Intermittent Versus Continuous Energy Restriction for Weight Loss and Metabolic Improvement: A Meta‐Analysis and Systematic Review

He, Shasha; Wang, Jiao; Zhang, Jie; Xu, Jixiong

doi:10.1002/oby.23023

Cited by 40 publications

(80 citation statements)

References 49 publications

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“…As with previous studies of IER [ 26 – 28 ], we detected little difference between the efficacy of the 5:2 and the active control condition. Although the 5:2 diet approach is expected to be more ‘forgiving’ than most other IER approaches, adherence to 5:2 declined from some 80% at 6 weeks to some 20% at one year.…”

Section: Discussionsupporting

confidence: 90%

“…Narrative reviews of IER [ 12 – 14 ] draw heavily on animal data and highlight the paucity of definitive human trials, but several studies evaluated stricter versions of IER in humans [ 11 , 15 – 27 ]. Typically, participants were asked to restrict energy to 25% of their usual daily calories every other day (‘alternate day fasting’) or on two consecutive days per week [ 28 ] sometimes after a period on a very-low energy diet. Participants were usually also asked to use prescriptive diets on non-fasting days.…”

Section: Introductionmentioning

confidence: 99%

“…insulin sensitivity and lipid profiles [ 15 – 18 ]. One review found a better weight loss with IER in the short term [ 28 ] while other meta analyses and systematic reviews found IER achieving similar results as CER [ 29 – 31 ]. However, these traditional versions of IER that require relatively severe fasting did not have a wide appeal and did not translate into clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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A randomised controlled trial of the 5:2 diet

et al. 2021

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Objective The 5:2 diet is a popular intermittent energy restriction method of weight management that awaits further evaluation. We compared the effects of one-off 5:2 instructions with the effects of one-off standard multicomponent weight-management advice; and also examined whether additional behavioural support enhances 5:2 adherence and efficacy compared to one-off instructions. Methods Three hundred adults with obesity were randomised to receive a Standard Brief Advice (SBA) covering diet and physical activity (N = 100); 5:2 self-help instructions (5:2SH) (N = 100); or 5:2SH plus six once-weekly group support sessions (N = 100). Participants were followed up for one year. Results Adherence to 5:2SH was initially high (74% at 6 weeks), but it declined over time (31% at 6 months and 22% at one year). 5:2SH and SBA achieved similar weight-loss at six months (-1.8kg (SD = 3.5) vs -1.7kg (SD = 4.4); b = 0.23, 95%CI:-0.79–1.27, p = 0.7) and at one year (-1.9kg (SD = 4.9) vs -1.8kg (SD = 5.7), b = 0.20, 95%CI:-1.21–1.60, p = 0.79), with 18% vs 15% participants losing ≥5% of their body weight with 5:2SH and SBA, respectively at one year (RR = 0.83, 95%CI:0.44–1.54, p = 0.55). Both interventions received positive ratings, but 5:2SH ratings were significantly higher. 5:2SH had no negative effect on fat and fiber intake and physical activity compared to SBA. Compared to 5:2SH, 5:2G generated a greater weight loss at 6 weeks (-2.3kg vs -1.5kg; b = 0.74, 95%CI:1.37–0.11, p = 0.02), but by one year, the difference was no longer significant (-2.6kg vs -1.9kg, p = 0.37; ≥5% body weight loss 28% vs 18%, p = 0.10). Conclusions Simple 5:2 advice and multicomponent weight management advice generated similar modest results. The 5:2 diet did not undermine other health behaviours, and it received more favourable ratings. Adding initial group support enhanced 5:2 adherence and effects, but the impact diminished over time. Health professionals who provide brief weight management advice may consider including the 5:2 advice as an option. Trial registration ISRCTN registry (ISRCTN79408248).

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A randomised controlled trial of the 5:2 diet

et al. 2021

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“…Eleven meta-analyses were included ( Figure ) (justification for excluded full-text articles available in eTable 2 in the Supplement ). 5 , 6 , 7 , 8 , 22 , 23 , 24 , 25 , 26 , 27 Eligible meta-analyses included 130 RCTs (45 unique RCTs) with a median (IQR) sample size per RCT of 38 (24-69) studies and a follow-up period of 3 (2-5) months ( Table 1 ). The quality of meta-analyses assessed using AMSTAR-2 found that none were rated as high confidence, 7 (64%) as moderate confidence, and 4 (36%) as low confidence ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

