Next Article in Journal
Triterpenoids and Polysaccharides from Ganoderma lucidum Improve the Histomorphology and Function of Testes in Middle-Aged Male Mice by Alleviating Oxidative Stress and Cellular Apoptosis
Next Article in Special Issue
Twelve-Month Outcomes in Patients with Obesity Following Bariatric Surgery—A Single Centre Experience
Previous Article in Journal
Effects of Green Kiwifruit Peel Extract on Sleep-Wake Profiles in Mice: A Polysomnographic Study Based on Electroencephalogram and Electromyogram Recordings
Previous Article in Special Issue
The Influence of Family History of Type 2 Diabetes on Metabolism during Submaximal Aerobic Exercise and in the Recovery Period in Postmenopausal Women
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Nutrients
Volume 14
Issue 22
10.3390/nu14224734
nutrients-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Effects of an Intermittent Fasting 5:2 Plus Program on Body Weight in Chinese Adults with Overweight or Obesity: A Pilot Study

by
Junren Kang
*,
Xiaodong Shi
,
Ji Fu
,
Hailong Li
,
Enling Ma
and
Wei Chen
Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan Dongcheng District, Beijing 100730, China
*
Author to whom correspondence should be addressed.
Nutrients 2022, 14(22), 4734; https://doi.org/10.3390/nu14224734
Submission received: 25 October 2022 / Revised: 7 November 2022 / Accepted: 7 November 2022 / Published: 9 November 2022
(This article belongs to the Special Issue Improving Body Composition and Metabolism with Exercise, Diet and Surgery: Translational Approaches)
Browse Figures
Review Reports Versions Notes

Abstract

:
To retrospectively review the efficacy of intermittent fasting 5:2 plus program (30% of energy requirements on fast days and 70% of energy requirements on nonfasting days) in Chinese patients with overweight or obesity. This retrospective cohort study evaluated weight loss outcomes of patients treated with 12 weeks weight loss program in clinic. Adults with overweight or obesity participated in intermittent fasting 5:2 plus, daily calorie restriction (70% of energy requirements every day) or daily calorie restriction with meal replacement (70% of energy requirements every day, partly provided with high-protein meal replacement) programs for 12 weeks. The primary objective was to compare the weight loss of three groups. The primary outcome measure was the change in the % total weight loss. A total of 131 patients (35.3 ± 10.1 years; 81.7% female) were included, and the mean weight loss was 7.8 ± 4.4% after 12 weeks. The intermittent fasting 5:2 plus group (n = 42) achieved 9.0 ± 5.3% weight loss, compared with 5.7 ± 3.7% in the daily calorie restriction group (n = 41) (p < 0.001) and 8.6 ± 3.5% in the meal replacement group (n = 48) (p = 0.650). A total of 85.7% of patients in the intermittent fasting 5:2 plus group lost more than 5% body weight, vs. 58.5% in the daily calorie restriction group (p = 0.008), and 45.2% lost more than 10% body weight, vs. 14.6% in the daily calorie restriction group (p = 0.005). No serious adverse events were reported in the three groups. The intermittent fasting 5:2 plus program more effectively led to weight loss than daily calorie restriction in the short-term in Chinese patients with overweight or obesity. A longer-term prospective randomized controlled trial is needed.

1. Introduction

The worldwide obesity prevalence has increased significantly, and China has the largest population of obesity [1,2]. Intensive nutrition and lifestyle modifications are basic, effective and safe interventions [3,4,5]. Intermittent fasting (IF) is a common intensive nutrition and lifestyle intervention strategy for obesity [6,7].
The mechanisms of IF in weight loss and metabolic health are complex and include enhancing defenses against oxidative and metabolic stress, eliminating or remediating damaged molecules and improving insulin resistance [8,9,10]. IF has been widely used in many long-term follow-up and large sample studies as a reliable intervention for obesity [11,12,13]. Common protocols of IF consist of time-restricted feeding [14], alternate-day fasting [15] and intermittent fasting 5:2 [12,13,16] diets.
Currently, in clinical practice IF programs provide 30–40% of energy requirements on fasting days and 100% or ~125% of energy requirements on nonfasting days [12,15]. A previous study found that more than 100% of energy requirements on nonfasting days increased fasting insulin [17], therefore, studies with less than 100% of energy requirements on nonfasting days were designed. In a 16-week RCT, an alternate-day fasting program providing approximately 1200 kcal of energy on nonfasting days led to improvements in fasting triglycerides and insulin and weight loss [18]. Meal replacements were used for energy restriction in this study, and the meal replacement programs for weight loss were simple, novel and effective [19,20,21].
Energy restriction on nonfasting days with alternate-day fasting model was shown to be effective in previous study [18]. However, research regarding energy restriction on nonfasting days with other IF models was limited. It is unclear whether energy restriction without meal replacements on nonfasting days would be more effective for weight loss, especially in the intermittent fasting 5:2 model. We have exploratory applied an intermittent fasting 5:2 plus program in which approximately 30% of energy requirements were provided on fasting days (two nonconsecutive days a week) and 70% of total energy requirements were provided on nonfasting days. To validate the efficacy of the intermittent fasting 5:2 plus program for weight loss, a retrospective cohort study was conducted to compare the effects of the intermittent fasting 5:2 plus program and two continuous energy restriction approaches for weight loss in Chinese patients with overweight or obesity.

