Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial
Trepanowski JF, Kroeger CM, Barnosky A, Klempel MC, Bhutani S, Hoddy KK, Gabel K, Freels S, Rigdon J, Rood J, Ravussin E, Varady KA
JAMA internal medicine · 469 citations
How it was studied
- Design
- Randomized controlled trial (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- National Heart, Lung, and Blood Institute
- Government
- National Institute of Diabetes and Digestive and Kidney Diseases
- Government
- NIDDK NIH HHS
- Government
- NHLBI NIH HHS
- Grants
- National Institute of Diabetes and Digestive and Kidney Diseases (F32DK107157); National Heart, Lung, and Blood Institute (R01 HL106228); National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK-072476)
Based on 4 listed funder(s).
Publication
- Published
- 2017-05-01 · JAMA Intern Med · vol. 177 · issue 7 · p. 930
- Publisher
- American Medical Association
- Cited
- 648 citations · more than 100% of similar papers · 24.7× the field average
- Impact
- Top 10% most cited in its field
- References
- 32 works
- Access
- Free to read
- Research areas
- Dietary Effects on Health · Diet and metabolism studies · Genetics, Aging, and Longevity in Model Organisms
- Keywords
- Medicine, Weight loss, Calorie restriction, Intermittent fasting, Body mass index, Randomized controlled trial, Weight change, Calorie, Obesity, Internal medicine, Very low calorie diet, Hazard ratio, Physical therapy, Gerontology, Confidence interval
- MeSH
- humans, cardiovascular diseases, obesity, weight loss, insulin, blood glucose, diet therapy, caloric restriction, fasting, risk factors, feeding behavior, patient compliance, adult, middle aged, female, male, outcome and process assessment, health care
12 authors
From US
- John F. TrepanowskiUniversity of Illinois Chicago
- Cynthia M. KroegerUniversity of Alabama at Birmingham; University of Illinois Chicago
- Adrienne BarnoskyUniversity of Illinois Chicago
- Monica C KlempelUniversity of Illinois Chicago
- Surabhi BhutaniUniversity of Illinois Chicago
- Kristin K. HoddyUniversity of Illinois Chicago
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.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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