Effectiveness of Yoga, Fast of Dawood, Green Tea and Apple Juice as Suppressors of PPAR-γ, C/EBP-α, and SREBP-c for Management of Obesity on Adolescents

Article Info: ABSTRACT Submitted: 10-10-2021 Revised: 05-12-2021 Accepted: 21-12-2021 Obesity is a condition that can increase the risk of some diseases such as reduced brain capacity, dyspnea, skin irritation, hypertension, and diabetes. Proper treatment is needed to overcome the problems of obesity. The objective of this study was to investigate the effectiveness of Yoga, fast of Dawood, Green Tea, and Apple juice to manage obesity in adolescents. The method used in this study was a literature review from journal publications through the database ScienceDirect, PUBMED, and google scholar, and the criteria were Indonesian and English with a range of publication years 2014-2021. Ten main articles were used as references in this study. These articles proved that yoga therapy could maintain the balance and health of the physical, emotional, and spiritual dimensions, and Fast of Dawood can limit the amount of calorie intake at a particular time. Moreover, consuming green tea as a source of polyphenol derivatives and apples with high of flavanol, anthocyanidin, dihydrochalcones, and hydroxycinnamic acid could decrease adolescents' body weight. Yoga and Fast of Dawood exercise can reduce adipogenesis and induce reverse cholesterol transport, cellular cholesterol released, reduced pro-inflammatory cytokines dan decreased the incidence of obesity.


INTRODUCTION
Obesity is a condition caused by fat accumulation in adipose tissue, the complication of obesity was low brain capacity, dyspnea, skin rash, hypertension and diabetes mellitus. The prevalence of obesity in girls is 10% higher in 10 countries. In 2015, 19,5% of the adolescent population was obese across the OECD countries, including Indonesia (Hamann et al., 2017). In Indonesia, the prevalence of obesity in adolescents aged 13-15 was 8.0%. Prevalence of obesity in senior high school (16)(17)(18) in Aceh found 2,7% had. The number of obese girls is higher (3,2%) than Indonesian boys (2,2%) (Prameswari, S, P, I., S, Aisah, 2013).
The general problem of obesity is related to energy balance and influenced by internal factors and external factors. Those are the type of lifestyle and low physical activity. The critical factor of obesity in adolescents is a low physical activity which is reported in previous researches such as: watching TV and playing games on a computer for a long time, consumption of junk food, economic status of the family, and history of obesity in the family (Mistry et al., 2014).
Management of obesity consists of two main treatments: diet treatment and exercise treatment. Diet treatment for obesity in adolescents includes modifying dietary intake, especially for the quantity and the quality of food intake (Tyson & Frank, 2018). Fast of Dawood is a well-known type of fasting that can arrange the quantity of food intake regularly and consistently. The quality of food intake can be arranged with the lower dose of sugar, fewer low nutrient foods, and more high nutrient foods (fruits and vegetables). Green tea and apple juice were known as optional nutrients to lose weight. Thus, both things can be optional treatments for adolescents with obesity. Exercises treatment for obesity includes increasing physical activity and reducing sedentary activity. Yoga treatment was an exercise to provide a balanced, healthy physical dimension, mental, emotional, and spiritual. (Bernstein et al, 2014;Dhananjay et al, 2013).
Based on the above phenomenon, the authors are interested in conducting a literature review that aims to determine the effectiveness of Yoga, fast of Dawood, green tea, and apple juice as obesity management for adolescents to prevent complications and maintain their weight. The article included in this study (n = 10) Records rejected because the topic is not for obesity or overweight (n =780), dan articles excluded due to the duplication (n=454)

RESULT
A total of 10 articles were reviewed based on the following articles search results The results showed that the intervention group experienced a decrease in body weight (-1.7 ± 1.3 kg), BMI (-0.6 ± 0.5 kg/m2), and visceral fat level (-0.6 ± 0.5) significantly after fasting David for four weeks. The percentage of body fat in the intervention group tends to decrease (-0. The ACV significantly reduced body weight, BMI, Hip circumference, visceral adiposity index (VAI), and appetite score (P ≤ 0.00). Furthermore, Plasma triglyceride (TG) and total cholesterol (TC) levels significantly decreased, and high-density lipoprotein cholesterol (HDL-C) concentration significantly increased in the ACV group in comparison to the control group (P ≤ 0.05).
considerable expenditure of energy and burning calories, which may be responsible for the decrease in weight (Bagade, A, H & Megha S, 2018). Cramer et al. (2016) showed that the abdominal circumference of respondents who participated in their study was significantly reduced compared to the participants in the control group. Yoga intervention lasted 12 weeks, including women with abdominal obesity, reduced participants' waist circumference, waist-hip ratio, body weight, BMI, percentage of body fat, and increased muscle mass. Yoga improved participants' mental and physical wellbeing and self-esteem and reduced perceived stress (Cramer et al., 2016). The effects of Yoga on anthropometric measures can be increased by a greater frequency, a longer duration, and the use of complex yoga interventions with multiple components and in combination with dietary (especially of a vegetarian diet with calorie reduction) (Rioux JG, 2013). Hagins et al. (2007) identified anthropometric effects of the intervention are due exclusively to the increase in physical activity: the reduction in the proportion in body fat that was achieved in the yoga group corresponds to a reduction of 1.3 kg of pure fat, or 12.000 (Hagins M, 2007).

