Acupuncture on Obesity: Clinical Evidence and Possible ...downloads.hindawi.com/journals/ecam/2018/6409389.pdf · Acupuncture on Obesity: Clinical Evidence and ... Numerous people

Review ArticleAcupuncture on Obesity Clinical Evidence andPossible Neuroendocrine Mechanisms

Kepei Zhang1 Shigao Zhou2 ChunyanWang 1 Hanchen Xu1 and Li Zhang 1

1 Institute of Digestive Diseases Longhua Hospital Shanghai University of Traditional Chinese Medicine Shanghai China2Department of TCM Demonstration Longhua Hospital Shanghai University of Traditional Chinese Medicine Shanghai China

Correspondence should be addressed to Li Zhang zhanglihl163com

Received 12 January 2018 Revised 14 May 2018 Accepted 27 May 2018 Published 14 June 2018

Academic Editor Meng Zhang

Copyright copy 2018 Kepei Zhang et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Objective Acupuncture as one of the complementary and alternative medicines represents an efficient therapeutic option forobesity control We conducted a meta-analysis to investigate the effectiveness of acupuncture in obesity and also summarized theavailable studies on exploring themechanismsDesignWe searched six databases from the inception toApril 2017 without languagerestriction Eligible studies consisted of acupuncture with comparative controls ((1) sham acupuncture (2) no treatment (3) dietand exercise and (4) conventional medicine) The primary outcomes consisted of BMI body weight reduction and incidence ofcardiovascular events (CVD) Secondary outcomes included waist circumference (WC) waist-to-hip ratio (WHR) body fat masspercent body fatmass (kg) total cholesterol (TC) triglyceride (TG) glucose low density lipoprotein cholesterol (LDL-c) reductionhigh density lipoprotein cholesterol (HDL-c) increase and adverse effects The quality of RCTs was assessed by the Cochrane Riskof Bias Tool Subgroup analyses were performed according to types of acupuncture A random effects model was used to adjust forthe heterogeneity of the included studies Publication bias was assessed using funnel plots Main Results We included 21 studieswith 1389 participants When compared with sham acupuncture significant reductions in BMI (MD=-122 95CI=-187 to -056)weight (MD=-154 95CI=-298 to -011) body fat mass (kg) (MD=-131 95CI=-247 to -016) and TC (SMD=-063 95CI=-100 to -025) were found When compared with no treatment group significant reductions of BMI (MD=-192 95CI=-304 to-079) WHR (MD=-005 95CI=-009 to -002) TC (MD=-026 95CI=-048 to -003) and TG (MD=-029 95CI=-039 to -018) were found When compared with diet and exercise group significant reduction in BMI (MD=-124 95CI=-187 to -062)and weight (MD=-327 95CI=-507 to -147) was found Adverse effects were reported in 5 studies Conclusions We concludedthat acupuncture is an effective treatment for obesity and inferred that neuroendocrine regulation might be involved

1 Introduction

Obesity is a chronic disease characterized by the rise ofbody fat stores It is caused by the interaction of geneticdietary lifestyle and environment factors The prevalenceof obesity among children adolescents and adults has beendramatically increased during the last decades Obesity andoverweight are closely related to type 2 diabetes hyper-tension and coronary heart disease [1] The World HealthOrganization (WHO) indicates that more than 19 billionadults 18 years and older were overweight Of these over650 million were obese in 2016 According to a report in theJAMA Journal of Internal Medicine more than two-thirds ofpeople in theUnited States are considered to be overweight orobesity [2] Data fromChinarsquos fourth national physical fitness

survey in 2014 showed that the morbidity of obesity in adultand the aged reached 105 and 139 respectively whichshowed 06 and 09 increase in comparison to the data in2010 Moreover the epidemics of obesity and overweight arenot limited in developed countries and the prevalence alsoincreases among people in developing countries

Obesity can be defined by BMI According to the WHOdefinition a BMI over 25kgm2 is taken as overweight andover 30kgm2 as obese In terms of the physique of the Asia-Pacific population and the characteristics of obesity-relateddisease theWHOobesity adviser group agrees that BMI over23kgm2 is defined as overweight and over 25kgm2 as obeseIn addition other guidelines also include parameters such asWC andWHR to define obesity

HindawiEvidence-Based Complementary and Alternative MedicineVolume 2018 Article ID 6409389 15 pageshttpsdoiorg10115520186409389

2 Evidence-Based Complementary and Alternative Medicine

Numerous people cannot manage the weight onlythrough dietary change and increasing physical activityAlthough pharmaceutical treatments for obesity such asFenfluramine and Sibutramine are effective there exist var-ious limits due to security reasons [3ndash6] As an alternativeintervention for obesity acupuncture is relatively easy cheapand safe and has been widely used in clinical practice [5ndash8] in both China and other countries Although efficacy ofthe acupuncture therapy has been reported the underlyingmechanisms have not been completely illustrated Thereforewe conducted a systematic review and meta-analysis toevaluate the effectiveness of acupuncture in obesity and alsosummarized the present studies on exploring mechanismsunder acupuncture treatment in obesity animals

2 Methods

21 Search Strategy To identify studies of acupunctureon obesity retrievals were implemented in three Englishdatabases (PubMed EMBASE and Cochrane Library) andthree Chinese databases (VIP information database Chi-nese National Knowledge Infrastructure and Wanfang DataInformation Site) from the inception to April 2017 Thesearch strategies were (weight loss OR overweight OR obesityOR weight control OR simple obesity OR weight reductionOR weight increase OR weight decrease OR weight watchOR overeat OR overfeed OR slim) AND (acupuncture andmoxibustion OR acupuncture OR embedding therapy ORacupoint catgut embedding OR electro-acupuncture OR EAOR auricula-acupuncture OR ear seed pressure OR auricularplaster OR auricular acupuncture OR auricular acupressureOR fire needle OR moxibustion OR herbal acupuncture ORdermal needle OR aqua acupuncture OR body acupunctureOR meridians OR abdominal acupuncture) AND (clinicaltrial OR clinical study OR efficacy OR effectiveness) AND(random OR random$) Conference proceedings disser-tations and reference lists of retrieved articles were alsosearched manually for additional relevant studies

22 Inclusion and Exclusion Criteria

221 Types of Studies Published randomized controlledtrials (RCTs) compared acupuncture with control (no treat-ment placebo acupuncture western medicine diet or exer-cise etc) and assessed the efficacy of acupuncture on obesityand overweight We excluded quasi-randomized studiessuch as those allocated by using alternate days of weekNo restriction was imposed on blinding Comments casereports technical reports animal studies self-control studiesor non-RCTs were excluded No language restriction wasmade for selecting the studies

222 Types of Participants We included participants withno limitation of age and gender All appropriate definitionsof overweight or obesity including BMI body weight orpercentage of weight excess compared with ideal weight wereaccepted A diagnosis of simple obesity patients was includedThe secondary obesity which was complicated with hypo-thalamus disease anterior hypopituitarism hypothyroidism

hypercriticism hypogonadotropic hypogonadism pregnan-cy lactation polycystic ovarian syndrome (PCOS) men-strual disorder amenorrhea or other serious medical condi-tions was excluded

223 Types of Intervention We recruited trials with variousacupuncture therapies The acupuncture therapy includedclassical acupuncture electroacupuncture (EA) laseracupuncture catgut embedding auricular acupressure andauricular acupuncture which could be analyzed in subgroupStudies that combined acupuncture with other therapiessuch as medication moxibustion or message were excludedthe studies with lifestyle intervention such as diet andexercise in treatment group were also included Based on thedifferent acupuncture therapies we performed the subgroupanalysis The control inventions were divided into four typessham acupuncture ((1) needle inserting into skin but notpenetrating the exact acupoints (2) needle inserted into anarea where it is near the exact acupoints) no treatment dietand exercise therapy medicine

224 Types of Outcome Measures The primary outcomesconsisted of BMI body weight reduction and the incidenceof CVD Secondary outcomes included WC WHR body fatmass percent body fat mass (kg) serum cholesterol (TC)triglyceride (TG) glucose low density lipoprotein choles-terol (LDL-c) reduction high density lipoprotein cholesterol(HDL-c) increase and adverse effects

23 Study Selection Data Extraction Management and Anal-ysis According to the prespecified inclusion and exclusioncriteria two authors (Kepei Zhang and Chunyan Wang)separately identified the eligible studies by reading the titleabstract and full text of every paper and then extracted thedata A discussion with the other authors was conducted tosolve any discrepancies

The following information was abstracted from all in-cluded publications year country number of includedpatients interventions of treatment and control groups basictreatment duration of treatment adverse reactions andoutcomes Authors of studies were contacted for clarificationwhen necessary

The quality of RCTs was assessed by the Cochrane Risk ofBias Tool including seven domains generation of a randomsequence allocation concealment blinding of participantsand personnel blinding of outcome assessment complete-ness of outcome data selectiveness of reporting and otherbiases A score of 1 or 0 was given for each item dependingon the information provided by study (1 low risk of bias theinformation of the domain was adequate in the text 0 highrisk of bias the information of the domain was inadequate inthe text)The studies with the cumulative score of at 3 ormorewere included in our study

Cochrane Review Manager (RevMan 53) software wasused for statistical analysis Binary data were reported asrisk ration (RR) and continuous data were reported asmean difference (MD) when the outcomes were measuredin the same way among different trials For trials reportingthe same outcome measures but used different methods

Evidence-Based Complementary and Alternative Medicine 3

Records identified throughdatabase searching

(n = 3241)Sc

reen

ing

Incl

uded

Elig

ibili

tyId

entifi

catio

n Additional records identifiedthrough other sources

(n = 20)

Records aer duplicates removed(n =2747)

Records screened(n =737)

Records excluded aertitle and abstract

screening (n =2010)-Not relevant(n=1532)

-Animal studies(n=209)-Review(n=140)

-conferenceabstract(n=32)

-Irrelevant with theefficacy of acupuncture

for obesity(n=97)

Full-text articles assessedfor eligibility

(n = 150)

Full-text articles excludedwith reasons

(n = 587)-Combined acupuncturewith other therapies in

treatment group (such asmoxibustion or message)

(n=254)-Inappropriate

intervention therapy incontrol group (n=170)

-Quasi-randomizedstudies or not real

RCTs(n=145)

Studies included inqualitative synthesis

(n = 21)

Studies included inquantitative synthesis

(meta-analysis)(n = 19)

-Cochrane score lt 3(n=18)

