Effect of diet combined with exercise intervention on tumor necrosis factor α in overweight or obese groups: based on the exercise dose-response relationship

Background: Chronic low-grade systemic inflammation caused by obesity or overweight is associated with multiple complications and risk of disease development. Tumor necrosis factor α (TNF-α) is one of the key inflammatory factors and has a significant impact on all body functions.
Objective: 1) To assess whether combined interventions are more effective than single interventions in combining diet and exercise. 2) To assess the effectiveness of exercise dose in different interventions on tumor necrosis factor (TNF-α) in patients with obesity or overweight.
Methods: Four electronic databases of randomized controlled trials involving exercise or dietary interventions in patients with obesity or overweight were searched comprehensively, including data from the build-up to August 2024. Two independent researchers evaluated the quality of the literature. Pairwise, network, and dose-response meta-analyses were conducted using random effects models to examine the impact of diverse interventions on tumor necrosis factor α.
Results: A total of 19 randomized controlled trials with 1479 patients with obesity or overweight were included. The network meta-analysis showed that the hypocaloric diet combined with aerobic training (HDAT) possessed the highest ranking (SMD= -1.00,95%CI -1.51 to -0.49), followed by hypocaloric diet (HD) (SMD= -0.40,95%CI -0.89 to 0.09), hypocaloric diet combined with resistance training (HDRT) (SMD= -0.48,95%CI- 1.43 to 0.48), and aerobic training combined with resistance training (ART) (SMD= -0.18,95%CI -0.92 to 0.57). In addition, in the hypocaloric diet combined with exercise, a significant improvement in TNF-α levels was observed when the total dose of exercise reached 150 metabolic equivalent of task-min/week.
Conclusion: Based on the GRADE rating guidelines, moderate-quality research evidence suggests that the hypocaloric diet combined with aerobic training (HDAT) is the optimal treatment for improving tumor necrosis factor α in patients with obesity or overweight. Furthermore, the total exercise dose and tumor necrosis factor α levels demonstrated a non-linear dose-response relationship. Future studies should further explore the effects of specific aerobic exercise modalities on inflammatory factor levels in obese or overweight patients to provide a more personalized exercise prescription.

背景：肥胖或超重引起的慢性低度全身性炎症与多种并发症及疾病发生风险密切相关。肿瘤坏死因子α（TNF-α）是关键的炎症因子之一，对全身各项功能具有显著影响。
目标：1）评估结合饮食和运动的综合干预措施是否比单一干预措施更有效。2）评估不同干预措施中运动剂量对肥胖或超重患者肿瘤坏死因子（TNF-α）的影响效果。
方法：全面检索了涉及肥胖或超重患者运动或饮食干预的随机对照试验的四个电子数据库，包括截至2024年8月前的数据。两名独立研究人员评估了文献质量。采用随机效应模型进行了配对、网络和剂量反应荟萃分析，以检验多样化干预措施对肿瘤坏死因子α的影响。
结果：共纳入19项随机对照试验，涉及1479名肥胖或超重患者。网络荟萃分析显示，低能量饮食结合有氧训练（HDAT）的疗效最高（SMD= -1.00，95%CI -1.51至-0.49），其次是低能量饮食（HD）（SMD= -0.40，95%CI -0.89至0.09），低能量饮食结合抗阻力训练（HDRT）（SMD= -0.48，95%CI -1.43至0.48），以及有氧训练结合抗阻力训练（ART）（SMD= -0.18，95%CI -0.92至0.57）。此外，在低能量饮食结合运动干预中，当运动总剂量达到每周150代谢等效任务分钟时，TNF-α水平显著改善。
结论：根据GRADE评级指南，中等质量的研究证据表明，低能量饮食结合有氧训练（HDAT）是改善肥胖或超重患者肿瘤坏死因子α的最佳治疗方案。此外，运动总剂量与肿瘤坏死因子α水平表现出非线性剂量反应关系。未来的研究应进一步探索特定有氧运动方式对肥胖或超重患者炎症因子水平的影响，以提供更为个性化的运动处方。