Introduction: While the prevalence of malnutrition in the free living elderly population is relatively low, the risk of malnutrition increases dramatically in the hospitalized elderly. Patients who are malnourished when admitted to the hospital tend to have longer hospital stays, experience more complications, and have greater risk of morbidity and mortality than those whose nutritional state is normal. Goal: To assess the nutritional status among hospitalized elderly in Secondary healthcare systems by the MNA screening tool. Materials and Methods: To the study were enrolled 411 hospitalized elderly patients in secondary healthcare systems. The study protocol was approved by the Ethics Committee of the HSUM, and written informed consent was obtained from all study participants. We assessed the participants’ nutritional status by the MNA (Mini nutritional assessment) tool and divided into three groups: malnourished, risk of malnutrition and normal nutritional status. We compared the relationship between nutritional status and some biochemical indicates such as total protein, albumin, cholesterol and blood glucose levels. The ANOVA and Pearson correlation tests were used for statistical analysis. Results: 146 (36.01%) elders were well nourished among our study participants. Serum albumin was significantly low in malnourished elders. Conclusion: Among the assessed elderly 36.01% had adequate nutritional status; 43.79% were at a risk of malnutrition and 20.19% were malnourished. Serum albumin was significantly low in malnourished elders.

Introduction: With advancing age, the risk of developing nutritional deficiencies increases. Malnutrition can lead to functional dependency, increases morbidity, mortality, and greater use of health care resources. Goal: The goal of our study was to assess the nutritional risk among recently hospitalized elderly in Secondary healthcare systems by the NSI screening tool and assess indicators of anthropometry assessment in nutritionally different groups. Materials and Methods: To the study were enrolled 411 hospitalized elderly patients in secondary healthcare systems. The study protocol was approved by the Ethics Committee of the HSUM, and written informed consent was obtained from all study participants. The nutritional status was classified by the NSI (Nutrition Screening Initiative) into: high risk of malnutrition, moderate risk of malnutrition and without malnutrition (adequate). Results: Among the assessed elderly, 8.03% had adequate nutritional status; 32.85% were at a risk of malnutrition and 59.12% were at a moderate risk of malnutrition. Some anthropometric variables such as weight, abdominal circumference, calf and mid-arm circumference assessed were significantly more deteriorated among the malnourished individuals. Among the NSI variables tooth loss/ mouth pain (21.6%), eating few fruits or vegetables or milk products (14.3%), chronic illness (13.8%), multiple medicines (13.4%) or economic hardship (11.3%) were found as the risk of malnourished elderly. Conclusion: There is an interrelationship between the nutritional status of the elderly and some anthropometric variables.

Background: Epidemiologic studies have shown a higher prevalenceof hypertriglyceridemia among patients with CHDthan among unaffected populations. Dozens of polymorphisms in different genesthat could have some effect on plasma TG levels havebeen analyzed. The most promising results are connected withvariants within the apolipoproteins (APO) APOA1/APOC3/ APOA4 gene cluster. Transgenic mice overexpressing human apolipoprotein A5decreased plasma triglyceride concentrations to one-third of those in control mice; conversely, knockout mice lacking APOA5 had four times as much plasma triglycerides as controls.The human APOA5 gene consistsof 4 exons and codes 369 aminoacidprotein, which is expressed almost exclusively in the liver.A minor allele of APOA5 (1259C, IVS3+476A and 1131C) which was independently associated with high plasma triglyceride levels in African-American, non Hispanic whites, Hispanic, Caucasians and Japanese were reported. Four polymorphisms in ApoA5 (1259T>C, IVS3+476G>A, S19W and 1131T>C) has been correlatedwith high TG levels in diabetic women. Materials and Methods: 162 people with MS for case group and 144 people for control group were selected in this study. MS was diagnosed according to IDF criteria and serum triglyceride, total cholesterol and HDL levels were determined. DNA from both case and control subjects were extracted from blood samples (20μL) using “G-spin™ Total DNA Extraction Kit”(iNtRON Biotechnology, Inc).The genotypes for fourpolymorphisms of ApoA5 were determined using a combination of PCR and sequence-specific oligonucleotide probes. Results: There were 304 total subjects included males 50.3% (153) and female 49.7% (151) in our study. The appearance of risk genotypes of 1177C>T, 1259T>C, IVS3+476G>A and 1131T>C polymorphisms in ApoA5 gene were higher in MS group than control group.Serum levels of triglycerides and total cholesterol differed significantly (p<0.001, p=0.029) among APOA5-1131T>C genotypes. Conclusion: TAG and TC level was higher in people with 1131T>C-CC genotype than other genotypes in both groups (p=0.010, p=0.001). We determined that the odds ratio for the hypertriglyceridemia was 5.98 for ApoA5-1131T>C CC-genotype carriers.

Background. A large number of longitudinal studies indicate significantly increased risk of cardiovascular events and death in people with the MetSyn and high plasma levels of triglycerides are an independent risk factor for the development of cardiovascular disease. Apolipoprotein A5 (APOA5) gene, a new member of the APOA1/C3/A4 gene cluster, was identified by comparative sequencing of human and mice DNA by Pennacchio and co-workers in 2001. Since this discovery, variants of ApoA5 gene have been independently assiociated with level of plasma triglyceride in many countries. Human ApoA5 is expressed in the liver then appears in plasma in association with VLDL and HDL and plays a major role in TG catabolism. Variant at ApoA5 gene locus, 1177C>T is located in 3’ UTR which often contains regulatory regions that influence post-transcriptional gene expression. One alteration can be responsible for the altered expression of many genes. Materials and Methods. 152 people with MS for case group and 152 people for control group were selected in this study. MS was diagnosed according to IDF criteria and serum triglyceride levels were determined. DNA from both case and control subjects were extracted from blood samples (200 ml) using “G-spin™ Total DNA Extraction Kit”(iNtRON Biotechnology, Inc). To detect the 1177C>T variation of ApoA5 gene, using High Pure PCR Template Preparation Kits, a forward primer 5’-CTCTGAGCCTCTAGCATGGTTGAGT- 3’ and the mismatch reverse primer 5’-GAGCATTCCCAAATGAGCAC-3’ were used to create the HinfI restriction site. Results. There were 304 total subjects included males 50.3% (153) and female 49.7% (151) in our study. Incident of CC genotype was 71.1% (216), CT genotype was 25% (76) and TT genotype was 3.9%, TAG level was higher in males than females in both groups (p=0.016, ð=0.001) for CC genotype and also, higher with MS in males for CT genotype (p=). But, TAG level was no significant difference among three genotypes in group with MS subjects (male p=0.236, female p=0.881). Conclusion: The TT genotype of the ApoA5 gene 1177C>T polymorphism frequency was 2.9% in control subjects and 4.9% in subjects with MS. However, TG level was not differ in both groups for TT genotype, TAG level in males was higher compared with females (p=0.016 in control, p=0.001 in group with MS).