Figure 1 Flow diagram or the number of studies included and excluded

the standardized mean difference (SMD) was reported 95confidence interval (95CI) was used as an effective sizefor the combined analysis A random effects model wasconducted to analyze pooled effects We tested heterogeneityusing the Chi2 statistic (with significance being set at Plt01)and the I2 statistic I2 value above 50 was set as substantialheterogeneity Possible sources of heterogeneitywere assessedby sensitivity and subgroup analysis The existence of publi-cation bias was checked using a funnel plot

3 Results

31 Study Description and Quality Assessment A total of3261 potentially relevant papers were retrieved 514 duplicaterecords were removed 737 articles were remaining afterthe scan of titles and abstract 2010 articles (including notrelevant animal studies review conference abstract andirrelevant with the efficacy of acupuncture for obesity) wereexcluded 150 articles were selected after screening full-text articles 587 articles (including studies which com-bined acupuncture with other therapies in treatment group

inappropriate intervention therapy in control group quasi-randomized studies or not real RCTs and Cochrane scorelt3)were excluded Finally we included 21 studies [9ndash29] 7[9ndash12 17 20 25] in English and 14 [13 16 18ndash21 21 2222 23 23 24 24ndash26] in Chinese 19 studies [9 10 1213 15ndash29] were included in meta-analysis The screeningprocess is summarized in Figure 1 The sample size of theincluded studies ranged from 9 to 43 enrolling a total of 1389participants altogether 760 patients in the treatment groupand 629 patients as the control Meanwhile among thesestudies the study by Han 2016 [13] included two independentexperiments so we divided this study into Han-1 2016 andHan-2 2016 The study by Darbandi et al 2014 [11] includedone experiment which contributed four independent com-parisons Descriptive analysis was used in this study Thebasic characteristics of studies included are summarized inTable 1 Of these 22 records there were 12 records [9ndash12 1516 18 21 24ndash26 29] reporting the effect of acupuncture versussham acupuncture 5 [13 17 19 27] acupuncture versus notreatment 4 [20 22 23 29] acupunctures versus diet andexercise and 1 [14] acupuncture versus medicine


Table1Ch

aracteris

ticso

fthe

inclu

dedstu

dies

Incl

uded

stud

ies

Cou

ntry

Num

bero

fpa

rtic

ipan

tsTr

ialC

ontr

olIn

terv

entio

nsTr

ialC

ontr

olBa

sictr

eatm

ent

Dur

atio

nof

trea

tmen

t(w

eek)

Advers

ere

actio

nsO

utco

mes

Dar

band

iet

al

2012

[9]

Iran

4343

Auric

ular

acup

ressure

Sham

auric

ular

Low-calorie

diet

6Non

eBW

BMIBF

Mplasm

aleptin

Dar

band

iet

al

2013

[10]

Iran

4244

Electro

-acupu

ncture

Sham

acup

uncture

Low-calorie

diet

6Non

eBM

BMIBF

Mplasm

aleptin

Dar

band

iet

al

2014

[11]

Iran

2020

2020

Body

electro

-acupu

ncture

Auric

ular

acup

uncture

Sham

body

electro

-acupu

ncture

sham

Auric

ular

acup

uncture

Low-calorie

diet

6Non

eHeightWHR

BMItrun

kfat

massCrA

lbum

inU

ricacid

FBSHLD

-cLDL-cWBC

RBC

Guc

elet

al

2012

[12]

Turkey

2020

Body

acup

uncture

Sham

acup

uncture

Non

e5

Not

repo

rted

WeightBM

Iinsulin

leptin

gh

relin

cho

lecysto

kinin

Han

-12

016

[13]

China

3637

Body

electro

-acupu

ncture

Notre

atment

Dietary

and

exercise

4

2Subcuta-

neou

sbleeding

and

hematom

a

BMIWC

hipcircum

ference

WHRandspleen

dampn

ess

improvethe

situatio

nof

symptom

score

Han

-22

016

[13]

China

4041

Body

electro

-acupu

ncture

Notre

atment

Dietary

and

exercise

4

3Subcuta-

neou

sbleeding

and

hematom

a

BMIWC

hipcircum

ference

WHRandspleen

dampn

ess

improvethe

situatio

nof

symptom

score

He

etal

20

08[1

4]Ch

ina

4040

Body

electro

-acupu

ncture

+Au

ricular

acup

uncture

Sibu

tram

ine

Non

e8

Norepo

rted

Body

weightBM

Iwaistandhip

circum

ferencea

ndWHR

Hsu

etal

20

09[1

5]Taiwan

2322

Auric

ular

acup

uncture

Sham

eauricular

acup

uncture

Non

e6

1Minor

inflamma-

tion

8mild

tend

erness

Body

weightBM

IWC

obesity

-related

horm

one

peptides

Hun

get

al

2016

[16]

Taiwan

3230

Verum

laser

acup

uncture

Sham

laser

acup

uncture

Non

e3

Non

eBM

IBF

Pwaist-

to-buttock

ratio

Kim

etal

20

14[1

7]Ko

rea

2524

Auric

ular

acup

ressure

Notre

atment

Non

e4

Non

eWeightBM

Ibo

dyfatm

ass

percentageW

HR

Lien

etal

20

12[1

8]Taiwan

4823

Auric

ular

stimulation

Sham

auric

ular

acup

uncture

Non

e8

1dizziness

BMIweightob

esity

-related

horm

onep

eptid

slifeq

uality

scores


Table1Con

tinued

Incl

uded

stud

ies

Cou

ntry

Num

bero

fpa

rtic

ipan

tsTr

ialC

ontr

olIn

terv

entio

nsTr

ialC

ontr

olBa

sictr

eatm

ent

Dur

atio

nof

trea

tmen

t(w

eek)

Advers

ere

actio

nsO

utco

mes

Luo

2006

[19]

China

4020

Electro

-acupu

ncture

on

lyacup

uncture

Notre

atment

Non

e3

Not

repo

rted

WHR

MBIT

CTG

HDL-c

LDL-cLE

PAd

ipon

ectin

(ADI)

Nou

rsha

hiet

al

2009

[20]

Iran

99

Acup

uncture

Notre

atmentd

ietand

exercise

Dietand

exercise

8Not

repo

rted

Body

weightskin

fold

thickn

ess

BMIfatm

ass

Tong

201

1[21

]Ch

ina

7642

Acup

uncture

Placebo-acup

uncture

Diet

5Non

eBM

ITC

TGG

lucoseB

UN

Uric

Acid

andadverser

eactions

Xing

2009

[22]

China

3130

Electro

acup

uncture

Dietand

exercise

Dietand

exercise

8Norepo

rted

Body

weightBM

ITG

TC

LDL-cHDL-cWHR

Leptin

Xio

nget

al

2016

[23]

China

2921

Acup

uncture

Exercise

Non

e4

Norepo

rted

Body

weightBM

I

Yeh

etal

20

15[2

4]Taiwan

3634

Auric

ular

electric

alstim

ulation

+auricular

acup

ressure

Samem

annerb

utat

sham

acup

oints

Diet

10Norepo

rted

BMIbloo

dpressureT

CTG

LeptinA

dipo

nectin

Yeo

etal

20

14[2

5]Ko

rean

4315

Eara

cupu

ncture

Sham

acup

uncture

Non

e8

Norepo

rted

BMIWC

weightbo

dyfatm

ass

(kg)percentageb

odyfatand

bloo

dpressure

Zhan

get

al

2012

[26]

China

1515

Electro

-acupu

ncture

Sham

Electro

-acupu

ncture

Non

e4

1Bleeding

WeightBM

Ibo

dyfatm

ass

Zhan

g20

12[2

7]Ch

ina

2928

Catgut

embedd

edNotre

atment

Dietand

exercise

8

Theb

leeding

ratewas

1875

intre

atment

grou

p

WeightBM

Iwaistlin

ehipline

circum

ferencequ

ality

oflife

Zhao

etal

20

11[2

8]Ch

ina

3535

Electro

-acupu

ncture

Sham

Electro

-acupu

ncture

Non

e4

Norepo

rted

BMIWeight

Zhao

201

0[2

9]Ch

ina

3030

Electro

-acupu

ncture

Dietand

exercise

Dietand

exercise

8Norepo

rted

BMIwaist

FBS2hPG

FIN

S2hFINS


The quality assessment of the included studies is summa-rized in Table 2 The majority of studies included had moreor less methodological weakness according to the qualitycriteria applied Of the 22 records 1 [20] fulfilled three 11 [9ndash12 15 17ndash19 23 24 28] fulfilled four 4 [14 22 25 28] fulfilledfive 3 [16 21 27] fulfilled six and 3 [13 26] fulfilled sevenAll records had random allocation 14 [9ndash11 13 15 18 20ndash28] in used random number table 4 [14 17 19 29] employeddraw lots 1 [12] used urn randomization 1 [16] performedpermuted block randomization and 1 [20] randomly listednames and assigned them to three groups Moreover 10 [1113 15 16 18 21 24ndash26] mentioned blinding of participantsand personnel and 7 [13 14 21 26 27] mentioned blinding ofoutcomes In addition 8 [13 16 22 24ndash28] reported the planof allocation and concealment Two [20 28] had no informa-tion about withdraws but provided complete outcome dataThree [15 24 25] had a loss to follow-up more than 15

