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Polyphenols and weight management

Polyphenols and weight management

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DOI: Blood sugar control for diabetics are Polylhenols metabolites from plant metabolism, widely distributed in nature. The major dietary sources of polyphenols are fruits, Polypyenols, chocolate and plant-derived mwnagement like tea, Polyphenols and weight management, coffee and wine.

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Polyphenols promote mnagement healthy profile of intestinal microbiota, decreasing Firmicutes and increasing Bacteroidetes.

Polyphenols may modulate carbohydrate digestion, glucose absorption and gluconeogenesis, thereby helping contain postprandial hyperglycemic excursions. They improve lipid metabolism by decreasing adipogenesis and inhibiting lipogenesis, and stimulating lipolysis and beta-oxidation.

Polyphenol ingestion was also associated with decreased food-intake and thermogenesis stimulation. Nevertheless, the effects described are still subject to debate because human studies are scarce and some results are inconsistent.

Keywords: AbsorptionAdipogenesisAdipose tissue browningFlavonoidsFoodFood-intakeLipogenesisLipolysisMetabolismMicrobiotaPolyphenolsPeroxisome proliferator-activated receptor alphaPeroxisome proliferatoractivated receptor gammaSterol regulatory element-binding proteinObesityThermogenesisUncoupling protein 1Weight loss.

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: Polyphenols and weight management

Brands harness plant polyphenols for weight management

DOI: Polyphenols are secondary metabolites from plant metabolism, widely distributed in nature. The major dietary sources of polyphenols are fruits, vegetables, chocolate and plant-derived beverages like tea, coffee and wine.

Polyphenols are mostly absorbed in the small intestine, extensively and quickly metabolized in the liver and appear in the circulation or are excreted into bile and urine as both intact and metabolized forms. Much attention has been given to polyphenols in the last decades, mainly due to the positive association between the consumption of polyphenol-rich foods and the low risk of chronic diseases like cardiovascular diseases, type 2 diabetes and obesity.

In fact, obesity has increased enormously worldwide and is becoming a threat to public health. Several studies suggest that polyphenols and polyphenol-rich foods have very interesting properties regarding the management of obesity and weight loss. Polyphenols promote a healthy profile of intestinal microbiota, decreasing Firmicutes and increasing Bacteroidetes.

Polyphenols may modulate carbohydrate digestion, glucose absorption and gluconeogenesis, thereby helping contain postprandial hyperglycemic excursions. They improve lipid metabolism by decreasing adipogenesis and inhibiting lipogenesis, and stimulating lipolysis and beta-oxidation.

Polyphenol ingestion was also associated with decreased food-intake and thermogenesis stimulation. Nevertheless, the effects described are still subject to debate because human studies are scarce and some results are inconsistent.

Polyphenol compounds were measured in both plasma and urine samples S 7. The co-primary outcomes of the DIRECT PLUS study were month changes in abdominal fat, the previously published intrahepatic fat IHF [ 28 ], and obesity.

A flow chart of the study is presented in Additional file 1 : Fig. For this report, we examined the effect of the green-MED diet on changes in VAT and both deep and superficial SAT over 18 months. We further evaluated the associations between the changes in abdominal adipose tissues with changes in blood biomarkers [ 13 ] and consumption of specific foods.

Continuous variables are presented as the means standard deviations. Nominal variables are expressed as numbers and percentages. The Kolmogorov-Smirnov test was used to determine whether variables were normally distributed, and natural log transformations were applied when necessary to achieve normal distributions.

Differences in values over time were tested using a paired sample T -test or the Wilcoxon test for month changes or three time points using ANOVA for repeated measures. The differences across the groups were tested using ANOVA, the Kruskal-Wallis test, or the chi-square statistic.

The Kendall tau correlation was used to examine the trend of p. Multiple comparisons were adjusted using the Tukey post hoc test for ANOVA and Bonferroni correction for Kruskal-Wallis. We used general and generalized linear regression models for adjustments and interaction models with the specific adjustments detailed in the results.

We calculated the cardiovascular risk score using the Systematic Coronary Risk Evaluation SCORE [ 53 ]. The month primary analyses of abdominal adipose tissues included all participants with intention-to-treat ITT analysis [ 13 ], imputing for missing observations of 59 participants at follow-up using multiple imputation techniques [ 54 ], wherein the following predictors were used in the imputation model: age, sex, baseline weight, and WC at 18 months [ 13 , 28 ].

We used the most recent values [ 33 ] for missing weight and WC data, as was used in the IHF paper as part of the DIRECT PLUS [ 28 ]. A sensitivity analysis revealed similar results from the per-protocol analysis, using data from completers only and the ITT analysis S 2. For urine polyphenolic compounds in untargeted analyses, zero values were imputed to the lowest detected, value once log2 transformed.

Sample size and power calculations are reported in S 8. The majority of results corresponding to the current study are included in the article or uploaded as supplementary material.

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The effect of green Mediterranean diet on cardiometabolic risk; a randomised controlled trial. Yaskolka Meir A, Rinott E, Tsaban G, et al. Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial. Moll R, Davis B.

Iron, vitamin B12 and folate. Shai I, Rosner BA, Shahar DR, et al. Dietary evaluation and attenuation of relative risk: multiple comparisons between blood and urinary biomarkers, food frequency, and hour recall questionnaires: the DEARR study.

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Am J Clin Nutr. Maersk M, Belza A, Stodkilde-Jorgensen H, et al. Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Shah RV, Murthy VL, Allison MA, et al. Diet and adipose tissue distributions: the multi-ethnic study of atherosclerosis.

Rosqvist F, Iggman D, Kullberg J, et al. Overfeeding polyunsaturated and saturated fat causes distinct effects on liver and visceral fat accumulation in humans.

Yaskolka Meir A, Tuohy K, von Bergen M, Krajmalnik-Brown R, Heinig U, Zelicha H, et al. Given the limitations of both CRD and PA, pharmaceutical and surgical approaches have been added to improve obesity treatments.

However, the safety of pharmaceutical treatments in the long-term remains questionable as they may cause side effects 8. Moreover, surgical procedures, such as bariatric surgery, are invasive, expensive, and have their own inherent risks, including weight regain 9.

The World Health Organization reported in that more than 1. Therefore, safe, effective and simple alternative strategies for weight loss beyond the conventional ones, are extremely needed and have become a current hot topic in clinical and public health research.

Polyphenols are bioactive compounds ubiquitously found in plant-based foods and beverages such as tea, coffee, wine, fruits, vegetables, whole-grain cereals, and cocoa They comprise a large variety of chemical structures which are divided into four main classes: flavonoids, and phenolic acids, lignans and stilbenes A growing body of research indicates that polyphenols may reduce or maintain body weight.

Indeed, after 5 years of follow-up, a significantly inverse association between polyphenol intake and body weight among participants was observed in the PREDIMED Prevención con Dieta Mediterránea study In a cross sectional study on 2, female twins, higher habitual intake of polyphenols was associated with a lower fat mass The relation between different classes of polyphenols and weight loss have also been supported by several systematic reviews and meta-analysis of randomized clinical trials RCTs 15 — Nevertheless, they generally agreed that further and larger studies are still needed to clarify the role of polyphenols in body weight and fat loss.

Overweight and obesity is caused by an imbalance between energy intake and energy expenditure. Weight and body fat loss can be usually achieved by reducing energy intake following a CRD or increasing energy expenditure following a PA program 5.

Fat oxidation is the main pathway affected by PA The metabolism responds to the reduction of energy intake by decreasing energy expenditure and decreasing fat oxidation in order to promote energy storage 6.

Energy restriction affects also the neuro-hormonal system by decreasing anorexigenic hormone e. The limitations of PA are more related to behavioral responses such as changes in eating behavioral, poor compliance to exercise programs and increase of the sedentary activities 7.

Moreover, a decrease of the resting metabolic rate occurs during PA 7. Involvement of polyphenols in weight loss has been proposed due to their anti-obesity properties, such as: i stimulating thermogenesis and energy expenditure 19 ; ii inhibiting adipocyte differentiation and growth 20 ; iii increasing lipolysis and inducing β-oxidation 21 ; and iv decreasing appetite It seems that polyphenols may mimic the PA pathways and strengthen the CRD changes, which led us to hypothesize that their combination may increase negative energy balance, increase fat oxidation, and provide a greater weight and fat loss.