Introduction: Cardiovascular diseases are one of the leading causes of mortality and morbidity in Mongolia during last 10 years. Accordingly, increasing number of the procedures cardiac open heart surgeries in Mongolia.The aim is to evaluate of the scientific literature related toestimation of expenditure for open heart surgeries.Method: The literature search strategies were developed to identify published studies. The following literature databases were searched and collected individually: MEDLINE PubMed, Google and abstract books in Mongolian libraries.Result: Analyzed the 28 published literatures which made in estimation of expenditures for open heart surgery. The most of the study were generally focused on the expenses of diagnosis and treatments of open heart surgery. Literature showed that for patients not covered by health insurance, valve replacement surgery typically costs from about $80,000 -$200,000 or more with an average, according to an American Heart Association report, of $164,238, not including the doctor fee. A surgeon fee can add $5,000 or more to the final bill. For example, Dartmouth-Hitchcock Medical Center in New Hampshire charges about $86,500, including doctor fee, after a 30% uninsured discount. St. Mary’s Hospital in Wisconsin charges an average of $107,000, but costs can reach $200,000 or more. AndBaptist Memorial Health Care charges about $75,000 -$140,000, not including doctor fee, but cost can go up to more than $200,000 with major complications. In Russia, total 700,000 people take surgery on annual average each year and on which they spend 10 902 500 000$ annually, it has been stated on Bokeriya.L found that 464 637.840 ruble annually on cardiac surgery coronary angioplasty surgery, 792 237 ruble on coronary heart disease surgery and 9 522 ruble on congenital heart defect repairment surgery. Up to per 15 years old children, 24 288 ruble spend on average. Bokeria et all reported that, expenses of medicine through ABC/VEN analysis, 47 types of medicines of A group(13.1% of total medicines) takes 79.62% of total expenses, 71 types of medicines of B group(19.8% of total medicines) takes 15.36% of total expenses, 242 types of medicines of C group(67.1% of total medicines) takes 5.02% of total expenses. Out of this report, N group’s portion of A group medicines takes 0.79% by VENanalysis. Approximate, all inclusive cost for open heart bypass surgery (CABG ) vary between USD 5500 - USD 7800, depending on the facility & city you chose to get the procedure done in India. D.Tsegeenjav and D.Bat-Undral reported the expenses on open heart surgery in Mongolia, as a result showed that health insurance spend 56 422 656 ₮ (appx 39,100,093$) for 156 numbers of procedures. But real cost expenditure was 440 300 000.00₮. It means health insurance spent 12.6% of total expenditure for procedures. Also health insurance expenditure for CABG and one valve replacement per patient were same as 643 272.00₮, but real expenditures for CABG was 2 000 000.00₮, and for one valve replacement surgery per patient was 5 000 000.00 ₮.Conclution: The scientific literatures showed that many studies related in estimation of expenditure for open heart surgery made in international countries such as Russia, USA, UK and India et all. But we didn’t found the study for estimation of expenditures for open heart surgery by using ABC/VEN analysis in Mongolia.References:1. Health indicators of Mongolia 2002-2012. Report of the state implementing agency.2. Цэгээнжав д, Бат-ундрал д. зүрхний нээлттэй мэс заслûн эмчилгээний зардлûн асуудалд, “авьяслаг шастинчууд 2013” эрдэм шинжилгээний хурлûн эмхэтгэл, х3-4Бокерия л. а.самородская и. в.ßрустовский и др., Oпыт применения авс- и ven-анализа в сердечно- сосудистой хирургии фгбу. Бюллетень нЦссх им. а.н. Бакулева рамн, 2012, ¹1, стр http://lekarius. ru/external/paper/26143. The European health report 2009: health and health system. WHO Library Cataloguing in Publication Data.4. Shear A, Scuffham P, Mollon P. The cost of coronary artery disease in the UK. Br. J. Cardiol. 2004. Vol. 11. P 218-223.5. Htt://health.costhelper.com/valve-replacement.html Heart valve replacement costKey words : Open heart surgery, expenditure

BackgroundLeptin is a mediator of long-term regulation of energy balance, suppressing food intake and therebyinducing weight loss.GoalThe main goal of our study was the analyzing of serum leptin level in correlation with some influencingfactors in adults with metabolic syndrome.Materials and MethodsWe included 260 randomly selected people aged 18-72 years old; among them 105 had metabolicsyndrome which was identified by the criteria of the International Diabetes Federation. All participantsunderwent general medical examinations and signed a written consent paper. Fasting blood glucose,triglyceride, HDL-C, insulin, adiponectin, leptin level were measured in fasting blood serum and insulinresistance was calculated as a HOMA-IR model.ResultsAverage level of leptin for participants with MS was 16.44±14.21ng/ml, in participants without MS was9.59±12.69ng/ml. MS exposed group had much higher level of leptin than the control group (p<0.001).Leptin level was correlated with waist circumference (β=-0.253±0.1; p=0.013), and body mass index(β=1.778±0.274; p<0.001).ConclusionLeptin level in the MS exposed group were higher than in the control group. The level of leptin had aconsistent and significant correlation with body mass index and waist circumference in compare to otherinfluencing factors.

BackgroundSchoolchildren spent most of time in school and the school environment is one of several settings thatcan influence children’s food choices and eating habits. Schools can ensure that the available food andbeverage options are healthy and help young people eat food that meets dietary recommendations forfruits, vegetables, whole grains, and nonfat or low-fat dairy products.GoalTo assess quality of common foods and diet in school environmentsObjectives:1. Define food items and groups in school environment;2. laboratory analysis in sample foods on “School lunch” and around school environmentMaterial and MethodsThirty public and private schools from six districts of city of UB were randomly selected from a list of allschools. Laboratory tests were analyzed total 250 samples from school canteens and within 250 metersdistances around sampled schools.ResultSchoolchildren are exposed to a wide range of unhealthy food and beverages in the school environmentand healthier food and drink’s choices are very limited in these settings. The high availability of differentvarieties of unhealthy food and drinks at affordable prices makes these products the most preferablechoices for children. Overall, 46.5 percent of schoolchildren were served in school canteen and 33.9percent of schoolchildren were served outside of schools including shops and buffet. Main factors of foodchoice were first, like eating (30.2%), food price (27.8%), hungry (16.7%) and food advertisement was6.3% among schoolchildren. Most of common foods (92.5%) were analyzed with high in salt, sugar andlow content of vitamins and minerals around school environment. There was very high sugar content per100 gram products for instance, “Batos” ice-cream 22.75 gr, “Iberry” ice cream 14.05 gr and, “Granat”juice 1364 gr. In addition, fat content is also high in schoolchildren’s common food consumption. Fatcontent tested 31.4gr in chips and 30.6 gr in pie, cake and 26.9 gr in biscuits per 100 gr products.

Introduction. The metabolic syndrome is related to increased risk of developing cardiovascular disease andtype 2 diabetes. Adiponectin is an adipose tissue-specific collagen-like factor, which is abundant in plasma, anda decrease of adiponectin is associated with obesity and type-2 diabetes.Goal. This study aimed to determine the ADIPOQ gene -11377 polymorphism in association with plasmaadiponectin level and risk factors of metabolic syndrome.Materials and Methods. We investigated adiponectin gene -11377C>G polymorphism in 156 subjects withmetabolic syndrome and 142 healthy control subjects. The -11377C>G polymorphic locus was amplified using theforward primer 5’-ACTTGCCCTGCCTCTGTCTG-3’ and the reverse primer, 5-CCTGGAGAACTGGAAGCTG-3’.A p value <0.05 was considered statistically significant.Results. Adiponectin level positively correlated with age, but correlated negatively with TG, waist circumference,waist hip ratio, diastolic blood pressure, weight and BMI (p < 0.05). With genotype CG and GG (6.57±3.09ng/ml) of -11377C>G had lower levels of serum adiponectin than those with the genotype CC (7.38±3.68ng/ml) butno significant difference in people with MS (p=0.157). Therefore with genotype CG and GG (168.56±113.31mg/dl) of -11377C>G had higher levels of serum triglycerides than those with the genotype CC (132.94±74.78mg/dl) significant difference in people with MS (OR=1.006, p=0.015). With CG and GG (75.04±12.49mg/dl) of-11377C>G had significantly higher glucose level compared to with the genotype CC (68.85±11.76mg/dl) inwithout MS (OR=1.071, p=0.017).Сonclusions.1. ADIPOQ gene -11377>G polymorphism of the adiponectin gene was found not to be related to adiponectinlevel (p=0.157).2. -11377C>G polymorphism was related to the metabolic syndrome susceptibility, and this polymorphismimpacted on circulating triglyceride and glucose concentrations.

