Modified acupuncture therapy, long-term acupoint stimulation versus sham control for weight control: a multicenter, randomized controlled trial

Liang Dai, Miao Wang, Ke-Pei Zhang, Lin Wang, Hui-Min Zheng, Chun-Bo Li, Wen-Jun Zhou, Shi-Gao Zhou, Guang Ji, Liang Dai, Miao Wang, Ke-Pei Zhang, Lin Wang, Hui-Min Zheng, Chun-Bo Li, Wen-Jun Zhou, Shi-Gao Zhou, Guang Ji

Abstract

Objective: Long-term acupoint stimulation (LAS), also called embedding acupuncture, is a modified acupuncture technique. The preliminary results have demonstrated its efficacy in body-weight control. However, the low quality of available trials limited its application. This study aimed to evaluate the efficacy and safety of LAS in body-weight control by using a randomized, parallel, sham-controlled clinical trial design.

Methods: This was a randomized, single-blind, sham-controlled clinical trial including 84 adult participants (18-60 years) with a body mass index (BMI) of ≥ 24 kg/m2 conducted in three general hospitals in Shanghai, China. Participants were equally assigned to receive LAS or sham LAS (SLAS) once per 10 days, eight times in total. After completion, an additional intervention with a 3-month follow-up period was set to examine the continued effect of LAS. The primary outcome was the change in body weight from baseline to treatment endpoint within the intention-to-treat (ITT) analysis. Secondary outcomes contained changes in waist-to-hip ratio (WHR), lipid metabolism, and visceral and subcutaneous adipose tissues.

Results: From 14 May 2018 to 03 November 2019, 84 participants out of 201 screened individuals met the eligibility criteria, were randomized, and were analyzed (42 participants in each group). From baseline to treatment endpoint, the body-weight reduction in the LAS group was significantly larger than in the sham control (net difference: 1.57 kg, 95% CI: 0.29-2.86, p = 0.012). The superior weight reduction effect persisted in the follow-up period (net difference: 3.20 kg, 95% CI: 1.17-5.21, p = 0.001). LAS therapy also showed improvement in triglyceride and subcutaneous adipose tissue (SAT) compared with sham control. One participant in the LAS group reported a slightly uncomfortable and tingling sensation after the additional intervention. No other adverse events (AEs) were documented.

Conclusion: LAS, a modified acupuncture technique, is safe and effective in body-weight control. It could be used as an alternative choice to classical acupuncture for obesity management.

Clinical trial registration: [www.chictr.org.cn], identifier [ChiCTR1800015498].

Keywords: acupuncture; long-term acupoint stimulation; randomized controlled trial; subcutaneous adipose tissue; visceral adipose tissue; weight control.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Dai, Wang, Zhang, Wang, Zheng, Li, Zhou, Zhou and Ji.

Figures

Figure 1
Figure 1
Participants’ flowchart.
Figure 2
Figure 2
Change of body weight from baseline to 180 days follow-up.

