medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-191medsovet-10173Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYЭволюция представлений об оптимальном питании как основе метаболического здоровьяEvolution of concepts on optimal nutrition as a pillar for improving metabolic healthhttps://orcid.org/0000-0001-6385-540XДемидоваТ. Ю.DemidovaT. Yu.

Демидова Татьяна Юльевна, д.м.н., профессор, заведующий кафедрой эндокринологии Института клинической медицины 

117513, Москва, ул. Островитянова, д. 1

Tatiana Yu. Demidova, Dr. Sci. (Med.), Professor, Head of the Department of Endocrinology 

1, Ostrovityanov St., Moscow, 117513

https://orcid.org/0000-0003-1699-0881НикитинИ. Г.NikitinI. G.

Никитин Игорь Геннадиевич, д.м.н., профессор, заведующий кафедрой госпитальной терапии имени академика Г.И. Сторожакова Института клинической медицины 

117513, Москва, ул. Островитянова, д. 1

Igor G. Nikitin, Dr. Sci. (Med.), Professor, Head of Department of Hospital Therapy Named After Academician G.I Storozhakov, Institute of Clinical Medicine 

1, Ostrovityanov St., Moscow, 117513

igor.nikitin.64@mail.ruhttps://orcid.org/0000-0001-9262-9233СтародубоваA. B.StarodubovaA. V.

Стародубова Антонина Владимировна, д.м.н., доцент, заведующий кафедрой факультетской терапии Института клинической медицины, заместитель директора по научной и лечебной работе, Федеральный исследовательский центр питания и биотехнологии; заведующий кафедрой факультетской терапии Института клинической медицины, Российский национальный исследовательский медицинский университет имени Н.И. Пирогова 

117513, Москва, ул. Островитянова, д. 1; 109240, Москва, Устьинский проезд, д. 2/14

Antonina V. Starodubova, Dr. Sci. (Med.), Associate Professor, Deputy Director for Research and Clinical Care, Federal Research Centre of Nutrition, Biotechnology and Food Safety; Head of the Department of Intermediate Level Therapy, Institute of Clinical Medicine, Pirogov Russian National Research Medical University

2/14, Ustinskiy Proezd, Moscow, 109240; 1, Ostrovityanov St., Moscow, 117513

lechebnoedelo@yandex.ruhttps://orcid.org/0000-0002-2028-8748КислякО. А.KislyakO. A.

Кисляк Оксана Андреевна, д.м.н., профессор, почетный профессор кафедры факультетской терапии Института клинической медицины 

117513, Москва, ул. Островитянова, д. 1

Oksana A. Kislyak, Dr. Sci. (Med.), Professor, Honorary Head of the Department of Intermediate Level Therapy, Institute of Clinical Medicine,

1, Ostrovityanov St., Moscow, 117513

https://orcid.org/0000-0002-1385-0245ИзмайловаМ. Я.IzmaylovaM. Ya.

Измайлова Марьям Ярагиевна, ассистент кафедры эндокринологии Института клинической медицины 

117513, Москва, ул. Островитянова, д. 1

Maryam Ya. Izmaylova, Assistant Professor of the Department of Endocrinology, Institute of Clinical Medicine 

1, Ostrovityanov St., Moscow, 117513

maremizm@gmail.comРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Федеральный исследовательский центр питания и биотехнологииРоссияPirogov Russian National Research Medical University; Federal Research Centre of Nutrition, Biotechnology and Food SafetyRussian Federation20262506202607113123Copyright © Демидова Т.Ю., Никитин И.Г., Стародубова A.B., Кисляк О.А., Измайлова М.Я., 20262026Демидова Т.Ю., Никитин И.Г., Стародубова A.B., Кисляк О.А., Измайлова М.Я.Demidova T.Y., Nikitin I.G., Starodubova A.V., Kislyak O.A., Izmaylova M.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/10173

