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Ribas-Latre A, Fernández-Veledo S, Vendrell J. Time-restricted eating, the clock ticking behind the scenes. Front Pharmacol 2024; 15:1428601. [PMID: 39175542 PMCID: PMC11338815 DOI: 10.3389/fphar.2024.1428601] [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: 05/06/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024] Open
Abstract
Introduction Maintaining metabolic balance relies on accumulating nutrients during feeding periods and their subsequent release during fasting. In obesity and metabolic disorders, strategies aimed at reducing food intake while simulating fasting have garnered significant attention for weight loss. Caloric restriction (CR) diets and intermittent fasting (IF) interventions have emerged as effective approaches to improving cardiometabolic health. Although the comparative metabolic benefits of CR versus IF remain inconclusive, this review focuses on various forms of IF, particularly time-restricted eating (TRE). Methods This study employs a narrative review methodology, systematically collecting, synthesizing, and interpreting the existing literature on TRE and its metabolic effects. A comprehensive and unbiased search of relevant databases was conducted to identify pertinent studies, including pre-clinical animal studies and clinical trials in humans. Keywords such as "Obesity," "Intermittent Fasting," "Time-restricted eating," "Chronotype," and "Circadian rhythms" guided the search. The selected studies were critically appraised based on predefined inclusion and exclusion criteria, allowing for a thorough exploration and synthesis of current knowledge. Results This article synthesizes pre-clinical and clinical studies on TRE and its metabolic effects, providing a comprehensive overview of the current knowledge and identifying gaps for future research. It explores the metabolic outcomes of recent clinical trials employing different TRE protocols in individuals with overweight, obesity, or type II diabetes, emphasizing the significance of individual chronotype, which is often overlooked in practice. In contrast to human studies, animal models underscore the role of the circadian clock in mitigating metabolic disturbances induced by obesity through time-restricted feeding (TRF) interventions. Consequently, we examine pre-clinical evidence supporting the interplay between the circadian clock and TRF interventions. Additionally, we provide insights into the role of the microbiota, which TRE can modulate and its influence on circadian rhythms.
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Affiliation(s)
- Aleix Ribas-Latre
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari de Tarragona, Tarragona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departament de Medicina i Cirugia, Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Sonia Fernández-Veledo
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari de Tarragona, Tarragona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departament de Medicina i Cirugia, Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Joan Vendrell
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari de Tarragona, Tarragona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)-Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departament de Medicina i Cirugia, Universitat Rovira i Virgili (URV), Tarragona, Spain
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Smith DL, Yang Y, Mestre LM, Henschel B, Parker E, Dickinson S, Patki A, Allison DB, Nagy TR. Impact of sustained calorie restriction and weight cycling on body composition in high-fat diet-fed male and female C57BL/6J mice. Obesity (Silver Spring) 2024; 32:959-968. [PMID: 38600047 PMCID: PMC11145641 DOI: 10.1002/oby.24015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The objective of this study was to investigate body composition changes with weight cycling (WC) among adult C57BL/6J mice with diet-induced obesity. METHODS A total of 555 single-housed mice were fed a high-fat diet ad libitum (AL) from 8 to 43 weeks of age. The 200 heaviest mice of each sex were randomized to the following four groups: ever obese (EO, continued AL feeding); obese weight loser (OWL, calorie-restricted); obese weight loser moderate (OWLM, body weight halfway between EO and OWL); and WC (diet restricted to OWL followed by AL refeeding cycles). Body weight and composition data were collected. Linear regression was used to calculate residuals between predicted and observed fat mass. Linear mixed models were used to compare diet groups. RESULTS Although weight loss and regain resulted in changes in body weight and composition, fat mass, body weight, and relative body fat were not significantly greater for the WC group compared with the EO group. During long-term calorie restriction, males (but not females) in the OWLM group remained relatively fatter than the EO group. CONCLUSIONS WC did not increase body weight or relative fat mass for middle-aged, high-fat diet-fed adult mice. However, long-term moderate calorie restriction resulted in lower body weight but greater "relative" fat in male mice.
