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Herz D, Karl S, Weiß J, Zimmermann P, Haupt S, Zimmer RT, Schierbauer J, Wachsmuth NB, Erlmann MP, Niedrist T, Khoramipour K, Voit T, Rilstone S, Sourij H, Moser O. Effects of Different Types of Intermittent Fasting Interventions on Metabolic Health in Healthy Individuals (EDIF): A Randomised Trial with a Controlled-Run in Phase. Nutrients 2024; 16:1114. [PMID: 38674802 PMCID: PMC11054438 DOI: 10.3390/nu16081114] [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: 02/22/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
The effects of intermittent fasting (IF) on health promotion in the healthy population remain controversial. Therefore, our study aimed to analyse the efficacy and feasibility of different IF protocols and evaluated the effects within a cohort with a controlled-run in phase on the body mass index (BMI) as the primary outcome, the body composition, and metabolic and haematological markers in healthy participants. A total of 25 individuals were randomised into three fasting groups: 16/8 fasting (n = 11), 20/4 fasting (n = 6), and alternate-day fasting (ADF, n = 8). Assessments were conducted at baseline (visit 1), after a four-week controlled-run in phase (visit 2), and after eight weeks of fasting (visit 3). Both the BMI (p = 0.01) and bodyweight (p = 0.01) were significantly reduced in the ADF group, which was not seen in the 16/8 and 20/4 groups (p > 0.05). Adherence was different but not statistically among the groups (16/8: 84.5 ± 23.0%; 20/4: 92.7 ± 9.5%; and ADF: 78.1 ± 33.5%, p = 0.57). Based on our obtained results, the data suggest that some fasting interventions might be promising for metabolic health. However, adherence to the specific fasting protocols remains challenging even for the healthy population.
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Affiliation(s)
- Daniel Herz
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
| | - Sebastian Karl
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
| | - Johannes Weiß
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
| | - Paul Zimmermann
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, 96049 Bamberg, Germany
| | - Sandra Haupt
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
- Faculty of Life Science—Food, Nutrition & Health, Chair of Molecular Exercise Physiology, University of Bayreuth, 95326 Kulmbach, Germany
| | - Rebecca Tanja Zimmer
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
| | - Janis Schierbauer
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
| | - Nadine Bianca Wachsmuth
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
| | - Maximilian Paul Erlmann
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
| | - Tobias Niedrist
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036 Graz, Austria;
| | - Kayvan Khoramipour
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman 76198-13159, Iran;
| | - Thomas Voit
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
| | - Sian Rilstone
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (D.H.); (S.K.); (J.W.); (P.Z.); (S.H.); (R.T.Z.); (J.S.); (N.B.W.); (M.P.E.); (T.V.); (S.R.)
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
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Sun ML, Yao W, Wang XY, Gao S, Varady KA, Forslund SK, Zhang M, Shi ZY, Cao F, Zou BJ, Sun MH, Liu KX, Bao Q, Xu J, Qin X, Xiao Q, Wu L, Zhao YH, Zhang DY, Wu QJ, Gong TT. Intermittent fasting and health outcomes: an umbrella review of systematic reviews and meta-analyses of randomised controlled trials. EClinicalMedicine 2024; 70:102519. [PMID: 38500840 PMCID: PMC10945168 DOI: 10.1016/j.eclinm.2024.102519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Background Benefits of Intermittent fasting (IF) on health-related outcomes have been found in a range of randomised controlled trials (RCTs). Our umbrella review aimed to systematically analyze and synthesize the available causal evidence on IF and its impact on specific health-related outcomes while evaluating its evidence quality. Methods We comprehensively searched the PubMed, Embase, Web of Science, and Cochrane databases (from inception up to 8 January 2024) to identify related systematic reviews and meta-analyses of RCTs investigating the association between IF and human health outcomes. We recalculated the effect sizes for each meta-analysis as mean difference (MD) or standardized mean difference (SMD) with corresponding 95% confidence intervals (CIs). Subgroup analyses were performed for populations based on three specific status: diabetes, overweight or obesity, and metabolic syndrome. The quality of systematic reviews was evaluated using A Measurement Tool to Assess Systematic Reviews (AMSTAR), and the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. This study is registered with PROSPERO (CRD42023382004). Findings A total of 351 associations from 23 meta-analyses with 34 health outcomes were included in the study. A wide range of outcomes were investigated, including anthropometric measures (n = 155), lipid profiles (n = 83), glycemic profiles (n = 57), circulatory system index (n = 41), appetite (n = 9), and others (n = 6). Twenty-one (91%) meta-analyses with 346 associations were rated as high confidence according to the AMSTAR criteria. The summary effects estimates were significant at p < 0.05 in 103 associations, of which 10 (10%) were supported by high certainty of evidence according to GRADE. Specifically, compared