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Khalafi M, Habibi Maleki A, Symonds ME, Rosenkranz SK, Rohani H, Ehsanifar M. The effects of intermittent fasting on body composition and cardiometabolic health in adults with prediabetes or type 2 diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2024; 26:3830-3841. [PMID: 38956175 DOI: 10.1111/dom.15730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 07/04/2024]
Abstract
AIM To perform a meta-analysis to investigate the effects of intermittent fasting (IF), as compared with either a control diet (CON) and/or calorie restriction (CR), on body composition and cardiometabolic health in individuals with prediabetes and type 2 diabetes (T2D). METHODS PubMed, Web of Science, and Scopus were searched from their inception to March 2024 to identify original randomized trials with parallel or crossover designs that studied the effects of IF on body composition and cardiometabolic health. Weighted mean differences (WMDs) or standardized mean differences with 95% confidence intervals (CIs) were calculated using random-effects models. RESULTS Overall, 14 studies involving 1101 adults with prediabetes or T2D were included in the meta-analysis. IF decreased body weight (WMD -4.56 kg [95% CI -6.23 to -2.83]; p = 0.001), body mass index (BMI; WMD -1.99 kg.m2 [95% CI -2.74 to -1.23]; p = 0.001), glycated haemoglobin (HbA1c; WMD -0.81% [95% CI -1.24 to -0.38]; p = 0.001), fasting glucose (WMD -0.36 mmol/L [95% CI -0.63 to -0.09]; p = 0.008), total cholesterol (WMD -0.31 mmol/L [95% CI -0.60 to -0.02]; p = 0.03) and triglycerides (WMD -0.14 mmol/L [95% CI -0.27 to -0.01]; p = 0.02), but did not significantly decrease fat mass, insulin, low-densitiy lipoprotein, high-density lipoprotein, or blood pressure as compared with CON. Furthermore, IF decreased body weight (WMD -1.14 kg [95% CI -1.69 to -0.60]; p = 0.001) and BMI (WMD -0.43 kg.m2 [95% CI -0.58 to -0.27]; p = 0.001), but did not significantly affect fat mass, lean body mass, visceral fat, insulin, HbA1c, lipid profiles or blood pressure. CONCLUSION Intermittent fasting is effective for weight loss and specific cardiometabolic health markers in individuals with prediabetes or T2D. Additionally, IF is associated with a reduction in body weight and BMI compared to CR, without effects on glycaemic markers, lipid profiles or blood pressure.
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Affiliation(s)
- Mousa Khalafi
- Department of Sport Sciences, Faculty of Humanities, University of Kashan, Kashan, Iran
| | - Aref Habibi Maleki
- Department of Exercise Physiology and Corrective Exercises, Faculty of Sport Sciences, Urmia University, Urmia, Iran
| | - Michael E Symonds
- Centre for Perinatal Research, Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sara K Rosenkranz
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Hadi Rohani
- Department of Exercise Physiology, Sport Sciences Research Institute, Tehran, Iran
| | - Mahsa Ehsanifar
- Department of Exercise Physiology and Corrective Exercises, Faculty of Sport Sciences, Urmia University, Urmia, Iran
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Ozcan M, Abdellatif M, Javaheri A, Sedej S. Risks and Benefits of Intermittent Fasting for the Aging Cardiovascular System. Can J Cardiol 2024; 40:1445-1457. [PMID: 38354947 DOI: 10.1016/j.cjca.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
Population aging and the associated increase in cardiovascular disease rates pose serious threats to global public health. Different forms of fasting have become an increasingly attractive strategy to directly address aging and potentially limit or delay the onset of cardiovascular diseases. A growing number of experimental studies and clinical trials indicate that the amount and timing of food intake as well as the daily time window during which food is consumed, are crucial determinants of cardiovascular health. Indeed, intermittent fasting counteracts the molecular hallmarks of cardiovascular aging and promotes different aspects of cardiometabolic health, including blood pressure and glycemic control, as well as body weight reduction. In this report, we summarize current evidence from randomized clinical trials of intermittent fasting on body weight and composition as well as cardiovascular and metabolic risk factors. Moreover, we critically discuss the preventive and therapeutic potential of intermittent fasting, but also possible detrimental effects in the context of cardiovascular aging and related disease. We delve into the physiological mechanisms through which intermittent fasting might improve cardiovascular health, and raise important factors to consider in the design of clinical trials on the efficacy of intermittent fasting to reduce major adverse cardiovascular events among aged individuals at high risk of cardiovascular disease. We conclude that despite growing evidence and interest among the lay and scientific communities in the cardiovascular health-improving effects of intermittent fasting, further research efforts and appropriate caution are warranted before broadly implementing intermittent fasting regimens, especially in elderly persons.
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Affiliation(s)
- Mualla Ozcan
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Mahmoud Abdellatif
- Department of Cardiology, Medical University of Graz, Graz, Austria; BioTechMed Graz, Graz, Austria
| | - Ali Javaheri
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA; John J. Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA
| | - Simon Sedej
- Department of Cardiology, Medical University of Graz, Graz, Austria; BioTechMed Graz, Graz, Austria; Institute of Physiology, Faculty of Medicine, University of Maribor, Maribor, Slovenia.
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3
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Brogi S, Tabanelli R, Puca S, Calderone V. Intermittent Fasting: Myths, Fakes and Truth on This Dietary Regimen Approach. Foods 2024; 13:1960. [PMID: 38998465 PMCID: PMC11241639 DOI: 10.3390/foods13131960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Intermittent fasting (IF) has been indicated as a valuable alternative to the classical caloric restriction dietary regimen for lowering body weight and preventing obesity-related complications, such as metabolic syndrome and type II diabetes. However, is it effective? In this review article, we analyzed over 50 clinical studies in which IF, conducted by alternate day fasting (ADF) or time-restricted feeding (TRF), was compared with the caloric restriction approach. We evaluated the different roles of IF in treating and preventing human disorders such as metabolic syndrome, type II diabetes, and some types of cancer, as well as the usefulness of IF in reducing body weight and cardiovascular risk factors such as hypertension. Furthermore, we explored the cellular pathways targeted by IF to exert their beneficial effects by activating effector proteins that modulate cell functions and resistance to oxidative stress. In contrast, we investigated concerns regarding human health related to the adoption of IF dietary regimens, highlighting the profound debate surrounding weight loss regimens. We examined and compared several clinical trials to formulate an updated concept regarding IF and its therapeutic potential.
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Affiliation(s)
- Simone Brogi
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy; (R.T.); (S.P.); (V.C.)
- Bioinformatics Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Rita Tabanelli
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy; (R.T.); (S.P.); (V.C.)
| | - Sara Puca
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy; (R.T.); (S.P.); (V.C.)
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy; (R.T.); (S.P.); (V.C.)
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Mao Z, Cawthon PM, Kritchevsky SB, Toledo FGS, Esser KA, Erickson ML, Newman AB, Farsijani S. The association between chrononutrition behaviors and muscle health among older adults: The study of muscle, mobility and aging. Aging Cell 2024; 23:e14059. [PMID: 38059319 PMCID: PMC11166361 DOI: 10.1111/acel.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
Emerging studies highlight chrononutrition's impact on body composition through circadian clock entrainment, but its effect on older adults' muscle health remains largely overlooked. To determine the associations between chrononutrition behaviors and muscle health in older adults. Dietary data from 828 older adults (76 ± 5 years) recorded food/beverage amounts and their clock time over the past 24 h. Studied chrononutrition behaviors included: (1) The clock time of the first and last food/beverage intake; (2) Eating window (the time elapsed between the first and last intake); and (3) Eating frequency (Number of self-identified eating events logged with changed meal occasion and clock time). Muscle mass (D3-creatine), leg muscle volume (MRI), grip strength (hand-held dynamometer), and leg power (Keiser) were used as outcomes. We used linear regression to assess the relationships between chrononutrition and muscle health, adjusting for age, sex, race, marital status, education, study site, self-reported health, energy, protein, fiber intake, weight, height, and moderate-to-vigorous physical activity. Average eating window was 11 ± 2 h/day; first and last intake times were at 8:22 and 19:22, respectively. After multivariable adjustment, a longer eating window and a later last intake time were associated with greater muscle mass (β ± SE: 0.18 ± 0.09; 0.27 ± 0.11, respectively, p < 0.05). The longer eating window was also marginally associated with higher leg power (p = 0.058). An earlier intake time was associated with higher grip strength (-0.38 ± 0.15; p = 0.012). Chrononutrition behaviors, including longer eating window, later last intake time, and earlier first intake time were associated with better muscle mass and function in older adults.
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Affiliation(s)
- Ziling Mao
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Aging and Population HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Peggy M. Cawthon
- California Pacific Medical Center Research InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Stephen B. Kritchevsky
- Department of Internal Medicine, Section on Gerontology & Geriatric Medicine and the Sticht Center for Healthy Aging and Alzheimer's PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Frederico G. S. Toledo
- Department of Medicine, Division of Endocrinology and MetabolismUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Karyn A. Esser
- Department of Physiology and AgingUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | | | - Anne B. Newman
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Aging and Population HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Samaneh Farsijani
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Aging and Population HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
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Rejeki PS, Pranoto A, Widiatmaja DM, Utami DM, Izzatunnisa N, Sugiharto, Lesmana R, Halim S. Combined Aerobic Exercise with Intermittent Fasting Is Effective for Reducing mTOR and Bcl-2 Levels in Obese Females. Sports (Basel) 2024; 12:116. [PMID: 38786985 PMCID: PMC11126026 DOI: 10.3390/sports12050116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
The integration of combined aerobic exercise and intermittent fasting (IF) has emerged as a strategy for the prevention and management of obesity, including its associated health issues such as age-related metabolic diseases. This study aimed to examine the potential of combined aerobic exercise and IF as a preventative strategy against cellular senescence by targeting mTOR and Bcl-2 levels in obese females. A total of 30 obese women, aged 23.56 ± 1.83 years, body fat percentage (FAT) 45.21 ± 3.73% (very high category), BMI 30.09 ± 3.74 kg/m2 were recruited and participated in three different types of interventions: intermittent fasting (IF), exercise (EXG), and a combination of intermittent fasting and exercise (IFEXG). The intervention program was carried out 5x/week for 2 weeks. We examined mTOR and Bcl-2 levels using ELISA kits. Statistical analysis used the one-way ANOVA test and continued with Tukey's HSD post hoc test, with a significance level of 5%. The study results showed that a combination of aerobic exercise and IF significantly decreased mTOR levels (-1.26 ± 0.79 ng/mL) compared to the control group (-0.08 ± 1.33 ng/mL; p ≤ 0.05). However, combined aerobic exercise and IF did not affect Bcl-2 levels significantly (-0.07 ± 0.09 ng/mL) compared to the control group (0.01 ± 0.17 ng/mL, p ≥ 0.05). The IF-only group, exercise-only group, and combined group all showed a significant decrease in body weight and fat mass compared to the control group (p ≤ 0.05). However, the combined aerobic exercise and IF program had a significant effect in reducing the total percentage of body fat and fat mass compared to the IF-only group (p ≤ 0.05). Therefore, it was concluded that the combined intermittent fasting and exercise group (IFEXG) undertook the most effective intervention of the three in terms of preventing cellular senescence, as demonstrated by decreases in the mTOR level, body weight, and fat mass. However, the IFEXG did not present reduced Bcl-2 levels.
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Affiliation(s)
- Purwo Sri Rejeki
- Physiology Division, Department of Medical Physiology and Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, East Java, Indonesia
| | - Adi Pranoto
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, East Java, Indonesia;
| | - Deandra Maharani Widiatmaja
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, East Java, Indonesia; (D.M.W.); (D.M.U.); (N.I.)
| | - Dita Mega Utami
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, East Java, Indonesia; (D.M.W.); (D.M.U.); (N.I.)
| | - Nabilah Izzatunnisa
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, East Java, Indonesia; (D.M.W.); (D.M.U.); (N.I.)
| | - Sugiharto
- Department of Sport Science, Faculty of Sport Science, Universitas Negeri Malang, Malang 65145, East Java, Indonesia;
| | - Ronny Lesmana
- Physiology Division, Department of Biomedical Science, Faculty of Medicine, Universitas Padjajaran, Bandung 45363, West Java, Indonesia;
| | - Shariff Halim
- Faculty of Health Sciences, University Technology MARA (UiTM) Pulau Pinang, Bertam Campus, Kepala Batas 13200, Pulau Pinang, Malaysia;
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6
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Yao K, Su H, Cui K, Gao Y, Xu D, Wang Q, Ha Z, Zhang T, Chen S, Liu T. Effectiveness of an intermittent fasting diet versus regular diet on fat loss in overweight and obese middle-aged and elderly people without metabolic disease: a systematic review and meta-analysis of randomized controlled trials. J Nutr Health Aging 2024; 28:100165. [PMID: 38308923 DOI: 10.1016/j.jnha.2024.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/31/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVE As the number of adults aged over 40 with obesity increases dramatically, intermittent fasting interventions (IF) may help them to lose fat and weight. This systematic review investigated the most recent research on the effects of intermittent fasting and a regular diet on body composition and lipids in adults aged over 40 with obesity without the metabolic disease. DATA SOURCES Randomized controlled trials (RCTs) on IF on adults aged over 40 with obesity were retrieved from PubMed, Web of Science, EBSCO, China Knowledge Network (CNKI), VIP database, Wanfang database with the experimental group using IF and the control group using a regular diet. Revman was used for meta-analysis. Effect sizes are expressed as weighted mean differences (WMD) and 95% confidence intervals (CI). STUDY SELECTION A total of 9 articles of randomised controlled trials that met the requirements were screened for inclusion. Studies typically lasted 2-6 weeks. The experimental population was aged 42-66 years, with a BMI range of 25.7-35 kg/m2. SYNTHESIS A total of 9 RCTs were included. meta-analysis showed that body weight (MD: -2.05 kg; 95% CI (-3.84, -0.27); p = 0.02), BMI (MD: -0.73 kg/m2; 95% CI (-1.05, -0.41); p < 0.001), fat mass (MD: -2.14 kg; 95% CI (-3.81, 0.47); p = 0.01), and TG (MD = -0.32 mmol/L, 95% CI (-0.50, -0.15, p < 0.001) were significantly lower in the experimental group than in the control group. No significant reduction in lean body mass (MD: -0.31 kg; 95% CI (-0.96, 0.34); p = 0.35). CONCLUSION IF had a reduction in body weight, BMI, fat mass, and TG in adults aged over 40 with obesity without metabolic disease compared to RD, and IF did not cause a significant decrease in lean body mass, which suggests healthy and effective fat loss. However, more long-term and high-quality trials are needed to reach definitive conclusions.