Fast of Dawood
fasting is a limitation on the number of calories in a vulnerable time. Fast of Dawood was one of the fasting relatively heavy because it is done on continuously with a one-day pause, in which they abstained from eating, drinking, or having sexual intercourse from the break of dawn to dusk with the expressed intent to fast every other day (Fidianingsih et al., 2018). Most studies showed that the fast of Dawood is described as intermittent fasting (IF). Intermittent fasting, whose proposed benefits include improving lipid profile and body weight loss, has gained considerable scientific and popular percussion (Santos & Macedo, 2018). Low calories diets can enhance lipid (Fothergill et al., 2016). According to Izzaturrahmi et al. (2017), in addition to weight loss, fat mass, concentrations of triacylglycerol and leptin also showed a significant decrease in the fasting group. Based on this research, it can be seen that alternateday fasting can lose weight and can be a preventive measure for heart disease (Izzaturahmi et al., 2017) Klempel et al. (2013) studied obese women who were intervened with intermittent fasting (IF) for two weeks. As a result, bodyweight decreased 3.9 ± 1.4 kg; lipids decreased 2.8 ± 1.2 kg; low-density lipoprotein cholesterol (LDLC) decreased 19 ± 10%. The effect of fasting on obesity could be characterized by the level of IL-6, CRP, and homocysteine. Fast of Dawood can induce cellular cholesterol and reverse cholesterol transport. This makes the cholesterol ester HDLC induce maturity and activate the gene Apolipoprotein-1 (ApoA1). ApoA1 will make LDL in the body attached to the LDL receptor (LDLR) divided and excreted by valeric vesical. Reverse cholesterol transport also improves the circulation of microRNA-33 for the ATP-binding cassette inhibit transporter 1 (ABCA1). Indirectly ABCA1 would undermine the atherosclerotic plaque in blood vessels composed of LDLC (Klempel et al., 2013). Meanwhile, a study conducted by Syawal & Nurdin (2021) showed that the intervention group experienced a decrease in body weight (-1.7 ± 1.3 kg), BMI (-0.6 ± 0.5 kg/m2), and visceral fat level (-0.6 ± 0.5) significantly after fasting David for four weeks. The percentage of body fat in the intervention group tends to decrease (-0.1 ± 0.8%) (Syawal & Nurdin, 2021).

