Potential of edible plant in regulation of obesity and metabolic abnormalities (svcp)

Potential of edible plant in regulation
of obesity and metabolic
abnormalities
Presented By:-
Vikas Kumar Jain
M. Pharm. (Pharmacology), M.B.A.
PhD (Persuing)
Assist. Professor
Acropolis Institute of Pharmaceutical Education & Research (AIPER) Indore

Contents
 Introduction
 Epidemiology
 Definition and Criteria of Obesity
 Pathogenesis of Obesity
 Inter abdominal adiposity and metabolic risk
 Pharmacotherapeutic Approaches
 Herbal Approaches
 Conclusion
 References
2AIPER, Indore01/11/2017

Introduction
• Rapid globalization & industrialization occurring in developing
countries has increase in life style related diseases.
• Obesity is a growing public health problem, and in many countries
has reached epidemic proportions. Overweight and obesity is
considered a problem only in high-income countries, but those are
now on the rise, dramatically, in low- and middle-income countries.
• Being overweight constitutes a health risk as it is associated with
several comorbidities including type 2 diabetes mellitus (T2DM),
cardiovascular diseases, hypertension, dyslipidemia,
hyperuricaemia, respiratory diseases, osteo-arthritis and
depression. Predisposition of obese patients to diabetes and
cardiovascular disease is called the ‘metabolic syndrome’,
‘syndrome X’, or ‘diabesity’.

Epidemiology
• According to the WHO World Health Statistics Report 2012:- 2.8
million individuals die each year due to overweight or obesity.
WHO Recent finding shows 2.3 billion overweight and 700 millions
adipose adult worldwide in 2015.
• According to the International Obesity Taskforce, more than 300
million people who have a body mass index greater than 30 kg/m²
are categorized as obese, that are increasing at an alarmingly high
rate, generating enormous social costs.
• It is expected that in 20 years nearly 600 million adults will
become diabetic because of the high obesity prevalence, aging,
high population growth, increase in living standards, increased
urbanization, and high-calorie fast food consumption.

Definition and Criteria
• Obesity is defined as an excess adiposity for a given body size,
results from an imbalance between energy intake and energy
expenditure. Body mass index (BMI), measured as body
weight in kilograms over the square of the height in meters
(kg/m2), and represents a widely accepted measure of
adiposity.
• Abdominal fat is defined by increased waist circumference,
represents an additional risk factor.
• Overnutrition, including excess consumption of fat and
carbohydrate, clearly plays a crucial role in the development
and progression of obesity.

Waist Circumference & BMI
Adopted from “Preventing and Managing the Global Epidemic of obesity, Report of the World Health Organization of Obesity” WHO Geneva, June 1997
* Disease risk for type 2 diabetes, hypertension and CVD,  Increased waist circumstance can also be a marker
for increased risk even in person of normal weight.
Table 1: - Classification of Overweight and Obesity by BMI, Waist Circumstance, and Associated
Disease Risk*
BMI
(kg/m2)
Obesity Class Disease Risk* (Relative to Weight and
Waist Circumstance)
Men 40 in (102 cm)
Women 35 in (88
cm)
> 40 in (> 102 cm)
> 35 in (> 88cm)
Underweight <18.5 - -
 18.5-24.9 - -
Overweight 25.0-29.9 Increased High
Obesity 30.0-34.9 I High Very High
35.0-39.9 II Very High Very High
Extreme Obesity 40 III Extremely High Extremely High

– x 2 early childhood
– x10 age 10 years
–x20 adolescence
Obesity tracks
into adulthood
Type 2 DiabetesObesity
Obesity, IGT
+ complications
Natural history of obesity

Diets and obesity
9
Epidemiological evidence for a relationship between fat intake and obesity was proved by a statistically
significant relationship between energy-adjusted fat intake and one or more measures of obesity.
AIPER, Indore01/11/2017

Metabolic
Syndrome
Visceral
adiposity
Insulin
Resistance
Cardiovascular disease
Dyslipidemia Type 2 Diabetes Hypertension
Stress
Pathogenesis of obesity

Lewis GF et al Endocrine Review 2002, 23, 201

Pro-atherogenic:
 atherothrombotic risk
PAI-1
 in IAA
Pro-atherogenic/pro-diabetic:
 insulin sensitivity in adipocytes (paracrine)
TNFa
 in IAA
Pro-atherogenic/pro-diabetic:
 vascular inflammation  insulin signalling
IL-6
 in IAA
Anti-atherogenic/antidiabetic:
 foam cells  vascular remodelling
 insulin sensitivity  hepatic glucose output
Adiponectin
 in IAA
Properties of Key Adipokines
IAA: intra-abdominal adiposityMarette A. Curr Opin Clin Nutr Metab Care 2002;5:377-83.