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Affiliation(s)
- Ke Yao
- Key Laboratory of Exercise and Physical Fitness, Beijing Sport University, Beijing, China; The School of Sports Science, Beijing Sport University, Beijing, China
| | - Hao Su
- Key Laboratory of Exercise and Physical Fitness, Beijing Sport University, Beijing, China; The School of Sports Science, Beijing Sport University, Beijing, China.
| | - Kaiyin Cui
- Key Laboratory of Exercise and Physical Fitness, Beijing Sport University, Beijing, China; The School of Sports Science, Beijing Sport University, Beijing, China
| | - Ye Gao
- Key Laboratory of Exercise and Physical Fitness, Beijing Sport University, Beijing, China; The School of Sports Science, Beijing Sport University, Beijing, China
| | - Dengyun Xu
- Key Laboratory of Exercise and Physical Fitness, Beijing Sport University, Beijing, China; The School of Sports Science, Beijing Sport University, Beijing, China
| | - Qian Wang
- Key Laboratory of Exercise and Physical Fitness, Beijing Sport University, Beijing, China; The School of Sports Science, Beijing Sport University, Beijing, China
| | - Zhitong Ha
- Key Laboratory of Exercise and Physical Fitness, Beijing Sport University, Beijing, China; The School of Sports Science, Beijing Sport University, Beijing, China
| | - Teng Zhang
- Key Laboratory of Exercise and Physical Fitness, Beijing Sport University, Beijing, China; The School of Sports Science, Beijing Sport University, Beijing, China
| | - Shuning Chen
- Key Laboratory of Exercise and Physical Fitness, Beijing Sport University, Beijing, China; The School of Sports Science, Beijing Sport University, Beijing, China
| | - Tao Liu
- Key Laboratory of Exercise and Physical Fitness, Beijing Sport University, Beijing, China; The School of Sports Science, Beijing Sport University, Beijing, China
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7
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Lange MG, Coffey AA, Coleman PC, Barber TM, Van Rens T, Oyebode O, Abbott S, Hanson P. Metabolic changes with intermittent fasting. J Hum Nutr Diet 2024; 37:256-269. [PMID: 37786321 PMCID: PMC10953463 DOI: 10.1111/jhn.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/29/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The prevalence of obesity is rising globally and effective strategies to treat obesity are needed. Intermittent fasting, a dietary intervention for weight management, has received growing interest from the general public, as well as healthcare professionals, as a form of lifestyle intervention. METHODS We executed a rapid review using PUBMED database to identify systematic reviews that examined the impact of intermittent fasting on metabolic indices, published between 2011 and 2022. RESULTS Intermittent fasting leads to weight loss of a similar magnitude to continuous energy restriction. Most of the evidence shows that intermittent fasting leads to greater fat loss as measured by fat mass (kg) or body fat percentage compared to an ad libitum diet, but fat loss attained during intermittent fasting is not significantly different to continuous energy restriction, although recent evidence shows intermittent fasting to be superior. There is mixed evidence for the impact of intermittent fasting on insulin resistance, fasting glucose and lipid profile. Some studies focused on populations of Muslim people, which showed that Ramadan fasting may lead to weight loss and improvement of metabolic parameters during fasting, although the effects are reversed when fasting is finished. CONCLUSIONS Intermittent fasting is more effective than an ad libitum dietary intake, and equally or more effective as continuous energy restriction, for weight management. However, there is inconclusive evidence on whether intermittent fasting has a clinically beneficial effect on glucose and lipid metabolism.
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Affiliation(s)
- Maria G. Lange
- Warwick Medical SchoolUniversity of WarwickCoventryUK
- Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
| | | | | | - Thomas M. Barber
- Warwick Medical SchoolUniversity of WarwickCoventryUK
- Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
| | | | - Oyinlola Oyebode
- Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Sally Abbott
- Department of DieteticsUniversity Hospitals Coventry and Warwickshire NHS TrustCoventryUK
- Research Centre for Intelligent HealthcareCoventry UniversityCoventryUK
| | - Petra Hanson
- Warwick Medical SchoolUniversity of WarwickCoventryUK
- Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
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8
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Mirrazavi ZS, Behrouz V. Various types of fasting diet and possible benefits in nonalcoholic fatty liver: Mechanism of actions and literature update. Clin Nutr 2024; 43:519-533. [PMID: 38219703 DOI: 10.1016/j.clnu.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the major causes of chronic liver injury, affecting around one-fourth of the general population across the world. Several important pathophysiological mechanisms underlying NAFLD include oxidative stress, inflammation, liver fibrosis, and apoptosis. Currently, therapeutic approaches are not ideal for managing NAFLD, thus new approaches and treatments are still needed. Over the last two decades, various fasting protocols have been explored to reduce body weight and improve metabolic disorders. In this review, we provide updated literature that supports fasting regimens for subjects with NAFLD and describes underlying mechanisms of action. We suggest that fasting regimens may modulate NAFLD via several mechanisms, including changes in gut microbiota, hepatic arginase, hepatic autophagy, inflammatory responses, liver functional enzymes and hepatic steatosis, fibroblast growth factors signaling, white adipose tissue browning, adipokines, circadian rhythms, lipid profiles, and body composition.
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Affiliation(s)
| | - Vahideh Behrouz
- Department of Nutrition, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran.
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9
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Hooshiar SH, Yazdani A, Jafarnejad S. Does an alternate-day modified fasting diet improve premenstrual syndrome symptoms and health-related quality of life in obese or overweight women with premenstrual syndrome? A randomized, controlled trial. Front Nutr 2024; 10:1298831. [PMID: 38268675 PMCID: PMC10806082 DOI: 10.3389/fnut.2023.1298831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024] Open
Abstract
Background Premenstrual syndrome disorder (PMS) is a condition that affects health-related quality of life (HRQoL) and encompasses a variety of symptoms, including psychological, physical, and behavioral symptoms. Some evidence suggests that an increase in body mass index (BMI) can reduce both HRQoL and menstrual quality. This is because the body fat tissue can affect menstrual cycles by changing the estrogen/progesterone ratio. This study investigated the impact of two diets alternate-day modified fasting (ADMF) and daily calorie restriction (DCR) - on PMS syndrome and HRQoL. Methods The study was a randomized controlled, open-label trial that lasted for 8 weeks and involved 60 obese/overweight women. Participants were recruited from the Health Service Centers of Kashan University of Medical Sciences using simple random sampling. The study compared the impact of the ADMF and DCR diets on HRQoL and PMS symptoms. Patients were classified based on their BMI and age and then allocated to either the intervention (ADMF) or control (DCR) group using a random numbers table. The study measured HRQoL, PMS severity, weight, BMI, body fat mass, waist circumference, fat-free mass, and skeletal muscle mass before and after the study. The study had an almost 18% dropout rate. Results Significant improvements were observed in mood lability (p = 0.044) and expressed anger (p < 0.001) in relation to PMS symptoms. However, no significant differences were detected in the changes of other COPE subscales. The ADMF diet had a significant impact on the 12-item Short-Form Health Survey (SF-12) total score (p < 0.001) and physical function subscales (p = 0.006) as well as mental health (p < 0.001) when compared to the control diet. This implies that the ADMF diet increased both SF-12 total score and its subscales. The intervention led to improvements in HRQoL, physical function, and mental health. Additionally, significant improvements in BMI and weight were observed between the two groups pre- and post-study (p < 0.001). Anthropometric data, including body fat mass and waist circumference, showed a significant improvement (p < 0.001 and p = 0.029, respectively) before and after the study. However, there were no significant changes in fat-free mass (p = 0.936) and skeletal muscle mass (p = 0.841) between the two groups. Conclusion The study suggested that ADMF can improve HRQoL, mood lability, and expressed anger. It also showed that ADMF can reduce waist circumference, weight, and body fat mass in obese/overweight women. Clinical trial registration The Iranian Registry of Clinical Trials (IRCT20220522054958N1).
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Affiliation(s)
- Saeedeh Hosseini Hooshiar
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Akram Yazdani
- Department of Biostatistics and Epidemiology, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Sadegh Jafarnejad
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
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10
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Hosseini E, Ammar A, Josephson JK, Gibson DL, Askari G, Bragazzi NL, Trabelsi K, Schöllhorn WI, Mokhtari Z. Fasting diets: what are the impacts on eating behaviors, sleep, mood, and well-being? Front Nutr 2024; 10:1256101. [PMID: 38264193 PMCID: PMC10803520 DOI: 10.3389/fnut.2023.1256101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024] Open
Abstract
Fasting diets (FDs) have drawn great attention concerning their contribution to health and disease over the last decade. Despite considerable interest in FDs, the effect of fasting diets on eating behaviors, sleep, and mood-essential components of diet satisfaction and mental health- has not been addressed comprehensively. Understanding the critical role that fasting plays in these elements will open up potential treatment avenues that have not yet been explored. The aim of the present paper was to conduct a comprehensive critical review exploring the effects of fasting on eating behaviors, sleep, and mood. There is currently a lack of clarity regarding which fasting option yields the most advantageous effects, and there is also a scarcity of consistent trials that assess the effects of FDs in a comparable manner. Similarly, the effects and/or treatment options for utilizing FDs to modify eating and sleep behaviors and enhance mood are still poorly understood. Further researches aiming at understanding the impacts of various fasting regimes, providing new insights into the gut-brain axis and offering new treatment avenues for those with resistant anxiety and depression, are warranted. Alteration of eating behaviors can have lasting effects on various physiological parameters. The use of fasting cures can underpin ancient knowledge with scientific evidence to form a new approach to the prevention and treatment of problems associated with co-morbidities or challenges pertaining to eating behaviors. Therefore, a thorough examination of the various fasting regimens and how they impact disease patterns is also warranted.
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Affiliation(s)
- Elham Hosseini
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Achraf Ammar
- Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | | | - Deanna L. Gibson
- Department of Biology, University of British Columbia, Kelowna, BC, Canada
- Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
| | - Gholamreza Askari
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nicola L. Bragazzi
- Human Nutrition Unit (HNU), Department of Food and Drugs, University of Parma, Parma, Italy
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
| | - Wolfgang I. Schöllhorn
- Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Zeinab Mokhtari
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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11
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Mao Z, Cawthon PM, Kritchevsky SB, Toledo FGS, Esser KA, Erickson ML, Newman AB, Farsijani S. The association between chrononutrition behaviors and muscle health among older adults: The Study of Muscle, Mobility and Aging (SOMMA). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.13.23298454. [PMID: 38014276 PMCID: PMC10680884 DOI: 10.1101/2023.11.13.23298454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Emerging studies highlight chrononutrition's impact on body composition through circadian clock entrainment, but its effect on older adults' muscle health remains largely overlooked. Objective To determine the associations between chrononutrition behaviors and muscle health in older adults. Methods Dietary data from 828 older adults (76±5y) recorded food/beverage amounts and their clock time over the past 24 hours. Studied chrononutrition behaviors included: 1) The clock time of the first and last food/beverage intake; 2) Eating window (the time elapsed between the first and last intake); and 3) Eating frequency (Number of self-identified eating events logged with changed meal occasion and clock time). Muscle mass (D 3 -creatine), leg muscle volume (MRI), grip strength (hand-held dynamometer), and leg power (Keiser) were used as outcomes. We used linear regression to assess the relationships between chrononutrition and muscle health, adjusting for age, sex, race, marital status, education, study site, self-reported health, energy, protein, fiber intake, weight, height, and moderate-to-vigorous physical activity. Results Average eating window was 11±2 h/d; first and last intake times were at 8:22 and 19:22, respectively. After multivariable adjustment, a longer eating window and a later last intake time were associated with greater muscle mass (β±SE: 0.18±0.09; 0.27±0.11, respectively, P <0.05). The longer eating window was also marginally associated with higher leg power ( P =0.058). An earlier intake time was associated with higher grip strength (-0.38±0.15; P =0.012). Conclusions Chrononutrition behaviors, including longer eating window, later last intake time, and earlier first intake time were associated with better muscle mass and function in older adults. GRAPHICAL ABSTRACT Key findings Chrononutrition behaviors, including longer eating window, later last intake time, and earlier first intake time were associated with better muscle mass and function in older adults.
