Effect of Intermittent Fasting on Weight Loss and Risk Factors for Cardiovascular Disease and Diabetes: A Systematic Review Public Deposited

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  • January 26, 2020
  • Antonelli, Ray
    • Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
  • BACKGROUND: Obesity is a global pandemic associated with substantial morbidity, mortality, and economic costs, yet there are few effective clinical interventions for weight loss. One novel approach is intermittent fasting, a dietary pattern in which patients are allocated to a predetermined number of fasting days per week and are permitted to consume food ad libitum on non-fasting days. OBJECTIVES: To conduct a systematic review of the efficacy of intermittent fasting versus daily caloric restriction on weight loss and improvement in risk factors associated with cardiovascular disease and diabetes. SEARCH METHODS: We searched MEDLINE, Embase, and CINAHL for published studies and clinicaltrials.gov for unpublished results prior to June 28th, 2017. We also checked references lists from previous reviews for possible references to include in this review. SELECTION CRITERIA: We selected randomized controlled trials of intermittent fasting interventions of ≥4 weeks’ duration. We excluded studies that did not explicitly have one day of ad libitum feeding per week. We also excluded studies in cancer patients and in which weight loss was not the desired outcome, including Ramadan fasting studies. DATA COLLECTION AND ANALYSIS: One author independently screened references, performed data extraction, risk of bias assessments, and used the GRADE tool to rate the strength of evidence underlying each of three Key Questions generated for this review. RESULTS: We screened titles and abstracts of 1401 studies. Of these, we reviewed 63 full-text articles for inclusion in the systematic review. After application of inclusion criteria, 10 papers reporting results from 9 studies and 11 intervention groups were identified for inclusion. In all 11 reported intermittent fasting groups, participants lost weight. Based on the reviewed data there is moderate strength of evidence in support of an association between intermittent fasting and weight loss. There is very low strength of evidence supporting a difference in efficacy between intermittent fasting and daily calorie restriction. There is also very low strength of evidence in support of an association between intermittent fasting and risk factors related to cardiovascular disease and diabetes. Few studies report intermittent fasting-associated harms, but those that did reported prevalence of headache and constipation to be 5-13% and 6.5-8% respectively, which was not significantly different from control groups. CONCLUSION: Intermittent fasting is equally effective as, but not superior to, daily caloric restriction. Some patients may find intermittent fasting preferable to traditional weight loss strategies. Further research is needed regarding associations between intermittent fasting and risk factors for cardiovascular disease and diabetes, as well as adverse events related to this dietary pattern.
Date of publication
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Rights statement
  • In Copyright
  • Paper type: Systematic review
  • Track: HC&P
  • Viera, Anthony
  • Faurot, Keturah
  • Master of Public Health
Academic concentration
  • Public Health
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2017
Deposit record
  • db088d60-6ee6-4a25-9217-097c8dc585b2

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