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Effect of Epidemic Intermittent Fasting on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

ABSTRACT: Intermittent fasting (IF) has gained attention as a promising diet for weight loss and dysmetabolic diseases management. This systematic review aimed to investigate the effects of IF on cardiometabolic risk factors (CMRFs). A systematic literature search was carried out using three electronic databases, namely PubMed, Embase, and the Cochrane Library, until October 2020. Randomized controlled trials that compared the IF intervention with a control group diet were included. Fourteen effect sizes were expressed as weighted mean difference (WMD) using a fixed-effects model and 95% confidence intervals (CI). Compared to the ones within control groups, participants exposed to the IF intervention reduced their body weight (WMD, −1.78 kg; 95% CI, −2.21 to −1.35; p <0.05), waist circumference (WMD, −1.19 cm; 95% CI, −1.8 to −0.57; p <0.05), fat mass (WMD, −1.26 kg; 95% CI, −1.57 to −0.95; p <0.05), body mass index (WMD, −0.58 kg/m2; 95% CI, −0.8 to −0.37; p <0.05), systolic blood pressure (WMD, −2.14 mmHg; 95% CI: −3.54 to −0.73; p <0.05), diastolic blood pressure (WMD: −1.38 mmHg, 95% CI, −2.35 to −0.41, p <0.05), fasting blood glucose (WMD: −0.053 mmol/L; 95% CI: −0.105 to 0.001; p <0.05), fasting insulin (WMD, −0.8 mIU/L; 95% CI, −1.15 to −0.44; p <0.05), insulin resistance (WMD, −0.21; 95% CI, −0.36 to −0.05; p <0.05), total cholesterol (WMD, −0.10 mmol/L; 95% CI, −0.17 to −0.02; p <0.05), and triglycerides (WMD, −0.09 mmol/L; 95% CI, −0.13 to −0.04; p <0.05). No effects were observed for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or glycosylated hemoglobin. This meta-analysis supports the role of IF in improving the component composition of CMRFs, including weight, waist circumference, fat mass, BMI, blood pressure, total cholesterol, triglycerides, fasting insulin, and insulin resistance, compared to a control group diet. Further research on IF interventions should take into account long-term and well-designed administration to draw definitive conclusions.

SUBMITTER: Yang F

PROVIDER: S-EPMC8558421 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe popularity of applying intermittent fasting (IF) has increased as more and more people are trying to avoid or alleviate obesity and metabolic disease. This study aimed to systematically explore the effects of various IF in humans.MethodsThe randomized controlled trials (RCTs) related to IF vs. non-intervention diet or caloric restriction (CR) were retrieved in PubMed, Web of Science, Cochrane Library database, and Embase. Extraction outcomes included, but were not limited to, weight, body mass index (BMI), waist circumference (WC), fasting glucose, and triglyceride (TG).ResultsThis study includes 43 RCTs with 2,483 participants. The intervention time was at least 1 month, and the median intervention time was 3 months. Contrasting results between IF and non-intervention diet showed that participants had lower weight (weighted mean difference (WMD) = 1.10, 95% CI: 0.09-2.12, p = 0.03) and BMI after IF (WMD = 0.38, 95% CI: 0.08-0.68, p = 0.01). The WC of participants after IF decreased significantly compared with the non-intervention diet (WMD = 1.02, 95% CI: 0.06-1.99, p = 0.04). IF regulated fat mass (FM) more effectively than non-intervention diet (WMD = 0.74, 95% CI: 0.17-1.31, p = 0.01). The fat-free mass of people after IF was higher (WMD = -0.73, 95% CI: (-1.45)-(-0.02), p = 0.05). There was no difference in fasting blood glucose concentrations between participants in the after IF and non-intervention diet groups. The results of insulin concentrations and HOMA-IR, though, indicated that IF was significantly more beneficial than non-intervention diet (standard mean difference (SMD) = -0.21, 95% CI: 0.02-0.40, p = 0.03, and WMD = 0.35, 95% CI: 0.04-0.65, p = 0.03, respectively). Cholesterol and TG concentrations in participants after IF were also lower than that after a nonintervention diet (SMD = 0.22, 95% CI: 0.09-0.35, p = 0.001 and SMD = 0.13, 95% CI: 0.00-0.26, p = 0.05, respectively). IF outcomes did not differ from CR except for reduced WC.ConclusionIntermittent fasting was more beneficial in reducing body weight, WC, and FM without affecting lean mass compared to the non-intervention diet. IF also effectively improved insulin resistance and blood lipid conditions compared with non-intervention diets. However, IF showed less benefit over CR.

Project description:ImportanceSeveral 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 reviewPubMed, 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.FindingsA 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.

Project description:Abstract Objectives Concerns exist that NSBs do not have established benefits, with major dietary guidelines recommending that water and not NSBs replace sugar-sweetened beverages (SSBs). Whether NSBs improve cardiometabolic risk factors similar to water in their intended substitution for SSBs is unclear. To inform the update of the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a systematic review and network meta-analysis to assess the effect of substituting NSBs for SSBs, water for SSBs and NSBs for water on cardiometabolic risk factors in people with and without diabetes. Methods We searched MEDLINE, Embase and the Cochrane Library through March 2019. Randomized controlled trials (RCTs) ≥ 1 week comparing NSBs, SSBs, and/or water were included. Outcomes were measures of adiposity, glycemic control, lipids, blood pressure, nonalcoholic fatty liver disease and uric acid. Two independent reviewers extracted data and assessed risk of bias. A frequentist network meta-analysis was performed for the substitution of NSBs for SSBs, water for SSBs and NSBs for water. Data were expressed as mean (MD) or standardized mean (SMD) differences with 95% confidence intervals (CI). GRADE assessed certainty of evidence. Results We identified 14 RCTs (n = 1530) substituting NSBs for SSBs (7 trials, N = 483), NSBs for water (7 trials, n = 852) and water for SSBs (2 trials, n = 285) mostly in people at risk for or with diabetes. Substitution of NSBs for SSBs reduced body weight (MD, −1.11 kg [95% CI, −1.90 to –0.32]), BMI (−0.32 kg/m2 [−0.58 to –0.07]), body fat (−0.60% [−1.03 to –0.18]), triglycerides (−0.24 mmol/L [−0.45 to −0.02]), and liver fat (SMD, −0.44 [95% CI, −0.69 to –0.19]). Substitution of water for SSBs reduced only uric acid (–0.05 mmol/L [–0.08 to −0.01]). There was no effect of substituting NSBs for water on any outcome except HbA1c (0.21% [0.02 to 0.40]). The certainty of the evidence ranged from low to high. Conclusions The intended substitution of NSBs for SSBs improves cardiometabolic risk factors, showing similar benefits to water. The available evidence supports the use of NSBs as an alternative replacement strategy for SSBs. There is a need for more high-quality RCTs. (ClinicalTrials.gov identifier, NCT02879500) Funding Sources Diabetes and Nutrition Study Group of the EASD, CIHR, Diabetes Canada.

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Effect of Epidemic Intermittent Fasting on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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