2. Materials and Methods

2.1. Patient Characteristics

This was a retrospective analysis of 12-week weight loss data. Data from electronic database of patients with overweight or obesity receiving 12 weeks of weight loss intervention at the Peking Union Medical College Hospital (PUMCH) from 1 July 2018 to 1 July 2020 were reviewed. The patients with overweight or obesity receiving different weight loss interventions were included. (1) Intermittent fasting 5:2 plus group: the patients were provided approximately 30% of their energy requirements on fasting days (two non-consecutive days a week) and 70% of their total energy requirements on nonfasting days. (2) Daily calorie restriction (CR) group: the patients were provided approximately 70% of their total energy requirements per day. The targeted percentages of energy derived from fat, protein, and carbohydrates were 20%, 20%, and 60%, respectively. The average eating frequency was defined as 5 times a day, including breakfast, lunch, dinner and two extra meals with fruit or yogurt at 10 AM and 4 PM. (3) Daily calorie restriction with high protein meal replacement (HP) group: the patients were provided approximately 70% of their total energy requirements per day. The targeted percentages of energy derived from fat, protein, and carbohydrates were 30%, 30%, and 40%, respectively. Approximately 50% of protein was provided by whey protein isolate powder as a meal replacement for breakfast and a snack in 4 PM. One scoop (23.2 g) of whey protein a meal replacement contained of 88.8 kcal, 20.0 g protein, 0.5 g fat, 0.6 g carbohydrate and 0.084 g sodium (manufactured by Milk Specialties Global, Ltd., Wautoma, WI, USA). These patients were asked to complete 150–300 min of moderate-intensity aerobic or resistance exercise per week. And several behavioral strategies were also advised and consisted of reducing high-fat food consumption, having regular eating times, having an average eating frequency of 5 times a day, eating vegetables and protein first and carbohydrates later, increasing the number of chewing cycles, self-weighing every day, avoiding prolonged periods of sitting, exercising every day and going to sleep early. Data on weight and body compositions were collected when the patients were reviewed in clinic every 4 weeks. Dietary education was provided by trained registered dietitians or physicians in clinic.
The inclusion criteria were as follows: (1) 18–70 years old; (2) BMI > 25 kg/m2, and (3) a 12-week weight loss intervention. Patients were excluded if they could not complete the 12-week weight loss intervention. The patients with type 1 or 2 diabetes, cardiovascular events, or cancer were excluded. The study was approved by the Ethics Committee of PUMCH (approval No. S-K 780).

2.2. Outcomes

The primary objective was to compare the weight loss effects of three groups for 12 weeks of weight loss. The primary outcome measure was the change in the % total weight loss (TWL). The secondary outcome measures were the fat mass (FM): total mass (TM) ratio and the fat free mass (FFM): total mass (TM) ratio. The body weights, body mass index (BMI) and body compositions of patients were measured after fasting for 8 h at 0 and 12 weeks with multi-frequency segmental bioelectrical impedance analysis (BIA, H-Key 350, SEEHIGHER, CHINA). Weight loss was defined as the initial weight minus the final weight. The % TWL was defined as the difference between the initial weight and final weight divided by the initial weight.

2.3. Data Collection

Clinical data such as age, sex, weight and body compositions at 0 and 12 weeks were collected from an independent electronic database. Data on adverse events were collected from the patients’ self-reported complications. The serious adverse events were define as death, pancreatitis, cholecystitis, serious abdominal pain of unknown aetiology. Data were abstracted and inputted independently by 2 trained investigators to ensure consistency and integrity. Disagreements on information were resolved by consensus or by retrieving further information from the electronic database.

2.4. Statistical Analysis

For the sample size calculation, IF was shown to reduce body weight by 6% in previous papers [15]. We calculated that approximately 29 patients would provide 95% power to detect a significant difference of 6% between baseline and week 12 (two-sided a = 0.05, β = 0.1). Thus, we aimed to recruit 39 patients per group with an expected dropout rate of 25%. The differences among three groups were compared by one-way ANOVA or Mann-Whitney U test and the chi-square test or Fisher’s exact test for dichotomous or categorical variables. The differences within groups between baseline and 12 weeks later were analyzed using paired t test for normally distributed variables or Wilcoxon test for nonnormally distributed continuous variables. A two-tailed p value of less than 0.05 was considered statistically significant. Statistical analyses were performed with SPSS software (Version 19, SPSS Inc., IBM, Armonk, NY, USA).

3. Results

3.1. Patient Characteristics

From 1 July 2018 to 1 July 2020, 531 patients with overweight or obesity received weight loss treatment in the same nutritional clinic. A total of 10 patients were excluded for out of age, 294 patients receiving less than 12 weeks treatment were excluded, 96 patients with type 1 or 2 diabetes, cardiovascular events, or cancer were excluded. A total of 131 patients with overweight or obesity who met the inclusion criteria were included. A flowchart of the recruitment was given in Figure 1. The mean age of the patients was 35.3 ± 10.1 (range, 19 to 67 years), and 81.7% (n = 107) were female. The mean body weight was 84.8 ± 16.4 kg, with a mean BMI of 30.7 ± 4.7 kg/m2. The baseline characteristics of patients were comparable among three groups (Table 1).

