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Relation
Bobe G, Michels AJ, Zhang WJ, et al. A randomized controlled trial of long-term (R)-α-lipoic acid supplementation promotes weight loss in overweight or obese adults without altering elevated plasma triglyceride concentrations.J Nutr. 2020;150(9):2336-2345.
Study objective
Primary:Evaluate the effectiveness of (R)-alpha-lipoic acid (R-LA) in reducing elevated plasma triglycerides in overweight and obese adults
Secondary:Evaluate the effectiveness of alpha lipoic acid in promoting weight loss and/or improving oxidative stress and/or inflammation
Draft
Randomized, double-blind, placebo-controlled trial
intervention
The duration of the experiment was 24 weeks. Participants received either 2 capsules containing 300 mg R-LA each or matching inert tablets on an empty stomach 30 minutes before breakfast. Researchers asked participants not to change any other aspects of diet or lifestyle over the course of the study.
Participant
The study involved 81 adults (57% women; aged 21 to 60 years; body mass index [BMI] ≥ 25 kg/m2).
All participants had elevated plasma triglycerides (≥100 mg/dL) at baseline.
Study parameters assessed
Primary:
- Plasma-Triglyceride
Secondary:
- Körpergewicht und Körperfettmasse
- Zell- und Plasma-Antioxidantien-Pool und -Kapazität
- Genexpression antioxidativer Enzyme
- Lipidperoxidation
- Zelluläre und plasmatische Entzündungsmarker
- Blutmarker der Immunüberwachung
Primary outcome measures
Change in plasma triglycerides.
Key insights
- Die Plasmatriglyzeride nahmen mit der R-LA-Ergänzung nicht ab.
- Die Behandlungsgruppe hatte nach 24 Wochen eine stärkere Reduktion des BMI als die Placebogruppe (–0,8; P=0,04)
- Nach 24 Wochen verloren Frauen und adipöse Teilnehmer in der Behandlungsgruppe (BMI ≥ 35) am meisten Gewicht (–5,0 % bzw. –4,8 %; beides). P<0,001) und Körperfett (–9,4 % bzw. –8,6 %; beides P<0,005).
- Genexpression von Antioxidantien in mononukleären Zellen, exprimiert durch Hämoxygenase 1 (HMOX1) genetische Expression, war in der Behandlungsgruppe nach 24 Wochen höher.
- Mehrere Marker zur Bewertung von oxidativem Stress und Entzündungen waren in der Behandlungsgruppe nach 24 Wochen niedriger, darunter weniger F2-Isoprostane im Urin (–25 %; P=0,005).
Practice implications
In some people, obesity and overweight are highly correlated with associated health risks, including elevated triglycerides,1.2Inflammation,3and oxidative stress.4
The extent to which these physiological changes may affect overall health5and mortality6is significant and warrants a multidisciplinary approach when working with this patient population.
After 24 weeks, women and obese participants in the treatment group (BMI ≥ 35) lost the most weight.
The road to thoroughly and lastingly implementing fundamental, health-promoting lifestyle changes can be long, arduous, and arduous. It therefore makes sense to use additional tools to improve your BMI. If this support serves directly to improve important physiological factors that might otherwise contribute to eventual pathological changes, it makes even more sense.
Although this study showed no effect on its primary endpoint, the effects observed on various secondary endpoints strongly suggest that R-LA may still fit this bill. The changes in the intervention group may arguably make a more impactful contribution to health than the primary outcome measure.
While this study did not show that R-LA lowered triglycerides, the clear effects on inflammation and oxidative stress that this nutrient appears to have in this patient population make R-LA clinically relevant. This is particularly true when considering the negative effects of inflammation and oxidative stress on hypertriglyceridemia-induced cardiovascular risk.6.7
Theoretically, the lack of effect observed on R-LA's primary outcome measure of plasma triglycerides could be interpreted to mean that there is no benefit from using R-LA. However, triglycerides themselves are not considered directly atherogenic, but rather as biomarkers of risk, as they often correlate with other atherogenic factors.8
In fact, increasing triglycerides can have questionable negative effects when inflammation is under control. Some evidence suggests that significant effects on endpoint markers of cardiovascular disease may occur even if triglycerides increase with treatment when inflammation and oxidative stress improve.9
As always, when treating patients, we should aim for a multi-pronged approach based on fundamental health-promoting principles (diet, exercise, sleep, stress reduction, etc.). However, various real-world circumstances that may come into play during patients' efforts can slow or hinder their progress. Having additional tools like R-LA on board or at the ready can help protect our patients in important ways as they work toward ever-increasing health-promoting lifestyles and improved health status.