References

    1. Tian Y, Jiang C, Wang M, Cai R, Zhang Y, He Z, et al. . Bmi, leisure-time physical activity, and physical fitness in adults in China: Results from a series of national surveys, 2000-14. Lancet Diabetes Endocrinol (2016) 4(6):487–97. doi: 10.1016/s2213-8587(16)00081-4
    1. NCD Risk Factor Collaboration . Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet (2016) 387(10026):1377–96. doi: 10.1016/s0140-6736(16)30054-x
    1. Li L, Liu DW, Yan HY, Wang ZY, Zhao SH, Wang B. Obesity is an independent risk factor for non-alcoholic fatty liver disease: Evidence from a meta-analysis of 21 cohort studies. Obes Rev (2016) 17(6):510–9. doi: 10.1111/obr.12407
    1. Mandviwala T, Khalid U, Deswal A. Obesity and cardiovascular disease: A risk factor or a risk marker? Curr Atheroscler Rep (2016) 18(5):21. doi: 10.1007/s11883-016-0575-4
    1. Nunez C, Bauman A, Egger S, Sitas F, Nair-Shalliker V. Obesity, physical activity and cancer risks: Results from the cancer, lifestyle and evaluation of risk study (Clear). Cancer Epidemiol (2017) 47:56–63. doi: 10.1016/j.canep.2017.01.002
    1. Durrer Schutz D, Busetto L, Dicker D, Farpour-Lambert N, Pryke R, Toplak H, et al. . European Practical and patient-centred guidelines for adult obesity management in primary care. Obes Facts (2019) 12(1):40–66. doi: 10.1159/000496183
    1. Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. . American Association of clinical endocrinologists and American college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract (2016) 22 Suppl 3:1–203. doi: 10.4158/
    1. Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, et al. . The science of obesity management: An endocrine society scientific statement. Endocr Rev (2018) 39(2):79–132. doi: 10.1210/er.2017-00253
    1. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, et al. . Association of pharmacological treatments for obesity with weight loss and adverse events: A systematic review and meta-analysis. JAMA (2016) 315(22):2424–34. doi: 10.1001/jama.2016.7602
    1. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: A systematic and clinical review. JAMA (2014) 311(1):74–86. doi: 10.1001/jama.2013.281361
    1. LeBlanc EL, Patnode CD, Webber EM, Redmond N, Rushkin M, O’Connor EA, et al. . Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: An updated systematic review for the us preventive services task force. Rockville (MD: Agency for Healthcare Research and Quality (US; (2018).
    1. Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: State of the art. Nat Rev Gastroenterol Hepatol (2017) 14(3):160–9. doi: 10.1038/nrgastro.2016.170
    1. Fang S, Wang M, Zheng Y, Zhou S, Ji G. Acupuncture and lifestyle modification treatment for obesity: A meta-analysis. Am J Chin Med (2017) 45(2):239–54. doi: 10.1142/s0192415x1750015x
    1. Zhang RQ, Tan J, Li FY, Ma YH, Han LX, Yang XL. Acupuncture for the treatment of obesity in adults: A systematic review and meta-analysis. Postgrad Med J (2017) 93(1106):743–51. doi: 10.1136/postgradmedj-2017-134969
    1. Huo J, Zhao J, Yuan Y, Wang J. [Research status of the effect mechanism on catgut-point embedding therapy]. Zhongguo Zhen Jiu (2017) 37(11):1251–4. doi: 10.13703/j.0255-2930.2017.11.031
    1. Huang CY, Choong MY, Li TS. Treatment of obesity by catgut embedding: An evidence-based systematic analysis. Acupunct Med (2012) 30(3):233–4. doi: 10.1136/acupmed-2012-010176
    1. Sheng J, Jin X, Zhu J, Chen Y, Liu X. The effectiveness of acupoint catgut embedding therapy for abdominal obesity: A systematic review and meta-analysis. Evid Based Complement Alternat Med (2019) 2019:9714313. doi: 10.1155/2019/9714313