Intermittent Fasting and Obesity-Related Health Outcomes

et al. 2021

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IMPORTANCE Several meta-analyses of randomized clinical trials (RCTs) have demonstrated the many health benefits of intermittent fasting (IF). However, there has been little synthesis of the strength and quality of this evidence in aggregate to date. OBJECTIVETo grade the evidence from published meta-analyses of RCTs that assessed the associations of IF (zero-calorie alternate-day fasting, modified alternate-day fasting, the 5:2 diet, and time-restricted eating) with obesity-related health outcomes. EVIDENCE REVIEW PubMed, Embase, and Cochrane database of systematic reviews were searched from database inception to January 12, 2021. Data analysis was conducted from April 2021 through July 2021. Meta-analyses of RCTs investigating effects of IF in adults were included. The effect sizes of IF were recalculated using a random-effects model. We assessed the quality of evidence per association by applying the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluations) as high, moderate, low, and very low.FINDINGS A total of 11 meta-analyses comprising 130 RCTs (median [IQR] sample size, 38 [24-69] participants; median [IQR] follow-up period, 3 [2-5] months) were included describing 104 unique associations of different types of IF with obesity-related health outcomes (median [IQR] studies per association, 4 [3-5]). There were 28 statistically significant associations (27%) that demonstrated the beneficial outcomes for body mass index, body weight, fat mass, low-density lipoprotein cholesterol, total cholesterol, triglycerides, fasting plasma glucose, fasting insulin, homeostatic model assessment of insulin resistance, and blood pressure. IF was found to be associated with reduced fat-free mass. One significant association (1%) supported by high-quality evidence was modified alternate-day fasting for 1 to 2 months, which was associated with moderate reduction in body mass index in healthy adults and adults with overweight, obesity, or nonalcoholic fatty liver disease compared with regular diet. Six associations (6%) were supported by moderate quality evidence. The remaining associations found to be significant were supported by very low (75 associations [72%]) to low (22 associations [21%]) quality evidence. CONCLUSIONS AND RELEVANCEIn this umbrella review, we found beneficial associations of IF with anthropometric and cardiometabolic outcomes supported by moderate to high quality of evidence, which supports the role of IF, especially modified alternate-day fasting, as a weight loss approach for adults with overweight or obesity. More clinical trials with long-term follow-up are needed to investigate the effects of IF on clinical outcomes such as cardiovascular events and mortality.

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“…The impact of obesity on people’s well-being and the resulting increase in the risk of chronic non-communicable diseases [ 1 , 2 , 3 , 4 ] are well-known facts about the condition. A combination of caloric restriction and physical exercise are the key components to observing a weight loss of approximately 10% in the sixth month of intervention [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of a Ketogenic Diet on the Nutritional Parameters of Obese Patients: A Systematic Review and Meta-Analysis

et al. 2021

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The effect of a ketogenic diet (KD) on biochemical parameters and nutritional status has been the subject of debate over the years, as several randomized clinical trials (RCTs) obtained different results. Method: A systematic review and random-effects meta-analysis of RCTs comparing KD with a balanced diet was performed by means of a search of PubMed, Cochrane Library, Scopus, and Web of Science. Trials where the method for measuring the response variables was unclear, those that considered pathologies other than chronic non-communicable diseases and those with participants receiving pharmacological treatment for obesity were excluded from the comparison. Results: Of the studies included in the meta-analysis, no statistically significant standardized mean differences were observed for body mass index (BMI) (d = −0.457, p = 0.359), total cholesterol, COL-T (d = 0.230, p = 0.591), high-density lipoprotein, HDL (d = −0.028, p = 0.934), low-density lipoprotein, LDL (d = 0.528, p = 0.173), or triglycerides, TG (d = −0.283, p = 0.222), with high values of heterogeneity. The percentage of women included in the studies is a significant moderating variable in terms of BMI ratio (z = −6.68, p < 0.001) and TG (z = −2.27, p = 0.023). Conclusion: A KD shows no more benefits on nutritional parameters than a balanced diet, and adverse effects of being on the diet are sometimes reported.

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Intermittent Versus Continuous Energy Restriction for Weight Loss and Metabolic Improvement: A Meta‐Analysis and Systematic Review

Cited by 40 publications

References 49 publications

A randomised controlled trial of the 5:2 diet

A randomised controlled trial of the 5:2 diet

Intermittent Fasting and Obesity-Related Health Outcomes

Effect of a Ketogenic Diet on the Nutritional Parameters of Obese Patients: A Systematic Review and Meta-Analysis

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