The Effect of Auricular Acupoint Stimulation in Overweight and Obese Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Tzu-Lin Yeh, Hsin-Hao Chen, Tsung-Ping Pai, Shu-Jung Liu, Shang-Liang Wu, Fang-Ju Sun, Lee-Ching Hwang, Tzu-Lin Yeh, Hsin-Hao Chen, Tsung-Ping Pai, Shu-Jung Liu, Shang-Liang Wu, Fang-Ju Sun, Lee-Ching Hwang

Abstract

Objective: To investigate the effect of auricular acupoint stimulation on overweight and obese adults.

Methods: We searched databases including PubMed, EMBASE, Allied and Complementary Medicine Database, National Knowledge Infrastructure, and the PerioPath Index to Taiwan Periodical Literature. The modified Jadad scale was used to assess study quality. We investigated the effect of auricular acupoint stimulation on anthropometric measurements.

Results: Eighteen randomized controlled trials (RCTs) were included in our systematic review. Thirteen RCTs were pooled in a meta-analysis that revealed a significant reduction in body weight (BW) with a mean difference (MD) of -1.21 kg and a 95% confidence interval (CI) from -1.94 to -0.47 with a heterogeneity of I2 = 88%. Significant decreases in body mass index (BMI; MD: -0.57 kg/m2; 95% CI -0.82 to -0.33; I2 = 78%), body fat (BF; MD: -0.83%; 95% CI -1.43 to -0.24; I2 = 0%), and waist circumference (WC; MD: -1.75 cm; 95% CI -2.95 to -0.55; I2 = 87%) were also revealed.

Conclusions: This meta-analysis shows that auricular acupoint stimulation improves physical anthropometric parameters including BW, BMI, BF, and WC in overweight and obese adults. These methods are less effective on hip circumference and waist-to-hip ratio.

Figures

Figure 1
Figure 1
Flowchart of the trial selection process.
Figure 2
Figure 2
The forest plot of outcome measure “body weight change magnitude.” Comparison. Auricular stimulation versus placebo. Subgroup analysis by treatment duration: shorter or longer or equal to six weeks.
Figure 3
Figure 3
The forest plot of outcome measure “body mass index change magnitude.” Comparison. Auricular stimulation versus placebo. Subgroup analysis by treatment duration: shorter or longer or equal to six weeks.
Figure 4
Figure 4
The forest plot of outcome measure “body fat change magnitude.” Comparison. Auricular stimulation versus placebo.
Figure 5
Figure 5
The forest plot of outcome measure “waist circumference change magnitude.” Comparison. Auricular stimulation versus placebo. Subgroup analysis by treatment duration: shorter or longer or equal to six weeks.
Figure 6
Figure 6
The forest plot of outcome measure “hip circumference change magnitude.” Comparison. Auricular stimulation versus placebo. Subgroup analysis by treatment duration: shorter or longer or equal to six weeks.
Figure 7
Figure 7
The forest plot of outcome measure “waist-to-hip ratio change magnitude.” Comparison. Auricular stimulation versus placebo. Subgroup analysis by treatment duration: shorter or longer or equal to six weeks.
Figure 8
Figure 8
Regression of numbers of auricular stimulation treatment on body weight. Std diff, standard difference.