Introduction: The metabolic syndrome (MS) is characterized by central obesity, hypertriglyceridemia,low high-density lipoprotein (HDL), increase blood pressure and raise fasting plasma glucose. ThePGC-1α gene is located on chromosome 4 p.15.1 in humans and encodes a protein containing 798amino acids. The protein encoded by this gene is a transcriptional coactivator that regulates thegenes involved in energy metabolism. PPARγ, a coactivator molecule recently identified based on itsability to interact with PPARγ, is involved in many important metabolic processes, including adaptivethermogenesis, mitochondrial biogenesis and fatty acid β–oxidation.Goal: To study the frequency of PGC-1α Gly482Ser polymorphism in people with MS in relation to therisk factors of the MS.Materials and methods: The study population comprised 302 unrelated Mongolian subjects (158 withmetabolic syndrome and 144 controls). The genotypes for polymorphism of candidate gene related toMS were determined using a RFLP analysis of the MspI digest of the PCR product.Result: From the control group, 33.4% (48) had GG, 47.2% (68) had GS and 19.4% (28) had SSgenotypes. 51.9% (82) of people with MS had GG, 35.4% (56) had GS and 12.7% (20) had SSgenotypes. The prevalence of G allele in people with MS was 69.6%, which is much higher than healthygroup. Comparing PGC-1α Gly482Ser GG, GS and SS genotypes with systolic arterial blood pressurerevealed statistically significant difference which was higher among subjects with GG genotype. Theblood pressure of people with MS and carrying GG genotype of PGC-1α Gly482Ser polymorphismwas significantly increased 2.35 times than people without MS.Conclusions:1. 69.6 percentages of the people with MS had G allele and 2.2 times more than those withoutmetabolic syndrome.2. We determined that the odds ratio for the high blood pressure and it was 2.35 times higher inpeople with GG allele of Gly482Ser carriers than GS and SS alleles carriers (OR = 2.35, p =0.012).

INTRODUCTION: The PGC-1 gene is located on chromosome 4 p.15.1 in humans and encodes a protein containing 798 amino acids. As PGC-1a regulates multiple aspects of energy metabolism, it is not surprising that PGC-1a has been found to be deregulated in several pathological conditions. Might be associated with type 2 diabetes because PGC-1, besides being a coactivator of PPAR a and b, has a critical role in glucose uptake and adaptive thermogenesis. Addition, a common polymorphism of the PGC-1 gene Gly482Ser, which apparently reduces PGC-1 activity, has been linked to increased risk of type 2 diabetes. Association has also been reported between the Gly482Ser substitution and insulin resistance in Japanese subjects. Similar reduction of PGC-1 expression was also observed in the adipose tissue of insulin-resistant and morbidly obese individuals. Previous studies have reported significant association between the Gly482Ser missense mutation of the PGC-1 gene and reduced insulin sensitivity in obese subjects. This association resulted independent from all other known modulators of insulin resistance, and suggests a primary role for the PGC-1 gene on the genetic susceptibility to insulin resistance in obesity.GOAL: To study the presence of PGC-1 gene Gly482Ser polymorphism in people with Metabolic syndrome and study the relation to serum insulin level and insulin resistance.MATERIALS AND METHODS: The study population comprised 302 unrelated Mongolian subjects (158 with metabolic syndrome and 144 controls). MS was determined by IDF (International Diabetes Federation) criteria. The genotypes for polymorphism of candidate gene related to MS were determined using a RFLP analysis of the MspI digest of the PCR product. We determined serum insulin by ELISA, using Eucardio Company’s kit and insulin resistance was defined by the HOMA-IR formula.RESULT: 33.4% (48) of control group had GG, 47.2% (68) had GS and 19.4% (28) had SS genotypes of PGC-1 gene. 51.9% (82) of people with MS had GG, 35.4% (56) had GS and 12.7% (20) had SS genotypes. The prevalence of G allele in people with MS was 69.6%, which is much higher than healthy group. Insulin and HOMA-IR of MS group were higher than compared to healthy group (p<0.05). HOMA-IR was lower in people with GS genotype comparing to GG and SS in people with metabolic syndrome. CONCLUTIONS: 1. People with MS had higher levels of serum insulin (p<0.013) and insulin resistance (p<0.004) in compare to healthy people. 2. 69.6 percentages of the people with MS had G allele, which was 2.2 times more than those without metabolic syndrome.3. People with MS who carry SS genotype had higher levels of serum insulin (p=0.02) and insulin resistance (p=0.008) than people without MS. Insulin resistance was significantly correlated (r=0.302, p<0.001) with hypertension in people with G allele.