Intermittent Energy Restriction and Weight Loss a Systematic Review

• Journal List
• Obes Sci Pract
• 5.2(3); 2016 Sep
• PMC5043510

Obes Sci Pract. 2016 Sep; 2(iii): 293–302.

Alternating‐day versus daily energy restriction diets: which is more effective for weight loss? A systematic review and meta‐assay

B. A. Alhamdan

ⁱ Department of Health, Beliefs and Society, Johns Hopkins Weight Management Eye, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,

A. Garcia‐Alvarez

¹ Section of Health, Behavior and Society, Johns Hopkins Weight Management Centre, Johns Hopkins Bloomberg School of Public Health, Baltimore, Doc, USA,

A. H. Alzahrnai

¹ Department of Wellness, Behavior and Gild, Johns Hopkins Weight Management Middle, Johns Hopkins Bloomberg School of Public Health, Baltimore, Doc, U.s.a.,

J. Karanxha

² Section of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Wellness, Baltimore, MD, U.s.a.,

D. R. Stretchberry

³ Department of International Wellness, Johns Hopkins Bloomberg School of Public Wellness, Baltimore, Doc, U.s.a.,

K. J. Contrera

⁴ Johns Hopkins University Schoolhouse of Medicine, Baltimore, Doc, USA,

A. F. Utria

⁴ Johns Hopkins Academy School of Medicine, Baltimore, MD, United states of america,

Fifty. J. Cheskin

^one Department of Wellness, Beliefs and Society, Johns Hopkins Weight Direction Center, Johns Hopkins Bloomberg School of Public Wellness, Baltimore, MD, United states of america,

Received 2015 Nov 23; Revised 2016 Jun 3; Accepted 2016 Jun 12.

Summary

Groundwork

Alternate‐day‐fasting (ADF) has been proposed as an effective dieting method. Studies have found that it also tin can increment life span in rodents, and reduce inflammation in humans. The aim of this paper was to systematically review the efficacy of ADF compared to very‐low‐calorie dieting (VLCD) in terms of weight loss, and reduction of fat mass and fatty‐free mass.

Methods

Systematic review: PubMed literature searches were performed. Fixed review procedures were applied. Studies were evaluated for quality. 20‐eight studies were included. Meta‐analysis: 10/28 studies (4 ADF and six matched VLCD) were further analyzed.

Results

Afterwards adjustment for BMI and elapsing, at that place was no significant difference in mean body weight loss (VLCD 0.88 kg more weight loss than ADF, 95% CI: −4.32, 2.56) or fatty‐free mass (VLCD 1.69 kg more fat‐complimentary mass loss than ADF, 95% CI: −3.62, 0.23); there was a significant difference observed in fat mass (ADF 3.31 kg more fat mass loss than VLCD, 95% CI: 0.05, 6.56). Meta‐analysis showed that, among ADF studies, the pooled change in body weight, fatty mass and fat‐free mass was 4.30 kg (95% CI: 3.41, five.20), 4.06 kg (95% CI: ii.99, 5.13) and 0.72 kg (95% CI: −0.07, 1.51), respectively, while among VLCD studies, the pooled alter was 6.28 kg (95% CI: 6.08, 6.49), four.22 kg (95% CI: three.95, 4.50) and 2.24 kg (95% CI: 1.95, 2.52), respectively.

Conclusions

Our results from both the systematic review and the meta‐analysis propose that ADF is an efficacious dietary method, and may be superior to VLCD for some patients because of ease of compliance, greater fatty‐mass loss and relative preservation of fatty‐costless mass. Head‐to‐caput randomized clinical trials are needed to further assess relative efficacy of these two approaches.

Keywords: Alternate‐day fasting, fat mass, obesity, very‐low‐calorie diet

Introduction

In 2014, there were more than than 1.9 billion adults classified equally overweight, of which 600 million were classified as obese (eleven% of men and xv% of women). These figures are double what they were in the 1980s, a clear indication that obesity is spreading widely beyond the globe. The obesity epidemic is now associated with more deaths globally than underweight ¹.