References

    1. 894. World Health Organization; 2000. Obesity: Preventing And Managing The Global Epidemic. Report of A WHO Consultation. Technical Report Series.
    1. Ogden C. L., Carroll M. D., Kit B. K., Flegal K. M. Prevalence of childhood and adult obesity in the United States, 2011-2012. The Journal of the American Medical Association. 2014;311(8):806–814. doi: 10.1001/jama.2014.732.
    1. Nguyen N. T., Magno C. P., Lane K. T., Hinojosa M. W., Lane J. S. Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the national health and nutrition examination survey, 1999 to 2004. Journal of the American College of Surgeons. 2008;207(6):928–934. doi: 10.1016/j.jamcollsurg.2008.08.022.
    1. Haslam D. W., James W. P. T. Obesity. The Lancet. 2005;366(9492):1197–1209. doi: 10.1016/S0140-6736(05)67483-1.
    1. Wang Y. C., McPherson K., Marsh T., Gortmaker S. L., Brown M. Health and economic burden of the projected obesity trends in the USA and the UK. The Lancet. 2011;378(9793):815–825. doi: 10.1016/S0140-6736(11)60814-3.
    1. Knowler W. C., Barrett-Connor E., Fowler S. E., et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine. 2002;346(6):393–403. doi: 10.1056/NEJMoa012512.
    1. Knowler W. C., Fowler S. E., Hamman R. F., Christophi C. A., Hoffman H. J., Brenneman A. T. 10-year follow-up of diabetes incidence and weight loss in the diabetes prevention program outcomes study. The Lancet. 2009;374(9702):1677–1686. doi: 10.1016/S0140-6736(09)61457-4.
    1. Wing R. R., Bolin P., Brancati F. L., et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. The New England Journal of Medicine. 2013;369(2):145–154. doi: 10.1056/NEJMoa1212914.
    1. Gori L., Firenzuoli F. Ear acupuncture in European traditional medicine. Evidence-Based Complementary and Alternative Medicine. 2007;4(1):13–16. doi: 10.1093/ecam/nem106.
    1. Belivani M., Dimitroula C., Katsiki N., Apostolopoulou M., Cummings M., Hatzitolios A. I. Acupuncture in the treatment of obesity: a narrative review of the literature. Acupuncture in Medicine. 2013;31(1):88–97. doi: 10.1136/acupmed-2012-010247.
    1. Hou P. W., Hsu H. C., Lin Y. W., Tang N., Cheng C. Y., Hsieh C. L. The history, mechanism, and clinical application of auricular therapy in traditional Chinese medicine. Evidence-Based Complementary and Alternative Medicine. 2015;2015:13. doi: 10.1155/2015/495684.495684
    1. Fang S., Wang M., Zheng Y., Zhou S., Ji G. Acupuncture and lifestyle modification treatment for obesity: a meta-analysis. American Journal of Chinese Medicine. 2017;45(02):1–16. doi: 10.1142/S0192415X1750015X.
    1. Guo T., Ren Y., Kou J., Shi J., Tianxiao S., Liang F. Acupoint catgut embedding for obesity: systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2015;2015:20. doi: 10.1155/2015/401914.401914
    1. Park J., Lee H., Shin B.-C., Lee M. S., Kim B., Kim J.-I. Pharmacopuncture in Korea: a systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine. 2016;2016:19. doi: 10.1155/2016/4683121.4683121
    1. Jadad A. R., Moore R. A., Carroll D., et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials. 1996;17(1):1–12. doi: 10.1016/0197-2456(95)00134-4.
    1. DerSimonian R., Laird N. Meta-analysis in clinical trials. Controlled Clinical Trials. 1986;7(3):177–188. doi: 10.1016/0197-2456(86)90046-2.
    1. Higgins J. P. T., Thompson S. G. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine. 2002;21(11):1539–1558. doi: 10.1002/sim.1186.
    1. Deeks J., Higgins J., Altman P. Chapter 9: analyzing data and undertaking meta-analyses: cochrane handbook for systematic reviews of interventions version 5.1.0. Cochrane Handbook for Systematic Reviews of Interventions Version 510, vol. 5, 2011.
    1. Egger M., Smith G. D., Schneider M., Minder C. Bias in meta-analysis detected by a simple, graphical test. British Medical Journal. 1997;315(7109):629–634. doi: 10.1136/bmj.315.7109.629.