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12
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Ozcan M, Guo Z, Valenzuela Ripoll C, Diab A, Picataggi A, Rawnsley D, Lotfinaghsh A, Bergom C, Szymanski J, Hwang D, Asnani A, Kosiborod M, Zheng J, Hayashi RJ, Woodard PK, Kovacs A, Margulies KB, Schilling J, Razani B, Diwan A, Javaheri A. Sustained alternate-day fasting potentiates doxorubicin cardiotoxicity. Cell Metab 2023; 35:928-942.e4. [PMID: 36868222 PMCID: PMC10257771 DOI: 10.1016/j.cmet.2023.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 11/24/2022] [Accepted: 02/07/2023] [Indexed: 03/05/2023]
Abstract
Fasting strategies are under active clinical investigation in patients receiving chemotherapy. Prior murine studies suggest that alternate-day fasting may attenuate doxorubicin cardiotoxicity and stimulate nuclear translocation of transcription factor EB (TFEB), a master regulator of autophagy and lysosomal biogenesis. In this study, human heart tissue from patients with doxorubicin-induced heart failure demonstrated increased nuclear TFEB protein. In mice treated with doxorubicin, alternate-day fasting or viral TFEB transduction increased mortality and impaired cardiac function. Mice randomized to alternate-day fasting plus doxorubicin exhibited increased TFEB nuclear translocation in the myocardium. When combined with doxorubicin, cardiomyocyte-specific TFEB overexpression provoked cardiac remodeling, while systemic TFEB overexpression increased growth differentiation factor 15 (GDF15) and caused heart failure and death. Cardiomyocyte TFEB knockout attenuated doxorubicin cardiotoxicity, while recombinant GDF15 was sufficient to cause cardiac atrophy. Our studies identify that both sustained alternate-day fasting and a TFEB/GDF15 pathway exacerbate doxorubicin cardiotoxicity.
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Affiliation(s)
- Mualla Ozcan
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Zhen Guo
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - Ahmed Diab
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - David Rawnsley
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - Carmen Bergom
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jeff Szymanski
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Daniel Hwang
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Aarti Asnani
- Beth Israel and Harvard Medical School, Boston, MA, USA
| | | | - Jie Zheng
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Robert J Hayashi
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Pamela K Woodard
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Attila Kovacs
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Kenneth B Margulies
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joel Schilling
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Babak Razani
- Washington University School of Medicine, St. Louis, MO 63110, USA; John Cochran Veterans Affairs Medical Center, Saint Louis, MO, USA
| | - Abhinav Diwan
- Washington University School of Medicine, St. Louis, MO 63110, USA; John Cochran Veterans Affairs Medical Center, Saint Louis, MO, USA
| | - Ali Javaheri
- Washington University School of Medicine, St. Louis, MO 63110, USA.
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13
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Hooshiar SH, Yazdani A, Jafarnejad S. Alternate-day modified fasting diet improves weight loss, subjective sleep quality and daytime dysfunction in women with obesity or overweight: a randomized, controlled trial. Front Nutr 2023; 10:1174293. [PMID: 37275639 PMCID: PMC10233006 DOI: 10.3389/fnut.2023.1174293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Background Both sleep time and quality can be associated with overweight or obesity. In obese people, visceral fat tissue develops, which results in an increment in the production of cytokines. The increased production of inflammatory cytokines can disturb the sleep/wake cycle. Therefore, weight loss by reducing fat tissue can improve sleep disorders. Intermittent fasting diets are popular and effective diets that can decrease body weight and improve anthropometric data and body composition. The present study aimed to evaluate the effect of Alternate-day Modified Fasting (ADMF) on sleep quality, body weight, and daytime sleepiness. Methods Classification of 56 obese or overweight women, based on age and body mass index (BMI), was done using stratified randomization. Then individuals were assigned to the ADMF group (intervention) or Daily Calorie Restriction (CR) group (control) using the random numbers table for 8 weeks. We measured the Pittsburgh sleep quality Index (PSQI), weight, BMI, and the Epworth sleepiness scale (ESS) as primary outcomes and assessed subjective sleep quality (SSQ), sleep latency, sleep disturbances, habitual sleep efficiency, daytime dysfunction, and sleep duration as secondary outcomes at baseline and after the study. Results Following an ADMF diet resulted in a greater decrease in weight (kg) [-5.23 (1.73) vs. -3.15 (0.88); P < 0.001] and BMI (kg/m2) [-2.05 (0.66) vs. -1.17 (0.34); P < 0.001] compared to CR. No significant differences were found in the changes of PSQI [-0.39 (1.43) vs. -0.45 (1.88); P = 0.73] and ESS [-0.22 (1.24) vs. -0.54 (1.67); P = 0.43] between two groups. Also, following the ADMF diet led to significant changes in SSQ [-0.69 (0.47) vs. -0.08 (0.40); P = <0.001], and daytime dysfunction [-0.65 (0.57) vs. 0.04 (0.75); P: 0.001] in compare with CR diet. Conclusion These results suggested that an ADMF could be a beneficial diet for controlling body weight and BMI. The ADMF diet didn't affect PSQI and ESS in women with overweight or obesity but significantly improved SSQ and daytime dysfunction. Clinical Trial Registration The Iranian Registry of Clinical Trials (IRCT20220522054958N3), https://www.irct.ir/trial/64510.
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Affiliation(s)
- Saeedeh Hosseini Hooshiar
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Akram Yazdani
- Department of Biostatistics and Epidemiology, Kashan University of Medical Sciences, Kashan, Iran
| | - Sadegh Jafarnejad
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
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14
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Arora N, Pulimamidi S, Yadav H, Jain S, Glover J, Dombrowski K, Hernandez B, Sarma AK, Aneja R. Intermittent fasting with ketogenic diet: A combination approach for management of chronic diseases. Clin Nutr ESPEN 2023; 54:166-174. [PMID: 36963859 DOI: 10.1016/j.clnesp.2023.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 01/30/2023]
Abstract
Intermittent Fasting (IF) is the consumption of food and drinks within a defined time, while the ketogenic diet (KD) switches the metabolism from glucose to fats. Continuation of intermittent fasting leads to the generation of ketones, the exact mechanism for a ketogenic diet. This article discusses the types of IF and KD, the monitoring required, and the mechanisms underlying IF and KD, followed by disorders in which the combination strategy could be applied. The strategies for successfully applying combination therapy are included, along with recommendations for the primary care physicians (PCP) which could serve as a handy guide for patient management. This opinion article could serve as the baseline for future clinical studies since there is an utmost need for developing new wholesome strategies for managing chronic disorders.
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Affiliation(s)
- Niraj Arora
- Department of Neurology, University of Missouri, Columbia, MO, United States.
| | - Shruthi Pulimamidi
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Hariom Yadav
- USF Center for Microbiome Research, Microbiomes Institute, University of South Florida, Tampa, FL, United States
| | - Shalini Jain
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | - Jennifer Glover
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | - Keith Dombrowski
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | - Beverly Hernandez
- Clinical Nutrition Services, Tampa General Hospital, Tampa, FL, United States
| | - Anand Karthik Sarma
- Department of Neurology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Rachna Aneja
- Department of Neurology, University of Missouri, Columbia, MO, United States
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15
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Semmler G, Datz C, Trauner M. Eating, diet, and nutrition for the treatment of non-alcoholic fatty liver disease. Clin Mol Hepatol 2023; 29:S244-S260. [PMID: 36517001 PMCID: PMC10029946 DOI: 10.3350/cmh.2022.0364] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Nutrition and dietary interventions are a central component in the pathophysiology, but also a cornerstone in the management of patients with non-alcoholic fatty liver disease (NAFLD). Summarizing our rapidly advancing understanding of how our diet influences our metabolism and focusing on specific effects on the liver, we provide a comprehensive overview of dietary concepts to counteract the increasing burden of NAFLD. Specifically, we emphasize the importance of dietary calorie restriction independently of the macronutrient composition together with adherence to a Mediterranean diet low in added fructose and processed meat that seems to exert favorable effects beyond calorie restriction. Also, we discuss intermittent fasting as a type of diet specifically tailored to decrease liver fat content and increase ketogenesis, awaiting future study results in NAFLD. Finally, personalized dietary recommendations could be powerful tools to increase the effectiveness of dietary interventions in patients with NAFLD considering the genetic background and the microbiome, among others.
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Affiliation(s)
- Georg Semmler
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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16
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Elortegui Pascual P, Rolands MR, Eldridge AL, Kassis A, Mainardi F, Lê KA, Karagounis LG, Gut P, Varady KA. A meta-analysis comparing the effectiveness of alternate day fasting, the 5:2 diet, and time-restricted eating for weight loss. Obesity (Silver Spring) 2023; 31 Suppl 1:9-21. [PMID: 36349432 PMCID: PMC10098946 DOI: 10.1002/oby.23568] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this meta-analysis was to compare the effectiveness of different intermittent fasting (IF) regimens on weight loss, in the general population, and compare these to traditional caloric energy restriction (CER). METHODS Three databases were searched from 2011 to June 2021 for randomized controlled trials (RCTs) that assessed weight loss and IF, including alternate day fasting (ADF), the 5:2 diet, and time-restricted eating (TRE). A random effect network analysis was used to compare the effectiveness between the three regimens. Meta-regression analysis was presented as weighted mean differences of body weight loss. RESULTS The exploratory random effects network analysis of 24 RCTs (n = 1768) ranked ADF as the most effective, followed by CER and TRE. The meta-analysis showed that IF regimens resulted in similar weight loss to CER (mean difference 0.26 kg, 95% CI: -0.31 to 0.84; p = 0.37). Compliance was generally high (>80%) in trials shorter than 3 months. CONCLUSIONS The present meta-analysis concludes that IF is comparable to CER and a promising alternative for weight loss. Among the three regimens, ADF showed the highest effectiveness for weight loss, followed by CER and TRE. Further well-powered RCTs with longer durations of intervention are required to draw solid conclusions.
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Affiliation(s)
| | - Maryann R Rolands
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Alison L Eldridge
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Amira Kassis
- Whiteboard Nutrition Science, Beaconsfield, Quebec, Canada
| | - Fabio Mainardi
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Kim-Anne Lê
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Leonidas G Karagounis
- Nestlé Health Science, Translation Research, Lausanne, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Philipp Gut
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Krista A Varady
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
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17
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Mokhtari Z, Hosseini E, Hekmatdoost A, Haskey N, Gibson DL, Askari G. The effects of fasting diets on nonalcoholic fatty liver disease. Nutr Rev 2022:6809036. [DOI: 10.1093/nutrit/nuac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the world. There is no confirmed treatment for NAFLD as yet. Recently, fasting regimens and their relationship to NAFLD have drawn a great deal of attention in the literature. We review the current evidence that supports fasting diets as an adjunctive therapeutic strategy for patients with NAFLD and address potential action mechanisms. We reason that the fasting diets might be a promising approach for modulating hepatic steatosis, fibroblast growth factors 19 and 21 signaling, lipophagy, and the metabolic profile.
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Affiliation(s)
- Zeinab Mokhtari
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences are with the , Isfahan, Iran
| | - Elham Hosseini
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences are with the , Isfahan, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and, Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences with the , Tehran, Iran
| | - Natasha Haskey
- Department of Biology, University of British Columbia—Okanagan Campus are with the , Kelowna, British Columbia, Canada
| | - Deanna L Gibson
- Department of Biology, University of British Columbia—Okanagan Campus are with the , Kelowna, British Columbia, Canada
| | - Gholamreza Askari
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences are with the , Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences with the , Isfahan, Iran
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18
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Alternate day fasting on subjective feelings of appetite and body weight for adults with overweight or obesity: a systematic review. J Nutr Sci 2022; 11:e94. [PMID: 36405095 PMCID: PMC9641525 DOI: 10.1017/jns.2022.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Alternate day fasting (ADF) with consumption of calories up to 25 % of the daily energy intake on fast days is one of the most used intermittent fasting regimens and promoted as a promising, alternative approach for treating obesity. Feelings of appetite are critical for adherence to dietary approaches, and therefore the success of dietary interventions. This systematic review aimed to assess the effects of a minimum of 8 weeks of ADF on subjective feelings of appetite and body weight for adults with overweight and obesity. We conducted the review in accordance with the Cochrane guidelines, including systematic searches in four databases. Because of the high level of clinical and methodological heterogeneity, a narrative approach was used to synthesise the results. Eight studies with a total of 456 participants met the eligibility criteria: three randomised controlled trials and five uncontrolled before-after studies. Seven of the studies had high risk of bias. Feelings of appetite were assessed by hunger in eight studies, fullness in seven studies, satisfaction in four studies and desire to eat in one study. All the studies assessed weight loss. The certainty of the evidence was rated low or very low for all outcomes, thus no firm conclusions can be drawn about the potential benefits of ADF on subjective feelings of appetite and body weight. Despite the high interest in ADF, good quality evidence is still needed to determine its effectiveness and if offered in clinical practice, ADF should be offered cautiously while concomitantly evaluated.
