Effects of Intermittent Compared With Continuous Energy Restriction on Blood Pressure Control in Overweight and Obese Patients With Hypertension

Abstract

Background and Aims: Weight-loss diets reduce body weight and improve blood pressure control in hypertensive patients. Intermittent energy restriction (IER) is an alternative to continuous energy restriction (CER) for weight reduction. We aimed to compare the effects of IER with those of CER on blood pressure control and weight loss in overweight and obese patients with hypertension during a 6-month period.Methods: Two hundred and five overweight or obese participants (BMI 28.7 kg/m2) with hypertension were randomized to IER (5:2 diet, a very-low-calorie diet for 2 days per week, 500 kcal/day for women and 600 kcal/day for men, along with 5 days of a habitual diet) compared to a moderate CER diet (1,000 kcal/day for women and 1,200 kcal/day for men) for 6 months. The primary outcomes of this study were changes in blood pressure and weight, and the secondary outcomes were changes in body composition, glycosylated hemoglobin A1c (HbA1c), and blood lipids.Results: Of the 205 randomized participants (118 women and 87 men; mean [SD] age, 50.2 [8.9] years; mean [SD] body mass index, 28.7 [2.6]; mean [SD] systolic blood pressure, 143 [10] mmHg; and mean [SD] diastolic blood pressure, 91 [9] mmHg), 173 completed the study. The intention-to-treat analysis demonstrated that IER and CER are equally effective for weight loss and blood pressure control: the mean (SEM) weight change with IER was −7.0 [0.6] kg vs. −6.8 [0.6] kg with CER, the mean (SEM) systolic blood pressure with IER was −7 [0.7] mmHg vs. −7 [0.6] mmHg with CER, and the mean (SEM) diastolic blood pressure with IER was −6 [0.5] mmHg vs. −5 [0.5] mmHg with CER, (diet by time P = 0.62, 0.39, and 0.41, respectively). There were favorable improvements in body composition, HbA1c, and blood lipid levels, with no differences between groups. Effects did not differ according to completer analysis. No severe hypoglycemia occurred in either group during the trial.Conclusions: Intermittent energy restriction is an effective alternative diet strategy for weight loss and blood pressure control and is comparable to CER in overweight and obese patients with hypertension.Clinical Trial Registration:http://www.chictr.org.cn, identifier: ChiCTR2000040468.

Comparative efficacy of energy‐restricted dietary interventions in overweight and obese populations: A systematic review and network meta‐analysis

“…This study identified 1805 records, of which 38 RCTs involving 3039 participants were included in the NMA (Figure 1) (Antoni et al, 2018; Beaulieu et al, 2021; Bowen et al, 2018; H. Cai et al, 2019; Carter et al, 2016, 2018; Castela et al, 2022; Catenacci et al, 2016; Conley et al, 2018; Coutinho et al, 2018; Erdem et al, 2022; Fagundes et al, 2023; Gabel et al, 2019; Gray et al, 2021; Harvie et al, 2011, 2013; C. J. He et al, 2021; M. He et al, 2022; Headland et al, 2016; Hooshiar et al, 2023; Hutchison et al, 2019; Isenmann et al, 2021; Kunduraci & Ozbek, 2020; Liu et al, 2022; Maroofi & Nasrollahzadeh, 2020; McDiarmid et al, 2022; Panizza et al, 2019; Parvaresh et al, 2019; Peeke et al, 2021; Pinto et al, 2020; Pureza et al, 2020; Razavi et al, 2021; Schübel et al, 2018; Steger et al, 2021; Sundfør et al, 2018; Thomas et al, 2022; Trepanowski et al, 2017; X. Wei et al, 2023).…”

“…The 5:2 diet had the most types of adverse effects, including increased hunger, appetite changes, dizziness, headache, mood changes, and sleep disturbances (Carter et al, 2016, 2018; Conley et al, 2018; Harvie et al, 2011, 2013; C. J. He et al, 2021; McDiarmid et al, 2022; Schübel et al, 2018; Sundfør et al, 2018). Alternate‐day fasting was primarily associated with increased hunger on fasting days (Beaulieu et al, 2021; Razavi et al, 2021), time‐restricted eating was mainly associated with dizziness and headache, and decreased appetite.…”

“…associated with energy-restricted diets (Beaulieu et al, 2021;Carter et al, 2016Carter et al, , 2018Conley et al, 2018;Harvie et al, 2011Harvie et al, , 2013; C. J. He et al, 2021;M. He et al, 2022;Liu et al, 2022;McDiarmid et al, 2022;Razavi et al, 2021;Schübel et al, 2018;Sundfør et al, 2018).…”

Dietary patterns and cardiometabolic health: Clinical evidence and mechanism

“… 42 Several RCTs have shown that the 5:2 diet is more effective in controlling blood glucose in patients with obesity, T2DM, and metabolic syndrome (MetS), and also significantly improves weight, BP, and adiposity factors. 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 Ramadan fasting is one of the five pillars of Islam. During Ramadan, Muslims keep fasting from sunrise to sunset, eating a large meal after sunset and a light meal before dawn.…”

“…The 5:2 diet, also listed as periodic fasting, is characterized by two fasting days (consecutive or nonconsecutive) and ad libidum intake for another 5 days 42 . Several RCTs have shown that the 5:2 diet is more effective in controlling blood glucose in patients with obesity, T2DM, and metabolic syndrome (MetS), and also significantly improves weight, BP, and adiposity factors 118–125 . Ramadan fasting is one of the five pillars of Islam.…”