Several animal studies have shown greater weight-lowering effects by adding polyphenol supplements to conventional strategies 23 — 25 , but results from human studies are still inconsistent 26 — However, many factors could affect the discrepancies between animal and human studies, such as: differences in the metabolism and mechanism of actions of polyphenols between animals and humans 29 , and difficulties in controlling the weight, CRD and PA programs, and polyphenol intake in free living humans.

Evidences from human studies have indicated that polyphenol effects are significantly stronger after at least one month of intervention Results on the additional effects of polyphenol supplementation on other obesity-related parameters were also discussed.

The review was designed according to the PRISMA guidelines. Our study protocol was previously registered in the PROSPERO database CRD To identify the articles, we searched in the following databases: PubMed, Web of Science, Cochrane CENTRAL up to December 31st, Reference lists of included manuscripts and relevant reviews were examined for any additional studies not previously identified Figure 1.

Both authors FL and RZ-R independently performed the search and the screen of the articles, and disagreements were discussed until consensus was reached. The research was limited to English language. Studies were excluded if they applied the polyphenol intervention after the weight loss program, reported incomplete data regarding CRD or PA programs e.

When two publications were identified from the same study, we included only the most completed one regarding the body composition parameters and extracted data from both if it was necessary.

In addition, we extracted data from these studies about the effects of polyphenols on other obesity-related outcomes. Based on the heterogeneity and the limited number of studies, data was only summarized in a descriptive manner and was not meta-analyzed.

In order to facilitate the synthesis and interpretation of the results, we have divided the studies by the type of the lifestyle intervention CRD or PA. The risk of bias of the included studies was independently assessed by both authors FL and RZ-R using the Cochrane RoB2 Tool Disagreements were resolved by discussion until consensus was reached.

Each domain was classified as low risk fulfilling all criteria , medium risk may have some issues that were likely to affect the conclusions , high risk not fulfilling the criteria , and not available insufficient details for judgment.

After screening of the eligible articles, 15 studies were included in this review. Four RCTs assessed the effects of polyphenol supplementation in addition to CRD 32 — 35 , and 11 in addition to PA 26 — 28 , 36 — The reasons for the excluded articles are presented in Figure 1.

Two of the 4 studies that combined CRD with polyphenols were carried out in Spain, one in the United States and the last in the Netherlands. The number of participants ranged from 46 to The RCTs were conducted among healthy adults or subjects without main cardiometabolic chronic diseases.

Detailed characteristics of the studies are presented in Table 1. Table 1. Characteristics of the studies that combined calorie restricted diets with polyphenols. Three of the 11 studies that combined PA with polyphenols were carried out in Canada, three in Spain, two in Australia, one in United States, one in Iran and one in Brazil.

The number of participants ranged from 33 to The duration of the studies was between 3 and 24 months. Nine of the RCTs were done in healthy adults or without cardiometabolic chronic diseases. Only one RCT included subjects with insulin resistance 38 , while another with non-alcoholic fatty liver disease One Canadian RCT 40 combined an initial period of 6-months of isoflavone or placebo supplementation alone, with 6-months of isoflavone or placebo plus PA treatment.

Except one study that did not informed regard the isoflavones type, the others used an isoflavone mixture supplementation genistein, daidzein, glycitein.

Three of them administrated isoflavone supplementation rich in genistein 27 , 37 , 39 , while other three, rich in daidzein 26 , 28 , Participants of 8 studies completed an aerobic exercise or walking program, two a combined program of aerobic and resistance exercise, and one a resistance exercise program.

In addition to PA intervention, one RCT recommended to the participants to follow an energy-balanced diet Also, two Spanish studies instructed their participants to adapt a Mediterranean diet pattern 27 , Detailed characteristics of the studies are presented in Table 2.

Table 2. Characteristics of the studies that combined physical activity with polyphenols. Body weight, BMI, WC, and body fat significantly decreased after both treatments: CRD and CRD-PP Table 3. No differences were observed between both treatments CRD vs.

Table 3. Changes of the outcomes after the intervention with calorie restricted diets and polyphenols. Among the four studies that assessed the effects of isoflavone and reported data for body weight, the Canadian RCT 40 with 12 months of duration showed a significant weight loss after PA-PP treatment but not PA alone Table 4.

Additionally, a study that described the effects of isoflavone in different time-point and reported weight reduce at 6 and 12 months only in the group that received supplementation with isoflavone data not shown Data regarding the effects of isoflavones on BMI were described by six RCTs.

The Canadian RCT 40 , revealed a BMI reduction only in the PA-PP group. Another Spanish RCT 27 with a months duration showed a greater BMI decrease in the PA-PP compared to the PA group.

Table 4. Changes of the outcomes after the intervention with physical activity programs and polyphenols. Isoflavone supplementation plus PA treatment but not PA alone caused a statistically significant total body fat mass loss in two of the RCTs 27 , Moreover, one study reported trunk fat mass loss only in PA-PP group but not in PA alone Two studies that administrated green tea capsule and beverage with small amount of caffeine, did not reported greater results for weight, BMI, WC, and total body fat 42 , Green tea catechins with smaller amount of caffeine plus PA 39 mg caused significant abdominal fat reduce, but not PA treatment alone Twelve of the fifteen selected studied informed about the adverse events due to polyphenols supplementation, while four did not do it 34 , 40 , No adverse events occurred in the rest of the RCTs.

Standardized risk of bias assessment was conducted following these domains: i randomization process; ii deviation from the intended intervention; iii missing outcome data; iv measurement of the outcome; and v selection of the reported studies Table 5.

Three of the RCTs presented a low risk of bias in the five domains 32 , 33 , Statement of randomization was reported, but the randomization method and allocation concealment were not specified in seven studies 28 , 35 , 37 , 38 , 40 , 41 , However, differences between groups at baseline on these studies did not suggest a major problem with the randomization process.

In any case, their bias due to the randomization process was classified at medium risk. Six RCTs did not perform a double-blind design, thus did not fulfill the low risk criteria of deviation from the intended intervention 27 , 34 , 37 , 38 , 41 , Only seven studies were classified at low risk of missing outcome data 28 , 32 — 34 , 36 , 42 , Six of the RCTs did not fulfill the same criteria, mainly for two reasons: i the high rate of drop-outs or loss of follow-up and; ii the lack of an adequate analysis method that correct this bias 27 , 37 — The bias of missing outcome data was not assessed in two studies due to the lack of relevant information for judgment 26 , All studies used objective standardized body composition measures and assessed them properly, thus they were free of bias regarding the measurement of the outcomes.

Selection of the reported results bias was also evaluated at low risk for all included studies. In this review, we have summarized the additional effects of polyphenol supplementation on body weight, BMI, WC, and body fat changes when combined with CRD and PA in adults with overweight or obesity.

Comparing CRD or PA intervention groups with vs. without polyphenols helped to understand how polyphenols affect the efficacy of the CRD or PA on body composition parameters. The types of polyphenol supplementation were; isoflavone capsule and soybean extract, cocoa extract, grapefruit, and grapefruit juice, epigallocatechin gallate capsule, green tea capsule, and beverage, and resveratrol capsule.

Isoflavone supplementation showed some additional effects in weight and fat loss during PA in overweight or obese postmenopausal women in the non-Asian studies.

No additional effects were indicated for other types of polyphenols during CRD or PA. In addition, these RCTs investigated the effects of polyphenol supplementation on several cardiometabolic parameters related to obesity, showing some protective results on insulin resistance and inflammation markers.

Complementing CRD with one to three months of polyphenol supplementation did not provide any additional effect on weight and fat loss in overweight and obese adults. The results are consistent with findings from a previous review 17 , showing that three months could be insufficient to detect significant polyphenol anti-obesity effects.

CRD triggers adaptive responses by declining energy expenditure, which may persist for at least one year after the weight loss Studies that assessed the effects of polyphenols after diet-induced weight loss found a prevention of weight regain by polyphenols 45 , These findings suggest that polyphenols might be more effective after the dynamic phase of the CRD in order to favor weight maintenance rather than for reducing weight per se during the CRD.

In comparison with CRD, the efficacy of PA was increased in some studies when polyphenols were added. It is important to bear in mind that the number of studies that assessed the effects of isoflavones in this review was larger and had longer duration 6 to 24 months.