    1. Allison D. B., Kreibich K., Heshka S., Heymsfield S. B. A randomised placebo-controlled clinical trial of an acupressure device for weight loss. International Journal of Obesity and Related Metabolic Disorders. 1995;19(9):653–658.
    1. Shafshak T. S. Electroacupuncture and exercise in body weight reduction and their application in rehabilitating patients with knee osteoarthritis. American Journal of Chinese Medicine. 1995;23(1):15–25. doi: 10.1142/S0192415X95000043.
    1. Richards D., Marley J. Stimulation of auricular acupuncture points in weight loss. Australian Family Physician. 1998;27(supplement 2):S73–S77.
    1. Hsu C.-H., Wang C.-J., Hwang K.-C., Lee T.-Y., Chou P., Chang H.-H. The effect of auricular acupuncture in obese women: a randomized controlled trial. Journal of Women's Health. 2009;18(6):813–818. doi: 10.1089/jwh.2008.1005.
    1. Hsieh C. H. The effects of auricular acupressure on weight loss and serum lipid levels in overweight adolescents. American Journal of Chinese Medicine. 2010;38(4):675–682. doi: 10.1142/S0192415X10008147.
    1. Hsieh C. H., Su T.-J., Fang Y.-W., Chou P.-H. Effects of auricular acupressure on weight reduction and abdominal obesity in asian young adults: a randomized controlled trial. American Journal of Chinese Medicine. 2011;39(3):433–440. doi: 10.1142/S0192415X11008932.
    1. Hsieh C. T., Fu W. P., Hsun C., Lo Y., Hsun C. Y. Standarizied protocol of acupuncuture to treat simple obesity. Chinese Journal of Gerontology. 2011;no. 24
    1. Abdi H., Abbasi-Parizad P., Zhao B., et al. Effects of auricular acupuncture on anthropometric, lipid profile, inflammatory, and immunologic markers: a randomized controlled trial study. The Journal of Alternative and Complementary Medicine. 2012;18(7):668–677. doi: 10.1089/acm.2011.0244.
    1. Ching H.-Y., Wu S.-L., Chen W.-C., Hsieh C.-L. Effects of auricular acupressure on body weight parameters in patients with chronic schizophrenia. Evidence-Based Complementary and Alternative Medicine. 2012;2012:8. doi: 10.1155/2012/151737.151737
    1. Darbandi M., Darbandi S., Mobarhan M. G., et al. Effects of auricular acupressure combined with low-Calorie diet on the leptin hormone in obese and overweight iranian individuals. Acupuncture in Medicine. 2012;30(3):208–213. doi: 10.1136/acupmed-2011-010121.
    1. He W., Zhou Z., Li J., Wang L., Zhu B., Litscher G. Auricular acupressure plus exercise for treating primary obese women: a randomized controlled clinical trial. Medical Acupuncture. 2012;24(4):227–232. doi: 10.1089/acu.2012.0881.
    1. Lien C. Y., Liao L. L., Chou P., Hsu C. H. Effects of auricular stimulation on obese women: a randomized, controlled clinical trial. European Journal of Integrative Medicine. 2012;4(1):e45–e53. doi: 10.1016/j.eujim.2011.12.002.
    1. Darbandi M., Darbandi S., Owji A. A., et al. Auricular or body acupuncture: which one is more effective in reducing abdominal fat mass in Iranian men with obesity: a randomized clinical trial. Journal of Diabetes & Metabolic Disorders. 2014;13(1, article 92) doi: 10.1186/s40200-014-0092-3.
    1. Kim D., Ham O. K., Kang C., Jun E. Effects of auricular acupressure using Sinapsis alba seeds on obesity and self-efficacy in female college students. The Journal of Alternative and Complementary Medicine. 2014;20(4):258–264. doi: 10.1089/acm.2012.0283.
    1. Schukro R. P., Heiserer C., Michalek-Sauberer A., Gleiss A., Sator-Katzenschlager S. The effects of auricular electroacupuncture on obesity in female patients—a prospective randomized placebo-controlled pilot study. Complementary Therapies in Medicine. 2014;22(1):21–25. doi: 10.1016/j.ctim.2013.10.002.
    1. Yeo S., Kim K. S., Lim S. Randomised clinical trial of five ear acupuncture points for the treatment of overweight people. Acupuncture in Medicine. 2014;32(2):132–138. doi: 10.1136/acupmed-2013-010435.
    1. Yeh M.-L., Chu N.-F., Hsu M.-Y. F., Hsu C.-C., Chung Y.-C. Acupoint stimulation on weight reduction for obesity: a randomized sham-controlled study. Western Journal of Nursing Research. 2015;37(12):1517–1530. doi: 10.1177/0193945914548707.