    1. MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, et al. . Revised standards for reporting interventions in clinical trials of acupuncture (Stricta): Extending the consort statement. PLoS Med (2010) 7(6):e1000261. doi: 10.1371/journal.pmed.1000261
    1. Schulz KF, Altman DG, Moher D. Consort 2010 statement: Updated guidelines for reporting parallel group randomised trials. BMJ (2010) 340:c332. doi: 10.1136/bmj.c332
    1. Chen C, Lu FC. The guidelines for prevention and control of overweight and obesity in Chinese adults. BioMed Environ Sci (2004) 17 Suppl:1–36.
    1. Figueiredo LM, Silva AH, Prado Neto AX, Hissa MN, Vasconcelos PR, Guimarães SB. Electroacupuncture stimulation using different frequencies (10 and 100 Hz) changes the energy metabolism in induced hyperglycemic rats. Acta Cir Bras (2011) 26 Suppl 1:47–52. doi: 10.1590/s0102-86502011000700010
    1. Kong XJ, Gao L, Peng H, Shi X. [Effects of electro-acupuncture on expression of obestatin in hypothalamus of rats with simple obesity]. Zhong Xi Yi Jie He Xue Bao (2010) 8(5):480–5. doi: 10.3736/jcim20100513
    1. Li M, Zhang Y. Modulation of gene expression in cholesterol-lowering effect of electroacupuncture at fenglong acupoint (ST40): A cDNA microarray study. Int J Mol Med (2007) 19(4):617–29. doi: 10.3892/ijmm.19.4.617
    1. Mo Q, Wu XM, Yang S. [Characteristics and rules of acupoints selection in treatment of simple obesity with acupoint catgut embedding]. Yunnan Zhong Yi Xue Yuan Xue Bao (2018) 41(2):67–72. doi: 10.19288/j.cnki.issn.1000-2723.2018.02.019
    1. Lerwick E. Studies on the efficacy and safety of polydioxanone monofilament absorbable suture. Surg Gynecol Obstet (1983) 156(1):51–5.
    1. Boenisch M, Mink A. Clinical and histological results of septoplasty with a resorbable implant. Arch Otolaryngol Head Neck Surg (2000) 126(11):1373–7. doi: 10.1001/archotol.126.11.1373
    1. Rimmer J, Ferguson LM, Saleh HA. Versatile applications of the polydioxanone plate in rhinoplasty and septal surgery. Arch Facial Plast Surg (2012) 14(5):323–30. doi: 10.1001/archfacial.2012.147
    1. Boenisch M, Tamás H, Nolst Trenité GJ. Influence of polydioxanone foil on growing septal cartilage after surgery in an animal model: New aspects of cartilage healing and regeneration (Preliminary results). Arch Facial Plast Surg (2003) 5(4):316–9. doi: 10.1001/archfaci.5.4.316
    1. Otto J, Binnebösel M, Pietsch S, Anurov M, Titkova S, Ottinger AP, et al. . Large-Pore pds mesh compared to small-pore pg mesh. J Invest Surg (2010) 23(4):190–6. doi: 10.3109/08941931003739741
    1. Belivani M, Dimitroula C, Katsiki N, Apostolopoulou M, Cummings M, Hatzitolios AI. Acupuncture in the treatment of obesity: A narrative review of the literature. Acupunct Med (2013) 31(1):88–97. doi: 10.1136/acupmed-2012-010247
    1. Cho WC, Li C, Chen HY. Clinical efficacy of acupoint embedment in weight control: A systematic review and meta-analysis. Med (Baltimore) (2018) 97(36):e12267. doi: 10.1097/md.0000000000012267
    1. Chen IJ, Yeh YH, Hsu CH. Therapeutic effect of acupoint catgut embedding in abdominally obese women: A randomized, double-blind, placebo-controlled study. J Womens Health (Larchmt) (2018) 27(6):782–90. doi: 10.1089/jwh.2017.6542
    1. Huang F, Xie Y, Zhao S, Feng Z, Chen G, Xu Y. The effectiveness and safety of acupoint catgut embedding for the treatment of postmenopausal osteoporosis: A systematic review and meta-analysis. Evid Based Complement Alternat Med (2019) 2019:2673763. doi: 10.1155/2019/2673763
    1. Shi Y, Hou T, Zheng Q, Liu Y, Yang T, Li Y. Acupoint catgut embedding for patients with chronic urticaria: A systematic review protocol. Med (Baltimore) (2019) 98(24):e16036. doi: 10.1097/md.0000000000016036
    1. Xu F, Xuan LH, Zhou HJ, Chen FY, Zheng ZJ, Bi Y, et al. . Acupoint catgut embedding alleviates insomnia in different Chinese medicine syndrome types: A randomized controlled trial. Chin J Integr Med (2019) 25(7):543–9. doi: 10.1007/s11655-018-2770-3
    1. Wang XL, Lin GH, Xu N, Zeng JC, Xu DH, Wang SX. [Analysis of adverse reactions of acupoint catgut embedding therapy]. Zhongguo Zhen Jiu (2020) 40(2):193–6. doi: 10.13703/j.0255-2930.20190316-k00034
    1. Chuang YT, Li TS, Lin TY, Hsu CJ. An unusual complication related to acupuncture point catgut embedding treatment of obesity. Acupunct Med (2011) 29(4):307–8. doi: 10.1136/acupmed.2011.010084
    1. Tchernof A, Després JP. Pathophysiology of human visceral obesity: An update. Physiol Rev (2013) 93(1):359–404. doi: 10.1152/physrev.00033.2011
    1. Huo L, Zhang HR, Zhan XH, Liang Y. [the concept alternation of "Liver govens dispersion"]. Zhongguo Zhong Yi Ji Chu Yi Xue Za Zhi (2021) 27(10):1533–5. doi: 10.19945/j.cnki.issn.1006-3250.2021.10.001
    1. Zhang K, Zhou S, Wang C, Xu H, Zhang L. Acupuncture on obesity: Clinical evidence and possible neuroendocrine mechanisms. Evid Based Complement Alternat Med (2018) 2018:6409389. doi: 10.1155/2018/6409389
    1. Zhu S, Wang Z, Heshka S, Heo M, Faith MS, Heymsfield SB. Waist circumference and obesity-associated risk factors among whites in the third national health and nutrition examination survey: Clinical action thresholds. Am J Clin Nutr (2002) 76(4):743–9. doi: 10.1093/ajcn/76.4.743
    1. Flicker L, McCaul KA, Hankey GJ, Jamrozik K, Brown WJ, Byles JE, et al. . Body mass index and survival in men and women aged 70 to 75. J Am Geriatr Soc (2010) 58(2):234–41. doi: 10.1111/j.1532-5415.2009.02677.x
    1. Wang LH, Huang W, Wei D, Ding DG, Liu YR, Wang JJ, et al. . Mechanisms of acupuncture therapy for simple obesity: An evidence-based review of clinical and animal studies on simple obesity. Evid Based Complement Alternat Med (2019) 2019:5796381. doi: 10.1155/2019/5796381
    1. Peplow PV. Repeated electroacupuncture in obese zucker diabetic fatty rats: Adiponectin and leptin in serum and adipose tissue. J Acupunct Meridian Stud (2015) 8(2):66–70. doi: 10.1016/j.jams.2014.06.013
    1. Huang Q, Chen R, Peng M, Li L, Li T, Liang FX, et al. . [Effect of electroacupuncture on Sirt1/Nf-κb signaling pathway in adipose tissue of obese rats]. Zhongguo Zhen Jiu (2020) 40(2):185–91. doi: 10.13703/j.0255-2930.20190324-00054
    1. Kojima M, Kangawa K. Ghrelin: Structure and function. Physiol Rev (2005) 85(2):495–522. doi: 10.1152/physrev.00012.2004
    1. Shen W, Wang Y, Lu SF, Hong H, Fu S, He S, et al. . Acupuncture promotes white adipose tissue browning by inducing Ucp1 expression on dio mice. BMC Complement Altern Med (2014) 14:501. doi: 10.1186/1472-6882-14-501
    1. Güçel F, Bahar B, Demirtas C, Mit S, Cevik C. Influence of acupuncture on leptin, ghrelin, insulin and cholecystokinin in obese women: A randomised, sham-controlled preliminary trial. Acupunct Med (2012) 30(3):203–7. doi: 10.1136/acupmed-2012-010127
    1. Wang F, Tian DR, Han JS. Electroacupuncture in the treatment of obesity. Neurochem Res (2008) 33(10):2023–7. doi: 10.1007/s11064-008-9822-6
    1. Chen J, Chen D, Ren Q, Zhu W, Xu S, Lu L, et al. . Acupuncture and related techniques for obesity and cardiovascular risk factors: A systematic review and meta-regression analysis. Acupunct Med (2020) 38(4):227–34. doi: 10.1136/acupmed-2018-011646
    1. Xu L, Ding C, Chen J, Tan R, Chen D, Xu S, et al. . [Efficacy difference between warming acupuncture and other acupuncture methods for primary obesity: A meta-analysis]. Zhongguo Zhen Jiu (2018) 38(9):1019–26. doi: 10.13703/j.0255-2930.2018.09.031

Source: PubMed

3
Předplatit