Effect of a Food Supplement with Natural Extracts of Cocoa, Amaranth Seed and Ginger in Overweight or Obese Patients

Clinical trial, randomized, double-blind, controlled with a placebo group, 40 patients between 18 and 60 years of age, with the presence of overweight, will be divided into parallel groups, group A cocoa, amaranth seed and ginger, group B cocoa, group C amaranth, group D placebo, with the objective of evaluating the effect of the nutritional supplement in overweight or obese patients on cytokines, insulin resistance and oxidative stress. The study consists of 4 visits: screening (-21 days), baseline (day 0), follow-up (week 6) and end of the study (12 weeks) and 2 follow-up calls (weeks 3 and 10). For 12 weeks they will take one sachet of the supplement containing cocoa, amaranth seed and ginger or placebo daily. Waist circumference, somatometric parameters, vital signs, nocturnal decrease in blood pressure, ankle arm index, cytokines, glucose, glycated hemoglobin, hs-CRP, lipid profile, insulin, antioxidant effect, blood cytometry, function tests will be evaluated. liver, urea, creatinine, uric acid and urine pregnancy test for women of childbearing age. A 24-hour reminder and frequency of consumption will be carried out to assess the diet at each of the visits and nutritional recommendations will be given. Adherence to treatment (Morisky-Green), adverse events and concomitant treatments will be verified throughout the study.

Overweight and obesity are a public health problem with worldwide prevalence and play an important role in the emergence of chronic diseases. Overweight is characterized by low-grade chronic inflammation and is associated with an abnormal inflammatory response, oxidative stress and low sensitivity. to insulin. Inflammation of adipose tissue is initiated and sustained over time by dysfunctional adipocytes that secrete inflammatory adipokines; elevated proinflammatory stimuli directly affect insulin signaling in target tissues. Oxidative stress alters mitochondrial activity, modifies the concentration of inflammation levels associated with many adipocytes, promotes lipogenesis, stimulates the change of preadipocytes for mature adipocytes and regulates the energy balance in neurons that control appetite. It is also an important regulator. of insulin sensitivity.

The solution to the consequences of obesity and overweight, low-grade inflammation, oxidative stress and insulin sensitivity are based on pharmaceutical treatments and surgical processes, but changes in lifestyle are the cornerstone of treatment, however the patient's adherence to treatment is low and the results are long-term, for this reason some authors have dedicated themselves to looking for alternatives that complement changes in lifestyle and improve health status.

Polyphenols are bioactive compounds that have been shown to influence insulin resistance, oxidative stress and inflammation. There is extensive evidence from clinical studies and meta-analyses in overweight patients to support the effects of this study's supplement on waist circumference, weight, BMI, blood pressure, insulin sensitivity, markers of inflammation, and oxidative stress.

Cocoa has been positioned as a preventive phytopharmaceutical due to its polyphenolic compounds, mainly flavonols with anti-inflammatory and antioxidant effects, which can help prevent or delay the complications of DM2 by modulating insulin secretion.

Amaranth seed is a source of protein, calcium, iron, dietary fiber, vitamin E and D, with a high content of monounsaturated fats and polyunsaturated fatty acids such as squalene, which have been given anti-inflammatory and antioxidant properties, Mozak and collaborators in 2018 did a clinical trial with amaranth seed in overweight patients with favorable results in reducing fasting insulin and the HOMA-IR index.

Ginger has been widely studied due to its potential in reducing glucose, lipid and body fat levels, and has been used as a preventative in chronic diseases. A clinical trial conducted in 2019 by Rahimlou and collaborators included 37 participants with metabolic syndrome, significantly decreased fasting glucose levels and improved insulin resistance.

The objective of the present study is to evaluate the effect of a supplement with cocoa, amaranth seed and ginger in overweight patients on inflammation, insulin resistance and oxidative stress.

Eligibility Criteria:
Inclusion criteria

1. Signed informed consent;
2. Men or women;
3. Age between 18 and 60 years;
4. Waist circumference ≥ 88 cm in women or ≥ 94 cm in men;
5. Plus one of the following criteria:

   * BMI \>25 kg/m2 and not \> 30 kg/m2 in both genders or history of bariatric surgery \> 6 months;
   * Fasting serum glucose of 100-125 mg/dL or HbA1c of 5.7-6.4% or on pharmacological treatment with OAD for prediabetes;
   * Insulin resistance by HOMA \> 2.6 and insulin sensitivity by QUICKI \<0.34;F.
   * Negative pregnancy test.

Exclusion criteria

1. On pharmacological treatment or diet for weight control;
2. Routine use of antioxidants in the last 3 months;
3. BMI ≥ 30 kg/m2 or recent bariatric surgery (\< 6 months);
4. LDL cholesterol \> 160 mg/dL or total cholesterol \> 200 mg/dL, and no treatment for dyslipidemia;
5. Major micro or macrovascular complications due to severe metabolic disease (history of acute coronary syndrome, cerebrovascular disease, peripheral arterial insufficiency or aortic aneurysm);
6. Pregnancy or breastfeeding;
7. Refusal to use an effective contraceptive method for the duration of the study;
8. Hypersensitivity to any of the components of the formula or phenylketonurics;
9. Endocrinological or rheumatic diseases;
10. Patient with recent initiation of vigorous physical exercise or exercise routine for weight loss and/or;
11. Liver or kidney failure by clinical and/or laboratory criteria.