Particularly, mixture isoflavone supplementation genistein, daidzein, glycitein enhances the effects of PA aerobic plus resistance exercise on body composition parameters. Indeed, a higher loss of body weight and fat after PA plus isoflavone was observed compared to PA alone, in postmenopausal women of non-Asian studies 27 , Although, the mean weight loss of 1.

Isoflavones are flavonoids found mostly in soy products and are known as phytooestrogene due to their anti- and estrogenic properties. Adipose tissue express estrogen receptors, therefore, phytoestrogens may affect body composition directly by binding these receptors 48 , then inhibiting lipogenesis and increasing lipolysis Similarly to our findings, in a previous meta-analysis of RCTs phytoestrogens alone including isoflavones showed a significant decrease in body weight in healthy postmenopausal women that received isoflavone mixture supplementations A subsequent meta-analysis in provided higher effectiveness of overall soy products in pre-menopausal women and in overweight or obese Asian participants The last meta-analysis 15 did not analyze the interaction between soy components and body weight which could have provided more insights into the weight-reducing role of each soy components: isoflavones, protein and fiber Soy protein and fiber may confound the effectiveness of isoflavone by increasing satiety Actually, an earlier meta-analysis that performed separate analysis for soy and isoflavones found anti-obesity effect of soy but not for isoflavone Overall, it is difficult to establish the role of isoflavone in weight and fat loss because there are relevant differences between reviews 15 , 50 , 53 regarding the population ethnicity, menopausal and health status, and type and dose of isoflavone supplementation.

A part from weight and fat loss, isoflavone supplementation showed improvement in liver function 26 , inflammation 27 , 37 , and glycemia in women with insulin resistance Although, two of the studies reported some beneficial effects in the fat free mass 28 , 40 , the majority did not observe any modification 26 , 27 , 37 — Blood pressure and lipid profile of healthy women were not affected by isoflavones.

Actually, the cardio-protective potential of isoflavone is stronger in persons with established hypertension 54 or hypercholesteremia Cocoa and its products e. The addition of 1. From animal studies, it has been suggested that the equivalent dose to a daily amount of 54 g of cocoa powder in human is necessary to have beneficial effects against obesity No additional effects of cocoa occurred in glucose and insulin levels, but beneficial effects were noticed in oxidation status Ibero-Baraibar and coworkers 57 also assessed the effects of cocoa in depression and found a decline of depressive symptoms only in the cocoa group.

This is actually an important finding that could be considered in future cocoa-obesity-related research, as depression and obesity have a bidirectional relationship To our knowledge, few human studies have investigated the implication of grapefruit polyphenols on body weight and fat.

These results are also in accordance with a meta-analysis of three RCTs that reported no influence of grapefruit on body weight The effectiveness of a grapefruit capsule, juice and fruit supplementation on weight has shown to be greater in participants with metabolic syndrome compare to healthy subjects The safety of different forms of grapefruit polyphenols intake at high doses deserves further investigation.

In the RCT by Silver et al.

YOU CAN STILL ADD MORE! Accepted : 11 Polypheols Blood sugar control for diabetics Br J Nutr. Home February Association between polyphenols Polyphenols and weight management diet and body weight mangement. Only one RCT included subjects with insulin resistance 38while another with non-alcoholic fatty liver disease Only seven studies were classified at low risk of missing outcome data 2832 — 343642 ,
Brands harness plant polyphenols for weight management

In this review, we aimed to emphasize the benefit of polyphenols and ω-3 PUFAs regular intake and their sources and to propose joint actions allied to consumer's behavior change for reducing obesity and its RMDs systematic inflammation, cardiovascular diseases, hypertension, diabetes mellitus, high insulin level, metabolic syndrome, and others.

Vegetables, fruits, seeds, almonds, and cereals are widely known in diets and supplementations for their enormous benefits on health improving, preventing, and reducing obesity and its RMDs 9 , Health benefits are associated with the effect of bioactive substances, mainly represented by compounds with antioxidant action that are responsible for functions such as the half-life of products and their by-products residue products as peel, pulp and seed 12 , 16 , 26 — The main polyphenol substances occurs in leaves, flowers, roots, bulbs, and rhizomes of several wild edible plants 31 , In addition, polyphenol is present in fruits as apple, grapes, pear, cherries, berries, coffee, cereals and chocolate 33 , citrus, mangoes, garlic, onions 34 , tomatoes, potatoes, carrots, leaves tea , and vegetables broccoli, cabbages, pumpkin, spinach, and lettuce.

In addition, these plants 35 are natural sources of anthocyanins and stilbenes resveratrol and piceatannol 26 , catechin, quercetin, kaempferol 27 , umbelliferone, epicatechin, phenolic acids gallic, ellagic, chlorogenic, caffeic, and coumaric 34 , hydroxytyrosol, tyrosol 35 , curcumin, rutin, chrysin 36 , myricetin, isorhamnetin, hesperidin, narirutin, naringin, apigenin, luteolin, pelargonidin, cyanidin, delphinidin, genistein, daidzein 37 , ellagitannins, and others The effects of vegetables, fruits and polyphenols on obesity and its RMDs in animal models are summarized in Table 1.

Table 1. Effects of polyphenols intake on obesity and its related metabolic diseases outcomes in animal model. In addition, some studies with humans administered polyphenols showed the same results that can be explained by genetic effects, ethnicity, gender, eating habits, length of time, lifestyle, and others Therefore, the reported high health benefits of regular consumption of polyphenol-rich plants and vegetables are widely recommended to prevent, control and reduce obesity and RMDs in humans and animals Likewise, the health benefit for humans with obesity, that administered vegetables, fruits and polyphenols for 4—12 weeks are summarized in Table 2.

Table 2. Effects of polyphenols from vegetables and fruits intake on obesity and its related metabolic diseases outcomes in human subjects. The main sources of ω-3 PUFAs, including ALA, EPA and DHA are green leafy vegetables, seaweed, seeds, nuts, vegetable oils, fish and fish oils 68 — The vegetable and fish origin ω-3 PUFAs are summarized in Table 3.

Table 3. Contents of n-3 PUFAs and their vegetable and fish sources used in human food. The ω-3 PUFAs and ω-6 PUFAs are essential fatty acids cannot be biosynthesized by the mammalian body, including humans are required from the diet 78 , The biosynthetic process of VLCFAs production, starting by ALA from the diet to the bloodstream is illustrated in Figure 2.

Figure 2. Biosynthesis pathway of very-long-chain polyunsaturated fatty acids LC-PUFAs and very long-chain fatty acids VLCFAs in the human body starting by the α-linolenic acid ALA obtained from the diet.

The LC-PUFAs and VLCFAs biosynthesis process occurs in hepatic cell mitochondria and peroxisome. These acids reach the bloodstream, which are conducted to different body parts for health benefits. When consumed and going through several physiological reactions in the body, EPA and DHA present positive effects such as anti-inflammation, vasodilation, bronchodilation and antiplatelet aggregation Beyond, both acids are correlated with cyclooxygenase, prostacyclin, thromboxane, leukotrienes, lipoxins, and resolvins, which play a crucial role in several beneficial physiologic actions 78 , 79 , The consumption of an ω-3 PUFAs-rich balanced diet, including ALA, EPA, and DHA is correlated with health-improving and decreasing and or preventing obesity and its RMDs, such as adipose tissue fat accumulation, insulin resistance, inflammation, hypertension, atherosclerosis, CVD, CHD, and DM 4 , 78 , However, due to the presence of double bond in carbon-3 of methyl end ω-3 , including ALA, EPA, and DHA, ω-3 PUFAs family is susceptible to oxidation by light, temperature, metal ions and microorganism degradation during oil extraction and storage by autoxidation reactions photochemical and photosensitized oxidation with 4-Hydroxyhexenal production 82 , These reactions result in enzymatic oxidation with increase the production of E-series resolvins from EPA, and D-series Resolvins DHA , prostaglandins, thromboxanes, leukotrienes, epoxy products 84 , Besides, the ω-3 PUFAs decrease in amount during food confections by thermal processing, while in inversely proportion occurs the increasing of degradation and hazard oxidized substances that damage cell membranes 86 , The oxidation products are higher in fried, followed by roasted, and boiled foods, which present the same proportion of oxidative products when compared to raw food 88 , The frying and roasting food confections release the most oxidative products 4 RS F4t-NeuroP, 4-Hydroxyhexenal production, and others , which are correlated with obesity, CVD, inflammation, hypertension, and others diseases 82 , Therefore, the application of natural antioxidant compounds such as carotenoids, tocopherols, tocotrienols, phytostanols, phytosterols, and ascorbic acid are recommended due to their symbiotic and synergistic interactions decrease oxidation and thermal degradation, prolonging the shelf life of ω-3 PUFAs during the period of storage 90 — Diets consumption rich in vegetables and fish and their by-products are correlated with reducing obesity and its RDMs effects for presenting ALA, EPA, and DHA in their composition 4 , 78 , 79 , and for animal models are summarizing in Table 4.

