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Garcia-Oropesa EM, Martinez-Lopez YE, Ruiz-Cejudo SM, Martínez-Ezquerro JD, Diaz-Badillo A, Ramirez-Pfeiffer C, Bustamante-Fuentes A, Lopez-Sosa EB, Moctezuma-Chavez OO, Nava-Gonzalez EJ, Perales-Torres AL, Perez-Navarro LM, Rosas-Diaz M, Carter K, Tapia B, Lopez-Alvarenga JC. Looking for Crumbs in the Obesity Forest: Anti-obesity Interventions and Obesity-Associated Cardiometabolic Traits in the Mexican Population. History and Systematic Review With Meta-Analyses. Front Med (Lausanne) 2021; 8:665023. [PMID: 34805192 PMCID: PMC8595206 DOI: 10.3389/fmed.2021.665023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022] Open
Abstract
Mexicans and Mexican Americans share culture, genetic background, and predisposition for chronic complications associated with obesity and diabetes making imperative efficacious treatments and prevention. Obesity has been treated for centuries focused-on weight loss while other treatments on associated conditions like gout, diabetes (T2D), and hypertriglyceridemia. To date, there is no systematic review that synthesizes the origin of obesity clinics in Mexico and the efforts to investigate treatments for obesity tested by randomized clinical trials (RCT). We conducted systematic searches in Pubmed, Scopus, and Web of Science to retrieve anti-obesity RCT through 2019 and without an inferior temporal limit. The systematic review included RCT of anti-obesity treatments in the Mexican adult population, covering alternative medicine, pharmacological, nutritional, behavioral, and surgical interventions reporting metabolism-associated traits such as BMI, weight, waist circumference, triglycerides, glucose, among others. Only the studies with at least 3 months of treatment were included in the meta-analyses in order to reduce placebo effects. We found 634 entries, after removal of duplicates and screening the studies based on eligibility criteria, we analyzed 43 national, and 2 multinational-collaborative studies. Most of the national studies had small sample sizes, and the implemented strategies do not have replications in the population. The nutrition/behavioral interventions were difficult to blind, and most studies have medium-to-high risk of bias. Nutritional/behavioral interventions and medications showed effects on BMI, waist circumference, and blood pressure. Simple measures like pure water instead of sweet beverages decrease triglycerides and systolic blood pressure. Dark chocolate showed the highest effect for BMI and high blood pressure, and treatment with insulin increased weight in those with T2D. The study of obesity in Mexico has been on-going for more than four decades, the interest on RCT just increased until this millennium, but with small sample sizes and lack of replication. The interventions affect different cardiometabolic associated traits, which should be analyzed in detail in the population living near the Mexico-U.S. border; therefore, bi-national collaboration is desirable to disentangle the cultural effects on this population's treatment response. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020221436, identifier: CRD42020221436.
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Affiliation(s)
- Esperanza M Garcia-Oropesa
- Laboratorio de Biología Molecular, Unidad Académica Multidisciplinaria Reynosa Aztlán (UAMRA), Universidad Autónoma de Tamaulipas, Reynosa, Mexico
| | - Yoscelina E Martinez-Lopez
- Programa de Doctorado en Ciencias Médicas y de la Salud, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Sonia María Ruiz-Cejudo
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento (UIESSAE), Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.,Programa de Maestría y Doctorado en Música, Cognición Musical, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - José Darío Martínez-Ezquerro
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento (UIESSAE), Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.,Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Alvaro Diaz-Badillo
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg, TX, United States.,Programa de Maestría en Salud Pública, Universidad México-Americana del Norte (UMAN), Reynosa, Mexico
| | - Carlos Ramirez-Pfeiffer
- Programa de Maestría en Salud Pública, Universidad México-Americana del Norte (UMAN), Reynosa, Mexico
| | | | | | | | - Edna J Nava-Gonzalez
- Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Adriana L Perales-Torres
- Laboratorio de Bromatología, Unidad Académica Multidisciplinaria Reynosa Aztlán (UAMRA), Universidad Autónoma de Tamaulipas Reynosa-Aztlán, Reynosa, Mexico
| | - Lucia M Perez-Navarro
- Servicio de Nefrología, Dirección de Investigación, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Marisol Rosas-Diaz
- Laboratorio de Biología Molecular, Unidad Académica Multidisciplinaria Reynosa Aztlán (UAMRA), Universidad Autónoma de Tamaulipas, Reynosa, Mexico
| | - Kathleen Carter
- Research and Education Library of the School of Medicine, Education & Academic Affairs, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Beatriz Tapia
- Office of Faculty Affairs and Department of Pediatrics, School of Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, United States
| | - Juan C Lopez-Alvarenga
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Edinburg, TX, United States.,Programa de Maestría en Salud Pública, Universidad México-Americana del Norte (UMAN), Reynosa, Mexico
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Abstract
Osteoarthritis (OA) is a painful and life-altering disease that severely limits the daily activity of millions of Americans, and is one of the most common causes of disability in the world. With obesity on the rise and the world's population living longer, the prevalence of OA is expected to increase dramatically in the coming decades, generating burdensome socioeconomic costs. This review summarizes current pharmaceutical, non-pharmaceutical, and prospective new treatments for OA, with primary focus on the dietary supplement Avocado/Soybean Unsaponifiables (ASU). ASU modulates OA pathogenesis by inhibiting a number of molecules and pathways implicated in OA. Anticatabolic properties prevent cartilage degradation by inhibiting the release and activity of matrix metalloproteinases (MMP-2,3,13) and increasing tissue inhibitors of these catabolic enzymes (TIMP-1). ASU also inhibits fibrinolysis by stimulating the expression of plasminogen activator inhibitor (PAI-1). Anabolic properties promote cartilage repair by stimulating collagen and aggrecan synthesis via inhibition of inflammatory cytokines such as IL1, IL6, IL8, TNF, ERK, and PGE2. Chondroprotective effects are mediated by correcting growth factor abnormalities, increasing TGFβ while decreasing vascular endothelial growth factor (VEGF) in synovial fluid. ASU also inhibits cholesterol absorption and endogenous cholesterol biosynthesis, which mediate reactive oxygen species pathology in chondrocytes. At the clinical level, ASU reduces pain and stiffness while improving joint function, resulting in decreased dependence on analgesics.
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Affiliation(s)
- Blaine A. Christiansen
- Department of Orthopaedic Surgery, Lawrence J. Ellison Musculoskeletal Research Center, University of California-Davis Health System, Sacramento, CA, USA
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