Resveratrol: uma abordagem de intervenção clínica nutricional e meta-análise de seus efeitos sobre a obesidade e síndrome metabólica

Abstract

Obesity is frequently presented as a chronic and progressive disturbance that leads to a precarious state of health, and increased morbimortality rates. It is characterized by the excessive accumulation of body fat and is currently considered a worldwide epidemic. Obesity's high prevalence, concomitant with health risk factors, is a relevant global public health challenge, along with the increasing prevalence of metabolic syndrome (MetS). The MetS is a systemic chronic pathological condition defined by low-grade inflammation and oxidative state characterized by the presence of three or more independent cardiovascular factors, including central obesity, hyperglycemia/insulin resistance, hypertriglyceridemia, decreased high-density lipoprotein cholesterol (HDL-c), and/or increased low-density lipoprotein (LDL) levels, and increased arterial pressure, each of these factors contributing to the development and progression of the metabolic alterations. The literature demonstrates that resveratrol (RSV) has beneficial effects on the Metabolic Syndrome (MetS) parameters, including improvements in glucose and lipids homeostasis, reduction of fat mass, arterial blood pressure, and low-grade inflammation. The first study was performed in the Nutrition Clinic/Tancredo Neves Ambulatory Specialties Center – CAETAN/Universidade Estadual de Montes Claros/UNIMONTES. The objective was to verify the effects of RSV oral supplementation associated with a nutritional intervention (NI) and the adoption of physical activity on anthropometrical and biochemical parameters. 25 individuals aged from 30 to 60 years old, with Body Mass Index (BMI) ≥ 30kg / m2 were included. Following the primary evaluation (anthropometric and clinical), the individuals were randomly divided into two groups: (1) Placebo: Physical activity + NI + Placebo; (2) RSV: Physical activity + NI + RSV (250 mg/day) for three months. The anthropometric and biochemical parameters were evaluated before and after the treatment period. Oral supplementation with resveratrol improved total cholesterol (TC) (p= 0.031), (HDL-c) (p= 0.026), very-low density lipoprotein cholesterol (VLDL-c) (p= 0.025), urea (p= 0.046), creatinine (p= 0.021) and albumin (p<0.01) levels. The second study aimed to evaluate the RSV supplementation effects on the MetS parameters through a systematic review and meta-analysis. The bibliographic search was carried out in 2021 in the following databases: PubMed, Web of Science, and Scopus. The study was conducted and reported based on the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) recommendations and the statistical analyzes were performed using RevMan Software V.5.3. The studies were selected based on defined inclusion criteria. After the studies selection, 35 clinical studies, comprising data from 1,490 participants, were included. The main findings showed that resveratrol overall effect significantly decreased systolic (MD: - 2.91; 95% CI, -4.57, -1.26; p=0.0006; I 2 : 42%) and diastolic blood pressure (MD: -1.23; 95% CI, -2.32, -0.15; p=0.03; I 2 : 46%), while no significant effects on the waist circumference and high-density lipoprotein were observed. Furthermore, the glucose levels were significantly decreased in the subgroup of the studies who reported mean differences (MD: -9.47; 95% CI: -13.53, -5.40; p < 0.00001; I 2 : 0%), although the overall effect is not statistically significant (p=0.67), while the triglyceride levels increased significantly after the treatment period (MD: 8.12; 95% CI, 1.22, 15.01; p=0.02; I 2 : 28%). The meta-analysis evidenced the potential therapeutic effect of resveratrol on improving some MetS features, especially regarding the SBP, DBP, and glucose reduction, however, the results are still borderline and sometimes controversial, which might be justified by the great methodological, clinical, and statistical heterogeneity of the included studies, the latter varying from 12 to 58%. In conclusion, the main findings of the present study evidenced the resveratrol therapeutic potential, which might potentialize the beneficial effects driven by nutritional intervention and the adoption of physical practice in the MetS treatment.