Via practica 5/2021

Nutraceuticals in obesity management as part of cardiovascular rehabilitation

Obesity is a chronic metabolic disease which incidence and negative effects on the health of the population are increasing worldwide. Insulin resistance (IR) is a key factor in the pathophysiology of obesity and associated cardiovascular (CV) risk factors. The development of IR syndrome involves dominant external influences, such as unhealthy diet (excess of monosaccharides and harmful lipids, as well as animal proteins leading to chronic mild acidosis), environmental toxins burden and lack of physical activity. The clinical and laboratory criteria for IR syndrome are well known, however using other parameters (e. g. adiponectin or postprandial insulin) could help to make the diagnosis in the initial stages of illness. Earlier therapeutic intervention leads to a decrease in the incidence of type 2 diabetes mellitus (DM2T) and CV complications. Professional societies recommend several formulas for medical nutritional therapy of obesity and DM2T. Their common feature is, in particular, the reduction of carbohydrates with the achievement of a regulation in the secretion of insulin and the sensitivity of tissues to its effects. Clinical studies have confirmed the reduction of obesity and DM2 with implementing healthy lifestyle and the socalled functional foods (e.g. extra virgin olive oil or nuts). Nutraceuticals are foods and substances of natural origin. Some of them have a preventive and / or therapeutic effect on IR and its CV complications. The basic mechanisms of their action are IR reduction, antioxidant, hypolipidemic and antihypertensive properties. Among the phytopharmaceuticals, the beneficial effect of the plant alkaloid berberine has been confirmed by relatively strong medical evidence. From minerals, it is possible to use the potential of chromium and magnesium in the reduction of IR and obesity, especially in patients with suspected or laboratory-proven deficiency. Vitamin D and coenzyme Q10 similarly improve insulin sensitivity and several markers in various CV diseases. Management of IR and obesity is an integral part of comprehensive CV rehabilitation, as proper diet and use of appropriate nutraceuticals contributes to a healthy metabolism and reduction of CV risk. It also improves the prognosis in patients with IR and obesity in the case of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection.

Keywords: obesity, insulin resistance, nutraceuticals, cardiovascular rehabilitation, COVID-19