32 Effectiveness

321 Acupuncture versus Sham Acupuncture A total of 12records [9ndash12 15 16 18 21 24ndash26 29] showed significant dif-ference in BMI reduction between the acupuncture and shamacupunctureThe random effectsmodel was used (MD=-12295CI=-187 to -056) the high heterogeneity was detected(heterogeneity Chi2 =6016 df =10 (Plt000001) I2=83)Sensitivity analysis was conducted to explore potential sourceof heterogeneity which yielded I2 ⩾50 results after theomission of each individual study Subgroup analyses wereperformed based on different acupuncture therapies Resultsshowed that both auricular acupuncture and EA signifi-cantly reduced BMI compared with control group (MD=-056 95CI=-098 to -015MD=-143 95CI=-183 to -104Figure 2(a)) The funnel plots were bilateral asymmetrysuggesting the publication bias may exist A total of 7 records[9 10 12 15 18 25 29] reported the data of weight lossTherewas significant difference between two groups The randomeffects model was used (MD=-154 95CI=-298 to -011)high heterogeneity was detected (heterogeneity Chi2 =3183df =6 (Plt000001) I2=81) Subgroup analyses showed thatEA significantly reducedweight comparedwith control group(MD=-371 95CI=-482 to -260 Figure 2(b)) Two records[16 18] showed no difference in WHR loss between twogroupsOne record [26] showed that EA significantly reducedWHR compared with control group Three records [15 1825] showed no difference in WC loss between two groupsThe random effects model was used (MD=-056 95CI=-203 to 091 Figure 2(c)) high heterogeneity was detected(heterogeneity Chi2 =441 df =2 (P=011) I2=55) Onerecord [11] showed auricular acupuncture and EA signif-icantly reduced WC compared with control group Threerecords [9 10 25] showed that the acupuncture significantlyreduced body fat mass (kg) The random effects model wasused (MD=-131 95CI=-247 to -016 heterogeneity Chi2=014 df =2 (P=093) I2=0) Subgroup analyses showedthat auricular acupuncture significantly reduced body fatmass (kg) comparedwith control group (MD=-132 95CI=-255 to -010 Figure 2(d)) Three records [16 25 26] showed

no significant difference between two groups in body fatmass percentage reduction Two records [15 24] showed thatthe auricular acupuncture significantly reduced serum totalcholesterol (TC) in patients The random effects model wasused (SMD=-063 95CI=-100 to -025 heterogeneity Chi2=005 df =1 (P=081) I2=0 Figure 2(e)) Two records[15 24] showed no significant difference in reducing TGin patients between groups The random effects model wasused (SMD=-035 95CI=-072 to 002 heterogeneity Chi2=049 df =1 (P=048) I2=0 Figure 2(f)) Two records[15 21] showed no significant difference in reducing glucosein patients One record [15] showed no significant differencein HDL-c and LDL-c between two groups One [26] caseof bleeding after treatment was reported in 1 record A fewparticipants developed minor inflammation and had mildtenderness at the acupuncture sites during the treatment in1 record [15] no major adverse effects were seen during thestudy A subject in treatment group experienced dizzinessimmediately after auricular acupuncture in 1 record [18]Slight bleeding was observed in 1 record [27]

322 Acupuncture versus No Treatment Five records [13 1719 27] showed acupuncture significantly reduced BMI Therandom effects model was used (MD=-192 95CI=-304 to-079) high heterogeneity in the data was detected (hetero-geneity Chi2 =1751 df =4 (P=0002) I2=77) Subgroupanalyses showed that EA significantly reducedBMI comparedwith control group (MD=-269 95CI=-493 to -045 Fig-ures 2(g) and 3) Three records [13 27] reported the data ofweight lossThere was no difference between two groupsTherandom effects model was used (MD=-308 95CI=-691 to074) heterogeneity in the data was detected (heterogeneityChi2 =452 df =2 (P=010) I2=56) Subgroup analysesshowed that there was no difference between EA and controlgroup in weight loss (MD=-525 95CI=-1058 to 008Figure 2(h)) Five records [13 17 19 27] showed acupuncturesignificantly reduced WHR The random effects model wasused (MD=-005 95CI=-009 to -002) high heterogeneityin the data was detected (heterogeneity Chi2 =2216 df =4(P=00002) I2=82) Subgroup analyses showed that EAsignificantly reduced WHR compared with control group(MD=-006 95CI=-011 to -002 Figure 2(i)) One record[27] showed acupuncture significantly reduced WC com-pared with control group Two records [13 19] showed theacupuncture significantly reduced TC The random effectsmodel was used (MD=-026 95CI=-048 to -003 hetero-geneity Chi2 =064 df =1 (P=042) I2=0 Figure 2(j))Two records [13 19] showed the acupuncture significantlyreduced TG The random effects model was used (MD=-029 95CI=-039 to -018 heterogeneity Chi2 =001 df=1 (P=090) I2=0 Figure 2(k)) One record [19] showedthe acupuncture significantly changed LDL-c in patientsOne record [19] showed no significant difference in HDL-c between two groups Subcutaneous bleeding or hematomaafter treatment was reported in 2 records [13]

323 Acupuncture versus Diet and Exercise The efficacy ofacupuncture was compared to diet and exercise in 4 records


(a)

(b)

(c)

Figure 2 Continued


(d)

(e)

(f)

(g)

Figure 2 Continued


(h)

(i)

(j)

(k)

Figure 2 Continued


(l)

(m)

Figure 2The forest plots of the efficacy of acupuncture for obesity (1) Acupuncture versus sham acupuncture (a) analysis of BMI in obesitypatients (b) analysis of weight loss in obesity patients (c) analysis of WC in obesity patients (d) analysis of body fat mass (kg) in obesitypatients (e) analysis of TC in obesity patients and (f) analysis of TG in obesity patients (2) Acupuncture versus no treatment (g) analysisof BMI in obesity patients (h) analysis of weight loss in obesity patients (i) analysis of WHR in obesity patients (j) analysis of TC in obesitypatients and (k) analysis of TG in obesity patients (3) Acupuncture versus diet and exercise (l) analysis of BMI in obesity patients and (m)analysis of weight loss in obesity patients

[20 22 23 29] The pooled effect on BMI outcome in3 records [22 23 29] showed no significant difference inBMI decrease The random effects model was used (MD=-124 95CI=-187 to -062) heterogeneity was detected (het-erogeneity Chi2 =411 df =2 (P=013) I2=51) Subgroupanalyses showed that EA significantly reducedBMI comparedwith control group (MD=-139 95CI=-225 to -053 Fig-ure 2(l)) One record [20] reported BMI but the data ofcontrol group was not given Therefore description analysiswas used and it suggested that no significant difference wasfound between the two groups Three records [22 23 29]showed the acupuncture significantly reduced weight Therandom effects model was used (MD=-327 95CI=-507 to-147) heterogeneity was detected (heterogeneity Chi2 =353df = 2 (P=017) I2=43) Subgroup analyses showed thatEA significantly reduced body weight compared with controlgroup (MD=-371 95CI=-621 to -120 Figure 2(m)) Onerecord [22] showed the acupuncture significantly changedWHR in the first duration of treatment but no significant

difference was found in the last two durations betweentwo groups One record [29] showed the treatment groupwas more effective than the control group in WC lossNo significant difference in body fat mass (kg) was foundbetween two groups in 1 record [29] One record [22] showedno significant change between two groups in serum TC TGLDL-c and HDL-c

324 Acupuncture versus Medicine Acupuncture was com-pared to medicine in 1 record [14] There was no significantlydifferent between two groups in BMI and weight decreaseControl groupwasmore effective than the acupuncture groupin WC andWHR reduction

33 Possible Mechanisms of Acupuncture on Obesity Acu-puncture is believed to be involved in neuroendocrine axisregulation Modulating eating habits and energy metabolismare the promising strategies for obesity and it is an immenselycomplex process involving the gastrointestinal tract many


Table 2 Risk of bias of the included studies

Included studies A B C D E F G TotalDarbandi et al 2012 [9] 1 0 0 0 1 1 1 4Darbandi et al 2013 [10] 1 0 0 0 1 1 1 4Darbandi et al 2014 [11] 1 0 1 0 1 0 1 4Gucel et al 2012 [12] 1 0 0 0 1 1 1 4Han-1 2016 [13] 1 1 1 1 1 1 1 7Han-2 2016 [13] 1 1 1 1 1 1 1 7He et al 2008 [14] 1 0 0 1 1 1 1 5Hsu et al 2009 [15] 1 0 1 0 1 0 1 4Hung et al 2016 [16] 1 1 1 0 1 1 1 6Kim et al 2014 [17] 1 0 0 0 1 1 1 4Lien et al 2012 [18] 1 0 1 0 1 0 1 4Luo 2006 [19] 1 0 0 0 1 1 1 4Nourshahi et al 2009 [20] 1 0 0 0 0 1 1 3Tong 2011 [21] 1 0 1 1 1 1 1 6Xing 2009 [22] 1 1 0 0 1 1 1 5Xiong et al 2016 [23] 1 0 0 0 1 1 1 4Yeh et al 2015 [24] 1 1 1 0 0 0 1 4Yeo et al 2014 [25] 1 1 1 0 1 0 1 5Zhang et al 2012 [26] 1 1 1 1 1 1 1 7Zhang 2012 [27] 1 1 0 1 1 1 1 6Zhao et al 2011 [28] 1 0 0 1 1 1 1 5Zhao 2010 [29] 1 0 0 0 1 1 1 4Note A adequate sequence generation B concealment of allocation C blinding of participants and personnel D blinding of outcome assessment Eincomplete outcome data F selective reporting G other bias 1 low risk of bias the information of the domain was adequate in the text 0 high risk of biasthe information of the domain was inadequate in the text

Figure 3 The funnel plots of the efficacy of acupuncture forobesity Funnel plots of the effect of acupuncture on BMI betweenacupuncture and sham acupuncture

hormones and both the central and autonomic nervoussystems (Figure 4)

The arcuate nucleus of the hypothalamus (ARH) is themain regulatory organ for appetite in human In diet-inducedobesity (DIO) rats EA treatment significantly decreased

food intake and reduced body weight compared with theuntreated rats Further analysis revealed that EA treatmentincreased peptide levels of 120572-MSH and mRNA expressionof its precursor proopiomelanocortin (POMC) in ARHneurons In addition 120572-MSH in cerebral spinal fluid (CSF)elevated upon EA application However the lesion in ARHcould abolish the inhibition effect of EA on food intakeand body weight suggesting the beneficial effects of EAtreatment are acted through ARH and that the stimulationof 120572-MSH expression and release might be involved in theprocess [30] In 14-week high-fat diet feeding rats 4-weekEA treatment causes a reduction of both in body weight andenergy intake along with the upregulation of the cocaineand amphetamine-regulated transcript (CART) peptide ananorexigenic peptide in the arcuate nucleus (ARC) [31]

Activating the satiety center tends to be one of theeffective methods in preventing obesity Su et al [32] haveshown that acupuncture can raise the frequency of neu-ral discharge in the hypothalamic ventral medial nucleus(VMH) indicating acupuncture could improve the excitabil-ity of the medial nucleus in experimental obese animalsLiu et al [33] have found that the frequency of spontaneousdischarges of nerve cells in VMH and the levels of tyrosine(Tyr) dopamine (DA) tryptophan (Typ) and 5-hydroxy-tryptamine (5-HT)5-hydroxyindole acetic acid (5-H1AA)ratio were elevated along with the decrease of 5-HT levelupon 12 days of consecutive acupuncture treatment Lateral


