с МС участие врача-психотерапевта является вспомогательным и направлено на снижение веса путем лечения расстройства приема пищи.

Aim. To investigate the role of obesity (O), as a psychopathological disorder, in metabolic syndrome (MS) development; to assess the effectiveness of psychotherapeutist’s participation in MS prevention and treatment. Material and methods. The presence and stage of O was assessed by body mass index (BMI). The study included 3 groups: Group I – patients with bulimia nervosa and O (n=64), including individuals with cardiovascular disease, CVD (n=12); Group II – patients with CVD, but without O or psychopathology (n=28); Group III – patients with CVD and with or without O, MS, and diabetes mellitus, DM (n=78). Group III was divided into 4 subgroups by symptom severity. In Groups I and II, psychological profile was assessed by clinical interview and MMPI test; in Group III, all MS components were measured, including lipid and glucose metabolism parameters. Results. In Groups I and II, CVD patients, regardless of concomitant O, had similar MMPI profiles, with maximal scores for scale 1 (hypochondria), which was different from the profile of bulimic patients in Group I. In Group II, in contrast to Group I and CVD subgroup, a tendency towards weight reduction in more advanced age was observed. The same tendency was also observed in 3 subgroups of Group III, being the strongest in the subgroup with the most severe symptoms (MS and DM). In all 4 subgroups of Group III O as a specific MS component, preceding the other MS symptoms, but independent from them in the case of developed MS. Conclusion. The only effective method for MS prevention is psychotherapeutic diagnostics and treatment of O at the stage preceding the development of metabolic disturbances. In the treatment of MS patients, the role of psychotherapeutist is complementary, being aimed at weight reduction by treating eating disorders.

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The authors declare that there are no conflicts of interest present.