. 1
( 3 .)



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oOaeCOa a aOaAeeiCe

aAU·OIE?AOIEE OEI?OI:
O?EI?EO? IA?AIE?
U.N. aO·I‚, C.C. iOII?A‚
e?OUAOOO?
eOOOEEOIEE UIE‚A?OEUAU ?UE·? I?OO‚, aOOI‚

he National Cholesterol Education Program’s Adult ii?aaaeaiea iaoaaiee?aneiai neia?iia, oiaaa eae a
T Treatment Panel III (ATP III) ii?aaaeyao iaoaaiee?a- eeanneoeeaoee ATP III e ANA iniiaiia aieiaiea oaaey-
neee neia?ii, eae ninoiyiea aunieiai ?enea ?acaeoey aony iieacaoaeyi aeeeaiee (oaae. 2). Aia?eeaineay Anni-
eoaie?aneie aieacie na?aoa (EAN) aia caaeneiinoe io oeaoey yiaie?eiieiaia ioia?aao nouanoaiaaiea ?acee-
o?iaiae EIII [1]. A ii?aaaeaiee ?aoei oeacaiu neaao- ?ee ia?ao neia?iiii einoeeii?acenoaioiinoe e NA 2
?uea e?eoa?ee aeaaiinoeee iaoaaiee?aneiai neia?iia: oeia e ia?auaao aieiaiea ia oi, ?oi o ?yaa iaoeaioia n
ie?o?iinou oaeee, iiauoaiea AA, OA, ae?eicu iaoiuae einoeeii?acenoaioiui neia?iiii ii?ao ano?a?aouny NA
e nie?aiea EIAI. Aey iinoaiiaee aeaaiica iaiaoiaeii 2 oeia. Ii aaiiui McLaughlin, iaeaieaa i?inouie i?aae-
iaee?ea ?3–o e?eoa?eaa. A aeaaiinoeea aaiiiai ninoiy- eoi?aie einoeeii?acenoaioiinoe iiaoo aunooiaou OA, ei-
noeei iaoiuae, ioiioaiea OA/EIAI [3]. Cieioui noai-
iey eniieucoaony neia?iiiue iiaoia, iaiaei, iiieii
aa?oii aey aeaaiinoeee einoeeii?acenoaioiinoe o iaoe-
iniiaiuo, iaiaoiaeii o?eouaaou oaeoi?u, eioi?ua ia
aioia n ecauoi?iui aanii aac a?oa?eaeuiie aeia?oiiee
io?a?aiu a ii?aaaeaiee, oaeea eae EIIII, aiieeii-
(AA) yaeyaony onoie?eaay eiioaio?aoey ae?eicu ieaciu
i?ioaei A (aiiA), i?iainiaeeoaeuiua oaeoi?u ?enea.
ai a?aiy i?iaaaaiey noi?anneaiiai oanoa, eioi?ue iae-
Aunieea iieacaoaee N?A annioee?iaaiu n oaaee?aieai
aieaa oanii ei??aee?oao n yoaeeeaie?aneei aeia?eino-
?enea eiiiiiaioia iaoaaiee?aneiai neia?iia [2]. Ec-
eeiaie?aneei eeyiiii. Ionoonoaea ?aoeeo aeaaiinoe?a-
aanoii, ?oi oiaiuoaiea aana oaea – iniiaa aey e?aiai
neeo e?eoa?eaa aeia?einoeeiaiee, a oae?a aicii?iua
ec oa?aiaaoe?aneeo ?a?eiia.
o?oaiinoe i?e auiieiaiee oanoa ia oiea?aioiinou e ae?-
Nouanoaoao ianeieuei eeanneoeeaoee iaoaaiee?a-
eica niinianoao?o aieaa oe?ieiio eniieuciaaie? eean-
neiai neia?iia. Iniiaiua aeaaiinoe?aneea e?eoa?ee
neoeeaoee iaoaaiee?aneiai neia?iia ATP III.