PeFPVNLHAVMHARH

Brain-Gut-Bacteria Axis Neuroendocrine Axis

Hypothalamus

Adipose Tissue

INS

LP

Figure 4 The potential neuroendocrine regulation under the efficacy of acupuncture in the animal studies

hypothalamic area (LHA) is the main neuroregulator intriggering ingestion Acupuncture is reported to reduce exci-tation of LHA inhibit hyperorexia and regulate the activityof 5-HT the catecholamine neurotransmitter and ATPaseactivity in the LHA [34 35]

Some studies [36 37] believed that acupuncture couldimprove the frequency of spontaneous discharges of nervecell in the paraventricular nucleus (PVN) and reduced theactivity of hypothalamic perifornical nucleus (PeF) neuronsJi et al [38] concluded that an upregulation of anorexigenicfactor POMC production in the nucleus tractus solitarius(NTS) and hypoglossal nucleus (HN) regions were generatedby EA Zusanli (ST36) thus preventing food intake and caus-ing weight loss Signal transduction of EA stimuli includedexpression of transient receptor potential vanilloid type-1(TRPV1) and neuronal nitric oxide synthase (nNOS) in theST36 and the NTSgracile nucleus through somatosensoryafferents-medulla pathways Kim et al [39] found that stimu-lation of auricular acupuncture point affected the expressionof NPY expression in the ARN and PVN in rats Fu et al[40] suggested that transcription factor STAT5 in the centralnervous system plays different roles in the hypothalamus andwhite fat tissue during gene transcription and acupuncturecould regulate a large amount of differentially expressedgenes toward their normal expression especially genes inthe hypothalamus Thus the weight loss effect of acupunc-ture might be attributed to its functional gene regulatorymechanisms Upregulation the transcription of adenosine51015840-monophosphate-activated protein kinase1205722 (AMPK1205722)promotion protein expression of liver kinase B1 (LKB1)and AMPK1205721 and inhibition acetyl-CoA carboxylase (ACC)protein expression in the hypothalamus were observed after4 weeks of EA treatment [41] However auricular acupunc-ture stimulation is reported to be associated with satiation

formation and preservation in the hypothalamus but fails towork on anorexia activity [42]

Certain hormones including insulin and ghrelin mayinfluence appetite in the hypothalamus [43] One study [44]showed that downregulation of ghrelin in the stomach andneuropeptide Y (NPY) in the hypothalamus was in line withthe reduction in food intake in rats receiving EA stimulationonce every day Liu et al [45] speculated that in high-fat diet(HFD) animals EA treatment (ST36 and LI11 20minutes perday for 28 days) could reduce the body weight homeostasismodel assessment-insulin resistance index adipocyte diam-eters and neuroprotein Yagouti-related protein and proteintyrosine phosphatase 1B levels In dbdbmice Liang et al [46]found that EA treatment (five times per week for eight weeks)contracted the increase of fasting blood glucose food intakeand body mass and maintained insulin levels via stimulationof skeletal muscle Sirtuin 1 (SIRT1)peroxisome proliferator-activated receptor 120574 coactivator 1120572 (PGC-1120572) suggesting therole of EA in improving insulin resistance Gong et al [47]applied EA stimulation to diet-induced obese rats for fourweeks and observed the reduced body weight plasma levelsof leptin and increased expression of leptin receptor inthe hypothalamus In addition Shen et al [48] discoveredthat four weeks of EA treatment caused remodeling whiteadipose tissues (WAT) to brown adipose tissue (BAT) viainducing uncoupling protein-1 (UCP1) in EA group Besidesacupuncture also adjusted the intestinal flora achieving thebalance of brain-gut-bacteria axis [49ndash51]

4 Discussion

Here we selected 21 RCTs including 1389 patients sufferingfrom obesity to evaluate the efficacy of acupuncture Wefound that acupuncture was more effective than shame


acupuncture in BMI weight body fat mass (kg) and TCacupuncture was more effective than no treatment group inBMI WHR and TG In addition acupuncture is showedto be more effective than diet and exercise group in BMIand weight loss To a limited extent we concluded thatacupuncture is an effective treatment for obesity

Currently the etiology of obesity has not been definedyet many factors such as neuromodulation viral immuneendocrine free radical and genetics are reported to beinvolved [52ndash57] Each indicator can affect a wide range offactors hormones and even genetic changes so the mecha-nisms of acupuncture on obesity tend to be the simultaneousadjustment of multiple systems and targets So we reviewedthe potential mechanisms under the efficacy of the animalstudies and highlighted neuroendocrine regulation to beessential in the process

The limitations of this work are as follows(1) Bias risk exists because most studies do not describe

the allocation of hidden methods or use blind methods [58]which might result in performance bias and detection bias

(2)The number of samples of each trial is relatively smallwhich might cause the insufficient sample size for analysisand test efficacy

(3) The researchers are evaluated by different diagnosticcriteria inclusion and exclusion criteria forms of acupunc-ture (acupuncture EA ear needles ear pressure and embed-ding) the course of treatment (different acupoints durationof treatment) basic intervention (diet and exercise) andthe confounding factors are different which might increaseheterogeneity

(4) Some researchers do notmention themethods used indealing withmissing data although they have a loss to follow-upmore than 15Most studies lack following course and failto understand the long-term effects of auricular acupressuretreatment which might increase attrition bias

(5) There are some objective factors like language andlimited search resource which may lead to the incompletesearching

In conclusion acupuncture is a reasonable and effec-tive treatment for people who suffer from obesity How-ever according to CONSORT Declaration and STRICTAStandard some researchers point out that the efficacy ofacupuncture on mild obesity is not significant which isdifficult for readers to understand the rationality of thestudy design the correctness of the implementation theauthenticity of the results and the clinical applications[59] Obesity is a chronic condition requiring long-termtreatment However the treatment period of obesity is rathershort in many studies varying from 3-8 weeks Follow-upsare needed to observe curative effect since the bodyweightmight be easily rebound In clinical obesity is the majorrisk of cardiovascular events so we put the incidence ofCVD as the primary outcome however no included studiesset CVD as primary outcome More researches need to bedone to evaluate CVD as the curative effect of acupuncturetreatment for obesity in clinical This systematic review wasconducted to critically assess evidence from RCTs regardingthe efficacy of various types of acupuncture therapies onobesity We analyzed the outcomes which were related to

obesity comprehensively In the future larger number ofsamples and higher-quality randomized controlled trials arerequired to verify the clinical effectiveness in treating obesityby acupuncture Moreover understanding the mechanismsunder the efficacy of acupuncture on weight loss providesreliable experimental basis thus convincing the patients withobesity with the application of acupuncture

Conflicts of Interest

The authors declared no conflicts of interest

Acknowledgments

This work was supported by the Shanghai Rising-Star Pro-gram (no 17QA1404000) and Shanghai Municipal Popu-lation and Family Planning Commission ldquoExcellent YouthTalent Training Programrdquo (no 2017YQ036)

References

[1] I Kawachi ldquoPhysical and psychological consequences of weightgainrdquo Journal of Clinical Psychiatry vol 60 supplement 21 pp5ndash9 1999

[2] L Yang and G A Colditz ldquoPrevalence of overweight and obe-sity in the United States 2007ndash2012rdquo JAMA Internal Medicinevol 175 no 8 pp 1412-1413 2015

[3] The Cooperative Group Will Be Evaluated after the Listingof Sibutramine Center ldquoClinical curative effect and safetyresearch in treatment of the simple obesity with sibutraminehydrochloride capsulerdquo Chinese Journal of Clinical Pharmacyno 15 pp 17ndash20 2004 (Chinese)

[4] A Ballinger ldquoOrlistat in the treatment of obesityrdquo ExpertOpinion on Pharmacotherapy vol 1 no 4 pp 841ndash847 2000

[5] Z Liu S Yan J Wu et al ldquoAcupuncture for chronic severefunctional constipation a randomized trialrdquo Annals of InternalMedicine vol 165 no 11 pp 761ndash769 2016

[6] X K Wu E Stener-Victorin H Y Kuang et al ldquoEffect of acu-puncture and clomiphene in Chinese women with polycysticovary syndrome a randomized clinical trialrdquo Journal of theAmerican Medical Association vol 317 no 24 pp 2502ndash25142017

[7] J P Briggs and D Shurtleff ldquoAcupuncture and the complexconnections between the mind and the bodyrdquo Journal of theAmerican Medical Association vol 317 no 24 pp 2489-24902017

[8] Z Liu Y Liu H Xu et al ldquoEffect of electroacupuncture on uri-nary leakage among women with stress urinary incontinenceA randomized clinical trialrdquo Journal of the American MedicalAssociation vol 317 no 24 pp 2493ndash2501 2017

[9] M Darbandi S Darbandi A A Owji et al ldquoThe effects ofElectro Acupuncture on leptin hormone in Iranian obese andoverweight subjectsrdquo Clinical Biochemistry vol 44 no 13 ppS127ndashS128 2011

[10] M Darbandi S Darbandi M G Mobarhan et al ldquoEffects ofauricular acupressure combined with low-Calorie diet on theleptin hormone in obese and overweight iranian individualsrdquoAcupuncture in Medicine vol 30 no 3 pp 208ndash213 2012

[11] M Darbandi S Darbandi A A Owji et al ldquoAuricular orbody acupuncture which one is more effective in reducingabdominal fat mass in Iranian men with obesity a randomized


clinical trialrdquo Journal of Diabetes amp Metabolic Disorders vol 13no 1 article 92 2014

[12] F Gucel B Bahar C Demirtas S Mit and C Cevik ldquoInfluenceof acupuncture on leptin ghrelin insulin and cholecystokininin obese women a randomised sham-controlled preliminarytrialrdquo Acupuncture in Medicine vol 30 no 3 pp 203ndash207 2012

[13] Y P Han Spleen Tune with Acupuncture on Simple ObesityFemale Patients with Spleen Dysfunction and Dampness Syn-drome Heilongjiang University Of Chinese Medicine 2016(Chinese)

[14] L He X-L Gao H-X Deng and Y-X Zhao ldquoEffects of acu-puncture on body mass index and waist-hip ratio in the patientof simple obesityrdquo Chinese Acupuncture ampMoxibustion vol 28no 2 pp 95ndash97 2008 (Chinese)

[15] C-HHsu C-JWang K-CHwang T-Y Lee P Chou andH-HChang ldquoThe effect of auricular acupuncture in obesewomena randomized controlled trialrdquo Journal of Womenrsquos Health vol18 no 6 pp 813ndash818 2009

