Discussion
obesity, tumor necrosis, inflammation, hypertensive, metabolic syndrome, weight loss, dryness
OBESITY, OBESE, TUMOR NECROSIS, INFLAMMATION, DYSFUNCTION, SYSTEMIC HYPERTENSION, INTERSTITIAL FIBROSIS, METABOLIC SYNDROME
This study proved that exercise (HIIAB) can significantly relieve DE symptoms. DE relief can be also maximized by the additional effect of MD in obese hypertensive elderly with DE. The mechanism that explains the effect of MD or exercises on DE is not fully sufficient in the literature.The popularity of MD in improving cardiovascular risk factors (including obesity) [The included olive oil, vegetables, poultry, nuts, cereal products, and sometimes meat are main sources of some essential fatty acids (EFAs) as omega-6 EFAs (O6EFAs). The included marine oil and fish are sources of other EFAs, omega-3 EFAs (O3EFAs) [It is supposed that the good choice to within-diet healthy foods maintains the ratio of O6EFAs: O3EFAs within 1:1. This ratio can maintain regular inflammatory and immune responses within the human body. Some unhealthy Western diets are low in O3EFAs, so the ratio become 17:1 [The high level of O6EFAs accelerates the production of pro-inflammatory mediators including PGE2 and LTB4. The low level of O3EFAs cannot block the formation of interleukins and tumor necrosis factor-alpha. A higher O3EFAs to O6EFAs ratio exerts an anti-inflammatory and immune-enhancing effect. The health advantages of dietary O3EFAs consumption have been documented for DE [As an alternative to oral supplementation, the integrative components of MD foods contain the needed O3EFAs and O6EFAs for the maintenance of healthy connective tissue [As it was previously proven in immortalized epithelial cells of the human meibomian gland, the regular administration of O3EFAs and O6EFAs can improve the quality and quantity of intracellular lipids that maintain tear production from the lacrimal gland [Virgin olive oil, as an MD component, contains a large oleic-acid (monounsaturated fatty acid) content. This fatty acid protects the organs’ tissue against oxidative damage. Also, hydroxytyrosol, as a phenolic compound present in virgin olive oil, has anti-oxidative, anti-inflammatory, and neuroprotective properties. These properties may exert their effects on the health of the cardiovascular system [Regarding exercise, the exercise-induced harmony between the sympathetic and parasympathetic nervous systems may be the cause of increased tear production. This regulated harmony can stimulate the within-eye epithelial sodium channels. This stimulation, in turn, can increase sodium reabsorption which plays a vital role in the maintenance of water and electrolytes found in produced tears [As it was evidence-based in the literature, exercise-induced reduction of adipose tissue improves the associated cascades of chronic low-grade systemic inflammation present in cardiovascular risk factors [Despite the low number of published studies, a recent study supported our results because its authors documented a decrease in tear production (assessed by Schirmer’s test) in systemic hypertension patients when matched with normal control subjects [The results of a relatively new published animal study supported our results. This animal study stated two facts. The first fact was the low rate of tear production in obese mice. The second one was the ability of exercise to increase this rate in addition to the suppression of reactive oxygen specimens (ROS) found in the lacrimal gland of this obese mouse [Another study conducted on rats in 2010 showed that CR is a new therapeutic tool that can be utilized to prevent age-associated dryness of the eye or lacrimal gland dysfunction. This animal study concluded that there is a positive role of a 6-month CR approach in the significant improvement of tear volume, tear protein, oxidative-stress-related destruction in the lacrimal gland, and preservation of lacrimal gland functions and structures (decreased interstitial fibrosis, preserved mitochondrial structure, and increased density of acinar unit of lacrimal gland) [The published studies assessing the effects of lifestyle changes on human DE are very low. Supporting our opinion, weight loss through 6-month lifestyle changes (MD alone or combined with 45-min walking/day) can cause a significant improvement of TBUT, OGS, DESS, Schirmer’s test, and OSDI questionnaire in DE participants with metabolic syndrome [Supporting the role of exercise in preventing DE, another study showed a significant increase in tear production and a decrease of tear cytokines after involving 43 without-DE healthy participants aged = 23.3 ± 3.6 years in one session of moderate intensity 0.5-h aerobic exercise on a treadmill [Also, another study reported an association between DE and sedentary behavior or lower level of energy expenditure in humans [Despite the observed improvement of subjective symptoms and the number of definite criteria diagnosing DE, the results of objective tests (staining score, TBUT, and Schirmer’s test) conducted by Kawashima et al. [