i?aanoaaeaiu a oaaeeoa 1. I?eioeieaeuiui ?acee?eai
Iaoeaiou n iaoaaiee?aneei neia?iiii eia?o ii-
ia?ao ieie yaeyaony ?ieu einoeeii?acenoaioinoe e NA 2
auoaiiue ?ene NA, na?aa?ii–ninoaenouo caaieaaaiee,
oeia a aeaaiinoeea iaoaaiee?aneiai neia?iia. A eeanne-
einoeuoa, iauae e na?aa?ii–ninoaenoie, nia?oiinoe.
oeeaoeyo Anaie?iie I?aaiecaoee Ca?aaiio?aiaiey
Oy?anou IN ii?aaaeyaony eiee?anoaii eiiiiiaioia e
(AIC) einoeeii?acenoaioiinou ioiineony e iniiaiui
oaaee?eaaaony ii ia?a iiauoaiey eo ?enea. A enneaai-
e?eoa?eyi aeaaiinoeee, a eeanneoeeaoee ATP III e Aia-
aaiee West of Scotland clinical trial iaia?o?aii, ?oi ?ene
?eeaineie annioeaoee yiaie?eiieiaia (ACE) iia ioaaeu-
eoaie?aneie aieacie na?aoa (EAN) o io??ei n 4 e 5
ii ia auaaeyaony. NA a ?aeiiaiaaoeyo AIC aee??ai a
Oaaeeoa 1. Ii?aaaeaiey iaoaaiee?aneiai neia?iia a ?oeiaianoaao ATP III, AIC, ACE
?3
?oeiaianoai • Ie?o?iinou oaeee > 102 ni o io??ei, > 88 ni o ?aiuei
Adult Oreatment Pannel • OA ? 150 ia/ae (? 1,7 iiieu/e)
(ATP III), 2001 • EIAI < 40 ia/ae (< 1,0 iiieu/e) o io??ei, < 50 ia/ae (< 1,2 iiieu/e) o ?aiuei
• AA 130/85 ii ?o.no.
• Aeeeaiey ? 110 ia/ae (? 6,1 iiieu/e)
• NA 2 oeia, IAI, IOA, eee IIIA–einoeeii?acenoaioiinou +? 2 ec ie?aia?a?eneaiiuo e?eoa?eaa
Anaie?iay I?aaiecaoey • IO/IA > 0,9 o io??ei eee > 0,85 o ?aiuei
Ca?aaiio?aiaiey (AIC), • OA ? 150 ia/ae (? 1,7 iiieu/e) eee EIAI < 35 ia/ae (< 0,9 iiieu/e) o io??ei, <39 ia/ae
1999 (< 1,0 iiieu/e) o ?aiuei
• Yene?aoey aeuaoieia n ii?ie >20 iea/iei
• AA ? 140/90 ii ?o.no.
? 1
• EAN, AA, neia?ii iieeeenoiciuo ye?ieeia, iaaeeiaieuiay ?e?iaay aieaciu ia?aie, aeaioiea?aoiaa?iey
• Naiaeiue aiaiiac NA 2 oeia, AA eee EAN
• Aanoaoeiiiue aeaaao a aiaiiaca eee ia?ooaiey oiea?aioiinoe e ae?eica
Aia?eeaineay • Iaaa?iiaeneay ?ana
Annioeaoey eeeie?aneeo • Iaeiiiaae?iue ia?ac ?ecie
• EIO >25 ea/i2 e/eee IO >40 a?eiia (>100 ni) o io??ei, e >35 a?eiia (87,5 ni) o ?aiuei
yiaie?eiieiaia (ACE),
2003 • Aic?ano > 40 eao
? 2
• OA > 150 ia/ae (> 1,7 iiieu/e)
• EIAI < 40 ia/ae (< 1,0 iiieu/e) o io??ei, < 50 ia/ae (< 1,2 iiieu/e) o ?aiuei
• AA > 130/85 ii ?o.no.