[16] Y-C Hung I-L Hung W-L Hu et al ldquoReduction in postpar-tumweight with laser acupuncture a randomized control trialrdquoMedicine vol 95 no 34 p e4716 2016

[17] D Kim O K Ham C Kang and E Jun ldquoEffects of auricularacupressure using Sinapsis alba seeds on obesity and self-efficacy in female college studentsrdquo The Journal of Alternativeand Complementary Medicine vol 20 no 4 pp 258ndash264 2014

[18] C Y Lien L L Liao P Chou and C H Hsu ldquoEffects of auric-ular stimulation on obese women a randomized controlledclinical trialrdquo European Journal of Integrative Medicine vol 4no 1 pp e45ndashe53 2012

[19] H L Luo Study on Effect andMechanism of Electroacupunctureon Simple Obesity Chongqing Medical University 2006 (Chi-nese)

[20] M Nourshahi S Ahmadizad H Nikbakht M A Heidarniaand E Ernst ldquoThe effects of triple therapy (acupuncture dietand exercise) on body weight A randomized clinical trialrdquoInternational Journal of Obesity vol 33 no 5 pp 583ndash587 2009

[21] J Tong J X Chen Z Q Zhang et al ldquoClinical observation onsimple obesity treated by acupuncturerdquo Chinese Acupuncture ampMoxibustion vol 31 no 8 pp 697ndash701 2011

[22] H J XingTheClinical Research on Acupuncture Combined withDietary Adjustment andAerobic Exercise for Treatment of SimpleObesity Hebei Medical University 2009 (Chinese)

[23] W Xiong H J Yuan S Y Luo and Y H Pan ldquoThe effect ofacupuncture in 29 obeserdquoHunan Journal of Traditional ChineseMedicine no 5 pp 115ndash117 2016 (Chinese)

[24] M-L Yeh N-F ChuM-Y F Hsu C-C Hsu and Y-C ChungldquoAcupoint stimulation on weight reduction for obesity a ran-domized sham-controlled studyrdquo Western Journal of NursingResearch vol 37 no 12 pp 1517ndash1530 2015

[25] S Yeo K S Kim and S Lim ldquoRandomised clinical trial of fiveear acupuncture points for the treatment of overweight peoplerdquoAcupuncture in Medicine vol 32 no 2 pp 132ndash138 2014

[26] L Zhang X L Zhou H M Zhang and M Q Hong ldquoClinicalobservation on simple obesity treated by electroacupuncturerdquoJournal of Sichuan of Traditional Chinese Medicine no 11 pp134ndash136 2012 (Chinese)

[27] J S Zhang Clinical observation on simple obesity treat by catgutembedded therapy combine with diet adjustment and aerobicexercise Chengdu University of TCM 2012 (Chinese)

[28] Y Zhao J Liu Y Yao and M Q Lin ldquoClinical research ofusing acupuncture which can invigorate spleen and eliminate

phlegm to treat simple obesityrdquo Journal of Sichuan of Tradi-tional Chinese Medicine no 4 pp 123ndash125 2011 (Chinese)

[29] L Q Zhao and Y Shi ldquoElectroacupuncture combined withdiets and exercises in treatment of simple obesity complicatedwith excess heat syndrome of stomach and intestinerdquo Journalof Anhui University of Chinese Medicine no 4 pp 33ndash37 2010(Chinese)

[30] F Wang D R Tian P Tso and J S Han ldquoArcuate nucleusof hypothalamus is involved in mediating the satiety effect ofelectroacupuncture in obese ratsrdquo Peptides vol 32 no 12 pp2394ndash2399 2011

[31] D-R Tian X-D Li FWang et al ldquoUp-regulation of the expres-sion of cocaine and amphetamine-regulated transcript peptideby electroacupuncture in the arcuate nucleus of diet-inducedobese ratsrdquoNeuroscience Letters vol 383 no 1-2 pp 17ndash21 2005

[32] J Su Z C Liu and M Zhao ldquoResearch on the effect of satietycenter in the reduction of weight by electropuncturerdquo ShanghaiJournal of Acupuncture and Moxibustion no 6 pp 30-31 1999(Chinese)

[33] Z C Liu F M Sun J Su et al ldquoStudy on action of acupunctureon ventromedial nucleus of hypothalamus in obese ratsrdquo Journalof Traditional Chinese Medicine no 3 pp 220ndash224 2001(Chinese)

[34] Z C Liu M F Sun Y Han et al ldquoEffect of acupuncture onlevel of monoamines and activity of adenosine triphosphatasein lateral hypothalamic area og obese ratsrdquo Chinese Journal ofIntegrated Traditional and Western Medicine no 7 pp 521ndash5232000 (Chinese)

[35] M Zhao et al ldquoEffect of acupuncture on feeding center ofhypothalamus in experimental fat ratsrdquo Chinese Acupuncture ampMoxibustion no 5 pp 49ndash51 2001 (Chinese)

[36] Z C Liu M F Sun M Zhao et al ldquoEffect of acupunctureon paraventricular nucleus of obese ratsrdquo Journal of TraditionalChinese Medicine no 7 pp 1031ndash1033 1059 2003 (Chinese)

[37] Z Sun Z C Zhang LMa and Z C Liu ldquoEffect of acupunctureon expression of hypothalamic neuropeptide Y gene in obeseratsrdquo Chinese Journal of Tissue Engineering Research no 15 pp135ndash138 2006 (Chinese)

[38] B Ji J Hu and S Ma ldquoEffects of electroacupuncture Zusanli(ST36) on food intake and expression of POMC and TRPV1through afferents-medulla pathway in obese prone ratsrdquo Pep-tides vol 40 pp 188ndash194 2013

[39] E-H Kim Y Kim M-H Jang et al ldquoAuricular acupuncturedecreases neuropeptide Y expression in the hypothalamus offood-deprived Sprague-Dawley ratsrdquo Neuroscience Letters vol307 no 2 pp 113ndash116 2001

[40] S-P Fu H Hong S-F Lu et al ldquoGenome-wide regulationof electro-acupuncture on the neural Stat5-loss-induced obesemicerdquo PLoS ONE vol 12 no 8 Article ID e0181948 2017

[41] J Xu L Chen L Tang et al ldquoElectroacupuncture inhibitsweight gain in diet-induced obese rats by activating hypotha-lamicLKB1-AMPK signalingrdquo BMC Complementary and Alter-native Medicine vol 15 no 1 article 147 2015

[42] T Shiraishi M Onoe T Kojima Y Sameshima and TKageyama ldquoEffects of auricular stimulation on feeding-relatedhypothalamic neuronal activity in normal and obese ratsrdquoBrainResearch Bulletin vol 36 no 2 pp 141ndash148 1995

[43] I Paspala N Katsiki D Kapoukranidou D P MikhailidisandA Tsiligiroglou-Fachantidou ldquoThe role of psychobiologicaland neuroendocrine mechanisms in appetite regulation andobesityrdquo The Open Cardiovascular Medicine Journal vol 6 no1 pp 147ndash155 2012


[44] N Tian F Wang D-R Tian et al ldquoElectroacupuncture sup-presses expression of gastric ghrelin and hypothalamic NPY inchronic food restricted ratsrdquo Peptides vol 27 no 9 pp 2313ndash2320 2006

[45] X Liu J-F He Y-T Qu et al ldquoElectroacupuncture ImprovesInsulinResistance byReducingNeuroproteinYAgouti-RelatedProtein Levels and Inhibiting Expression of Protein TyrosinePhosphatase 1B in Diet-induced Obese Ratsrdquo JAMS Journal ofAcupuncture andMeridian Studies vol 9 no 2 pp 58ndash64 2016

[46] F Liang R Chen A Nakagawa et al ldquoLow-frequency elec-troacupuncture improves insulin sensitivity in obese diabeticmice through activation of SIRT1PGC-1alpha in skeletal mus-clerdquo Evidence-Based Complementary and Alternative Medicinevol 2011 Article ID 735297 9 pages 2011

[47] MGong XWang ZMaoQ Shao X Xiang and B Xu ldquoEffectof electroacupuncture on leptin resistance in rats with diet-induced obesityrdquoAmerican Journal of Chinese Medicine vol 40no 3 pp 511ndash520 2012

[48] W Shen Y Wang S-F Lu et al ldquoAcupuncture promotes whiteadipose tissue browning by inducing UCP1 expression on DIOmicerdquo BMC Complementary and Alternative Medicine vol 14no 1 article 501 2014

[49] L P ZhouThe Acupuncture Regulate Mechanism of the Intesti-nal Flora of Obesity Patients Chengdu University of TCM 2011(Chinese)

[50] M Liang The Clinical Studies of Acupuncture Treatment onthe Effects of Gut Microbiota of Patients with Simple ObesityGuangxi University of TCM 2016 (Chinese)

[51] Y C Si W N Miao J Y He andW J Ding ldquoRegulation mech-anism of acupuncture method of invigorating spleen andreplenishing qi on the intestinal flora and TLR4 of obesity micebased on the lsquobrain-gut-bacteriarsquo axisrdquo Journal of TraditionalChinese Medicine no 10 pp 4457ndash4460 2017 (Chinese)

[52] J Yamamoto J Imai IzumiTH Takahashi Y Kawana K Taka-hashi et al ldquoNeuronal signals regulate obesity induced beta-cellproliferation by FoxM1 dependent mechanismrdquo Nature Com-munications vol 8 no 1 p 1930 2017

[53] M Tanaka M Itoh Y Ogawa and T Suganami ldquoMolecularmechanism of obesity-induced lsquometabolicrsquo tissue remodelingrdquoJournal of Diabetes Investigation vol 9 no 2 pp 256ndash261 2017

[54] M S Ellulu I Patimah H Khazarsquoai A Rahmat and Y AbedldquoObesity and inflammation the linking mechanism and thecomplicationsrdquo Archives of Medical Science vol 4 pp 851ndash8632017

[55] A Engin ldquoDiet-induced obesity and the mechanism of leptinresistancerdquoAdvances in ExperimentalMedicine and Biology vol960 pp 381ndash397 2017

[56] MW Schwartz R J Seeley L M Zeltser et al ldquoObesity Patho-genesis An Endocrine Society Scientific Statementrdquo EndocrineReviews vol 38 no 4 pp 267ndash296 2017

[57] K E Bouter D H van Raalte A K Groen andM NieuwdorpldquoRole of theGutMicrobiome in the Pathogenesis of Obesity andObesity-RelatedMetabolic DysfunctionrdquoGastroenterology vol152 no 7 pp 1671ndash1678 2017