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19
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Ye YF, Zhang MX, Lin Z, Tang L. Is Intermittent Fasting Better Than Continuous Energy Restriction for Adults with Overweight and Obesity? Diabetes Metab Syndr Obes 2022; 15:2813-2826. [PMID: 36134390 PMCID: PMC9484493 DOI: 10.2147/dmso.s376409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
Abstract
As a popular weight management intervention, intermittent fasting (IF) has been widely applied to the treatment of overweight and obesity in adults. This review describes the different forms and implementation protocols of IF and their effects on body weight, body composition, cardiometabolic risk factors and other diseases. The existing evidence suggests that IF is as effective as continuous energy restriction and may be a feasible and effective approach to weight loss.
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Affiliation(s)
- Ya-Fei Ye
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
- Health Management Centre, Taizhou Hospital, Zhejiang University, Linhai, 317000, People’s Republic of China
| | - Mei-Xian Zhang
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, People’s Republic of China
| | - Zhi Lin
- Operating Rooms, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, People’s Republic of China
| | - Leiwen Tang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
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20
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Cooke MB, Deasy W, Ritenis EJ, Wilson RA, Stathis CG. Effects of Intermittent Energy Restriction Alone and in Combination with Sprint Interval Training on Body Composition and Cardiometabolic Biomarkers in Individuals with Overweight and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137969. [PMID: 35805627 PMCID: PMC9265557 DOI: 10.3390/ijerph19137969] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 02/01/2023]
Abstract
The popularity of intermittent fasting (IF) and high intensity (sprint) interval training (SIT) has increased in recent years amongst the general public due to their purported health benefits and feasibility of incorporation into daily life. The number of scientific studies investigating these strategies has also increased, however, very few have examined the combined effects, especially on body composition and cardiometabolic biomarkers, which is the primary aim of this investigation. A total of thirty-four male and female participants (age: 35.4 ± 8.4 y, body mass index (BMI): 31.3 ± 3.5 kg/m2, aerobic capacity (VO2peak) 27.7 ± 7.0 mL·kg−1·min−1) were randomized into one of three 16-week interventions: (1) 5:2 IF (2 non-consecutive days of fasting per week, 5 days on ad libitum eating), (2) supervised SIT (3 bouts per week of 20s cycling at 150% VO2peak followed by 40 s of active rest, total 10 min duration), and (3) a combination of both interventions. Body composition, haemodynamic and VO2peak were measured at 0, 8 and 16 weeks. Blood samples were also taken and analysed for lipid profiles and markers of glucose regulation. Both IF and IF/SIT significantly decreased body weight, fat mass and visceral fat compared to SIT only (p < 0.05), with no significant differences between diet and diet + exercise combined. The effects of diet and/or exercise on cardiometabolic biomarkers were mixed. Only exercise alone or with IF significantly increased cardiorespiratory fitness. The results suggest that energy restriction was the main driver of body composition enhancement, with little effect from the low volume SIT. Conversely, to achieve benefits in cardiorespiratory fitness, exercise is required.
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Affiliation(s)
- Matthew B. Cooke
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3000, Australia; (W.D.); (R.A.W.)
- Department of Health Sciences and Biostatistics, Swinburne University of Technology, Melbourne, VIC 3122, Australia;
- Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, VIC 3021, Australia
- Correspondence: (M.B.C.); (C.G.S.); Tel.: +61-(3)-9214-5560 (M.B.C.); +61-(3)-9919-4293 (C.G.S.)
| | - William Deasy
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3000, Australia; (W.D.); (R.A.W.)
- College of Clinical Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
| | - Elya J. Ritenis
- Department of Health Sciences and Biostatistics, Swinburne University of Technology, Melbourne, VIC 3122, Australia;
| | - Robin A. Wilson
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3000, Australia; (W.D.); (R.A.W.)
- Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, VIC 3021, Australia
| | - Christos G. Stathis
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 3000, Australia; (W.D.); (R.A.W.)
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia
- Correspondence: (M.B.C.); (C.G.S.); Tel.: +61-(3)-9214-5560 (M.B.C.); +61-(3)-9919-4293 (C.G.S.)
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21
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Gu L, Fu R, Hong J, Ni H, Yu K, Lou H. Effects of Intermittent Fasting in Human Compared to a Non-intervention Diet and Caloric Restriction: A Meta-Analysis of Randomized Controlled Trials. Front Nutr 2022; 9:871682. [PMID: 35586738 PMCID: PMC9108547 DOI: 10.3389/fnut.2022.871682] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/28/2022] [Indexed: 12/17/2022] Open
Abstract
Background The popularity of applying intermittent fasting (IF) has increased as more and more people are trying to avoid or alleviate obesity and metabolic disease. This study aimed to systematically explore the effects of various IF in humans. Methods The randomized controlled trials (RCTs) related to IF vs. non-intervention diet or caloric restriction (CR) were retrieved in PubMed, Web of Science, Cochrane Library database, and Embase. Extraction outcomes included, but were not limited to, weight, body mass index (BMI), waist circumference (WC), fasting glucose, and triglyceride (TG). Results This study includes 43 RCTs with 2,483 participants. The intervention time was at least 1 month, and the median intervention time was 3 months. Contrasting results between IF and non-intervention diet showed that participants had lower weight (weighted mean difference (WMD) = 1.10, 95% CI: 0.09–2.12, p = 0.03) and BMI after IF (WMD = 0.38, 95% CI: 0.08–0.68, p = 0.01). The WC of participants after IF decreased significantly compared with the non-intervention diet (WMD = 1.02, 95% CI: 0.06–1.99, p = 0.04). IF regulated fat mass (FM) more effectively than non-intervention diet (WMD = 0.74, 95% CI: 0.17–1.31, p = 0.01). The fat-free mass of people after IF was higher (WMD = −0.73, 95% CI: (−1.45)–(−0.02), p = 0.05). There was no difference in fasting blood glucose concentrations between participants in the after IF and non-intervention diet groups. The results of insulin concentrations and HOMA-IR, though, indicated that IF was significantly more beneficial than non-intervention diet (standard mean difference (SMD) = −0.21, 95% CI: 0.02–0.40, p = 0.03, and WMD = 0.35, 95% CI: 0.04–0.65, p = 0.03, respectively). Cholesterol and TG concentrations in participants after IF were also lower than that after a nonintervention diet (SMD = 0.22, 95% CI: 0.09–0.35, p = 0.001 and SMD = 0.13, 95% CI: 0.00–0.26, p = 0.05, respectively). IF outcomes did not differ from CR except for reduced WC. Conclusion Intermittent fasting was more beneficial in reducing body weight, WC, and FM without affecting lean mass compared to the non-intervention diet. IF also effectively improved insulin resistance and blood lipid conditions compared with non-intervention diets. However, IF showed less benefit over CR.
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Affiliation(s)
- Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Rongrong Fu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaze Hong
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Haixiang Ni
- The Department of Endocrinology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Kepin Yu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Haiying Lou
- Department of Endocrinology, Zhuji People's Hospital, Shaoxing, China
- *Correspondence: Haiying Lou
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The Role of Intermittent Energy Restriction Diet on Metabolic Profile and Weight Loss among Obese Adults. Nutrients 2022; 14:nu14071509. [PMID: 35406122 PMCID: PMC9002823 DOI: 10.3390/nu14071509] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 02/01/2023] Open
Abstract
Obesity is a disease defined by an elevated body mass index (BMI), which is the result of excessive or abnormal accumulation of fat. Dietary intervention is fundamental and essential as the first-line treatment for obese patients, and the main rule of every dietary modification is calorie restriction and consequent weight loss. Intermittent energy restriction (IER) is a special type of diet consisting of intermittent pauses in eating. There are many variations of IER diets such as alternate-day fasting (ADF) and time-restricted feeding (TRF). In the literature, the IER diet is known as an effective method for bodyweight reduction. Furthermore, IER diets have a beneficial effect on systolic or diastolic pressure, lipid profile, and glucose homeostasis. In addition, IER diets are presented as being as efficient as a continuous energy restriction diet (CER) in losing weight and improving metabolic parameters. Thus, the IER diet could present an alternative option for those who cannot accept a constant food regimen.
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23
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Song DK, Kim YW. Beneficial effects of intermittent fasting: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2022; 40:4-11. [PMID: 35368155 PMCID: PMC9946909 DOI: 10.12701/jyms.2022.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Abstract
Caloric restriction is a popular approach to treat obesity and its associated chronic illnesses but is difficult to maintain for a long time. Intermittent fasting is an alternative and easily applicable dietary intervention for caloric restriction. Moreover, intermittent fasting has beneficial effects equivalent to those of caloric restriction in terms of body weight control, improvements in glucose homeostasis and lipid profiles, and anti-inflammatory effects. In this review, the beneficial effects of intermittent fasting are discussed.
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Affiliation(s)
- Dae-Kyu Song
- Department of Physiology & Obesity-mediated Disease Research Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yong-Woon Kim
- Department of Physiology, Yeungnam University College of Medicine, Daegu, Korea,Corresponding author: Yong-Woon Kim, MD, PhD Department of Physiology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-640-6922 • Fax: +82-53-629-7093 • E-mail:
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24
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Chair SY, Cai H, Cao X, Qin Y, Cheng HY, Ng MT. Intermittent Fasting in Weight Loss and Cardiometabolic Risk Reduction: A Randomized Controlled Trial. J Nurs Res 2022; 30:e185. [PMID: 35050952 DOI: 10.1097/jnr.0000000000000469] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Intermittent fasting is an effective approach to promote weight loss. The optimal model of intermittent fasting in achieving weight management and cardiometabolic risk reduction is an underexplored but important issue. PURPOSE This study was designed to examine the effects of alternate-day fasting (ADF) and 16/8 time-restricted fasting (16/8 TRF) on weight loss, blood glucose, and lipid profile in overweight and obese adults with prediabetes. METHODS A randomized controlled trial was conducted on a sample of 101 overweight and obese adults with prediabetes. The participants were randomized into the ADF group (n = 34), 16/8 TRF group (n = 33), and control group (n = 34). The intervention lasted for 3 weeks. Data on body weight, body mass index, waist circumference, blood glucose, and lipid profile were collected at baseline, at the end of the intervention, and at the 3-month follow-up. RESULTS The reductions in body weight, body mass index, and waist circumference in the ADF and 16/8 TRF groups were more significant than those in the control group across the study period (all ps < .05). Moreover, significant reductions on blood glucose and triglycerides were observed in the two intervention groups as well. Furthermore, the reductions in body weight and body mass index in the ADF group were more significant than those in the 16/8 TRF group (all ps < .001). However, differences on the changes in blood glucose, waist circumference, and low-density lipoprotein cholesterol between the two intervention groups were not significant. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The benefits of ADF and 16/8 TRF in promoting weight loss in overweight/obese adults with prediabetes were shown in this study. ADF was shown to have more-significant reduction effects on body weight and body mass index than 16/8 TRF. These findings indicate the potential benefit of integrating intermittent fasting regimens into normal dietary patterns to reduce the risk of diabetes and cardiovascular disease in this population.
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Affiliation(s)
- Sek Ying Chair
- PhD, RN, FAAN, Professor, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Hua Cai
- BSN, RN, Head Nurse, Department of Gastroenterology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Xi Cao
- PhD, RN, Postdoctoral Fellow, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Yuelan Qin
- MSN, RN, Director, Department of Nursing, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Ho Yu Cheng
- PhD, RN, Assistant Professor, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Michael Timothy Ng
- MSc, Clinical Psychologist, Social Services Department, Po Leung Kuk, Fo Tan, Shatin, N.T., Hong Kong SAR, China
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25
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Effects of Intermittent Fasting on Cardiometabolic Health: An Energy Metabolism Perspective. Nutrients 2022; 14:nu14030489. [PMID: 35276847 PMCID: PMC8839160 DOI: 10.3390/nu14030489] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/19/2022] Open
Abstract
This review summarizes the effects of different types of intermittent fasting (IF) on human cardiometabolic health, with a focus on energy metabolism. First, we discuss the coordinated metabolic adaptations (energy expenditure, hormonal changes and macronutrient oxidation) occurring during a 72 h fast. We then discuss studies investigating the effects of IF on cardiometabolic health, energy expenditure and substrate oxidation. Finally, we discuss how IF may be optimized by combining it with exercise. In general, IF regimens improve body composition, ectopic fat, and classic cardiometabolic risk factors, as compared to unrestricted eating, especially in metabolically unhealthy participants. However, it is still unclear whether IF provides additional cardiometabolic benefits as compared to continuous daily caloric restriction (CR). Most studies found no additional benefits, yet some preliminary data suggest that IF regimens may provide cardiometabolic benefits in the absence of weight loss. Finally, although IF and continuous daily CR appear to induce similar changes in energy expenditure, IF regimens may differentially affect substrate oxidation, increasing protein and fat oxidation. Future tightly controlled studies are needed to unravel the underlying mechanisms of IF and its role in cardiometabolic health and energy metabolism.
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26
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Semmler G, Datz C, Reiberger T, Trauner M. Diet and exercise in NAFLD/NASH: Beyond the obvious. Liver Int 2021; 41:2249-2268. [PMID: 34328248 PMCID: PMC9292198 DOI: 10.1111/liv.15024] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 12/12/2022]
Abstract
Lifestyle represents the most relevant factor for non-alcoholic fatty liver disease (NAFLD) as the hepatic manifestation of the metabolic syndrome. Although a tremendous body of clinical and preclinical data on the effectiveness of dietary and lifestyle interventions exist, the complexity of this topic makes firm and evidence-based clinical recommendations for nutrition and exercise in NAFLD difficult. The aim of this review is to guide readers through the labyrinth of recent scientific findings on diet and exercise in NAFLD and non-alcoholic steatohepatitis (NASH), summarizing "obvious" findings in a holistic manner and simultaneously highlighting stimulating aspects of clinical and translational research "beyond the obvious". Specifically, the importance of calorie restriction regardless of dietary composition and evidence from low-carbohydrate diets to target the incidence and severity of NAFLD are discussed. The aspect of ketogenesis-potentially achieved via intermittent calorie restriction-seems to be a central aspect of these diets warranting further investigation. Interactions of diet and exercise with the gut microbiota and the individual genetic background need to be comprehensively understood in order to develop personalized dietary concepts and exercise strategies for patients with NAFLD/NASH.
