Zeng Bing-Yan, Zeng Bing-Syuan, Chen Yen-Wen, Hung Chao-Ming, Sun Cheuk-Kwan, Cheng Yu-Shian, Stubbs Brendon, Carvalho Andre F, Brunoni Andre R, Su Kuan-Pin, Tu Yu-Kang, Wu Yi-Cheng, Chen Tien-Yu, Lin Pao-Yen, Liang Chih-Sung, Hsu Chih-Wei, Tseng Ping-Tao, Li Cheng-Ta
Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.
Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan.
Int J Obes (Lond). 2021 Aug;45(8):1705-1716. doi: 10.1038/s41366-021-00833-2. Epub 2021 May 10.
BACKGROUND/OBJECTIVES: Obesity has recently been recognized as a neurocognitive disorder involving circuits associated with the reward system and the dorsolateral prefrontal cortex (DLPFC). Noninvasive brain stimulation (NIBS) has been proposed as a strategy for the management of obesity. However, the results have been inconclusive. The aim of the current network meta-analysis (NMA) was to evaluate the efficacy and acceptability of different NIBS modalities for weight reduction in participants with obesity.
Randomized controlled trials (RCTs) examining NIBS interventions in patients with obesity were analyzed using the frequentist model of NMA. The coprimary outcome was change in body mass index (BMI) and acceptability, which was calculated using the dropout rate.
Overall, the current NMA, consisting of eight RCTs, revealed that the high-frequency repetitive transcranial magnetic stimulation (TMS) over the left DLPFC was ranked to be associated with the second-largest decrease in BMI and the largest decrease in total energy intake and craving severity, whereas the high-frequency deep TMS over bilateral DLPFC and the insula was ranked to be associated with the largest decrease in BMI.
This pilot study provided a "signal" for the design of more methodologically robust and larger RCTs based on the findings of the potentially beneficial effect on weight reduction in participants with obesity by different NIBS interventions.
背景/目的：肥胖最近被认为是一种神经认知障碍，涉及与奖赏系统和背外侧前额叶皮质（DLPFC）相关的神经回路。非侵入性脑刺激（NIBS）已被提议作为管理肥胖的一种策略。然而，结果尚无定论。当前网络荟萃分析（NMA）的目的是评估不同NIBS方式对肥胖参与者体重减轻的疗效和可接受性。
使用NMA的频率学派模型分析了检查NIBS干预肥胖患者的随机对照试验（RCT）。共同主要结局是体重指数（BMI）的变化和可接受性，可接受性通过脱落率计算。
总体而言，当前由八项RCT组成的NMA显示，左侧DLPFC的高频重复经颅磁刺激（TMS）在BMI下降幅度方面排名第二，在总能量摄入和渴望严重程度下降幅度方面排名第一，而双侧DLPFC和脑岛的高频深部TMS在BMI下降幅度方面排名第一。
这项初步研究基于不同NIBS干预对肥胖参与者体重减轻的潜在有益影响的研究结果，为设计更具方法学稳健性和更大规模的RCT提供了一个“信号”。