    1. Hsu Y. K. Acupuncture to treat simple obesity: clinical cases discussion. Asia-Pacific Traditional Medicine. 2016;(01)
    1. Cho S.-H., Lee J.-S., Thabane L., Lee J. Acupuncture for obesity: a systematic review and meta-analysis. International Journal of Obesity. 2009;33(2):183–196. doi: 10.1038/ijo.2008.269.
    1. Sui Y., Zhao H. L., Wong V. C. W., et al. A systematic review on use of chinese medicine and acupuncture for treatment of obesity. Obesity Reviews. 2012;13(5):409–430. doi: 10.1111/j.1467-789x.2011.00979.x.
    1. Ruan Z., Xiang Y., Li J., Zhou X., Huang Z., Dong C. Auricular acupuncture for obesity: a systematic review and meta-analysis. International Journal of Clinical and Experimental Medicineis. 2016;9(2):1772–1779.
    1. Yeh C.-H., Yeh S.-C. J. Effects of ear points' pressing on parameters related to obesity in non-obese healthy and obese volunteers. The Journal of Alternative and Complementary Medicine. 2008;14(3):309–314. doi: 10.1089/acm.2007.0678.
    1. Peuker E. T., Filler T. J. The nerve supply of the human auricle. Clinical Anatomy. 2002;15(1):35–37. doi: 10.1002/ca.1089.
    1. Lee Y.-C., Li T.-M., Tzeng C.-Y., et al. Electroacupuncture at the Zusanli (ST-36) acupoint induces a hypoglycemic effect by stimulating the cholinergic nerve in a rat model of streptozotocine-induced insulin-dependent diabetes mellitus. Evidence-Based Complementary and Alternative Medicine. 2011;2011:6. doi: 10.1093/ecam/neq068.650263
    1. Lin R.-T., Chen C.-Y., Tzeng C.-Y., et al. Electroacupuncture improves glucose tolerance through cholinergic nerve and nitric oxide synthase effects in rats. Neuroscience Letters. 2011;494(2):114–118. doi: 10.1016/j.neulet.2011.02.071.
    1. Chi T.-C., Ho Y.-J., Chen W.-P., et al. Serotonin enhances β-endorphin secretion to lower plasma glucose in streptozotocin-induced diabetic rats. Life Sciences. 2007;80(20):1832–1838. doi: 10.1016/j.lfs.2007.02.016.
    1. Oke S. L., Tracey K. J. The inflammatory reflex and the role of complementary and alternative medical therapies. Annals of the New York Academy of Sciences. 2009;1172:172–180. doi: 10.1196/annals.1393.013.
    1. Wang X., Yang Z., Xue B., Shi H. Activation of the cholinergic antiinflammatory pathway ameliorates obesity-induced inflammation and insulin resistance. Endocrinology. 2011;152(3):836–846. doi: 10.1210/en.2010-0855.
    1. Gilbert J. G. Auricular complication of acupuncture. New Zealand Medical Journal. 1987;100(819):141–142.
    1. Jensen M. D., Ryan D. H., Apovian C. M., et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the american college of cardiology/american heart association task force on practice guidelines and the obesity society. Journal of the American College of Cardiology. 2014;63(25, part B):2985–3023.
    1. Yeh C. H., Chiang Y. C., Hoffman S. L., et al. Efficacy of auricular therapy for pain management: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2014;2014:14. doi: 10.1155/2014/934670.934670
    1. Wang L., Zhao B., Zhou L. Status and strategies analysis on international standardization of auricular acupuncture points. Journal of Traditional Chinese Medicine. 2013;33(3):408–412. doi: 10.1016/s0254-6272(13)60188-0.
    1. Oleson T. Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture. 3rd. Kidlington, UK: Churchill Livingstone; 2003.
    1. Zhang C. S., Yang A. W., Zhang A. L., May B. H., Xue C. C. Sham control methods used in ear-acupuncture/ear-acupressure randomized controlled trials: a systematic review. The Journal of Alternative and Complementary Medicine. 2014;20(3):147–161. doi: 10.1089/acm.2013.0238.
    1. Dincer F., Linde K. Sham interventions in randomized clinical trials of acupuncture—a review. Complementary Therapies in Medicine. 2003;11(4):235–242. doi: 10.1016/S0965-2299(03)00124-9.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi