Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis.
Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis.
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DOI：
10.11124/jbisrir-2016-003248
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发表时间：
2018-02-01
期刊：
影响因子：
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通讯作者：
Ells, Louisa
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文献类型：
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作者：
Harris, Leanne;Hamilton, Sharon;Ells, Louisa
目的：观察间歇能量限制治疗成人超重和肥胖的疗效，并与常规护理治疗和不治疗进行比较。结论：间歇能量限制包括间歇禁食、隔日禁食和每周禁食两天。尽管最近间歇性能量限制和相关的减肥声明很受欢迎，但支持证据基础是有限的。结论标准：这项综述包括超重或肥胖(BMI≥25 kg/m)成年人(≥18岁)。间歇性能量限制定义为至少一天消耗800k卡的≤，但每周不超过六天。间歇性能量限制干预与不治疗(随意饮食)或常规护理(持续能量限制为推荐能量摄入量的25%)进行比较。纳入的干预措施从基线到结果测量后的最短持续时间为12周。研究类型包括随机对照试验和伪随机对照试验。这项综述的主要结果是体重的变化。次要结果包括：i)人体测量结果(体重指数、腰围、脂肪质量、脱脂质量的变化)；ii)心脏代谢结果(血糖和胰岛素、脂蛋白谱和血压的变化)；iii)生活方式结果：饮食、体力活动、生活质量和不良事件。检索以下电子数据库：Medline、Embase、CINAHL、Cochrane Library、ClinicalTrials.gov、ISRCTN REGISTRY和anzctr.org.au，限定文章语言种类为英文。两名独立评价者使用乔安娜·布里格斯研究所的标准化批判性评估工具对纳入研究的方法学质量进行了评估。数据是由两名独立审查员使用乔安娜·布里格斯研究所的标准化数据提取工具从审查中包括的论文中提取的。效应大小以加权平均差异表示，并计算其95%可信区间用于荟萃分析。结果：本综述纳入6项研究。间歇性能量限制方案在不同的研究中有所不同，包括隔日禁食、禁食两天和每周最多四天。研究时间从3个月到12个月不等。四项研究包括作为对照干预的持续能量限制，两项研究包括无治疗对照干预。Meta分析显示，间歇性能量限制比不进行能量限制对体重减轻更有效(-4.14 kg；95%CI-6.30 kg至-1.99 kg；p≤0.001)。虽然两种治疗干预措施的体重变化相似(约7 kg)，但研究间歇性能量限制与持续能量限制的效果的研究的汇总估计显示，体重减轻方面没有显著差异(-1.03 kg；95%CI-2.46 kg至0.40 kg；p = 0.156)。结论：间歇性能量限制可能是治疗超重和肥胖的有效策略。在超重和肥胖的成年人中，间歇性能量限制与持续能量限制在短期体重减轻方面具有可比性。间歇性能量限制被证明比不治疗更有效，然而，由于研究数量较少，应该谨慎地解释这一点，未来的研究有理由证实这一综述的结果。
OBJECTIVE: To examine the effectiveness of intermittent energy restriction in the treatment for overweight and obesity in adults, when compared to usual care treatment or no treatment.INTRODUCTION: Intermittent energy restriction encompasses dietary approaches including intermittent fasting, alternate day fasting, and fasting for two days per week. Despite the recent popularity of intermittent energy restriction and associated weight loss claims, the supporting evidence base is limited.INCLUSION CRITERIA: This review included overweight or obese (BMI ≥25 kg/m) adults (≥18 years). Intermittent energy restriction was defined as consumption of ≤800 kcal on at least one day, but no more than six days per week. Intermittent energy restriction interventions were compared to no treatment (ad libitum diet) or usual care (continuous energy restriction 25% of recommended energy intake). Included interventions had a minimum duration of 12 weeks from baseline to post outcome measurements. The types of studies included were randomized and pseudo-randomized controlled trials. The primary outcome of this review was change in body weight. Secondary outcomes included: i) anthropometric outcomes (change in BMI, waist circumference, fat mass, fat free mass); ii) cardio-metabolic outcomes (change in blood glucose and insulin, lipoprotein profiles and blood pressure); and iii) lifestyle outcomes: diet, physical activity, quality of life and adverse events.METHODS: A systematic search was conducted from database inception to November 2015. The following electronic databases were searched: MEDLINE, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov, ISRCTN registry, and anzctr.org.au for English language published studies, protocols and trials. Two independent reviewers evaluated the methodological quality of included studies using the standardized critical appraisal instruments from the Joanna Briggs Institute. Data were extracted from papers included in the review by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute. Effect sizes were expressed as weighted mean differences and their 95% confidence intervals were calculated for meta-analyses.RESULTS: Six studies were included in this review. The intermittent energy restriction regimens varied across studies and included alternate day fasting, fasting for two days, and up to four days per week. The duration of studies ranged from three to 12 months. Four studies included continuous energy restriction as a comparator intervention and two studies included a no treatment control intervention. Meta-analyses showed that intermittent energy restriction was more effective than no treatment for weight loss (-4.14 kg; 95% CI -6.30 kg to -1.99 kg; p ≤ 0.001). Although both treatment interventions achieved similar changes in body weight (approximately 7 kg), the pooled estimate for studies that investigated the effect of intermittent energy restriction in comparison to continuous energy restriction revealed no significant difference in weight loss (-1.03 kg; 95% CI -2.46 kg to 0.40 kg; p = 0.156).CONCLUSIONS: Intermittent energy restriction may be an effective strategy for the treatment of overweight and obesity. Intermittent energy restriction was comparable to continuous energy restriction for short term weight loss in overweight and obese adults. Intermittent energy restriction was shown to be more effective than no treatment, however, this should be interpreted cautiously due to the small number of studies and future research is warranted to confirm the findings of this review.