with non-intervention diet in adults with overweight or obesity, IF reduced waist circumference (WC) (MD = -1.02 cm; 95% CI: -1.99 to -0.06; p = 0.038), fat mass (MD = -0.72 kg; 95% CI: -1.32 to -0.12; p = 0.019), fasting insulin (SMD = -0.21; 95% CI: -0.40 to -0.02; p = 0.030), low-density lipoprotein cholesterol (LDL-C) (SMD = -0.20; 95% CI: -0.38 to -0.02; p = 0.027), total cholesterol (TC) (SMD = -0.29; 95% CI: -0.48 to -0.10; p = 0.003), and triacylglycerols (TG) (SMD = -0.23; 95% CI: -0.39 to -0.06; p = 0.007), but increased fat free mass (FFM) (MD = 0.98 kg; 95% CI: 0.18-1.78; p = 0.016). Of note, compared with the non-intervention diet, modified alternate-day fasting (MADF) reduced fat mass (MD = -0.70 kg; 95% CI: -1.38 to -0.02; p = 0.044). In people with overweight or obesity, and type 2 diabetes, IF increases high-density lipoprotein cholesterol (HDL-C) levels compared to continuous energy restriction (CER) (MD = 0.03 mmol/L; 95% CI: 0.01-0.05; p = 0.010). However, IF was less effective at reducing systolic blood pressure (SBP) than a CER diet in adults with overweight or obesity (SMD = 0.21; 95% CI: 0.05-0.36; p = 0.008). Interpretation Our findings suggest that IF may have beneficial effects on a range of health outcomes for adults with overweight or obesity, compared to CER or non-intervention diet. Specifically, IF may decreased WC, fat mass, LDL-C, TG, TC, fasting insulin, and SBP, while increasing HDL-C and FFM. Notably, it is worth noting that the SBP lowering effect of IF appears to be weaker than that of CER. Funding This work was supported by the National Key Research and Development Program of China (Q-JW), the Natural Science Foundation of China (Q-JW and T-TG), Outstanding Scientific Fund of Shengjing Hospital of China Medical University (Q-JW), and 345 Talent Project of Shengjing Hospital of China Medical University (T-TG).
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Affiliation(s)
- Ming-Li Sun
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Yao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiao-Ying Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Song Gao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Krista A. Varady
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Sofia K. Forslund
- Experimental and Clinical Research Center, A Cooperation of Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Max Delbruck Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Miao Zhang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zan-Yu Shi
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fan Cao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bing-Jie Zou
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ming-Hui Sun
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ke-Xin Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi Bao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jin Xu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue Qin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qian Xiao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lang Wu
- Cancer Epidemiology Division, Population Sciences in the Pacific Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Yu-Hong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - De-Yu Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- NHC Key Laboratory of Advanced Reproductive Medicine and Fertility (China Medical University), National Health Commission, Shenyang, China
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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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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Xiaoyu W, Yuxin X, Li L. The effects of different intermittent fasting regimens in people with type 2 diabetes: a network meta-analysis. Front Nutr 2024; 11:1325894. [PMID: 38332802 PMCID: PMC10850351 DOI: 10.3389/fnut.2024.1325894] [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: 10/22/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
Objective To compare the effects of four intermittent fasting regimens on blood glucose and insulin sensitivity in people with type 2 diabetes. Methods Randomized controlled trials of intermittent fasting in the treatment of patients with type 2 diabetes mellitus in PubMed, the Cochrane Library, Embase, ScienceDirect, Web of Science, CNKI, VIP Database, and WANFANG Database were searched for from the library to September 2023. 2 review authors independently screened studies and extracted data. RevMan 5.4 was used for direct comparison of meta-results. Network meta-analysis was performed using Stata16 software. Results 13 studies with a total of 867 patients were included. The intervention effects of twice-per-week fasting, fasting-mimicking diet, time-restricted eating, and peridic fasting were better than that of conventional diet. The results of the network comparison showed that there was no significant difference in the intervention effect of the intermittent fasting regimens. SUCRA ranking results showed that the twice-per-week fasting was best for comprehensive interventions for improvement. Conclusion From the perspective of fasting blood glucose, glycated hemoglobin and insulin resistance, the twice-per-week fasting intervention has a good effect, which can be used as a reference for patients with inter-type 2 diabetes to choose intermittent fasting regimen. However, more clinical trials are needed to verify this at a later stage.
