Huang Tongjiang, Liao Xiaoyun, Zhang Yajun, Wang Pingzhu, Li Peiqi, Fang Jianqiao, Shao Xiaomei
The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Key Laboratory for Research of Acupuncture Treatment and Transformation of Emotional Diseases, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Medicine (Baltimore). 2025 Sep 5;104(36):e44372. doi: 10.1097/MD.0000000000044372.
Multiple non-pharmacological and nonsurgical interventions have demonstrated efficacy in improving abdominal obesity. However, the optimal intervention remains uncertain. This study aimed to assess the relative effectiveness and safety of these interventions in reducing waist circumference, waist-to-hip ratio, waist-to-height ratio (WHtR), body mass index (BMI), and body weight among adults with abdominal obesity.
Eight databases, including PubMed, Web of Science, Excerpta Medica Database, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Database, and China Science and Technology Journal Database, were systematically searched from inception to February 20, 2025 for published randomized controlled trials (RCTs). Methodological rigor was assessed through the Cochrane Risk of Bias tool. After establishing direct evidence through pairwise comparisons in STATA 17.0, we implemented a Bayesian hierarchical model in R 4.4.2 to generate treatment rankings for abdominal obesity interventions.
Thirty RCTs (involving 3334 participants) were included in the meta-analysis. Among the interventions, acupoint catgut embedding (ACE) combined with electroacupuncture (EA), ACE combined with manual acupuncture, ACE alone, high-intensity interval training, and warming needle were the 5 most effective interventions for reducing waist circumference in patients with abdominal obesity. For improving waist-to-hip ratio, the top interventions included low-intensity steady-state training, ACE, EA, high-intensity continuous training, and high-intensity continuous training combined with a calorie-restricted diet, while ACE was the most effective intervention for reducing waist-to-height ratio. In terms of BMI and body weight reduction, ACE combined with EA, warming needle, and ACE ranked as the top 3 effective interventions.
ACE combined with EA achieved the greatest waist circumference reductions among non-pharmacological and nonsurgical interventions for adults with abdominal obesity, with observed benefits extending to secondary outcomes including BMI and body weight. This integrated therapy exhibits considerable potential for clinical management of abdominal obesity. Future large-scale, multicenter RCTs involving diverse populations are warranted to further validate and refine its application.
多种非药物和非手术干预措施已被证明在改善腹型肥胖方面有效。然而，最佳干预措施仍不确定。本研究旨在评估这些干预措施在降低腹型肥胖成年人的腰围、腰臀比、腰高比（WHtR）、体重指数（BMI）和体重方面的相对有效性和安全性。
系统检索了8个数据库，包括PubMed、Web of Science、医学文摘数据库、Cochrane图书馆、中国知网、万方数据库、中国生物医学数据库和中国科技期刊数据库，检索时间从建库至2025年2月20日，以获取已发表的随机对照试验（RCT）。通过Cochrane偏倚风险工具评估方法的严谨性。在Stata 17.0中通过成对比较建立直接证据后，我们在R 4.4.2中实施了贝叶斯分层模型，以生成腹型肥胖干预措施的治疗排名。
荟萃分析纳入了30项RCT（涉及3334名参与者）。在这些干预措施中，穴位埋线（ACE）联合电针（EA）、ACE联合手针、单纯ACE、高强度间歇训练和温针是降低腹型肥胖患者腰围最有效的5种干预措施。对于改善腰臀比，排名靠前的干预措施包括低强度稳态训练、ACE、EA、高强度持续训练以及高强度持续训练联合热量限制饮食，而ACE是降低腰高比最有效的干预措施。在降低BMI和体重方面，ACE联合EA、温针和ACE位列最有效的前3种干预措施。
对于腹型肥胖成年人，在非药物和非手术干预措施中，ACE联合EA在降低腰围方面效果最佳，观察到的益处还扩展至包括BMI和体重在内的次要结局。这种综合疗法在腹型肥胖的临床管理中具有相当大的潜力。未来有必要开展涉及不同人群的大规模、多中心RCT，以进一步验证和完善其应用。
