4. Discussion
obesity, FM, inflammation, gastrointestinal (GI) functions, failure of weight loss, satiety, weight loss
OBESITY, INFLAMMATION, CHRONIC RENAL FAILURE
The results of the present study indicate that overweight/obese adults attending Outpatients Clinic of the Departmental program “Diet therapy in transplantation and chronic renal failure”, School of Medicine, “Federico II” University of Naples, treated with the supplementation of The study justified the choice of Our results are in agreement with those of a previous study where Jung and coworkers investigated the effects of dietary cinchonine on the reduction in high-fat-diet- (HFD) induced adipogenesis and inflammation in a mouse model. In particular, the authors showed that HFD-fed mice treated with 0.05% dietary cinchonine for 10 weeks presented a reduction in body weight as well as an improvement in blood parameters, such as triglycerides, cholesterol and glycemia, accompanied by an attenuation in proinflammatory cytokine production. Therefore, the authors suggested that cinchona is able to prevent obesity due to its effects on adipogenesis and inflammation [Furthermore, adults belonging to the treated group showed a surprising reduction in the percentage of FM compared with that in the placebo group, confirming previous data presented by Cettour-Rose and coworkers, who studied the effect of 0.1% quinine on body weight and body composition in male mice fed a balanced diet. In particular, they showed that quinine, a cinchona alkaloid belonging to the aryl-amino alcohol group of drugs, is effective in the management and control of body weight and fat mass without affecting food intake. Therefore, the authors indicated that this could represent a novel tool to counteract obesity [It is interesting that adults belonging to the treated group revealed greater satiety throughout the duration of treatment, suggesting that nutraceutical treatment with cinchona is able to modulate gastrointestinal (GI) functions, including intestinal hormones, leading to an increased satiety and the consequent fine modulation of energy intake.The results of this study indicate that the treatment with cinchona plus hypocaloric diet was accompanied by an interesting resetting of hormonal secretion by intestinal endocrine cells. The hypocaloric diet in the P-group, indeed, induced a decrease in CCK secretion and blood levels, as previously observed in the induction of weight loss via hypocaloric diet treatment. However, it is worth noting that the chinchona supplementation plus the hypocaloric diet did not modify the CCK secretion and blood levels, suggesting that cinchona was effective in facilitating CCK secretion, which was sequentially accompanied by higher satiety in the adults, as detected in our T-group. Therefore, CCK secretion and unmodified blood levels trigger the adaptation to weight loss induced by cinchona, as characterized by a decrease in hunger stimulation and better compliance to the hypocaloric diet. This likely suggests that this adaptation facilitates weight loss with a real improvement in all the morphometric and functional parameters under all time periods of treatment in our treated cases compared to those in the placebo group. On the other hand, in the P-group, the decrease in CCK secretion and blood levels indicate that the risk of hunger stimulation may play a key role in major alterations or failure in weight loss management.In conclusion, weight loss management triggers the adaptation of circulating hormones, which is characterized by a decrease in CCK secretion with the consequent risk of failure of weight loss maintenance. Supplementation with cinchona in a hypocaloric diet facilitates higher circulating levels of CCK, which are effective in promoting patient satiety and reducing the risk of hunger stimulation and failure in weight loss attempts. These data call for further studies to clarify the complex interplay of different gut-derived hormones in the modulation of food and energy intake.