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Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial.
JAMA Intern Med. 2017 07 01; 177(7):930-938.JIM

Abstract

Importance

Alternate-day fasting has become increasingly popular, yet, to date, no long-term randomized clinical trials have evaluated its efficacy.

Objective

To compare the effects of alternate-day fasting vs daily calorie restriction on weight loss, weight maintenance, and risk indicators for cardiovascular disease.

Design, Setting, and Participants

A single-center randomized clinical trial of obese adults (18 to 64 years of age; mean body mass index, 34) was conducted between October 1, 2011, and January 15, 2015, at an academic institution in Chicago, Illinois.

Interventions

Participants were randomized to 1 of 3 groups for 1 year: alternate-day fasting (25% of energy needs on fast days; 125% of energy needs on alternating "feast days"), calorie restriction (75% of energy needs every day), or a no-intervention control. The trial involved a 6-month weight-loss phase followed by a 6-month weight-maintenance phase.

Main Outcomes and Measures

The primary outcome was change in body weight. Secondary outcomes were adherence to the dietary intervention and risk indicators for cardiovascular disease.

Results

Among the 100 participants (86 women and 14 men; mean [SD] age, 44 [11] years), the dropout rate was highest in the alternate-day fasting group (13 of 34 [38%]), vs the daily calorie restriction group (10 of 35 [29%]) and control group (8 of 31 [26%]). Mean weight loss was similar for participants in the alternate-day fasting group and those in the daily calorie restriction group at month 6 (-6.8% [95% CI, -9.1% to -4.5%] vs -6.8% [95% CI, -9.1% to -4.6%]) and month 12 (-6.0% [95% CI, -8.5% to -3.6%] vs -5.3% [95% CI, -7.6% to -3.0%]) relative to those in the control group. Participants in the alternate-day fasting group ate more than prescribed on fast days, and less than prescribed on feast days, while those in the daily calorie restriction group generally met their prescribed energy goals. There were no significant differences between the intervention groups in blood pressure, heart rate, triglycerides, fasting glucose, fasting insulin, insulin resistance, C-reactive protein, or homocysteine concentrations at month 6 or 12. Mean high-density lipoprotein cholesterol levels at month 6 significantly increased among the participants in the alternate-day fasting group (6.2 mg/dL [95% CI, 0.1-12.4 mg/dL]), but not at month 12 (1.0 mg/dL [95% CI, -5.9 to 7.8 mg/dL]), relative to those in the daily calorie restriction group. Mean low-density lipoprotein cholesterol levels were significantly elevated by month 12 among the participants in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9-21.1 mg/dL]) compared with those in the daily calorie restriction group.

Conclusions and Relevance

Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs daily calorie restriction.

Trial Registration

clinicaltrials.gov Identifier: NCT00960505.

Authors+Show Affiliations

Department of Kinesiology and Nutrition, University of Illinois at Chicago.Department of Kinesiology and Nutrition, University of Illinois at Chicago2Nutrition Obesity Research Center, University of Alabama at Birmingham.Department of Kinesiology and Nutrition, University of Illinois at Chicago.Department of Kinesiology and Nutrition, University of Illinois at Chicago.Department of Kinesiology and Nutrition, University of Illinois at Chicago.Department of Kinesiology and Nutrition, University of Illinois at Chicago.Department of Kinesiology and Nutrition, University of Illinois at Chicago.Department of Epidemiology and Biostatistics, University of Illinois at Chicago.Quantitative Sciences Unit, Stanford University, Stanford, California.Nutrition Obesity Research Center, Pennington Biomedical Research Center, Baton Rouge, Louisiana.Nutrition Obesity Research Center, Pennington Biomedical Research Center, Baton Rouge, Louisiana.Department of Kinesiology and Nutrition, University of Illinois at Chicago.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28459931