Ожирение представляет собой одну из наиболее значимых медико-социальных проблем современности, являясь ведущей предотвратимой причиной глобальной заболеваемости и преждевременной смертности. Согласно результатам крупных эпидемиологических исследований, за последние десятилетия распространенность данной патологии приобрела характер пандемии неинфекционных заболеваний: общемировой уровень ожирения увеличился почти втрое, став серьезным вызовом для систем здравоохранения в XXI в. и обуславливая колоссальные экономические потери. В соответствии с актуальными позициями ведущих мировых и отечественных профессиональных сообществ, базисом успешной терапии остается комплексная персонализированная модификация образа жизни, включающая коррекцию пищевого поведения и регулярную физическую активность. Опубликованные в 2026 г. Федеральным правительством США обновленные диетические рекомендации (Dietary Guidelines for Americans) ознаменовали внедрение принципиально новой визуальной модели питания, базирующейся на концепции приоритета цельных продуктов и жестком ограничении ультрапереработанной пищи, что фактически привело к трансформации традиционной схемы в «инвертированную» пирамиду, ориентированную на высокую пищевую ценность рациона питания. Однако ключевым вектором и инновационным прорывом современной доказательной медицины в лечении ожирения становится приоритетное использование инновационных фармакологических агентов – агонистов рецепторов глюкагоноподобного пептида-1 и двойных агонистов рецепторов ГПП-1 и глюкозозависимого инсулинотропного полипептида, таких как семаглутид и тирзепатид. Данные препараты, реализуя свои плейотропные механизмы и обладая системным многофакторным воздействием на кардиометаболические, ренальные и биомеханические параметры, позволяют не только достигать значимых целевых показателей снижения массы тела, сопоставимых с результатами бариатрических вмешательств, но и патогенетически обоснованно минимизировать риски больших сердечно-сосудистых событий (MACE) и замедлять прогрессирование хронической болезни почек, существенно улучшая качество жизни и долгосрочный прогноз у данной категории пациентов.

Obesity is one of the most significant medical and social problems of our time, being the leading preventable cause of global morbidity and premature mortality. According to the results of large-scale epidemiological studies, over the past few decades the prevalence of this condition has taken on the characteristics of a pandemic of non-communicable diseases: the global prevalence of obesity has almost tripled, posing a serious challenge to healthcare systems in the 21st century and resulting in colossal economic losses. The updated dietary guidelines (Dietary Guidelines for Americans) marked the introduction of a fundamentally new visual model of nutrition, based on the concept of prioritising whole foods and strictly limiting ultraprocessed foods, which effectively led to the transformation of the traditional model into an ‘inverted’ pyramid focused on the nutritional density of the diet. In line with the current positions of leading global and domestic professional communities, the basis for successful treatment remains a comprehensive, personalised lifestyle modification, including dietary behaviour correction and regular physical activity. However, the priority use of innovative pharmacological agents – glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1 receptor agonists – is becoming a key driver and innovative breakthrough in modern evidence-based medicine.

