russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2014-3-63-71russjcardiol-19Research ArticleПЕРЕДОВАЯ СТАТЬЯМЕТАБОЛИЧЕСКИЙ СИНДРОМ: СЛОЖНЫЕ И НЕРЕШЕННЫЕ ПРОБЛЕМЫMETABOLIC SYNDROME: CHALLENGING AND UNRESOLVED ISSUESЧумаковаГ. А.ChumakovaG. A. A.

д.м.н., проф. кафедры госпитальной и поликлинической терапии, вед.н.сотр. отдела мультифокального атеросклероза

g.a.chumakova@mail.ruВеселовскаяН. Г.VeselovskayaN. G.

к.м.н., ст. н.сотр. отдела мультифокального атеросклероза, врач

ГриценкоО. В.GritsenkoO. V.

к.м.н., врач, н. сотр. отдела мультифокального атероскле­роза

ОттА. В.OttA. V.

врач

Алтайский государственный медицинский университет МЗ РФ, Барнаул; НИИ комплексных проблем сердечно-сосудистых заболеваний СО РАМН, КемеровоРоссияAltay State Medical University, Barnaul; Research Institute for Complex Cardiovascular Disease Issues, Siberian Branch, Russian Academy of Medical Sciences, KemerovoRussian FederationАлтайский государственный медицинский университет МЗ РФ, Барнаул; Алтайский краевой кардиологический диспансер, Барнаул, РоссияРоссияAltay State Medical University, Barnaul; Altay Region Cardiology Dispanser, Barnaul, RussiaRussian FederationАлтайский государственный медицинский университет МЗ РФ, Барнаул; НИИ комплексных проблем сердечно-сосудистых заболе­ваний СО РАМН, КемеровоРоссияAltay State Medical University, Barnaul; Research Institute for Complex Cardiovascular Disease Issues, Siberian Branch, Russian Academy of Medical Sciences, KemerovoRussian FederationАлтайский краевой кардиологический диспансер, Барнаул, Россия.РоссияAltay Region Cardiology Dispanser, Barnaul, RussiaRussian Federation201428032014036371Copyright © Чумакова Г.А., Веселовская Н.Г., Гриценко О.В., Отт А.В., 20142014Чумакова Г.А., Веселовская Н.Г., Гриценко О.В., Отт А.В.Chumakova G.A., Veselovskaya N.G., Gritsenko O.V., Ott A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/19

В статье обсуждаются спорные вопросы метаболического синдрома (МС), четкости его критериев, реальной прогностической значимости. Описываются разные типы ожирения, которые складываются из разнообразных сочетаний общего и висцерального ожирения. Обосновывается необходимость выделе­ния понятий "МС в узком и широком смысле слова", которые имеют разные патогенетические механизмы и предполагают дифференцированный подход к их лечению. Приводится патогенетическое обоснование включения в кла­стер МС в узком смысле слова таких его компонентов как жировой гепатоз, синдром поликистозных яичников и других. Предлагаются в порядке обсужде­ния более точные формулировки для синдрома кластера множественных факторов риска вместо МС.

 

 

 

 

The paper focuses on the contradictory issues related to metabolic syndrome (MS), its criteria, and real-world prognostic value. Different types of obesity, which result from a variety of combinations of general and visceral obesity, are described. The authors emphasise the need for two separate definitions of MS (a wider one and a more specific one), which are characterised by different pathogenetic mechanisms and require different therapeutic approaches. The more specific MS definition could benefit from the inclusion of such criteria as fatty liver and polycystic ovary syndrome. More detailed definitions for the multiple risk factor cluster syndrome, as an alternative to the current MS definition, are proposed for further discussion.