Table 4. Effects of EPA and DHA intake on obesity and related metabolic diseases outcomes in animal models. These positive effects observed are correlated with ω-3 PUFAs that improve and repair several organs for normal function linked to hepatic organ for better lipogenesis, insulin resistance, lipid homeostasis, adipocytes function, β-oxidation, and increasing leptin and adiponectin production, pro-inflammatory mediators reducing from LA and arachidonic AA acids 78 , 79 , However, some studies reported a discrepancy effect of ω-3 PUFAs to diabetes, cholesterol, plasma glucose , overweight and obesity , inflammatory cytokines , cardiovascular diseases, and others These ω-3 PUFAs fail results can be associated with its preparation, doses quantity, administration duration period, subject target, statistics, and other factors , Therefore, ω-3 PUFAs regular consumption is recommended due to numerous studies that demonstrated strong positive effects against several metabolic diseases in animal models and human subjects, as summarized in Table 5.

Table 5. Effects of EPA and DHA intake on obesity and its related metabolic diseases outcomes in human subjects. Furthermore, lowering obesity and its RMDs were observed for human subjects daily administered 2 ×2 g of flaxseed powder, as well as in proportion of and of LA and ALA for 1 and 2 weeks , , EPA daily dosed 3 × mg or 3 × mg, dose of 1, mg during 12 weeks and 5 years — , and doses of EPA and DHA during 8—25 weeks in proportions of Increasing of obesity and its RMDs are already observed from childhood to elderly individuals and have become a public health problem in modern society , A practical alternative against obesity and its RDMs in humans can be associated with diet-rich in polyphenols and ω-3 PUFAs in composition, including their by-products In the body, polyphenols and ω-3 PUFAs DHA and EPA physiologically act protecting and inhibiting cascade inflammatory reaction processes that can evolve into obesity, diabetes, CVD, hypercholesterolemia, and others metabolic diseases , Thus, mechanisms that polyphenols and ω-3 PUFAs are involved in the body, which are crucial to prevent several metabolic diseases, which can be used as adjuvant therapy, are summarized in Figure 3.

Figure 3. Mechanism involved in an inflammatory condition and its resolution using ω-3 PUFAs and polyphenols dietary. The action of products from PUFAs metabolization hepatic biosynthesis or tissue under inflammation , lipoxins, resolvins, protectins, and maresins on macrophage profile change and the endothelial cells.

As a result, there are anti-inflammatory interleukins, nitric oxide NO and hydrogen sulfite H 2 S being produced, which will provide the resolution and tissue regeneration.

Products from polyphenols metabolization are also connected with this anti-inflammatory pathway to several organs in the body. M1, type 1 macrophages; M2, type 2 macrophages; IL, interleukin; TNF-α, tumor necrosis factor-alpha.

Green lines mean resolution of the inflammatory process and red lines mean the uncontrolled inflammatory process leading to an inflammatory cascade. In the liver, PUFAs are metabolized and converted into prostaglandins PGE2 and leukotrienes, which reach the inflammation site being converted into lipoxins, resolvins, protectins, and maresins, which will stimulate type 2 macrophages more so than the type 1 kind, leading to the production of anti- inflammatory interleukins , Likewise, polyphenols are absorbed in the intestine after being hydrolyzed by intestine enzymes and the host's microbiota Then, the resulting molecules can interact with free radicals and inhibit enzymes involved in the AA pathway, modulating the inflammatory response and blocking the AA pathway Besides that, endothelial cells are also being stimulated by both products from polyphenols and ω-3 PUFAs metabolization to produce NO and H 2 S in the first case, which will aid the resolution of the inflammatory situation and the tissue regeneration, or trigger signaling cascades by interacting with cell membrane receptors such as vascular endothelial growth factor VEGF or blocking p-AKT, NF-κB, and MMP-9 activities , The mechanisms involved in balancing the inflammatory process are the change of the phospholipid fatty acid composition of the cell membrane, inhibition of the NF-κβ activation, thus reducing the expression of pro-inflammatory genes and production of resolving mediators by macrophages Choosing daily healthy food type intake is the chief component and managed by humans to improve their own and all family healthy lifestyle Among the several factors of healthy lifestyle or prevalence of obesity and its RMDs can be associated with regular or irregularly and healthy or unhealthy daily food consumed in each meal 22 , In addition, it may also be associated with the lower purchase price of unhealthy foods on the market compared with healthy ones, whose edible parts leaves, peel, flesh, seeds, and others are wasted in homes, restaurants and other food enterprises due to their lack of nutritional knowledge , In addition, also it is known that refined sugar is often always added to edible vegetables, fruits, natural juices and other by-products and other beverages, which can be associated with obesity, overweight, CVD, and other metabolic diseases prevalence Thereby, Figure 4 summarizes food types that improve healthy life green line , which oil rich in ω-3 PUFAs, oleic acid and short-chain fatty acid are widely recommended 4.

Figure 4. Healthy food green line intake reduce obesity to normal conditions, while unhealthy food red line conduces to obesity and its related metabolic diseases. Paradoxically, nowadays, meals rich in vegetables and fruits are associated with poor and traditional peoples, while meat and sweetened ones are associated with rich and modern life 24 , , The consumption of foods marked by the red line Figure 4 must be reduced, because they are sweetened and fatted, including long-chain saturated fatty acids mainly myristic and palmitic acids , ω-6 PUFAs and industrialized trans-fatty acids present high amounts of calories in their composition, which are primarily associated with obesity and its prevalent RDMs Hence, for human behavior changes, joint activities between Universities, Research Centers, Health Ministries, and others will be legally necessary constitution of Departments that could be responsible by outline joint projects and approaches for health promotion through seminars, and lectures to implement in schools Primary and Secondary , enterprises and families to promote healthy food cooking, sale, and intake to pave the way to reduce obesity and its RMDs prevalence — Thus, for behavior change, it is necessary to draw out a joint projects of research institutions and the Health Ministries to schools, enterprises and families to promote healthy food intake to reduce obesity and its related metabolic diseases.

TS, DM, VZ-P, DB, AP, and RG conceptualized the topic, researched and analyzed the literature, wrote the manuscript, and including interpretation. PF, GM, PH, MV, RF, EC, and VN contributed with draft and interpretation and revised the manuscript critically for intellectual content.

All authors have read and approved the final version of the manuscript, ensure the accuracy and integrity of the work, and agree to be accountable for all appearance. This study was financed in part by the CAPES-finance code The study was also supported by research grants from the National Council for Scientific and Technological Development Conselho Nacional de Desenvolvimento Científico e Tecnológico-CNPq.

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. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.

Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

We thank the Graduate Program in Material Sciences, Graduate Program in Biotechnology and Biodiversity, and the Graduate Program in Health and Development in the Central-West Region, Federal University of Mato Grosso do Sul-UFMS for support.

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Several studies suggest that polyphenols and polyphenol-rich foods have very interesting properties regarding the management of obesity and weight loss. Polyphenols promote a healthy profile of intestinal microbiota, decreasing Firmicutes and increasing Bacteroidetes.

Polyphenols may modulate carbohydrate digestion, glucose absorption and gluconeogenesis, thereby helping contain postprandial hyperglycemic excursions. They improve lipid metabolism by decreasing adipogenesis and inhibiting lipogenesis, and stimulating lipolysis and beta-oxidation.

Polyphenol ingestion was also associated with decreased food-intake and thermogenesis stimulation. Nevertheless, the effects described are still subject to debate because human studies are scarce and some results are inconsistent.

