Intermittent versus continuous energy restriction on weight loss and cardiometabolic outcomes: a systematic review and meta-analysis of randomized controlled trials

• Published in: Journal of translational medicine Vol. 16; no. 1; pp. 371 - 15
• Main Authors: Cioffi, Iolanda, Evangelista, Andrea, Ponzo, Valentina, Ciccone, Giovannino, Soldati, Laura, Santarpia, Lidia, Contaldo, Franco, Pasanisi, Fabrizio, Ghigo, Ezio, Bo, Simona
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 24.12.2018; BioMed Central; BMC
• Subjects: Adult; Aged; Analysis; Biomarkers - metabolism; Blood pressure; Body composition; Body weight loss; Caloric Restriction; Cardiovascular disease; Clinical trials; Collaboration; Continuous energy restriction; Coronary vessels; Diabetes; Diet; Energy; Fasting; Fasting glucose; Female; Heart - physiology; Humans; Insulin; Intermittent energy restriction; Libraries; Male; Medical imaging; Medical Subject Headings-MeSH; Meta-analysis; Metabolism; Middle Aged; Obesity; Publication Bias; Randomized Controlled Trials as Topic; Review; Risk factors; Rodents; Studies; Subject heading schemes; Systematic review; Triglycerides; Weight control; Weight Loss; Intermittent energy restriction; Triglycerides; Continuous energy restriction; Fasting glucose; Weight loss
• ISSN: 1479-5876; 1479-5876
• DOI: 10.1186/s12967-018-1748-4

This systematic review and meta-analysis summarized the most recent evidence on the efficacy of intermittent energy restriction (IER) versus continuous energy restriction on weight-loss, body composition, blood pressure and other cardiometabolic risk factors. Randomized controlled trials were systematically searched from MEDLINE, Cochrane Library, TRIP databases, EMBASE and CINAHL until May 2018. Effect sizes were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). Eleven trials were included (duration range 8-24 weeks). All selected intermittent regimens provided ≤ 25% of daily energy needs on "fast" days but differed for type of regimen (5:2 or other regimens) and/or dietary instructions given on the "feed" days (ad libitum energy versus balanced energy consumption). The intermittent approach determined a comparable weight-loss (WMD: - 0.61 kg; 95% CI - 1.70 to 0.47; p = 0.87) or percent weight loss (WMD: - 0.38%, - 1.16 to 0.40; p = 0.34) when compared to the continuous approach. A slight reduction in fasting insulin concentrations was evident with IER regimens (WMD = - 0.89 µU/mL; - 1.56 to - 0.22; p = 0.009), but the clinical relevance of this result is uncertain. No between-arms differences in the other variables were found. Both intermittent and continuous energy restriction achieved a comparable effect in promoting weight-loss and metabolic improvements. Long-term trials are needed to draw definitive conclusions.