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Affiliation(s)
- Georg Semmler
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Christian Datz
- Department of Internal MedicineGeneral Hospital OberndorfTeaching Hospital of the Paracelsus Medical University SalzburgSalzburgAustria
| | - Thomas Reiberger
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Michael Trauner
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
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27
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Templeman I, Smith HA, Chowdhury E, Chen YC, Carroll H, Johnson-Bonson D, Hengist A, Smith R, Creighton J, Clayton D, Varley I, Karagounis LG, Wilhelmsen A, Tsintzas K, Reeves S, Walhin JP, Gonzalez JT, Thompson D, Betts JA. A randomized controlled trial to isolate the effects of fasting and energy restriction on weight loss and metabolic health in lean adults. Sci Transl Med 2021; 13:13/598/eabd8034. [PMID: 34135111 DOI: 10.1126/scitranslmed.abd8034] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/22/2021] [Accepted: 05/10/2021] [Indexed: 12/15/2022]
Abstract
Intermittent fasting may impart metabolic benefits independent of energy balance by initiating fasting-mediated mechanisms. This randomized controlled trial examined 24-hour fasting with 150% energy intake on alternate days for 3 weeks in lean, healthy individuals (0:150; n = 12). Control groups involved a matched degree of energy restriction applied continuously without fasting (75% energy intake daily; 75:75; n = 12) or a matched pattern of fasting without net energy restriction (200% energy intake on alternate days; 0:200; n = 12). Primary outcomes were body composition, components of energy balance, and postprandial metabolism. Daily energy restriction (75:75) reduced body mass (-1.91 ± 0.99 kilograms) almost entirely due to fat loss (-1.75 ± 0.79 kilograms). Restricting energy intake via fasting (0:150) also decreased body mass (-1.60 ± 1.06 kilograms; P = 0.46 versus 75:75) but with attenuated reductions in body fat (-0.74 ± 1.32 kilograms; P = 0.01 versus 75:75), whereas fasting without energy restriction (0:200) did not significantly reduce either body mass (-0.52 ± 1.09 kilograms; P ≤ 0.04 versus 75:75 and 0:150) or fat mass (-0.12 ± 0.68 kilograms; P ≤ 0.05 versus 75:75 and 0:150). Postprandial indices of cardiometabolic health and gut hormones, along with the expression of key genes in subcutaneous adipose tissue, were not statistically different between groups (P > 0.05). Alternate-day fasting less effectively reduces body fat mass than a matched degree of daily energy restriction and without evidence of fasting-specific effects on metabolic regulation or cardiovascular health.
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Affiliation(s)
- Iain Templeman
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Harry Alex Smith
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Enhad Chowdhury
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Yung-Chih Chen
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK.,Department of Physical Education, National Taiwan Normal University, Taipei City 106, Taiwan
| | - Harriet Carroll
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK.,Cardiovascular Research-Hypertension, Clinical Research Centre, Lund University, Malmö 221 00, Sweden
| | - Drusus Johnson-Bonson
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Aaron Hengist
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Rowan Smith
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Jade Creighton
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK.,School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK
| | - David Clayton
- School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK
| | - Ian Varley
- School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK
| | - Leonidas Georgios Karagounis
- Nestlé Health Science, Translation Research, Avenue Nestlé 55, CH-1800 Vevey, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Andrew Wilhelmsen
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK
| | - Kostas Tsintzas
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK
| | - Sue Reeves
- Department of Life Sciences, University of Roehampton, London SW15 4JD, UK
| | - Jean-Philippe Walhin
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Javier Thomas Gonzalez
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Dylan Thompson
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK
| | - James Alexander Betts
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath BA2 7AY, UK.
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28
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Williamson E, Moore DR. A Muscle-Centric Perspective on Intermittent Fasting: A Suboptimal Dietary Strategy for Supporting Muscle Protein Remodeling and Muscle Mass? Front Nutr 2021; 8:640621. [PMID: 34179054 PMCID: PMC8219935 DOI: 10.3389/fnut.2021.640621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
Muscle protein is constantly “turning over” through the breakdown of old/damaged proteins and the resynthesis of new functional proteins, the algebraic difference determining net muscle gain, maintenance, or loss. This turnover, which is sensitive to the nutritional environment, ultimately determines the mass, quality, and health of skeletal muscle over time. Intermittent fasting has become a topic of interest in the health community as an avenue to improve health and body composition primarily via caloric deficiency as well as enhanced lipolysis and fat oxidation secondary to attenuated daily insulin response. However, this approach belies the established anti-catabolic effect of insulin on skeletal muscle. More importantly, muscle protein synthesis, which is the primary regulated turnover variable in healthy humans, is stimulated by the consumption of dietary amino acids, a process that is saturated at a moderate protein intake. While limited research has explored the effect of intermittent fasting on muscle-related outcomes, we propose that infrequent meal feeding and periods of prolonged fasting characteristic of models of intermittent fasting may be counter-productive to optimizing muscle protein turnover and net muscle protein balance. The present commentary will discuss the regulation of muscle protein turnover across fasted and fed cycles and contrast it with studies exploring how dietary manipulation alters the partitioning of fat and lean body mass. It is our position that intermittent fasting likely represents a suboptimal dietary approach to remodel skeletal muscle, which could impact the ability to maintain or enhance muscle mass and quality, especially during periods of reduced energy availability.
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Affiliation(s)
- Eric Williamson
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Daniel R Moore
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
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Steger FL, Donnelly JE, Hull HR, Li X, Hu J, Sullivan DK. Intermittent and continuous energy restriction result in similar weight loss, weight loss maintenance, and body composition changes in a 6 month randomized pilot study. Clin Obes 2021; 11:e12430. [PMID: 33305526 PMCID: PMC9361403 DOI: 10.1111/cob.12430] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 12/14/2022]
Abstract
Poor adherence is a barrier to successful weight control. Intermittent energy restriction (IER) provides an alternative approach to those for whom daily energy restriction is not ideal. This study assessed changes in weight, body composition, and macronutrient intake for an IER and a continuous energy restriction (CONT) approach within a multicomponent weight management intervention. We randomized 35 adults with overweight/obesity (BMI = 31.2 ± 2.4 kg/m2 ) to CONT or IER for 24 weeks (12-week weight loss intervention and 12 weeks of weight loss maintenance). Diets were delivered within a multimodal weight management program including weekly group meetings with a registered dietitian, increased physical activity, and a comprehensive lifestyle change program. Retention and adherence were similar for CONT and IER. Weight, BMI, fat mass, percentage body fat, waist circumference, hip circumference, blood pressure, and heart rate all decreased after 24 weeks (all, P < .01), but there were no main effects of group (all, P > .27). Weight loss was clinically relevant in both CONT (11.38 ± 7.9%) and IER (9.37 ± 9.7%), and the proportion of each group achieving 5% weight loss was 82 and 61% (P = .16), respectively. Participant satisfaction was high in both groups. The results from this study (a) support the feasibility of IER as an alternative for weight loss and weight loss maintenance, (b) indicate that IER is an effective alternative to CONT for weight control and improvements in body composition, and (c) emphasize the importance of intensive lifestyle interventions with ongoing support for effective behaviour modification.
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Affiliation(s)
- Felicia L. Steger
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas
| | - Joseph E. Donnelly
- Center for Physical Activity and Weight Management, University of Kansas Medical Center, Kansas City, Kansas
| | - Holly R. Hull
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas
| | - Xinyang Li
- Center for Research in Leadership and Education, Texas Tech University, Lubbock, Texas
| | - Jinxiang Hu
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Debra K. Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas
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Abstract
Obesity affects 2 of 5 Americans, and nearly 1 of 10 is considered severely obese, with the greatest risk of morbidity and mortality. A reduction in body weight of 2% to 5% can lead to improvements in cardiovascular health, with weight loss maintenance associated with the best health outcomes. Lifestyle interventions that focus on changes in diet and physical activity behaviors are best to maintain weight loss. This article provides a review of the treatment of adult obesity with a focus on dietary interventions.
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Affiliation(s)
- Sina Gallo
- Foods and Nutrition, University of Georgia, Dawson Hall room 209, 305 Sanford Drive, Athens, GA 30602, USA.
| | - Lawrence J Cheskin
- Nutrition and Food Studies, George Mason University, Johns Hopkins School of Medicine, Peterson Hall, 4114, 1F7, 4400 University Drive, Fairfax, VA 22030, USA
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31
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Holmer M, Lindqvist C, Petersson S, Moshtaghi-Svensson J, Tillander V, Brismar TB, Hagström H, Stål P. Treatment of NAFLD with intermittent calorie restriction or low-carb high-fat diet - a randomised controlled trial. JHEP Rep 2021; 3:100256. [PMID: 33898960 PMCID: PMC8059083 DOI: 10.1016/j.jhepr.2021.100256] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/26/2021] [Accepted: 02/06/2021] [Indexed: 12/19/2022] Open
Abstract
Background & Aims The first-line treatment for non-alcoholic fatty liver disease (NAFLD) is weight reduction. Several diets have been proposed, with various effects specifically on liver steatosis. This trial compared the effects of intermittent calorie restriction (the 5:2 diet) and a low-carb high-fat diet (LCHF) on reduction of hepatic steatosis. Methods We conducted an open-label randomised controlled trial that included 74 patients with NAFLD randomised in a 1:1:1 ratio to 12 weeks' treatment with either a LCHF or 5:2 diet, or general lifestyle advice from a hepatologist (standard of care; SoC). The primary outcome was reduction of hepatic steatosis as measured by magnetic resonance spectroscopy. Secondary outcomes included transient elastography, insulin resistance, blood lipids, and anthropometrics. Results The LCHF and 5:2 diets were both superior to SoC treatment in reducing steatosis (absolute reduction: LCHF: -7.2% [95% CI = -9.3 to -5.1], 5:2: -6.1% [95% CI = -8.1 to -4.2], SoC: -3.6% [95% CI = -5.8 to -1.5]) and body weight (LCHF: -7.3 kg [95% CI = -9.6 to -5.0]; 5:2: -7.4 kg [95% CI = -8.7 to -6.0]; SoC: -2.5 kg [95% CI =-3.5 to -1.5]. There was no difference between 5:2 and LCHF (p = 0.41 for steatosis and 0.78 for weight). Liver stiffness improved in the 5:2 and SoC but not in the LCHF group. The 5:2 diet was associated with reduced LDL levels and was tolerated to a higher degree than LCHF. Conclusions The LCHF and 5:2 diets were more effective in reducing steatosis and body weight in patients with NAFLD than SoC, suggesting dietary advice can be tailored to meet individual preferences. Lay summary For a person with obesity who suffers from fatty liver, weight loss through diet can be an effective treatment to improve the condition of the liver. Many popular diets that are recommended for weight reduction, such as high-fat diets and diets based on intermittent fasting, have not had their effects on the liver directly evaluated. This study shows that both a low-carb high-fat and the 5:2 diet are effective in treating fatty liver caused by obesity. Clinical Trials Registration This study is registered at Clinicaltrials.gov (NCT03118310).
