Intermittent fasting and health outcomes: an umbrella review of systematic reviews and meta-analyses of randomised controlled trials
Sun ML, Yao W, Wang XY, Gao S, Varady KA, Forslund SK, Zhang M, Shi ZY, Cao F, Zou BJ, Sun MH, Liu KX, Bao Q, Xu J, Qin X, Xiao Q, Wu L, Zhao YH, Zhang DY, Wu QJ, Gong TT
EClinicalMedicine · 71 citations
How it was studied
- Design
- Meta-analysis (classified by our AI screen)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- National Natural Science Foundation of China
- University or hospital
- China Medical University
- Government
- National Key Research and Development Program of China
- University or hospital
- Shengjing Hospital
- Grants
- National Key Research and Development Program of China (2022YFC2704205); National Natural Science Foundation of China (82373674); National Natural Science Foundation of China (82073647); National Natural Science Foundation of China (2022YFC2704205); National Natural Science Foundation of China (82103914)
Based on 4 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2024-03-11 · EClinicalMedicine · vol. 70 · p. 102519
- Publisher
- Elsevier BV
- Cited
- 94 citations · more than 99% of similar papers · 7.9× the field average
- Impact
- Top 10% most cited in its field
- References
- 109 works
- Access
- Open access (journal) · CC-BY-NC-ND
- Research areas
- Dietary Effects on Health · Genetics, Aging, and Longevity in Model Organisms · Diet and metabolism studies
- Keywords
- Medicine, Meta-analysis, Systematic review, Randomized controlled trial, MEDLINE, Alternative medicine, Physical therapy, Surgery, Internal medicine, Pathology
21 authors
From CN, US, DE
- Mingli SunChina Medical University
- Wei YaoChina Medical University
- Xiaoying WangChina Medical University
- Song GaoChina Medical University
- Krista A VaradyUniversity of Illinois Chicago
- Sofia Kirke ForslundMax Delbrück Center; Humboldt-Universität zu Berlin; German Centre for Cardiovascular Research; Freie Universität Berlin; Charité - Universitätsmedizin Berlin
Abstract
Background
Benefits of Intermittent fasting (IF) on health-related outcomes have been found in a range of randomised controlled trials (RCTs). Our umbrella review aimed to systematically analyze and synthesize the available causal evidence on IF and its impact on specific health-related outcomes while evaluating its evidence quality.
Methods
We comprehensively searched the PubMed, Embase, Web of Science, and Cochrane databases (from inception up to 8 January 2024) to identify related systematic reviews and meta-analyses of RCTs investigating the association between IF and human health outcomes. We recalculated the effect sizes for each meta-analysis as mean difference (MD) or standardized mean difference (SMD) with corresponding 95% confidence intervals (CIs). Subgroup analyses were performed for populations based on three specific status: diabetes, overweight or obesity, and metabolic syndrome. The quality of systematic reviews was evaluated using A Measurement Tool to Assess Systematic Reviews (AMSTAR), and the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. This study is registered with PROSPERO (CRD42023382004).
Findings
A total of 351 associations from 23 meta-analyses with 34 health outcomes were included in the study. A wide range of outcomes were investigated, including anthropometric measures (n = 155), lipid profiles (n = 83), glycemic profiles (n = 57), circulatory system index (n = 41), appetite (n = 9), and others (n = 6). Twenty-one (91%) meta-analyses with 346 associations were rated as high confidence according to the AMSTAR criteria. The summary effects estimates were significant at p p = 0.038), fat mass (MD = -0.72 kg; 95% CI: -1.32 to -0.12; p = 0.019), fasting insulin (SMD = -0.21; 95% CI: -0.40 to -0.02; p = 0.030), low-density lipoprotein cholesterol (LDL-C) (SMD = -0.20; 95% CI: -0.38 to -0.02; p = 0.027), total cholesterol (TC) (SMD = -0.29; 95% CI: -0.48 to -0.10; p = 0.003), and triacylglycerols (TG) (SMD = -0.23; 95% CI: -0.39 to -0.06; p = 0.007), but increased fat free mass (FFM) (MD = 0.98 kg; 95% CI: 0.18-1.78; p = 0.016). Of note, compared with the non-intervention diet, modified alternate-day fasting (MADF) reduced fat mass (MD = -0.70 kg; 95% CI: -1.38 to -0.02; p = 0.044). In people with overweight or obesity, and type 2 diabetes, IF increases high-density lipoprotein cholesterol (HDL-C) levels compared to continuous energy restriction (CER) (MD = 0.03 mmol/L; 95% CI: 0.01-0.05; p = 0.010). However, IF was less effective at reducing systolic blood pressure (SBP) than a CER diet in adults with overweight or obesity (SMD = 0.21; 95% CI: 0.05-0.36; p = 0.008).
Interpretation
Our findings suggest that IF may have beneficial effects on a range of health outcomes for adults with overweight or obesity, compared to CER or non-intervention diet. Specifically, IF may decreased WC, fat mass, LDL-C, TG, TC, fasting insulin, and SBP, while increasing HDL-C and FFM. Notably, it is worth noting that the SBP lowering effect of IF appears to be weaker than that of CER.
Funding
This work was supported by the National Key Research and Development Program of China (Q-JW), the Natural Science Foundation of China (Q-JW and T-TG), Outstanding Scientific Fund of Shengjing Hospital of China Medical University (Q-JW), and 345 Talent Project of Shengjing Hospital of China Medical University (T-TG).
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC-ND).
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