Features of lipid and carbohydrate metabolism in patients with gastroesophageal reflux disease against type 2 diabetes, depending on the presence of obesity
Authors:   Kharkiv National Medical Univercity, Bondar-Кeleberda O.S. 
Published: December 2023

The aim: To reveal the peculiarities of lipid and carbohydrate metabolism in patients with isolated gastroesophageal reflex disease (GERD), GERD on the background of type 2 diabetes mellitus (T2DM) and with type 2 DM, depending on the body mass index (BMI). Materials and methods. To participate in the study, 100 patients were recruited, who were divided into 3 groups: 1 group — patients with type 2 diabetes in combination with GERD (60 people), the second group included patients with isolated GERD (20 people), the third group — patients with type 2 diabetes (20 people). Patients of the group of type 2 DM in combination with GERD were further divided into 2 subgroups 30 men with normal weight or excess body weight (BWM), and 30 men with obesity of various degrees. The control group consisted of 20 practically healthy people. Patients underwent anthropometric measurements using the Quetelet index. The calculation was made according to the formula: BMI = m/h2, where m is body weight, h is height. Levels of blood serum glucose, glycosylated hemoglobin (HbA1c) were determined using autoanalyzers (Architect c8000, Abbott Laboratories Inc., Abbott Park, IL, USA), the glucose-hexokinase method and G8 (Tosoh Bioscience, Tessenderlo, Belgium), using a high-performance liquid chromatography. Lipid profile indicators were determined by biochemical methods in accordance with the standard for determining total cholesterol (LC), low-density lipoprotein cholesterol (LDL-C), cholesterol of very low-density lipoproteins (VLDL), high[1]density lipoprotein cholesterol (HDL), and triglycerides (TG) by the photometric method based on the central research laboratory of the Kharkiv National Medical University (TNML). The coefficient of atherogenicity (CA) was calculated according to a mathematical formula. The level of insulin was determined in blood serum by enzyme-linked immunosorbent assay (ELISA) on the “Labline-90” analyzer (Austria) using a commercial test system manufactured by DRG (ELISA, USA). Index of insulin resistance (HOMA-IR) was determined by mathematical calculation. Statistical analysis was performed using the program StatTech v. 1.2.0, «Statistica 10», Exel 7.0. Discussion of the obtained results. In patients of group 1 (type 2 diabetes mellitus + GERD), reliable direct correlations of average strength of indicators with BMI were established: insulin (ρ=0.349; p=0.006), ZX (ρ=0.398; p=0.002), TG (ρ=0.393; p=0.002), CA (ρ=0.596; p=0.000). The reliable weak direct correlations were NOMA-IR, HDL-C with BMI (ρ=0.264; p=0.042), (ρ=0.259; p=0.046), respectively. We reliably recorded significant (p<0.05) increases in some indicators in the subgroup of type 2 DM + GERD with obesity of various degrees, compared to the subgroup of type 2 DM + GERD with normal weight or NMT. Thus, the «BMI» indicator was (34.88±0.87) and (23.07±0.59); «Insulin» index (20.18±1.40) and (15.89±1.61); HvA1C (9.35±0.43) and (8.18±0.39); NOMA-IR (10.89±1.35) and (7.06±0.87); CS (5.95±0.33) and (4.83±0.24); TG (1.83±0.10) and (1.42±0.11); CA (2.72±0.09) and (2.06±0.09), respectively. When processing the results, it was found that such indicators as glucose, HvA1C, cholesterol-LDL, cholesterol-LDL did not show statistically significant correlations with BMI. Analyzing the 2nd group of patients with isolated GERD, reliable direct correlations of average strength with BMI of such indicators as insulin (ρ = 0.481; p=0.032), NOMA-IR (ρ = 0.453; p=0.045); a reliable direct strong correlation was found in the processing of KA (ρ = 0.722; p=0.000) with BMI and a reliable medium-strength inverse relationship had HDL-C (ρ = -0.453; p=0.045) with BMI. No statistically significant correlations with BMI were found in the group of patients with isolated GERD when studying such indicators as glucose, HvA1c, HC, TG, VLDL-HC, LDL-HC. In group 3, the following results were obtained: reliable direct correlations of average strength of indicators with BMI: insulin (ρ=0.616; p=0.004), NOMA-IR (ρ=0.473; p=0.0035), TG (ρ=0.680; p=0.001), HDL-C (ρ=0.647; p=0.002), LDL-C (ρ=0.481; p=0.0031). Whereas, when studying LDL-C, a reliable inverse correlation with BMI was recorded (ρ=-0.465; p=0.0039). Examining the TG index in this group, a strong direct correlation with the CH-LDL index was found (ρ=0.863). Conclusions: When evaluating the correlations of indicators with BMI in the studied groups, it was probably determined that some indicators reliably depend on BMI. So, looking at group 1, we can say that such indicators as insulin, NOMA-IR, HC, TG, HDL-C and KA are reliably involved in the formation of BMI. When these indicators increase by 1, an increase in BMI should be expected. When analyzing the subgroup with obesity and normal weight or NMT (type 2 DM + GERD group), it was found that the results of BMI, insulin, HvA1C, NOMA-IR, HC, TG and KA were significantly greater in the subgroup with existing obesity. In patients with an isolated course of GERD (group 2), it was determined that an increase in BMI had an effect on insulin, NOMA[1]IR, CA namely, with an increase in BMI by 1, an increase in these indicators should be expected. It was found that HDL-C will increase with a decrease in BMI. Characterizing the 3rd group of patients (type 2 diabetes), we can conclude that with an increase in insulin, NOMA-IR, TG, HDL-C, and LDL-C by 1, a decrease in BMI should be expected, and with a decrease in LDL-C, an increase should be expected BMI. If we systematize the above, we can say that BMI plays an important role in formation of disorders of lipid and carbohydrate metabolism in patients with these nosologies.