Citation

Trepanowski, John F., et al. "Effect of Alternate-Day Fasting On Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: a Randomized Clinical Trial." JAMA Internal Medicine, vol. 177, no. 7, 2017, pp. 930-938.
Trepanowski JF, Kroeger CM, Barnosky A, et al. Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Intern Med. 2017;177(7):930-938.
Trepanowski, J. F., Kroeger, C. M., Barnosky, A., Klempel, M. C., Bhutani, S., Hoddy, K. K., Gabel, K., Freels, S., Rigdon, J., Rood, J., Ravussin, E., & Varady, K. A. (2017). Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Internal Medicine, 177(7), 930-938. https://doi.org/10.1001/jamainternmed.2017.0936
Trepanowski JF, et al. Effect of Alternate-Day Fasting On Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: a Randomized Clinical Trial. JAMA Intern Med. 2017 07 1;177(7):930-938. PubMed PMID: 28459931.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. AU - Trepanowski,John F, AU - Kroeger,Cynthia M, AU - Barnosky,Adrienne, AU - Klempel,Monica C, AU - Bhutani,Surabhi, AU - Hoddy,Kristin K, AU - Gabel,Kelsey, AU - Freels,Sally, AU - Rigdon,Joseph, AU - Rood,Jennifer, AU - Ravussin,Eric, AU - Varady,Krista A, PY - 2017/5/2/pubmed PY - 2017/8/25/medline PY - 2017/5/2/entrez SP - 930 EP - 938 JF - JAMA internal medicine JO - JAMA Intern Med VL - 177 IS - 7 N2 - Importance: Alternate-day fasting has become increasingly popular, yet, to date, no long-term randomized clinical trials have evaluated its efficacy. Objective: To compare the effects of alternate-day fasting vs daily calorie restriction on weight loss, weight maintenance, and risk indicators for cardiovascular disease. Design, Setting, and Participants: A single-center randomized clinical trial of obese adults (18 to 64 years of age; mean body mass index, 34) was conducted between October 1, 2011, and January 15, 2015, at an academic institution in Chicago, Illinois. Interventions: Participants were randomized to 1 of 3 groups for 1 year: alternate-day fasting (25% of energy needs on fast days; 125% of energy needs on alternating "feast days"), calorie restriction (75% of energy needs every day), or a no-intervention control. The trial involved a 6-month weight-loss phase followed by a 6-month weight-maintenance phase. Main Outcomes and Measures: The primary outcome was change in body weight. Secondary outcomes were adherence to the dietary intervention and risk indicators for cardiovascular disease. Results: Among the 100 participants (86 women and 14 men; mean [SD] age, 44 [11] years), the dropout rate was highest in the alternate-day fasting group (13 of 34 [38%]), vs the daily calorie restriction group (10 of 35 [29%]) and control group (8 of 31 [26%]). Mean weight loss was similar for participants in the alternate-day fasting group and those in the daily calorie restriction group at month 6 (-6.8% [95% CI, -9.1% to -4.5%] vs -6.8% [95% CI, -9.1% to -4.6%]) and month 12 (-6.0% [95% CI, -8.5% to -3.6%] vs -5.3% [95% CI, -7.6% to -3.0%]) relative to those in the control group. Participants in the alternate-day fasting group ate more than prescribed on fast days, and less than prescribed on feast days, while those in the daily calorie restriction group generally met their prescribed energy goals. There were no significant differences between the intervention groups in blood pressure, heart rate, triglycerides, fasting glucose, fasting insulin, insulin resistance, C-reactive protein, or homocysteine concentrations at month 6 or 12. Mean high-density lipoprotein cholesterol levels at month 6 significantly increased among the participants in the alternate-day fasting group (6.2 mg/dL [95% CI, 0.1-12.4 mg/dL]), but not at month 12 (1.0 mg/dL [95% CI, -5.9 to 7.8 mg/dL]), relative to those in the daily calorie restriction group. Mean low-density lipoprotein cholesterol levels were significantly elevated by month 12 among the participants in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9-21.1 mg/dL]) compared with those in the daily calorie restriction group. Conclusions and Relevance: Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs daily calorie restriction. Trial Registration: clinicaltrials.gov Identifier: NCT00960505. SN - 2168-6114 UR - https://www.unboundmedicine.com/medline/citation/28459931/Effect_of_Alternate_Day_Fasting_on_Weight_Loss_Weight_Maintenance_and_Cardioprotection_Among_Metabolically_Healthy_Obese_Adults:_A_Randomized_Clinical_Trial_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2017.0936 DB - PRIME DP - Unbound Medicine ER -