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Affiliation(s)
- Daniel L. Smith
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294 USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294 USA
- Diabetes Research Center, University of Alabama at Birmingham, Birmingham, AL 35294 USA
- Nathan Shock Center of Excellence in the Basic Biology of Aging, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Yongbin Yang
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294 USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Luis M. Mestre
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington IN, USA
| | - Beate Henschel
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington IN, USA
| | - Erik Parker
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington IN, USA
| | - Stephanie Dickinson
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington IN, USA
| | - Amit Patki
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - David B. Allison
- Nathan Shock Center of Excellence in the Basic Biology of Aging, University of Alabama at Birmingham, Birmingham, AL 35294 USA
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington IN, USA
| | - Tim R. Nagy
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294 USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294 USA
- Diabetes Research Center, University of Alabama at Birmingham, Birmingham, AL 35294 USA
- Nathan Shock Center of Excellence in the Basic Biology of Aging, University of Alabama at Birmingham, Birmingham, AL 35294 USA
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Meng S, Wang Z, Liu X, Shen K, Gu Y, Yu B, Wang L. Uptake of ox-LDL by binding to LRP6 mediates oxidative stress-induced BMSCs senescence promoting obesity-related bone loss. Cell Signal 2024; 117:111114. [PMID: 38387686 DOI: 10.1016/j.cellsig.2024.111114] [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: 01/09/2024] [Revised: 02/10/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
Obesity has long been thought to be a main cause of hyperlipidemia. As a systemic disease, the impact of obesity on organs, tissues and cells is almost entirely negative. However, the relationship between obesity and bone loss is highly controversial. On the one hand, obesity has long been thought to have a positive effect on bone due to increased mechanical loading on the skeleton, conducive to increasing bone mass to accommodate the extra weight. On the other hand, obesity-related metabolic oxidative modification of low-density lipoprotein (LDL) in vivo causes a gradual increase of oxidized LDL (ox-LDL) in the bone marrow microenvironment. We have reported that low-density lipoprotein receptor-related protein 6 (LRP6) acts as a receptor of ox-LDL and mediates the bone marrow stromal cells (BMSCs) uptake of ox-LDL. We detected elevated serum ox-LDL in obese mice. We found that ox-LDL uptake by LRP6 led to an increase of intracellular reactive oxygen species (ROS) in BMSCs, and N-acetyl-L-cysteine (NAC) alleviated the cellular senescence and impairment of osteogenesis induced by ox-LDL. Moreover, LRP6 is a co-receptor of Wnt signaling. We found that LRP6 preferentially binds to ox-LDL rather than dickkopf-related protein 1 (DKK1), both inhibiting Wnt signaling and promoting BMSCs senescence. Mesoderm development LRP chaperone (MESD) overexpression inhibits ox-LDL binding to LRP6, attenuating oxidative stress and BMSCs senescence, eventually rescuing bone phenotype.
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Affiliation(s)
- Senxiong Meng
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zhuan Wang
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xiaonan Liu
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ke Shen
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yuan Gu
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Bin Yu
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Lei Wang
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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Veiga GB, Zanini BM, Garcia DN, Hense JD, Barreto MM, Isola JVV, Mondadori RG, Masternak MM, Stout MB, Schneider A. Effects of calorie, protein, and branched chain amino acid restriction on ovarian aging in mice. Reprod Biol 2024; 24:100856. [PMID: 38295721 PMCID: PMC10978239 DOI: 10.1016/j.repbio.2024.100856] [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: 11/26/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 04/02/2024]
Abstract
Calorie restriction (CR) is an intervention that promotes longevity and preserves the ovarian reserve. Some studies have observed that the positive impacts of CR can be linked to restriction of protein (PR) and branched-chain amino acids (BCAAs) independent of calorie intake. The aim of this study was to compare the effects of protein and BCAA restriction to 30% CR on the ovarian reserve of female mice. For this, 3 month-old C57BL/6 female mice (n = 35) were randomized into four groups for four months dietary interventions including: control group (CTL; n = 8), 30% CR (CR; n = 9), protein restriction (PR; n = 9) and BCAA restriction (BCAAR; n = 9). Body mass gain, body composition, food intake, serum levels of BCAAs, ovarian reserve and estrous cyclicity were evaluated. We observed that CR, protein and BCAA restriction prevented weight gain and changed body composition compared to the CTL group. The BCAA restriction did not affect the ovarian reserve, while both PR and CR prevented activation of primordial follicles. This prevention occurred in PR group despite the lack of reduction of calorie intake compared to CTL group, and CR did not reduce protein intake in levels similar to the PR group. BCAA restriction resulted in increased calorie intake compared to CTL and PR mice, but only PR reduced serum BCAA levels compared to the CTL group. Our data indicates that PR has similar effects to CR on the ovarian reserve, whereas BCAA restriction alone did not affect it.