3.2. The Differences among Groups

At week 12, the weight change from baseline was 7.9 ± 5.0 kg in the IF group, 7.5 ± 3.6 kg in the HP group and 4.7 ± 3.4 kg in the CR group (Variance analysis, p = 0.001) (Table 2). The % TWL from baseline was 9.0 ± 5.3% in the IF group, 8.6 ± 3.5% in the HP group and 5.7 ± 3.7% in the CR group, and as shown in Figure 2, the % TWL among three groups had significant differences (ANOVA, p < 0.001).
There were also significant differences in percentages of more than 5% weight loss and more than 10% weight loss among groups (Fisher’s exact test, p = 0.008 and 0.005, respectively) (Table 2). Compared to the CR group, proportion of subjects with more than 5% weight loss and more than 10% weight loss were higher in the IF and HP groups. Approximately 85.7% of patients in the IF group lost more than 5% body weight and 81.3% of patients in the HP group, while 45.2% of patients in the IF group and 41.7% in the HP group lost more than 10% body weight. There was no significant differences in the % TWL (Fisher’s exact test, p = 0.650), proportion of subjects with more than 5% weight loss (Fisher’s exact test, p = 0.57) and more than 10% weight loss (Fisher’s exact test, p = 0.730) between the IF group and HP group.

3.3. The Differences within Groups

After 12 weeks of weight loss intervention, 131 patients lost an average of 6.8 ± 4.3 kg and had a 7.8 ± 4.4% reduction in body weight. The changes in weight, BMI, FM/TM and FFM/TM were shown in Table 3. Forty-two patients were in the intermittent fasting 5:2 plus group, the weight change at week 12 from baseline was 7.9 ± 5.0 kg (Paired t tests for differences within groups, t = 10.203, p < 0.001). 41 were in the daily calorie restriction group, the weight change from baseline was 4.7 ± 3.4 kg (Paired t tests, t = 8.890, p < 0.001). 48 were in the daily calorie restriction with high protein meal replacement group, the weight change from baseline was 7.5 ± 3.6 kg (Paired t tests, t = 14.390, p < 0.001). As shown in Figure 3, the BMI and FM/TM of the three groups were all significantly decreased at week 12 compared to baseline, whereas FFM/TM was increased.

3.4. Adverse Events

During follow-up, all patients were interviewed face-to-face every 4 weeks. No serious adverse events were reported in the three groups. The common self-reported complications were constipation (6.8%), fatigue (5.3%) and hair loss (4.6%). There were no significant differences in the rates of constipation, fatigue and hair loss among the three groups (Fisher’s exact test, p = 0.257, 0.597 and 0.985, respectively).

4. Discussion

In the current study, we demonstrated that the intermittent fasting 5:2 plus program produced superior weight loss compared with the daily calorie restriction for 12 weeks in Chinese patients with overweight or obesity. There were no serious adverse events during the intermittent fasting 5:2 plus program.
The worldwide obesity prevalence has increased significantly. People with obesity have a higher risk of diabetes, hyperlipidemia, hyperuricemia, nonalcoholic fatty liver, polycystic ovary syndrome, kidney disease, and cancer, consuming many medical insurance costs and national public health investments [1,2]. As a common intensive nutrition and lifestyle intervention strategy for obesity, IF has been shown to achieve weight reduction and improve insulin resistance and metabolic health [6,22,23]. Intermittent fasting has been widely used in individuals with obesity, cardiovascular disease [24] and diabetes mellitus [25,26]. The reliability of IF has been verified in long-term studies [11,12,13].
Several types of IF have been reported [27]. Time-restricted feeding [28,29], alternate-day fasting [30,31] and intermittent fasting 5:2 [12,13,20] are common types of IF. Alternate-day fasting and intermittent fasting 5:2 programs provide 30–40% of energy on fasting days and 100% or more of energy needs on nonfasting days [12,15].
The provision of less than 100% of energy requirements on nonfasting days has been explored in RCTs. An alternate-day fasting study provided approximately 70% of energy on nonfasting days led to improvements in fasting triglycerides and insulin and weight loss [18]. In this intermittent fasting 5:2 study, 30% of energy requirements on fasting days and 70% on nonfasting days were provided. The % TWL was higher in the intermittent fasting 5:2 group than in the daily calorie restriction group, which was in line with the results of a previous study [18]. Calorie restriction has been shown to improve insulin resistance, lower blood lipids, fasting insulin and reduce inflammation [5,32,33,34].
Both the CR and HP groups had equal percentages of caloric restriction (−30% of total energy requirements), and the % TWL was higher in the HP group than in the CR group. This finding is consistent with the outcomes of previous studies. Meal replacement programs for weight loss were associated with eliminating choices, controlling portions and enhancing adherence [19,20,21]. On the other hand, meal replacements may require a higher overall cost and are associated with adverse effects in 76.8% of individuals [21], and individuals only partially replacing meals with meal replacements might quickly regain weight [35]. In this study, the meal replacement group had less weight loss at 12 weeks than the IF group, although the difference was not significant.
Therefore, in addition to reduced calorie intake, other mechanisms may underlie the weight loss observed with IF. Several mechanisms of IF have been reported, such as metabolic switching, metabolic adaptations, enhanced mitochondrial health and blunted inflammation [8,10,36]. IF may also influence the intestinal microbiota and human circadian rhythms, resulting in impacts on obesity [37].
In previous studies, the common adverse effects of IF included dizziness, headache, nausea and temporary sleep disturbances [12]. Participants in IF programs sometimes felt hungry and irritable on fasting days, which usually improved within a month [8]. In this study, a daily multivitamin supplement and 2000–2500 mL water were recommended to prevent the risk of complications, and regular face-to-face interviews were recommended to monitor complications. Behavioral interventions, such as going to sleep early [38,39], eating an average frequency of 5 times a day [40], avoiding prolonged periods of sitting [41] and eating vegetables and protein first [42], were also advised to develop healthy habits. There were no serious adverse events, which was in consistent with a previous literature [16]. In a secondary analysis of dietary data of two studies of intermittent fasting 5:2 in New Zealand, Scholtens EL et al. found that although fibre intake of IF had lower than recommended and IF was safe and acceptable for weight-loss [16].
There are several limitations in our study. First, this was a retrospective cohort study, and the study group assignment was not randomized, although the baseline characteristics were comparable among groups. A prospective randomized controlled trial is needed in the future. Second, this is a short-term study and the duration of 12 weeks was relatively short. The effects of weight loss were superior in 8-week or 12-week time-restricted feeding interventions compared with CR interventions [14,43], but were without obvious advantages in the 12-month weight loss program [15,44]. Studies of the long-term follow-up should be conducted in the future [45]. Third, the patients with BMI > 25 kg/m2 were enrolled in this study, and we cannot generalize the benefits of the 5:2 plus program in other populations. For example, in lean, healthy adults, intermittent fasting was shown to less effectively improve postprandial indices of cardiometabolic health and reduce body fat mass than CR in a randomized controlled trial [46].
Nonetheless, to our knowledge, this is the first exploratory study to examine the weight loss effect of 12-week intermittent fasting 5:2 plus intervention in Chinese patients with overweight or obesity. The findings of this study could help adults with overweight or obesity select an appropriate intervention for short-term weight loss.