Tea Treatment
Teas are the most popular beverages consumed in the world. Several kinds of tea are commonly consumed, such as green tea, black tea, and oolong. Green Tea (Camellia synesis) has a significant effect on controlling diseases. Green tea consists of Anti-allergic, anti-cancer, antiobesity, anti-mutagenic, anti-apoptotic, neuroprotective, antihyperglycemic, antioxidant, anti-microbial, and anti-inflammatory effects. Green Tea (Camellia synesis) also has many antioxidant polyphenols (Azevedo et al., 2018). The characteristic of polyphenolic compounds in green tea is known as catechins, which include: (-) epigallocatechin-3-gallate (EGCG), (-) epigallocatechin (EGC), (-) epicatechin-3-gallate (ECG), and (-) epicatechin (EC) (Yang et al., 2017). The primary catechin (40% higher of the total catechin content) is Epigallocatechin-3-gallate (EGCG), found on green Tea (Zagury, Kazir, & Livney, 2019). Most studies showed that EGCG significantly reduces body weight and adipose tissue weight (Yang et al., 2017). In research showed intervenes EGCG on obese mice for eight weeks made some genes PPAR-γ, C/EBP-α, and SREBP-close their expressions. They explained before that PPAR-γ and C/EBP-α become regulatory genes that play a role in adipogenesis (Kim, H.S., Quon, M.J. and Kim, J.A., 2014). If these two genes are muted or lose expression, the lipid profile will also decrease. Generally, the expression of PPAR-γ and C / EBP-α stimulates deep adipogenesis NIH 3T3 fibroblasts show an essential role of deep transcription factors regulating adipogenesis. PPAR-γ and C / EBP-α are found almost exclusively in adipose tissue and associated with adipocyte differentiation. The combination of PPAR-γ and C / EBP-α has a synergistic effect in promoting the conversion of fat cells to myoblasts, and this showed that this gene is essential for adipocyte fat accumulation. These transcription factors coordinate gene expression in maintaining adipocyte phenotypes, including AP2. AP2 kind of intracellular lipid-binding proteins showed the protein is involved in the formation of atherosclerosis mainly through direct modification of cholesterol and inflammatory macrophages. EGCG in adipogenesis induces a reduction in PPAR-γ protein in cells 3T3-L1, accompanied by attenuation of C / EBP-α expression(Moon, H.S., Lee, H.G., Choi, Y.J., Kim, T.G. and Cho, 2007;Wang et al., 2014). The results of Hardani & Lestariana (2014) showed a significant decrease in the total body fat of overweight and obese women after being given green tea extraction drinks. The decrease in total body fat occurs because green tea has a high inhibitory effect on linoleic acid oxidation (omega 6 fatty acid). This high inhibitory power is due to the presence of catechin compounds in green tea, which are the most potent components and chemically have the most muscular biological activity among other catechin compounds (Hardani & Lestariana, 2014). Catechins (EGCG) have a hypocholesterolemic effect because EGCG can suppress cholesterol absorption in the intestine. Fatty acids are oxidized to acetyl CoA and synthesized from acetic-CoA (Chen et al., 2015) Chen et al. (2015) showed a significant weight loss, from 76.8 ± 11.3 kg to 75.7 ± 11.5 kg (p ¼ 0.025), as well as decreases in BMI (p ¼ 0.018) and waist circumference (p ¼ 0.023) were observed in the treatment group after 12 weeks of high-dose EGCG treatment (Chen et al., 2015). Several previous studies also stated that when overweight and obese patients were given green tea extract (ETH) containing catechins (EGCG), there would inhibit the catechol-Omethyltransferase enzyme, resulting in increased activity in the sympathetic nervous system. An increase in activity in the sympathetic nervous system will cause an increase in catecholamine hormones, epinephrine, norepinephrine, and glucagon. These four hormones are instrumental in increasing lipolysis (decomposition and digestion of fat). Increased lipolysis will be followed by increased thermogenesis (heat in the body to burn fat and calories) and fatty acid oxidation (Belza et al., 2009). More acetyl-CoA is formed to produce energy with increased fatty acid oxidation. , the less fat stored in adipose tissue. This process of lipolysis and thermogenesis can suppress hunger and increase satiety, which will impact nutritional status, and subsequently, this nutritional status will affect TLT conditions and lipid profiles (Chen et al., 2015).

Apple Treatment
Apples are the most commonly consumed fruit globally and an essential source of phytonutrients. Apples are rich in fibres, vitamins, and polyphenols. Apple phenolics comprise four main polyphenol classes: Cinnamic acid, flavanols, and many antioxidants (Trošt et al., 2018). Polyphenols significantly affect accessible radical interventions, regulate gene expression, and change signal transduction in tissues or target cells. A high intake of polyphenols significantly reduces weight and adipose tissue. Polyphenols decrease of leptin (Lep), perilipin (Plan), and level of mRNA sterol binding transcription factor 1 (Srebf1) but increasing of aquaporin 7 (Aqp7), adipocyte enhancer-binding protein 1 (Aebp1), and mRNA-level peroxisome proliferator-activated receptor-gamma coactivator 1 alpha (PPARγC1α) in adipocytes. The increase of Aebp1 has a higher effect on preventing adipogenesis. Previous studies showed that Polyphenol extract suppresses adipocyte differentiation by Srebf1 downregulation. Supplementation of AP in parallel can reduce leptin expenditure in plasma, and this study revealed a fat mass in epididymal adipocytes attenuated (Zheng et al., 2018;Barth et al., 2012;Thesis, 2013;Hyson, 2011). Khezri et al. (2018) showed that the oral administration of ACV and RCD significantly decreased body weight, BMI, hip circumference, and Visceral Adiposity Index (VAI) compared to the control (Khezri et al., 2018). Moreover, approximately half a kilogram weight loss more than the expected amount for this duration may be related to the thermic effect of ACV. The mechanism of the effect of vinegar consumption on serum triglyceride may be attributed to a reduction in the formation of triglycerides in the liver due to a reduction in body weight (Fushimi et al., 2006).

CONCLUSION
According to 10 articles that authors have reviewed, it can be concluded that yoga treatment can reduce cortisol and leptin in the body and increase adenopectin, which can reduce adipogenesis. Fast of Dawood can induce reverse cholesterol transport and expenditure of cellular cholesterol and reduce some pro-cytokines inflammation so that it has a positive impact in reducing the body lipid. Meanwhile, green tea and apples contain high polyphenols, which play a role in inducing lipolysis. In addition, EGCG is contained in green tea; it is proven to reduce the PPAR-gene, SREBP-c, and C / EBP-α, which is the primary regulator in energy metabolism. Through method combination of these interventions, it is expected that the incidence of obesity, in particular, is expected in adolescents can be minimized.