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Key Words
- 5:2 diet
- ALA, α-linolenic acid
- ALT, alanine aminotransferase
- CAP, controlled attenuation parameter
- CT, computed tomography
- Diet treatment
- E%, energy percent
- EoT, end of treatment
- HOMA-IR, homeostatic model assessment for insulin resistance
- ICR, intermittent calorie restriction
- IR, insulin resistance
- ITT, intention-to-treat analysis
- Intermittent calorie restriction
- LCHF, low-carb high-fat diet
- Low-carb-high fat (LCHF)
- MRS, magnetic resonance spectroscopy
- MUFA, monounsaturated fatty acids
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- NNR, Nordic Nutrition Recommendations 2012
- OGTT, oral glucose tolerance test
- Obesity
- PP, per protocol analysis
- PUFAs, polyunsaturated fatty acids
- SFAs, saturated fatty acids
- SoC, standard of care
- T2DM, type 2 diabetes mellitus
- WHR, waist-to-hip ratio
- low-CHO, low-carbohydrate diet
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Affiliation(s)
- Magnus Holmer
- Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.,Unit of Gastroenterology and Hepatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Lindqvist
- Medical Unit Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Sven Petersson
- Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Division of Medical Imaging and Technology, Stockholm, Sweden.,Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Veronika Tillander
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Torkel B Brismar
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Hannes Hagström
- Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.,Unit of Gastroenterology and Hepatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Per Stål
- Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.,Unit of Gastroenterology and Hepatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
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Allaf M, Elghazaly H, Mohamed OG, Fareen MFK, Zaman S, Salmasi AM, Tsilidis K, Dehghan A. Intermittent fasting for the prevention of cardiovascular disease. Cochrane Database Syst Rev 2021; 1:CD013496. [PMID: 33512717 PMCID: PMC8092432 DOI: 10.1002/14651858.cd013496.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death worldwide. Lifestyle changes are at the forefront of preventing the disease. This includes advice such as increasing physical activity and having a healthy balanced diet to reduce risk factors. Intermittent fasting (IF) is a popular dietary plan involving restricting caloric intake to certain days in the week such as alternate day fasting and periodic fasting, and restricting intake to a number of hours in a given day, otherwise known as time-restricted feeding. IF is being researched for its benefits and many randomised controlled trials have looked at its benefits in preventing CVD. OBJECTIVES To determine the role of IF in preventing and reducing the risk of CVD in people with or without prior documented CVD. SEARCH METHODS We conducted our search on 12 December 2019; we searched CENTRAL, MEDLINE and Embase. We also searched three trials registers and searched the reference lists of included papers. Systematic reviews were also viewed for additional studies. There was no language restriction applied. SELECTION CRITERIA We included randomised controlled trials comparing IF to ad libitum feeding (eating at any time with no specific caloric restriction) or continuous energy restriction (CER). Participants had to be over the age of 18 and included those with and without cardiometabolic risk factors. Intermittent fasting was categorised into alternate-day fasting, modified alternate-day fasting, periodic fasting and time-restricted feeding. DATA COLLECTION AND ANALYSIS Five review authors independently selected studies for inclusion and extraction. Primary outcomes included all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and heart failure. Secondary outcomes include the absolute change in body weight, and glucose. Furthermore, side effects such as headaches and changes to the quality of life were also noted. For continuous data, pooled mean differences (MD) (with 95% confidence intervals (CIs)) were calculated. We contacted trial authors to obtain missing data. We used GRADE to assess the certainty of the evidence. MAIN RESULTS: Our search yielded 39,165 records after the removal of duplicates. From this, 26 studies met our criteria, and 18 were included in the pooled analysis. The 18 studies included 1125 participants and observed outcomes ranging from four weeks to six months. No studies included data on all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and heart failure at any point during follow-up. Of quantitatively analysed data, seven studies compared IF with ab libitum feeding, eight studies compared IF with CER, and three studies compared IF with both ad libitum feeding and CER. Outcomes were reported at short term (≤ 3 months) and medium term (> 3 months to 12 months) follow-up. Body weight was reduced with IF compared to ad libitum feeding in the short term (MD -2.88 kg, 95% CI -3.96 to -1.80; 224 participants; 7 studies; low-certainty evidence). We are uncertain of the effect of IF when compared to CER in the short term (MD -0.88 kg, 95% CI -1.76 to 0.00; 719 participants; 10 studies; very low-certainty evidence) and there may be no effect in the medium term (MD -0.56 kg, 95% CI -1.68 to 0.56; 279 participants; 4 studies; low-certainty evidence). We are uncertain about the effect of IF on glucose when compared to ad libitum feeding in the short term (MD -0.03 mmol/L, 95% CI -0.26 to 0.19; 95 participants; 3 studies; very-low-certainty of evidence) and when compared to CER in the short term: MD -0.02 mmol/L, 95% CI -0.16 to 0.12; 582 participants; 9 studies; very low-certainty; medium term: MD 0.01, 95% CI -0.10 to 0.11; 279 participants; 4 studies; low-certainty evidence). The changes in body weight and glucose were not deemed to be clinically significant. Four studies reported data on side effects, with some participants complaining of mild headaches. One study reported on the quality of life using the RAND SF-36 score. There was a modest increase in the physical component summary score. AUTHORS' CONCLUSIONS Intermittent fasting was seen to be superior to ad libitum feeding in reducing weight. However, this was not clinically significant. There was no significant clinical difference between IF and CER in improving cardiometabolic risk factors to reduce the risk of CVD. Further research is needed to understand the safety and risk-benefit analysis of IF in specific patient groups (e.g. patients with diabetes or eating disorders) as well as the effect on longer-term outcomes such as all-cause mortality and myocardial infarction.
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Affiliation(s)
| | | | | | | | - Sadia Zaman
- School of Medicine, Imperial College London, London, UK
| | - Abdul-Majeed Salmasi
- Department of Cardiology, London North West University Healthcare NHS Trust, London, UK
| | - Kostas Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Abbas Dehghan
- School of Public Health, Imperial College London, London, UK
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Food Liking but Not Wanting Decreases after Controlled Intermittent or Continuous Energy Restriction to ≥5% Weight Loss in Women with Overweight/Obesity. Nutrients 2021; 13:nu13010182. [PMID: 33435287 PMCID: PMC7827400 DOI: 10.3390/nu13010182] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/29/2020] [Accepted: 01/06/2021] [Indexed: 12/02/2022] Open
Abstract
Food reward (i.e., liking and wanting) has been shown to decrease after different types of weight management interventions. However, it is unknown whether specific dietary modalities (continuous (CER) vs. intermittent (IER) energy restriction) have differing effects on liking and implicit wanting after weight loss (WL) and whether these changes are sustained after 1-year of no-contact. Women with overweight or obesity (age 18–55 years) were randomly allocated to controlled-feeding CER (25% daily energy restriction) or IER (alternating ad libitum and 75% energy restriction days). Study visits were conducted at baseline, post-WL (to ≥5% WL within 12 weeks) and 1-year post-WL. The main outcomes were liking and implicit wanting for 4 categories of common food varying in fat and taste assessed by the Leeds Food Preference Questionnaire. Linear mixed models were conducted on the 30 participants achieving ≥5% WL and 15 returners. After an initial WL of −5.1 ± 0.2 kg, after 1-year 2.6 ± 0.5 kg were regained. Liking but not wanting decreased after WL. Food reward after 1-year did not differ from baseline, but the high loss to follow-up prevents generalization. IER and CER did not differ in their effects on food reward during WL or at 1-year follow-up.
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Shvabskaia OB, Karamnova NS, Izmailova OV. Healthy Diet: New Rations for Individual Use. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-12-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Nutrition is one of the most significant factors influencing the state of health, the development of diseases and the generally the human longevity. The nature of nutrition, which has a protective effect, is the basis of the healthy diet. Among healthy nutritious rations, there are those that have developed naturally, formed from the cultural food heritage and later were made in scientific nutritional recommendations. These are such diets as the Mediterranean type of food, the Scandinavian diet, the Tibetan style of food, etc. At the same time, there are diets specially developed by specialists for specific purposes. All of them correspond to the basic principles of the healthy diet: balance, usefulness and energy balance. This article offers an overview of the use of individual diets that have been developed by nutritionists, such as the intermittent fasting diet, the Paleo diet, and the DASH (Dietary Approaches to Stop Hypertension) diet. The article discusses the differences and advantages of these dietary approaches, presents the results of effectiveness, considers the limitations and features of their use.
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Affiliation(s)
- O. B. Shvabskaia
- National Medical Research Center for Therapy and Preventive Medicine
| | - N. S. Karamnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. V. Izmailova
- National Medical Research Center for Therapy and Preventive Medicine
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Park J, Seo YG, Paek YJ, Song HJ, Park KH, Noh HM. Effect of alternate-day fasting on obesity and cardiometabolic risk: A systematic review and meta-analysis. Metabolism 2020; 111:154336. [PMID: 32777443 DOI: 10.1016/j.metabol.2020.154336] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/15/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Alternate-day fasting (ADF) is related to weight reduction, lowered risks of weight regain, and relative lean body mass preservation compared to continuous energy restriction. This meta-analysis aimed to assess the effects of ADF on obesity-related factors and cardiometabolic risk factors in adults. METHODS Using PubMed, EMBASE, and Cochrane online databases, an electronic search was performed. Randomized controlled trials were investigated to evaluate ADF effects on body mass index (BMI), body weight (BW), waist circumference, body fat mass (FM), lean body mass, and cardiometabolic risk factors in adults aged ≥18 years. By utilizing a random-effects model, meta-analyses to assess weighted mean difference (WMD) with 95% confidence intervals (CIs) were performed for eight randomized controlled trials (total participants = 728). RESULTS We observed significant effects of ADF for BMI (WMD -0.73 kg/m2, 95% CI -1.13 to -0.34), FM (WMD -1.27 kg, 95% CI -2.09 to -0.46), and total cholesterol (WMD -8.14 mg/dL, 95% CI -14.59 to -1.69). Subgroup analyses indicated that significant intervention effects were observed for BMI, BW, FM, and total cholesterol when compared to the control, the participants were overweight, and the study duration was <6 months. ADF is effective in reducing waist circumference in adults aged ≥40 years with obesity. However, there was no difference between ADF and continuous energy restriction, time-restricted feeding, or control with regard to lean body mass. CONCLUSIONS Current evidence suggests that ADF effectively lowers BMI, BW, FM, and total cholesterol in adults with overweight within 6 months compared to the control.
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Affiliation(s)
- Jihyun Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Republic of Korea
| | - Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Republic of Korea.
| | - Yu-Jin Paek
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Republic of Korea
| | - Hong Ji Song
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Republic of Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Republic of Korea
| | - Hye-Mi Noh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Republic of Korea
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36
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Sarro AA, Payedimarri AB, Concina DD, Farsoni MF, Piu NN, Rinaldi C, Panella MP. The efficacy of fasting regimens on health outcomes: a systematic overview. Minerva Gastroenterol (Torino) 2020; 67:289-298. [PMID: 32914941 DOI: 10.23736/s2724-5985.20.02757-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Fasting can be defined as abstinence or reduction from food, drink, or both, for a defined period. There are many different types of fasting regimens, such as Ramadan fasting, intermittent fasting, Christian Orthodox fasting. The aim of this overview is to provide an exhaustive summary on the beneficial effects and harms associated with fasting regimens and discuss mechanisms by which this non-pharmacological approach might lead to improve human health. EVIDENCE ACQUISITION A systematic search was performed on MEDLINE (PubMed), Embase, Cochrane Library and CINHAL. We included systematic reviews (SRs) that report on impact of different types of fasting regimens on health. Selection of SRs, data extraction and quality assessment were undertaken in duplicate. EVIDENCE SYNTHESIS A total of 21 SRs were included. Cumulatively, 97 health outcomes were identified. Of them, cardiovascular risk factors were the most frequently analyzed. Ramadan fasting is associated with significant improvements in body weight and visceral lean mass, high-density lipoprotein cholesterol (HDL-c), and with reductions in low-density lipoprotein cholesterol (LDL-c) and total cholesterol (T-chol), especially in cardiac patients. Similarly, reviews on Intermittent and Orthodox fasting proved benefits of those on weight, BMI, lipidic and glucose profile, inflammatory markers. CONCLUSIONS Fasting regimens showed potential beneficial effects on several health indicators in adult populations. Nevertheless, evidence on some specific health dimensions (cognitive function, well-being, quality of life) is limited. Thus, in the future, further RCTs or cohort studies with good methodological quality and larger sample sizes are warranted to better understand the underlying biological mechanism and the benefits on multidimensional aspects of health.
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Affiliation(s)
- Andrea A Sarro
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy -
| | - Anil B Payedimarri
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Diego D Concina
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Marco F Farsoni
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Nicola N Piu
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Carmela Rinaldi
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy.,Maggiore della Carità University Hospital, Novara, Italy
| | - Massimiliano P Panella
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy
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The Effects of Intermittent Fasting Combined with Resistance Training on Lean Body Mass: A Systematic Review of Human Studies. Nutrients 2020; 12:nu12082349. [PMID: 32781538 PMCID: PMC7468742 DOI: 10.3390/nu12082349] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022] Open
Abstract
Diets utilising intermittent fasting (IF) as a strategic method to manipulate body composition have recently grown in popularity, however, dietary practices involving fasting have also been followed for centuries for religious reasons (i.e., Ramadan). Regardless of the reasons for engaging in IF, the impacts on lean body mass (LBM) may be detrimental. Previous research has demonstrated that resistance training promotes LBM accrual, however, whether this still occurs during IF is unclear. Therefore, the objective of this review is to systematically analyse human studies investigating the effects of variations of IF combined with resistance training on changes in LBM in previously sedentary or trained (non-elite) individuals. Changes in body weight and fat mass, and protocol adherence were assessed as a secondary objective. This review followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. MEDLINE, CINAHL, PubMed and SportDiscus databases were searched for articles investigating IF, combined with resistance training that reported measures of body composition. Eight studies met the eligibility criteria. LBM was generally maintained, while one study reported a significant increase in LBM. Body fat mass or percentage was significantly reduced in five of eight studies. Results suggest that IF paired with resistance training generally maintains LBM, and can also promote fat loss. Future research should examine longer-term effects of various forms of IF combined with resistance training compared to traditional forms of energy restriction. Prospero registration CRD42018103867.
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Hoddy KK, Marlatt KL, Çetinkaya H, Ravussin E. Intermittent Fasting and Metabolic Health: From Religious Fast to Time-Restricted Feeding. Obesity (Silver Spring) 2020; 28 Suppl 1:S29-S37. [PMID: 32700827 PMCID: PMC7419159 DOI: 10.1002/oby.22829] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/14/2022]
Abstract
Over the past 10 to 15 years, intermittent fasting has emerged as an unconventional approach to reduce body weight and improve metabolic health beyond simple calorie restriction. In this review, we summarize findings related to Ramadan and Sunnah fasting. We then discuss the role of caloric restriction not only as an intervention for weight control, but importantly, as a strategy for healthy aging and longevity. Finally, we review the four most common intermittent fasting (IF) strategies used to date for weight management and to improve cardiometabolic health. Weight loss is common after IF but does not appear to be different than daily caloric restriction when compared directly. IF may also provide additional cardiometabolic benefit, such as insulin sensitization, that is independent from weight loss. While no specific fasting regimen stands out as superior at this time, there is indeed heterogeneity in responses to these different IF diets. This suggests that one dietary regimen may not be ideally suited for every individual. Future studies should consider strategies for tailoring dietary prescriptions, including IF, based on advanced phenotyping and genotyping prior to diet initiation.
