Abstract
Introduction: In obesogenic patients, epigenetics provides answers to the relationship between hereditary and environmentally acquired patterns that have contributed significantly to the global increase in the prevalence of obesity. In this context, microRNAs (20-24 non-coding nucleotides) stand out as important biomarkers and modulators of post-transcriptional gene expression in obese patients. Understanding these molecules is crucial, as the prevalence of obesity is increasing significantly, and it is estimated that approximately 60% of the global adult population will be overweight or obese by 2030. Objective: It was to explore and describe the main considerations of nutritional therapy in obese patients, highlighting the management of inflammatory and metabolic processes through exosomes and microRNAs. Methods: The systematic review guidelines of the PRISMA Platform were followed. The search was conducted from July to August 2025 across Scopus, Embase, PubMed, ScienceDirect, Scielo, and Google Scholar databases. Study quality was assessed using the GRADE tool, and risk of bias was analyzed using the Cochrane tool. Results and Conclusion: A total of 128 articles were found. A total of 21 articles were fully assessed, and 16 were included in this systematic review. Using the Cochrane risk of bias tool, the overall assessment revealed 22 studies with a high risk of bias and 25 studies that did not meet the GRADE criteria. Most studies presented homogeneous results, with Chi-Square X2=72.7%>50%. It was concluded that exosomes and miRNAs, through nutritional therapy, are related to 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 results than hypocaloric enteral nutritional protocols in glycemic and lipid profiles, in order to satisfy the better regulation of exosomes and microRNAs, mainly originating from the intestinal microbiota, for the control of inflammatory and metabolic processes