метаболический синдромкластер факторов рискависце­ральное ожирениеmetabolic syndromerisk factor clustervisceral obesityReferencesKatsiki N, Athyros VG, Karagiannis A, et al. Metabolic Syndrome and Non-Cardiac Vascular Diseases: an Update from Human Studies. Curr Pharm Des. 2013 [Epub ahead of print].Katsiki N, Athyros VG, Karagiannis A, et al. Metabolic Syndrome and Non-Cardiac Vascular Diseases: an Update from Human Studies. Curr Pharm Des. 2013 [Epub ahead of print].Traish AM, Guay A, Feeley R, et al. The Dark Side of Testosterone Deficiency: I. Metabolic Syndrome and Erectile Dysfunction. Journal of Andrology. 2009;30 (1):10-22.Traish AM, Guay A, Feeley R, et al. The Dark Side of Testosterone Deficiency: I. Metabolic Syndrome and Erectile Dysfunction. Journal of Andrology. 2009;30 (1):10-22.Alexander CM, Landsman PB, Teutsch SM. NCEF — defined metabolic syndrome, diabetes mellitus, and prevalens of coronary heart disease among NHANES 111 participants age 50 years and older. Diabetes. 2003;52:1210-4.Alexander CM, Landsman PB, Teutsch SM. NCEF — defined metabolic syndrome, diabetes mellitus, and prevalens of coronary heart disease among NHANES 111 participants age 50 years and older. Diabetes. 2003;52:1210-4.Meigs JB, Wilson PW, Nathan DM. Prevalence and Characteristics of the Metabolic Syndrome in the San Antonio Heart and Framingham Offspring Studies. Diabetes. 2003; (52):2160-7.Meigs JB, Wilson PW, Nathan DM. Prevalence and Characteristics of the Metabolic Syndrome in the San Antonio Heart and Framingham Offspring Studies. Diabetes. 2003; (52):2160-7.Nikitin YP, Kazeka GR, Simonova GI. Prevalence of metabolic syndrome X in unorganized urban population (epidemiological study). Cardiology. 2001; 9:37-40. Russian (Никитин Ю.П., Казека Г. Р., Симонова Г. И. Распространенность компонентов мета¬болического синдрома X в неорганизованной городской популяции (эпидемиологи¬ческое исследование). Кардиология. 2001;9:37-40).Nikitin YP, Kazeka GR, Simonova GI. Prevalence of metabolic syndrome X in unorganized urban population (epidemiological study). Cardiology. 2001; 9:37-40. Russian (Никитин Ю.П., Казека Г. Р., Симонова Г. И. Распространенность компонентов мета¬болического синдрома X в неорганизованной городской популяции (эпидемиологи¬ческое исследование). Кардиология. 2001;9:37-40).Hu G, Oiao O, Tuomilehto J. Prevalence of the Metabolic Syndrome and Its Relation to All-Cause and Cardiovascular Mortality in Nondiabetic European Men and Women. Arch Intern Med. 2004;164:1066-76.Hu G, Oiao O, Tuomilehto J. Prevalence of the Metabolic Syndrome and Its Relation to All-Cause and Cardiovascular Mortality in Nondiabetic European Men and Women. Arch Intern Med. 2004;164:1066-76.Gami AS, Witt BJ, Howard OE. Metabolic syndrome and risk of incident cardiovascular events and death. Asystematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49:403-14.Gami AS, Witt BJ, Howard OE. Metabolic syndrome and risk of incident cardiovascular events and death. Asystematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49:403-14.Moebus S, Stang A. The metabolic syndrome — a controversial diagnostic concept. Herz. 2007;32 (7):529-40.Moebus S, Stang A. The metabolic syndrome — a controversial diagnostic concept. Herz. 2007;32 (7):529-40.Bastien M, Poirier P, Lemieux I, et al. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis. 2014;56 (4):369-81.Bastien M, Poirier P, Lemieux I, et al. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis. 2014;56 (4):369-81.Boban M, Persic V, Jovanovic Z, et al. Obesity dilemma in the global burden of cardiovascular diseases. Int J Clin Pract. 2014;68 (2):173-9.Boban M, Persic V, Jovanovic Z, et al. Obesity dilemma in the global burden of cardiovascular diseases. Int J Clin Pract. 