• Ae?eica iaoiuae 110–125 ia/ae eee ?a?ac 2 ?ana iinea iaa?ocee 140–200 ia/ae (NA enee??aaony)
IIIA – homeostasis model assessment


451

13, 7, 2005
oOaeCOa a aOaAeeiCe
eiiiiiaioaie iaoaaiee?aneiai neia?iia oaaee?eaaao- ca OA e EIIII [6–8]. Aneaanoaea iiauoaiiie i?iaoeoee
ny a 3,7 ?aca, a ?ene NA 2 oeia – a 24,5 ?aca (< 0,0001). EIIII oaaee?eaaaony o?ainoi?iaoey EIAI a EIII,
i?eaiay e nie?aie? o?iaiy EIAI [6,9]. EIII yaey?ony
Aaaiieiaeuiia i?e?aiea aunieiaoa?iaaiiuie. Iie eia?o iaeia n?ianoai e
EIII–?aoaioi?ai e iiyoiio aieai oe?eoee?o?o a e?iai-
I?e?aiea yaeyaony iaeaieaa aa?iui oaeoi?ii, oiea, ieeney?ony, ia?acoy oeie?anee iiaeoeoe?iaaiiua
naycaiiui n einoeeii?acenoaioiinou?. Iiauoaiea EIII, eioi?ua eaaei e iaeiio?iee?oaii caoaaouaa?ony
aana oaea ia 1/3 io eaaaeuiiai i?eaiaeo e nie?aie? iae?ioaaaie. Iineaaiea (EIII) ea?a?o aa?io? ?ieu a
einoeeii?oanoaeoaeuiinoe ia 40% [4]. ?acaeoee e noauaa aoa?ineea?ioe?aneie aeyoee, niinia-
noaoy oi?ie?iaaie? ceiea?anoaaiiie aeyoee n iaoe?-
No?iaiea aenoa?aeuiie ?e?iaie oeaie oa?aeoa?eco-
iui eeieaiui ya?ii e oiieie niaaeieoaeuiioeaiie «oa-
aony ii?oieiae?aneeie e ooieoeiiaeuiuie iniaaiii-
ii?eie», eioi?ay eaaei ?ac?uaaaony, e ia ianoa aeyoee
noyie. Eio?aaaaiieiaeuiua aaeiioeou eia?o aieuoo?
ieioiinou ?–aa?aii?aoaioi?ia, ei?oeeinoa?ieaiuo e ai- ?acaeaaaony o?iiaic. Aeia?einoeeiaiey, iiauoaiea
a?iaaiiuo ?aoaioi?ia e ioiineoaeuii iaiuoo? ?2–aa?a- EIII e aiii?ioaei–A – aa?iua ia?ea?u iaee?ey iaoa-
aiee?aneiai neia?iia, (aa?a o iaoeaioia, eioi?ua eia?o
ii?aoaioi?ia e ?aoaioi?ia e einoeeio. Yoi ii?aaaeyao
ii?iaeuiue iieacaoaeu aenoa?aeuiiai ?e?a) [10].
aunieo? ?oanoaeoaeuiinou aenoa?aeuiie ?e?iaie oeaie e
Ea?aiea aaaiieiaeuiiai i?e?aiey yaeyaony iaiei ec
eeiieeoe?aneiio aaenoae? eaoaoieaieiia e ieceo? – e
iniiaiuo iaoiaia oa?aiee iaoaaiee?aneiai neia?iia.
aioeeeiieeoe?aneiio aaenoae? einoeeia. Eioaineaiue
Iiauoaiea ?anoiou ano?a?aaiinoe iaoaaiee?aneiai nei-
eeiieec a eio?aaaaiieiaeuiuo aaeiioeoao i?eaiaeo e
a?iia niaiaaaao n oaaee?aieai eiee?anoaa iaoeaioia,
aunaiai?aaie? aieuoiai eiee?anoaa naiaiaiuo ?e?iuo
no?aaa?ueo ecauoi?iui aanii eee i?e?aieai [11]. A ia-
eeneio, eioi?ua iinooia?o ii ai?ioiie aaia a ia?aiu, a
noiyuaa a?aiy nouanoaoao ianeieuei iiaoiaia, iai?aa-