[58] Q Yu ldquoChoice of blindness and placebo evaluating the efficacyof acupuncturerdquo Chinese Journal of Integrative Medicine on Car-dioCerebrovascular Disease no 4 pp 196ndash198 2003 (Chinese)

[59] P Sun Y H Du J Xiong et al ldquoAssessment of the reportingquality of randomized controlled trials on acupuncture forsimple obesity with CONSORT statement and STRICTArdquo Lish-izhen Medicine and Materia Medica Research no 4 pp 943ndash945 2010 (Chinese)

Stem Cells International

Hindawiwwwhindawicom Volume 2018


MEDIATORSINFLAMMATION

of

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

Hindawi Publishing Corporation httpwwwhindawicom Volume 2013Hindawiwwwhindawicom

The Scientific World Journal

Volume 2018

Immunology ResearchHindawiwwwhindawicom Volume 2018

Journal of

ObesityJournal of



Computational and Mathematical Methods in Medicine


Behavioural Neurology

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinsonrsquos Disease

Evidence-Based Complementary andAlternative Medicine

Volume 2018Hindawiwwwhindawicom

Submit your manuscripts atwwwhindawicom


Numerous people cannot manage the weight onlythrough dietary change and increasing physical activityAlthough pharmaceutical treatments for obesity such asFenfluramine and Sibutramine are effective there exist var-ious limits due to security reasons [3ndash6] As an alternativeintervention for obesity acupuncture is relatively easy cheapand safe and has been widely used in clinical practice [5ndash8] in both China and other countries Although efficacy ofthe acupuncture therapy has been reported the underlyingmechanisms have not been completely illustrated Thereforewe conducted a systematic review and meta-analysis toevaluate the effectiveness of acupuncture in obesity and alsosummarized the present studies on exploring mechanismsunder acupuncture treatment in obesity animals

2 Methods

21 Search Strategy To identify studies of acupunctureon obesity retrievals were implemented in three Englishdatabases (PubMed EMBASE and Cochrane Library) andthree Chinese databases (VIP information database Chi-nese National Knowledge Infrastructure and Wanfang DataInformation Site) from the inception to April 2017 Thesearch strategies were (weight loss OR overweight OR obesityOR weight control OR simple obesity OR weight reductionOR weight increase OR weight decrease OR weight watchOR overeat OR overfeed OR slim) AND (acupuncture andmoxibustion OR acupuncture OR embedding therapy ORacupoint catgut embedding OR electro-acupuncture OR EAOR auricula-acupuncture OR ear seed pressure OR auricularplaster OR auricular acupuncture OR auricular acupressureOR fire needle OR moxibustion OR herbal acupuncture ORdermal needle OR aqua acupuncture OR body acupunctureOR meridians OR abdominal acupuncture) AND (clinicaltrial OR clinical study OR efficacy OR effectiveness) AND(random OR random$) Conference proceedings disser-tations and reference lists of retrieved articles were alsosearched manually for additional relevant studies

22 Inclusion and Exclusion Criteria

221 Types of Studies Published randomized controlledtrials (RCTs) compared acupuncture with control (no treat-ment placebo acupuncture western medicine diet or exer-cise etc) and assessed the efficacy of acupuncture on obesityand overweight We excluded quasi-randomized studiessuch as those allocated by using alternate days of weekNo restriction was imposed on blinding Comments casereports technical reports animal studies self-control studiesor non-RCTs were excluded No language restriction wasmade for selecting the studies

222 Types of Participants We included participants withno limitation of age and gender All appropriate definitionsof overweight or obesity including BMI body weight orpercentage of weight excess compared with ideal weight wereaccepted A diagnosis of simple obesity patients was includedThe secondary obesity which was complicated with hypo-thalamus disease anterior hypopituitarism hypothyroidism

hypercriticism hypogonadotropic hypogonadism pregnan-cy lactation polycystic ovarian syndrome (PCOS) men-strual disorder amenorrhea or other serious medical condi-tions was excluded

223 Types of Intervention We recruited trials with variousacupuncture therapies The acupuncture therapy includedclassical acupuncture electroacupuncture (EA) laseracupuncture catgut embedding auricular acupressure andauricular acupuncture which could be analyzed in subgroupStudies that combined acupuncture with other therapiessuch as medication moxibustion or message were excludedthe studies with lifestyle intervention such as diet andexercise in treatment group were also included Based on thedifferent acupuncture therapies we performed the subgroupanalysis The control inventions were divided into four typessham acupuncture ((1) needle inserting into skin but notpenetrating the exact acupoints (2) needle inserted into anarea where it is near the exact acupoints) no treatment dietand exercise therapy medicine

224 Types of Outcome Measures The primary outcomesconsisted of BMI body weight reduction and the incidenceof CVD Secondary outcomes included WC WHR body fatmass percent body fat mass (kg) serum cholesterol (TC)triglyceride (TG) glucose low density lipoprotein choles-terol (LDL-c) reduction high density lipoprotein cholesterol(HDL-c) increase and adverse effects

23 Study Selection Data Extraction Management and Anal-ysis According to the prespecified inclusion and exclusioncriteria two authors (Kepei Zhang and Chunyan Wang)separately identified the eligible studies by reading the titleabstract and full text of every paper and then extracted thedata A discussion with the other authors was conducted tosolve any discrepancies

The following information was abstracted from all in-cluded publications year country number of includedpatients interventions of treatment and control groups basictreatment duration of treatment adverse reactions andoutcomes Authors of studies were contacted for clarificationwhen necessary

The quality of RCTs was assessed by the Cochrane Risk ofBias Tool including seven domains generation of a randomsequence allocation concealment blinding of participantsand personnel blinding of outcome assessment complete-ness of outcome data selectiveness of reporting and otherbiases A score of 1 or 0 was given for each item dependingon the information provided by study (1 low risk of bias theinformation of the domain was adequate in the text 0 highrisk of bias the information of the domain was inadequate inthe text)The studies with the cumulative score of at 3 ormorewere included in our study

Cochrane Review Manager (RevMan 53) software wasused for statistical analysis Binary data were reported asrisk ration (RR) and continuous data were reported asmean difference (MD) when the outcomes were measuredin the same way among different trials For trials reportingthe same outcome measures but used different methods



(n = 3241)Sc

reen

ing

Incl

uded

Elig

ibili

tyId

entifi

catio


(n = 20)








for obesity(n=97)


(n = 150)







RCTs(n=145)


(n = 21)






3 Results




Table1Ch

aracteris

ticso

fthe

inclu

dedstu

dies

Incl

uded

stud

ies

Cou

ntry

Num

bero

fpa

rtic

ipan

tsTr

ialC

ontr

olIn

terv

entio

nsTr

ialC

ontr

olBa

sictr

eatm

ent

Dur

atio

nof

trea

tmen

t(w

eek)

Advers

ere

actio

nsO

utco

mes

Dar

band

iet

al

2012

[9]

Iran

4343

Auric

ular

acup

ressure

Sham

auric

ular

Low-calorie

diet

6Non

eBW

BMIBF

Mplasm

aleptin

Dar

band

iet

al

2013

[10]

Iran

4244

Electro

-acupu

ncture

Sham

acup

uncture

Low-calorie

diet

6Non

eBM

BMIBF

Mplasm

aleptin

Dar

band

iet

al

2014

[11]

Iran

2020

2020

Body

electro

-acupu

ncture

Auric

ular

acup

uncture

Sham

body

electro

-acupu

ncture

sham

Auric

ular

acup

uncture

Low-calorie

diet

6Non

eHeightWHR

BMItrun

kfat

massCrA

lbum

inU

ricacid

FBSHLD

-cLDL-cWBC

RBC

Guc

elet

al

2012

[12]

Turkey

2020

Body

acup

uncture

Sham

acup

uncture

Non

e5

Not

repo

rted

WeightBM

Iinsulin

leptin

gh

relin

cho

lecysto

kinin

Han

-12

016

[13]

China

3637

Body

electro

-acupu

ncture

Notre

atment

Dietary

and

exercise

4

2Subcuta-

neou

sbleeding

and

hematom

a

BMIWC

hipcircum

ference

WHRandspleen

dampn

ess

improvethe

situatio

nof

symptom

score

Han

-22

016

[13]

China

4041

Body

electro

-acupu

ncture

Notre

atment

Dietary

and

exercise

4

3Subcuta-

neou

sbleeding

and

hematom

a

BMIWC

hipcircum

ference

WHRandspleen

dampn

ess

improvethe

situatio

nof

symptom

score

He

etal

20

08[1

4]Ch

ina

4040

Body

electro

-acupu

ncture

+Au

ricular

acup

uncture

Sibu

tram

ine

Non

e8

Norepo

rted

Body

weightBM

Iwaistandhip

circum

ferencea

ndWHR

Hsu

etal

20

09[1

5]Taiwan

2322

Auric

ular

acup

uncture

Sham

eauricular

acup

uncture

Non

e6

1Minor

inflamma-

tion

8mild

tend

erness

Body

weightBM

IWC

obesity

-related

horm

one

peptides

Hun

get

al

2016

[16]

Taiwan

3230

Verum

laser

acup

uncture

Sham

laser

acup

uncture

Non

e3

Non

eBM

IBF

Pwaist-

to-buttock

ratio

Kim

etal

20

14[1

7]Ko

rea

2524

Auric

ular

acup

ressure

Notre

atment

Non

e4

Non

eWeightBM

Ibo

dyfatm

ass

percentageW

HR

Lien

etal

20

12[1

8]Taiwan

4823

Auric

ular

stimulation

Sham

auric

ular

acup

uncture

Non

e8

1dizziness

BMIweightob

esity

-related

horm

onep

eptid

slifeq

uality

scores


Table1Con

tinued

Incl

uded

stud

ies

Cou

ntry

Num

bero

fpa

rtic

ipan

tsTr

ialC

ontr

olIn

terv

entio

nsTr

ialC

ontr

olBa

sictr

eatm

ent

Dur

atio

nof

trea

tmen

t(w

eek)

Advers

ere

actio

nsO

utco

mes

Luo

2006

[19]

China

4020

Electro

-acupu

ncture

on

lyacup

uncture

Notre

atment

Non

e3

Not

repo

rted

WHR

MBIT

CTG

HDL-c

LDL-cLE

PAd

ipon

ectin

(ADI)

Nou

rsha

hiet

al

2009

[20]

