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Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis.
JBI Database System Rev Implement Rep. 2018 02; 16(2):507-547.JD

Abstract

OBJECTIVE

To examine the effectiveness of intermittent energy restriction in the treatment for overweight and obesity in adults, when compared to usual care treatment or no treatment.

INTRODUCTION

Intermittent energy restriction encompasses dietary approaches including intermittent fasting, alternate day fasting, and fasting for two days per week. Despite the recent popularity of intermittent energy restriction and associated weight loss claims, the supporting evidence base is limited.

INCLUSION CRITERIA

This review included overweight or obese (BMI ≥25 kg/m) adults (≥18 years). Intermittent energy restriction was defined as consumption of ≤800 kcal on at least one day, but no more than six days per week. Intermittent energy restriction interventions were compared to no treatment (ad libitum diet) or usual care (continuous energy restriction ∼25% of recommended energy intake). Included interventions had a minimum duration of 12 weeks from baseline to post outcome measurements. The types of studies included were randomized and pseudo-randomized controlled trials. The primary outcome of this review was change in body weight. Secondary outcomes included: i) anthropometric outcomes (change in BMI, waist circumference, fat mass, fat free mass); ii) cardio-metabolic outcomes (change in blood glucose and insulin, lipoprotein profiles and blood pressure); and iii) lifestyle outcomes: diet, physical activity, quality of life and adverse events.

METHODS

A systematic search was conducted from database inception to November 2015. The following electronic databases were searched: MEDLINE, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov, ISRCTN registry, and anzctr.org.au for English language published studies, protocols and trials. Two independent reviewers evaluated the methodological quality of included studies using the standardized critical appraisal instruments from the Joanna Briggs Institute. Data were extracted from papers included in the review by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute. Effect sizes were expressed as weighted mean differences and their 95% confidence intervals were calculated for meta-analyses.

RESULTS

Six studies were included in this review. The intermittent energy restriction regimens varied across studies and included alternate day fasting, fasting for two days, and up to four days per week. The duration of studies ranged from three to 12 months. Four studies included continuous energy restriction as a comparator intervention and two studies included a no treatment control intervention. Meta-analyses showed that intermittent energy restriction was more effective than no treatment for weight loss (-4.14 kg; 95% CI -6.30 kg to -1.99 kg; p ≤ 0.001). Although both treatment interventions achieved similar changes in body weight (approximately 7 kg), the pooled estimate for studies that investigated the effect of intermittent energy restriction in comparison to continuous energy restriction revealed no significant difference in weight loss (-1.03 kg; 95% CI -2.46 kg to 0.40 kg; p = 0.156).

CONCLUSIONS

Intermittent energy restriction may be an effective strategy for the treatment of overweight and obesity. Intermittent energy restriction was comparable to continuous energy restriction for short term weight loss in overweight and obese adults. Intermittent energy restriction was shown to be more effective than no treatment, however, this should be interpreted cautiously due to the small number of studies and future research is warranted to confirm the findings of this review.

Authors+Show Affiliations

College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom. Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom.Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom. Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom.Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom. Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom.Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom. Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom.Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom. Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom.Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom. Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom.Independent Public Health Consultant, United Kingdom.College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom. Teesside Centre for Evidence Informed Practice: a Joanna Briggs Institute Centre of Excellence, United Kingdom.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