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Affiliation(s)
- Gabriel B Veiga
- Universidade Federal de Pelotas (UFPEL), Pelotas, RS, Brazil
| | - Bianka M Zanini
- Universidade Federal de Pelotas (UFPEL), Pelotas, RS, Brazil
| | | | - Jéssica D Hense
- Universidade Federal de Pelotas (UFPEL), Pelotas, RS, Brazil
| | | | - José V V Isola
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | - Michal M Masternak
- College of Medicine, Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL, USA; Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Michael B Stout
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
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Habiby M, Ezati P, Soltanian D, Rahehagh R, Hosseini F. Comparison of three methods of intermittent fasting in high-fat-diet-induced obese mice. Heliyon 2024; 10:e25708. [PMID: 38390147 PMCID: PMC10881537 DOI: 10.1016/j.heliyon.2024.e25708] [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: 12/12/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
Purpose Intermittent fasting (IF), describes a variety of diets that the individual is exposed to intermittent periods of fasting and refeeding. The present study was designed to compare the three most popular intermittent fasting methods in high-fat-diet-induced obese mice. Methods 50 male C57BL/6 mice were divided into Normal Control (CN), High-Fat Control (CH), IF1 (Alternate Day Fasting), IF2 (Time-Restricted Feeding), IF3 (5:2 Diet) diets. In the first phase of the study, the mice were fed ad libitum either with a 54% Calorie high-fat (CH, IF1, IF2, IF3) or standard CHOW (CN) for 8 weeks. Then, in the intervention phase, the IF groups were fasted for four weeks based on their fasting protocol. At the end of the study, the mice fasting blood, liver and fat tissue samples were biochemically and pathologically assessed. Results The weight loss during the fasting period in IF1 and IF2 groups was significantly greater than CH. The epididymal fat pad weight was significantly lower in IF2 and IF3 compared to CH. The serum Triglyceride was significantly greater in CH than in the CN group. The tissue injury scores of the high-fat-diet groups were significantly greater than CN. Also, the tissue injury score was greater in IF1 group compared to the high-fat control group. Conclusion All of the fasting protocols can prompt acceptable energy restriction and the ADF and TRF protocols can significantly cause weight loss. Also, the TRF and 5:2 Diets can lower the visceral adiposity. However further human studies focusing on dietary adherence seem necessary.
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Affiliation(s)
- Mehrdad Habiby
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Pourya Ezati
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Danial Soltanian
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ramesh Rahehagh
- Department of Pathology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Foruzan Hosseini
- Department of Medical Physiology and Pharmacology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Murta L, Seixas D, Harada L, Damiano RF, Zanetti M. Intermittent Fasting as a Potential Therapeutic Instrument for Major Depression Disorder: A Systematic Review of Clinical and Preclinical Studies. Int J Mol Sci 2023; 24:15551. [PMID: 37958535 PMCID: PMC10647529 DOI: 10.3390/ijms242115551] [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: 09/29/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Recent studies have reported positive effects of Intermittent Fasting (IF) on metabolic parameters, cognition, and mood. However, regarding depressive symptoms, the effect of IF is not clear. The purpose of this review was to assess the available evidence on IF interventions for depression in both clinical and preclinical studies. Of the 23 included studies, 15 were performed on humans and 8 on animal models. The studies on rodents suggested that IF acts as a circadian regulator, improving neurotransmitter availability and increasing the levels of neurotrophic factors in the brain. However, the investigations on humans mainly evaluated healthy volunteers and showed a great heterogeneity regarding both the IF regimen studied and the observed effects on mood. Most available clinical trials have specific limitations, such as small sample sizes and uncontrolled designs. A comprehensive systematic review was conducted on five databases, PubMed, Cochrane, the Central Register of Controlled Trials, Web of Science databases, BVS and Scopus, identifying 23 relevant studies up to 6 October 2022. IF has potentially relevant physiological effects for the treatment of mood disorders, but better designed studies and controlled evaluations are needed to evaluate its efficiency in the treatment of major depression.
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Affiliation(s)
- Laís Murta
- Hospital Sírio-Libanês, Sao Paulo 01308-050, Brazil; (L.H.); (M.Z.)
| | - Daniela Seixas
- Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 01246-903, Brazil; (D.S.); (R.F.D.)
| | - Luana Harada
- Hospital Sírio-Libanês, Sao Paulo 01308-050, Brazil; (L.H.); (M.Z.)
| | - Rodolfo Furlan Damiano
- Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 01246-903, Brazil; (D.S.); (R.F.D.)
| | - Marcus Zanetti
- Hospital Sírio-Libanês, Sao Paulo 01308-050, Brazil; (L.H.); (M.Z.)
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Ageeli RY, Sharma S, Puppa M, Bloomer RJ, Buddington RK, van der Merwe M. Fasting Protocols Do Not Improve Intestinal Architecture and Immune Parameters in C57BL/6 Male Mice Fed a High Fat Diet. MEDICINES (BASEL, SWITZERLAND) 2023; 10:18. [PMID: 36827218 PMCID: PMC9961949 DOI: 10.3390/medicines10020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND The intestinal ecosystem, including epithelium, immune cells, and microbiota, are influenced by diet and timing of food consumption. The purpose of this study was to evaluate various dietary protocols after ad libitum high fat diet (HFD) consumption on intestinal morphology and mucosal immunity. METHODS C57BL/6 male mice were fed a 45% high fat diet (HFD) for 6 weeks and then randomized to the following protocols; (1) chow, (2) a purified high fiber diet known as the Daniel Fast (DF), HFD consumed (3) ad libitum or in a restricted manner; (4) caloric-restricted, (5) time-restricted (six hours of fasting in each 24 h), or (6) alternate-day fasting (24 h fasting every other day). Intestinal morphology and gut-associated immune parameters were investigated after 2 months on respective protocols. RESULTS Consuming a HFD resulted in shortening of the intestine and reduction in villi and crypt size. Fasting, while consuming the HFD, did not restore these parameters to the extent seen with the chow and DF diet. Goblet cell number and regulatory T cells had improved recovery with high fiber diets, not seen with the HFD irrespective of fasting. CONCLUSION Nutritional content is a critical determinant of intestinal parameters associated with gut health.
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Affiliation(s)
| | | | | | | | | | - Marie van der Merwe
- College of Health Sciences, The University of Memphis, Memphis, TN 38152, USA
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Tawfik MK, Badran DI, Keshawy MM, Makary S, Abdo M. Alternate-day fat diet and exenatide modulate the brain leptin JAK2/STAT3/SOCS3 pathway in a fat diet-induced obesity and insulin resistance mouse model. Arch Med Sci 2023; 19:1508-1519. [PMID: 37732053 PMCID: PMC10507768 DOI: 10.5114/aoms/158534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/24/2022] [Indexed: 09/22/2023] Open
Abstract
Introduction Obesity is one of the most burdensome health problems and is closely linked to leptin resistance. The study examined whether an alternate-day high-fat diet (ADF) and/or GLP-1 agonist (exenatide) modulate brain leptin resistance caused by a high-fat diet (HFD). Material and methods Sixty adult male mice were divided into 6 groups: (i) normal palatable diet (NPD), (ii) exenatide control (NPD received exenatide) (iii) HFD, (iv) ADF treated, (v) exenatide treated, (vi) ADF and exenatide treated. All animal groups were fed a HFD for 8 weeks, before they received treatment (ADF and/or exenatide) for 8 additional weeks. Body weight was assessed at the start and at the end of the experiment. Lipid profile, brain leptin and its receptor expression with the leptin-sensitive pathway, JAK2/STAT3/SOCS3/PTP1B, fasting blood glucose (FBG), serum insulin, liver metabolic handling via its regulators IRS1/PI3K/GLUT4 for hyperinsulinemia/obesity-induced PDK3/NAFLD2 modification, and liver enzymes were determined at the end of the experiment. Results ADF and exenatide reduced body weight and FBG in HFD-obese mice (p < 0.05). The combined ADF and exenatide regimen enhanced the brain anorexic leptin/JAK2/STAT3 and attenuated the SOCS3/PTP1B pathway (p < 0.05). The ADF/exenatide anorexigenic brain effect also modulated liver glucose via IRS1/PI3K/GLUT4 expression (p < 0.05), attenuating NAFLD2 and PDK3 expression (p < 0.05). Liver enzymes and the histopathological profile confirmed the improvement. Conclusions In HFD caloric consumption, a combination of ADF and GLP-1 agonist enhances the brain leptin anorexigenic effect with the improvement of the metabolic sequelae of hyperinsulinemia, hyperlipidemia and liver steatosis.
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Affiliation(s)
- Mona K. Tawfik
- Department of Pharmacology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Dahlia I. Badran
- Department of Biochemistry, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Biochemistry, Faculty of Medicine, Badr University, Cairo, Egypt
| | - Mohammed M. Keshawy
- Department of Internal Medicine, Nephrology Division, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Samy Makary
- Department of Physiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohamed Abdo
- Department of Physiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Intermittent Fasting: Potential Bridge of Obesity and Diabetes to Health? Nutrients 2022; 14:nu14050981. [PMID: 35267959 PMCID: PMC8912812 DOI: 10.3390/nu14050981] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Obesity has been an escalating worldwide health problem for decades, and it is likely a risk factor of prediabetes and diabetes. Correlated with obesity, the number of diabetic patients is also remarkable. A modest weight loss (5–10%) is critical to alleviate the risk of any other metabolic disease. Reduced energy intake has been an essential factor for weight loss reduction. As a new behavior intervention to lose weight, intermittent fasting (IF) attracts considerable attention and has become a popular strategy among young people. IF is a diet pattern that cycles between periods of fasting and eating on a regular schedule, involving various types, mainly Intermittent Energy Restriction and Time-Restricted Fasting. Accumulating evidence shows that short-term IF has a greatly positive effect in animal studies and contributes favorable benefits in human trials as well. Nevertheless, as an emerging, diverse, and relatively premature behavior intervention, there are still limited studies considering patients with obesity and type 2 diabetes mellitus. It is also a controversial intervention for the treatment of metabolic disease and cancer. The risks and challenges appear consequently. Additionally, whether intermittent fasting can be applied to long-term clinical treatment, and whether it has side effects during the long-term period or not, demands more large-scale and long-term experiments.
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Power Guerra N, Parveen A, Bühler D, Brauer DL, Müller L, Pilz K, Witt M, Glass Ä, Bajorat R, Janowitz D, Wolkenhauer O, Vollmar B, Kuhla A. Fibroblast Growth Factor 21 as a Potential Biomarker for Improved Locomotion and Olfaction Detection Ability after Weight Reduction in Obese Mice. Nutrients 2021; 13:nu13092916. [PMID: 34578793 PMCID: PMC8470262 DOI: 10.3390/nu13092916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022] Open
Abstract
Obesity is one of the most challenging diseases of the 21st century and is accompanied by behavioural disorders. Exercise, dietary adjustments, or time-restricted feeding are the only successful long-term treatments to date. Fibroblast growth factor 21 (FGF21) plays a key role in dietary regulation, but FGF21 resistance is prevalent in obesity. The aim of this study was to investigate in obese mice whether weight reduction leads to improved behaviour and whether these behavioural changes are associated with decreased plasma FGF21 levels. After establishing a model for diet-induced obesity, mice were subjected to three different interventions for weight reduction, namely dietary change, treadmill exercise, or time-restricted feeding. In this study, we demonstrated that only the combination of dietary change and treadmill exercise affected all parameters leading to a reduction in weight, fat, and FGF21, as well as less anxious behaviour, higher overall activity, and improved olfactory detection abilities. To investigate the interrelationship between FGF21 and behavioural parameters, feature selection algorithms were applied designating FGF21 and body weight as one of five highly weighted features. In conclusion, we concluded from the complementary methods that FGF21 can be considered as a potential biomarker for improved behaviour in obese mice after weight reduction.
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Affiliation(s)
- Nicole Power Guerra
- Rudolf-Zenker-Institute for Experimental Surgery, Rostock University Medical Centre, Schillingallee 69a, 18057 Rostock, Germany; (N.P.G.); (A.P.); (D.B.); (L.M.); (B.V.)
- Department of Anatomy, Rostock University Medical Centre, Gertrudenstraße 9, 18057 Rostock, Germany;
| | - Alisha Parveen
- Rudolf-Zenker-Institute for Experimental Surgery, Rostock University Medical Centre, Schillingallee 69a, 18057 Rostock, Germany; (N.P.G.); (A.P.); (D.B.); (L.M.); (B.V.)
| | - Daniel Bühler
- Rudolf-Zenker-Institute for Experimental Surgery, Rostock University Medical Centre, Schillingallee 69a, 18057 Rostock, Germany; (N.P.G.); (A.P.); (D.B.); (L.M.); (B.V.)
| | - David Leon Brauer
- Department of Systems Biology and Bioinformatics, University of Rostock, Ulmenstraße 69, 18057 Rostock, Germany; (D.L.B.); (O.W.)
| | - Luisa Müller
- Rudolf-Zenker-Institute for Experimental Surgery, Rostock University Medical Centre, Schillingallee 69a, 18057 Rostock, Germany; (N.P.G.); (A.P.); (D.B.); (L.M.); (B.V.)
- Department of Psychosomatic Medicine and Psychotherapy, Rostock University Medical Centre, Gehlsheimerstraße 20, 18147 Rostock, Germany
- Centre for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Centre, Gehlsheimerstraße 20, 18147 Rostock, Germany
| | - Kristin Pilz
- Department of Psychiatry, University of Greifswald, Ellernholzstraße 1-2, 17489 Greifswald, Germany; (K.P.); (D.J.)
| | - Martin Witt
- Department of Anatomy, Rostock University Medical Centre, Gertrudenstraße 9, 18057 Rostock, Germany;
| | - Änne Glass
- Institute for Biostatistics and Informatics, Rostock University Medical Centre, Ernst-Heydemann-Straße 8, 18057 Rostock, Germany;
| | - Rika Bajorat
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Centre, Schillingallee 35, 18057 Rostock, Germany;
| | - Deborah Janowitz
- Department of Psychiatry, University of Greifswald, Ellernholzstraße 1-2, 17489 Greifswald, Germany; (K.P.); (D.J.)
| | - Olaf Wolkenhauer
- Department of Systems Biology and Bioinformatics, University of Rostock, Ulmenstraße 69, 18057 Rostock, Germany; (D.L.B.); (O.W.)
- Leibniz-Institute for Food Systems Biology, Technical University of Munich, Lise-Meitner-Straße 34, 85354 Freising, Germany
| | - Brigitte Vollmar
- Rudolf-Zenker-Institute for Experimental Surgery, Rostock University Medical Centre, Schillingallee 69a, 18057 Rostock, Germany; (N.P.G.); (A.P.); (D.B.); (L.M.); (B.V.)
- Centre for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Centre, Gehlsheimerstraße 20, 18147 Rostock, Germany
| | - Angela Kuhla
- Rudolf-Zenker-Institute for Experimental Surgery, Rostock University Medical Centre, Schillingallee 69a, 18057 Rostock, Germany; (N.P.G.); (A.P.); (D.B.); (L.M.); (B.V.)
- Centre for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Centre, Gehlsheimerstraße 20, 18147 Rostock, Germany
- Correspondence: ; Tel.: +49-381-494-2503
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11
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Henderson CG, Turner DL, Swoap SJ. Health Effects of Alternate Day Fasting Versus Pair-Fed Caloric Restriction in Diet-Induced Obese C57Bl/6J Male Mice. Front Physiol 2021; 12:641532. [PMID: 33732170 PMCID: PMC7959851 DOI: 10.3389/fphys.2021.641532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/05/2021] [Indexed: 12/27/2022] Open
Abstract
Alternate day fasting (ADF) induces weight loss and improves various markers of health in rodents and humans. However, it is unclear whether the benefits of ADF are derived from the lower caloric intake of ADF or from the 24-h fasting period. Therefore, this study directly compared selected markers for health – such as glucose control, body weight, liver triglycerides, T cell frequencies, and others – in high-fat (60% calories from fat) diet-induced obese mice subjected to either ADF or caloric restriction (CR). Obese mice were randomly assigned to one of four groups: (1) ADF: remained on the high-fat diet, but fed on alternate days (n = 5), (2) PF: remained on the high-fat diet, but pair-fed to the ADF group (n = 5), (3) LF: moved to a chow ad libitum diet (n = 5; 17% calories from fat), and (4) HF: remained on the high-fat ad libitum diet (n = 5). An additional group of non-obese mice maintained on a chow diet since weaning were used as controls (CON: n = 5). After 10 weeks, ADF, PF, and LF mice ate fewer kcals, had a lower body mass, had smaller epididymal fat pads, improved glucose tolerance, and had a lower hepatic triglyceride content relative to HF mice (p < 0.05), but none reached that of CON mice in these measures. T cell frequencies of the spleen, blood, and mesenteric lymph nodes were reduced in ADF, PF, and HF compared to the CON group. Importantly, there were no significant differences between the ADF and PF groups in any of the measurements made in the current study. These data suggest that ADF, PF, and LF diets each lead to improved markers of health relative to high-fat diet-induced obese mice, and that the caloric restriction associated with ADF is the major factor for the noted improvements.
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Affiliation(s)
- Chloe G Henderson
- Department of Biology, Williams College, Williamstown, MA, United States
| | - Damian L Turner
- Department of Biology, Williams College, Williamstown, MA, United States
| | - Steven J Swoap
- Department of Biology, Williams College, Williamstown, MA, United States
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12
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Sable HJ, MacDonnchadh JJ, Lee HW, Butawan M, Simpson RN, Krueger KM, Bloomer RJ. Working memory and hippocampal expression of BDNF, ARC, and P-STAT3 in rats: effects of diet and exercise. Nutr Neurosci 2021; 25:1609-1622. [PMID: 33593241 DOI: 10.1080/1028415x.2021.1885230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Mounting evidence suggests diet and exercise influence learning and memory (LM). We compared a high-fat, high-sucrose Western diet (WD) to a plant-based, amylose/amylopectin blend, lower-fat diet known as the Daniel Fast (DF) in rats with and without regular aerobic exercise on a task of spatial working memory (WM). METHODS Rats were randomly assigned to the WD or DF at 6 weeks of age. Exercised rats (WD-E, DF-E) ran on a treadmill 3 times/week for 30 min while the sedentary rats did not (WD-S, DF-S). Rats adhered to these assignments for 12 weeks, inclusive of ab libitum food intake, after which mild food restriction was implemented to encourage responding during WM testing. For nine months, WM performance was assessed once daily, six days per week, after which hippocampal sections were collected for subsequent analysis of brain-derived neurotrophic factor (BDNF), activity-regulated cytoskeletal protein (ARC), and signal transducer and activator of transcription 3 (P-STAT3, Tyr705). RESULTS DF-E rats exhibited the best DSA performance. Surprisingly, the WD-S group outperformed the WD-E group, but had significantly lower BDNF and ARC relative to the DF-S group, with a similar trend from the WD-E group. P-STAT3 expression was also significantly elevated in the WD-S group compared to both the DF-S and WD-E groups. DISCUSSION These results support previous research demonstrating negative effects of the WD on spatial LM, demonstrate the plant-based DF regimen combined with chronic aerobic exercise produces measurable WM and neuroprotective benefits, and suggest the need to carefully design exercise prescriptions to avoid over-stressing individuals making concurrent dietary changes.
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Affiliation(s)
- Helen J Sable
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | | | - Harold W Lee
- College of Health Sciences, University of Memphis, Memphis, TN, USA
| | - Matthew Butawan
- College of Health Sciences, University of Memphis, Memphis, TN, USA
| | - Raven N Simpson
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Katie M Krueger
- Department of Psychology, University of Memphis, Memphis, TN, USA
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13
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Queiroz JDN, Macedo RCO, Tinsley GM, Reischak-Oliveira A. Time-restricted eating and circadian rhythms: the biological clock is ticking. Crit Rev Food Sci Nutr 2020; 61:2863-2875. [DOI: 10.1080/10408398.2020.1789550] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jéssica do Nascimento Queiroz
- Physical Education, Physiotherapy and Dance School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rodrigo Cauduro Oliveira Macedo
- Physical Education, Physiotherapy and Dance School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Nutrition Department, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Grant M. Tinsley
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Alvaro Reischak-Oliveira
- Physical Education, Physiotherapy and Dance School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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14
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Gunebakan E, Yalcin E, Cikler Dulger E, Yigitbasi A, Ates N, Caglayan A, Beker MC, Sahin K, Korkaya H, Kilic E. Short-Term Diet Restriction but Not Alternate Day Fasting Prevents Cisplatin-Induced Nephrotoxicity in Mice. Biomedicines 2020; 8:biomedicines8020023. [PMID: 32028692 PMCID: PMC7168297 DOI: 10.3390/biomedicines8020023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 12/30/2022] Open
Abstract
Cisplatin (CP) is one of the most preferred platinum-containing antineoplastic drugs. However, even in nontoxic plasma concentrations, it may cause kidney injury. To be able to increase its effective pharmacological dose, its side effects need to be regarded. Diet restriction (DR) has been demonstrated to improve cellular survival in a number of disorders. In this context, we investigated the role of DR in CP-induced nephrotoxicity (CPN). Besides alternate DR, animals were exposed to DR for 3 days prior or after CP treatment. Here, we observed that both 3 days of DR reverses the nephrotoxic effect of CP, which was associated with improved physiological outcomes, such as serum creatine, blood-urea nitrogen and urea. These treatments significantly increased phosphorylation of survival kinases PI3K/Akt and ERK-1/2 and decreased the level of stress kinase JNK were noted. In addition, the activation level of signal transduction mediator p38 MAPK phosphorylation was higher particularly in both three-day DR groups. Next, animals were fed with carbohydrate-, protein- or fat-enriched diets in the presence of CP. Results indicated that not only fasting but also dietary content itself may play a determinant role in the severity of CPN. Our data suggest that DR is a promising approach to reduce CPN by regulating metabolism and cell signaling pathways.
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Affiliation(s)
- Evrin Gunebakan
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey; (E.G.); (E.Y.); (A.C.); (M.C.B.)
| | - Esra Yalcin
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey; (E.G.); (E.Y.); (A.C.); (M.C.B.)
| | - Esra Cikler Dulger
- Department of Histology and Embryology, Hamidiye Medical School, University of Health Sciences, Istanbul 34668, Turkey;
| | - Ahmet Yigitbasi
- Department of Internal Medicine, School of Medicine, Trakya University, Edirne 22030, Turkey;
| | - Nilay Ates
- Department of Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey;
| | - Aysun Caglayan
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey; (E.G.); (E.Y.); (A.C.); (M.C.B.)
| | - Mustafa C. Beker
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey; (E.G.); (E.Y.); (A.C.); (M.C.B.)
| | - Kazim Sahin
- Animal Nutrition Department, School of Veterinary Medicine, Firat University, Elazig 23119, Turkey;
| | - Hasan Korkaya
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
| | - Ertugrul Kilic
- Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey; (E.G.); (E.Y.); (A.C.); (M.C.B.)
- Correspondence: or ; Tel.: +90-216-681-5344; Fax: +90-212-531-7555
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15
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van der Merwe M, Sharma S, Caldwell JL, Smith NJ, Gomes CK, Bloomer RJ, Buddington RK, Pierre JF. Time of Feeding Alters Obesity-Associated Parameters and Gut Bacterial Communities, but Not Fungal Populations, in C57BL/6 Male Mice. Curr Dev Nutr 2020; 4:nzz145. [PMID: 32025616 PMCID: PMC6992463 DOI: 10.1093/cdn/nzz145] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/02/2019] [Accepted: 12/31/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fasting and timed feeding strategies normalize obesity parameters even under high-fat dietary intake. Although previous work demonstrated that these dietary strategies reduce adiposity and improve metabolic health, limited work has examined intestinal microbial communities. OBJECTIVES We determined whether timed feeding modifies the composition of the intestinal microbiome and mycobiome (yeast and fungi). METHODS Male C57BL/6 mice were fed a high-fat diet (HF) for 6 wk. Animals were then randomly assigned to the following groups (n = 8-10/group): 1) HF ad libitum; 2) purified high-fiber diet (Daniel Fast, DF); 3) HF-time-restricted feeding (TRF) (6 h); 4) HF-alternate-day fasting (ADF); or 5) HF at 80% total caloric restriction (CR). After 8 wk, obesity and gut parameters were characterized. We also examined changes to the gut microbiome and mycobiome before, during, and following dietary interventions. RESULTS Body mass gain was reduced with all restricted dietary groups. HF-fed microbiota displayed lower α-diversity along with reduced phylum levels of Bacteroidetes and increased Firmicutes. Animals switched from HF to DF demonstrated a rapid transition in bacterial taxonomic composition, α-, and β-diversity that initially resembled HF, but was distinct after 4 and 8 wk of DF feeding. Time-or calorie-restricted HF-fed groups did not show changes at the phylum level, but α-diversity was increased, with specific genera altered. Six weeks of HF feeding reduced various fungal populations, particularly Alternaria, Aspergillus, Cladosporium, and Talaromyces, and increased Candida, Hanseniaspora, and Kurtzmaniella. However, 8 wk of intervention did not change the fungal populations, with the most abundant genera being Candida, Penicillium, and Hanseniaspora. CONCLUSIONS These data suggest that timed-feeding protocols and diet composition do not significantly affect the gut fungal community, despite inducing measurable shifts in the bacterial population that coincide with improvements in metabolism.
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Affiliation(s)
| | - Sunita Sharma
- School of Health Studies, University of Memphis, Memphis, TN, USA
| | - Jade L Caldwell
- School of Health Studies, University of Memphis, Memphis, TN, USA
| | - Nicholas J Smith
- School of Health Studies, University of Memphis, Memphis, TN, USA
| | - Charles K Gomes
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | - Joseph F Pierre
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
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16
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Jamshed H, Beyl RA, Della Manna DL, Yang ES, Ravussin E, Peterson CM. Early Time-Restricted Feeding Improves 24-Hour Glucose Levels and Affects Markers of the Circadian Clock, Aging, and Autophagy in Humans. Nutrients 2019; 11:E1234. [PMID: 31151228 PMCID: PMC6627766 DOI: 10.3390/nu11061234] [Citation(s) in RCA: 349] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 12/21/2022] Open
Abstract
Time-restricted feeding (TRF) is a form of intermittent fasting that involves having a longer daily fasting period. Preliminary studies report that TRF improves cardiometabolic health in rodents and humans. Here, we performed the first study to determine how TRF affects gene expression, circulating hormones, and diurnal patterns in cardiometabolic risk factors in humans. Eleven overweight adults participated in a 4-day randomized crossover study where they ate between 8 am and 2 pm (early TRF (eTRF)) and between 8 am and 8 pm (control schedule). Participants underwent continuous glucose monitoring, and blood was drawn to assess cardiometabolic risk factors, hormones, and gene expression in whole blood cells. Relative to the control schedule, eTRF decreased mean 24-hour glucose levels by 4 ± 1 mg/dl (p = 0.0003) and glycemic excursions by 12 ± 3 mg/dl (p = 0.001). In the morning before breakfast, eTRF increased ketones, cholesterol, and the expression of the stress response and aging gene SIRT1 and the autophagy gene LC3A (all p < 0.04), while in the evening, it tended to increase brain-derived neurotropic factor (BNDF; p = 0.10) and also increased the expression of MTOR (p = 0.007), a major nutrient-sensing protein that regulates cell growth. eTRF also altered the diurnal patterns in cortisol and the expression of several circadian clock genes (p < 0.05). eTRF improves 24-hour glucose levels, alters lipid metabolism and circadian clock gene expression, and may also increase autophagy and have anti-aging effects in humans.
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Affiliation(s)
- Humaira Jamshed
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Robbie A Beyl
- Biostatistics and Analysis Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
| | - Deborah L Della Manna
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Eddy S Yang
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Eric Ravussin
- Translational Physiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
| | - Courtney M Peterson
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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