OBESITY: DIETARY STRATEGIES AND THERAPEUTIC OPTIONS IN THE PROGRAM OF REGULATION AND CORRECTION OF INTESTINAL MICROFLORA AND REDUCING THE PERCENTAGE OF RECURRENCES OF VAGINAL DYSBIOSIS

Abstract

Background. One of the factors of vaginal microecosystem dysbiosis is a high frequency of metabolic disorders, in particular, obesity. In the reviewed literature, works devoted to the evaluation of the vaginal microbiota in overweight and obese women are few and contradictory. The aim of the study was to evaluate potential microbial metabolites and their changes when using the intestinal microbiota regulation program in patients with obesity and vaginal dysbiosis.

Materials and Methods. A study was conducted on 90 patients with dysbiotic changes in the vaginal mucosa: 60 overweight women (the first group) and 30 women with normal body mass index (the second group). The control group was formed by 30 women of reproductive age with a normal body mass index and normobiocenosis of the vaginal mucosa. To assess the level of endotoxin and the severity of anti-endotoxin immunity, the concentration of serum lipopolysaccharides and lipopolysaccharide-binding protein was determined by enzyme-linked immunosorbent assay. The correction of vaginal dysbiosis and intestinal microbiocenosis was used with the inclusion of dietary strategies and therapeutic options in the program - a combined synbiotic, omega-3 polyunsaturated fatty acids and a vitamin-mineral complex with coenzyme Q₁₀.

Results. In the examined obese patients, a mono-infection of vulvovaginal candidiasis (21.7% of cases), a mono-infection of bacterial vaginosis (16.7% of cases), a combination of vulvovaginal candidiasis and bacterial vaginosis (46.7% of cases) and non-specific vaginitis (15.0% of cases) was established. Symptoms of intestinal dyspepsia in the form of flatulence and frequent stools were noted in every third patient. Examination of the vaginal biotope allowed to establish moderate and pronounced dysbiosis - in 66.6%, in 25.0% of cases a significant role was assigned to anaerobic flora, as well as a sharp decrease in representatives of normal vaginal microflora (Lactobacillus spp. and Bifidobacterium spp.), which was verified only in a third of patients. The obtained results demonstrate an increase in the risk of recurrence of bacterial vaginosis (OR=3.0; 0.95% CI 1.0-9.85, p<0.05) and candidiasis (OR=3.05; 0.95% CI 1.09-8.57, p<0.05) in the case of overweight and obesity. The study of the endotoxemia level demonstrates the presence of endotoxin in blood serum in various concentrations, but exceeding 1.0 Eu/mL in overweight and obese women, and in 29 people (48.3%) the level of endotoxin was in the range of 1.5-1.8 Eu/mL. The assessment of the effectiveness of the proposed therapy was characterized not only by the restoration of normobiocenosis in most patients, but also by a 1.5 times lower relapse rate in the main group.

Conclusions. The proposed therapy with the addition of a synbiotic, omega-3 polyunsaturated fatty acids and a vitamin-mineral complex was characterized not only by twice as effective recovery of normobiocenosis, but also by a 1.5-fold decrease in the frequency of relapses in overweight patients.