A widely used strategy to lose weight is caloric restriction (CR) ^two. A common CR method that became pop in the 1980s was very‐depression‐calorie dieting (VLCD) ³. VLCD is by definition prescribing fewer than 800 calories to be consumed daily ⁴. Although VLCD has been shown to be an constructive weight loss strategy in the brusque term ³, it has also been argued that its risk of weight regain is greater due to its association with binge eating disorder ^v, behavioural fatigue ⁶ and loss of fat free mass ⁷.

Intermittent CR regimens were designed to improve adherence ⁸. An intermittent CR regimen that has recently emerged is alternate‐day‐fasting (ADF). With ADF, there is a fasting mean solar day, during which typically 25% of the dieter'due south estimated energy needs (typically <800 calories/day) are consumed, followed by a normal feeding day when food and liquids are consumed ad libitum ^nine. ADF has been associated with lower risk of weight regain, peradventure due to better compliance ^ten and with relative preservation of fat‐gratuitous mass ^seven.

Aside from the possible weight control benefits, at least in some animal studies, fasting or ADF appears to take multiple health‐promoting effects, notably related to aging, cancer, inflammation and neurodegeneration ^eleven. With respect to aging, one written report has suggested that ADF can increase the life span of rodents by upward to lxxx%. The possible mechanism of this consequence is that fasting decreases glucose levels and insulin‐like growth cistron (IGF‐ane), which are crumbling promoters ¹². With respect to cancer, a study has suggested that ADF greatly reduces the incidence of lymphoma in mice ¹³, and another written report institute that fasting one day per week may delay oncogenesis in p53‐missing mice ^fourteen. In addition, a recent study concluded that past reducing glucose levels, insulin and ketone bodies, intermittent fasting may create a difficult environment for cancer cells to survive, thus improving the activity of chemotherapeutic agents ¹⁵.

In humans, a contempo report has shown that intermittent fasting reduces oxidative stress and inflammation and information technology improves cellular glucose uptake and insulin sensitivity ¹¹. In addition, ii studies have shown that fasting may amend neurologic function in the following means: past increasing the levels of antioxidants, neurotropic factors and protein chaperones, and reducing the level of pro‐inflammatory markers ^xvi, and by upregulating the expression of synaptic plasticity‐related proteins, besides equally anti‐apoptotic pathways ¹⁷.

In terms of body composition, a study showed that intermittent fasting reduces body weight, fat mass, waist circumference and blood force per unit area ¹⁸. The aforementioned authors stated that the metabolic effects of intermittent fasting include reductions in total cholesterol, LDL and triglycerides, as well as improvement of satiety through reductions in Leptin and Resistin, and increases in Adiponectin ¹⁸.

A recent review comparing weight loss reported using daily CR and intermittent CR constitute that intermittent CR was as effective every bit daily CR in reducing torso weight likewise as in preserving fat‐free mass ⁷. In the present review, we compared two types of severely free energy‐restricted diets, achieved through either daily free energy restriction or every‐other‐twenty-four hour period energy restriction.

We systematically reviewed the efficacy of ADF diets compared to VLCD (the control) in terms of weight loss, and reduction of fatty mass and fat‐free mass. Our objective was to explore the hypothesis that ADF could be an effective culling to more restrictive dieting approaches, namely VLCD.

Methods

Data sources

Literature searches were conducted using PubMed, with the time frame of publication 1 January 2000 to thirty September 2015. An instance of search commands is detailed as follows:

(Caloric restriction [tiab] OR VLED [tiab] OR LED [tiab] OR very low energy diet [tiab] OR low free energy diet [tiab] OR LCD [tiab] OR 25% energy deficit weight loss diet [tiab] OR calorie restriction [tiab] OR Modifast [tiab] OR very‐low‐calorie diet [tiab] OR dietary brake [tiab] OR daily energy brake [tiab] OR VLCD [tiab] OR energy restriction [tiab] OR depression calorie [tiab] OR very low calorie dietary intervention [tiab] OR continuous energy restriction [tiab] OR CER [tiab] OR continuous diet[tiab] OR alternate day fasting[tiab] OR ADF[tiab] OR every other day fast[tiab] OR ADMF[tiab] OR advertisement libitum every other solar day[tiab] OR ADCR diet[tiab] OR alternate day calorie restriction[tiab] OR modified alternate fasting[tiab] OR intermittent fasting[tiab] OR diet in every other day[tiab] ) AND "weight loss"[Mesh]

Written report selection and criteria

The following exclusion criteria were practical: example reports, letters, comments, reviews or animal studies; languages other than English; and publication date other than from one Jan 2000 to 30 September 2015. The following inclusion criteria were applied: adults aged 18–lxx years, with BMI ≥25 kg/m², expert general land of health (i.e. without a diagnosed condition), on but very‐depression‐energy diets (<800 calories/d) for VLCD studies and interventions lasting between iii and 12 weeks.

Data extraction

Studies were selected for data extraction if they met the above inclusion and exclusion criteria and reported at least weight loss data. We only included study arms where diet only was used; nosotros excluded whatever artillery that used concrete activity or drugs to ensure ameliorate comparability between study interventions. Sample size and intervention length were recorded. Characteristics of the initial study sample (e.grand. age, sex and weight), baseline body weight, fatty mass, fat‐costless mass and waist circumference were captured when available. Conversion of units to keep data comparable was implemented when necessary. 2 reviewers independently reviewed the studies, extracted data and and then resolved disparities past agreement (Supplementary Tabular array S1, available as Supplementary data at OSP online).

Quality assessment

2 reviewers used the Downs and Black quality checklist to assess the adventure of study bias (ROB) for each included study ¹⁹: (i) low ROB: when a written report fulfilled all the following criteria: stated the objective, described the main outcomes, described the characteristics of the enrolled subjects, clearly described the interventions, described the master findings, randomized the subjects to the intervention groups, concealed the intervention assignments until recruitment was consummate and partially or fully described the distribution of potential confounders in each treatment grouping; (2) moderate ROB: if a study did non fulfil one of the in a higher place criteria, or if such could not be verified and (3) high ROB: if a written report did not fulfil more than 1 of the above criteria.

Statistics and meta‐assay

All statistical analysis were pre‐specified. The dietary interventions were grouped into two sets: ADF and VLCD. Study‐level data were summarized using descriptive statistics. If not reported, the standard error of ways were computed using the following formula: SE = SD/ √north. STATA 14 was used both for the meta‐analysis and the meta‐regression. The random‐furnishings meta‐analysis approach was performed to approximate the overall divergence in each intervention. Meta‐regression models were used to adjust for BMI and length of intervention. The residual maximum‐likelihood method was used to gauge the additive (between‐written report) component of variance Tau². Heterogeneity was tested using I² test. The p‐values calculated by Monte Carlo permutation test were used to address multiple testing. A statistically meaning difference was defined by a p‐value less than 0.05.

Results

Information retrieval

A menses chart showing the systematic review procedure is provided in Figure1. The initial search resulted in two,357 publications. Later on applying the exclusion criteria, 627 remained. The total text of these studies was then retrieved, and after screening for inclusion criteria, data were extracted from 28 studies, half dozen ADF and 22 VLCD studies. Four articles contributed to more than than one arm of the analysis. Only the ten studies that reported the change with standard errors for all iii outcomes of interest (i.due east. weight loss, fatty mass and fat‐gratuitous mass were included in the meta‐assay) (Figureone).

Catamenia chart of the systematic review process.

Characteristics of written report participants

A full of i,193 study participants were included in the analyses, 132 who underwent ADF and 1,060 who underwent VLCD. For ADF studies reporting this information, hateful age of participants was 42.33 years, 92.42% were female, hateful BMI was 33.17 kg/m², mean baseline body weight was 90.28 kg, mean fatty mass was 38.06 kg, mean fat‐free mass was 48.32 kg and hateful waist circumference was 97.70 cm. For the VLCD studies, mean age of participants was 40.04 years, 67.76% were female, mean BMI was 31.15 kg/m², hateful baseline body weight was 83.55 kg, hateful fat mass was 31.34 kg, mean fatty‐free mass was 44.52 kg and mean waist circumference was 100.56 cm (Table1A).

Table 1A

Patient characteristics

Patient characteristics	ADF (132)	VLCD (1,060)
Historic period (years)	42.33	xl.04
Females (%)	92.42	67.76
BMI (kg/g2)	33.17	31.15
Body weight (kg)	90.28	83.55
Fat mass (kg)	38.06	31.34
Fat‐free mass (kg)	48.32	44.52
Waist circumference (cm)	97.70	100.56

Characteristics of included studies

For the included ADF studies, one was published between 2000 and 2010, and five betwixt 2011 and 2015. Two studies had intervention durations of 3–8 weeks, and 4 ix–12 weeks. Four studies were conducted in North America and two in Asia. Of the included VLCD studies, 14 were published between 2000 and 2010, and eight betwixt 2011 and 2015. Xviii had intervention durations of 3–eight weeks, and 4 9–12 weeks. Nineteen were conducted in Europe and three in Commonwealth of australia (Table1B).

Table 1B

Study characteristics

Study characteristics	Number of studies (ADF)	Number of participants	Number of studies (VLCD)	Number of participants
Publication year
2000–2010	1	16	14	883
2011–2015	5	116	eight	177
Intervention length
3–eight weeks	2	41	18	917
nine–12 weeks	four	91	4	143
Study location
North America	iv	91
Europe			19	1,000
Asia	2	41
Other			3	60

Of the 28 studies included in the systematic review (Supplementary Table S2, available as Supporting Information at OSP online), later on applying quality assessment based on Downs and Black criteria ¹⁹, twenty had high ROB, 7 had moderate ROB and 1 had low ROB. Of the x studies used in the meta‐analysis, v had loftier ROB and five had moderate ROB.

Missing data

Gender reporting was missing in three studies, age reporting in six and BMI reporting in one study. Baseline body weight was missing in 3 studies, fatty mass in 11, fat‐free mass in eighteen and waist circumference in 12 studies.

Characteristics of the studies included in the meta‐analysis

Table2A details the 10 studies included in the meta‐analysis: iv ADF and six VLCD. Mean age of the 662 participants included in the meta‐assay was 44.69 ± i.nine years, mean BMI was 31.31 kg/thousand^two and 78.06% were females. ADF studies were all grant funded, while all of the VLCD studies were industry funded.

Table 2A

Studies included in the meta‐analysis

Proper name	Sample size (n)	Females(%)	Historic period * (years)	Baseline BMI*	Length (weeks)	Change in body weight* (kg)	Change in fat mass* (kg)	Change in fat‐free mass* (kg)
ADF
Varady, 2013 20	fifteen	66	47 ± 3.0	26 ± 1.0	12	5.xx ± 0.9	3.60 ± 0.7	one.threescore ± 0.5
Bhutani, 2013 21	25	96	40 ± ii.0	35 ± 1.0	12	iii.00 ± i.0	2.00 ± 1.0	1.00 ± 1.0
Klemple, 2013 (HF) 9	17	100	42 ± three.0	35 ± 0.7	viii	4.30 ± 1.0	5.forty ± ane.5	ane.10 ± 1.3
Klemple, 2013 (LF) 9	18	100	43 ± two.0	36 ± 0.7	viii	3.70 ± 0.vii	4.20 ± 0.6	0.50 ± 0.7
Varady, 2009 x	16	75	46 ± two.0	34 ± 1.0	8	5.60 ± i.0	5.40 ± 0.viii	0.x ± 0.1
VLCD
Munro, 2013 (placebo) 22	xix	79	47 ± 2.0	34 ± 0.8	4	5.79 ± 0.4	4.19 ± 0.4	1.33 ± 0.4
Munro, 2013 (fish oil)22	20	75	45 ± 2.0	31 ± 0.half-dozen	iv	six.12 ± 0.iii	4.36 ± 0.3	1.68 ± 0.3
Westerterp‐P, 2005† 23	76	70		28 ± 0.iii	iv	5.90 ± 0.2	5.00 ± 0.2	two.50 ± 0.5
Lejeune, 2005 24	113		45 ± ane.0	29 ± 0.2	4	6.30 ± 0.iii	4.00 ± 0.3	2.30 ± 0.2
Westerterp‐P, 2004 25	148		44 ± 0.8	30 ± 0.2	4	half dozen.40 ± 0.1	3.90 ± 0.3	2.fifty ± 0.2
Kovacs, 2004 26	104	75		30 ± 0.3	iv	half-dozen.40 ± 0.3	4.00 ± 0.iii	2.xl ± 0.3
Lejeune, 2003 27	91			29 ± 0.3	4	vi.sixty ± 0.ii	iv.ten ± 0.two	2.l ± 0.2

Meta‐analysis results

Unadjusted values show that compared to the VLCD studies, ADF participants had a smaller loss in body weight (−1.99 kg, 95% confidence interval [CI]: −ii.94, −1.04) and a smaller loss in fat‐free mass (−1.60 kg, 95% CI: −two.40, −0.80), while no significant change was observed between diet interventions in fat mass (−0.16 kg, 95% CI: −i.19, 0.87) (Tabular array2B).

Table 2B

Meta‐regression results

Variables	Unadjusted (95% CI)	P‐value	Adjusted (95% CI)	P‐value
Body weight (kg)
ADF	−1.99 (−ii.94, −one.04)	<0.01	−0.88 (−four.32, 2.56)	0.57
BMI			−0.08 (−0.26, 0.09)	0.28
Length			−0.14 (−0.68, 0.twoscore)	0.56
Fat mass (kg)
ADF	−0.xvi (−1.nineteen, 0.87)	0.73	3.31 (0.05, half dozen.56)	0.05
BMI			−0.10 (−0.27, 0.06)	0.19
Length			−0.57 (−i.08, −0.05)	0.03
Fat‐free mass (kg)
ADF	−i.threescore (−ii.xl, −0.80)	<0.01	−1.69 (−3.62, 0.23)	0.07
BMI			−0.eighteen (−0.33, −0.03)	0.02
Length			0.06 (−0.28, 0.41)	0.68

Later aligning for BMI and duration of the dietary intervention, in that location was no pregnant difference betwixt interventions in trunk weight (−0.88 kg, 95% CI: −4.32, 2.56) or fatty‐complimentary mass (−1.69 kg, 95% CI: −3.62, 0.23) (Table2B). There was a meaning difference between interventions in that the adjusted loss of fat mass on the ADF regimens was iii.31 kg greater than on the VLCD regimens (95% CI: 0.05, six.56).

Regarding change in body weight, Effigyii shows that, among ADF studies, the smallest reduction was iii.00 kg (95% CI: 1.04, 4.96) and the greatest reduction was five.60 kg (95% CI: iii.64, vii.56). The pooled change was 4.30 kg (95% CI: 3.41, five.20). Among the VLCD studies, the smallest reduction in torso weight was 5.79 kg (95% CI: iv.92, six.65) and greatest reduction was half-dozen.40 kg (95% CI: 5.81, six.98). The pooled change was vi.28 kg (95% CI: vi.08, 6.49).

ADF versus VLCD: trunk weight departure pooled results.

With regard to alter in fat mass, Figure3 shows that, amongst ADF studies, the smallest reduction was 2.00 kg (95% CI: 0.04, 3.96) and the greatest was 5.twoscore kg (95% CI: iii.83, vi.97). The pooled modify was 4.06 kg (95% CI: two.99, 5.thirteen). For the VLCD studies, the smallest reduction in fatty mass was 3.90 kg (95% CI: 3.31, 4.49) and greatest was 5.00 kg (95% CI: 4.41, 5.59). The pooled alter was 4.22 kg (95% CI: iii.95, four.50).

ADF versus VLCD: fat mass difference pooled results.

For change in fat‐costless mass, Figurefour shows that, among ADF studies, the smallest reduction was 0.10 kg (95% CI: −0.i, 0.30) and the greatest i.60 kg (95% CI: 0.62, 2.58). The pooled modify was 0.72 kg (95% CI: −0.07, 1.51). Amongst the VLCD studies, the smallest reduction was 1.33 kg (95% CI: 0.59, 2.07) and the greatest two.l kg (95% CI: 2.ten, two.89). The pooled change was 2.24 kg (95% CI: 1.95, two.52).

ADF versus VLCD: fat‐free mass divergence pooled results.

Discussion

This is the get-go newspaper to perform a systematic review together with a meta‐analysis comparison ADF and VLCD regimens in terms of weight, fatty mass and fat‐free mass reduction.

Our meta‐analysis shows that both dietary interventions are efficacious, resulting in substantial body weight loss. Although the magnitude of weight loss by VLCD is somewhat greater, ADF results in greater relative reduction of fatty mass and lesser reduction of fat‐free mass.

While magnitude of initial weight loss is greater using VLCD, studies accept shown, however, that VLCD may increase the hazard of headache, fatigue, dizziness, pilus loss, constipation and dehydration. As a result, it requires regular medical supervision ²⁸, ²⁹, ³⁰, ³¹. Also, VLCD has been associated with an increased take chances of developing gallstones; one study showed that after 8 weeks of VLCD, 25% of patients developed gallstones and 6% required cholecystectomy ³². VLCD may also be associated with development of binge eating disorder. Post-obit a VLCD regimen 1 study showed that the disorder developed among 62% of subjects, only decreased among 39% ³³. Yet, Wadden et al. (1994) found no divergence in binge‐eating occurrence or in weight loss among binge eaters versus not‐rampage eaters who were both post-obit a VLCD regimen. Their hypothesis was that rampage eaters might find VLCD easier to follow than conventional calorie‐restrictive diets ³⁴.

In their meta‐analysis, Tsai and Wadden (2006) concluded that VLCD may be a feasible option to lose weight in the short term; however, they found that patients failed to maintain 15 to 25% of VLCD‐associated initial weight loss, due to hard compliance, adaptive hormonal changes and our toxic nutrient environment ³.

We found that ADF may be every bit constructive equally even the very restrictive VLCD with respect to fat‐mass reduction, and provides relative preservation of fat‐gratuitous mass. Two recent reviews have evaluated the effects of intermittent diets versus daily CR on weight loss, fatty mass and fat‐gratis mass ^seven, ³⁵. 1 (not‐systematic) reported fat‐free mass preservation by the intermittent diets ⁷, while the other ane (systematic) reported no difference between the diets ³⁵.

In our review, efficacy of ADF for weight‐ and fat‐mass reduction was an expected finding, and it is most likely explained by the substantial overall decrease in energy intake that adherence to alternate‐twenty-four hour period energy restriction will provide. Information technology is noteworthy, withal, that equally prescribed, VLCD would provide somewhat greater levels of free energy restriction than ADF, equally it by and large provides a >50% reduction in estimated energy needs ⁴. This implies logically that in lodge for mean weight and fat loss on ADF regimens to exist as good as that achieved on VLCD regimens, average compliance with ADF must have been superior to compliance with VLCD.

On the other hand, preservation of fat‐costless mass, at the toll of fat mass during weight reduction ^eighteen is unexpected with the level of free energy brake that ADF prescribes. To our knowledge, this is the first review to report this finding. The machinery for this effect, if confirmed past other studies, is unclear, although it is possible that either the fasting menses is brief enough that there is less loss of lean tissue in the commencement place, or that the days where full energy needs are met allow for recovery of fat‐free mass by rebuilding lean tissue lost on the fasting days.

Several studies have reported that ADF did not appear to cause a hyperphagic response on the feeding day ^ix, ^twenty, ²¹, which may accept facilitated the subjects' ability to maintain a substantial level of mean energy restriction. In line with this, Klempel et al. (2010) conducted a modified ADF report and institute that, on feeding days, subjects only consumed 95% of their calculated energy intake ³⁶. ADF has also been found to decrease hunger and increase satiety and dieting satisfaction in 8 to 12‐week studies, all of which may raise the adherence to the diet ^seven, ⁹. The possible mediators of these appetite effects include reductions in Leptin and Resistin, and increases in Adiponectin ^eighteen. While a counter‐intuitive approach to weight command, it has been argued that ADF regimens may achieve relatively loftier levels of dietary adherence considering they require energy restriction only every other day ¹⁰ and practice not require a alter in the types of food consumed, but rather a alter in the design of consumption ⁹. Varady et al. (2009) reported ADF efficacy for weight reduction even during self‐implementation periods ¹⁰. For all the reasons presented earlier, we consider ADF a feasible culling approach to weight control, as also suggested by others ³⁷.

As with any diet for weight loss, ADF reduction in body weight was related to the level of adherence to this dietary intervention ¹⁸, ³⁸, ³⁹. Its efficacy in at least one of the reviewed studies was maximized when combined with exercise at least three times per calendar week ²¹. However, a very contempo study by Barnoski et al. (2015) – who examined whether ADF improves eating behaviours in a manner that promotes successful weight loss and weight loss maintenance – observed a reduction in body weight even without a change in concrete activity ⁴⁰. The same study observed no changes in ambition ratings (hunger, satisfaction and fullness), dietary restraint, emotional eating, uncontrolled eating or cocky‐efficacy in the ADF or the calorie restriction groups every bit compared to the control. The authors ended that the part of beneficial eating behaviours in body weight reduction through ADF or CR remains unclear ⁴⁰, hence warranting further research.

