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The knowledge about the features of energy metabolism in MAFLD in the population living at different climatic and geographic heights is lacking. The goal of this study is to explore the biochemical parameters of blood and erythrocyte energy consumption in patients with MAFLD with and without DM2 living in the low- and moderate-altitude regions of Central Asia. Our study was carried out on patients living in low-altitude mountains: Bishkek, altitude=750-800 m; n=67 (MAFLD with DM 2: n=24; MAFLD without DM2: n=25; control: n=18), and At-Bashy District, Naryn Region, altitude=2046-2300 m; n=58 (MAFLD with DM2: n=28; MAFLD without DM2: n=18; control: n=12). Non-alcoholic fatty liver disease was diagnosed according to history, laboratory tests, liver ultrasound, and exclusion of other liver diseases. The level of liver fibrosis was determined using the FIB-4 score. Blood adenosine 5'-triphosphate (ATP) was determined using the CellTiter-Glo method. Healthy residents living in moderate altitudes have significantly higher levels of cytosolic ATP in their blood (p+≤+0.05) than residents living in low mountains. MAFLD is characterized by an increase in the level of ATP concentration in their blood. ATP concentration decreased significantly in patients with MAFLD with DM2 living in moderate-altitude in comparison to those living in low-altitude mountains. The results suggest that chronic altitude hypoxia leads to a breakdown in adaptive mechanisms of energy metabolism of ATP in patients with MAFLD with type 2 DM., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Aim: To study the peculiarities of lipid metabolism disorders in non-alcoholic fatty liver disease in lean and obese patients in medium altitude conditions., Materials and Methods: The study was carried out within the framework of the project "Etiopathogenetic features and rates of development of non-alcoholic fatty liver disease (NAFLD) in the conditions of Kyrgyzstan" (№ of state registration MHN/TZ-2020-3). An open comparative study of patients with two forms of NAFLD: fatty liver and non-alcoholic steatohepatitis ( n =236) living in low mountains (Bishkek, altitude above sea level - 750-800 m; n =111) and middle mountains (At-Bashy district , Naryn region, height above sea level - 2046-2300 m; n =125) Kyrgyzstan. The average age of the patients was 55.7±0.95 years. Given that genetic factors may play a role in the development of NAFLD, we analyzed a population represented only by ethnic Kyrgyz. Patients in each group were divided into lean (BMI≤23) and obese (BMI>23) groups. To determine physical activity, a physical activity questionnaire was used, which was compiled on the basis of the materials of the International Physical Activity Prevalence Study www.ipaq.ki.se. Physical examination included measurement of anthropometric parameters (height, body weight, waist circumference), calculation of body mass index (BMI), skeletal muscle mass index (SMM), percentage of body fat. According to the grades of the WHO, the degree of obesity was assessed by BMI for Asians. Blood samples were taken for research in the morning on an empty stomach after at least 12 hours of fasting. The following indicators were determined: glucose, lipid spectrum (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), alanine aminotransferase (ALT), aspartate aminotransferase (AST) levels. The BARD scale was used as a predictor for assessing the development of liver fibrosis in patients with NAFLD. The scoring system included three variables: BMI, AST/ALT, and the presence of DM 2. The diagnosis of NAFLD made on the basis of history, laboratory tests, ultrasound examination of the liver, and exclusion of other liver diseases. The results were analyzed using the SPSS 16.0 statistical software package for Windows. A p -value<0.05 was considered statistically significant at the 95% confidence level., Results: It was found that the inhabitants of the middle mountains with NAFLD are represented by a lower BMI relative to the inhabitants of the low mountains. In women, the levels of SMM and the percentage of fat are significantly and statistically significantly correlated ( r =-0.971; p <0.001), while in men these two indicators are not related. Men showed a trend towards higher percentages of fat, regardless of body weight and region of residence. For women, this indicator was within acceptable limits and did not exceed 31%. There was found a statistically significant difference in total cholesterol levels between low and middle mountain people in the group of obese patients ( p <0.001) suffering from NAFLD. Statistically significant low ALT indices were revealed in the group of obese patients living in mid-mountain conditions., Conclusion: Taken together, our results suggest that chronic mid-mountain hypoxia may slow down the course of overweight-induced NAFLD.

Introduction: The purpose of the study was to establish spirometric reference values for a Central Asian population of highlanders and lowlanders. Methods: Spirometries from a population-based cross-sectional study performed in 2013 in rural areas of Kyrgyzstan were analyzed. Using multivariable linear regression, Global Lung Function Initiative (GLI) equations were fitted separately for men and women, and altitude of residence (700-800 m, 1,900-2,800 m) to data from healthy, never-smoking Kyrgyz adults. The general GLI equation was applied: Predicted value = e a 0 + a 1 ×  ln ( Height ) + a 2 ×  ln ( Age ) + b 1 ×  ln ( Age 100 ) + b 2 ×  ln ( Age 100 ) 2 + b 3 ×  ln ( Age 100 ) 3              + b 4 ×  ln ( Age 100 ) 4 + b 5 ×  ln ( Age 100 ) 5 Results: Of 2,784 screened Kyrgyz, 448 healthy, non-smoking highlanders (379 females) and 505 lowlanders (368 females), aged 18-91 years, were included. Predicted FVC in Kyrgyz fit best with GLI "North-East Asians," predicted FEV 1 fit best with GLI "Other/Mixed." Predicted FEV 1 /FVC was lower than that of all GLI categories. Age- and sex-adjusted mean FVC and FEV 1 were higher in highlanders (+0.138l, +0.132l) than in lowlanders ( P < 0.001, all comparisons), but FEV 1 /FVC was similar. Conclusion: We established prediction equations for an adult Central Asian population indicating that FVC is similar to GLI "North-East Asian" and FEV 1 /FVC is lower than in all other GLI population categories, consistent with a relatively smaller airway caliber. Central Asian highlanders have significantly greater dynamic lung volumes compared to lowlanders, which may be due to environmental and various other effects., (Copyright © 2020 Ulrich, Furian, Estebesova, Toktogulova, Beishekeeva, Ulrich, Burney, Sooronbaev and Bloch.)