Late-Onset MS: Diagnosis After 50

When it comes to age, multiple sclerosis (MS) doesn’t discriminate. Although most people are between 20 and 50 when they’re diagnosed, the disease can strike folks who are older. This is called late-onset MS and it’s commonly defined as the occurrence of the first MS symptoms after age 50.

 Verywell / Nusha Ashjaee

The way the disease manifests in late-onset MS can be different from what normally happens in adult-onset MS, which most commonly affects people in their mid-20s and 30s.

3 MS Patients Share Their Experiences Facing Mobility Challenges

Causes

MS is a chronic disease of the central nervous system (CNS), which includes your brain, spinal cord, and optic nerves, located in your eyes. In MS, your immune system attacks your nerve cells and the fatty myelin sheath surrounding them, causing scarring.

The myelin scar tissue essentially jams communication between your brain and your body. The resulting distortion and blocking of messages between the brain and spinal cord lead to the symptoms and disability that are recognized as MS.

It’s not yet known what turns on the immune system response when you have MS. However, this appears to occur in people with a genetic susceptibility to the disease who are exposed to one or more environmental triggers, including smoking, stress, and vitamin D deficiency.

It’s also unknown why some people develop MS later than others. Further research needs to be done to understand the causes and onset of MS more clearly.

Types

There are three kinds of MS.

Relapsing-Remitting MS (RRMS)

With relapsing-remitting MS, people have relapses or flares—bouts of disability alternating with periods of normal function. Once the attack is over, MS symptoms may disappear. RRMS is by far the most common type of MS, affecting 85—90% of MS patients, most of whom are younger adults.

Secondary Progressive MS (SPMS)

Secondary progressive MS occurs when RRMS takes on a progressive form. Within 25 years of having RRMS, an estimated 90% of untreated patients gradually transitioned to SPMS.

Primary Progressive MS (PPMS)

With primary progessive MS, there’s a slow and steady decline in function due to permanent damage to nerves. Relapses and plateaus may occur in some people. PPMS usually starts with problems walking, such as foot-dragging or stiffness in one or both legs. Over the course of months and years, the degree of disability increases.

This type affects around 15% of people with MS. Older adults are more likely to be diagnosed with PPMS than younger adults.

Diagnostic Challenges

It’s fairly rare for people over the age of 50 to be diagnosed with MS, but it’s unclear exactly how many people are affected by late-onset MS. Many studies estimate that around 4% of MS patients start having MS symptoms after the age of 50.

Unfortunately, MS may be harder to diagnose in this population for a variety of reasons. One of the main barriers is that MS has not been studied in the older adult population as much as in younger adults.

This is important because the disease may vary between younger and older people, including the range of symptoms experienced. Because of this, late-onset MS is often missed by doctors who are more familiar with the disease in younger adults.

Even some diagnostic tests may be incorrectly interpreted if steps are not taken to explore immune-mediated diseases.

For example, magnetic resonance imaging (MRI) scans commonly used to diagnose MS may show the white-matter brain damage consistent with MS but be interpreted as damage caused by any one of several vascular diseases common in older people.

In late-onset MS, symptoms can easily mimic those of other disorders including:

Disease Progression

While the initial symptoms of late-onset MS develop later in life, research suggests that physical disability and loss of motor function occur faster and more frequently when MS develops later. 

Studies differ on which type of MS is diagnosed more often in late-onset MS; some say PPMS, while others say RRMS. PPMS does tend to be diagnosed when people are in their 40s and 50s though, around the same time that the majority of people with RRMS transition into secondary progressive MS (SPMS).

A 2016 study published in the journal PLoS One concluded that people with late-onset MS reached a higher disability level faster—a median time of 6.5 years—compared to a median of 12.8 years for people with adult-onset MS. Males were also found to progress significantly faster to disability than females.

Delayed diagnosis and treatment are among the reasons why people with late-onset MS tend to have a worse outcome. The effects of aging, more rapid physical disability, and having PPMS are other factors.

Treatment

Your treatment plan will depend on the type of MS you’ve been diagnosed with, other medical conditions you may have, and how severe your disease is. Your neurologist will go over the strategies for managing MS that will be most effective for you and your individual situation.

Medications

If you’ve recently found out you have MS and you’re over 50, your medication options may be more limited than they are for a younger adult.

This is partly because many past clinical trials on medications for MS purposely excluded people over 50, so it’s not always clear what’s most effective or safe for those in this age group. Thankfully, many newer studies have expanded the age of participants to 60 or 65.

The drugs used to treat MS are called disease-modifying therapies (DMTs) and they work by targeting the immune system and slowing down disease progression. There are some potential limitations to DMTs for people over 50.

Ocrevus (ocrelizumab), the only DMT approved by the Food and Drug Administration (FDA) for treating PPMS, has been shown to significantly decrease disability. However, the 2017 study that found this used patients with an average age of 45 years, which may not accurately reflect the drug’s effectiveness in older people.

And as with any powerful medication, Ocrevus has side effects, including some that could be especially problematic for older people, such as increasing the risk of respiratory infections and causing abnormal tissue growth.

For RRMS, patients who are over the age of 50 may not respond as well as younger patients to Novantrone (mitoxantrone), one of the DMTs that’s FDA-approved to treat both RRMS and secondary progressive MS.

Rehabilitation Therapies

Even though medications for PPMS are limited, there are many rehabilitation treatments available to help with MS symptoms. Your doctor may recommend one or more of the following:

• Physical therapy (PT): A physical therapist can help you build muscle strength and teach you techniques to compensate for loss of function. 
• Occupational therapy (OT): OT can help you modify your home so you’re better able to work around your limitations when taking care of yourself. This could include a bath transfer bench and rearranging cabinets so the items are easy to reach. You also can learn ways to move your body to reduce fatigue.
• Speech-language therapy: A speech-language therapist can help you improve your breathing, teach you strategies that minimize swallowing problems and aspiration, and reduce your speech difficulties.
• Cognitive rehabilitation: This therapy helps with cognitive abilities like memory, attention, organization, and language.
• Vocational rehabilitation: Specialists can help you make your job more accommodating to your needs or find one is a better fit.

A Word From Verywell

In the end, the course of late-onset MS and how different it is from regular adult-onset MS is still not entirely clear, but a prompt and accurate diagnosis is as critically important in late-onset MS as it is at any age.

This is because starting treatment with disease-modifying medications as soon as possible can reduce MS attacks and new lesions, as well as slow the progression of the disease. If you think you might have symptoms of MS, be sure to see your doctor.

Late-Onset Multiple Sclerosis

What Is Late-Onset Multiple Sclerosis?

When you have multiple sclerosis, your immune system attacks nerve cells and fibers in your brain. When this happens, your brain can’t send electrical messages to your body as well as it should. That changes the way your body moves and operates. Most people start to get MS symptoms between 20 and 40 years old. But sometimes, you won’t have any MS symptoms until you’re 50 or older. When this happens, doctors call it later-onset multiple sclerosis (LOMS).

Symptoms of Late-Onset MS

Symptoms of late-onset multiple sclerosis are often mistaken for signs of normal aging. They typically include:

• Fatigue
• Muscle weakness
• Changes in your vision
• Decline in cognitive ability (memory trouble, having a hard time focusing)

Late-onset MS causes a lot of changes in your motor skills too. You might notice:

• Bladder and bowel problems
• Tremors
• Stiffness
• Balance and coordination problems
• Trouble walking

Diagnosis of Late-Onset MS

There isn’t a single lab test doctors use to diagnosis multiple sclerosis. Instead, they use several tests to check out your nervous system and brain. Some of the tests your doctor might use to diagnose late-onset multiple sclerosis include:

• MRI of the brain and spinal cord. The magnetic resonance imaging test can show any plaque or scars on your brain, which is a key indicator of MS.
• Cerebrospinal fluid (CSF) evaluation. To do this test, your doctor will take a sample of the fluid that surrounds and protects your spine and brain. They’ll examine the amount of chemicals in the fluid for abnormalities or problems with your immune system.
• Sensory evoked potential studies. Your doctor might test how your brain responds to sight, sound, and electrical stimuli to measure how electrical impulses travel in your brain and spinal cord.

But as you age, it can be harder to diagnose MS, so your doctor may study your neurological history as well to help confirm late-onset MS.

Progression of Late-Onset MS

Multiple sclerosis is a difficult condition to predict. Sometimes, the condition progresses slowly, but at other times, it moves quickly. Late-onset MS shows similar nervous system changes as early onset MS. But when you develop the condition later in life, it may progress faster.

Older adults with MS have a greater risk of the primary progressive form of the condition as well. This means that your body will likely gradually decline over time even though you may not have a lot of MS flare-ups.

Treatment of Late-Onset MS

There is no cure for any type of multiple sclerosis, but there are many ways for you to manage the condition. Some common treatments for late-onset multiple sclerosis include:

• Medication. There are many types of medications to treat relapsing forms of MS. But there are no FDA-approved medications to treat primary progressive multiple sclerosis. The good news is your doctor can give you treatments that help manage your symptoms.
• Managing relapses. Corticosteroids, or steroid hormones, adrenocorticotropic hormone (ACTH) in a gel, or a plasma exchange can help manage MS flare-ups.
• Rehabilitation. Physical, occupational, and cognitive rehabilitation can help you manage the way MS changes your body. These programs can give you better mobility, limit fatigue, and improve your memory. If you have trouble speaking or swallowing, speech language pathology can help.

Talk to your doctor if you’ve been diagnosed with late-onset multiple sclerosis. There are many ways they can help you manage symptoms and improve your quality of life.

Late-Onset Multiple Sclerosis

What Is Late-Onset Multiple Sclerosis?

When you have multiple sclerosis, your immune system attacks nerve cells and fibers in your brain. When this happens, your brain can’t send electrical messages to your body as well as it should. That changes the way your body moves and operates. Most people start to get MS symptoms between 20 and 40 years old. But sometimes, you won’t have any MS symptoms until you’re 50 or older. When this happens, doctors call it later-onset multiple sclerosis (LOMS).

Symptoms of Late-Onset MS

Symptoms of late-onset multiple sclerosis are often mistaken for signs of normal aging. They typically include:

• Fatigue
• Muscle weakness
• Changes in your vision
• Decline in cognitive ability (memory trouble, having a hard time focusing)

Late-onset MS causes a lot of changes in your motor skills too. You might notice:

• Bladder and bowel problems
• Tremors
• Stiffness
• Balance and coordination problems
• Trouble walking

Diagnosis of Late-Onset MS

There isn’t a single lab test doctors use to diagnosis multiple sclerosis. Instead, they use several tests to check out your nervous system and brain. Some of the tests your doctor might use to diagnose late-onset multiple sclerosis include:

• MRI of the brain and spinal cord. The magnetic resonance imaging test can show any plaque or scars on your brain, which is a key indicator of MS.
• Cerebrospinal fluid (CSF) evaluation. To do this test, your doctor will take a sample of the fluid that surrounds and protects your spine and brain. They’ll examine the amount of chemicals in the fluid for abnormalities or problems with your immune system.
• Sensory evoked potential studies. Your doctor might test how your brain responds to sight, sound, and electrical stimuli to measure how electrical impulses travel in your brain and spinal cord.

But as you age, it can be harder to diagnose MS, so your doctor may study your neurological history as well to help confirm late-onset MS.

Progression of Late-Onset MS

Multiple sclerosis is a difficult condition to predict. Sometimes, the condition progresses slowly, but at other times, it moves quickly. Late-onset MS shows similar nervous system changes as early onset MS. But when you develop the condition later in life, it may progress faster.

Older adults with MS have a greater risk of the primary progressive form of the condition as well. This means that your body will likely gradually decline over time even though you may not have a lot of MS flare-ups.

Treatment of Late-Onset MS

There is no cure for any type of multiple sclerosis, but there are many ways for you to manage the condition. Some common treatments for late-onset multiple sclerosis include:

• Medication. There are many types of medications to treat relapsing forms of MS. But there are no FDA-approved medications to treat primary progressive multiple sclerosis. The good news is your doctor can give you treatments that help manage your symptoms.
• Managing relapses. Corticosteroids, or steroid hormones, adrenocorticotropic hormone (ACTH) in a gel, or a plasma exchange can help manage MS flare-ups.
• Rehabilitation. Physical, occupational, and cognitive rehabilitation can help you manage the way MS changes your body. These programs can give you better mobility, limit fatigue, and improve your memory. If you have trouble speaking or swallowing, speech language pathology can help.

Talk to your doctor if you’ve been diagnosed with late-onset multiple sclerosis. There are many ways they can help you manage symptoms and improve your quality of life.

Late-Onset Multiple Sclerosis

What Is Late-Onset Multiple Sclerosis?

When you have multiple sclerosis, your immune system attacks nerve cells and fibers in your brain. When this happens, your brain can’t send electrical messages to your body as well as it should. That changes the way your body moves and operates. Most people start to get MS symptoms between 20 and 40 years old. But sometimes, you won’t have any MS symptoms until you’re 50 or older. When this happens, doctors call it later-onset multiple sclerosis (LOMS).

Symptoms of Late-Onset MS

Symptoms of late-onset multiple sclerosis are often mistaken for signs of normal aging. They typically include:

• Fatigue
• Muscle weakness
• Changes in your vision
• Decline in cognitive ability (memory trouble, having a hard time focusing)

Late-onset MS causes a lot of changes in your motor skills too. You might notice:

• Bladder and bowel problems
• Tremors
• Stiffness
• Balance and coordination problems
• Trouble walking

Diagnosis of Late-Onset MS

There isn’t a single lab test doctors use to diagnosis multiple sclerosis. Instead, they use several tests to check out your nervous system and brain. Some of the tests your doctor might use to diagnose late-onset multiple sclerosis include:

• MRI of the brain and spinal cord. The magnetic resonance imaging test can show any plaque or scars on your brain, which is a key indicator of MS.
• Cerebrospinal fluid (CSF) evaluation. To do this test, your doctor will take a sample of the fluid that surrounds and protects your spine and brain. They’ll examine the amount of chemicals in the fluid for abnormalities or problems with your immune system.
• Sensory evoked potential studies. Your doctor might test how your brain responds to sight, sound, and electrical stimuli to measure how electrical impulses travel in your brain and spinal cord.

But as you age, it can be harder to diagnose MS, so your doctor may study your neurological history as well to help confirm late-onset MS.

Progression of Late-Onset MS

Multiple sclerosis is a difficult condition to predict. Sometimes, the condition progresses slowly, but at other times, it moves quickly. Late-onset MS shows similar nervous system changes as early onset MS. But when you develop the condition later in life, it may progress faster.

Older adults with MS have a greater risk of the primary progressive form of the condition as well. This means that your body will likely gradually decline over time even though you may not have a lot of MS flare-ups.

Treatment of Late-Onset MS

There is no cure for any type of multiple sclerosis, but there are many ways for you to manage the condition. Some common treatments for late-onset multiple sclerosis include:

• Medication. There are many types of medications to treat relapsing forms of MS. But there are no FDA-approved medications to treat primary progressive multiple sclerosis. The good news is your doctor can give you treatments that help manage your symptoms.
• Managing relapses. Corticosteroids, or steroid hormones, adrenocorticotropic hormone (ACTH) in a gel, or a plasma exchange can help manage MS flare-ups.
• Rehabilitation. Physical, occupational, and cognitive rehabilitation can help you manage the way MS changes your body. These programs can give you better mobility, limit fatigue, and improve your memory. If you have trouble speaking or swallowing, speech language pathology can help.

Talk to your doctor if you’ve been diagnosed with late-onset multiple sclerosis. There are many ways they can help you manage symptoms and improve your quality of life.

Can MS begin in the over fifties?

Summary

At one time, it was thought that MS rarely developed in people over 50 but opinion is changing as more cases are now being identified. This study looked at the characteristics of MS when it begins over the age of 50.

People in south-east Wales whose MS began at age 50 or above were identified from a regional database of 2654 people with MS. Some distinct differences were found compared with those whose MS began at a younger age. The researchers found that sensory and motor symptoms were more frequently found, there were fewer relapses and faster progression of disability.

The researchers comment that this makes it even more important to identity this group and to ensure that they have the support they need from MS services.

Background

MS is often diagnosed when someone is in their twenties or thirties. At one time, it was thought that MS rarely developed in people over 50 but opinion is changing as more cases are now being identified.

Diagnosing MS can be difficult in a person of any age but there are additional challenges as people get older. This is because there are other age related conditions which need to be taken into consideration when deciding what the correct diagnosis might be. In addition, there is little information available on the long term pattern of MS in people who develop it late in life.

How this study was carried out

People in south-east Wales whose MS began at age 50 or above were identified from a regional database of 2654 people with MS. The over 50’s group was named “late onset MS” and was compared with an adult (under age 50) onset group.

The medical notes of the late onset group were reviewed to see what diagnoses were considered apart from MS.

What was found

132 people (5.2%) had late onset MS which had begun between the ages of 50 and 72. Some distinct differences were found:

• Over half (58%) of the late onset group were women as compared with just over two thirds (70%) of the adult onset group.
• Almost half (47%) had primary progressive MS (PPMS) whereas less than one in ten (9%) had PPMS in the adult onset group
• The average time from first symptoms to diagnosis was 2.7 years as compared with 4.6 years
• People in the late onset group were more likely to test negative when cerebrospinal fluid from a lumbar puncture was analysed for oligoclonal bands (23% as compared with 16%)

In four out of ten (42%) cases of late onset MS, no other diagnosis was considered likely and so diagnosis was made more rapidly (on average after 1.8 years).

For those where other possible diagnoses were considered, it took an average of 3.2 years to come to the definite diagnosis of MS. The most common possibilities considered were cerebrovascular disease (16%), degenerative spinal disease (8%) and motor neurone disease (6%).

The most common first symptoms were sensory and cerebellar symptoms for the older age group whereas optic neuritis was most common in the adult onset group.

The late onset group had about half as many relapses in the first ten years compared with the adult onset group. However, they reached disability milestones more quickly as judged by the time taken to reach a particular EDSS score. For example they took an average of 4.8 years to reach an EDSS of 4 as compared with 15.5 years; an average of 5.7 years to reach an EDSS of 6 as compared with 20.4 years; an average of 16.8 years to reach an EDSS of 8 as compared with 39.0 years. However, as their MS had begun later in life, the late onset group were between five and 11 years older when they got to each disability milestone.

What does it mean?

When MS occurs in adults over 50 it can be difficult to diagnose as it may be quite different from MS in younger adults and because it may appear similar to other conditions which occur in older age groups. The most common differences in the older age group are that sensory and motor symptoms are more frequently found, there are fewer relapses and faster progression of disability.

Once MS has begun, disability progresses more rapidly than in younger people with MS. The researchers comment that this makes it even more important to diagnose the older group and to ensure that they have the support they need from MS services.

Harding K, Griffiths M, Wardle M, et al.
Late-onset multiple sclerosis in south-east Wales.
J Neurol Neurosurg Psychiatry. 2013 Nov;84(11):e2.
abstract

More about diagnosing MS

MS can be very difficult to diagnose and it often takes a long time to get a definite diagnosis.

All the symptoms of MS can also be symptoms of other conditions so the neurologist has to work out which of all the possibilities is the correct one. This can mean lots of tests to rule out other conditions and then more tests to see if it might be MS. It is sometimes a question of watching and waiting to see how symptoms develop as this can help distinguish MS from the other possibilities. All this can be very frustrating and worrying but it is quite a common experience.

Tests used in the diagnosis of MS

There is no simple test for MS which will say “yes” or “no” like a pregnancy test. The neurologist has to take a multi-pronged approach and use their experience to decide if it is MS or not. Sometimes, it is still impossible to be absolutely certain.

Neurologists will usually ask about any history of unexplained symptoms.The most common next step is to have an MRI scan which can detect the tiny scars caused by MS. These show up as little white patches in the brain and spinal cord and are usually called lesions. Everyone gets more white patches in their brain as they get older so the neurologist has to judge if they are all age-related or possibly due to MS. Sometimes a chemical called gadolinium is injected into a vein before the scan as it can help the radiologist and neurologist distinguish between active MS lesions and old areas of scarring.

Some people will have a lumbar puncture also known as a spinal tap. In this test, a sample is taken of the cerebrospinal fluid which bathes the brain and spinal cord. The fluid can be analysed in the laboratory and if more protein bands are seen than usual (called oligoclonal bands) this can suggest MS.

In some cases, evoked potential tests are carried out. This involves putting small electrodes on the head, arms or legs to measure the speed of messages travelling along the nerves from the eyes, ears or skin on the limbs. If the messages are slowed then this may be due to MS.

The neurologist will review all the test results alongside a person’s medical history to decide if it all adds up to a diagnosis of MS.

Research by topic areas…

Early signs of MS | Multiple Sclerosis Society UK

What are usually the first signs and symptoms of MS?

There’s no typical pattern of MS symptoms that applies to everyone – people can have different symptoms at different times.

One of the more obvious first signs of MS is a problem with vision, known as optic neuritis. This is often because it’s a more concrete symptom as opposed to vaguer neurological symptoms like numbness and tingling. You shouldn’t assume these symptoms are a sign of MS though – not everyone who experiences them will get an MS diagnosis.

If you’ve searched for symptoms online or you know someone with MS, it may be at the front of your mind. But many symptoms of MS can also be symptoms of other conditions.

What are some of the common symptoms of MS?

Some of the most common symptoms of multiple sclerosis are listed below. There are lots of symptoms that MS can cause, but not everyone will experience all of them.

Fatigue

Fatigue in MS is not just an ordinary tiredness, like you might get at the end of a hard day’s work. People describe it as an overwhelming sense of tiredness with no obvious cause.

Read more about fatigue

Numbness and tingling

A common type of discomfort in MS is unpleasant, unusual sensations that appear to be in your skin, like numbness and tingling. They’re caused by damage to nerves.

Read more about pain and unpleasant sensations

Loss of balance and dizziness

Problems with balance and feeling dizzy are common in MS, and can affect your walking.

Read more about balance and dizziness

Stiffness or spasms

Muscle stiffness and spasms are common MS symptoms, and are often described as ‘spasticity’.

Read more about stiffness and spasms

Tremor

A tremor is a trembling or shaking movement. It can be mild or more pronounced, causing a drink to spill when a cup is full, for example, or affecting handwriting.

Read more about tremor

Pain

Pain in MS can take many different and unusual forms. It can be caused by direct nerve damage. Or it can come from your symptoms and strains they place on your body.

Read more about pain

Bladder problems

There are two main types of bladder problems in MS: problems with storage and problems with emptying.

Read more about bladder problems

Bowel trouble

MS can cause bowel problems like constipation and incontinence.

Read more about bowel problems

Vision problems

The most common problems with vision in MS are optic neuritis and eye movement problems. Optic neuritis is often an early symptom of multiple sclerosis, although you might have problems with your eyes at any time.

Read more about vision

Memory and thinking

Problems with memory and thinking – also called ‘cognitive problems’ – can affect people with MS, but most people will be affected mildly.

Read more about memory and thinking

What age does MS usually start?

In the UK people are most likely to find out they have MS in their thirties, forties and fifties. But the first signs of MS often start years earlier. Many people notice their first symptoms years before they get their diagnosis.

How does multiple sclerosis begin?

Multiple sclerosis is likely to begin due to a mix of factors – something in your environment and some lifestyle factors. No one knows for sure why people get MS.

Read more about the possible causes of MS

How is MS diagnosed?

Only a neurologist can diagnose MS. If your GP thinks your symptoms need further investigation, they’ll refer you to a specialist.

Some people describe this period of time as ‘limbo’ – where they don’t have a diagnosis but they’re experiencing symptoms.

Read more about getting a diagnosis and coping during this time

Who Gets Multiple Sclerosis? – My Shepherd Connection

Who Gets Multiple Sclerosis?

In the United States today, there are about 400,000 people with multiple sclerosis (MS), and 200 more people are diagnosed every week. Worldwide, MS is thought to affect more than 2.1 million people. While the disease is not contagious or directly inherited, epidemiologists — the scientists who study patterns of disease — have identified factors in the distribution of MS around the world that may eventually help determine causes of the disease. These factors include gender, genetics, age, geography and ethnic background.

• As in other autoimmune diseases, MS is significantly more common (at least 2-3 times) in women than men. This gender difference has stimulated important research initiatives to study the role of hormones in MS. The disease is not directly inherited, but genetics play an important role in who gets the disease. While the risk of developing MS in the general population is 1 in 750, the risk rises to 1 in 40 in anyone who has a close relative (parent, sibling, child) with the disease. In families in which several people have been diagnosed with MS, the risk may be even higher. Even though identical twins share the same genetic makeup, the risk for an identical twin is only 1 in 4, which means that some factor(s) other than genetics are involved.
• While most people are diagnosed between the ages of 20 and 50, MS can appear in young children and teens, as well as much older adults. Studying the disease in different age groups may help scientists determine the cause of MS and explain why the disease course differs from one person to another. Important questions are:  Why does the disease appear so early in some children? Why do people who are diagnosed after age 50 tend to have a more steadily progressive course that primarily affects their ability to walk?
• In all parts of the world, MS is more common at northern latitudes that are farther from the equator and less common in areas closer to the equator. Researchers are now investigating whether increased exposure to sunlight and the vitamin D it provides may have a protective effect on those living nearer the equator.
• MS occurs in most ethnic groups, including African-Americans, Asians and Hispanics/Latinos, but is more common in Caucasians of northern European ancestry. However, some ethnic groups, such as the Inuit, Aborigines and Maoris, have few, if any, documented cases of MS regardless of where they live. These variations that occur even within geographic areas with the same climate suggest that geography, ethnicity and other factors interact in some complex way.

While more people are being diagnosed with MS today than in the past, epidemiologists have found no evidence to suggest that the disease is on the increase. More likely explanations include a greater awareness of the disease, improved medical care and more effective tools for making the diagnosis. In addition, the availability of effective treatments makes physicians more likely to communicate the diagnosis to their patients.

A “cluster” of MS can be defined as the perception that a very high number of cases of MS has occurred over a specific time period and/or in a certain area. Such clusters of MS — or of other diseases where clusters are occasionally reported — are of interest because they may provide clues to environmental or genetic risk factors that might cause or trigger the disease. So far, cluster studies (in the Faroe Islands; Galion, Ohio; DePue, Ill.; and El Paso, Texas, among others) have not produced clear evidence for the existence of any causative or triggering factor or factors in MS.  

Source: National MS Society  

Norms, requirements and conditions for their implementation in the sport of “swimming”

9001 5

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requirements and conditions for their fulfillment for the assignment of the sports title “Master of Sports of Russia” (MS)

Age at which criminal responsibility occurs

The age at which criminal responsibility occurs (Article 20 of the Criminal Code of the Russian Federation).

Article 20. Age at which criminal responsibility occurs

1. A person who has reached the age of sixteen by the time the crime was committed shall be subject to criminal liability.

2. Persons who have reached the age of fourteen at the time of the commission of a crime shall be subject to criminal liability for murder (Article 105), intentional infliction of grievous bodily harm (Article 111), intentional infliction of medium gravity harm to health (Article 112), kidnapping (Article 126) , rape (article 131), violent acts of a sexual nature (article 132), theft (article 158), robbery (article 161), robbery (article 162), extortion (article 163), unlawful seizure of a car or other vehicle without the purpose of theft (Article 166), deliberate destruction or damage to property under aggravating circumstances (second part of Article 167), terrorist act (Article 205), hostage-taking (Article 206), knowingly false reporting of an act of terrorism (Article 207), aggravated hooliganism ( second part of Article 213), vandalism (Article 214), theft or extortion of weapons, ammunition, explosives and explosive devices deeds (Article 226), theft or extortion of narcotic drugs or psychotropic substances (Article 229), rendering vehicles or communication lines unusable (Article 267).

3. If a minor has reached the age provided for in the first or second parts of this article, but due to a mental retardation not related to a mental disorder, during the commission of a socially dangerous act, he could not fully realize the actual nature and social danger of his actions (inaction ) or lead them, he is not subject to criminal liability. /

Reaching the age established by the Criminal Code of the Russian Federation is one of the general mandatory conditions for a person’s criminal liability (Art.19 of the Criminal Code of the Russian Federation). The age criterion of responsibility in any legal system is inextricably linked with a person’s ability to realize the significance of his actions and to lead them, i.e. with his sanity. Bringing a minor to responsibility for actions, the danger of which he is not aware, excludes sanity and does not correspond to the purposes of punishment (see Art. 43 of the Criminal Code of the Russian Federation).

Legally, the age of the subject of a crime is determined not on the day of his birth, but upon its expiration, i.e. from zero hours of the next day.In the absence of documents, the age of a person can be determined on the basis of the conclusion of a forensic expert and the last day of the year indicated in the conclusion is considered the birthday. If it is impossible to determine the year of birth and establish the age within the minimum and maximum number of years, the age is determined based on their minimum number, i.e. doubts are interpreted in favor of the person.

In paragraph 4.1 of the UN Standard Minimum Rules for the Administration of Juvenile Justice (The Beijing Rules of November 29, 1985.), it is noted that in legal systems that recognize the concept of the age of criminal responsibility for minors, the lower limit of such an age should not be set at too low an age level, taking into account aspects of emotional, spiritual and intellectual maturity. That is, the minimum age limit for criminal responsibility cannot be lower than the age when a person develops certain legal ideas, when he is able to understand and assimilate criminal law prohibitions.

However, in order to establish the age of criminal responsibility, it is also necessary to take into account the possibilities of society to fight against socially dangerous actions of adolescents without applying criminal punishment, through educational measures. The issue of determining the age of responsibility is not only socio-psychological or pedagogical, but also criminal-political. The higher the level of preventive and educational work, the higher may be the age of criminal responsibility.

The Criminal Code traditionally maintains a differentiated approach to establishing the age of criminal responsibility.

According to the general rule defined in Part 1 of Art. 20 of the Criminal Code of the Russian Federation, a person who has reached the age of 16 at the time of the crime is subject to criminal liability.

Part 2 of Art. 20 of the Criminal Code of the Russian Federation exhaustively lists the corpus delicti for which responsibility comes from the age of 14.

Crimes with a lower age of criminal responsibility are distinguished according to certain criteria. At the same time, a high degree of public danger is not the only and not the main one.When differentiating the age of responsibility, the possibility of minors to perceive and evaluate different legal prohibitions is taken into account. Therefore, the number of crimes for which responsibility begins at the age of 14 include only such acts, the social danger of which is understandable at this age. As can be seen from the list, we are talking about attacks on life, health, sexual freedom, property relations and public safety, i.e. mainly about single-object crimes, expressed in active actions that entailed material consequences on the objective side, the public danger of which is obvious.