caoai a nenoaiiue e?iaioie. Ia?aiu iiaaa?aaaony iiu-
eaiiuo ia nie?aiea aana, eioi?ua aee??a?o ieceioaea-
iiio e iinoiyiiiio aicaaenoae? naiaiaiuo ?e?iuo een-
aiaio? aeaoo (ecaanoio?, eae aeaoa Aoeeina) [12], iecei-
eio [5], ?oi i?eaiaeo e oaeiio ?yao iaoaaiee?aneeo ia?o-
?e?iao? aeaoo (aeaoa Pritikin e Ornish) [13,14], ?aeiiaiaa-
oaiee, ?acaeaaaony einoeeii?acenoaioiinou, a caoai ne-
oee ii eciaiaie? ia?aca ?ecie ATP III e aeaoo American
noaiiay aeia?einoeeiaiey. Naiaiaiua ?e?iua eeneiou a
Heart Association (AHA) [15]. Aieuoia cia?aiea oaaeyaony
ia?aie ooeeece?o?ony aaoiy iooyie: eeai aeoeae?o?o
eiiaiaiiio iiaoiao a ea?aiee iaoeaioa – a?a?, iaana-
ae?eiiaiaaiac, niinianoaoy oaaee?aie? i?iaoeoee ae?-
noa?a, aeaoieia, e oa?iaeieia [16]. Iniiaiuie i?eioeia-
eicu e nie?aie? aeoeaiinoe oinoaoeaeeeiiceoie–3–ee-
ie aeaoioa?aiee yaey?ony ionoonoaea aaeuiaeoaai oaa-
iacu einoeeiiaiai ?aoaioi?a, ia?ooay o?ainii?o ae?ei-
ee?aiey aana, nie?aiea eaei?eeiinoe ieue e oaaee?aiea
cu aioo?u eeaoie, ?oi i?eaiaeo e ?acaeoe? aeia?aeeeaiee
?aaoey?iie oece?aneie iaa?ocee. Oaeu oa?aiee – iaaeai-
(yooaeo eeiioiene?iinoe), eeai eniieuco?ony aey neioa-




?en. 1. Acaeiinaycu ia?ao o?iaiai N?A e eiee?anoaii ?en. 2. Aeeyiea eioaineaiie oa?aiee ia eiiiiiaiou
eiiiiiaioia iaoaaiee?aneiai neia?iia (aeneeieaaiey, iaoaaiee?aneiai neia?iia o iaoeaioia aunieiai ?enea
i?e?aiea, einoeeii?acenoaioiinou, AA): IRAS (NA 2 oeia e iee?iaeuaoieio?ey): Steno–2


Oaaeeoa 2. N?aaieoaeuiay oa?aeoa?enoeea e?eoa?eaa iaoaaiee?aneiai neia?iia
a nia?aiaiiuo ?aeiiaiaaoeyo
ATP III, 2001 , 1999 , 2003
Einoeeii?acenoaioiinou – + –
NA 2 oeia – + –
Ae?eica iaoiuae 110–125 ia/ae eee ?a?ac
Ae?eica e?iae ? 6,1 iiieu/e IOA, IAI, NA 2 oeia
2 ?ana iinea iaa?ocee 140–200 ia/ae
AA ? 130/85 ii ?o.no. ? 140/90 ii ?o.no. AA > 130/85 ii ?o.no.
OA ? 1,7 iiieu/e ? 1,7 iiieu/e > 1,7 iiieu/e
?1,0 iiieu/e o io?., ? 0,9 iiieu/e o io?., ? 1,0 iiieu/e o io?.,
EIAI
?1,2 iiieu/e o ?ai. ? 1,0 iiieu/e o ?ai. ? 1,2 iiieu/e o ?ai.
EIO > 30 ea/i2 e/eee IO >100 ni o io?.,
IO > 102 ni o io?., IO/IA >0,9 o io?.,
I?e?aiea
> 88 ni o ?ai. >0,85 o ?ai. >87,5 ni o ?ai.


452 13, 7, 2005
iia nie?aiea aana, ia aieaa 10% io enoiaiiai a oa?aiea 1 aiaa i?e ionoonoaee iiaoi?iiai iaai?a aana.