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Affiliation(s)
| | | | - Lai Li
- School of Nursing, Chengdu Medical College, Chengdu, China
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Cheung K, Chan V, Chan S, Wong MMH, Chung GKK, Cheng WY, Lo K, Zeng F. Effect of Intermittent Fasting on Cardiometabolic Health in the Chinese Population: A Meta-Analysis of Randomized Controlled Trials. Nutrients 2024; 16:357. [PMID: 38337642 PMCID: PMC10857210 DOI: 10.3390/nu16030357] [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: 12/13/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
The efficacy of intermittent fasting (IF), as an emerging weight management strategy, in improving cardiometabolic health has been evaluated in various populations, but that among Chinese individuals has not been systematically studied. A comprehensive search on multiple databases was performed to identify eligible randomized controlled trials (RCTs) up to October 2022. The primary outcome was post-intervention weight loss, and secondary outcomes included changes in cardiometabolic indicators. Effect estimates were meta-analyzed using a random-effects model. In total, nine RCTs with 899 Chinese participants were included. Time-restricted eating was the most adopted IF protocol in this study (six out of nine), followed by alternate-day fasting. The IF intervention significantly reduced body weight, body mass index, body fat mass, homeostatic model assessment of insulin resistance, low-density lipoprotein cholesterol, and triglycerides when compared with control groups. However, no statistically significant reductions in waist circumference, total cholesterol, high-density lipoprotein cholesterol, fasting glucose, systolic blood pressure, and diastolic blood pressure were found. To sum up, IF can be a weight management strategy and may improve the cardiometabolic health of Chinese adults, but more long-term trials using different IF strategies are required to generate robust evidence of its efficacy.
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Affiliation(s)
- Katy Cheung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China (G.K.-K.C.)
| | - Vicky Chan
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong 100872, China; (V.C.); (W.-Y.C.)
| | - Stephanie Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China (G.K.-K.C.)
| | - Martin Ming Him Wong
- Institute of Epidemiology and Health Care, University College London, London WC1E 6BT, UK;
| | - Gary Ka-Ki Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China (G.K.-K.C.)
| | - Wai-Yin Cheng
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong 100872, China; (V.C.); (W.-Y.C.)
- Research Institute for Future Food, The Hong Kong Polytechnic University, Hong Kong 100872, China
| | - Kenneth Lo
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong 100872, China; (V.C.); (W.-Y.C.)
- Research Institute for Future Food, The Hong Kong Polytechnic University, Hong Kong 100872, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 100872, China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China
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Bradley M, Melchor J, Carr R, Karjoo S. Obesity and malnutrition in children and adults: A clinical review. OBESITY PILLARS (ONLINE) 2023; 8:100087. [PMID: 38125660 PMCID: PMC10728708 DOI: 10.1016/j.obpill.2023.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 12/23/2023]
Abstract
Background In the U.S., children and adults are consuming more low-nutrient foods with added sugar and excess fats as compared to healthy, high-quality calories and micronutrients. This diet is increasing the prevalence of malnutrition and nutritional deficiencies, despite high calorie intake. This is a review of the common micronutrient deficiencies, the risk factors for malnutrition, dietary plans, and the health consequences in children and adults with obesity in the U.S. Methods This clinical review of literature was performed on the MEDLINE (PubMed) search engine. A total of 1391 articles were identified and after review, a total of 130 were found to be most pertinent. Discussion The most common micronutrient deficiencies found in patients with obesity were vitamin A, thiamine (B1), folate (B9), cobalamin (B12), vitamin D, iron, calcium, and magnesium, especially prior and after bariatric surgery. Diets that produced the most weight reduction also further puts these individuals at risk for worsening malnutrition. Malnutrition and micronutrient deficiencies can worsen health outcomes if not properly managed. Conclusion Adequate screening and awareness of malnutrition can improve the health outcomes in patients with obesity. Physiologic changes in response to increased adiposity and inadequate intake increase this population's risk of adverse health effects. Malnutrition affects the individual and contributes to worse public health outcomes. The recommendations for screening for malnutrition are not exclusive to individuals undergoing bariatric procedures and can improve the health outcomes of any patient with obesity. However, clearly, improved nutritional status can assist with metabolism and prevent adverse nutritional outcomes post-bariatric surgery. Clinicians should advise on proper nutrition and be aware of diets that worsen deficiencies.
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Affiliation(s)
- Morgan Bradley
- Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL, 32304, USA
| | - Julian Melchor
- Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL, 32304, USA
| | - Rachel Carr
- Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL, 32304, USA
| | - Sara Karjoo
- Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL, 32304, USA
- Johns Hopkins All Children's Hospital, 601 5th St. S. Suite 605, St. Petersburg, FL, 33701, USA
- University of South Florida Morsani College of Medicine, 560 Channelside Drive MDD 54, Tampa, FL, 33602, USA
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Pérez-Gerdel T, Camargo M, Alvarado M, Ramírez JD. Impact of Intermittent Fasting on the Gut Microbiota: A Systematic Review. Adv Biol (Weinh) 2023; 7:e2200337. [PMID: 36950759 DOI: 10.1002/adbi.202200337] [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: 12/27/2022] [Revised: 02/17/2023] [Indexed: 03/24/2023]
Abstract
Obesity often results in severe negative health consequences and represents a growing issue for global health. Reducing food intake is a crucial factor for weight loss. Intermittent fasting is a relatively new intervention that contributes to weight reduction. Considering the intimate relationship between obesity and inflammatory pathologies with gut microbiota alterations, a systematic review of the literature was herein conducted to elucidate the relationship between time-restricted food intake and gut microbiota diversity in humans. Searches are carried out in three databases (PubMed, MedLine/OVID, and Academic Search Complete) between April 2019 and April 2022. Nine studies (all with longitudinal design) were identified as eligible by presenting data about the impact of intermittent fasting schemes on gut microbiota. At the phylum level, Firmicutes and Bacteroidetes increase throughout follow-ups, while 16 bacteria genera change their abundance in response to intermittent fasting. Finally, some genera associated with clinical predictors such as weight change, abdominal circumference, and metabolic variables were reported. Changes induced by fasting schemes positively impact the diversity and abundance of gut microbiota and the biomarkers described here. However, the changes previously reported have been studied in short periods and some return to their basal state after fasting intervention.
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Affiliation(s)
- Theodoro Pérez-Gerdel
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá D.C., 112111, Colombia
| | - Milena Camargo
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá D.C., 112111, Colombia
- Centro de Tecnología en Salud (CETESA), Innovaseq SAS, Funza-Cundinamarca, 250027, Colombia
| | - Mateo Alvarado
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá D.C., 112111, Colombia
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá D.C., 112111, Colombia
- Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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8
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Kamarul Zaman M, Teng NIMF, Kasim SS, Juliana N, Alshawsh MA. Effects of time-restricted eating with different eating duration on anthropometrics and cardiometabolic health: A systematic review and meta-analysis. World J Cardiol 2023; 15:354-374. [PMID: 37576544 PMCID: PMC10415860 DOI: 10.4330/wjc.v15.i7.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Time-restricted eating (TRE) is a dietary approach that limits eating to a set number of hours per day. Human studies on the effects of TRE intervention on cardiometabolic health have been contradictory. Heterogeneity in subjects and TRE interventions have led to inconsistency in results. Furthermore, the impact of the duration of eating/fasting in the TRE approach has yet to be fully explored. AIM To analyze the existing literature on the effects of TRE with different eating durations on anthropometrics and cardiometabolic health markers in adults with excessive weight and obesity-related metabolic diseases. METHODS We reviewed a series of prominent scientific databases, including Medline, Scopus, Web of Science, Academic Search Complete, and Cochrane Library articles to identify published clinical trials on daily TRE in adults with excessive weight and obesity-related metabolic diseases. Randomized controlled trials were assessed for methodological rigor and risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2). Outcomes of interest include body weight, waist circumference, fat mass, lean body mass, fasting glucose, insulin, HbA1c, homeostasis model assessment for insulin resistance (HOMA-IR), lipid profiles, C-reactive protein, blood pressure, and heart rate. RESULTS Fifteen studies were included in our systematic review. TRE significantly reduces body weight, waist circumference, fat mass, lean body mass, blood glucose, insulin, and triglyceride. However, no significant changes were observed in HbA1c, HOMA-IR, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, heart rate, systolic and diastolic blood pressure. Furthermore, subgroup analyses based on the duration of the eating window revealed significant variation in the effects of TRE intervention depending on the length of the eating window. CONCLUSION TRE is a promising chrononutrition-based dietary approach for improving anthropometric and cardiometabolic health. However, further clinical trials are needed to determine the optimal eating duration in TRE intervention for cardiovascular disease prevention.
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Affiliation(s)
- Mazuin Kamarul Zaman
- Centre of Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA Cawangan Selangor, Puncak Alam 42300, Selangor, Malaysia
| | - Nur Islami Mohd Fahmi Teng
- Centre of Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA Cawangan Selangor, Puncak Alam 42300, Selangor, Malaysia.
| | - Sazzli Shahlan Kasim
- Department of Cardiology, Faculty of Medicine, Hospital Universiti Teknologi MARA (HUiTM), Puncak Alam 42300, Selangor, Malaysia
| | - Norsham Juliana
- Department of Physiology, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Mohammed Abdullah Alshawsh
- Department of Pharmacology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton 3168, Victoria, Australia
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9
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Jaramillo AP, Castells J, Ibrahimli S, Jaramillo L, Briones Andriuoli RR, Moncada D, Revilla JC. Time-Restricted Feeding and Intermittent Fasting as Preventive Therapeutics: A Systematic Review of the Literature. Cureus 2023; 15:e42300. [PMID: 37609101 PMCID: PMC10441815 DOI: 10.7759/cureus.42300] [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] [Accepted: 07/22/2023] [Indexed: 08/24/2023] Open
Abstract
Multiple studies have shown that intermittent fasting (IF) is associated with better health conditions and longer lifespans, as is time-restricted feeding (TRF). One crucial explanation is that IF and TRF permit a set length of time for caloric ingestion, during which our systems activate a variety of mechanisms that lead to the enhancement and renewal of different body systems. Accordingly, the benefits of IF and TRF are a lot greater than those of complete calorie restriction (CR). Accordingly, TRF and IF offered the underpinnings for human studies that revealed that when we eat and when we are fasting, we experience fluctuations in all body systems. For relevant medical literature, we investigated medical databases such as PubMed/Medline, PubMed Central, Cochrane Library, and Google Scholar. The chosen articles were evaluated based on eligibility criteria and vetted by quality evaluation methods; 15 finished research papers were included in the study. Of the 15 recognized studies, four were systematic reviews of literature, and 11 were review articles. The chosen publications all examined the efficacy and comparability with other restrictive diets. The study articles indicated that the advantages of IF and TRF represent complex interplay involving periodic digestion of food, gut flora, and the circadian clock. Accordingly, further research is necessary to get a comprehensive grasp of this very complex molecular blueprint. This could aid in producing an effectively planned food treatment that can regulate numerous chronic health ailments and disorders. Furthermore, it might lead to the development and investigation of new pharmacological medicines that mimic the nutritional and therapeutic benefits of IF for those who are unwilling or unable to follow this kind of feeding regimen.