5. Conclusions

The intermittent fasting 5:2 plus program led to effective weight loss in the short-term in Chinese patients with overweight or obesity. A longer-term prospective randomized controlled trial is needed.

Author Contributions

W.C., E.M. and J.K. equally contributed to the conception; J.K. contributed to the design of the research; X.S., J.F. and H.L. contributed to the acquisition and analysis of the data; E.M. and J.K. contributed to the interpretation of the data; and J.K. drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported by National High Level Hospital Clinical Research Funding (2022-PUMCH-A-061).

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Peking Union Medical College Hospital (PUMCH) (Approval No. S-K 780, 2 June 2019).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data that support the findings of this study are included in this article. Further inquiries can be directed to the corresponding author if needed.

Conflicts of Interest

The authors have no conflict of interest to declare.

References

  1. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet 2016, 387, 1377–1396. [Google Scholar] [CrossRef] [Green Version]
  2. Chen, Y.; Peng, Q.; Yang, Y.; Zheng, S.; Wang, Y.; Lu, W. The prevalence and increasing trends of overweight, general obesity, and abdominal obesity among Chinese adults: A repeated cross-sectional study. BMC Public Health 2019, 19, 1293. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  3. Lean, M.E.; Leslie, W.S.; Barnes, A.C.; Brosnahan, N.; Thom, G.; McCombie, L.; Peters, C.; Zhyzhneuskaya, S.; Al-Mrabeh, A.; Hollingsworth, K.G.; et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): An open-label, cluster-randomised trial. Lancet 2018, 391, 541–551. [Google Scholar] [CrossRef] [Green Version]
  4. Brun, J.F.; Myzia, J.; Varlet-Marie, E.; Raynaud de Mauverger, E.; Mercier, J. Beyond the Calorie Paradigm: Taking into Account in Practice the Balance of Fat and Carbohydrate Oxidation during Exercise? Nutrients 2022, 14, 1605. [Google Scholar] [CrossRef] [PubMed]
  5. Sayón-Orea, C.; Razquin, C.; Bulló, M.; Corella, D.; Fitó, M.; Romaguera, D.; Vioque, J.; Alonso-Gómez, Á.M.; Wärnberg, J.; Martínez, J.A.; et al. Effect of a Nutritional and Behavioral Intervention on Energy-Reduced Mediterranean Diet Adherence Among Patients with Metabolic Syndrome: Interim Analysis of the PREDIMED-Plus Randomized Clinical Trial. JAMA 2019, 322, 1486–1499. [Google Scholar] [CrossRef]
  6. Welton, S.; Minty, R.; O’Driscoll, T.; Willms, H.; Poirier, D.; Madden, S.; Kelly, L. Intermittent fasting and weight loss: Systematic review. Can. Fam. Physician 2020, 66, 117–125. [Google Scholar]
  7. Roman, Y.M.; Dominguez, M.C.; Easow, T.M.; Pasupuleti, V.; White, C.M.; Hernandez, A.V. Effects of intermittent versus continuous dieting on weight and body composition in obese and overweight people: A systematic review and meta-analysis of randomized controlled trials. Int. J. Obes. 2019, 43, 2017–2027. [Google Scholar] [CrossRef]
  8. de Cabo, R.; Mattson, M.P. Effects of Intermittent Fasting on Health, Aging, and Disease. N. Engl. J. Med. 2019, 381, 2541–2551, Erratum in 2020, 382, 298. Erratum in 2020, 382, 978. [Google Scholar] [CrossRef]
  9. Patterson, R.E.; Sears, D.D. Metabolic Effects of Intermittent Fasting. Annu. Rev. Nutr. 2017, 37, 371–393. [Google Scholar] [CrossRef] [Green Version]
  10. Mattson, M.P.; Longo, V.D.; Harvie, M. Impact of intermittent fasting on health and disease processes. Ageing Res. Rev. 2017, 39, 46–58. [Google Scholar] [CrossRef]
  11. Headland, M.; Clifton, P.M.; Carter, S.; Keogh, J.B. Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Intermittent Energy Restriction Trials Lasting a Minimum of 6 Months. Nutrients 2016, 8, 354. [Google Scholar] [CrossRef] [PubMed]
  12. Sundfør, T.M.; Svendsen, M.; Tonstad, S. Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: A randomized 1-year trial. Nutr. Metab. Cardiovasc. Dis. 2018, 28, 698–706. [Google Scholar] [CrossRef] [Green Version]
  13. Headland, M.L.; Clifton, P.M.; Keogh, J.B. Effect of intermittent compared to continuous energy restriction on weight loss and weight maintenance after 12 months in healthy overweight or obese adults. Int. J. Obes. 2019, 43, 2028–2036, Erratum in 2019, 43, 942. [Google Scholar] [CrossRef] [PubMed]
  14. Cienfuegos, S.; Gabel, K.; Kalam, F.; Ezpeleta, M.; Wiseman, E.; Pavlou, V.; Lin, S.; Oliveira, M.L.; Varady, K.A. Effects of 4- and 6-h Time-Restricted Feeding on Weight and Cardiometabolic Health: A Randomized Controlled Trial in Adults with Obesity. Cell Metab. 2020, 32, 366.e3–378.e3. [Google Scholar] [CrossRef] [PubMed]
  15. Trepanowski, J.F.; Kroeger, C.M.; Barnosky, A.; Klempel, M.C.; Bhutani, S.; Hoddy, K.K.; Gabel, K.; Freels, S.; Rigdon, J.; Rood, J.; et al. Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Intern. Med. 2017, 177, 930–938. [Google Scholar] [CrossRef]
  16. Scholtens, E.L.; Krebs, J.D.; Corley, B.T.; Hall, R.M. Intermittent fasting 5:2 diet: What is the macronutrient and micronutrient intake and composition? Clin. Nutr. 2020, 39, 3354–3360. [Google Scholar] [CrossRef]
  17. Hutchison, A.T.; Liu, B.; Wood, R.E.; Vincent, A.D.; Thompson, C.H.; O’Callaghan, N.J.; Wittert, G.A.; Heilbronn, L.K. Effects of Intermittent Versus Continuous Energy Intakes on Insulin Sensitivity and Metabolic Risk in Women with Overweight. Obesity 2019, 27, 50–58. [Google Scholar] [CrossRef] [Green Version]
  18. Bowen, J.; Brindal, E.; James-Martin, G.; Noakes, M. Randomized Trial of a High Protein, Partial Meal Replacement Program with or without Alternate Day Fasting: Similar Effects on Weight Loss, Retention Status, Nutritional, Metabolic, and Behavioral Outcomes. Nutrients 2018, 10, 1145. [Google Scholar] [CrossRef] [Green Version]
  19. Kalam, F.; Gabel, K.; Cienfuegos, S.; Ezpeleta, M.; Wiseman, E.; Varady, K.A. Alternate Day Fasting Combined with a Low Carbohydrate Diet: Effect on Sleep Quality, Duration, Insomnia Severity and Risk of Obstructive Sleep Apnea in Adults with Obesity. Nutrients 2021, 13, 211. [Google Scholar] [CrossRef]
  20. Astbury, N.M.; Aveyard, P.; Nickless, A.; Hood, K.; Corfield, K.; Lowe, R.; Jebb, S.A. Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): Pragmatic randomised controlled trial. BMJ 2018, 362, k3760. [Google Scholar] [CrossRef] [Green Version]
  21. Ard, J.D.; Lewis, K.H.; Rothberg, A.; Auriemma, A.; Coburn, S.L.; Cohen, S.S.; Loper, J.; Matarese, L.; Pories, W.J.; Periman, S. Effectiveness of a Total Meal Replacement Program (OPTIFAST Program) on Weight Loss: Results from the OPTIWIN Study. Obesity 2019, 27, 22–29. [Google Scholar] [CrossRef] [PubMed]
  22. Harris, L.; Hamilton, S.; Azevedo, L.B.; Olajide, J.; De Brún, C.; Waller, G.; Whittaker, V.; Sharp, T.; Lean, M.; Hankey, C.; et al. Intermittent fasting interventions for treatment of overweight and obesity in adults: A systematic review and meta-analysis. JBI Database Syst. Rev. Implement. Rep. 2018, 16, 507–547. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  23. Harris, L.; McGarty, A.; Hutchison, L.; Ells, L.; Hankey, C. Short-term intermittent energy restriction interventions for weight management: A systematic review and meta-analysis. Obes Rev. 2018, 19, 1–13. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  24. Allaf, M.; Elghazaly, H.; Mohamed, O.G.; Fareen, M.F.K.; Zaman, S.; Salmasi, A.M.; Tsilidis, K.; Dehghan, A. Intermittent fasting for the prevention of cardiovascular disease. Cochrane Database Syst Rev. 2021, 1, CD013496. [Google Scholar] [CrossRef]
  25. Horne, B.D.; Grajower, M.M.; Anderson, J.L. Limited Evidence for the Health Effects and Safety of Intermittent Fasting Among Patients with Type 2 Diabetes. JAMA 2020, 324, 341–342. [Google Scholar] [CrossRef]
  26. Rajpal, A.; Ismail-Beigi, F. Intermittent fasting and ‘metabolic switch’: Effects on metabolic syndrome, prediabetes and type 2 diabetes. Diabetes Obes Metab. 2020, 22, 1496–1510. [Google Scholar] [CrossRef]
  27. Grajower, M.M.; Horne, B.D. Clinical Management of Intermittent Fasting in Patients with Diabetes Mellitus. Nutrients 2019, 11, 873. [Google Scholar] [CrossRef] [Green Version]
  28. Wilkinson, M.J.; Manoogian, E.N.C.; Zadourian, A.; Lo, H.; Fakhouri, S.; Shoghi, A.; Wang, X.; Fleischer, J.G.; Navlakha, S.; Panda, S.; et al. Ten-Hour Time-Restricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patients with Metabolic Syndrome. Cell Metab. 2020, 31, 92.e5–104.e5. [Google Scholar] [CrossRef]
  29. Gabel, K.; Hoddy, K.K.; Haggerty, N.; Song, J.; Kroeger, C.M.; Trepanowski, J.F.; Panda, S.; Varady, K.A. Effects of 8-hour time restricted feeding on body weight and metabolic disease risk factors in obese adults: A pilot study. Nutr. Healthy Aging 2018, 4, 345–353. [Google Scholar] [CrossRef]
  30. Trepanowski, J.F.; Kroeger, C.M.; Barnosky, A.; Klempel, M.; Bhutani, S.; Hoddy, K.K.; Rood, J.; Ravussin, E.; Varady, K.A. Effects of alternate-day fasting or daily calorie restriction on body composition, fat distribution, and circulating adipokines: Secondary analysis of a randomized controlled trial. Clin Nutr. 2018, 37, 1871–1878. [Google Scholar] [CrossRef]
  31. Gabel, K.; Kroeger, C.M.; Trepanowski, J.F.; Hoddy, K.K.; Cienfuegos, S.; Kalam, F.; Varady, K.A. Differential Effects of Alternate-Day Fasting Versus Daily Calorie Restriction on Insulin Resistance. Obesity 2019, 27, 1443–1450. [Google Scholar] [CrossRef] [PubMed]
  32. Redman, L.M.; Smith, S.R.; Burton, J.H.; Martin, C.K.; Il’yasova, D.; Ravussin, E. Metabolic Slowing and Reduced Oxidative Damage with Sustained Caloric Restriction Support the Rate of Living and Oxidative Damage Theories of Aging. Cell Metab. 2018, 27, 805.e4–815.e4. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  33. Kraus, W.E.; Bhapkar, M.; Huffman, K.M.; Pieper, C.F.; Krupa Das, S.; Redman, L.M.; Villareal, D.T.; Rochon, J.; Roberts, S.B.; Ravussin, E.; et al. 2 years of calorie restriction and cardiometabolic risk (CALERIE): Exploratory outcomes of a multicentre, phase 2, randomised controlled trial. Lancet Diabetes Endocrinol. 2019, 7, 673–683. [Google Scholar] [CrossRef]
  34. Trevizol, A.P.; Brietzke, E.; Grigolon, R.B.; Subramaniapillai, M.; McIntyre, R.S.; Mansur, R.B. Peripheral interleukin-6 levels and working memory in non-obese adults: A post-hoc analysis from the CALERIE study. Nutrition 2019, 58, 18–22. [Google Scholar] [CrossRef] [PubMed]
  35. Hartmann-Boyce, J.; Theodoulou, A.; Oke, J.L.; Butler, A.R.; Scarborough, P.; Bastounis, A.; Dunnigan, A.; Byadya, R.; Hobbs, F.R.; Sniehotta, F.F.; et al. Association between characteristics of behavioural weight loss programmes and weight change after programme end: Systematic review and meta-analysis. BMJ 2021, 374, n1840. [Google Scholar] [CrossRef]
  36. Han, K.; Singh, K.; Rodman, M.J.; Hassanzadeh, S.; Wu, K.; Nguyen, A.; Huffstutler, R.D.; Seifuddin, F.; Dagur, P.K.; Saxena, A.; et al. Fasting-induced FOXO4 blunts human CD4+ T helper cell responsiveness. Nat. Metab. 2021, 3, 318–326. [Google Scholar] [CrossRef]
  37. Patterson, R.E.; Laughlin, G.A.; Sears, D.D.; LaCroix, A.Z.; Marinac, C.; Gallo, L.C.; Hartman, S.J.; Natarajan, L.; Senger, C.M.; Martínez, M.E.; et al. Intermittent Fasting and Human Metabolic Health. J. Acad. Nutr. Diet. 2015, 115, 1203–1212. [Google Scholar] [CrossRef] [Green Version]
  38. Zhao, B.; Sun, S.; He, X.; Yang, J.; Ma, X.; Yan, B. Sleep fragmentation and the risk of obesity: The Sleep Heart Health Study. Obesity 2021, 29, 1387–1393. [Google Scholar] [CrossRef]
  39. Yang, Y.; Miao, Q.; Zhu, X.; Qin, L.; Gong, W.; Zhang, S.; Zhang, Q.; Lu, B.; Ye, H.; Li, Y. Sleeping Time, BMI, and Body Fat in Chinese Freshmen and Their Interrelation. Obes. Facts 2020, 13, 179–190. [Google Scholar] [CrossRef] [PubMed]
  40. Zerón-Rugerio, M.F.; Hernáez, Á.; Porras-Loaiza, A.P.; Cambras, T.; Izquierdo-Pulido, M. Eating Jet Lag: A Marker of the Variability in Meal Timing and Its Association with Body Mass Index. Nutrients 2019, 11, 2980, Erratum in 2020, 12, 816. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  41. Chastin, S.; McGregor, D.; Palarea-Albaladejo, J.; Diaz, K.M.; Hagströmer, M.; Hallal, P.C.; van Hees, V.T.; Hooker, S.; Howard, V.J.; Lee, I.M.; et al. Joint association between accelerometry-measured daily combination of time spent in physical activity, sedentary behaviour and sleep and all-cause mortality: A pooled analysis of six prospective cohorts using compositional analysis. Br. J. Sports Med. 2021, 55, 1277–1285. [Google Scholar] [CrossRef] [PubMed]
  42. Shukla, A.P.; Dickison, M.; Coughlin, N.; Karan, A.; Mauer, E.; Truong, W.; Casper, A.; Emiliano, A.B.; Kumar, R.B.; Saunders, K.H.; et al. The impact of food order on postprandial glycaemic excursions in prediabetes. Diabetes Obes. Metab. 2019, 21, 377–381. [Google Scholar] [CrossRef] [PubMed]
  43. Pureza, I.R.O.M.; Melo, I.S.V.; Macena, M.L.; Praxedes, D.R.S.; Vasconcelos, L.G.L.; Silva-Júnior, A.E.; Florencio, T.M.; Bueno, N.B. Acute effects of time-restricted feeding in low-income women with obesity placed on hypoenergetic diets: Randomized trial. Nutrition 2020, 77, 110796. [Google Scholar] [CrossRef] [PubMed]
  44. de Oliveira Maranhão Pureza, I.R.; da Silva Junior, A.E.; Silva Praxedes, D.R.; Lessa Vasconcelos, L.G.; de Lima Macena, M.; Vieira de Melo, I.S.; Florêncio, T.M.D.M.T.; Bueno, N.B. Effects of time-restricted feeding on body weight, body composition and vital signs in low-income women with obesity: A 12-month randomized clinical trial. Clin. Nutr. 2021, 40, 759–766. [Google Scholar] [CrossRef]
  45. Kang, J.; Ma, E. Long-term outcomes of dietary carbohydrate restriction for HbA1c reduction in type 2 diabetes mellitus are needed. Diabetologia 2022, 65, 1058–1059. [Google Scholar] [CrossRef] [PubMed]
  46. Templeman, I.; Smith, H.A.; Chowdhury, E.; Chen, Y.C.; Carroll, H.; Johnson-Bonson, D.; Hengist, A.; Smith, R.; Creighton, J.; Clayton, D.; et al. A randomized controlled trial to isolate the effects of fasting and energy restriction on weight loss and metabolic health in lean adults. Sci. Transl. Med. 2021, 13, eabd8034. [Google Scholar] [CrossRef]
Nutrients 14 04734 g001 550
Figure 1. Study Flow Diagram.
Figure 1. Study Flow Diagram.
Nutrients 14 04734 g001
Nutrients 14 04734 g002 550
Figure 2. The differences in % total weight loss between groups. IF, Intermittent fasting 5:2 plus; CR, daily calorie restriction; HP, high protein with portion meal replacements. * p < 0.001 for difference among the three groups.
Figure 2. The differences in % total weight loss between groups. IF, Intermittent fasting 5:2 plus; CR, daily calorie restriction; HP, high protein with portion meal replacements. * p < 0.001 for difference among the three groups.
Nutrients 14 04734 g002
Nutrients 14 04734 g003 550
Figure 3. The differences within groups. (A) Weight; (B) BMI; (C) FM/TM; (D) FFM/TM. BMI, Body Mass Index; IF, Intermittent fasting 5:2 plus; CR, daily calorie restriction; HP, high protein with portion meal replacements; FM, fat mass; TM, total mass; FFM, fat free mass. * p < 0.001 for difference from baseline in groups.
Figure 3. The differences within groups. (A) Weight; (B) BMI; (C) FM/TM; (D) FFM/TM. BMI, Body Mass Index; IF, Intermittent fasting 5:2 plus; CR, daily calorie restriction; HP, high protein with portion meal replacements; FM, fat mass; TM, total mass; FFM, fat free mass. * p < 0.001 for difference from baseline in groups.
Nutrients 14 04734 g003
Table
Table 1. Baseline participant characteristics.
Table 1. Baseline participant characteristics.
CharacteristicsIF (n = 42)CR (n = 41)HP (n = 48)p for Difference among Groups
Age, y, mean ± SD34.7 ± 9.837.5 ± 11.734.0 ± 8.90.25
Range22–6322–6719–58
Sex (%) 0.472
Male9 (21.4)5 (12.2)10 (20.8)
Female33 (78.6)36 (87.8)38 (79.2)
Height, cm166.1 ± 9.3165.4 ± 7.4166.1 ± 7.40.896
Weight, kg86.2 ± 18.682.8 ± 14.685.3 ± 16.00.624
BMI, kg/m230.9 ± 4.930.2 ± 4.230.8 ± 5.10.772
Basic energy expenditure, kcal1529.3 ± 298.01463.3 ± 156.71492.7 ± 196.60.473
SD, Standard deviation; BMI, Body Mass Index; IF, Intermittent fasting 5:2 plus; CR, daily calorie restriction; HP, high protein with portion meal replacements.
Table
Table 2. Participant characteristics after 12 weeks of weight loss intervention.
Table 2. Participant characteristics after 12 weeks of weight loss intervention.
CharacteristicsIF (n = 42)CR (n = 41)HP (n = 48)p for Difference among Groups
Weight loss, kg, mean ± SD7.9 ± 5.04.7 ± 3.47.5 ± 3.60.001
Percentage of weight loss, %9.0 ± 5.35.7 ± 3.78.6 ± 3.5<0.001
5% weight loss (%)36 (85.7)24 (58.5)39 (81.3)0.008
10% weight loss (%)19 (45.2)6 (14.6)20 (41.7)0.005
SD, Standard deviation; BMI, Body Mass Index; IF, Intermittent fasting 5:2 plus; CR, daily calorie restriction; HP, high protein with portion meal replacements.
Table
Table 3. Change in study outcomes at baseline and 12 weeks.
Table 3. Change in study outcomes at baseline and 12 weeks.
CharacteristicsIF (n = 42)CR (n = 41)HP (n = 48)p for Difference among Groups
Weight, kg, mean ± SD
Baseline86.2 ± 18.682.8 ± 14.685.3 ± 16.00.624
Week 1278.2 ± 16.9 *78.1 ± 13.6 *77.8 ± 14.2 *0.99
BMI, kg/m2
Baseline30.9 ± 4.930.2 ± 4.230.8 ± 5.10.772
Week 1228.1 ± 4.6 *28.4 ± 4.0 *28.2 ± 4.5 *0.934
FM/TM, %
Baseline38.9 ± 6.338.7 ± 6.138.8 ± 6.30.99
Week 1234.5 ± 7.2 *35.7 ± 6.7 *34.9 ± 7.0 *0.706
FFM/TM, %
Baseline61.1 ± 6.261.3 ± 6.261.2 ± 6.40.994
Week 1265.6 ± 7.2 *64.3 ± 6.6 *65.2 ± 7.0 *0.71
SD, Standard deviation; BMI, Body Mass Index; IF, Intermittent fasting 5:2 plus; CR, daily calorie restriction; HP, high protein with portion meal replacements; FM, fat mass; TM, total mass; FFM, fat free mass. * p < 0.001 for difference from baseline in groups.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Kang, J.; Shi, X.; Fu, J.; Li, H.; Ma, E.; Chen, W. Effects of an Intermittent Fasting 5:2 Plus Program on Body Weight in Chinese Adults with Overweight or Obesity: A Pilot Study. Nutrients 2022, 14, 4734. https://doi.org/10.3390/nu14224734

AMA Style

Kang J, Shi X, Fu J, Li H, Ma E, Chen W. Effects of an Intermittent Fasting 5:2 Plus Program on Body Weight in Chinese Adults with Overweight or Obesity: A Pilot Study. Nutrients. 2022; 14(22):4734. https://doi.org/10.3390/nu14224734

Chicago/Turabian Style

Kang, Junren, Xiaodong Shi, Ji Fu, Hailong Li, Enling Ma, and Wei Chen. 2022. "Effects of an Intermittent Fasting 5:2 Plus Program on Body Weight in Chinese Adults with Overweight or Obesity: A Pilot Study" Nutrients 14, no. 22: 4734. https://doi.org/10.3390/nu14224734

APA Style

Kang, J., Shi, X., Fu, J., Li, H., Ma, E., & Chen, W. (2022). Effects of an Intermittent Fasting 5:2 Plus Program on Body Weight in Chinese Adults with Overweight or Obesity: A Pilot Study. Nutrients, 14(22), 4734. https://doi.org/10.3390/nu14224734

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop