Effects of auriculotherapy on weight and body mass index reduction in patients with overweight or obesity: Systematic review and meta-analysis

Effects of auricular stimulation on weight- and obesity-related parameters: a systematic review and meta-analysis of randomized controlled clinical trials

Background

Over the last three decades, the number of randomized controlled trials (RCTs) using stimulation of auricular vagal sensory nerves by means of electrical stimulation, auricular acupuncture, or acupressure to support weight loss has increased markedly. This systematic review focuses on the effects of auricular stimulation (AS) on anthropometric parameters and obesity-related blood chemistry.

Methods and analysis

The following databases were searched until November 2021: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, and Scopus Database. Data collection and analysis were conducted by two reviewers independently. Quality and risk assessment of included studies was performed using the risk of bias tool of the Cochrane Handbook, and the meta-analysis of the effect of the most frequently assessed biomarkers was conducted using the statistical software RevMan.

Results

The full texts of 1,274 studies were screened; 22 contained data on obesity-related outcomes, and 15 trials with 1,333 patients were included in the meta-analysis. The overall quality of the included trials was moderate. AS significantly reduced body mass index (BMI) (mean difference (MD) = -0.38 BMI points, 95% CI (-0.55 to -0.22), p < 0.0001), weight (MD = -0.66 kg, 95% CI (-1.12 to -0.20), p = 0.005), waist circumference (MD = -1.44 cm, 95% CI (-2.69 to -0.20), p = 0.02), leptin, insulin, and HOMA insulin resistance compared to controls. No significant reduction was found in body fat, hip circumference, ratio of waist/hip circumference, cholesterol, LDL, triglycerides, adiponectin, ghrelin, and glucose levels. The AS was safe throughout the trials, with only minor adverse reactions.

Conclusion

The study results suggest that a reduction of weight and BMI can be achieved by AS in obese patients; however, the size of the effect does not appear to be of clinical relevance. The effects might be underestimated due to active sham trials.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021231885.

The Effects of Auricular Acupressure on Menopausal Symptoms, Stress, and Sleep in Postmenopausal Middle-Aged Women: A Randomized Single-Blind Sham-Controlled Trial

INTRODUCTION

Middle-aged women in the postmenopausal period experience menopause symptoms, stress, and poor sleep quality due to hormonal changes. Nonetheless, most of them recognize such symptoms as an aging process without receiving proper treatment, and there are few nonpharmacologic interventions available.

METHODS

This was a randomized single-masked, sham-controlled trial. For the intervention group, a vaccaria seed was applied to the auricular points of Shenmen, anterior lobe, adrenal glands, central rim, and endocrine that are related to the menopause symptoms, stress, and sleep while applying a seed to the auricular points not related to the forementioned symptoms to the control group. The Menopause Rating Scale (MRS), Perceived Stress Scale (PSS), heart rate variability, and electroencephalogram (EEG) were measured before the intervention, 4 weeks after the intervention, and 8 weeks after the intervention. Actigraphy was measured with a Fitbit, and the Pittsburgh Sleep Quality Index (PSQI) was measured before and after the intervention. The study was registered with the World Health Organization International Clinical Trials Registry Platform (KCT0007364).

RESULTS

The MRS showed significant differences over time in the intervention group (F, 22.057; P < .001). There was a significant difference over time in the PSS (F, 22.576; P < .001), stress index measured by heart rate variability (F, 14.027; P = .001), and antistress quotient of the right brain measured by EEG (F, 4.865; P = .033). Sleep quality, measured by the PSQI (t = -4.050, P < .001), and sleep efficiency measured by actigraphy (t = 5.996, P < .001) were found to be significantly different over time in the intervention group.

DISCUSSION

This study demonstrated that auricular acupressure is effective in improving menopause symptoms, stress, and sleep in postmenopausal middle-aged women. Therefore, auricular acupressure may be a useful nonpharmacologic intervention for alleviating these symptoms in this population.

The Effect of Auriculotherapy on an Overweight Pregnant Women's Weight-Gaining Pattern: A Randomized Controlled Clinical Trial

Background

A concomitant increase in pregnancy complications has accompanied the growing global trend of excessive weight gain during pregnancy. This study evaluates the effect of ear acupressure (auriculotherapy) on the weight-gaining pattern of overweight women during pregnancy.