29419624

Citation

Harris, Leanne, et al. "Intermittent Fasting Interventions for Treatment of Overweight and Obesity in Adults: a Systematic Review and Meta-analysis." JBI Database of Systematic Reviews and Implementation Reports, vol. 16, no. 2, 2018, pp. 507-547.
Harris L, Hamilton S, Azevedo LB, et al. Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis. JBI Database System Rev Implement Rep. 2018;16(2):507-547.
Harris, L., Hamilton, S., Azevedo, L. B., Olajide, J., De Brún, C., Waller, G., Whittaker, V., Sharp, T., Lean, M., Hankey, C., & Ells, L. (2018). Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis. JBI Database of Systematic Reviews and Implementation Reports, 16(2), 507-547. https://doi.org/10.11124/JBISRIR-2016-003248
Harris L, et al. Intermittent Fasting Interventions for Treatment of Overweight and Obesity in Adults: a Systematic Review and Meta-analysis. JBI Database System Rev Implement Rep. 2018;16(2):507-547. PubMed PMID: 29419624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis. AU - Harris,Leanne, AU - Hamilton,Sharon, AU - Azevedo,Liane B, AU - Olajide,Joan, AU - De Brún,Caroline, AU - Waller,Gillian, AU - Whittaker,Vicki, AU - Sharp,Tracey, AU - Lean,Mike, AU - Hankey,Catherine, AU - Ells,Louisa, PY - 2018/2/9/entrez PY - 2018/2/9/pubmed PY - 2019/11/5/medline SP - 507 EP - 547 JF - JBI database of systematic reviews and implementation reports JO - JBI Database System Rev Implement Rep VL - 16 IS - 2 N2 - OBJECTIVE: To examine the effectiveness of intermittent energy restriction in the treatment for overweight and obesity in adults, when compared to usual care treatment or no treatment. INTRODUCTION: Intermittent energy restriction encompasses dietary approaches including intermittent fasting, alternate day fasting, and fasting for two days per week. Despite the recent popularity of intermittent energy restriction and associated weight loss claims, the supporting evidence base is limited. INCLUSION CRITERIA: This review included overweight or obese (BMI ≥25 kg/m) adults (≥18 years). Intermittent energy restriction was defined as consumption of ≤800 kcal on at least one day, but no more than six days per week. Intermittent energy restriction interventions were compared to no treatment (ad libitum diet) or usual care (continuous energy restriction ∼25% of recommended energy intake). Included interventions had a minimum duration of 12 weeks from baseline to post outcome measurements. The types of studies included were randomized and pseudo-randomized controlled trials. The primary outcome of this review was change in body weight. Secondary outcomes included: i) anthropometric outcomes (change in BMI, waist circumference, fat mass, fat free mass); ii) cardio-metabolic outcomes (change in blood glucose and insulin, lipoprotein profiles and blood pressure); and iii) lifestyle outcomes: diet, physical activity, quality of life and adverse events. METHODS: A systematic search was conducted from database inception to November 2015. The following electronic databases were searched: MEDLINE, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov, ISRCTN registry, and anzctr.org.au for English language published studies, protocols and trials. Two independent reviewers evaluated the methodological quality of included studies using the standardized critical appraisal instruments from the Joanna Briggs Institute. Data were extracted from papers included in the review by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute. Effect sizes were expressed as weighted mean differences and their 95% confidence intervals were calculated for meta-analyses. RESULTS: Six studies were included in this review. The intermittent energy restriction regimens varied across studies and included alternate day fasting, fasting for two days, and up to four days per week. The duration of studies ranged from three to 12 months. Four studies included continuous energy restriction as a comparator intervention and two studies included a no treatment control intervention. Meta-analyses showed that intermittent energy restriction was more effective than no treatment for weight loss (-4.14 kg; 95% CI -6.30 kg to -1.99 kg; p ≤ 0.001). Although both treatment interventions achieved similar changes in body weight (approximately 7 kg), the pooled estimate for studies that investigated the effect of intermittent energy restriction in comparison to continuous energy restriction revealed no significant difference in weight loss (-1.03 kg; 95% CI -2.46 kg to 0.40 kg; p = 0.156). CONCLUSIONS: Intermittent energy restriction may be an effective strategy for the treatment of overweight and obesity. Intermittent energy restriction was comparable to continuous energy restriction for short term weight loss in overweight and obese adults. Intermittent energy restriction was shown to be more effective than no treatment, however, this should be interpreted cautiously due to the small number of studies and future research is warranted to confirm the findings of this review. SN - 2202-4433 UR - https://www.unboundmedicine.com/medline/citation/29419624/Intermittent_fasting_interventions_for_treatment_of_overweight_and_obesity_in_adults:_a_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.11124/JBISRIR-2016-003248 DB - PRIME DP - Unbound Medicine ER -