Abstract
The aim of this systematic review and meta-analysis is to summarise the effects of intermittent energy restriction on weight and biological markers in long term intervention studies of >6 months duration. An electronic search was performed using the MEDLINE, EMBASE and the Cochrane Library databases for intervention trials lasting 6 months or longer investigating the effects of intermittent energy restriction. A total of nine studies were identified as meeting the pre-specified criteria. All studies included an intermittent energy restriction arm, with six being directly compared to continuous energy restriction. A total of 981 subjects were enrolled and randomised, with weight loss observed in all intermittent energy restriction arms regardless of study duration or follow up length. Eight interventions in six trials were used for the meta-analyses, with results indicating neither intermittent or continuous energy restriction being superior with respect to weight loss, 0.084 ± 0.114 (overall mean difference between groups ± standard error; p = 0.458). The effects of intermittent energy restriction in the long term remain unclear. The number of long term studies conducted is very limited, and participant numbers typically small (less than 50 completers), indicating the need for larger, long term trials of 12 months or more, to be conducted in order to understand the impact of intermittent energy restriction on weight loss and long term weight management. Blood lipid concentrations, glucose, and insulin were not altered by intermittent energy expenditure in values greater than those seen with continuous energy restriction.
Highlights
In 2014, the World Health Organisation, classified 39% of the worlds’ adult population as overweight (BMI between 25.0 and 29.9 kg/m2 ) and 13% as obese (BMI ě 30.0 kg/m2 ) [1]
The purpose of this paper is to provide a systematic review and meta-analysis of studies looking at the long term effects (ě6 month’s duration) of intermittent energy restriction on weight and biological markers in intervention studies and to determine any gaps in the literature which may assist with future study designs
Weight loss was observed in the intermittent energy restriction (IER) arms of all arms of all studies regardless of study duration
Summary
In 2014, the World Health Organisation, classified 39% of the worlds’ adult population as overweight (BMI between 25.0 and 29.9 kg/m2 ) and 13% as obese (BMI ě 30.0 kg/m2 ) [1]. Continuous or daily energy restriction is the main form of restriction used by individuals wishing to lose weight via dietary means. This typically involves restricting energy intake by 15%–60% of baseline requirements every day [9]. Whilst continuous energy restriction (CER) has been shown to be an effective weight loss strategy in overweight and obese populations, many individuals find the rigidity of the regime too difficult to maintain [10]. An alternative dietary regime to the traditional CER, intermittent energy restriction (IER), has gained popularity in the last decade [11]. Various forms of IER are currently being investigated, including alternate-day fasting (ADF).
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