Iran

99

Acup

uncture

Notre

atmentd

ietand

exercise

Dietand

exercise

8Not

repo

rted

Body

weightskin

fold

thickn

ess

BMIfatm

ass

Tong

201

1[21

]Ch

ina

7642

Acup

uncture

Placebo-acup

uncture

Diet

5Non

eBM

ITC

TGG

lucoseB

UN

Uric

Acid

andadverser

eactions

Xing

2009

[22]

China

3130

Electro

acup

uncture

Dietand

exercise

Dietand

exercise

8Norepo

rted

Body

weightBM

ITG

TC

LDL-cHDL-cWHR

Leptin

Xio

nget

al

2016

[23]

China

2921

Acup

uncture

Exercise

Non

e4

Norepo

rted

Body

weightBM

I

Yeh

etal

20

15[2

4]Taiwan

3634

Auric

ular

electric

alstim

ulation

+auricular

acup

ressure

Samem

annerb

utat

sham

acup

oints

Diet

10Norepo

rted

BMIbloo

dpressureT

CTG

LeptinA

dipo

nectin

Yeo

etal

20

14[2

5]Ko

rean

4315

Eara

cupu

ncture

Sham

acup

uncture

Non

e8

Norepo

rted

BMIWC

weightbo

dyfatm

ass

(kg)percentageb

odyfatand

bloo

dpressure

Zhan

get

al

2012

[26]

China

1515

Electro

-acupu

ncture

Sham

Electro

-acupu

ncture

Non

e4

1Bleeding

WeightBM

Ibo

dyfatm

ass

Zhan

g20

12[2

7]Ch

ina

2928

Catgut

embedd

edNotre

atment

Dietand

exercise

8

Theb

leeding

ratewas

1875

intre

atment

grou

p

WeightBM

Iwaistlin

ehipline

circum

ferencequ

ality

oflife

Zhao

etal

20

11[2

8]Ch

ina

3535

Electro

-acupu

ncture

Sham

Electro

-acupu

ncture

Non

e4

Norepo

rted

BMIWeight

Zhao

201

0[2

9]Ch

ina

3030

Electro

-acupu

ncture

Dietand

exercise

Dietand

exercise

8Norepo

rted

BMIwaist

FBS2hPG

FIN

S2hFINS



32 Effectiveness






(a)

(b)

(c)

Figure 2 Continued


(d)

(e)

(f)

(g)

Figure 2 Continued


(h)

(i)

(j)

(k)

Figure 2 Continued


(l)

(m)















PeFPVNLHAVMHARH


Hypothalamus

Adipose Tissue

INS

LP






4 Discussion















Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of





















(n = 3241)Sc

reen

ing

Incl

uded

Elig

ibili

tyId

entifi

catio


(n = 20)








for obesity(n=97)


(n = 150)







RCTs(n=145)


(n = 21)






3 Results




Table1Ch

aracteris

ticso

fthe

inclu

dedstu

dies

Incl

uded

stud

ies

Cou

ntry

Num

bero

fpa

rtic

ipan

tsTr

ialC

ontr

olIn

terv

entio

nsTr

ialC

ontr

olBa

sictr

eatm

ent

Dur

atio

nof

trea

tmen

t(w

eek)

Advers

ere

actio

nsO

utco

mes

Dar

band

iet

al

2012

[9]

Iran

4343

Auric

ular

acup

ressure

Sham

auric

ular

Low-calorie

diet

6Non

eBW

BMIBF

Mplasm

aleptin

Dar

band

iet

al

2013

[10]

Iran

4244

Electro

-acupu

ncture

Sham

acup

uncture

Low-calorie

diet

6Non

eBM

BMIBF

Mplasm

aleptin

Dar

band

iet

al

2014

[11]

Iran

2020

2020

Body

electro

-acupu

ncture

Auric

ular

acup

uncture

Sham

body

electro

-acupu

ncture

sham

Auric

ular

acup

uncture

Low-calorie

diet

6Non

eHeightWHR

BMItrun

kfat

massCrA

lbum

inU

ricacid

FBSHLD

-cLDL-cWBC

RBC

Guc

elet

al

2012

[12]

Turkey

2020

Body

acup

uncture

Sham

acup

uncture

Non

e5

Not

repo

rted

WeightBM

Iinsulin

leptin

gh

relin

cho

lecysto

kinin

Han

-12

016

[13]

China

3637

Body

electro

-acupu

ncture

Notre

atment

Dietary

and

exercise

4

2Subcuta-

neou

sbleeding

and

hematom

a

BMIWC

hipcircum

ference

WHRandspleen

dampn

ess

improvethe

situatio

nof

symptom

score

Han

-22

016

[13]

China

4041

Body

electro

-acupu

ncture

Notre

atment

Dietary

and

exercise

4

3Subcuta-

neou

sbleeding

and

hematom

a

BMIWC

hipcircum

ference

WHRandspleen

dampn

ess

improvethe

situatio

nof

symptom

score

He

etal

20

08[1

4]Ch

ina

4040

Body

electro

-acupu

ncture

+Au

ricular

acup

uncture

Sibu

tram

ine

Non

e8

Norepo

rted

Body

weightBM

Iwaistandhip

circum

ferencea

ndWHR

Hsu

etal

20

09[1

5]Taiwan

2322

Auric

ular

acup

uncture

Sham

eauricular

acup

uncture

Non

e6

1Minor

inflamma-

tion

8mild

tend

erness

Body

weightBM

IWC

obesity

-related

horm

one

peptides

Hun

get

al

2016

[16]

Taiwan

3230

Verum

laser

acup

uncture

Sham

laser

acup

uncture

Non

e3

Non

eBM

IBF

Pwaist-

to-buttock

ratio

Kim

etal

20

14[1

7]Ko

rea

2524

Auric

ular

acup

ressure

Notre

atment

Non

e4

Non

eWeightBM

Ibo

dyfatm

ass

percentageW

HR

Lien

etal

20

12[1

8]Taiwan

4823

Auric

ular

stimulation

Sham

auric

ular

acup

uncture

Non

e8

1dizziness

BMIweightob

esity

-related

horm

onep

eptid

slifeq

uality

scores


Table1Con

tinued

Incl

uded

stud

ies

Cou

ntry

Num

bero

fpa

rtic

ipan

tsTr

ialC

ontr

olIn

terv

entio

nsTr

ialC

ontr

olBa

sictr

eatm

ent

Dur

atio

nof

trea

tmen

t(w

eek)

Advers

ere

actio

nsO

utco

mes

Luo

2006

[19]

China

4020

Electro

-acupu

ncture

on

lyacup

uncture

Notre

atment

Non

e3

Not

repo

rted

WHR

MBIT

CTG

HDL-c

LDL-cLE

PAd

ipon

ectin

(ADI)

Nou

rsha

hiet

al

2009

[20]

Iran

99

Acup

uncture

Notre

atmentd

ietand

exercise

Dietand

exercise

8Not

repo

rted

Body

weightskin

fold

thickn

ess

BMIfatm

ass

Tong

201

1[21

]Ch

ina

7642

Acup

uncture

Placebo-acup

uncture

Diet

5Non

eBM

ITC

TGG

lucoseB

UN

Uric

Acid

andadverser

eactions

Xing

2009

[22]

China

3130

Electro

acup

uncture

Dietand

exercise

Dietand

exercise

8Norepo

rted

Body

weightBM

ITG

TC

LDL-cHDL-cWHR

Leptin

Xio

nget

al

2016

[23]

China

2921

Acup

uncture

Exercise

Non

e4

Norepo

rted

Body

weightBM

I

Yeh

etal

20

15[2

4]Taiwan

3634

Auric

ular

electric

alstim

ulation

+auricular

acup

ressure

Samem

annerb

utat

sham

acup

oints

Diet

10Norepo

rted

BMIbloo

dpressureT

CTG

LeptinA

dipo

nectin

Yeo

etal

20

14[2

5]Ko

rean

4315

Eara

cupu

ncture

Sham

acup

uncture

Non

e8

Norepo

rted

BMIWC

weightbo

dyfatm

ass

(kg)percentageb

odyfatand

bloo

dpressure

Zhan

get

al

2012

[26]

China

1515

Electro

-acupu

ncture

Sham

Electro

-acupu

ncture

Non

e4

1Bleeding

WeightBM

Ibo

dyfatm

ass

Zhan

g20

12[2

7]Ch

ina

2928

Catgut

embedd

edNotre

atment

Dietand

exercise

8

Theb

leeding

ratewas

1875

intre

atment

grou

p

WeightBM

Iwaistlin

ehipline

circum

ferencequ

ality

oflife

Zhao

etal

20

11[2

8]Ch

ina

3535

Electro

-acupu

ncture

Sham

Electro

-acupu

ncture

Non

e4

Norepo

rted

BMIWeight

Zhao

201

0[2

9]Ch

ina

3030

Electro

-acupu

ncture

Dietand

exercise

Dietand

exercise

8Norepo

rted

BMIwaist

FBS2hPG

FIN

S2hFINS



32 Effectiveness






(a)

(b)

(c)

Figure 2 Continued


(d)

(e)

(f)

(g)

Figure 2 Continued


(h)

(i)

(j)

(k)

Figure 2 Continued


(l)

(m)















PeFPVNLHAVMHARH


Hypothalamus

Adipose Tissue

INS

LP






4 Discussion















Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of




















Table1Ch

aracteris

ticso

fthe

inclu

dedstu

dies

Incl

uded

stud

ies

Cou

ntry

Num

bero

fpa

rtic

ipan

tsTr

ialC

ontr

olIn

terv

entio

nsTr

ialC

ontr

olBa

sictr

eatm

ent

Dur

atio

nof

trea

tmen

t(w

eek)

Advers

ere

actio

nsO

utco

mes

Dar

band

iet

al

2012

[9]

Iran

4343

Auric

ular

acup

ressure

Sham

auric

ular

Low-calorie

diet

6Non

eBW

BMIBF

Mplasm

aleptin

Dar

band

iet

al

2013

[10]

Iran

4244

Electro

-acupu

ncture

Sham

acup

uncture

Low-calorie

diet

6Non

eBM

BMIBF

Mplasm

aleptin

Dar

band

iet

al

2014

[11]

Iran

2020

2020

Body

electro

-acupu

ncture

Auric

ular

acup

uncture

Sham

body

electro

-acupu

ncture

sham

Auric

ular

acup

uncture

Low-calorie

diet

6Non

eHeightWHR

BMItrun

kfat

massCrA

lbum

inU

ricacid

FBSHLD

-cLDL-cWBC

RBC

Guc

elet

al

2012

[12]