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Affiliation(s)
- Kristin K. Hoddy
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Kara L. Marlatt
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Hatice Çetinkaya
- Department of Nutrition and Dietetics, Faculty of Health Science, Izmir Katip Celebi University, 35620, Izmir, Turkey
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
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Dinu M, Pagliai G, Angelino D, Rosi A, Dall'Asta M, Bresciani L, Ferraris C, Guglielmetti M, Godos J, Del Bo’ C, Nucci D, Meroni E, Landini L, Martini D, Sofi F. Effects of Popular Diets on Anthropometric and Cardiometabolic Parameters: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials. Adv Nutr 2020; 11:815-833. [PMID: 32059053 PMCID: PMC7360456 DOI: 10.1093/advances/nmaa006] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/19/2019] [Accepted: 01/14/2020] [Indexed: 12/14/2022] Open
Abstract
The prevalence of overweight, obesity, and their related complications is increasing worldwide. The purpose of this umbrella review was to summarize and critically evaluate the effects of different diets on anthropometric parameters and cardiometabolic risk factors. Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, and Web of Science, from inception to April 2019, were used as data sources to select meta-analyses of randomized controlled trials that examined the effects of different diets on anthropometric parameters and cardiometabolic risk factors. Strength and validity of the evidence were assessed through a set of predefined criteria. Eighty articles reporting 495 unique meta-analyses were examined, covering a wide range of popular diets: low-carbohydrate (n = 21 articles), high-protein (n = 8), low-fat (n = 9), paleolithic (n = 2), low-glycemic-index/load (n = 12), intermittent energy restriction (n = 6), Mediterranean (n = 11), Nordic (n = 2), vegetarian (n = 9), Dietary Approaches to Stop Hypertension (DASH) (n = 6), and portfolio dietary pattern (n = 1). Great variability in terms of definition of the intervention and control diets was observed. The methodological quality of most articles (n = 65; 81%), evaluated using the "A MeaSurement Tool to Assess systematic Reviews-2" questionnaire, was low or critically low. The strength of evidence was generally weak. The most consistent evidence was reported for the Mediterranean diet, with suggestive evidence of an improvement in weight, BMI, total cholesterol, glucose, and blood pressure. Suggestive evidence of an improvement in weight and blood pressure was also reported for the DASH diet. Low-carbohydrate, high-protein, low-fat, and low-glycemic-index/load diets showed suggestive and/or weak evidence of a reduction in weight and BMI, but contrasting evidence for lipid, glycemic, and blood pressure parameters, suggesting potential risks of unfavorable effects. Evidence for paleolithic, intermittent energy restriction, Nordic, vegetarian, and portfolio dietary patterns was graded as weak. Among all the diets evaluated, the Mediterranean diet had the strongest and most consistent evidence of a beneficial effect on both anthropometric parameters and cardiometabolic risk factors. This review protocol was registered at www.crd.york.ac.uk/PROSPERO/ as CRD42019126103.
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Affiliation(s)
- Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuditta Pagliai
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Donato Angelino
- Faculty of Bioscience and Technology for Food, Agriculture, and Environment, University of Teramo, Teramo, Italy
| | - Alice Rosi
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - Margherita Dall'Asta
- Department of Animal Science, Food, and Nutrition, Università Cattolica del Sacro Cuore, Piacenza, Italy
| | - Letizia Bresciani
- Human Nutrition Unit, Department of Veterinary Science, University of Parma, Parma, Italy
| | - Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Monica Guglielmetti
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | | | - Cristian Del Bo’
- Department of Food, Environmental, and Nutritional Sciences, Università degli Studi di Milano, Milan, Italy
| | - Daniele Nucci
- Digestive Endoscopy Unit, Veneto Institute of Oncology, Padua, Italy
| | - Erika Meroni
- Department of Food, Environmental, and Nutritional Sciences, Università degli Studi di Milano, Milan, Italy
| | - Linda Landini
- Medical Affairs Janssen, Cologno-Monzese, Milan, Italy
| | | | - Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Clinical Nutrition, University Hospital of Careggi, Florence, Italy
- Don Carlo Gnocchi Foundation Italy, Onlus, Florence, Italy
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Kord-Varkaneh H, Nazary-Vannani A, Mokhtari Z, Salehi-sahlabadi A, Rahmani J, Clark CCT, Fatahi S, Zanghelini F, Hekmatdoost A, Okunade K, Mirmiran P. The Influence of Fasting and Energy Restricting Diets on Blood Pressure in Humans: A Systematic Review and Meta-Analysis. High Blood Press Cardiovasc Prev 2020; 27:271-280. [DOI: 10.1007/s40292-020-00391-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022] Open
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Abstract
Obesity is a chronic, systemic disease defined as a pathologically increased fat mass, which is associated with an increased health risk. A BMI >30 kg/m2 is usually considered as a sign of obesity. Obesity requires a multidisciplinary and multimodal treatment, which varies depending on the phase of disease and the purpose (e.g. weight loss, weight maintenance). The treatment should be based on evidence. The goal of obesity therapy is to reduce the body weight by reducing fat mass in the long term in combination with a change in behavior, which aims to improve obesity-associated risk factors, reduce obesity-related illnesses, reduce the risk of premature mortality, incapacitation and early retirement, and improve quality of life. Non-surgical lifestyle therapy comprises nutrition, exercise, behavior change ("basic therapy") which becomes more effective when combined with initial formula diet. A formula diet as initial therapy is indicated if a relative weight loss more than 10% is intended. A successful and sustained obesity therapy needs a clear structure, a well-trained team of professionals, and the coverage of the costs. Drugs can support obesity therapy, while other drugs can promote weight gain. The multimodal approach is the most effective non-surgical therapy resulting in a relative weight loss of 15-25%. The primary obesity therapy should be with a non-surgical approach, but bariatric surgery may be needed if the problem cannot otherwise be solved. A clear and realistic interface to bariatric surgery needs to be defined. Weight maintenance strategies including and beyond dietetic concepts are usually needed throughout life for long-term stabilization of body weight.
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Affiliation(s)
- Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany.
| | - Anna Schweinlin
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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Schwingshackl L, Zähringer J, Nitschke K, Torbahn G, Lohner S, Kühn T, Fontana L, Veronese N, Schmucker C, Meerpohl JJ. Impact of intermittent energy restriction on anthropometric outcomes and intermediate disease markers in patients with overweight and obesity: systematic review and meta-analyses. Crit Rev Food Sci Nutr 2020; 61:1293-1304. [PMID: 32363896 DOI: 10.1080/10408398.2020.1757616] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This systematic review aims to investigate the effects of intermittent energy restriction (IER) on anthropometric outcomes and intermediate disease markers. A systematic literature search was conducted in three electronic databases. Randomized controlled trials (RCTs) were included if the intervention lasted ≥12 weeks and IER was compared with either continuous energy restriction (CER) or a usual diet. Random-effects meta-analysis was performed for eight outcomes. Certainty of evidence was assessed using GRADE. Seventeen RCTs with 1328 participants were included. IER in comparison to a usual diet may reduce body weight (mean difference [MD]: -4.83 kg, 95%-CI: -5.46, -4.21; n = 6 RCTs), waist circumference (MD: -1.73 cm, 95%-CI: -3.69, 0.24; n = 2), fat mass (MD: -2.54 kg, 95%-CI: -3.78, -1.31; n = 6), triacylglycerols (MD: -0.20 mmol/L, 95%-CI: -0.38, -0.03; n = 5) and systolic blood pressure (MD: -6.11 mmHg, 95%-CI: -9.59, -2.64; n = 5). No effects were observed for LDL-cholesterol, fasting glucose, and glycosylated-hemoglobin. Both, IER and CER have similar effect on body weight (MD: -0.55 kg, 95%-CI: -1.01, -0.09; n = 13), and fat mass (MD: -0.66 kg, 95%-CI: -1.14, -0.19; n = 10), and all other outcomes. In conclusion, IER improves anthropometric outcomes and intermediate disease markers when compared to a usual diet. The effects of IER on weight loss are similar to weight loss achieved by CER.
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Affiliation(s)
- Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jasmin Zähringer
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kai Nitschke
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriel Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Szimonetta Lohner
- Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Luigi Fontana
- Faculty of Medicine and Health and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicola Veronese
- Primary Care Department, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Christine Schmucker
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
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Kusumawardani W, Farapti F. Hubungan Perilaku Diet Dengan Massa Lemak Tubuh Pada Remaja Putri Di SMA Negeri 5 Surabaya. AMERTA NUTRITION 2020. [DOI: 10.20473/amnt.v4i1.2020.65-71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The fat body mass can be increased especially in adolescent girl. When fat body mass increased it can affect the nutritional status and body image. If someone wants to have the ideal body imaged, they can try to do diet to decreased fat body mass. Objectives: This study aimed to analyze a relationship of dieting behavior with fat body mass at SMA Negeri 5 Surabaya.Methods: The design of the study was cross sectional involving 76 selected samples in the simple random sampling. The aimed of measuring body height, weight and body fat mass for scoring the nutritional status and percentage of fat body mass. Some characteristic of the respondents were age, amount of pocket money, physical activity and nutritional status. The data were analyzed by using Chi-Square correlation test with p<0.05.Results: The averaged of respondents age was 16 years old, most of all the amounted of pocket money from the respondents approximately IDR 25,000-75,000 (35.5%). The category of physical activity was mild (42.1%), and the nutritional status of respondents was normal (61.3%). Some of the respondents was doing a healthy diet (61.8%) with averaged score was 39.8. The averaged of body fat mass from the respondents was 25.24%. The result showing there was no relationship between diet behavior with fat body mass in girl adolescent (p>0.060).Conclusions: Diet behavior was not founded to be related to the fat body mass in female adolescent. Therefore the students needed to get more information about dieting behavior and fat body mass to prevented more nutritional problems.ABSTRAKLatar Belakang: Peningkatan massa lemak tubuh biasa dialami oleh remaja putri. Massa lemak tubuh yang berlebih akan berdampak pada status gizi serta bentuk tubuh. Diet merupakan salah satu cara untuk menurunkan massa lemak tubuh tersebut agar bentuk tubuh menjadi ideal.Tujuan:menganalisis hubungan antara perilaku diet dengan massa lemak tubuh remaja putri di SMA Negeri 5 Surabaya.Metode: Penelitian ini menggunakan desain studi cross sectional dan melibatkan 76 responden yang dipilih secara simple random sampling. Data dikumpulkan dengan melakukan pengukuran berat badan dan tinggi badan untuk menilai status gizi serta pengukuran persentase massa lemak tubuh menggunakan BIA (Bioelectrical Impedance Analysis). Wawancara dan pengisian kuesioner untuk mengetahui karakteristik dan perilaku diet responden. Teknik analisis data yang digunakan adalah uji korelasi chi-square dengan p<0,05.Hasil: rata-rata usia subyek 15,93±0,64 tahun dengan rerata besar uang saku harian sebesar Rp 22.474±12.62i, Aktivitas fisik tingkat ringan sebanyak 42,1% siswi, dan status gizi responden berdasarkan IMT/U didominasi oleh kategori normal sebanyak 80,3%. Sebagian besar responden menjalankan diet sehat sebanyak 61,8% dengan rata-rata nilai sebesar 39,8.Sebanyak 31,6% subyek dengan kategori massa lebih lebihHasil analisis menunjukkan tidak adanya hubungan antara perilaku diet dengan persen lemak tubuh remaja putri (p>0,06).Kesimpulan: Perilaku diet tidak memiliki hubungan yang bermakna dengan massa lemak tubuh remaja putri. Diperlukan penelitian lebih lanjut untuk menganalisis faktor lain yang berhubungan dengan perilaku diet dan massa lemak tubuh pada remaja putri.
