Management of enteral/parenteral therapy in patients with obesity in the light of exosomes/microRNAs: a systematic review

Introduction: Alteration in the homeostasis of the intestinal microbiota is related to the prevalence of obesity, which could reach up to 57.8% of the adult world population by 2030. Likewise, the global incidence rate of type 2 diabetes, which represents 90-95 % of all diabetes cases. Extracellular vesicles (exosomes and microRNAs) have emerged as main vehicles for intercellular and intermolecular communication, including those established between the intestinal microbiota and mammals. Providing adequate nutritional therapy with essential nutrients can help mitigate the consequences of the catabolic response. Objective: It was to bring together the main considerations of enteral/parenteral nutritional therapy in patients with obesity, highlighting the management of inflammatory and metabolic processes through exosomes and microRNAs. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 118 articles were found. A total of 44 articles were evaluated in full and 39 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 22 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =52.5%>50%. It was concluded that exosomes and miRNAs, through enteral/parenteral nutritional therapy, are involved in the control of weight gain, glucose homeostasis, and lipid metabolism. Some clinical studies have shown that enteral nutritional therapy is effective and safe before bariatric surgery, with ketogenic enteral nutrition leading to better clinical outcomes than hypocaloric enteral nutritional protocols in glycemic and lipid profiles to satisfy better regulation of exosomes. and microRNAs, mainly from the intestinal microbiota, for the control of inflammatory and metabolic processes.