Pathophysiology of Obesity-Related Non-communicable Chronic Diseases and Advancements in Preventive Strategies

Abstract

Obesity is characterized by an excessive accumulation of white adipose tissue (WAT) causing increases in body weight and Body Mass Index (BMI >30 kg/m(2)). WAT stores energy and releases free fatty acids, but it is also a dynamic endocrine organ that triggers the production of a wide array of bioactive products such as adipokines, leptin, tumor necrosis factor (TNF-alpha), cytokines and interleukins(IL-1, IL-6, IL-11). Adipokines regulate appetite, insulin sensitivity, angiogenesis, blood pressure and immune response. Leptin reduces body weight. TNF-alpha, cytokines and interleukins are pro-inflammatory and activate atherosclerosis and oxidative stress, leading to the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS). ROS and RNS adversely affects structure and function of cellular membrane and damages DNA. Obesity can be seen as the mother of numerous non-communicable chronic diseases, namely: diabetes mellitus, metabolic syndrome, dyslipidemia, several cardiovascular diseases, nephropathy, neurodegenerative disorders (dementia, Alzheimer's disease), osteoarthritis, sleep apnea, depression, and enhanced risk of breast and colon cancer, resulting in high morbidity and mortality among obese patients. The burden of healthcare for obesity-related diseases is escalating worldwide. This review highlights the incidences of obesity-related diseases and their preventive strategies through synthetic drugs and alternative therapies such as Ayurvedic remedies, herbal medicines, dietary interventions, nutraceuticals, lifestyle modifications, and psychotherapy. Currently nutraceuticals, probiotics, herbal remedies, and Mediterranean-type diets that are rich in fibers, fresh fruits and vegetables, olive oil, fish, poultry and dairy products are being promoted for the prevention and management of obesity-related chronic diseases and metabolic pathologies. Anti-obesity drugs assist with weight reduction by reducing appetite or decreasing the absorption of carbohydrates and saturated fats in the gut. Naturally occurring dietary polyphenols, nutraceuticals, and bioactive ingredients present in plants and spices (resveratrol, green tea catechins, quercetin, berberine, turmeric, cinnamon, red chili, black pepper, fenugreek, thymol, rosemary) are recommended for their anti-obesity actions produced through metabolism stimulation. Phytotherapies or botanical extracts attenuate adipose tissue expansion and cause adipocyte remodeling by altering inflammation-related mechanisms. Several plant-derived remedies such as Ginko biloba, Momordica charantia, Aegle marmelos, Azadirachta indica have anti-oxidant and anti-inflammatory potential, and are indicated for the prevention and treatment of obesity associated metabolic syndrome and chronic diseases such as type 2 diabetes, cancers, kidney pathology, as well as numerous cardiovascular and neurodegenerative disorders. The alternative therapies, healthy foods and exercise interventions are safe and effective therapeutic options to improve metabolism in body and obesity reduction. This review summarizes the mounting evidence that dietary therapies, healthy food habits, and increases in physical activity are helpful in reducing obesity and treating obesity-related complications. The purported underlying mechanisms of complementary and alternative therapies are also discussed.