2014;68 (2):173-9.Clark AL, Fonarow GC, Horwich TB. Obesity and the Obesity Paradox in Heart Failure. Prog Cardiovasc Dis. 2014;56 (4):409-14.Clark AL, Fonarow GC, Horwich TB. Obesity and the Obesity Paradox in Heart Failure. Prog Cardiovasc Dis. 2014;56 (4):409-14.De Schutter A, Lavie CJ, Milani RV. The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. Prog Cardiovasc Dis. 2014;56 (4):401-8.De Schutter A, Lavie CJ, Milani RV. The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. Prog Cardiovasc Dis. 2014;56 (4):401-8.Coutinho T, Goel K, Correa De Sa D, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: Role of "normal weight central obesity". J Am Coll Cardiol. 2013;61:553-60.Coutinho T, Goel K, Correa De Sa D, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: Role of "normal weight central obesity". J Am Coll Cardiol. 2013;61:553-60.Minutello RM, Chou ET, Hong MK. Impact of body mass index on in-hospital outcomes following percutaneous coronary intervention (report from the New York State Angioplasty Registry). Am J Cardiol. 2004; 93:1229-32.Minutello RM, Chou ET, Hong MK. Impact of body mass index on in-hospital outcomes following percutaneous coronary intervention (report from the New York State Angioplasty Registry). Am J Cardiol. 2004; 93:1229-32.Romero-Corral A, Montori VM, Somers VK. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: A systematic review of cohort studies. Lancet. 2006;368:666-78.Romero-Corral A, Montori VM, Somers VK. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: A systematic review of cohort studies. Lancet. 2006;368:666-78.Schols AMWJ, Broekhuizen R, Weling-Scheepers CA, et al. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr. 2005;82 (1):53-9.Schols AMWJ, Broekhuizen R, Weling-Scheepers CA, et al. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr. 2005;82 (1):53-9.Carnethon MR, De Chavez PJD, Biggs ML, et al. Association of weight status with mortality in adults with incident diabetes. JAMA. 2012;308 (6):581-90.Carnethon MR, De Chavez PJD, Biggs ML, et al. Association of weight status with mortality in adults with incident diabetes. JAMA. 2012;308 (6):581-90.Angeras O, Albertsson P, Karason K, et al. Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry. Eur Heart J. 2013;34 (5): 345-53.Angeras O, Albertsson P, Karason K, et al. Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry. Eur Heart J. 2013;34 (5): 345-53.Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53 (21):1925-32.Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53 (21):1925-32.Dalamaga M. Obesity, insulin resistance, adipocytokines and breast cancer: New biomarkers and attractive therapeutic targets. World J Exp Med. 2013;3 (3):34-42.Dalamaga M. Obesity, insulin resistance, adipocytokines and breast cancer: New biomarkers and attractive therapeutic targets. World J Exp Med. 2013;3 (3):34-42.McAuley PA, Blair SN. Obesity paradoxes. J Sports Sci. 2011;29 (8):773-82.McAuley PA, Blair SN. Obesity paradoxes. J Sports Sci. 2011;29 (8):773-82.Surya M, Artham MD, Lavie CJ. Obesity and Hypertension, Heart Failure, and Coronary Heart Disease-Risk Factor, Paradox, and Recommendations for Weight Loss. Ochsner J. 2009;9 (3):124-32.Surya M, Artham MD, Lavie CJ. Obesity and Hypertension, Heart Failure, and Coronary Heart Disease-Risk Factor, Paradox, and Recommendations for Weight Loss. Ochsner J. 2009;9 (3):124-32.Lainscak M, Haehling S, Doehner W, et al. The obesity paradox in chronic disease: facts and numbers. Journal of Cachexia, Sarcopenia and Muscle. 2012;3 (1):1-4.Lainscak M, Haehling S, Doehner W, et al. The obesity paradox in chronic disease: facts and numbers. Journal of Cachexia, Sarcopenia and Muscle. 2012;3 (1):1-4.De Schutter A, Lavie CJ, Patel DA, et al. Obesity paradox and the heart: which indicator of obesity best describes this complex relationship? Curr Opin Clin Nutr Metab Care. 2013;16 (5):517-24.De Schutter A, Lavie CJ, Patel DA, et al. Obesity paradox and the heart: which indicator of obesity best describes this complex relationship? Curr Opin Clin Nutr Metab Care. 2013;16 (5):517-24.Roytberg GE, Dorosh ZhV, Kurushkins OV. Metabolic syndrome and fat distribution: common ground and contradictory relationship. Preventive Medicine. 2010, 13 (1):22-25 Russian (Ройтберг ГЕ, Дорош ЖВ, Курушкина ОВ) Метаболический синдром и рас¬пределение жировой ткани: точки соприкосновения и противоречивость взаимоот¬ношений. Профилактическая медицина. 2010;13 (1):22-250.Roytberg GE, Dorosh ZhV, Kurushkins OV. Metabolic syndrome and fat distribution: common ground and contradictory relationship. Preventive Medicine. 2010, 13 (1):22-25 Russian (Ройтберг ГЕ, Дорош ЖВ, Курушкина ОВ) Метаболический синдром и рас¬пределение жировой ткани: точки соприкосновения и противоречивость взаимоот¬ношений. Профилактическая медицина. 2010;13 (1):22-250.Schnabel R, Messow CM, Lubos E. Association of adiponectin with adverse outcome in coronary artery disease patients: results from the AtheroGene study. JAMA. 2009;302:345-56.Schnabel R, Messow CM, Lubos E. Association of adiponectin with adverse outcome in coronary artery disease patients: results from the AtheroGene study. JAMA. 2009;302:345-56.Kvitkova LV, Borodkina DA, Gruzdeva OV. Metabolic signs of abdominal obesity in patients with acute myocardial infarction with normal and elevated body mass. Problems of Endocrinology. 2012; 4:27-31Russian (Квиткова Л.В., Бородкина Д. А.,Kvitkova LV, Borodkina DA, Gruzdeva OV. Metabolic signs of abdominal obesity in patients with acute myocardial infarction with normal and elevated body mass. Problems of Endocrinology. 2012; 4:27-31Russian (Квиткова Л.В., Бородкина Д. А.,Груздева О. В. Метаболические признаки абдоминального ожирения у больных острым инфарктом миокарда с нормальной и повышенной массой тела. Проблемы эндокринологии. 2012;4:27-31).Груздева О. В. Метаболические признаки абдоминального ожирения у больных острым инфарктом миокарда с нормальной и повышенной массой тела. Проблемы эндокринологии. 2012;4:27-31).Pouliot MC, Despers JP, Lemieux S. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994;73 (7): 460-8.Pouliot MC, Despers JP, Lemieux S. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994;73 (7): 460-8.Wang Y Rimm EB, Stampfer MJ, et al. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2005;81 (3):555-63.Wang Y Rimm EB, Stampfer MJ, et al. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2005;81 (3):555-63.Yusuf S, Hawken S, Ounpuu S, et al. INTERHEART Study Investigators. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366:1640-9.Yusuf S, Hawken S, Ounpuu S, et al. INTERHEART Study Investigators. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366:1640-9.Hu G, Tuomilehto J, Silventoinen K, et al. Joint effects of physical activity, body mass index, waist circumference and waist-to-hip ratio with the risk of cardiovascular disease among middle-aged Finnish men and women. Eur Heart J. 2004;24:2212-9.Hu G, Tuomilehto J, Silventoinen K, et al. Joint effects of physical activity, body mass index, waist circumference and waist-to-hip ratio with the risk of cardiovascular disease among middle-aged Finnish men and women. Eur Heart J. 2004;24:2212-9.Lofgren I, Herron K, Zern T, et al. Waist circumference is a better predictor than body mass index of coronary heart disease risk in overweight premenopausal women. J Nutr. 2004;134:1071-6.Lofgren I, Herron K, Zern T, et al. Waist circumference is a better predictor than body mass index of coronary heart disease risk in overweight premenopausal women. J Nutr. 2004;134:1071-6.2013 ESH/ESC guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Russ J Cardiol. 2014, 1 (105):5-952013 ESH/ESC guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Russ J Cardiol. 2014, 1 (105):5-95Klein S, Allison DB, Heymsfield SB, et al. Waist circumference and cardiometabolic risk: a consensus statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Am J Clin Nutr. 2007;85 (5):1197-202.Klein S, Allison DB, Heymsfield SB, et al. Waist circumference and cardiometabolic risk: a consensus statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Am J Clin Nutr. 2007;85 (5):1197-202.National Institutes of Health (NIH). Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults: The Evidence Report. Washington D.C: Government Printing Office.1998.National Institutes of Health (NIH). Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults: The Evidence Report. Washington D.C: Government Printing Office.1998.Boden G, Shulman GI. Free acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and b-cell dysfunction. Eur J Clin Invest. 2002;32:14-23.Boden G, Shulman GI. Free acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and b-cell dysfunction. Eur J Clin Invest. 2002;32:14-23.Franssen R, Monajemi H, Stroes ES. Obesity and dyslipidemia. Med Clin North Am. 2011;95 (5.):893-902.Franssen R, Monajemi H, Stroes ES. Obesity and dyslipidemia. Med Clin North Am. 2011;95 (5.):893-902.Juge-Aubry CE, Henrichot CE, Meier CA. Adipose tissue: a regulator of inflammation. Best Pract Res Clin Endocrinol Metab. 2005;19 (4):547-66.Juge-Aubry CE, Henrichot CE, Meier CA. Adipose tissue: a regulator of inflammation. Best Pract Res Clin Endocrinol Metab. 2005;19 (4):547-66.Oliveros E, Somers VK, Sochor O, et al. The Concept of Normal Weight Obesity. Progress in Cardiovascular Diseases. 2014;56 (4):426-33.Oliveros E, Somers VK, Sochor O, et al. The Concept of Normal Weight Obesity. Progress in Cardiovascular Diseases. 2014;56 (4):426-33.Succurro E, Marini MA, Frontoni S, et al. Insulin secretion in metabolically obese, but normal weight, and in metabolically healthy but obese individuals. Obesity (Silver Spring). 2008;16:1881-6.Succurro E, Marini MA, Frontoni S, et al. Insulin secretion in metabolically obese, but normal weight, and in metabolically healthy but obese individuals. Obesity (Silver Spring). 2008;16:1881-6.Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. Ann Intern Med. 2013;159 (11):758-69.Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. Ann Intern Med. 2013;159 (11):758-69.Roberson LL, Aneni EC, Maziak W, et al. Beyond BMI: The "Metabolically healthy obese" phenotype; its association with clinical/subclinical cardiovascular disease and all-cause mortality — a systematic review. BMC Public Health. 2014;8;14 (1):14.Roberson LL, Aneni EC, Maziak W, et al. Beyond BMI: The "Metabolically healthy obese" phenotype; its association with clinical/subclinical cardiovascular disease and all-cause mortality — a systematic review. BMC Public Health. 2014;8;14 (1):14.Vliet-Ostaptchouk JV, Nuotio ML, Slagter SN, et al. The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies. BMC Endocr Disord. 2014;14 (1):9.Vliet-Ostaptchouk JV, Nuotio ML, Slagter SN, et al. The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies. BMC Endocr Disord. 2014;14 (1):9.Marques-Vidal P, Pecoud A, Hayoz D, et al. Normal weight obesity: relationship with lipids, glycaemic status, liver enzymes and inflammation. Nutr Metab Cardiovasc Dis. 2010;20:669-675.Marques-Vidal P, Pecoud A, Hayoz D, et al. Normal weight obesity: relationship with lipids, glycaemic status, liver enzymes and inflammation. Nutr Metab Cardiovasc Dis. 2010;20:669-675.Karelis AD, St-Pierre DH, Conus F, et al. Metabolic and body composition factors in subgroups of obesity: what do we know? J Clin Endocrinol Metab. 2004;89:2569-75.Karelis AD, St-Pierre DH, Conus F, et al. Metabolic and body composition factors in subgroups of obesity: what do we know? J Clin Endocrinol Metab. 2004;89:2569-75.Romero-Corral A, Somers VK, Sierra-Johnson J, et al. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J. 2010;31:737-46.Romero-Corral A, Somers VK, Sierra-Johnson J, et al. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J. 2010;31:737-46.Madeira FB, Silva AA, Veloso HF, et al. Normal weight obesity is associated with metabolic syndrome and insulin resistance in young adults from a middle-income country. PLoS One. 2013;8: e60673.Madeira FB, Silva AA, Veloso HF, et al. Normal weight obesity is associated with metabolic syndrome and insulin resistance in young adults from a middle-income country. PLoS One. 2013;8: e60673.The Examination Committee of Criteria for 'Obesity Disease' in Japan: New criteria for obesity disease' in Japan. Circulation J. 2002;66:987-92.The Examination Committee of Criteria for 'Obesity Disease' in Japan: New criteria for obesity disease' in Japan. Circulation J. 2002;66:987-92.Alberti KG, Eckel RG, Grundy SM, et al. Harmonizing the Metabolic Syndrome- A Joint Interim Statement of the International Diabetes. Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640-5.Alberti KG, Eckel RG, Grundy SM, et al. Harmonizing the Metabolic Syndrome- A Joint Interim Statement of the International Diabetes. Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640-5.Matsuzawa Y Funahashi T, Nakamura T. The Concept of Metabolic Syndrome: Contribution of Visceral Fat Accumulation and Its Molecular Mechanism. Journal of Atherosclerosis and Thrombosis. 2011;18 (8):629-39.Matsuzawa Y Funahashi T, Nakamura T. The Concept of Metabolic Syndrome: Contribution of Visceral Fat Accumulation and Its Molecular Mechanism. Journal of Atherosclerosis and Thrombosis. 2011;18 (8):629-39.Okauchi Y Nishizawa H, Funahashi T, et al. Reduction of visceral fat is associated with decrease in the number of metabolic risk factors in Japanese men. Diabetes Care. 2007;30:2392-4.Okauchi Y Nishizawa H, Funahashi T, et al. Reduction of visceral fat is associated with decrease in the number of metabolic risk factors in Japanese men. Diabetes Care. 2007;30:2392-4.Despres JP. Intra-abdominal obesity: an untreated risk factor for Type 2 diabetes and cardiovascular disease. J Endocrinol Invest. 2006;29 (3):77-82.Despres JP. Intra-abdominal obesity: an untreated risk factor for Type 2 diabetes and cardiovascular disease. J Endocrinol Invest. 2006;29 (3):77-82.Belyaeva OD, Mandal V, Ananeva NI. The thickness of the intima-media of the carotid arteries as an early marker of atherosclerosis in patients with abdominal obesity. Hypertension. 2008,14 (1):71-6. Russia (Беляева ОД, Мандал В, Ананьева НИ. Толщина комплекса интима-медиа сонных артерий как ранний маркер атеросклеро¬за у пациентов с абдоминальным ожирением. Артериальная гипертензия. 2008;14 (1):71-6).Belyaeva OD, Mandal V, Ananeva NI. The thickness of the intima-media of the carotid arteries as an early marker of atherosclerosis in patients with abdominal obesity. Hypertension. 2008,14 (1):71-6. Russia (Беляева ОД, Мандал В, Ананьева НИ. Толщина комплекса интима-медиа сонных артерий как ранний маркер атеросклеро¬за у пациентов с абдоминальным ожирением. Артериальная гипертензия. 2008;14 (1):71-6).Sokolov EI, Pisarevskaya AL. Visceral obesity as a pathogenetic factor in coronary heart disease. Cardiology. 2007; 1:11-5 Russia (Соколов ЕИ, Писаревская АЛ. Висцеральное ожирение как патогенетический фактор ишемической болезни сердца. Кардиология. 2007;1:11-5).Sokolov EI, Pisarevskaya AL. Visceral obesity as a pathogenetic factor in coronary heart disease. Cardiology. 2007; 1:11-5 Russia (Соколов ЕИ, Писаревская АЛ. Висцеральное ожирение как патогенетический фактор ишемической болезни сердца. Кардиология. 2007;1:11-5).Hall JE. Mechanisms of abnormal renal sodium handling in obesity hypertension. Am J Hypertens.1997;10:49-55.Hall JE. Mechanisms of abnormal renal sodium handling in obesity hypertension. Am J Hypertens.1997;10:49-55.Goodpaster BH, Theriault R, Watkins SC. Intramuscular lipid content is increased in obesity and decreased by weight loss. Metabolism. 