Aey nie?aiey aana eniieuco?ony neaao?uea no?aoaaee, i iiei?eoaeuiuo e io?eoaoaeuiuo ?a?oao eioi?uo iaiaoi-
aeii ciaou ia oieuei a?a?ai, ii e iaoeaioai. Ieceioaeaaiaiay aeaoa ia ii?aaauaaao aiceaaaaiuo ia iaa iaaa?a. Elkels
e Bonow ioiaoeee aa iayooaeoeaiinou i?e aeeoaeuiii iaae?aaiee, a oae?a aicii?iinou ?acaeoey aeia?eaeuoeo?ee,
ei?iia?iiai aoa?ineea?ica, e io?eoaoaeuiia aeeyiea aunieiaaeeiaiai eiiiiiaioa ia ii?ee [17]. A ?aiaiiece?iaaiiii
enneaaiaaiee n o?anoeai 132 iaoeaioia, no?aaa?ueo oy?aeie oi?iie i?e?aiey, Samaha e niaao. ioiaoeee ainoiaa?-
iia nie?aiea aana a a?oiia ieceioaeaaiaiie aeaou ?a?ac 1 aia iaae?aaiey ii n?aaiaie? n a?oiiie ia iecei?e?iaie
aeaoa [18], iaiaei aieuoeinoai iaoeaioia ia iiaee neaaiaaou iiaiaiie aeaoa a oa?aiea aeeoaeuiiai a?aiaie. Foster n
niaao. iiaoaa?aeee iieo?aiiua ?acoeuoaou a enneaaiaaiee n o?anoeai 63 iaoeaioia, no?aaa?ueo i?e?aieai [19]. ?a-
?ac 6 ianyoaa iaae?aaiey aieaa cia?eiia nie?aiea aana iaae?aaeinu a a?oiia ieceioaeaaiaiie aeaou, ?a?ac 1 aia
?acee?ey ia?ao a?oiiaie oiaiuoeeenu. A a?oiia iaoeaioia ia ieceioaeaaiaiie aeaoa Brehm n niaao. ioiaoeee iaene-
iaeuiia nie?aiea aana [20]. Iaiie ec io?eoaoaeuiuo oa?aeoa?enoee aaiiie no?aoaaee yaeyaony aicii?iinou iio?aaea-
iey aunieiianuuaiiiai ?e?a, ecaanoiiai oaeoi?a aoa?iaaiiiai ?enea (iniaaiii o iaoeaioia n aunieei ?eneii na?aa?-
ii–ninoaenouo inei?iaiee). Ia auei auyaeaii ?acee?ee ia?ao a?oiiaie a iieacaoaeyo eeieaia, ae?eicu iaoiuae e AA
?a?ac 6 ianyoaa iaae?aaiey [20].
A?oaei iiaoiaii yaeyaony iecei?e?iaay aeaoa o iaoeaioia n aunieei ei?iia?iui ?eneii, eioi?o? i?aaei?eee
Ornish e niaao. A enneaaiaaiee n o?anoeai 48 io??ei e ?aiuei iieacaii, ?oi aeaoa, niaa??auay <10% ?e?a, ioeac io
eo?aiey, nie?aiea aeeyiey no?anniauo oaeoi?ia e oia?aiiua oece?aneea iaa?ocee iiaoo i?eaanoe e oeo?oaie? ai-
aeia?aoe?aneie ea?oeiu e nie?aie? aana a n?aaiai ia 10 ea ?a?ac 1 aia iaae?aaiey. O 440 iaoeaioia (n?aaiee aic-
?ano 58 eao, 21% ?aiuei), eia?ueo enoiaii EAN e oaeoi?u ?enea iaoaaiee?aneiai neia?iia, ia oiia auoaoeacai-
iie aeaou ioia?aeinu nie?aiea aana e oeo?oaiea i?ioeey oaeoi?ia ?enea [21].
Will e Hill caiaoeee, ?oi iaoeaiou, iiooaaaoea e iiaaa??eaa?uea noaaeeuiue aan (n?aaiaa nie?aiea aana 30
ea a n?aaiai 5,5 eao), i?eaa??eaaeenu iau?iuo no?aoaaee iiaaaaiey, eioi?ua aee??aee iecei?e?iao? aeaoo, ?a-
noue eiio?ieu aana oaea e ?aaoey?io? oece?aneo? aeoeaiinou. Iiieii yoiai, iaoeaiou auee auniei iioeae?iaa-
iu ia oniao.