TG and
HDL cholesterol
ß cell function
BG
Adipocytokines & FFA
Insulin resistance
CVS and renal complications
Obesity - A Unifying Hypothesis
Aging
Family history
(Genetics or
shared environment)
Psychosocial
stress
Visceral fat
GH and IGF-1
Testosterone (M)
Testosterone (F)
Cortisol
SNS
RAAS BP
Activated immunity
Adapted from Björntorp P. Obes Res 1993; 1: 206-22 and Chan JCN et al. Diabetes Care 1995; 18: 1013-6. Luk A and Chan JCN Diabetes Res Clin Pract 2008: 82
Suppl 1:S15-20

17
• The regulation of energy homeostasis for metabolic diseases is
one of the most rapidly advancing topics in biomedical research
today. Breakthrough in understanding the molecular
mechanisms regulating body weight have also provided
potential opportunities for therapeutic intervention and has
brought renewed hope and vitality for the development of
antiobesity drugs.
• Despite the plethora of research data available on obesity, it
still remains, largely, an unsolved medical problem. The market
for antiobesity drugs is potentially huge, as it accounts for 2–6%
of total health care costs in several developed countries.
Pharmacological Approaches
AIPER, Indore01/11/2017

Pharmacological approaches
S.No Class of Drugs Examples
1 Centrally acting
sympathomimetic
(Amphetamine
derivatives)
NE release / NE reuptake inhibitor:
Phentermine, Diethylpropion, Phendimetrazine,Desoxyephedrine
NE & 5HT reuptake inhibitor:
Sibutramine
2 Serotonergic
agents
Non selective: Fenfluramine,
Dexfenfluramine. Selective: Lorcaserin
3 CB1 receptor
antagonist
Rimonobant, Taranabant, Otenabant,Surnibant, Ibipinabant
4 Lipase inhibitors Orlistat, Cetilistat
5 Anti DM drugs Exenetide, Liraglutide (GLP1 analogs), Metformin (Biguanide),
Pramlinitide (Islet amyloid peptide), Dapogliflozin (SGLT-2 Inhibitor)
6 Antidepressant Bupropion
7 Anti-epileptic drugs Topiramate, Zonisamide
8 Experimental
peptides
Leptin, peptide YY, Oxyntomodulin, Melanocortin 4 Receptor agonist
9 Combination drugs Phentermine – Topiramate, Naltrexone – Bupropion

Herbal approaches
• Different methods have been used to reduce body weight and its
complications for many years. Disappointing results after cessation the
lifestyle modification or pharmacotherapy compelled the researchers
and physicians to rethink to find a new, safe, and striking therapeutic
alternative for this global health concern.
• Herbal medicines have been in attention as an effective option to
reduce body weight and body fat.
• The use of natural remedies for weight loss has increased, based on
reliability, safety, and cost compared with synthetic drugs or surgical
procedures, which may have limitations.
• Many scientific communities have become increasingly interested in the
molecular regulation of triglyceride synthesis, fatty acid oxidation and
low-level chronic inflammation through the phyto-chemicals,
presenting an exciting opportunity for the discovery of newer anti-
obesity agents.

Edible plant
• Wild edible plants provide a major dietary source for
phytochemicals with potential anti-obesity properties, with
the types and levels varying markedly between species
because they contained various phytoconstitiuent like
flavonoids, total phenolics, anthocynanin and ascorbic acid.
• Various edible plant extracts act as anti-obese agent through
inhibiting pancreatic lipase activity, enhancing thermogenesis,
preventing adipocyte differentiation, enhancing lipid
metabolism and decreasing appetite.
• Flavonoids regulate carbohydrate digestion, adipose
deposition, insulin release, and glucose uptake in insulin-
responsive tissues through numerous cell-signaling pathways.