Another criterion is the form of guilt: persons between the ages of 14 and 16 are not liable for reckless crimes. An exception may be Art. 267 of the Criminal Code of the Russian Federation on responsibility for rendering vehicles or communication lines unusable, if these acts entailed, by negligence, the infliction of death or serious harm to human health.

A significant role is also played by the relative prevalence of crimes committed during adolescence: those listed in para.2 tbsp. 20 of the Criminal Code of the Russian Federation structures provide the main share in the structure of juvenile delinquency.

Some complex crimes involve actions that in themselves constitute other crimes. For example, the composition of banditry is completed from the moment the gang was created, and therefore the robbery committed by the gang requires qualification according to the rules of the real aggregate of these crimes, as provided for in Art. 17 of the Criminal Code of the Russian Federation (see, for example, clause 13 of the Resolution of the Plenum of the Supreme Court of the Russian Federation of February 1, 2011 N 1 “On judicial practice in the application of legislation regulating the peculiarities of criminal liability and punishment of minors”).

If responsibility for a compound crime occurs from the age of 16, and for the actions included in it as an element – from the age of 14, then when these actions are committed by a subject aged 14 to 16 years, they should be qualified taking into account the rules of Art. 20 of the Criminal Code of the Russian Federation. So, if a gang committed a robbery, then its members over the age of 16 are responsible for both banditry and robbery, and at the age of 14 to 16 – only for robbery (see paragraph 14 of the Resolution of the Plenum of the Supreme Court of the Russian Federation from 1 February 2011 N 1 “On judicial practice of the application of legislation regulating the peculiarities of criminal liability and punishment of minors”).This, in particular, reflects the principles of humanism and guilt.

Establishing the general age of responsibility at 16 does not mean that this rule is mandatory for any crime not specified in Part 2 of Art. 20 of the Criminal Code of the Russian Federation. So, in accordance with Part 1 of Art. 20 of the Criminal Code of the Russian Federation of criminal liability, for example, under Art. 222 of the Criminal Code of the Russian Federation, is subject to a person who has reached the age of 16 by the time the crime was committed. Therefore, if the illegal acquisition, carrying, sale of firearms is committed by a person during the period when he has not reached the age of criminal responsibility, then he is not the subject of the specified crime

At the same time, the Criminal Code of the Russian Federation also contains such offenses that, due to the special characteristics of the subject or the specifics of the objective side, or the blanketness of criminal law norms, can only be carried out by adults.

Sometimes in the text of the Criminal Code itself it is directly indicated that the subject of a specific crime can only be a person who has reached the age of 18, for example, in Art. 134 of the Criminal Code of the Russian Federation (sexual intercourse and other actions of a sexual nature with a person under the age of 16), Art. 150 of the Criminal Code of the Russian Federation (involving a minor in the commission of a crime), part 2 of Art. 157 of the Criminal Code of the Russian Federation (malicious evasion of adult able-bodied children from paying funds for the maintenance of disabled parents).

In other cases, the crime, due to its peculiarities, cannot be carried out by minors, for example, falsification of electoral documents (Art.142 of the Criminal Code of the Russian Federation), failure to fulfill the duties of raising a minor (Article 156 of the Criminal Code of the Russian Federation), abuse of powers by private notaries and auditors (Article 202 of the Criminal Code of the Russian Federation), as well as all crimes the subject of which is a serviceman or a person holding a public office. This also includes criminal violations of various safety rules in transport, in explosive industries, etc., since labor legislation prohibits the use of labor by persons under 18 years of age in jobs associated with such harmful or dangerous working conditions.

The establishment in the law of a formalized age limit for criminal liability has an important general preventive value, is one of the expressions of the regulatory function of criminal law and serves as a guarantee of legality.

The legislator, when determining the age of criminal responsibility, proceeds from the presumption of a person reaching a sufficient level of development by this age to be aware of the nature of their actions and their prohibition. However, the rates of mental development in adolescents are not the same, there may be a significant developmental delay, which is not associated with mental illness and does not serve as a criterion for insanity.Therefore, not only the physical age of a person is of criminal law importance, but also the level of his mental development corresponding to his age.

Part 3 Art. 20 of the Criminal Code of the Russian Federation establishes that a minor who, due to such a lag while committing a socially dangerous act, could not fully realize the actual nature and social danger of his actions (inaction), or control them, is not subject to criminal liability. In this regard, among the circumstances to be established during the investigation and trial of a case of a crime committed by a juvenile is also the question of whether a juvenile could fully realize the factual nature and social danger of his actions (inaction) or control them (part …2 tbsp. 421 of the Criminal Procedure Code of the Russian Federation).

The Plenum of the RF Armed Forces indicated that in the presence of data indicating a lag in the mental development of a minor, by virtue of Art. Art. 195 and 196, part 2 of Art. 421 of the Code of Criminal Procedure of the Russian Federation, a comprehensive psychological and psychiatric examination should be appointed in order to resolve the issue of his mental state and the ability to correctly perceive circumstances that are important for a criminal case. At the same time, the experts should be asked about the influence of the mental state of a minor on his intellectual development, taking into account age (see.Clause 14 of the Resolution of the Plenum of the Supreme Court of the Russian Federation of February 1, 2011 N 1 “On the judicial practice of the application of legislation regulating the peculiarities of criminal liability and punishment of minors”).

Thus, there is a combination of the formalized age limit of liability established by the legislator, with the possibility of adjusting it within the framework of the individualization of responsibility determined by the law enforcement officer.

The establishment of a fixed age of criminal responsibility in the Criminal Code of the Russian Federation means that a person who has reached the age of 16, and in certain cases, 14 years of age, may be the subject of a crime and be held criminally responsible for his socially dangerous actions.But it does not follow from this that the criminal law recognizes these persons as fully socially mature. Until they reach the age of 18, they are considered minors. The expression of the principles of humanism, individualization of responsibility and the economy of repression are the norms governing the issues of sentencing minors, the conditions and procedure for serving punishment, release from punishment and responsibility.

In a number of cases, the law defines an increased age of criminal responsibility, which is a kind of characteristic of a special subject.This feature is not regulated by Art. 20 of the Criminal Code of the Russian Federation, and the norms of articles of the Special Part of the Criminal Code of the Russian Federation, including taking into account their blanketness. Establishment of a special age of responsibility is carried out in cases where an adult person with an established worldview, life experience, with a stronger will, etc. is supposed to be the subject of a crime.

In this regard, reaching the age of 18, as one of the grounds for recognizing a person as a serviceman, is required in accordance with Art. 331 of the Criminal Code of the Russian Federation for the offensive of responsibility for crimes against military service.The subject of a number of crimes against justice, committed, for example, by judges of a district court, can only be a person who has reached the age of 25.

biography, age, battles, how the rap career began

Real name: Anna Morozova
Date of birth: 21.05.1997
Place of birth: pos. Petrodolinskoe, Ukraine

Biography of MC Anyuta

MC Anyuta, she is Anna Morozova was born in the village of Petrodolinskoye, which is located in the Odessa region, where the girl lives to this day.From childhood, Anya could not find a common language with her peers, so the girl was constantly offended starting from kindergarten. During her school years, in the fifth grade, the girl was even pushed out of the second floor window; the situation took place in the school toilet. After this incident, the girl was forced to visit doctors for several years due to spinal problems.

After finishing 9th grade, Anya Morozova finishes her studies at school and goes to work at the plant. There, the girl lasted almost a year, but unable to withstand the load she went to work in a local grocery store as a cashier-seller.All this time, for 7 years, the girl recorded tracks, and every year she released at least 1 album.

The beginning of rap art

Anya met rap thanks to the work of the Ukrainian rapper Artem Loik. Anya always wanted to try to record her own rap track, but the girl did not know how to do it. In 2010, when Anya was in the 7th grade, friends from school filmed a video on the phone where the girl freestyle. It was from this moment that the career of MC Anyuta began. A video with Ani’s participation spread throughout the school in a matter of days.Despite the chuckles in the direction of the young rapper, MC Anyuta did not quit filming video and recording tracks.

Between 2010 and 2013, MC Anyuta was very productive and released 7 albums. The video in support of Viktor Yanukovych brought particular popularity to the girl. Later, the girl released such bangers as Pokemon, Shlyager, Dangerous Village, which gained several hundred thousand views on youtube.

Concerts of MC Anyuta

At the end of 2016 MC Anyuta received an invitation to perform at the concert of the famous underground rapper Pasha Technik in Kiev.

Many of Pasha’s listeners liked Ani’s performance, the girl was seen off the stage with applause.

MC Anyuta’s Battle on RapSoxBattle

In October 2017, on the best Ukrainian battle rap platform RapSox, an issue with the participation of MC Anyuta is released. The girl’s rival was MC Lina. As a result, the judges gave their votes equally, and the victory was won by a young rapper from the village – Anyuta.

Although Anya does not have a strong flow, double rhymes and does not wear stylish clothes, her rap still clings with its primitiveness.We can confidently say that MC Anyuta is the best rural rapper in Ukraine and Russia.

Biographies are reviewed with this artist:

UPD: 3-4-2019
Published: 7-11-2017

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About orienteering grades

TO THE QUESTION OF RELATIONSHIP OF THE ACTIVITY OF THE SYMPATHIC-ADRENAL SYSTEM AND MEDIATORS OF IMMUNE DISORDERS IN PATIENTS WITH METABOLIC SYNDROME | Uzbekova

1.Stryuk RI, Ciganok NYu. Neurohomoral mechanisms of the pathogenesis of the metabolic syndrome. Cardioligy. 2006; 4: 54-9. Russian. (Stryuk R. I., Tsyganok N. Yu. Neurohumoral mechanisms of the pathogenesis of metabolic syndrome. Cardiology. 2006; 4: 54-9.)

2. Chazova IE, Michka VB. The metabolic syndrome. Moscow: Media Medica. 2008 319 p. Russian. (Chazova I.E., Mychka V. B. Metabolic syndrome. M .: Media Medica. 2008.319 s.),

3. Tentolouris N, Liatis S, Katsilambros N. Sympathetic system activity in obesity and meta-bolic syndrome. Ann. N.Y Acad. Sci. 2006; 1083: 129-52.

4. Kidambi S, Kpichen JM, Grim CE, et al. Association of adrenal steroids with hypertension and the metabolic syndrome in blacks. Hypertension. 2007; 49 (3): 704.

5.Straznisky NE, Grima MT, Sari CI, et al. The relation of glucose metabolism to left ven- triculas mass and function and sympathetic nervous system activity in obese subjects with metabolic syndrome. J. Clin. Endocrinol. Metab. 2013; 98 (2): 227-37.

6. Zabelina VD, Zemskov VM, Mkrtumian AM, et al. Features of the immune system in patients with metabolic syndrome. Ter. Archive. 2004; 5: 66-72. Russian. (Zabelina V.D., Zemskov V.M., Mkrtumyan A.M. et al. Features of the state of the immune system in patients with metabolic syndrome. Ter. archive. 2004; 5: 66-72).

7. Stalinskaya OA. The ratio of immune parameters and vasomotor amines in healthy men. Rus. J. Allergol. 2007, 3: 363. Russian. (Stalinskaya O.A. The ratio of immune

8. indicators and vasomotor amines in apparently healthy men.Grew up. allergol. magazine. 2007; 3: 363).

9. Tentolouris N, Li AT, Katsilambros N. Sympathetic system activity in obesity and metabolic syndrome. Ann. N.Y Acad. Sci. 2006; 1083: 129-52.

10. Repin VP. The effect of different concentrations of adrenaline on immune parameters. J. Med. Immunology. 2007; 2-3 (9): 309-10. Russian. (Repin V.P. Influence of various concentrations of adrenaline on immune parameters. Honey. immunology. 2007; 2-3 (9): 309-10).

11. Paleev NR, Paleev FN. Cytokines and their role in the pathogenesis of heart diseases. Clinical Medicine. 2004; 5: 4-12. Russian. (Paleev NR, Paleev FN Cytokines and their role in the pathogenesis of heart disease. Clinical medicine. 2004; 5: 4-12).

12.Lambert E, Dawood T, Strazhicky N, et al. Association between the sympathetic fir¬ing anxiety level in patients with the metabolic syndrome and elevated blood pressure. J. Hypertens. 2010; 28 (3): 543-50.

13. Sokolov EI, Mironova E, Zykova AA. Hormone disruption in the metabolic syn¬drome. Olinical Medicine. 2008; 2: 52-6. Russian. (Sokolov E.I., Mironova E.K., Zykova A.A. Hormonal disintegration in metabolic syndrome.Wedge. medicine. 2008; 2: 52-6).

14. Judkin JS. Infammation, obesity and the metabolic syndrome. Horm. Metab. Res. 2007; 39 (10): 707-09.

I am a mother! – Insurance Medical Company: “Astramed-MS”

The basis for receiving medical nutrition through dairy kitchens is a conclusion issued by a pediatrician. You need to contact the clinic at the place of residence or stay.The conclusion (direction) must be passed directly to a specialist in the dairy kitchen or to the department of social protection. After being included in the register, you can receive food for the entire duration of the conclusion.

In addition to the referral, the doctor must issue a prescription. It must be presented when receiving food in the dairy kitchen. After the prescription expires, it must be renewed.

Pregnant women are referred to antenatal clinics. This can be done immediately after registration. Breastfeeding women receive a referral from a pediatrician who looks after the baby.

The general procedure for the allocation of medical food, including through dairy kitchens, is approved by Article 39 of Federal Law No. 323-FZ. According to this law, the powers to organize medical nutrition are vested in the constituent entities of the Russian Federation and municipalities.

You can get products from the dairy kitchen:

1. for children under 1 year old, if they are on artificial or combined (mixed) feeding;
2. for children under 3 years old;
3. for children aged 3 to 7 years, if they are from large families;
4. for disabled children under 15 years of age.

Women have the right to receive dairy products during pregnancy, during breastfeeding up to 6 months. Additional categories of recipients may be approved by local and regional regulations.

Required documents:

• Application from a woman or legal representative of a child
• child’s birth certificate
• OMS policy
• passport of a woman or legal representative of a child
• documents confirming the status of a large family

ITU certificate of a child’s disability

GBUZ “Tuapse District Hospital No. 1” MH KK

In recent years, a new syndrome has been described called “metabolic syndrome”. It includes pathology from the cardiovascular system and metabolic disorders of lipid and carbohydrate metabolism.

The main components of metabolic syndrome are arterial hypertension (AH), obesity (abdominal type), hyperlipidemia, prediabetes (impaired glucose tolerance) or type 2 diabetes mellitus (DM).

The combination of all these risk factors in the disease “metabolic syndrome” significantly increases the likelihood of developing serious cardiovascular complications – atherosclerosis, myocardial infarction, cerebral stroke, sudden death.Moreover, they appear early enough.

If a 40-year-old man has the above factors, i.e. moderate hypertension, slightly elevated cholesterol (cholesterol) levels, moderate diabetes, a few extra pounds of weight, and he also smokes several cigarettes a day, leads a sedentary lifestyle with periodic stress, he has a high probability of developing cardiovascular complications already at the age of 47 …

Arterial hypertension

AH – a repeatedly fixed increase in the level of blood pressure (BP) more than 140/90 mm Hg.Art.
Normal blood pressure of an adult is up to 130/85 mm Hg. Art.
“Ideal” blood pressure of an adult is 120/70 mm Hg.

The mechanisms of the development of hypertension are very complex and diverse: hereditary predisposition, obesity, impaired carbohydrate and fat metabolism, excessive salt intake, a sedentary lifestyle, psychoemotional stress, smoking, alcohol abuse.

Why is arterial hypertension – AH dangerous?

AG has a significant impact on health, duration and quality of life.AH is the main risk factor for the development of diseases such as myocardial infarction, stroke, heart failure. REMEMBER! In patients with untreated hypertension, heart attack develops 2 times more often, stroke 4 times, heart failure 4 times!

Why is the combination of hypertension with diabetes dangerous?

AH and diabetes are two interrelated diseases that have a powerful mutually reinforcing damaging effect on vital organs: heart, kidneys, eye vessels, arteries.

The goal of treatment for hypertension is to reduce blood pressure to the target level, which corresponds to the minimum risk of developing complications of cardiovascular and renal, as well as keeping the patient at this level of pressure.

The usefulness of lowering elevated blood pressure is due to a decrease in :
– the risk of developing fatal and non-fatal cerebral stroke (by 42%),
– all cardiovascular complications (by 14%),
– mortality from cardiovascular diseases (by 21%), 90,029 – mortality from all causes (by 14%).

Diabetes mellitus

Diabetes mellitus is a condition in which the body cannot absorb glucose well. Type 1 diabetes usually develops in young people and should be treated with insulin.Type 2 diabetes tends to occur in people who are overweight. This type of diabetes can be controlled by diet and weight loss.

Diabetes indicates elevated blood glucose (sugar) levels

Type 2 diabetes often affects the blood vessels. This leads to the development of hypertension, atherosclerosis, coronary heart disease (IHD), vascular pathology, kidney and eye damage. REMEMBER! With diabetes, organ damage and the development of various complications occurs much faster.

In case of diabetes mellitus, which is accompanied by hypertension, it is important to monitor renal function: to control the level of creatinine in the blood, excretion of albumin in the urine.
Adding hypertension to diabetes increases the risk of serious cardiovascular complications not even two-fold, but three-fold.
If, for example, hypertension and an increased level of cholesterol in the blood join diabetes, then the likelihood of cardiovascular complications will be six times higher.
This is why diabetes management should be based on existing cardiovascular risk factors.

If diabetes and hypertension are well controlled, then the likelihood of developing pathology from the heart is minimized.

What do you need to know?

> If you are 40 years of age or older, have a family history of diabetes, are overweight, high blood pressure and / or cholesterol levels in the blood, you should test your blood glucose level.
> Reduce weight if overweight.
> Eat a balanced diet, reduce fat intake, and eat more vegetables and fruits rich in dietary fiber.
> Monitor blood glucose levels at home, record them in a diary.
> Be physically active.

The main thing when treating a patient with hypertension and diabetes is to control:
– pressure level;
– the level of glucose in the blood both on an empty stomach and in the periods after meals in order to maintain compensation for carbohydrate metabolism for a long time;
– protein content in urine;
– levels of cholesterol and other blood lipids.

In diabetes, it is important to control glycated hemoglobin in the blood, which reflects the average value of glucose (sugar) in the blood over the last 3 months. Determination of this indicator is recommended every 6 months or more often if the recommended level is not reached, and every 12 months if glucose control is good.

Hyperlipidemia

The presence of hyperlipidemia is indicated by an increase in the level of total cholesterol in the blood. When cholesterol is elevated, its excess can be deposited in the walls of the arteries and lead to the formation of plaques that constrict blood vessels – this is how atherosclerosis develops. Myocardial infarction, angina pectoris, cerebral stroke are already serious complications of atherosclerosis.

There are:
– “bad” low-density lipoprotein cholesterol (LDL), which is responsible for the delivery of cholesterol to organs and tissues, as well as to the vessel wall; it is often called “atherogenic”. The lower the concentration of LDL cholesterol in the blood, the better;
– “good” high-density lipoprotein cholesterol (HDL), which, on the contrary, removes excess cholesterol from organs, tissues and walls of arteries, and thereby protects them from the development of atherosclerosis; it is often referred to as “anti-atherogenic”.The higher the concentration of HDL cholesterol in the blood, the better;
– triglycerides, which are “atherogenic” lipids. The higher their content in the blood, the more often cardiovascular complications develop, and especially myocardial infarction.

Excess weight

The accumulation of fat in the abdominal area and the subsequent increase in the body’s need for insulin is one of the main causes of the development of metabolic syndrome.
In Russia, almost every second person is overweight (overweight).
An extra kilogram of weight increases blood pressure by an average of 1-3 mm Hg. On the contrary, the loss of 5 extra kilograms leads to a decrease in blood pressure by 5 mm Hg. and more.
Weight gain by 5-8 kg increases the risk of myocardial infarction and death from CHD by 25%.

It is necessary to calculate your body mass index – Quetelet index: the ratio (body weight in kg) to the square (height in meters), i.e. (weight in kg) / (height in meters) ² .

BMI allows you to assess what risk your weight poses to your health BMI (kg / m ² ) Health risk

Less than 18.5 – You are underweight. You should get better as lack of weight increases the risk of cardiovascular disease.

18.5 – 24.9 – Congratulations, you have your ideal weight.

25.0 – 29.9 – You are overweight and at risk of complications. It’s time to think about diet and exercise.

30.0 – 39.9 – You are obese and have a high health risk. You should consult a doctor for examination and drawing up an individual program of nutrition and physical activity, and maybe drug treatment.

More than 40.0 – You have severe obesity. The health risk is very high. You should immediately contact your doctor to develop an individualized weight loss program.

Waist circumference (OT) is the best indicator of the amount of fat in the abdominal region (omentum, mesentery). FROM is measured in cm between the navel and the lower ribs.

For men with OT 94-102 cm and women with OT 80-88 cm, it is advisable not to gain any more weight.
For men with OT over 102 cm and women with OT over 88 cm, it is desirable to lose weight.

An increase in the volume of your waist indicates the presence of abdominal obesity (abdominal obesity).

It is known that middle-aged people have a progressive weight gain of 0.5-1.5 kg each year, therefore weight stabilization can contribute to a successful goal, i.e. suspend the rise in blood pressure.

Check if you have metabolic syndrome?

Criteria for the presence of the disease “metabolic syndrome”:

Indicators / Pathology – Compare with your results
Blood pressure level (mmHg.Art.) 130/85 and above, or treated with AG
Waist circumference (cm) Men 94 and more
Waist circumference (cm) Women 80 and more
Blood triglyceride level (mmol / L) 1.7 and more
The level of “good »HDL cholesterol (mmol / L) Men less than 1.03 or treatment with lipid-lowering drugs
Level of” good “HDL-cholesterol (mmol / L) Women less than 1.29 or treatment with lipid-lowering drugs
Blood glucose level (mol / L) Fasting 5.6 and more or the presence of type 2 DM

What needs to be done?

Treatment of metabolic syndrome consists of active lowering of blood pressure by non-drug methods and regular daily intake of medications, which are individually selected by your doctor.
Non-drug treatment is a set of measures to change lifestyle, physical activity and nutrition, which help to reduce blood pressure, and also have a positive effect on other components of the metabolic syndrome: excess weight, hyperlipidemia, diabetes.

STEP 1 to control the blood pressure level

Target blood pressure level, which should be aimed at during treatment:
V below 140/90 mm Hg.Art. – for all patients
V below 130/80 mm Hg – for patients with diabetes mellitus, after myocardial infarction, cerebral stroke, or suffering from angina pectoris, intermittent claudication,
V below 125/75 mm Hg. – for patients with kidney disease (presence of protein in the urine) and chronic renal failure.

STEP 2 to control cholesterol and other lipid levels

Criteria for the target (optimal) level of serum lipids, which must be achieved against the background of dietary changes, increased physical activity, weight loss and the use of lipid-lowering drugs (as prescribed by a doctor):

– in persons without cardiovascular diseases, but with an additional risk factor such as hypertension, overweight, etc.p .:
* Total cholesterol – less than 5.0 mmol / L
* LDL cholesterol (“bad cholesterol”) – less than 3.0 mmol / L
– in persons with several risk factors, s metabolic syndrome, diabetes mellitus, in most patients with coronary artery disease, atherosclerosis of the carotid arteries, arteries of the lower extremities:
* Total cholesterol – less than 4.5 mmol / L
* LDL cholesterol (“bad cholesterol”) – less than 2, 5 mmol / L
– for all persons and patients
* Triglycerides (“bad lipids”) – less than 1.7 mmol / L
* HDL cholesterol (“good cholesterol”) – in Men 1.0 mmol / l and more
* HDL cholesterol (“good cholesterol”) – in women 1.2 mmol / l and more

STEP 3 to body weight control

One of the main reasons for the increase in body weight is the excessive consumption of high-calorie foods rich in fats and easily digestible carbohydrates, a chaotic diet with a predominance of abundant food in the evening and at night.

Unfortunately, people tend to overeat fatty, high-calorie foods, since such food is tasty due to the increased content of fat-soluble aromatic molecules and does not require thorough chewing. About half of the calories in the daily diet are consumed outside the home, usually in high-fat cafes and fast food restaurants.

An excess of 50 kcal per day, the source of which may be the consumption of 1/3 of an iron can of Coca-Cola, a handful of chips or 25 g of ice cream, leads to an increase in body weight by 2.25 kg per year.
Excess consumption of easily digestible carbohydrates (sugar, candy, honey, chocolate, juices, etc.) increases the concentration in the blood of “bad lipids” – triglycerides (fats), sugar (glucose) and insulin (pancreatic hormone), which contributes to the development of metabolic disorders (insulin resistance, pre- and diabetes) and increases the likelihood of the appearance of the disease “metabolic syndrome”.

Eaten fat provides twice as many calories as the same amount of carbohydrates and protein.The body handles calories from fat in a very different way than calories from protein or carbohydrates. Fatty calories are converted by organisms to fat much faster than calories from carbohydrates and protein. As a result, 100 calories in a tablespoon of butter are much more likely to end up on the stomach or thighs than 100 calories in a bun without butter.

100 kcal contain: 25 g of almonds, 25 g of sunflower seeds, 50 g of hard cheese, 215 g of ice cream, 11/2 donuts with jam, 1 sausage, ½ avacado, 5 chocolate chip cookies.2 pieces of cooked sausage, 480 ml of whole milk.

Since an increase in blood pressure levels is associated with an increase in body weight, it is important to control it that the caloric content of the diet corresponds to the energy expenditure of the body. By reducing total fat intake (primarily from saturated fat), a person has a double benefit: it reduces the waist and reduces the risk of developing cardiovascular diseases.

Sample menu of a hyponatric diet for a patient with hypertension and overweight (caloric content 1700-1800 kcal).

Breakfast – a glass of freshly made juice. 150 g of low-fat cottage cheese with 1-2 teaspoons of jam. A cup of green or herbal tea, or a glass of milk. Apple, orange, or other fruit to taste.
First snack – fruit salad. A glass of tea.
Lunch – vegetable salad with vegetable oil. A cup of chopped leafy greens such as lettuce. 180 g of stew or fish, vegetable stew – for a side dish. A glass of vegetable or fruit juice with pulp.
Second snack – Muesli, Fruit or salad Glass of tea or mineral water
Dinner – vegetable salad or vinaigrette (200 g) with vegetable oil. A glass of natural yogurt. Banana. Compote.
At night – A glass of low-fat kefir. 1-2 apples.

Initial dietary goal is 5-10% weight loss from baseline over 6 months.

Basic rules:
– Eat regularly – minimum interval between meals 1.5-2 hours, the last meal is desirable before 19 hours, about 2/3 of the calorie content of the daily diet in the first half of the day.
– The nutritional value of a snack is not more than 200 kcal, suitable for snacks: raw or dried fruits, vegetables, low-fat dairy products and cheese, cereal bread, nuts.
– Eat at the table
– Before eating, drink a glass of water to reduce appetite
– Use small plates for table setting
– Completely concentrate on food, chewing food thoroughly.

Do not eat:
– in the absence of hunger
– “for the company”
– for fear of getting hungry in the future
– in moments of anxiety and anxiety
– in front of the TV.

Recommended:
> to sharply limit consumption of: butter, meat, sausages, eggs, cheeses and whole milk products; confectionery products from shortbread and pastry dough, potato chips, fried peanuts, sunflower seeds, mayonnaise, condensed milk, chocolate, sugar, sweets, jam.
> to consume more complex carbohydrates (slowly digestible) – oatmeal, brown and wild rice, durum wheat pasta, buckwheat and wheat groats. From varieties of bread – rye, wheat from wholemeal flour with bran.
> to use a variety of sources of protein, it is desirable that red meat is present on the table no more than 2 times a week and is represented by lean varieties (beef, veal), on other days it is better to give preference to white meat of chicken, rabbit, turkey.
> to resort to fasting days (with a calorie content of 700-900 kcal) 1-2 times a week, the frequency of meals is 5 times a day, fasting days: apple (1.5 kg of apples), watermelon (1.5 kg of watermelon) , vegetable (1-2 kg of fresh vegetable salad), cottage cheese (300-400 low-fat cottage cheese), potato (1-1.5 kg of baked potatoes), etc.

How to organize nutrition for weight loss?
* Your goal is no more than 40-50 g of fat per day
* Try not to skip breakfast – this is the most important meal of the day
* Eating three meals a day helps prevent hunger and thus most control weight.Do not go to extremes – do not constantly snack, if you are hungry, have lunch, but do not drink tea with sandwiches or cookies with colleagues several times a day
* Start food with low-fat soup or salad
* Eat at least three daily palm-sized servings of vegetables and two pieces of fruit
* Limit alcohol consumption – it contains a lot of calories
* Watch yourself: do you often eat when something worries or worries, or when you are in a bad mood? Try to gradually get rid of this habit
* Never eat until the end if you are not hungry
* Watch the portion size, do not take additives (except for vegetable dishes)
* Never leave the house hungry, be sure to Have a snack.
* Eat slowly, chewing well. If you eat too fast, the feeling of fullness “lags behind” the amount of food consumed, as a result you overeat.
* Avoid “additives” other than vegetable dishes; watch the portion size.

STEP 4 regular physical activity

Effects of increased physical activity:
– Gives confidence
– Maintains total muscle mass
– Burns calories and fat
– Increases metabolic rate.
– relieves the fat “ring” on the abdomen
– regulates appetite and food intake
– lowers blood pressure
– lowers triglycerides and total cholesterol levels in the blood
– increases the concentration of HDL cholesterol in the blood …

Walking a good pace for 1 hour burns 400 calories. Walking this step in 15 minutes, 1.61 km, you burn 100 calories. You can burn 36,500 calories per year.Dividing this amount by 3500 (this is exactly the amount you need to burn in order to lose half a kilo), you will see that the total weight loss will be 4.5 kg!

STEP 5 to systematize the intake of prescribed medications:

V You should truly understand why, when and how you should take your doctor’s prescribed medication.
V Asking about things that you do not understand
V Choose the best time to take the medicine and a place to store it so that it is easier to remember when to take it
V Make a table or some other visual aid, so that it can be used to determine whether the required medicine was taken today
V Use convenient memorization methods so as not to miss a drug intake.

What Every Hypertension Patient Should Know?

Consult your doctor and fill in the table of your personal values ​​that determine your health:

What you need to know – your value today and your goal “for tomorrow”
Blood pressure level
Body mass index (BMI) or weight and height
Waist circumference
Total blood cholesterol level
Blood triglyceride level
Level of “good” HDL cholesterol
Blood glucose level
Blood creatinine level
Is there protein in the urine?
Is there hypertrophy (thickening) of the heart muscle on ECG or ECHO-KG?
Name, dose and time of drug intake

A balanced attitude towards health is equal attention to all cardiovascular risk factors, without preference or disregard for any of them.