Metabolic changes with intermittent fasting

Case report of a female western Indian vegetarian with obesity

Background

South Asians are defined as those indigenous to the Indian subcontinent - India, Pakistan, Sri Lanka, Nepal, Maldives, Bhutan, and Bangladesh. This ethnic group is a unique population with increased prevalence of metabolic syndrome even at a lower body mass index (BMI). Should they also have increased BMI, the risk for development of diabetes mellitus and cardiovascular complications are further magnified. Strong cultural perceptions about ideal body weight, lack of awareness about the race and ethnicity-specific risks, and knowledge gaps regarding different dietary patterns among the healthcare providers confound further the metabolic issues pertinent to South Asians living in North America.

Methods

In this case study of a South Asian patient, we present asynchronous co-management of obesity by an obesity specialist and the primary care provider in a university-based clinic.

Results

Intense lifestyle interventions including a custom-tailored Indian vegetarian meal plan and weekly injectable Semaglutide was offered to the patient as treatment plan. The patient lost 59 pounds, and BMI changed from 34.1 kg/m2 to 23.5 kg/m2.

Conclusion

Intensive lifestyle interventions with custom-tailored dietary changes, regular physical activity and behavior modifications combined with appropriate pharmacotherapy can be very successful in the management of obesity among South Asians living in North America.

Intermittent fasting and cardiovascular disease: A scoping review of the evidence

Intermittent fasting (IF), characterized by alternating periods of fasting and unrestricted eating, typically within an 8-hour window or less each day, has gained significant attention as a possible dietary approach. While it is recognized for its metabolic advantages, like weight loss and enhanced glucose and insulin sensitivity, its effect on cardiovascular health remains a topic of mixed opinions. Recent findings suggest a potential downside, with reports indicating a concerning association: a 91 % higher risk of cardiovascular disease (CVD) mortality compared to eating spread across a 12- to 16-hour period. Despite this alarming statistic, the evidence cannot establish a causal link. The impact of IF on CVD is still insufficiently understood, with benefits sometimes exaggerated and risks downplayed in popular discourse. This scoping review aims to consolidate the current evidence, addressing unresolved questions about the benefits and risks of IF, particularly its association with CVD risks and mortality. The goal is to provide a balanced perspective on the potential health implications of IF, emphasizing the need for further research to clarify its long-term effects on cardiovascular health.

The Role of Intermittent Fasting on Metabolic Syndrome: A Systematic Review and Meta-Analysis

Intermittent fasting has gained popularity as a dietary intervention to improve metabolic health. Metabolic syndrome may benefit from intermittent fasting by improving weight, cholesterol levels, blood pressure (BP), and glucose control. This study aims to assess the effects of intermittent fasting on weight, BMI, cholesterol levels, BP, and glucose in individuals with metabolic syndrome. This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and included 11 studies examining the effects of intermittent fasting on metabolic syndrome. A comprehensive search of PubMed and Google Scholar identified 6,451 studies, of which 11 met the inclusion criteria. Data on weight, BMI, cholesterol, BP, and glucose levels were extracted, and a random effects meta-analysis was conducted to assess outcomes. Analysis showed significant improvements in weight, with a mean reduction of 3.59 kg (95% CI: -4.59 to -2.59, p < 0.0001) and a decrease in BMI of 1.39 kg/m2 (95% CI: -1.87 to -0.92, p < 0.0001). Low-density lipoprotein (LDL) cholesterol levels dropped by 56.22 mg/dL (95% CI: -80.14 to -32.29, p < 0.0001), and systolic BP decreased by 5.54 mmHg (95% CI: -7.55 to -3.53, p < 0.0001). However, high-density lipoprotein (HDL) cholesterol showed minimal changes, and glucose levels remained stable. Intermittent fasting led to significant reductions in weight, BMI, LDL cholesterol, and BP, making it a promising non-pharmacological strategy for managing metabolic syndrome. Further research is needed to explore long-term effects and optimal fasting protocols for different populations.

Intermittent Fasting in Youth: A Scoping Review

Intermittent fasting (IF) focuses on the timing of eating rather than diet quality or energy intake, with evidence supporting its effects on weight loss and cardiometabolic outcomes in adults. However, there is limited evidence for its efficacy in adolescents and emerging adults. To address this, a scoping review examined IF regimens in individuals aged 10 to 25, focusing on methodology, intervention parameters, outcomes, adherence, feasibility, and efficacy. The review included 39 studies with 731 participants aged 15 to 25. Methodologies varied, with 18 studies on time-restricted eating and others requiring caloric restriction. Primary outcomes included cardiometabolic risk factors (11/29), body composition (9/29), anthropometric measurements (8/29), and feasibility (2/29). Most studies reported significant weight loss. This review underscores IF's potential in treating obesity in this age group but highlights the need for rigorous studies with standardized frameworks for feasibility to ensure comparability and determine IF's practicality in this age group.

Calorie Restriction and Time-Restricted Feeding: Effective Interventions in Overweight or Obese Patients Undergoing Radiotherapy Treatment with Curative Intent for Cancer

This study assesses the feasibility of calorie restriction (CR) and time-restricted feeding (TRF) in overweight and obese cancer patients who realized little to no physical activity undergoing curative radiotherapy, structured as a prospective, interventional, non-randomized open-label clinical trial. Of the 27 participants initially enrolled, 21 patients with breast cancer were selected for analysis. The participants self-selected into two dietary interventions: TRF, comprising a sugar and saturated fat-free diet calibrated to individual energy needs consumed within an 8 h eating window followed by a 16 h fast, or CR, involving a 25% reduction in total caloric intake from energy expenditure distributed across 4 meals and 1 snack with 55% carbohydrates, 15% protein, and 30% fats, excluding sugars and saturated fats. The primary goal was to evaluate the feasibility of these diets in the specific patient group. The results indicate that both interventions are effective and statistically significant for weight loss and reducing one's waist circumference, with TRF showing a potentially stronger impact and better adherence. Changes in the LDL, HDL, total cholesterol, triglycerides, glucose and insulin were not statistically significant.