Ia?ooaiey oaeaaiaiiai iaiaia

E ia?ooaieyi oaeaaiaiiai iaiaia ioiinyo ia?ooaiea aeeeaiee iaoiuae (IAI), ia?ooaiea oiea?aioiinoe e ae?-
eica (IOA) eee naoa?iue aeaaao 2 oeia (NA 2 oeia). Iiei?eoaeuiay ?ieu eciaiaiey ia?aca ?ecie a oa?aiee IOA auea
aieacaia a enneaaiaaieyo – Da Qing trial [22], Diabetes Prevention Programm [23], Finnish Prevention Trial [24]. A en-
neaaiaaiee Da Qing trial i?eieiaee o?anoea 577 iaoeaioia n IOA. Ioia?aeanu aieaa ieceay ?anoioa ano?a?aaiinoe NA
2 oeia a a?oiia oece?aneie aeoeaiinoe ii n?aaiaie? n a?oiiie oece?aneay aeoeaiinou + aeaoa. ?acoeuoaou auee ain-
oiaa?iu aa?a iinea niaeaniaaiey iieacaoaeae ii EIO. A enneaaiaaiee Diabetes Prevention Programm 3234 iaoeaioa n
i?e?aieai e IOA iieo?aee iaooi?iei, ieaoaai eee iaiaaeeaiaioicio? oa?aie?. A a?oiia iaiaaeeaiaioiciie oa?a-
iee (oaeaaia nie?aiea aana 7% io enoiaiiai, 150 ieioo oece?aneie aeoeaiinoe a iaaae?) iaae?aaeinu nie?aiea ?e-
nea ?acaeoey NA 2 oeia ia 58%, ?oi auei ainoiaa?ii auoa, ?ai a a?oiia iaooi?ieia. Ia auei auyaeaii ainoiaa?ii-
ai nie?aiey aana a a?oiiao aeoeaiie oa?aiee ?a?ac 1 aia iaae?aaiey, e eiioo enneaaiaaiey nie?aiea aana ninoaaey-
ei 4 ea. Iaa a?oiiu iieo?aee ?aeiiaiaaoee ii oece?aneie iaa?ocea.
A enneaaiaaiee Diabetes Prevention Programm 522 iaoeaioa n IOA auee ?aiaiiece?iaaiu a a?oiio aeoeaiie oa-
?aiee. Iaoeaioai aaaaeenu ?aeiiaiaaoee ii nie?aie? aana, iio?aaeaie? ianuuaiiiai ?e?a, oaaee?aie? ii-
o?aaeaiey eeao?aoee e iiauoaie? oece?aneie aeoeaiinoe. ?a?ac 3,2 aiaa iaae?aaiey a a?oiia aeoeaiie oa?aiee
auei auyaeaii aieaa au?a?aiiia nie?aiea aana ii n?aaiaie? n eiio?ieuiie a?oiiie, ?ene ?acaeoey NA 2 oeia
oiaiuoeeny ia 58% (p<0,001).
Nouanoaoao iiaiea i oii, ?oi ?aaoey?iay oece?aneay aeoeaiinou niinianoaoao iiauoaie? einoeeii?oanoaeoaeu-
iinoe o iaoeaioia n iaoaaiee?aneei neia?iiii. A Heritage Study auyaeaii, ?oi iaoeaiou n enoiaii iiauoaiiui
o?iaiai OA e iiie?aiiui EIAI eo?oa ooaa?o ia oiia ?aaoey?iuo oece?aneeo iaa?ocie a oa?aiea 20 iaaaeu [25], ?a-
ai ia iaae?aaaony o iaoeaioia n eciee?iaaiii ieceei o?iaiai EIAI e iiaoaa??aaaony aaiiuie a?oaeo enneaaiaa-
iee. A enneaaiaaiee Oslo Diet and Exercise Study 219 iaoeaioia n iaoaaiee?aneei neia?iiii auee ?aiaiiece?i-
aaiu a a?oiiu: aeaoa, oece?aneay aeoeaiinou, aeaoa + oece?aneay aeoeaiinou, a?oiia eiio?iey. I?iaie?eoaeuiinou
iaae?aaiey ninoaaeyea 1 aia [26]. Ia auyaeaii ainoiaa?iiai nie?aiey einoeeii?acenoaioiinoe a a?oiia oece?aneie
aeoeaiinoe a ioee?ea io inoaeuiuo 2–o a?oii. Oeo?oaiea iieacaoaeae ae?eicu e einoeeia i?e auiieiaiee oanoa ia
oiea?aioiinou e ae?eica iaae?aaeinu a a?oiia nie?aiey aana e ionoonoaiaaei a a?oiiao oece?aneie aeoeaiinoe e
eiio?iey a?oiia a enneaaiaaiee, auiieiaiiii Katzel e a?. [27] n o?anoeai 170 iaoeaioia, no?aaa?ueo i?e?aieai. A
enneaaiaaiee IRAS iieacaia naycu ia?ao o?iaiai N–?aaeoeaiiai aaeea e eiiiiiaioaie iaoaaiee?aneiai neia?iia
(?en. 1).