ожирениерациональное питаниеметаболическое здоровьепирамида питанияинкретиныобраз жизниobesitybalanced dietmetabolic healthfood pyramidincretinslifestyleReferencesBanerjee D, Mani A. Obesity’s systemic impact: exploring molecular and physiological links to diabetes, cardiovascular disease, and heart failure. Front Endocrinol. 2025;16:1681766. https://doi.org/10.3389/fendo.2025.1681766.Banerjee D, Mani A. Obesity’s systemic impact: exploring molecular and physiological links to diabetes, cardiovascular disease, and heart failure. Front Endocrinol. 2025;16:1681766. https://doi.org/10.3389/fendo.2025.1681766.Westbury S, Oyebode O, van Rens T, Barber TM. Obesity Stigma: Causes, Consequences, and Potential Solutions. Curr Obes Rep. 2023;12(1):10–23. https://doi.org/10.1007/s13679-023-00495-3.Westbury S, Oyebode O, van Rens T, Barber TM. Obesity Stigma: Causes, Consequences, and Potential Solutions. Curr Obes Rep. 2023;12(1):10–23. https://doi.org/10.1007/s13679-023-00495-3.Dai H, Alsalhe TA, Chalghaf N, Riccò M, Bragazzi NL, Wu J. The global burden of disease attributable to high body mass index in 195 countries and territories, 1990–2017: An analysis of the Global Burden of Disease Study. PloS Med. 2020;17(7):e1003198. https://doi.org/10.1371/journal.pmed.1003198.Dai H, Alsalhe TA, Chalghaf N, Riccò M, Bragazzi NL, Wu J. The global burden of disease attributable to high body mass index in 195 countries and territories, 1990–2017: An analysis of the Global Burden of Disease Study. PloS Med. 2020;17(7):e1003198. https://doi.org/10.1371/journal.pmed.1003198.Kivimäki M, Strandberg T, Pentti J, Nyberg ST, Frank P, Jokela M et al. Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study. Lancet Diabetes Endocrinol. 2022;10(4):253–263. https://doi.org/10.1016/S2213-8587(22)00033-X.Kivimäki M, Strandberg T, Pentti J, Nyberg ST, Frank P, Jokela M et al. Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study. Lancet Diabetes Endocrinol. 2022;10(4):253–263. https://doi.org/10.1016/S2213-8587(22)00033-X.Calcaterra V, Cena H, Magenes VC, Vincenti A, Comola G, Beretta A et al. Sugar-Sweetened Beverages and Metabolic Risk in Children and Adolescents with Obesity: A Narrative Review. Nutrients. 2023;15(3):702. https://doi.org/10.3390/nu15030702.Calcaterra V, Cena H, Magenes VC, Vincenti A, Comola G, Beretta A et al. Sugar-Sweetened Beverages and Metabolic Risk in Children and Adolescents with Obesity: A Narrative Review. Nutrients. 2023;15(3):702. https://doi.org/10.3390/nu15030702.Ndumele CE, Matsushita K, Lazo M, Bello N, Blumenthal RS, Gerstenblith G et al. Obesity and subtypes of incident cardiovascular disease. J Am Heart Assoc. 2016;5(8):e003921. https://doi.org/10.1161/jaha.116.003921.Ndumele CE, Matsushita K, Lazo M, Bello N, Blumenthal RS, Gerstenblith G et al. Obesity and subtypes of incident cardiovascular disease. J Am Heart Assoc. 2016;5(8):e003921. https://doi.org/10.1161/jaha.116.003921.Yang M, Liu S, Zhang C. The related metabolic diseases and treatments of obesity. Healthcare. 2022;10(9):1616. https://doi.org/10.3390/healthcare10091616.Yang M, Liu S, Zhang C. The related metabolic diseases and treatments of obesity. Healthcare. 2022;10(9):1616. https://doi.org/10.3390/healthcare10091616.Uti DE, Atangwho IJ, Omang WA, Alum EU, Obeten UN, Udeozor PA et al. Cytokines as key players in obesity low grade inflammation and related complications. Obes Med. 2025;54:100585. https://doi.org/10.1016/j.obmed.2025.100585.Uti DE, Atangwho IJ, Omang WA, Alum EU, Obeten UN, Udeozor PA et al. Cytokines as key players in obesity low grade inflammation and related complications. Obes Med. 2025;54:100585. https://doi.org/10.1016/j.obmed.2025.100585.Shimobayashi M, Albert V, Woelnerhanssen B, Frei IC, Weissenberger D, Meyer-Gerspach AC et al. Insulin resistance causes inflammation in adipose tissue. J Clin Invest. 2018;128(4):1538–1550. https://doi.org/10.1172/JCI96139.Shimobayashi M, Albert V, Woelnerhanssen B, Frei IC, Weissenberger D, Meyer-Gerspach AC et al. Insulin resistance causes inflammation in adipose tissue. J Clin Invest. 2018;128(4):1538–1550. https://doi.org/10.1172/JCI96139.Powell-Wiley TM, Poirier P, Burke LE, Després J-P, Gordon-Larsen P, Lavie CJ et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143(21):e984–e1010. https://doi.org/10.1161/CIR.0000000000000973.Powell-Wiley TM, Poirier P, Burke LE, Després J-P, Gordon-Larsen P, Lavie CJ et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143(21):e984–e1010. https://doi.org/10.1161/CIR.0000000000000973.Banerjee D, Sinha A, Saikia S, Gogoi B, Rathore AK, Das AS et al. Inflammation-induced mTORC2-Akt-mTORC1 signaling promotes macrophage foam cell formation. Biochimie. 2018;151:139–149. https://doi.org/10.1016/j.biochi.2018.06.001.Banerjee D, Sinha A, Saikia S, Gogoi B, Rathore AK, Das AS et al. Inflammation-induced mTORC2-Akt-mTORC1 signaling promotes macrophage foam cell formation. Biochimie. 2018;151:139–149. https://doi.org/10.1016/j.biochi.2018.06.001.Raman P, Khanal S. Leptin in atherosclerosis: focus on macrophages, endothelial and smooth muscle cells. Int J Mol Sci. 2021;22(11):5446. https://doi.org/10.3390/ijms22115446.Raman P, Khanal S. Leptin in atherosclerosis: focus on macrophages, endothelial and smooth muscle cells. Int J Mol Sci. 2021;22(11):5446. https://doi.org/10.3390/ijms22115446.Sarma S, Sockalingam S, Dash S. Obesity as a multisystem disease: trends in obesity rates and obesity‐related complications. Diabetes Obes Metab. 2021;23(S1):3–16. https://doi.org/10.1111/dom.14290.Sarma S, Sockalingam S, Dash S. Obesity as a multisystem disease: trends in obesity rates and obesity‐related complications. Diabetes Obes Metab. 2021;23(S1):3–16. https://doi.org/10.1111/dom.14290.Wang S, Li S. Type 2 diabetes, heart failure and the treatment of their comorbidity. Minerva Med. 2025;116(2):141–155. https://doi.org/10.23736/S0026-4806.24.09264-4.Wang S, Li S. Type 2 diabetes, heart failure and the treatment of their comorbidity. Minerva Med. 2025;116(2):141–155. https://doi.org/10.23736/S0026-4806.24.09264-4.Nadolsky K, Garvey WT, Agarwal M, Bonnecaze A, Burguera B, Chaplin MDG et al. American Association of Clinical Endocrinology Consensus Statement: Algorithm for the Evaluation and Treatment of Adults with Obesity/Adiposity-Based Chronic Disease – 2025 Update. Endocr Pract. 2025;31(11):1351–1394. https://doi.org/10.1016/j.eprac.2025.07.017.Nadolsky K, Garvey WT, Agarwal M, Bonnecaze A, Burguera B, Chaplin MDG et al. American Association of Clinical Endocrinology Consensus Statement: Algorithm for the Evaluation and Treatment of Adults with Obesity/Adiposity-Based Chronic Disease – 2025 Update. Endocr Pract. 2025;31(11):1351–1394. https://doi.org/10.1016/j.eprac.2025.07.017.Busetto L, Dicker D, Frühbeck G, Halford JCG, Sbraccia P, Yumuk V, Goossens GH. A new framework for the diagnosis, staging and management of obesity in adults. Nat Med. 2024;30(9):2395–2399. https://doi.org/10.1038/s41591-024-03095-3.Busetto L, Dicker D, Frühbeck G, Halford JCG, Sbraccia P, Yumuk V, Goossens GH. A new framework for the diagnosis, staging and management of obesity in adults. Nat Med. 2024;30(9):2395–2399. https://doi.org/10.1038/s41591-024-03095-3.Snetselaar LG, de Jesus JM, DeSilva DM, Stoody EE. Dietary Guidelines for Americans, 2020-2025: Understanding the Scientific Process, Guidelines, and Key Recommendations. Nutr Today. 2021;56(6):287–295. https://doi.org/10.1097/NT.0000000000000512.Snetselaar LG, de Jesus JM, DeSilva DM, Stoody EE. Dietary Guidelines for Americans, 2020-2025: Understanding the Scientific Process, Guidelines, and Key Recommendations. Nutr Today. 