Materials and Methods

This study was a single-blinded randomized clinical trial conducted between January and September 2022. This study took place in health centers of Qom University of Medical Sciences in Iran. One-hundred thirty overweight pregnant women were selected by a purposeful sampling method and then divided into two groups by block randomization method. In the intervention group, two seeds were placed in the left ear on the metabolism and stomach points, while two seeds were placed in the right ear on the mouth and appetite points. Participants in the intervention group must press the seeds six times a day, 20 minutes before a meal for five weeks. For the placebo group, the Vaccaria seedless label was placed at the same points as the intervention group. A digital scale with an accuracy of 0.1 kg was used to weigh the pregnant women during each visit. Descriptive statistics, independent T-test, chi-square, and repeated measure ANOVA (analysis of variance) test were used to check the research objectives.

Results

There was a statistically significant difference between the auriculotherapy and placebo groups immediately after completing the study (1120.68 ± 425.83 vs. 2704.09 ± 344.96 (g); P = 0.018), respectively. Also, there was a substantial difference in the weight gain of women two weeks (793.10 ± 278.38 vs. 1090.32 ± 330.31 (g); P < 0.001) and four weeks after the intervention (729.31 ± 241.52 vs. 964.51 ± 348.35 (g); P < 0.001) between the auriculotherapy and placebo groups. Discussion. The results of the present study indicated the effectiveness of auriculotherapy in controlling the weight gain of overweight pregnant women. This treatment could be used as a safe method, with easy access, and low cost in low-risk pregnancies. Trial Registration. This trial is registered with IRCT20200104046002N1.

Cardiovascular effects of auricular stimulation -a systematic review and meta-analysis of randomized controlled clinical trials

Background

The number of randomized controlled trials using auricular stimulation (AS) such as transauricular vagus nerve stimulation, or other auricular electrostimulation or auricular acupuncture or acupressure, in experimental and clinical settings, has increased markedly over the last three decades. This systematic review focusses on cardiovascular effects of auricular stimulation.

Methods and analysis

The following databases were searched: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, and Scopus Database. RCTs were reviewed that had been published in English and European languages. Data collection and analysis was conducted by two reviewers independently. Quality and risk assessment of included studies was performed and the meta-analysis of the effect of the most frequently assessed biomarkers.

Results

Altogether, 78 trials were included. 38 studies assessed heart rate (HR), 19 studies analyzed heart rate variability (HRV), 31 studies analyzed blood pressure (BP) and 7 studies were identified that measured oxygen saturation (O2), 2 studies on baroreflex sensitivity and 2 studies on skin conductance were evaluated in this review. 26 studies contained continuous data and were eligible for meta-analysis, 50 trials reported non continuous data and were evaluated descriptively. The overall quality of the studies was moderate to low. AS leads to a significant reduction of HR, the changes though were not considered an adverse reaction. Furthermore, when looking at HRV, AS was able to reduce the LF/HF ratio significantly compared to control procedures. No other cardiovascular parameters (blood pressure, oxygen saturation, baroreflex sensitivity) were changed significantly. AS produced only minor side effects in all trials.

Conclusion

AS can lead to clinically safe reduction of HR and changes in the LF/HF ratio of the HRV, which is presumably via an increase in vagal activity. More research is needed to clarify whether AS can be used to modulate tachycardia or indications with autonomic imbalance.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=231885 PROSPERO, ID CRD42021231885.

Comparison of Chinese Acupressure with Traditional Iranian Medicine Along with Aerobic Exercise on Weight Loss and Serum Lipid Factors in Obese and Overweight Women

Background: Overweightness and obesity were major health problems in the last century. Chinese acupressure, traditional Iranian medicine, and aerobic exercise are low-risk and low-cost methods for its prevention and treatment. Objectives: The purpose of this study was a comparison of six weeks of Chinese acupressure with traditional Iranian medicine along with aerobic exercise on body weight and serum lipid factors in obese and overweight women. Methods: In this applied study, 24 obese and overweight women with a BMI above 25 were randomly divided into two groups of 12: Chinese acupressure and Iranian traditional medicine with aerobic exercise. In the Chinese acupressure group, the ear acupressure method was used using herbal seed and in the traditional Iranian medicine group, the lunch elimination method was used. The aerobic exercise program of the two groups was performed for six weeks, three sessions per week, and each session lasted 60 minutes with moderate intensity. Body weight, waist-to-hip ratio, lipid factors, blood sugar, blood pressure, and nutritional status of the subjects were measured before and after the study and were analyzed using independent and dependent t-tests. Results: The results of the present study showed that in the Chinese acupressure group, along with aerobic exercise, lipid factors improved, and body weight decreased. In the traditional Iranian medicine group, along with aerobic exercise, lipid factors improved, while blood pressure and blood sugar decreased significantly. In the intergroup results, there was a significant difference only in the blood sugar variable. Conclusions: Both Iranian and Chinese medicine, along with aerobic exercise, had a relatively similar effect on the variables.

Effectiveness of auriculotherapy for anxiety, stress or burnout in health professionals: a network meta-analysis

OBJECTIVE

to analyze the effectiveness of auriculotherapy, when compared to the control group, placebo or usual treatment for anxiety, stress or burnout in health professionals.

METHOD

a systematic review conducted in nine information sources, being selected experimental or quasi-experimental studies with auriculotherapy intervention in health professionals, compared to control, placebo or usual treatment groups. Descriptive analysis and network meta-analysis by means of direct and indirect comparison. Quality of the outcomes was assessed with the Confidence in Network Meta-analysis.

RESULTS

15 articles were included: 66.6% with Nursing teams and 53.3% with interventions involving semi-permanent needles. The shen men, brainstem, kidney, sympathetic, lung and liver acupoints predominated. There was a reduction in anxiety with semi-permanent needles (CI -8.18, -6.10), magnetic palettes (CI -7.76, -5.54), placebo (CI -5.47, -3.36) and seeds (CI -6.35, -4.05); as well as in stress with semi-permanent needles (CI -37.21, -10.88) and seeds with (CI -28.14, -11.70) and without a closed protocol (CI -36.42, -10.76). Meta-analysis was unfeasible for burnout; however, significant reductions were verified when it was treated with auriculotherapy.

CONCLUSION

Auriculotherapy is effective to reduce anxiety and stress in health professionals; however, this assertion cannot be made in the case of burnout. It was evidenced that workers' health is favored with the use of auriculotherapy.

The Effect of Auriculotherapy on Situational Anxiety Trigged by Examinations: A Randomized Pilot Trial

Background: Auriculotherapy may activate the parasympathetic nerve system and reduce anxiety levels. Short-term auriculotherapy’s effects and safety on university students’ anxiety levels was assessed prior to exams. Methods: A randomized, controlled pilot trial was conducted. The day before the exam, university students were randomly allocated to the auriculotherapy group (AA, n = 13) or the waiting-list group (WG, n = 13). Baseline measures were taken 4 weeks before the exam at Time point (TP 0); at 7.30 a.m. on the day before the exam (TP I); at 11 a.m. before auriculotherapy (TP II); 30 min after AA (TP III); and at 7.30 a.m. before the exam (TP IV). The outcomes were the State-Trait-Anxiety Inventory (STAI); quality of night-sleep, Visual Analogue scale (VAS) for anxiety, and salivary cortisol. Adverse events were also recorded. Results: A total of 26 students participated in this study and became more anxious as assessed by STAI in TPII (p = 0.002) and TPIV (p = 0.000) than TP0. AA reduced the STAI in TPIII (p = 0.045) and PIV (p = 0.001) and the VAS (p = 0.012) in TPIV. Cortisol was reduced in TPIII (p = 0.004), and the AA slept better (p = 0.014) at TPIV. Discomfort at the auricular site was reported in only one AA participant. Conclusions: Auriculotherapy appeared safe and effective in reducing anxiety levels before university exams.

Acupuncture Therapies for Individuals with Overweight or Obesity: An Overview of Systematic Reviews

Purpose

An increasing number of people are affected by overweight or obesity, and the personal and social health burden is growing rapidly. Acupuncture is gaining popularity as an alternative treatment to manage weight. This research aims to update and synthesize the evidence of acupuncture therapies from systematic reviews for treating overweight and obesity.

Methods

Nine databases were searched from their inception to March 2022. Overweight or obesity was classified using standard diagnostic criteria. Published systematic reviews that included randomized controlled trials and quasi-randomized studies were eligible. Quality was assessed via the AMSTAR-2 scale and risk of bias using the ROBIS tool.

Results

Thirty-eight systematic reviews were identified. Acupuncture therapies and auricular acupoint stimulation showed benefits in terms of reducing body weight and body mass index. Catgut embedding therapy and abdominal acupuncture are currently not in widespread use with insufficient evidence. Acupuncture therapies appear to be safe. Most of the reviews were assessed as having high risk of bias and low confidence in the findings.

Conclusion

There is a need for larger and more methodologically sound randomized controlled trials to evaluate the effectiveness of acupuncture therapies for individuals who are affected by overweight or obesity.