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Parvaresh A, Razavi R, Abbasi B, Yaghoobloo K, Hassanzadeh A, Mohammadifard N, Safavi SM, Hadi A, Clark CC. Modified alternate-day fasting vs. calorie restriction in the treatment of patients with metabolic syndrome: A randomized clinical trial. Complement Ther Med 2019; 47:102187. [DOI: 10.1016/j.ctim.2019.08.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/09/2019] [Accepted: 08/27/2019] [Indexed: 12/20/2022] Open
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Kalam F, Gabel K, Cienfuegos S, Wiseman E, Ezpeleta M, Steward M, Pavlou V, Varady KA. Alternate day fasting combined with a low-carbohydrate diet for weight loss, weight maintenance, and metabolic disease risk reduction. Obes Sci Pract 2019; 5:531-539. [PMID: 31890243 PMCID: PMC6934424 DOI: 10.1002/osp4.367] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Alternate day fasting (ADF) is a popular weight loss regimen. Whether carbohydrate restriction can enhance the weight loss achieved with ADF remains unclear. Accordingly, this study examined the effect of ADF combined with a low-carbohydrate diet on body weight and metabolic disease risk factors. METHODS Adults with obesity (n = 31) participated in ADF (600 kcal "fast day" alternated with an ad libitum "feast day") with a low-carbohydrate background diet (30% carbohydrates, 35% protein, and 35% fat). The 6-month trial consisted of a 3-month weight loss period followed by a 3-month weight maintenance period. RESULTS Body weight decreased (-5.5 ± 0.5%; P < .001) during the weight loss period (month 0-3) but remained stable (P = .57) during the weight maintenance period (month 4-6). Net weight loss by month 6 was -6.3 ± 1.0%. Fat mass was reduced (P < .01) by month 6, while lean mass and visceral fat mass remained unchanged. Total cholesterol and low-density lipoprotein (LDL) cholesterol levels decreased (P < .05) by -6 ± 2% and - 8 ± 3%, respectively, by month 6. Systolic blood pressure was also reduced (P = .03) by -7 ± 3 mm Hg. Fasting insulin decreased (P = .03) by -24 ± 8% by month 6 relative to baseline. High-density lipoprotein (HDL) cholesterol, triglycerides, diastolic blood pressure, heart rate, fasting glucose, homeostatic model assessment of insulin resistance (HOMA-IR), and haemoglobin A1C (HbA1c) remained unchanged. CONCLUSIONS These findings suggest that ADF combined with a low-carbohydrate diet is effective for weight loss, weight maintenance, and improving certain metabolic disease risk factors such as LDL cholesterol, blood pressure, and fasting insulin. While these preliminary findings are promising, they still require confirmation by a randomized control trial.
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Affiliation(s)
- Faiza Kalam
- Department of Kinesiology and NutritionUniversity of Illinois at ChicagoChicagoIllinois
| | - Kelsey Gabel
- Department of Kinesiology and NutritionUniversity of Illinois at ChicagoChicagoIllinois
| | - Sofia Cienfuegos
- Department of Kinesiology and NutritionUniversity of Illinois at ChicagoChicagoIllinois
| | - Eric Wiseman
- Department of Kinesiology and NutritionUniversity of Illinois at ChicagoChicagoIllinois
| | - Mark Ezpeleta
- Department of Kinesiology and NutritionUniversity of Illinois at ChicagoChicagoIllinois
| | - Malik Steward
- Department of Kinesiology and NutritionUniversity of Illinois at ChicagoChicagoIllinois
| | - Vasiliki Pavlou
- Department of Kinesiology and NutritionUniversity of Illinois at ChicagoChicagoIllinois
| | - Krista A. Varady
- Department of Kinesiology and NutritionUniversity of Illinois at ChicagoChicagoIllinois
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Harris L, Hamilton S, Azevedo LB, Olajide J, De Brún C, Waller G, Whittaker V, Sharp T, Lean M, Hankey C, Ells L. Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2019; 16:507-547. [PMID: 29419624 DOI: 10.11124/jbisrir-2016-003248] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To examine the effectiveness of intermittent energy restriction in the treatment for overweight and obesity in adults, when compared to usual care treatment or no treatment. INTRODUCTION Intermittent energy restriction encompasses dietary approaches including intermittent fasting, alternate day fasting, and fasting for two days per week. Despite the recent popularity of intermittent energy restriction and associated weight loss claims, the supporting evidence base is limited. INCLUSION CRITERIA This review included overweight or obese (BMI ≥25 kg/m) adults (≥18 years). Intermittent energy restriction was defined as consumption of ≤800 kcal on at least one day, but no more than six days per week. Intermittent energy restriction interventions were compared to no treatment (ad libitum diet) or usual care (continuous energy restriction ∼25% of recommended energy intake). Included interventions had a minimum duration of 12 weeks from baseline to post outcome measurements. The types of studies included were randomized and pseudo-randomized controlled trials. The primary outcome of this review was change in body weight. Secondary outcomes included: i) anthropometric outcomes (change in BMI, waist circumference, fat mass, fat free mass); ii) cardio-metabolic outcomes (change in blood glucose and insulin, lipoprotein profiles and blood pressure); and iii) lifestyle outcomes: diet, physical activity, quality of life and adverse events. METHODS A systematic search was conducted from database inception to November 2015. The following electronic databases were searched: MEDLINE, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov, ISRCTN registry, and anzctr.org.au for English language published studies, protocols and trials. Two independent reviewers evaluated the methodological quality of included studies using the standardized critical appraisal instruments from the Joanna Briggs Institute. Data were extracted from papers included in the review by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute. Effect sizes were expressed as weighted mean differences and their 95% confidence intervals were calculated for meta-analyses. RESULTS Six studies were included in this review. The intermittent energy restriction regimens varied across studies and included alternate day fasting, fasting for two days, and up to four days per week. The duration of studies ranged from three to 12 months. Four studies included continuous energy restriction as a comparator intervention and two studies included a no treatment control intervention. Meta-analyses showed that intermittent energy restriction was more effective than no treatment for weight loss (-4.14 kg; 95% CI -6.30 kg to -1.99 kg; p ≤ 0.001). Although both treatment interventions achieved similar changes in body weight (approximately 7 kg), the pooled estimate for studies that investigated the effect of intermittent energy restriction in comparison to continuous energy restriction revealed no significant difference in weight loss (-1.03 kg; 95% CI -2.46 kg to 0.40 kg; p = 0.156). CONCLUSIONS Intermittent energy restriction may be an effective strategy for the treatment of overweight and obesity. Intermittent energy restriction was comparable to continuous energy restriction for short term weight loss in overweight and obese adults. Intermittent energy restriction was shown to be more effective than no treatment, however, this should be interpreted cautiously due to the small number of studies and future research is warranted to confirm the findings of this review.
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Affiliation(s)
- Leanne Harris
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Sharon Hamilton
- Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom.,Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom
| | - Liane B Azevedo
- Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom.,Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom
| | - Joan Olajide
- Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom.,Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom
| | - Caroline De Brún
- Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom.,Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom
| | - Gillian Waller
- Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom.,Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom
| | - Vicki Whittaker
- Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom.,Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom
| | - Tracey Sharp
- Independent Public Health Consultant, United Kingdom
| | - Mike Lean
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Catherine Hankey
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Louisa Ells
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom
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Abstract
Cardiovascular diseases are the most prominent maladies in aging societies. Indeed, aging promotes the structural and functional declines of both the heart and the blood circulation system. In this review, we revise the contribution of known longevity pathways to cardiovascular health and delineate the possibilities to interfere with them. In particular, we evaluate autophagy, the intracellular catabolic recycling system associated with life- and health-span extension. We present genetic models, pharmacological interventions, and dietary strategies that block, reduce, or enhance autophagy upon age-related cardiovascular deterioration. Caloric restriction or caloric restriction mimetics like metformin, spermidine, and rapamycin (all of which trigger autophagy) are among the most promising cardioprotective interventions during aging. We conclude that autophagy is a fundamental process to ensure cardiac and vascular health during aging and outline its putative therapeutic importance.
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Affiliation(s)
- Mahmoud Abdellatif
- From the Department of Cardiology, Medical University of Graz, Austria (M.A., S.S.)
| | - Simon Sedej
- From the Department of Cardiology, Medical University of Graz, Austria (M.A., S.S.).,BioTechMed Graz, Austria (S.S., D.C.-G., F.M.)
| | - Didac Carmona-Gutierrez
- BioTechMed Graz, Austria (S.S., D.C.-G., F.M.).,Institute of Molecular Biosciences, NAWI Graz, University of Graz, Austria (D.C.-G., F.M.)
| | - Frank Madeo
- BioTechMed Graz, Austria (S.S., D.C.-G., F.M.).,Institute of Molecular Biosciences, NAWI Graz, University of Graz, Austria (D.C.-G., F.M.)
| | - Guido Kroemer
- Equipe 11 Labellisée Ligue Contre le Cancer, Centre de Recherche des Cordeliers, Paris, France (G.K.).,Cell Biology and Metabolomics Platforms, Gustave Roussy Comprehensive Cancer Center, Villejuif, France (G.K.).,INSERM, U1138, Paris, France (G.K.).,Université Paris Descartes, Sorbonne Paris Cité, France (G.K.).,Université Pierre et Marie Curie, Paris, France (G.K.).,Pôle de Biologie, Hôpital Européen Georges Pompidou, Paris, France (G.K.).,Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden (G.K.)
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Swoap SJ, Bingaman MJ, Hult EM, Sandstrom NJ. Alternate-day feeding leads to improved glucose regulation on fasting days without significant weight loss in genetically obese mice. Am J Physiol Regul Integr Comp Physiol 2019; 317:R461-R469. [DOI: 10.1152/ajpregu.00140.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Alternate-day fasting (ADF) is effective for weight loss and increases insulin sensitivity in diet-induced obese rodents. However, the efficacy of ADF in genetic models of obesity has not been comprehensively studied. Mice that are deficient in leptin ( ob/ob mice) are obese, diabetic, and prone to deep bouts of torpor when fasted. We tested the hypotheses that an ADF protocol in ob/ob mice would result in 1) induction of torpor on fasted days, 2) minimal body weight loss if the mice experienced torpor, and 3) no improvement in glucose control in the absence of weight loss. Female ob/ob mice and littermate controls were assigned to 1) an ad libitum regimen or 2) an ADF regimen, consisting of fasting every other day with ad libitum feeding between fasts. Over a 19-day period, littermate control mice on the ADF regimen consumed the same amount of food as littermate control mice on the ad libitum regimen, whereas the ADF ob/ob mice consumed 37% less food than ad libitum ob/ob mice. Fasting days, but not fed days, led to torpor in both genotypes. Fasting days, but not fed days, led to weight loss in both genotypes relative to ad libitum controls. Fasting days, but not fed days, produced enhanced insulin sensitivity in both genotypes and normalized circulating glucose in ob/ob mice. These data demonstrate improved glucose control on fasting days with the use of ADF in a genetic model of obesity in the face of minimal weight loss.
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Affiliation(s)
- Steven J. Swoap
- Department of Biology, Williams College, Williamstown, Massachusetts
| | - Mark J. Bingaman
- Department of Biology, Williams College, Williamstown, Massachusetts
| | - Elissa M. Hult
- Department of Biology, Williams College, Williamstown, Massachusetts
| | - Noah J. Sandstrom
- Department of Psychology, Williams College, Williamstown, Massachusetts
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Abstract
Obesity remains a major public health concern and intermittent fasting is a popular strategy for weight loss, which may present independent health benefits. However, the number of diet books advising how fasting can be incorporated into our daily lives is several orders of magnitude greater than the number of trials examining whether fasting should be encouraged at all. This review will consider the state of current understanding regarding various forms of intermittent fasting (e.g. 5:2, time-restricted feeding and alternate-day fasting). The efficacy of these temporally defined approaches appears broadly equivalent to that of standard daily energy restriction, although many of these models of intermittent fasting do not involve fed-fasted cycles every other 24 h sleep-wake cycle and/or permit some limited energy intake outside of prescribed feeding times. Accordingly, the intervention period therefore may not regularly alternate, may not span all or even most of any given day, and may not even involve absolute fasting. This is important because potentially advantageous physiological mechanisms may only be initiated if a post-absorptive state is sustained by uninterrupted fasting for a more prolonged duration than applied in many trials. Indeed, promising effects on fat mass and insulin sensitivity have been reported when fasting duration is routinely extended beyond sixteen consecutive hours. Further progress will require such models to be tested with appropriate controls to isolate whether any possible health effects of intermittent fasting are primarily attributable to regularly protracted post-absorptive periods, or simply to the net negative energy balance indirectly elicited by any form of dietary restriction.
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Avoiding holiday seasonal weight gain with nutrient-supported intermittent energy restriction: a pilot study. J Nutr Sci 2019; 8:e11. [PMID: 30931109 PMCID: PMC6436006 DOI: 10.1017/jns.2019.8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 12/26/2022] Open
Abstract
This pilot randomised controlled study evaluated the effects of a nutrient-supported intermittent energy restriction nutrition programme to prevent weight gain in healthy overweight adults during the 6-week winter holiday period between Thanksgiving and New Year. For 52 d, twenty-two overweight adults (mean age 41·0 years, BMI 27·3 kg/m2) were assigned to either the nutrition programme (n 10; two fasting days of 730 kcal/d (3050 kJ/d) of balanced shake and dietary supplements to support weight management efforts, followed by 5 d of habitual diet) or a control group (n 12; habitual diet). A significant weight loss from baseline (pre-holiday 10 d before Thanksgiving) to day 52 (post-holiday 3 January) was observed in the nutrition programme (75·0 (sd 9·8) v. 76·3 (sd 9·8) kg; P < 0·05). Body weight did not significantly change in the control group and there was no between-group difference. Increases from baseline in fasting insulin (42·9 %; P = 0·0256), updated homoeostasis model assessment (HOMA2) (43 %; P = 0·025), LDL-cholesterol (8·4 %; P = 0·0426) and total cholesterol (7·1 %; P = 0·0154) levels were also reported in the control group. In the nutrition programme group, baseline HDL-cholesterol and TAG levels measured after two fasting days increased (13 %; P = 0·0245) and decreased (22·8 %; P = 0·0416), respectively. There was no significant change in HOMA2. Between-group differences in changes in insulin levels (P = 0·0227), total cholesterol:HDL-cholesterol ratio (P = 0·0419) and HOMA2 (P = 0·0210) were significant. Overall compliance rate was 98 % and no severe adverse events were reported. These preliminary findings suggest that this intermittent energy restriction intervention might support weight management efforts and help promote metabolic health during the winter holiday season.
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