BACKGROUND: Insufficiency and deficiency of vitamin D are recorded in a significant part of the population. Vitamin D, along with the formation of bone tissue, is included in all types of metabolism, determining the growth and development of the body, immunity, and the normal development of the nervous system. The consequences of deficiency can be long-term and in some cases irreversible. The problem of deficiency in infants is not well understood. AIM: To determine the content of vitamin D and indicators of bone metabolism in children of the first year of life of the Kazakh population. MATERIALS AND METHODS: 250 infants of the Kazakh population were examined. The content of vitamin D in the blood was determined. The state of bone metabolism was assessed by the results of a blood test to determine the serum concentration of calcium, phosphorus, parathyroid hormone, osteocalcin, calcitonin, and in the urine deoxypyridinoline. RESULTS: There is a wide prevalence (77.8%) of vitamin D insufficiency/deficiency in children under one year old in the Kazakh population. The greatest decrease in vitamin D was found in newborns. Statistically significant differences were found in the levels of bone metabolism indicators, such as total calcium, phosphorus, calcitonin and osteocalcin in different age groups. Indicators of bone metabolism, such as total calcium, phosphorus, parathyroid hormone, osteocalcin, depend on the degree of decrease in vitamin D levels. The most sensitive indicator that responds to changes in vitamin D levels is osteocalcin. The level of serum vitamin D can be used as a marker for the preclinical diagnosis of metabolic disorders of bone homeostasis in children. CONCLUSIONS: The study confirms the effect of vitamin D on metabolic processes in the skeletal system. The most sensitive indicator that responds to changes in vitamin D levels is osteocalcin. Research in this direction may be the basis for discussing the feasibility of vitamin D substitution and clarifying prenatal care schemes.

Introduction: The study of the genetic aspects of bone metabolism disorders in children is a theoretical and practical interest for pediatrics, especially according to the age and ethnic positions. There is a number of gene polymorphisms (primarily the vitamin D receptor (VDR) gene) that determine the norm and pathology of bone tissue formation. Calcium absorption worsens when there is no functional VDR and active forms of vitamin D. As a result the level of bone mineralization decreases. In children such disorders lead to the development of osteopenia. Objective: To determine the frequency of allelic variants of the VDR gene (rs1544410, rs2228570) and to evaluate its relationship with the level of vitamin D in children under one year old in the Kazakh population. Material and methods: 197 children under one year of age were examined for vitamin D by electrochemiluminescent immunoassay and genotyping of the VDR polymorphism (rs1544410, rs2228570) by PCR. Results: It was found out that children with the C allele of the VDR rs2228570 gene have a reduced level of vitamin D by 1.84 times (95% CI 1.10 - 3.07) and CC - by 2.3 times compared with children with normal vitamin D levels. Statistical analysis by the Kruskal-Wallis method showed that the serum level of vitamin D in AA carriers for the VDR rs1544410 was significantly reduced comparing to the level in GG and GA carriers (p=0.03). Conclusion: The study confirms the need for further in-depth study of the genetic aspects of bone metabolism disorders in children for the development of personalized medicine.

BACKGROUND: Non-pharmacological treatments are an integral part of the treatment of all patients with type 2 diabetes (T2D). However, due to many factors, doctors and patients themselves tend to underestimate or completely neglect such effective methods in managing the course of the disease. Despite the high level of evidence of the effectiveness of this type of treatment for T2D, every year scientists around the world continue to actively study the effect of various non-drug methods on the course of the disease.AIM: To study the effect of a 24-week structured non-pharmacological treatment program on glycated hemoglobin reduction and weight loss in middle-aged patients with compensated T2D taking metformin.MATERIALS AND METHODS: A two-group, randomized, parallel-group, blinded trial was designed. Patients with an established diagnosis of T2D in the stage of compensation (HbA_1c ≤7%), aged 45–59 years, taking metformin, were randomized to receive either standard non-pharmacological treatment of diabetes according to clinical protocol of T2D treatment in Kazakhstan, or an intensive course of non-pharmacological treatment according to a structured program developed by researchers. The duration of the intervention was 24 weeks. Primary outcomes were glycated hemoglobin, body weight. Secondary outcomes: blood pressure, waist circumference, insulin resistance index (HOMA-IR), lipid profile: total cholesterol, high and low density lipoproteins, triglycerides. The outcomes of the participants in both groups were assessed at baseline, 12 and 24 weeks after randomization. The study is registered with ClinicalTrials.gov NCT04632823.RESULTS: The study included 200 patients, 67 patients completed the study: intervention group n=33, control group n=34. After 24 weeks of observation, patients in the intervention group showed a significant decrease in HbA_1c from 6.34% to 6.22%, p<0.001, while for the control group the level of HbA_1c remained the same at 6.5% (p=0.703). Patients in both groups significantly reduced body weight, however, the decrease in the intervention group was more significant: by 6.7% of the initial level, while in the control group, only 1.1%. LDL, triglycerides, cholesterol level, HOMA-IR 2, and diastolic blood pressure did not decline significantly in the control group. All biochemical characteristics except triglycerides and LDL decreased significantly in the intervention group.CONCLUSION: The use of a structured program of non-pharmacological treatment of type 2 diabetes mellitus among compensated (HbA_1c ≤7%) middle-aged patients who took metformin significantly reduced body weight and glycated hemoglobin in 24 weeks.

This study investigates genetic markers, such as polymorphisms in the vitamin D receptor (VDR) and receptor activator of nuclear factor-kappa B ligand (RANKL) genes, to determine if they can serve as prognostic indicators for the development of bone-tissue pathologies in childhood. The study included 104 healthy children aged from birth to 12 months. Genetic testing was conducted to identify polymorphisms in the VDR and RANKL genes. 78% of the 104 children from the Kazakh population showed a decrease in the level of vitamin D, with particularly promising results in infants seven to 12 months old. Indicators of total calcium and phosphorus in children were uninformative for bone-metabolism analysis. The homozygous C/C type according to RANKL rs9594759 was detected in 17% of children; the homozygous T/T variant according to RANKL rs9594738 was detected in 28%; the homozygous T/T according to VDR rs2228570 was detected in 17%; and the homozygous A/A according to VDR rs2228570 was detected in 4%. These variant polymorphisms are associated with reduced bone density. RANKL rs9594738 and RANKL rs9594759 have shown a moderate connection with vitamin D serum concentration. A relatively strong relationship was found between the T/T and C/T genotypes of the VDR gene and the concentration of vitamin D falling below the norm, and there is a direct relationship between vitamin D levels and bone pathology risk in children.