Intermittent Fasting and Obesity-Related Health Outcomes: An Umbrella Review of Meta-analyses of Randomized Clinical Trials
Patikorn C, Roubal K, Veettil SK, Chandran V, Pham T, Lee YY, Giovannucci EL, Varady KA, Chaiyakunapruk N
JAMA network open · 219 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Systematic review (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2021-12-17 · JAMA Netw Open · vol. 4 · issue 12 · p. e2139558
- Publisher
- American Medical Association
- Cited
- 296 citations · more than 100% of similar papers · 21.3× the field average
- Impact
- Top 10% most cited in its field
- References
- 40 works
- Access
- Open access (journal) · CC-BY
- Research areas
- Dietary Effects on Health · Diet and metabolism studies · Genetics, Aging, and Longevity in Model Organisms
- Keywords
- Medicine, Body mass index, Meta-analysis, Obesity, Randomized controlled trial, Internal medicine, Physical therapy
- MeSH
- humans, obesity, weight loss, treatment outcome, fasting, models, statistical, meta-analysis as topic, randomized controlled trials as topic, non-alcoholic fatty liver disease, heart disease risk factors
9 authors
From TH, US, IN, MY
- Chanthawat PatikornChulalongkorn University
- Kiera RoubalUniversity of Wisconsin–Madison
- Sajesh Kalkandi VeettilUniversity of Utah
- Viji Pulikkel ChandranManipal Academy of Higher Education
- Tuan Anh PhamUniversity of Utah
- Yeong Yeh LeeHospital Universiti Sains Malaysia
Abstract
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.
Objective
To 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 relevance
In 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.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY).
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