Edible plant
• Flavonoids are a diverse group of polyphenolic compounds primarily
known as the pigments responsible for producing the many colors
present in flowers, fruit, and leaves. These polyphenolic compounds
were well known for their medicinal properties in health long before .
Over the last 20 years, a significant amount of research has focused on
polyphenol compounds of plant origin because of their potential
benefits in human health.
• A number of clinical and research studies have suggested that
Flavonoids have positive effects in the treatment, prevention, and
alleviation of various diseases.
• Numerous in vitro cell and in vivo animal studies support the beneficial
effects of dietary Flavonoids on glucose homeostasis for the prevention
and treatment of obesity and diabetes.

Flavonoids and their subsequent effects

Few herbal plants for treatment of obesity
S.No. Mode of Action Herbal preparations
1. Inhibiting pancreatic lipase activity Chitosan, Levan, Mate tea, Oolong
tea, Jasmine tea, Green tea
2. Enhancing thermogenesis Sea weed, Bitter orange, Soybean
3. Preventing adipocyte differentiation Turmeric, Capsicum, Palm oil, Banana
leaf, Brown algae, Garlic, Flaxseed,
Black soybean
4. Enhancing lipid metabolism Herb teas, Cinnamon
5. Decreasing appetite Pine nut, Pomegranate leaf, Ginseng,
Hoodia gordonii

01/11/2017 AIPER, Indore 25
Some marketed herbal preparations

Reasons to prefer herbal products
• Health benefits of weight loss without any side effects.
• Less demanding than accepted lifestyle changes, such as
exercise and diet.
• Easily available without a prescription.
• More easily accepted than a professional consultation
with a physician or a nutritionist.
• 100% natural origin and perception that natural means
safe.

Ideal herbal remedy for obesity
Consistent and safe herbal product for weight reduction is a needed to
assess the suitability as an anti obesity product. Salient futures for an ideal
herbal product for the management of obesity.
• Should bring down the body weight by 10% over placebo in a well
designed randomized placebo con-trolled clinical trial.
• Should show evidence of improvement of bio mark-ers like blood
pressure, lipids and glycemia.
• Should have known mechanism of action.
• Should be standardized with bioactive phytochemicals which is/are
responsible for anti obesity activity.
• Should not have any kind of side effects

Conclusion
• A better understanding in the existing evidence will further guide a
qualitative research in obesity management that will attract the end
users by the effective benefits.
• True randomized, double blinded, placebo-controlled clinical trials
using herbal products will demonstrate their potential benefits.
• Significant weight loss after placebo sub-traction along with known
mechanism of action are required in order to generate conviction
amongst users as effective agent for weight management.
• With its growing worldwide prevalence, the mushrooming market for
Anti-obese drugs and the vast sum of money is at stake and assures
that research in this therapeutic area will not slow down within the
foreseeable future.

References
• Hossain M K et al., “Review: Molecular Mechanisms of the Anti-Obesity
and Anti-Diabetic Properties of Flavonoids” Int. J. Mol. Sci., (2016),
17:568-609.
• Hasani-Ranjbar et al., “ A systematic review of anti-obesity medicinal
plants - an update” Journal of Diabetes & Metabolic Disorders (2013),
12:28-40.
• Chandrasekaran C.V et al., “Review Article: Herbal Approach for Obesity
Management” American Journal of Plant Sciences., (2012), 3:1003-1014.
• Obesity and overweight fact sheet. WHO. Accessed on 21/12/2015 from
http://www.who.int/mediacentre/factsheets/fs311/en/
• Grundy SM et al., “Hypertriglyceridemia, insulin resistance, and the
metabolic syndrome” Am J Cardiol (1999) 83:25F-29F
• Guariguata L et al., “Global estimates of diabetes prevalence for 2013 and
projections for 2035” Diabetes Res. Clin. Pract. (2014), 103, 137–149.

01/11/2017 AIPER, Indore 31
Vikas Kumar Jain
M. Pharm. (Pharmacology),M.B.A

Potential of edible plant in regulation of obesity and metabolic abnormalities (svcp)

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