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Affiliation(s)
- Arturo P Jaramillo
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Javier Castells
- Internal Medicine, Universidad Católica de Santiago de Guayaquil, Guayaquil, ECU
| | | | - Luisa Jaramillo
- Internal Medicine, Universidad Católica de Santiago de Guayaquil, Guayaquil, ECU
| | | | - Denisse Moncada
- Internal Medicine, Universidad Católica de Santiago de Guayaquil, Guayaquil, ECU
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10
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Xu R, Cao Y, Wang PY, Chen XL, Tao D. Intermittent energy restriction vs. continuous energy restriction on cardiometabolic risk factors in patients with metabolic syndrome: a meta-analysis and systematic review. Front Nutr 2023; 10:1090792. [PMID: 37229479 PMCID: PMC10204925 DOI: 10.3389/fnut.2023.1090792] [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: 11/18/2022] [Accepted: 03/28/2023] [Indexed: 05/27/2023] Open
Abstract
Background This is a systematic review and meta-analysis to compare the efficacy of intermittent energy restriction (IER) vs. continuous energy restriction (CER) on weight loss, body composition, blood pressure, and other cardiometabolic risk factors in patients with metabolic syndrome (MetS) risk factors. Methods We searched and screened PubMed, Embase, Cochrane Library, and Web of Science from inception to May 8, 2022 for randomized controlled trials. Two review authors independently selected studies, extracted data, assessed quality and risk of bias and cross-checked extracts to resolve discrepancies when required. We expressed effect size as mean difference (MD) and 95% confidence interval (CI). The major outcome was the improvement of MetS risk factors, including changes in waist circumference (WC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), blood pressure (BP), and fasting plasma glucose (FPG) levels. The secondary outcomes were body weight (BW), body mass index (BMI), body fat (BF), fat free mass (FFM), hip circumference (HC), fasting insulin (FINs), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-c). Results The meta-analysis included 16 articles (20 trials) with a total of 1,511 participants. All studies had a low risk of bias for random sequence generation. The IER and CER intervention equally improved MetS risk factors WC (MD = -0.47, 95% CI [-1.19, 0.25]), TG (MD = -0.02 mmol/L, 95% CI [-0.11, 0.07]), FPG (MD = -0.02 mmol/L, 95% CI [-0.10, 0.05]) and BP (systolic blood pressure: MD = 0.93 mmHg, 95% CI [-2.74, 4.61]; diastolic blood pressure: MD =1.15 mmHg, 95% CI [-0.24, 2.55]), but HDL-c (MD = 0.03 mmol/L, 95% CI [0.01, 0.05]) was significant improved in IER when compared with CER. For second outcomes, BW (MD = -0.8 kg, 95% CI [-1.26, -0.33]), BF (MD = -0.75 kg, 95% CI [-1.73, -0.13]) and FFM (MD = -0.49 kg, 95% CI [-0.92, -0.05]) were also significant improved in IER, and not for other outcomes. Conclusion Both IER and CER could improve MetS biomarkers, but IER was more effective than CER in the improvement of HDL-c only. For secondary outcomes, IER was also more effective for BW, BF and FFM, but there were no differences in effects for other outcomes.
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Affiliation(s)
- Rui Xu
- School of Sports and Health, Nanjing Sport Institute, Nanjing, China
- Sports and Health Engineering Collaborative Innovation Center of Jiangsu Province, Nanjing, China
| | - Youxiang Cao
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Peng-Ying Wang
- School of Sports and Health, Nanjing Sport Institute, Nanjing, China
| | - Xiao-Lan Chen
- School of Sports and Health, Nanjing Sport Institute, Nanjing, China
| | - Dan Tao
- Department of Government and International Studies, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
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11
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Samakidou GE, Koliaki CC, Liberopoulos EN, Katsilambros NL. Non-Classical Aspects of Obesity Pathogenesis and Their Relative Clinical Importance for Obesity Treatment. Healthcare (Basel) 2023; 11:healthcare11091310. [PMID: 37174852 PMCID: PMC10178220 DOI: 10.3390/healthcare11091310] [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: 03/16/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
Obesity is a chronic disease and a major public health problem due to its association with non-communicable diseases and all-cause mortality. An increased energy intake and decreased physical activity have been long recognized as the classical parameters that contribute to the development of obesity. However, several other, non-classical factors have also been associated with obesity through various complex mechanisms. Some of them are diet related, such as diet quality, dietary habits and speed of eating. Other factors are non-dietary, such as endocrine-disrupting chemicals, sleep quality and quantity, psychotropic medications and light at night. The scope of the present narrative review is to address these non-classical factors that are implicated in the pathogenesis of obesity, to clarify their potential role in the management of obesity and, where possible, to provide some practical clinical recommendations.
