Effect of a ketogenic diet, time-restricted eating, or alternate-day fasting on weight loss in adults with obesity: a randomized clinical trial
Martínez-Montoro JI, Bandera B, Gutiérrez-Bedmar M, Gómez-Pérez AM, Macías-González M, Moreno-Indias I, Tinahones FJ
BMC medicine · 3 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
- Servicio Andaluz de Salud
- Government
- Instituto de Salud Carlos III
- Grants
- Instituto de Salud Carlos III (C-0029-2014); Instituto de Salud Carlos III (PI18/01160); Servicio Andaluz de Salud (B-0033-2014); Instituto de Salud Carlos III (CPII21-00013); Servicio Andaluz de Salud (RC-0001-2018); Servicio Andaluz de Salud (PI18/01160); Servicio Andaluz de Salud (C-0029-2014); Instituto de Salud Carlos III (JR24/00006); Instituto de Salud Carlos III (CM22/00217)
Based on 2 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2025-07-01 · BMC Med · vol. 23 · issue 1 · p. 368
- Publisher
- BioMed Central
- Cited
- 13 citations · more than 98% of similar papers · 6.9× the field average
- Impact
- Top 10% most cited in its field
- References
- 38 works
- Access
- Open access (journal) · CC-BY-NC-ND
- Research areas
- Dietary Effects on Health · Diet and metabolism studies · Enhanced Recovery After Surgery
- Keywords
- Medicine, Ketogenic diet, Weight loss, Obesity, Randomized controlled trial, Intermittent fasting, Clinical trial, Pediatrics, Internal medicine, Physical therapy, Epilepsy, Psychiatry
- MeSH
- humans, obesity, weight loss, body mass index, treatment outcome, caloric restriction, fasting, adult, middle aged, female, male, diet, ketogenic
7 authors
From ES
- José Ignacio Martínez‐Montoro · correspondingInstituto de Salud Carlos III; Andalusian Centre for Nanomedicine and Biotechnology; Hospital Clínico Universitario Virgen de la Victoria; Instituto de Investigación Biomédica de Málaga; Universidad de Málaga
- Borja BanderaInstituto de Salud Carlos III; Hospital Clínico Universitario Virgen de la Victoria; Instituto de Investigación Biomédica de Málaga; Universidad de Málaga
- Mario Gutiérrez‐BedmarInstituto de Salud Carlos III; Centro de Investigación en Red en Enfermedades Cardiovasculares; Centro de Investigación Biomédica en Red; Instituto de Investigación Biomédica de Málaga; Universidad de Málaga
- Ana María Gómez‐PérezInstituto de Salud Carlos III; Hospital Clínico Universitario Virgen de la Victoria; Instituto de Investigación Biomédica de Málaga
- Manuel Macías‐GonzálezInstituto de Salud Carlos III; Hospital Clínico Universitario Virgen de la Victoria; Instituto de Investigación Biomédica de Málaga
- Isabel Moreno‐Indias · correspondingInstituto de Salud Carlos III; Hospital Clínico Universitario Virgen de la Victoria; Instituto de Investigación Biomédica de Málaga
Abstract
Background
Studies evaluating the effects of novel, alternative dietary approaches for weight loss compared with the Mediterranean diet (MedDiet) are lacking. We aimed to evaluate the effects of diets with varying ketogenic potential, i.e., a very-low carbohydrate diet (ketogenic diet, KD), time-restricted eating (TRE), and modified alternate-day fasting (mADF) on weight loss in obesity, compared with a MedDiet.
Methods
Three-month, parallel-arm, randomized clinical trial including 160 adults with obesity. Participants were randomized to 1 of 5 groups: control (MedDiet), KD, early TRE (eTRE), late TRE (lTRE), or mADF. All diets were calorie-restricted. The primary outcome was differences in weight loss from baseline to 3 months between a calorie-restricted MedDiet and each of the four remaining calorie-restricted dietary interventions. Secondary outcomes included change in body mass index, body composition, and cardiometabolic risk factors.
Results
The mean age was 45.7 years (SD 10.7), and 70.6% were women. One hundred forty participants completed the study. Significant differences in weight loss from baseline to 3 months were found between KD and the control group [- 3.78 kg (- 5.65 to - 1.91 kg)], between mADF and the control group [- 3.14 kg (- 4.98 to - 1.30 kg)], and between lTRE and the control group [- 2.27 kg (- 4.13 to - 0.40 kg)], but not between eTRE and the control group [- 1.22 kg (- 3.07 to 0.64 kg)].
Conclusions
These results suggest that a calorie-restricted KD, mADF, or lTRE may be more effective for weight loss than a calorie-restricted MedDiet in obesity. Further research is needed to evaluate the long-term feasibility and efficacy of these dietary interventions compared with the MedDiet.
Trial registration
ClinicalTrials.gov (NCT04453150).
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC-ND).
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