An Evidence-based Proposal Of The Acupuncture Treatment For Simple Obesity Based On Network Meta-analysis And Case Series

ObjectiveTo find the optimal acupuncture intervention for simple obesity,based on network meta-analysis,formulate an evidence-based scheme with the combination of expert experiences and included studies’regimens.Evaluate the effect and safety of evidence-based proposal by case series to provide reference for better design of RCTs.MethodsRelevant databases including China National Knowledge Infrastructure,Chinese Biomedical Literature Service System,Wanfang database,Cochrane Library,PubMed,Medline University Resource Center and EMBASE were retrieved from their establishment to September 30,2019.After a rigorous screen,the quality of included research was assessed,and general information was extracted.Heterogeneity and consistency tests were performed by STATA 14.0 and GeMTC 14.3,respectively.The combination of direct evidence and indirect evidence was used to select the best intervention.Then,the evidence-based proposal was developed combining the expert experience and the included schemes in network meta.7 Patients were collected after strictly selecting from The First Affiliated Hospital of Guangzhou University of Chinese Medicine and publicity posters.The treatment was the evidence-based proposal from network meta-analysis,once on alternate days,three times a week for 4 weeks.BMI,BM,WC,HC,WHR and subcutaneous fat fullness were recorded before treatment,2 and 4 weeks after the start of treatment.Adverse reactions were recorded after each treatment.Data analysis and safety evaluation were conducted after the study.Results1.A total of 1590 studies were retrieved,and 102 qualified studies were initially included.The improved JADAD scale was used for quality evaluation.The results showed that 86 literature with scores ranging from 0 to 2,accounting for 84.3%,and 16 literature with scores ranging from 3 to 7,accounting for 15.7%.In terms of random sequences,89.2%of the studies involved the generation of random sequences,and 48.0%described specific random methods.In terms of concealment of allocation and blinding,only 8.8%of research described randomized methods and 12.7%were blind to researchers.In terms of withdrawal,84.3%did not report or described only the cause or quantity of shedding.2.There was little heterogeneity between the catgut embedding group and placebo group in BMI,BM and WC,as well as the auricular acupuncture group and placebo group in LDL and HDL.There were no differences between the direct and indirect evidence in closed loops showed by consistency tests and node segmentation methods.3.The network meta showed that the decrease of BMI in warm acupuncture group was statistically significant(P<0.05)compared with that in the catgut embedding group,electroacupuncture group,auricular acupuncture group,acupuncture group,placebo group and blank group.The differences in WC between the warm needle group and acupuncture group were statistically significant(P<0.05).There were no differences(P>0.05)in BM,BMI,WHR and subcutaneous fat fullness before and after treatment.No serious adverse events occurred.Conclusions1.Based on the network meta-analysis of the published high-quality randomized clinical trials,electroacupuncture has the highest probability of being the optimal measure.2.The optimal proposal can effectively reduce the WC and HC of patients with simple obesity,and it is probably related to the decrease of BMI,BM and subcutaneous fat fullness in this trial.3.It is feasible to integrate a large amount of evidence and formulate an evidence-based treatment based on network meta-analysis.4.In order to enhance the credibility of studies,researchers should focus on the design of randomization concealment and blind method.The differences between acupuncture treatments should be further explored.5.Researchers should improve measurement systems of simple obesity and pay attention to the intervention bias caused by the diet and exercise.