2000;49:467-72.Goodpaster BH, Theriault R, Watkins SC. Intramuscular lipid content is increased in obesity and decreased by weight loss. Metabolism. 2000;49:467-72.Verlohren S, Dubrovska G, Tsang SY Visceral periadventitial adipose tissue regulates arterial tone of mesenteric arteries. Hypertension. 2004;44:271-6.Verlohren S, Dubrovska G, Tsang SY Visceral periadventitial adipose tissue regulates arterial tone of mesenteric arteries. Hypertension. 2004;44:271-6.Wildman RP, Farhat GN, Patel AS. Weight change is associated with change in arterial stiffness among healthy young adults. Hypertension. 2005;45:187-92.Wildman RP, Farhat GN, Patel AS. Weight change is associated with change in arterial stiffness among healthy young adults. Hypertension. 2005;45:187-92.Gao YJ, Takemori K, Su LY Perivascular adipose tissue promotes vasoconstriction: the role of superoxide anion. Cardiovasc Res. 2006;71:363-73.Gao YJ, Takemori K, Su LY Perivascular adipose tissue promotes vasoconstriction: the role of superoxide anion. Cardiovasc Res. 2006;71:363-73.Wheeler G. L., Shi R., Beck S. R. Pericardial and visceral adipose tissue measured volumetrically with computed tomography are highly associated in type 2 diabetic families. Invest Radiol. 2005;40:97-101.Wheeler G. L., Shi R., Beck S. R. Pericardial and visceral adipose tissue measured volumetrically with computed tomography are highly associated in type 2 diabetic families. Invest Radiol. 2005;40:97-101.Iacobellis G., Barbaro G. The double role of epicardial adipose tissue as pro- and anti¬inflammatory organ. Horm Metab Res. 2008;40 (7):442-5.Iacobellis G., Barbaro G. The double role of epicardial adipose tissue as pro- and anti¬inflammatory organ. Horm Metab Res. 2008;40 (7):442-5.Mazurek T., Zhang L., Zalewski A. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108 (20):2460-6.Mazurek T., Zhang L., Zalewski A. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108 (20):2460-6.Iacobellis G., Bianco A. C. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab. 2011;22:450-7.Iacobellis G., Bianco A. C. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends Endocrinol Metab. 2011;22:450-7.Veselovskaya NG, Chumakova GA, Elykomov VA, et al. Risk factors for restenosis after coronary stenting in patients with obesity. Cardiovascular Therapy and Prevention. 2013; 3:4-9. Russia (Веселовская НГ, Чумакова ГА, Елыкомов ВА, и др. Факторы риска рестеноза после коронарного стентирования у пациентов с ожирением. Кардиоваскулярная терапия и профилактика. 2013;3:4-9).Veselovskaya NG, Chumakova GA, Elykomov VA, et al. Risk factors for restenosis after coronary stenting in patients with obesity. Cardiovascular Therapy and Prevention. 2013; 3:4-9. Russia (Веселовская НГ, Чумакова ГА, Елыкомов ВА, и др. Факторы риска рестеноза после коронарного стентирования у пациентов с ожирением. Кардиоваскулярная терапия и профилактика. 2013;3:4-9).Chumakova GA, Veselovskaya NG, Gritsenko OV, et al. Epicardial obesity as a risk factor for coronary atherosclerosis. Cardiology. 2013; 1:51-5. Russia (Чумакова Г. А., Веселовская Н. Г., Гриценко О. В., и др. Эпикардиальное ожирение как фактор риска коронарного атеросклероза. Кардиология. 2013;1:51-5).Chumakova GA, Veselovskaya NG, Gritsenko OV, et al. Epicardial obesity as a risk factor for coronary atherosclerosis. Cardiology. 2013; 1:51-5. Russia (Чумакова Г. А., Веселовская Н. Г., Гриценко О. В., и др. Эпикардиальное ожирение как фактор риска коронарного атеросклероза. Кардиология. 2013;1:51-5).Veselovskaya NG, Chumakova GA, Ott AV, et al. Noninvasive marker of insulin resistance in obese patients. Russian Journal of Cardiology. 2013; 6:28-32. Russian (Веселовская НГ, Чумакова ГА, Отт АВ. Неинвазивный маркер инсулинорезистентности у пациентов с ожирением. Российский кардиологический журнал. 2013;6:28-32).Veselovskaya NG, Chumakova GA, Ott AV, et al. Noninvasive marker of insulin resistance in obese patients. Russian Journal of Cardiology. 2013; 6:28-32. Russian (Веселовская НГ, Чумакова ГА, Отт АВ. Неинвазивный маркер инсулинорезистентности у пациентов с ожирением. Российский кардиологический журнал. 2013;6:28-32).Perseghin G. Viewpoints on the way to a consensus session: where does insulin resistance start? The liver. Diabetes Care. 2009;32 (2):164-7.Perseghin G. Viewpoints on the way to a consensus session: where does insulin resistance start? The liver. Diabetes Care. 2009;32 (2):164-7.Marchesini G., Brizi M., Bianchi G., et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50:1844-50.Marchesini G., Brizi M., Bianchi G., et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50:1844-50.Sattar N, Scherbakova O, Ford I, et al. Elevated alanine aminotransferase predicts new-onset type 2 diabetes independently of classical risk factors, metabolic syndrome, and C-reactive protein in the West of Scotland Coronary Prevention Study. Diabetes. 2004;53:2855-60.Sattar N, Scherbakova O, Ford I, et al. Elevated alanine aminotransferase predicts new-onset type 2 diabetes independently of classical risk factors, metabolic syndrome, and C-reactive protein in the West of Scotland Coronary Prevention Study. Diabetes. 2004;53:2855-60.Stefan N, Kantartzis K, Machann J, et al. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. 2008;68:1609-16.Stefan N, Kantartzis K, Machann J, et al. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. 2008;68:1609-16.Zhang WJ, Chen LL, Zheng J, et al. Association of adult weight gain and nonalcoholic fatty liver in a cross-sectional study in Wan Song Community, China.Braz J Med Biol Res. 2014;47 (2):151-6.Zhang WJ, Chen LL, Zheng J, et al. Association of adult weight gain and nonalcoholic fatty liver in a cross-sectional study in Wan Song Community, China.Braz J Med Biol Res. 2014;47 (2):151-6.Perseghin G., Bonfanti R., Magni S., et al. Insulin resistance and whole body energy homeostasis in obese adolescents with fatty liver disease. Am J Physiol Endocrinol Metab. 2006;291:697-703.Perseghin G., Bonfanti R., Magni S., et al. Insulin resistance and whole body energy homeostasis in obese adolescents with fatty liver disease. Am J Physiol Endocrinol Metab. 2006;291:697-703.Petersen K. F., Arioglu Oral E., Dufour S., et al. Leptin reverses insulin resistance and hepatic steatosis in patients with severe lipodystrophy. J Clin Invest. 2002;109:1345-50.Petersen K. F., Arioglu Oral E., Dufour S., et al. Leptin reverses insulin resistance and hepatic steatosis in patients with severe lipodystrophy. J Clin Invest. 2002;109:1345-50.Guzel E. C., Celik C., Abali R., et al. Omentin and chemerin and their association with obesity in women with polycystic ovary syndrome. Gynecol Endocrinol. 2014 [Epub ahead of print].Guzel E. C., Celik C., Abali R., et al. Omentin and chemerin and their association with obesity in women with polycystic ovary syndrome. Gynecol Endocrinol. 2014 [Epub ahead of print].Yildiz Y, Ozaksit G., Serdar Unlu B., et al. Serum adiponectin level and clinical, metabolic, and hormonal markers in patients with polycystic ovary syndrome. Int J Fertil Steril. 2014;7 (4):331-6.Yildiz Y, Ozaksit G., Serdar Unlu B., et al. Serum adiponectin level and clinical, metabolic, and hormonal markers in patients with polycystic ovary syndrome. Int J Fertil Steril. 2014;7 (4):331-6.Salehpour S., Broujeni P. T., Samani E. N. Leptin, ghrelin, adiponectin, homocysteine and insulin resistance related to polycystic ovary syndrome. Int J Fertil Steril. 2008;2 (3):101-4.Salehpour S., Broujeni P. T., Samani E. N. Leptin, ghrelin, adiponectin, homocysteine and insulin resistance related to polycystic ovary syndrome. Int J Fertil Steril. 2008;2 (3):101-4.

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