2021;56(6):287–295. https://doi.org/10.1097/NT.0000000000000512.Mozaffarian D. The 2025–2030 Dietary Guidelines for Americans. JAMA. 2026;335(7):575–577. https://doi.org/10.1001/jama.2026.0283.Mozaffarian D. The 2025–2030 Dietary Guidelines for Americans. JAMA. 2026;335(7):575–577. https://doi.org/10.1001/jama.2026.0283.Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4):311–322. https://doi.org/10.1056/NEJMoa1603827.Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4):311–322. https://doi.org/10.1056/NEJMoa1603827.Bensignor MO, Bramante CT, Bomberg EM, Fox CK, Hale PM, Kelly AS et al. Evaluating potential predictors of weight loss response to liraglutide in adolescents with obesity: A post hoc analysis of the randomized, placebo-controlled SCALE Teens trial. Pediatr Obes. 2023;18(9):e13061. https://doi.org/10.1111/ijpo.13061.Bensignor MO, Bramante CT, Bomberg EM, Fox CK, Hale PM, Kelly AS et al. Evaluating potential predictors of weight loss response to liraglutide in adolescents with obesity: A post hoc analysis of the randomized, placebo-controlled SCALE Teens trial. Pediatr Obes. 2023;18(9):e13061. https://doi.org/10.1111/ijpo.13061.Amaro A, Sugimoto D, Wharton S. Efficacy and safety of semaglutide for weight management: evidence from the STEP program. Postgrad Med. 2022;134(sup1):5–17. https://doi.org/10.1080/00325481.2022.2147326.Amaro A, Sugimoto D, Wharton S. Efficacy and safety of semaglutide for weight management: evidence from the STEP program. Postgrad Med. 2022;134(sup1):5–17. https://doi.org/10.1080/00325481.2022.2147326.Ryan DH, Lingvay I, Deanfield J, Kahn SE, Barros E, Burguera B et al. Longterm weight loss effects of semaglutide in obesity without diabetes in the SELECT trial. Nat Med. 2024;30(7):2049–2057. https://doi.org/10.1038/s41591-024-02996-7.Ryan DH, Lingvay I, Deanfield J, Kahn SE, Barros E, Burguera B et al. Longterm weight loss effects of semaglutide in obesity without diabetes in the SELECT trial. Nat Med. 2024;30(7):2049–2057. https://doi.org/10.1038/s41591-024-02996-7.Butler J, Shah SJ, Petrie MC, Borlaug BA, Abildstrøm SZ, Davies MJ et al. Semaglutide versus placebo in people with obesity-related heart failure with preserved ejection fraction: a pooled analysis of the STEP-HFpEF and STEP-HFpEF DM randomised trials. Lancet. 2024;403(10437):1635–1648. https://doi.org/10.1016/S0140-6736(24)00469-0.Butler J, Shah SJ, Petrie MC, Borlaug BA, Abildstrøm SZ, Davies MJ et al. Semaglutide versus placebo in people with obesity-related heart failure with preserved ejection fraction: a pooled analysis of the STEP-HFpEF and STEP-HFpEF DM randomised trials. Lancet. 2024;403(10437):1635–1648. https://doi.org/10.1016/S0140-6736(24)00469-0.Phase 3 ESSENCE Trial: Semaglutide in Metabolic Dysfunction-Associated Steatohepatitis. Gastroenterol Hepatol. 2024;20(12 Suppl. 11):6–7. Available at: https://pubmed.ncbi.nlm.nih.gov/39896971/.Phase 3 ESSENCE Trial: Semaglutide in Metabolic DysfunctionAssociated Steatohepatitis. Gastroenterol Hepatol. 2024;20(12 Suppl. 11):6–7. Available at: https://pubmed.ncbi.nlm.nih.gov/39896971/.Sattar N, García-Pérez LE, Rodríguez A, Kapoor R, Stefanski A, Hankosky ER. Tirzepatide and cardiometabolic parameters in obesity: Summary of current evidence. Diabetes Obes Metab. 2025;27(10):5386–5392. https://doi.org/10.1111/dom.16549.Sattar N, García-Pérez LE, Rodríguez A, Kapoor R, Stefanski A, Hankosky ER. Tirzepatide and cardiometabolic parameters in obesity: Summary of current evidence. Diabetes Obes Metab. 2025;27(10):5386–5392. https://doi.org/10.1111/dom.16549.Malhotra A, Grunstein RR, Fietze I, Weaver TE, Redline S, Azarbarzin A et al. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med. 2024;391(13):1193–1205. https://doi.org/10.1056/NEJMoa2404881.Malhotra A, Grunstein RR, Fietze I, Weaver TE, Redline S, Azarbarzin A et al. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med. 2024;391(13):1193–1205. https://doi.org/10.1056/NEJMoa2404881.

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