Keywords: Absorption , Adipogenesis , Adipose tissue browning , Flavonoids , Food , Food-intake , Lipogenesis , Lipolysis , Metabolism , Microbiota , Polyphenols , Peroxisome proliferator-activated receptor alpha , Peroxisome proliferatoractivated receptor gamma , Sterol regulatory element-binding protein , Obesity , Thermogenesis , Uncoupling protein 1 , Weight loss.

The Relevance of Polyphenols in Obesity Therapy, Recent Advances in Obesity Research Understanding Obesity: From its Causes to Impact on Life 1: The Anatomical Foundations of Regional Anesthesia and Acute Pain Medicine Macroanatomy Microanatomy Sonoanatomy Functional anatomy. Recent Advances in Obesity Research.

Back Understanding Obesity: From its Causes to Impact on Life DOI: Cite as. In comparison with CRD, the efficacy of PA was increased in some studies when polyphenols were added.

It is important to bear in mind that the number of studies that assessed the effects of isoflavones in this review was larger and had longer duration 6 to 24 months. Particularly, mixture isoflavone supplementation genistein, daidzein, glycitein enhances the effects of PA aerobic plus resistance exercise on body composition parameters.

Indeed, a higher loss of body weight and fat after PA plus isoflavone was observed compared to PA alone, in postmenopausal women of non-Asian studies 27 , Although, the mean weight loss of 1.

Isoflavones are flavonoids found mostly in soy products and are known as phytooestrogene due to their anti- and estrogenic properties. Adipose tissue express estrogen receptors, therefore, phytoestrogens may affect body composition directly by binding these receptors 48 , then inhibiting lipogenesis and increasing lipolysis Similarly to our findings, in a previous meta-analysis of RCTs phytoestrogens alone including isoflavones showed a significant decrease in body weight in healthy postmenopausal women that received isoflavone mixture supplementations A subsequent meta-analysis in provided higher effectiveness of overall soy products in pre-menopausal women and in overweight or obese Asian participants The last meta-analysis 15 did not analyze the interaction between soy components and body weight which could have provided more insights into the weight-reducing role of each soy components: isoflavones, protein and fiber Soy protein and fiber may confound the effectiveness of isoflavone by increasing satiety Actually, an earlier meta-analysis that performed separate analysis for soy and isoflavones found anti-obesity effect of soy but not for isoflavone Overall, it is difficult to establish the role of isoflavone in weight and fat loss because there are relevant differences between reviews 15 , 50 , 53 regarding the population ethnicity, menopausal and health status, and type and dose of isoflavone supplementation.

A part from weight and fat loss, isoflavone supplementation showed improvement in liver function 26 , inflammation 27 , 37 , and glycemia in women with insulin resistance Although, two of the studies reported some beneficial effects in the fat free mass 28 , 40 , the majority did not observe any modification 26 , 27 , 37 — Blood pressure and lipid profile of healthy women were not affected by isoflavones.

Actually, the cardio-protective potential of isoflavone is stronger in persons with established hypertension 54 or hypercholesteremia Cocoa and its products e. The addition of 1. From animal studies, it has been suggested that the equivalent dose to a daily amount of 54 g of cocoa powder in human is necessary to have beneficial effects against obesity No additional effects of cocoa occurred in glucose and insulin levels, but beneficial effects were noticed in oxidation status Ibero-Baraibar and coworkers 57 also assessed the effects of cocoa in depression and found a decline of depressive symptoms only in the cocoa group.

This is actually an important finding that could be considered in future cocoa-obesity-related research, as depression and obesity have a bidirectional relationship To our knowledge, few human studies have investigated the implication of grapefruit polyphenols on body weight and fat.

These results are also in accordance with a meta-analysis of three RCTs that reported no influence of grapefruit on body weight The effectiveness of a grapefruit capsule, juice and fruit supplementation on weight has shown to be greater in participants with metabolic syndrome compare to healthy subjects The safety of different forms of grapefruit polyphenols intake at high doses deserves further investigation.

In the RCT by Silver et al. The results of the selected studies in this review were not supportive for any extra anti-obesity effects of green tea polyphenols catechins during CRD treatment. Diepvens et al. Dulloo et al. Another potential explanation of the null effects of green tea could be the ethnicity of the participants of this review.

It has been suggested that green tea may have greater influence in Asian rather than non-Asian participants 62 due to the genetic difference in the catechol O-methyltransferase COMT enzyme Green tea catechins inhibit COMT that degrades norepinephrine, which prolongs the action of sympathetically released norepinephrine, a key mediator to increase energy expenditure and promote the oxidation of fat Caffeine intake is a potential co-factor that should be considered when analyzing green tea activity.

In the RCT of Diepvens et al. The administration of green tea catechins without caffeine could not affect the anthropometric measures The intervention of three months with epigallocatechin-gallate during PA treatment, also, did not result in an additional reduction of weight and fat A meta-analysis of Kapoor et al.

Thus, the relation of epigallocatechin-gallate and body weight, merit prospective research, especially long-term clinical trials. These discrepancies in results indicate that effects of green tea might be more evident in subjects with higher BMI. Incorporating green tea catechins in conventional strategies CRD and PA did not change their effects in glycemia 33 , 41 , 42 , blood pressure 35 , 41 , lipid profile 33 , 41 , 42 , and anti-inflammatory components leptin, adiponectin and C-reactive protein 33 , However, green tea showed a significantly greater decrease of glucose in persons with glucose intolerance 41 , and a higher decline of triglycerides among participants with high triglyceride levels before the intervention Body lean mass was not affected by green tea during PA treatment 41 , One study also reported no influence in exercise performance by considering the changes of oxygen consumption peak VO 2 It is suggested that the improvement of exercise performance by green tea could be attributed, at least partly, to muscle glycogen sparing due to the stimulation of whole-body fat utilization Therefore, this approach have been followed in physically fit subjects and showing an increase of whole-body fat utilization Resveratrol is a stilbene present in the skin of grapes, blueberries, raspberries as well as wine that can improve the metabolic syndrome However, these results 70 presented a large heterogeneity regarding dosage and duration.

Thus, further studies with established doses are warranted for a better comprehension of the anti-obesity potential of resveratrol. Although, weight and fat loss did not reach statistically significance in the Faghihzadeh et al.

Indeed, the current evidence is mostly supportive for the potential liver and cardio-protective effects of resveratrol Our review has some strengths. Firstly, this is the first review summarizing the additional effects of polyphenol supplementation in addition to a conventional obesity therapy CRD and PA.

Secondly, we did not restrict the study selection regarding the gender of participants, their health status, ethnicity, and type of polyphenol supplemented. We considered these differences during the interpretation of the results and a comprehensive understanding of the overall evidence was reached.

However, some limitation should be also considered. The number of eligible and selected studies was small. Non-English studies were excluded, so we probably missed few studies, especially some Asian RCTs. Furthermore, the body composition parameters were not primary outcomes in all the included RCTs, and therefore, some data was missing.

Due to incomplete data and the small number of studies, it was not feasible to perform a meta-analysis. Moreover, the included studies also presented some methodological drawbacks.

Generally, they had a short duration, so the prolonged effects of polyphenols remain unclear. The small number of participants in most of the studies caused a low statistical power to identify significant differences.

The compliance to polyphenol intake among the participants was uncertain in several of the studies. Only two RCTs 32 , 39 measured it by plasma or urine metabolites, five RCTs counted the consumed containers 26 , 34 , 36 , 42 , 43 and eight did not report anything.

Diet and PA outside the study protocol was not controlled in the majority of the RCTs. Moreover, some bias was detected regarding the randomization process, blindness and the missing outcome data bias.

The methodological drawbacks should be considered by future researchers to minimize or avoid them. Findings from this review also suggest that the effects of polyphenols in metabolic parameters might be stronger in patients with already cardiometabolic diseases. Based on the current evidence, the anti-obesity potential of CRD and PA was not improved by adding other types of polyphenols.

There is some evidence suggesting that polyphenols may be more effective in weight maintenance rather than inducing weight loss.

Moreover, new RCTs should also focus on investigating the plausible implicated pathways to obesity, such as energy expenditure, fat metabolism, and appetite.

FL and RZ-R contributed to conception and design, screening of the article, data extraction and assessing the quality of the studies. FL wrote the first draft and RZ-R critically revised and edited the manuscript.

Both authors read and approved the final manuscript. ERDF, a way to build Europe. 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.