Turkey

2020

Body

acup

uncture

Sham

acup

uncture

Non

e5

Not

repo

rted

WeightBM

Iinsulin

leptin

gh

relin

cho

lecysto

kinin

Han

-12

016

[13]

China

3637

Body

electro

-acupu

ncture

Notre

atment

Dietary

and

exercise

4

2Subcuta-

neou

sbleeding

and

hematom

a

BMIWC

hipcircum

ference

WHRandspleen

dampn

ess

improvethe

situatio

nof

symptom

score

Han

-22

016

[13]

China

4041

Body

electro

-acupu

ncture

Notre

atment

Dietary

and

exercise

4

3Subcuta-

neou

sbleeding

and

hematom

a

BMIWC

hipcircum

ference

WHRandspleen

dampn

ess

improvethe

situatio

nof

symptom

score

He

etal

20

08[1

4]Ch

ina

4040

Body

electro

-acupu

ncture

+Au

ricular

acup

uncture

Sibu

tram

ine

Non

e8

Norepo

rted

Body

weightBM

Iwaistandhip

circum

ferencea

ndWHR

Hsu

etal

20

09[1

5]Taiwan

2322

Auric

ular

acup

uncture

Sham

eauricular

acup

uncture

Non

e6

1Minor

inflamma-

tion

8mild

tend

erness

Body

weightBM

IWC

obesity

-related

horm

one

peptides

Hun

get

al

2016

[16]

Taiwan

3230

Verum

laser

acup

uncture

Sham

laser

acup

uncture

Non

e3

Non

eBM

IBF

Pwaist-

to-buttock

ratio

Kim

etal

20

14[1

7]Ko

rea

2524

Auric

ular

acup

ressure

Notre

atment

Non

e4

Non

eWeightBM

Ibo

dyfatm

ass

percentageW

HR

Lien

etal

20

12[1

8]Taiwan

4823

Auric

ular

stimulation

Sham

auric

ular

acup

uncture

Non

e8

1dizziness

BMIweightob

esity

-related

horm

onep

eptid

slifeq

uality

scores


Table1Con

tinued

Incl

uded

stud

ies

Cou

ntry

Num

bero

fpa

rtic

ipan

tsTr

ialC

ontr

olIn

terv

entio

nsTr

ialC

ontr

olBa

sictr

eatm

ent

Dur

atio

nof

trea

tmen

t(w

eek)

Advers

ere

actio

nsO

utco

mes

Luo

2006

[19]

China

4020

Electro

-acupu

ncture

on

lyacup

uncture

Notre

atment

Non

e3

Not

repo

rted

WHR

MBIT

CTG

HDL-c

LDL-cLE

PAd

ipon

ectin

(ADI)

Nou

rsha

hiet

al

2009

[20]

Iran

99

Acup

uncture

Notre

atmentd

ietand

exercise

Dietand

exercise

8Not

repo

rted

Body

weightskin

fold

thickn

ess

BMIfatm

ass

Tong

201

1[21

]Ch

ina

7642

Acup

uncture

Placebo-acup

uncture

Diet

5Non

eBM

ITC

TGG

lucoseB

UN

Uric

Acid

andadverser

eactions

Xing

2009

[22]

China

3130

Electro

acup

uncture

Dietand

exercise

Dietand

exercise

8Norepo

rted

Body

weightBM

ITG

TC

LDL-cHDL-cWHR

Leptin

Xio

nget

al

2016

[23]

China

2921

Acup

uncture

Exercise

Non

e4

Norepo

rted

Body

weightBM

I

Yeh

etal

20

15[2

4]Taiwan

3634

Auric

ular

electric

alstim

ulation

+auricular

acup

ressure

Samem

annerb

utat

sham

acup

oints

Diet

10Norepo

rted

BMIbloo

dpressureT

CTG

LeptinA

dipo

nectin

Yeo

etal

20

14[2

5]Ko

rean

4315

Eara

cupu

ncture

Sham

acup

uncture

Non

e8

Norepo

rted

BMIWC

weightbo

dyfatm

ass

(kg)percentageb

odyfatand

bloo

dpressure

Zhan

get

al

2012

[26]

China

1515

Electro

-acupu

ncture

Sham

Electro

-acupu

ncture

Non

e4

1Bleeding

WeightBM

Ibo

dyfatm

ass

Zhan

g20

12[2

7]Ch

ina

2928

Catgut

embedd

edNotre

atment

Dietand

exercise

8

Theb

leeding

ratewas

1875

intre

atment

grou

p

WeightBM

Iwaistlin

ehipline

circum

ferencequ

ality

oflife

Zhao

etal

20

11[2

8]Ch

ina

3535

Electro

-acupu

ncture

Sham

Electro

-acupu

ncture

Non

e4

Norepo

rted

BMIWeight

Zhao

201

0[2

9]Ch

ina

3030

Electro

-acupu

ncture

Dietand

exercise

Dietand

exercise

8Norepo

rted

BMIwaist

FBS2hPG

FIN

S2hFINS



32 Effectiveness






(a)

(b)

(c)

Figure 2 Continued


(d)

(e)

(f)

(g)

Figure 2 Continued


(h)

(i)

(j)

(k)

Figure 2 Continued


(l)

(m)















PeFPVNLHAVMHARH


Hypothalamus

Adipose Tissue

INS

LP






4 Discussion















Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of




















Table1Con

tinued

Incl

uded

stud

ies

Cou

ntry

Num

bero

fpa

rtic

ipan

tsTr

ialC

ontr

olIn

terv

entio

nsTr

ialC

ontr

olBa

sictr

eatm

ent

Dur

atio

nof

trea

tmen

t(w

eek)

Advers

ere

actio

nsO

utco

mes

Luo

2006

[19]

China

4020

Electro

-acupu

ncture

on

lyacup

uncture

Notre

atment

Non

e3

Not

repo

rted

WHR

MBIT

CTG

HDL-c

LDL-cLE

PAd

ipon

ectin

(ADI)

Nou

rsha

hiet

al

2009

[20]

Iran

99

Acup

uncture

Notre

atmentd

ietand

exercise

Dietand

exercise

8Not

repo

rted

Body

weightskin

fold

thickn

ess

BMIfatm

ass

Tong

201

1[21

]Ch

ina

7642

Acup

uncture

Placebo-acup

uncture

Diet

5Non

eBM

ITC

TGG

lucoseB

UN

Uric

Acid

andadverser

eactions

Xing

2009

[22]

China

3130

Electro

acup

uncture

Dietand

exercise

Dietand

exercise

8Norepo

rted

Body

weightBM

ITG

TC

LDL-cHDL-cWHR

Leptin

Xio

nget

al

2016

[23]

China

2921

Acup

uncture

Exercise

Non

e4

Norepo

rted

Body

weightBM

I

Yeh

etal

20

15[2

4]Taiwan

3634

Auric

ular

electric

alstim

ulation

+auricular

acup

ressure

Samem

annerb

utat

sham

acup

oints

Diet

10Norepo

rted

BMIbloo

dpressureT

CTG

LeptinA

dipo

nectin

Yeo

etal

20

14[2

5]Ko

rean

4315

Eara

cupu

ncture

Sham

acup

uncture

Non

e8

Norepo

rted

BMIWC

weightbo

dyfatm

ass

(kg)percentageb

odyfatand

bloo

dpressure

Zhan

get

al

2012

[26]

China

1515

Electro

-acupu

ncture

Sham

Electro

-acupu

ncture

Non

e4

1Bleeding

WeightBM

Ibo

dyfatm

ass

Zhan

g20

12[2

7]Ch

ina

2928

Catgut

embedd

edNotre

atment

Dietand

exercise

8

Theb

leeding

ratewas

1875

intre

atment

grou

p

WeightBM

Iwaistlin

ehipline

circum

ferencequ

ality

oflife

Zhao

etal

20

11[2

8]Ch

ina

3535

Electro

-acupu

ncture

Sham

Electro

-acupu

ncture

Non

e4

Norepo

rted

BMIWeight

Zhao

201

0[2

9]Ch

ina

3030

Electro

-acupu

ncture

Dietand

exercise

Dietand

exercise

8Norepo

rted

BMIwaist

FBS2hPG

FIN

S2hFINS



32 Effectiveness






(a)

(b)

(c)

Figure 2 Continued


(d)

(e)

(f)

(g)

Figure 2 Continued


(h)

(i)

(j)

(k)

Figure 2 Continued


(l)

(m)















PeFPVNLHAVMHARH


Hypothalamus

Adipose Tissue

INS

LP






4 Discussion















Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of





















32 Effectiveness






(a)

(b)

(c)

Figure 2 Continued


(d)

(e)

(f)

(g)

Figure 2 Continued


(h)

(i)

(j)

(k)

Figure 2 Continued


(l)

(m)















PeFPVNLHAVMHARH


Hypothalamus

Adipose Tissue

INS

LP






4 Discussion















Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of




















(a)

(b)

(c)

Figure 2 Continued


(d)

(e)

(f)

(g)

Figure 2 Continued


(h)

(i)

(j)

(k)

Figure 2 Continued


(l)

(m)















PeFPVNLHAVMHARH


Hypothalamus

Adipose Tissue

INS

LP






4 Discussion















Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of




















(d)

(e)

(f)

(g)

Figure 2 Continued


(h)

(i)

(j)

(k)

Figure 2 Continued


(l)

(m)















PeFPVNLHAVMHARH


Hypothalamus

Adipose Tissue

INS

LP






4 Discussion















Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of




















(h)

(i)

(j)

(k)

Figure 2 Continued


(l)

(m)















PeFPVNLHAVMHARH


Hypothalamus

Adipose Tissue

INS

LP






4 Discussion















Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of




















(l)

(m)















PeFPVNLHAVMHARH


Hypothalamus

Adipose Tissue

INS

LP






4 Discussion















Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of




























PeFPVNLHAVMHARH


Hypothalamus

Adipose Tissue

INS

LP






4 Discussion















Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of




















PeFPVNLHAVMHARH


Hypothalamus

Adipose Tissue

INS

LP






4 Discussion















Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of
































Acknowledgments


References




































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of











































































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of








































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of























of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of



















Documents

Acupuncture on Obesity: Clinical Evidence and Possible ...downloads.hindawi.com/journals/ecam/2018/6409389.pdf · Acupuncture on Obesity: Clinical Evidence and ... Numerous people