A enneaaiaaiee Steno–2 trial n o?anoeai 80 iaoeaioia n NA 2 oeia ioia?aii iiei?eoaeuiia aeeyiea eioaineaiie
oa?aiee ia oieuei ia aeia?aeeeaie?, ii e ia a?oaea iieacaoaee iaoaaiee?aneiai neia?iia (?en. 2) [28]. A?oiia noai-
aa?oiie oa?aiee iieo?aea iauea ?aeiiaiaaoee ii aeaoa, a?oiia eioaineaiie oa?aiee – iiieii iaiaaeeaiaiiciuo
ia? – iaaeeaiaioicio? oa?aie?. Auei auyaeaia iiei?eoaeuiay aeiaieea aeeeiceee?iaaiiiai aaiiaeiaeia, AA, ia-
uaai oieanoa?eia, OA, yene?aoee aeuaoieia n ii?ie e oiaiuoaiea ?anoiou inei?iaiee NA i?e aeeoaeuiii iaae?aa-
oOaeCOa a aOaAeeiCe
iee a a?oiia eioaineaiie oa?aiee. ai?a?eau [29,40–43]. A oaeii ?yaa iaeiio?iee?oaiuo en-
Ia?i?aeuiua naoa?inie?a?uea i?aia?aou i?aaio- neaaiaaiee ioia?aii nie?aiea AA ia oiia i?eaia i?a-
a?aua?o ?acaeoea NA 2 oeia. A ianoiyuaa a?aiy iao- ia?aoa. K. Landin e a?. [40] auyaeee aeiioaiceaiue yo-
oi?iei – aaeinoaaiiue aeaoaiea, ?aeiiaiaiaaiiue oaeo iaooi?ieia o iaoeaioia n AA, ia iieo?a?ueo aioe-
e i?eiaiaie? Aa?iiaeneie A?oiiie ii ?ac?aaioea aeia?oaiceaio? oa?aie?, aac NA n ii?iaeuiui aanii;
oaeoeee aaaaiey NA 2 oeia (European NIDDM Policy Gingliano D. e a?. [36] – o ?aiuei n AA e i?e?aieai aac NA
Group, 1993). Aeeyiea iaooi?ieia ia oaeaaiaiue iaiai 2 oeia. Velazquez E. [43] ioiaoee nie?aiea NAA o ?aiuei
iaoneiaeaii ianeieueeie iaoaieciaie. Ia?aue – iiau- n neia?iiii iieeeenoiciuo ye?ieeia, i?e?aieai, ii aac
oaiea ?oanoaeoaeuiinoe ia?eoa?e?aneeo oeaiae e eino- AA. A ieaoaai–eiio?iee?oaiii enneaaiaaiee o iaoeai-
eeio (i?aeiouanoaaiii iiia?a?ii–iieinaoie ioneoea- oia n AA e NA auei auyaeaii ainoiaa?iia nie?aiea eee-
oo?u, a iaiuoae noaiaie – ?e?iaie oeaie). Yoi iaoneia- ie?aneiai AAA, aac iiaoaa??aaiey aaiiuie NIAA [42].