RCT, randomized clinical trial; CRD, calorie restricted diet; PA, physical activity; CRD-PP, calorie restricted diet plus polyphenol supplementation; PA-PP, physical activity plus polyphenol supplementation; WC, waist circumference. Swift DL, Houmard JA, Slentz CA, Kraus WE. Effects of aerobic training with and without weight loss on insulin sensitivity and lipids.

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Polyphenols and their anti-obesity role mediated by the gut microbiota: a comprehensive review

French company Fytexia also employs citrus polyphenols for its weight management ingredient Sinetrol—a combination of grapefruit and sweet orange extracts, 26 other flavanones, 13 additional phenolic compounds and caffeine—sold in more than 50 countries.

Among the companies NutraIngredients-USA interviewed, spokespersons cited some combined 70 scientific papers backing the efficacy of their polyphenol-based ingredients or products. Polyphenols impart anti-obesity functions by reducing the digestion of carbohydrates and fats lowering energy intake, the researchers wrote.

The compounds also stimulate energy expenditure, appetite suppression, inhibit the formation of fat cells from stem cells, regulate lipid metabolism and modulate the gut microbiota. The researchers drew a comparison between the incidence of obesity a decade ago among adults in Japan 3. In European countries, consumption was to 1, mg per day.

Explaining how Sinetrol works to alter body composition, Fytexia says that it takes advantage of a process called adipose beiging. This is where white adipose tissue assumes the characteristics of brown adipose tissue, which is highly metabolically active and specialized for burning calories to produce heat.

Some supplements offer a one-two-punch to combat obesity. For this reason, it has been considered as a therapeutic target to treat obesity. Another important factor to consider is the mechanism by which the human body controls energy intake, or calories, through hormonal signaling.

Overweight individuals can generate a resistance to certain hormones involved in the sensation of hunger or satiety. Polyphenols are secondary metabolites from plant metabolism, widely distributed in nature.

The major dietary sources of polyphenols are fruits, vegetables, chocolate and plant-derived beverages like tea, coffee and wine. Polyphenols are mostly absorbed in the small intestine, extensively and quickly metabolized in the liver and appear in the circulation or are excreted into bile and urine as both intact and metabolized forms.

Much attention has been given to polyphenols in the last decades, mainly due to the positive association between the consumption of polyphenol-rich foods and the low risk of chronic diseases like cardiovascular diseases, type 2 diabetes and obesity.

In fact, obesity has increased enormously worldwide and is becoming a threat to public health. Several studies suggest that polyphenols and polyphenol-rich foods have very interesting properties regarding the management of obesity and weight loss.

Polyphenols promote a healthy profile of intestinal microbiota, decreasing Firmicutes and increasing Bacteroidetes. Polyphenols may modulate carbohydrate digestion, glucose absorption and gluconeogenesis, thereby helping contain postprandial hyperglycemic excursions.

They improve lipid metabolism by decreasing adipogenesis and inhibiting lipogenesis, and stimulating lipolysis and beta-oxidation.

Polyphenol ingestion was also associated with decreased food-intake and thermogenesis stimulation. Nevertheless, the effects described are still subject to debate because human studies are scarce and some results are inconsistent.

Keywords: Absorption , Adipogenesis , Adipose tissue browning , Flavonoids , Food , Food-intake , Lipogenesis , Lipolysis , Metabolism , Microbiota , Polyphenols , Peroxisome proliferator-activated receptor alpha , Peroxisome proliferatoractivated receptor gamma , Sterol regulatory element-binding protein , Obesity , Thermogenesis , Uncoupling protein 1 , Weight loss.

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Diet Safe hunger management exercise Polyphenols and weight management the Muscle repair supplements to Polpyhenols weight, but Blood sugar control for diabetics people fail to see noticeable Polyphenosl by eating well wekght increasing their physical activity. If this sounds all too familiar, ensuring maanagement you get the right micronutrients may help you boost your metabolism and lose weight naturally. Read on to discover how specific polyphenols nutrients may support your weight loss efforts. To understand the benefits of polyphenols, you need a basic understanding of metabolism function. Your body needs a constant energy supply to power it around the clock. Your metabolism is what supplies that power by converting the food you eat into energy.

Polyphenols and weight management -

However, the safety of pharmaceutical treatments in the long-term remains questionable as they may cause side effects 8. Moreover, surgical procedures, such as bariatric surgery, are invasive, expensive, and have their own inherent risks, including weight regain 9.

The World Health Organization reported in that more than 1. Therefore, safe, effective and simple alternative strategies for weight loss beyond the conventional ones, are extremely needed and have become a current hot topic in clinical and public health research. Polyphenols are bioactive compounds ubiquitously found in plant-based foods and beverages such as tea, coffee, wine, fruits, vegetables, whole-grain cereals, and cocoa They comprise a large variety of chemical structures which are divided into four main classes: flavonoids, and phenolic acids, lignans and stilbenes A growing body of research indicates that polyphenols may reduce or maintain body weight.

Indeed, after 5 years of follow-up, a significantly inverse association between polyphenol intake and body weight among participants was observed in the PREDIMED Prevención con Dieta Mediterránea study In a cross sectional study on 2, female twins, higher habitual intake of polyphenols was associated with a lower fat mass The relation between different classes of polyphenols and weight loss have also been supported by several systematic reviews and meta-analysis of randomized clinical trials RCTs 15 — Nevertheless, they generally agreed that further and larger studies are still needed to clarify the role of polyphenols in body weight and fat loss.

Overweight and obesity is caused by an imbalance between energy intake and energy expenditure. Weight and body fat loss can be usually achieved by reducing energy intake following a CRD or increasing energy expenditure following a PA program 5.

Fat oxidation is the main pathway affected by PA The metabolism responds to the reduction of energy intake by decreasing energy expenditure and decreasing fat oxidation in order to promote energy storage 6. Energy restriction affects also the neuro-hormonal system by decreasing anorexigenic hormone e.

The limitations of PA are more related to behavioral responses such as changes in eating behavioral, poor compliance to exercise programs and increase of the sedentary activities 7. Moreover, a decrease of the resting metabolic rate occurs during PA 7.

Involvement of polyphenols in weight loss has been proposed due to their anti-obesity properties, such as: i stimulating thermogenesis and energy expenditure 19 ; ii inhibiting adipocyte differentiation and growth 20 ; iii increasing lipolysis and inducing β-oxidation 21 ; and iv decreasing appetite It seems that polyphenols may mimic the PA pathways and strengthen the CRD changes, which led us to hypothesize that their combination may increase negative energy balance, increase fat oxidation, and provide a greater weight and fat loss.

Several animal studies have shown greater weight-lowering effects by adding polyphenol supplements to conventional strategies 23 — 25 , but results from human studies are still inconsistent 26 — However, many factors could affect the discrepancies between animal and human studies, such as: differences in the metabolism and mechanism of actions of polyphenols between animals and humans 29 , and difficulties in controlling the weight, CRD and PA programs, and polyphenol intake in free living humans.

Evidences from human studies have indicated that polyphenol effects are significantly stronger after at least one month of intervention Results on the additional effects of polyphenol supplementation on other obesity-related parameters were also discussed.

The review was designed according to the PRISMA guidelines. Our study protocol was previously registered in the PROSPERO database CRD To identify the articles, we searched in the following databases: PubMed, Web of Science, Cochrane CENTRAL up to December 31st, Reference lists of included manuscripts and relevant reviews were examined for any additional studies not previously identified Figure 1.

Both authors FL and RZ-R independently performed the search and the screen of the articles, and disagreements were discussed until consensus was reached.

The research was limited to English language. Studies were excluded if they applied the polyphenol intervention after the weight loss program, reported incomplete data regarding CRD or PA programs e.

When two publications were identified from the same study, we included only the most completed one regarding the body composition parameters and extracted data from both if it was necessary.

In addition, we extracted data from these studies about the effects of polyphenols on other obesity-related outcomes. Based on the heterogeneity and the limited number of studies, data was only summarized in a descriptive manner and was not meta-analyzed.

In order to facilitate the synthesis and interpretation of the results, we have divided the studies by the type of the lifestyle intervention CRD or PA. The risk of bias of the included studies was independently assessed by both authors FL and RZ-R using the Cochrane RoB2 Tool Disagreements were resolved by discussion until consensus was reached.

Each domain was classified as low risk fulfilling all criteria , medium risk may have some issues that were likely to affect the conclusions , high risk not fulfilling the criteria , and not available insufficient details for judgment.

After screening of the eligible articles, 15 studies were included in this review. Four RCTs assessed the effects of polyphenol supplementation in addition to CRD 32 — 35 , and 11 in addition to PA 26 — 28 , 36 — The reasons for the excluded articles are presented in Figure 1.

Two of the 4 studies that combined CRD with polyphenols were carried out in Spain, one in the United States and the last in the Netherlands. The number of participants ranged from 46 to The RCTs were conducted among healthy adults or subjects without main cardiometabolic chronic diseases.

Detailed characteristics of the studies are presented in Table 1. Table 1. Characteristics of the studies that combined calorie restricted diets with polyphenols.

Three of the 11 studies that combined PA with polyphenols were carried out in Canada, three in Spain, two in Australia, one in United States, one in Iran and one in Brazil. The number of participants ranged from 33 to The duration of the studies was between 3 and 24 months. Nine of the RCTs were done in healthy adults or without cardiometabolic chronic diseases.

Only one RCT included subjects with insulin resistance 38 , while another with non-alcoholic fatty liver disease One Canadian RCT 40 combined an initial period of 6-months of isoflavone or placebo supplementation alone, with 6-months of isoflavone or placebo plus PA treatment.

Except one study that did not informed regard the isoflavones type, the others used an isoflavone mixture supplementation genistein, daidzein, glycitein. Three of them administrated isoflavone supplementation rich in genistein 27 , 37 , 39 , while other three, rich in daidzein 26 , 28 , Participants of 8 studies completed an aerobic exercise or walking program, two a combined program of aerobic and resistance exercise, and one a resistance exercise program.

In addition to PA intervention, one RCT recommended to the participants to follow an energy-balanced diet Also, two Spanish studies instructed their participants to adapt a Mediterranean diet pattern 27 , Detailed characteristics of the studies are presented in Table 2.

Table 2. Characteristics of the studies that combined physical activity with polyphenols. Body weight, BMI, WC, and body fat significantly decreased after both treatments: CRD and CRD-PP Table 3.

No differences were observed between both treatments CRD vs. Table 3. Changes of the outcomes after the intervention with calorie restricted diets and polyphenols. Among the four studies that assessed the effects of isoflavone and reported data for body weight, the Canadian RCT 40 with 12 months of duration showed a significant weight loss after PA-PP treatment but not PA alone Table 4.

Additionally, a study that described the effects of isoflavone in different time-point and reported weight reduce at 6 and 12 months only in the group that received supplementation with isoflavone data not shown Data regarding the effects of isoflavones on BMI were described by six RCTs.

The Canadian RCT 40 , revealed a BMI reduction only in the PA-PP group. Another Spanish RCT 27 with a months duration showed a greater BMI decrease in the PA-PP compared to the PA group.

Table 4. Changes of the outcomes after the intervention with physical activity programs and polyphenols. Isoflavone supplementation plus PA treatment but not PA alone caused a statistically significant total body fat mass loss in two of the RCTs 27 , Moreover, one study reported trunk fat mass loss only in PA-PP group but not in PA alone Two studies that administrated green tea capsule and beverage with small amount of caffeine, did not reported greater results for weight, BMI, WC, and total body fat 42 , Green tea catechins with smaller amount of caffeine plus PA 39 mg caused significant abdominal fat reduce, but not PA treatment alone Twelve of the fifteen selected studied informed about the adverse events due to polyphenols supplementation, while four did not do it 34 , 40 , No adverse events occurred in the rest of the RCTs.

Standardized risk of bias assessment was conducted following these domains: i randomization process; ii deviation from the intended intervention; iii missing outcome data; iv measurement of the outcome; and v selection of the reported studies Table 5.

Three of the RCTs presented a low risk of bias in the five domains 32 , 33 , Statement of randomization was reported, but the randomization method and allocation concealment were not specified in seven studies 28 , 35 , 37 , 38 , 40 , 41 , However, differences between groups at baseline on these studies did not suggest a major problem with the randomization process.

In any case, their bias due to the randomization process was classified at medium risk. Six RCTs did not perform a double-blind design, thus did not fulfill the low risk criteria of deviation from the intended intervention 27 , 34 , 37 , 38 , 41 , Only seven studies were classified at low risk of missing outcome data 28 , 32 — 34 , 36 , 42 , Six of the RCTs did not fulfill the same criteria, mainly for two reasons: i the high rate of drop-outs or loss of follow-up and; ii the lack of an adequate analysis method that correct this bias 27 , 37 — The bias of missing outcome data was not assessed in two studies due to the lack of relevant information for judgment 26 , All studies used objective standardized body composition measures and assessed them properly, thus they were free of bias regarding the measurement of the outcomes.

Selection of the reported results bias was also evaluated at low risk for all included studies. In this review, we have summarized the additional effects of polyphenol supplementation on body weight, BMI, WC, and body fat changes when combined with CRD and PA in adults with overweight or obesity.

Comparing CRD or PA intervention groups with vs. without polyphenols helped to understand how polyphenols affect the efficacy of the CRD or PA on body composition parameters.

The types of polyphenol supplementation were; isoflavone capsule and soybean extract, cocoa extract, grapefruit, and grapefruit juice, epigallocatechin gallate capsule, green tea capsule, and beverage, and resveratrol capsule.

Isoflavone supplementation showed some additional effects in weight and fat loss during PA in overweight or obese postmenopausal women in the non-Asian studies.

No additional effects were indicated for other types of polyphenols during CRD or PA. In addition, these RCTs investigated the effects of polyphenol supplementation on several cardiometabolic parameters related to obesity, showing some protective results on insulin resistance and inflammation markers.

Complementing CRD with one to three months of polyphenol supplementation did not provide any additional effect on weight and fat loss in overweight and obese adults. The results are consistent with findings from a previous review 17 , showing that three months could be insufficient to detect significant polyphenol anti-obesity effects.

CRD triggers adaptive responses by declining energy expenditure, which may persist for at least one year after the weight loss Studies that assessed the effects of polyphenols after diet-induced weight loss found a prevention of weight regain by polyphenols 45 , These findings suggest that polyphenols might be more effective after the dynamic phase of the CRD in order to favor weight maintenance rather than for reducing weight per se during the CRD.

In comparison with CRD, the efficacy of PA was increased in some studies when polyphenols were added. It is important to bear in mind that the number of studies that assessed the effects of isoflavones in this review was larger and had longer duration 6 to 24 months.

Particularly, mixture isoflavone supplementation genistein, daidzein, glycitein enhances the effects of PA aerobic plus resistance exercise on body composition parameters.

Indeed, a higher loss of body weight and fat after PA plus isoflavone was observed compared to PA alone, in postmenopausal women of non-Asian studies 27 , Although, the mean weight loss of 1.

Isoflavones are flavonoids found mostly in soy products and are known as phytooestrogene due to their anti- and estrogenic properties. Adipose tissue express estrogen receptors, therefore, phytoestrogens may affect body composition directly by binding these receptors 48 , then inhibiting lipogenesis and increasing lipolysis Similarly to our findings, in a previous meta-analysis of RCTs phytoestrogens alone including isoflavones showed a significant decrease in body weight in healthy postmenopausal women that received isoflavone mixture supplementations A subsequent meta-analysis in provided higher effectiveness of overall soy products in pre-menopausal women and in overweight or obese Asian participants The last meta-analysis 15 did not analyze the interaction between soy components and body weight which could have provided more insights into the weight-reducing role of each soy components: isoflavones, protein and fiber Soy protein and fiber may confound the effectiveness of isoflavone by increasing satiety Actually, an earlier meta-analysis that performed separate analysis for soy and isoflavones found anti-obesity effect of soy but not for isoflavone Overall, it is difficult to establish the role of isoflavone in weight and fat loss because there are relevant differences between reviews 15 , 50 , 53 regarding the population ethnicity, menopausal and health status, and type and dose of isoflavone supplementation.

A part from weight and fat loss, isoflavone supplementation showed improvement in liver function 26 , inflammation 27 , 37 , and glycemia in women with insulin resistance Although, two of the studies reported some beneficial effects in the fat free mass 28 , 40 , the majority did not observe any modification 26 , 27 , 37 — Blood pressure and lipid profile of healthy women were not affected by isoflavones.