In line with other recent studies, the first finding of our review is that ADF appears to exist an effective strategy for initial weight loss (at least the first eight weeks) in overweight and subjects with obesity. But nearly chiefly, our review suggests that ADF may be superior to daily CR in terms of type of weight lost (fatty vs. non‐fat), and adherence.

Health risks may besides be affected favourably by ADF. Waist circumference, a marker of visceral obesity which is associated with coronary heart disease and diabetes ⁴¹, ⁴², was reduced past 4–10% from baseline in the studies reviewed, and correlated with overall weight reduction ^vii, ^ten, ⁴³. Adherence to this regimen was also associated with a decrease in triglycerides, full cholesterol and LDL. These effects were also correlated with the reduction in torso weight and visceral fatty. The possible mechanism by which ADF alters lipids is via an increase in oxidation of free fat acids during periods of weight loss, while free fatty acid synthesis is reduced ⁴⁴. This leads to a reduction in very depression density lipoprotein (VLDL) synthesis by the liver and thus reduced circulating levels of LDL ⁴⁵. Thus, adherence to an ADF diet may be cardio protective.

This review was limited past the small-scale number of ADF studies published to date, necessitating the inclusion of non‐randomized clinical trials. Furthermore, of the studies that were included in this review, there was an over representation of women on the ADF regimens (92%). Glucose response in women is adversely affected following a fast ⁴⁶; therefore, it is possible that gender differences in physiologic response to the ADF regimen may have afflicted our analysis. Animal studies accept suggested that gender plays an important office in the evolutionary accommodation to fasting. One study found that only female mice demonstrated increases in arousal and reduced Gherlin, suggesting that women may stand to achieve greater benefit from ADF ⁴⁷. While these differences, on a physiologic level, are important in determining which nutrition may be most appropriate for a given patient, it is important to note that no gender differences in weight loss take yet been shown in human being studies ⁴⁸. Ameliorate responses to the ADF have, however, been shown in older individuals and Caucasians, but nosotros were unable to assess this from the papers included in this review ⁴⁸.

Conclusion

Among individuals with obesity, ADF is an efficacious dietary method, and may be superior to VLCD for some patients because of ease of compliance, greater fatty‐mass loss and relative preservation of fat‐costless mass. Still, farther studies comparing ADF to VLCD (ideally head‐to‐head randomized clinical trials) that as well command for patient characteristics, are needed to confirm the efficaciousness of these two approaches for weight loss, and to make up one's mind if ADF is better suited to certain populations. This data is of interest to wellness care providers and dietitians, equally well every bit individuals with obesity seeking effective and potentially easier to follow methods to lose weight.

Conflict of interests

None declared.

Author contributions

BA, AGA, JK and DS did the literature search and the systematic review of the studies. AGA did the quality assessment. BA and AA did the statistical analysis and the meta‐assay. BA and LC wrote the manuscript. BA, AGA, AA, KC, AU and LC contributed to the interpretation and word of the results and reviewed and edited drafts of the manuscript.

Funding

BA was funded past a postdoctoral fellowship from Saudi Arabian Cultural Mission (SACM).

Acknowledgements

Our sincere gratitude to Dr. John McGready and Gayene Yenokyan for their help with data analysis, and the Saudi Arabian Cultural Mission (SACM) for financial support. Our gratitude to Drs. John McGready and Gayene Yenokyan from the Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, for their aid with data analysis.

Notes

Alhamdan, B. A. , Garcia‐Alvarez, A. , Alzahrnai, A. H. , Karanxha, J. , Stretchberry, D. R. , Contrera, 1000. J. , Utria, A. F. , and Cheskin, L. J. (2016) Alternate‐day versus daily free energy restriction diets: which is more effective for weight loss? A systematic review and meta‐analysis. Obesity Science & Do, 2: 293–302. doi: 10.1002/osp4.52. [PMC costless commodity] [PubMed] [Google Scholar]

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