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Affiliation(s)
- Georgia E Samakidou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Chrysi C Koliaki
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Evangelos N Liberopoulos
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Nikolaos L Katsilambros
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
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Dietary Patterns and Meal Timing to Achieve a Healthy Body Weight and Promote Cardiometabolic Health: What Is the Evidence? J Cardiovasc Nurs 2023; 38:3-5. [PMID: 36260843 DOI: 10.1097/jcn.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Lao BN, Luo JH, Xu XY, Fu LZ, Tang F, Ouyang WW, Xu XZ, Wei MT, Xiao BJ, Chen LY, Wu YF, Liu XS. Time-restricted feeding's effect on overweight and obese patients with chronic kidney disease stages 3-4: A prospective non-randomized control pilot study. Front Endocrinol (Lausanne) 2023; 14:1096093. [PMID: 37082115 PMCID: PMC10111616 DOI: 10.3389/fendo.2023.1096093] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/17/2023] [Indexed: 04/22/2023] Open
Abstract
Background Time-restricted feeding (TRF) has become a popular weight loss method in recent years. It is widely used in the nutritional treatment of normal obese people and obese people with chronic diseases such as diabetes mellitus and hypertension, and has shown many benefits. However, most TRF studies have excluded chronic kidney disease (CKD) patients, resulting in a lack of sufficient evidence-based practice for the efficacy and safety of TRF therapy for CKD. Therefore, we explore the efficacy and safety of TRF in overweight and obese patients with moderate-to-severe stage CKD through this pilot study, and observe patient compliance to assess the feasibility of the therapy. Methods This is a prospective, non-randomized controlled short-term clinical trial. We recruited overweight and obese patients with CKD stages 3-4 from an outpatient clinic and assigned them to either a TRF group or a control diet (CD) group according to their preferences. Changes in renal function, other biochemical data, anthropometric parameters, gut microbiota, and adverse events were measured before the intervention and after 12 weeks. Results The change in estimated glomerular filtration rate (eGFR) before and after intervention in the TRF group (Δ = 3.1 ± 5.3 ml/min/1.73m2) showed significant improvement compared with the CD group (Δ = -0.8 ± 4.4 ml/min/1.73m2). Furthermore, the TRF group had a significant decrease in uric acid (Δ = -70.8 ± 124.2 μmol/L), but an increase in total protein (Δ = 1.7 ± 2.5 g/L), while the changes were inconsistent for inflammatory factors. In addition, the TRF group showed a significant decrease in body weight (Δ = -2.8 ± 2.9 kg) compared to the CD group, and body composition indicated the same decrease in body fat mass, fat free mass and body water. Additionally, TRF shifted the gut microbiota in a positive direction. Conclusion Preliminary studies suggest that overweight and obese patients with moderate-to-severe CKD with weight loss needs, and who were under strict medical supervision by healthcare professionals, performed TRF with good compliance. They did so without apparent adverse events, and showed efficacy in protecting renal function. These results may be due to changes in body composition and alterations in gut microbiota.
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Affiliation(s)
- Bei-ni Lao
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jiang-hong Luo
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xue-yi Xu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Li-zhe Fu
- Chronic Disease Management Outpatient, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Fang Tang
- Chronic Disease Management Outpatient, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wen-wei Ouyang
- Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Xin-zhu Xu
- Nutritional Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Meng-ting Wei
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Bing-jie Xiao
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Lin-yi Chen
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yi-fan Wu
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Yi-fan Wu, ; Xu-sheng Liu,
| | - Xu-sheng Liu
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Yi-fan Wu, ; Xu-sheng Liu,
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