Actually, the cardio-protective potential of isoflavone is stronger in persons with established hypertension 54 or hypercholesteremia Cocoa and its products e. The addition of 1. From animal studies, it has been suggested that the equivalent dose to a daily amount of 54 g of cocoa powder in human is necessary to have beneficial effects against obesity No additional effects of cocoa occurred in glucose and insulin levels, but beneficial effects were noticed in oxidation status Ibero-Baraibar and coworkers 57 also assessed the effects of cocoa in depression and found a decline of depressive symptoms only in the cocoa group.

This is actually an important finding that could be considered in future cocoa-obesity-related research, as depression and obesity have a bidirectional relationship To our knowledge, few human studies have investigated the implication of grapefruit polyphenols on body weight and fat.

These results are also in accordance with a meta-analysis of three RCTs that reported no influence of grapefruit on body weight The effectiveness of a grapefruit capsule, juice and fruit supplementation on weight has shown to be greater in participants with metabolic syndrome compare to healthy subjects The safety of different forms of grapefruit polyphenols intake at high doses deserves further investigation.

In the RCT by Silver et al. The results of the selected studies in this review were not supportive for any extra anti-obesity effects of green tea polyphenols catechins during CRD treatment. Layers of the abdominal wall: anatomical investigation of subcutaneous tissue and superficial fascia.

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J Roy Stat Soc B Met. Download references. We thank the DIRECT-PLUS participants for their valuable contributions. We thank the California Walnut Commission, Wissotzky Tea Company, and Hinoman, Ltd. for kindly supplying food items for this study. We thank Dr. Dov Brikner, Efrat Pupkin, Eyal Goshen, Avi Ben Shabat, Benjamin Sarusi, and Evyatar Cohen from the Nuclear Research Center Negev and Liz Shabtai from Ben-Gurion University of the Negev for their valuable contributions to this study.

This work was supported by grants from the German Research Foundation DFG , German Research Foundation - project number - SFB ; B11 to I. Klöting, and M.

Blüher; Israel Ministry of Health grant to I. Shai ; Israel Ministry of Science and Technology grant to I. Shai , and the California Walnuts Commission to I.

None of the funding providers was involved in any stage of the design, conduct, or analysis of the study, and they had no access to the study results before publication. Department of Medicine, University of Leipzig, Leipzig, Germany. Nora Kloting, Uta Ceglarek, Berend Isermann, Michael Stumvoll, Rita Nana Quayson, Martin von Bergen, Beatrice Engelmann, Ulrike E.

Department of Engineering, Sapir Academic College, Ashkelon, Israel. Helmholtz Institute for Metabolic, Obesity and Vascular Research HI-MAG of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany.

Department of Epidemiology, Harvard T. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T. You can also search for this author in PubMed Google Scholar. HZ had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: IS. Conduct of the study: HZ, AK, AYM, ER, GT, and IS. Collection, management, analysis, and interpretation of the data: all authors. Review and approval of the manuscript: all authors. Statistical analysis: HZ. Supervision: IS.

All authors read and approved the final manuscript. Correspondence to Iris Shai. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Adherence to the intervention. Sensitivity analysis. Inclusion and Exclusion criteria. Physical activity recommendations protocol.

Polyphenol-rich foods, provided at no cost to participants. Magnetic resonance imaging. Clinical parameters, laboratory methodology, and blood and urine polyphenols assessments. Sample size and power calculations.

DIRECT PLUS flow chart. Heatmap of abdominal adipose depots and metabolic and cardiovascular parameters at baseline. Illustrative MRI image. The association between Mankai consumption and lipid profile change among the green-MED group DIRECT PLUS.

Table S1. Outline of dietary and PA recommendations. Open Access This article is licensed under a Creative Commons Attribution 4.

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Download PDF. Research article Open access Published: 30 September The effect of high-polyphenol Mediterranean diet on visceral adiposity: the DIRECT PLUS randomized controlled trial Hila Zelicha 1 , Nora Kloting 2 , Alon Kaplan 1 , Anat Yaskolka Meir 1 , Ehud Rinott 1 , Gal Tsaban 1 , Yoash Chassidim 3 , Matthias Bluher 4 , Uta Ceglarek 2 , Berend Isermann 2 , Michael Stumvoll 2 , Rita Nana Quayson 2 , Martin von Bergen 2 , Beatrice Engelmann 2 , Ulrike E.

Rolle-Kampczyk 2 , Sven-Bastiaan Haange 2 , Kieran M. Tuohy 5 , Camilla Diotallevi 5 , Ilan Shelef 6 , Frank B. Abstract Background Mediterranean MED diet is a rich source of polyphenols, which benefit adiposity by several mechanisms.

Methods In the month Dietary Intervention Randomized Controlled Trial PoLyphenols UnproceSsed DIRECT-PLUS weight-loss trial, participants were randomized to A healthy dietary guidelines HDG , B MED, or C green-MED diets, all combined with physical activity.

Trial registration ClinicalTrials. gov , NCT Background Visceral adipose tissue VAT accumulation is one of the main key factors that differentiate between metabolic healthy and unhealthy obese individuals [ 1 , 2 ].

Results Baseline characteristics DIRECT-PLUS participants Table 1 ; Additional file 1 : Fig. Full size image. Discussion In this month dietary intervention study, the green-MED diet, richer in dietary polyphenols and green plant-based proteins and lower in red meat, might be a more effective strategy for VAT loss than the traditional healthy MED diet achieving more than twice the degree of VAT reduction, despite similar weight loss.

Conclusion A green-MED diet enriched with polyphenols and decreased red meat consumption might serve as an improved version of the MED diet for targeted VAT reduction.

Methods Study design The DIRECT-PLUS trial ClinicalTrials. Outcome measures The abdominal fat depots were assessed at two time points, baseline and 18 months thereafter, using 3-T MRI Philips Ingenia 3. Statistical analysis The co-primary outcomes of the DIRECT PLUS study were month changes in abdominal fat, the previously published intrahepatic fat IHF [ 28 ], and obesity.

Availability of data and materials The majority of results corresponding to the current study are included in the article or uploaded as supplementary material.

Abbreviations CVD: Cardiovascular disease ECG: Epicatechin gallate EGC: Epigallocatechin EGCG: Epigallocatechin gallate FDR: False discovery rate GAE: Gallic acid equivalents HDG: Healthy dietary guidelines IHF: Intrahepatic fat MED: Mediterranean MET: Metabolic equivalent PA: Physical activity SAT: Subcutaneous adipose tissue T2D: Type 2 diabetes VAT: Visceral adipose tissue WC: Waist circumference.

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Since , IDIBELL has been an Accredited Center of the AECC Scientific Foundation FCAECC. Dietary Intake of 91 Individual Polyphenols and 5-Year Body Weight Change in the EPIC-PANACEA Cohort. Mercedes Gil-Lespinard et al. Association between classes and subclasses of polyphenol intake and 5-year body weight changes in the EPIC-PANACEA study.

Jazmin Castañeda et al. Home February Association between polyphenols from diet and body weight change. Association between polyphenols from diet and body weight change. GO BACK.

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Poljphenols of plant Polyphnols have been historically recognized Xnd being beneficial to our weighht since they are rich in bioactive compounds that make them nutritionally very interesting such Blood sugar control for diabetics vitamins, weighy, or polyphenols. Fresh and locally sourced seeds latter are weihht in Polyphenoks, vegetables, anf grains, cocoa, Pumpkin Seed Smoothie oil, red wine, tea, and coffee. In Recovery nutrition guide diet, about individual polyphenols of different classes and subclasses have been identified. Polyphenols have proven to have antioxidant and anti-inflammatory properties among others, in addition, they could prevent or delay the risk of obesity and associated diseases such as diabetes, some types of cancers, or cardiovascular diseases. The Nutrition and Cancer Research Team of the Bellvitge Biomedical Research Institute IDIBELL and the Catalan Institute of Oncology ICO has evaluated the association between polyphenols consumption and body weight change. The results, published in Antioxidant and Obesity scientific journals, show that the intake of most polyphenols is associated with maintenance or a lower weight gain, highlighting those polyphenols present in fruits, vegetables, olive oil, tea, cocoa, or cereals integral. Polyphenols and weight management

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