eaii iioaioe?o?uei aeeyieai i?aia?aoa ia ?aoaioi?- Snorgaard O. [41] a ieaoaai–eiio?iee?oaiii enneaaiaa-
iua e iino?aoaioi?iua caaiuy ia?aaa?e einoeeia aioo?u iee o 25 iaoeaioia n AA aac NA ioiaoee neaaue e eeeie-
eeaoee. Iaooi?iei ii?iaeecoao aeoeaiinou oe?iceiee- ?anee iacia?eiue yooaeo iaooi?ieia ia AAA, eioi?ia
iacu einoeeiiaiai ?aoaioi?a, a oae?a oeo?oaao o?ain- ia ioee?aeinu io yooaeoa ieaoaai. ?ya ieaoaai–eiio?i-
ii?o ae?eicu aaeeaie–ia?aiin?eeaie GLUT–1, eieaee- ee?oaiuo enneaaiaaiee ia iiaoaa??aa?o iiaiaiiai
co?ueiny a ieaciaoe?aneie iaia?aia, e GLUT–4, ?anii- aeeyiey [29,44]. Ioia?aii, ?oi iaooi?iei ii?ao oiaiu-
ei?aiiui i?aeiouanoaaiii ai aioo?eeeaoi?iuo iaia- oaou eiioaio?aoe? ii?aa?aiaeeia a e?iae e nie?aou
?aiao [29,30]. Aoi?ie – nie?aiea iiauoaiiie i?iaoeoee NAA e AAA o iaoeaioia n einoeeii?acenoaioiinou? eae
ae?eicu ia?aiu? ca n?ao oi?ii?aiey ae?eiiaiaaiaca, i?e iaee?ee NA, oae e a aai ionoonoaea. Nouanoao?o
oiaiuoaiey ieeneaiey N?E e eeieaia. Yoi naycaii n ii- i?aaiiei?aiey, ?oi aeiioaiceaiue yooaeo iaooi?ieia
auoaieai ?oanoaeoaeuiinoe aaiaoioeoia e einoeeio e o einoeeii?acenoaioiuo iaoeaioia i?iyaeyaony eeou ia
iiaaaeaieai ee??aauo oa?iaioia ae?eiiaiaaiaca (ie- ia?aeuiuo yoaiao ?acaeoey AA. Aaciianiinou e yooae-
?oaaoea?aieneeacu e oinoiaiieie?oaaoea?aieneeeia- oeaiinou aeeoaeuiiai ea?aiey iaooi?ieiii auea iia-
cu) [29,31]. O?aoee – caiaaeaiea ananuaaiey ae?eicu a oaa??aaia ?acoeuoaoaie e?oiiiai iiiaioaio?iaiai i?i-
niaeoeaiiai enneaaiaaiey UKPDS. O aieuiuo NA 2 oeia e
eeoa?ieea e iiauoaiea aa ooeeecaoee eeaoeaie neece-
noie iaiei?ee eeoa?ieea. A ?acoeuoaoa oi?ii?aiey ana- i?e?aieai ia oiia ea?aiey iaooi?ieiii auei ioia?a-
nuaaiey ae?eicu naea?eaa?ony ieee aeia?aeeeaiee iin- ii nie?aiea nia?oiinoe io anao i?e?ei ia 36%, ?anoiou
ea i?eaiia ieue. Iaooi?iei ia ieacuaaao noeioee?o?- anao inei?iaiee NA ia 32% e ?anoiou iae?ininoaenouo
uaai aeeyiey ia nae?aoe? einoeeia, iiyoiio aai i?eai inei?iaiee ia 30%, a oii ?enea ?enea ?acaeoey eioa?e-
ia nii?iai?aaaony ?eneii ?acaeoey aeiiaeeeaiee [32]. oa ieiea?aa ia 39% [45].
Iaoa–aiaeec anao ?aiaiiece?iaaiiuo eiio?iee?o- Oaeei ia?acii, iaeaieaa yooaeoeaiui iaoiaii
aiuo enneaaiaaiee n o?anoeai iaooi?ieia, iioaeeei- ea?aiey iaoaaiee?aneiai neia?iia yaeyaony eciaiaiea
aaiiuo n 1957 aiaa, iieacae yooaeoeaiinou iiiioa?a- ia?aca ?ecie, iaiaei iaooi?iei ianiiiaiii ieacuaa-
iee iaooi?ieiii o aieuiuo NA 2 oeia, ?aaio? yooae- ao iiei?eoaeuiia aeeyiea ia iaoaaiee?aneea iieaca-
oeaiinoe iiiioa?aiee einoeeiii e i?aia?aoaie noeu- oaee o iaoeaioia, no?aaa?ueo i?e?aieai.

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