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Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial
Open accessAbstract
Importance: Alternate-day fasting has become increasingly popular, yet, to date, no long-term randomized clinical trials have evaluated its efficacy. Objective: To compare the effects of alternate-day fasting vs daily calorie restriction on weight loss, weight maintenance, and risk indicators for cardiovascular disease. Design, Setting, and Participants: A single-center randomized clinical trial of obese adults (18 to 64 years of age; mean body mass index, 34) was conducted between October 1, 2011, and January 15, 2015, at an academic institution in Chicago, Illinois. Interventions: Participants were randomized to 1 of 3 groups for 1 year: alternate-day fasting (25% of energy needs on fast days; 125% of energy needs on alternating "feast days"), calorie restriction (75% of energy needs every day), or a no-intervention control. The trial involved a 6-month weight-loss phase followed by a 6-month weight-maintenance phase. Main Outcomes and Measures: The primary outcome was change in body weight. Secondary outcomes were adherence to the dietary intervention and risk indicators for cardiovascular disease. Results: Among the 100 participants (86 women and 14 men; mean [SD] age, 44 [11] years), the dropout rate was highest in the alternate-day fasting group (13 of 34 [38%]), vs the daily calorie restriction group (10 of 35 [29%]) and control group (8 of 31 [26%]). Mean weight loss was similar for participants in the alternate-day fasting group and those in the daily calorie restriction group at month 6 (-6.8% [95% CI, -9.1% to -4.5%] vs -6.8% [95% CI, -9.1% to -4.6%]) and month 12 (-6.0% [95% CI, -8.5% to -3.6%] vs -5.3% [95% CI, -7.6% to -3.0%]) relative to those in the control group. Participants in the alternate-day fasting group ate more than prescribed on fast days, and less than prescribed on feast days, while those in the daily calorie restriction group generally met their prescribed energy goals. There were no significant differences between the intervention groups in blood pressure, heart rate, triglycerides, fasting glucose, fasting insulin, insulin resistance, C-reactive protein, or homocysteine concentrations at month 6 or 12. Mean high-density lipoprotein cholesterol levels at month 6 significantly increased among the participants in the alternate-day fasting group (6.2 mg/dL [95% CI, 0.1-12.4 mg/dL]), but not at month 12 (1.0 mg/dL [95% CI, -5.9 to 7.8 mg/dL]), relative to those in the daily calorie restriction group. Mean low-density lipoprotein cholesterol levels were significantly elevated by month 12 among the participants in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9-21.1 mg/dL]) compared with those in the daily calorie restriction group. Conclusions and Relevance: Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs daily calorie restriction. Trial Registration: clinicaltrials.gov Identifier: NCT00960505.
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“There were no statistically significant differences between the alternate-day fasting group and the daily calorie restriction group for fat mass, lean mass, or visceral fat mass at month 6 or month 12.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Weight Loss and Weight Maintenance
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In the paper
“There were also no statistically significant differences in heart rate between the alternate-day fasting group and the daily calorie restriction group at month 6 or month 12 (Table 2).”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Blood Pressure and Heart Rate
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In the paper
“Blood pressure was not significantly different between the intervention groups, or relative to controls, at month 6 or month 12 (Table 2).”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Blood Pressure and Heart Rate
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In the paper
“Total cholesterol levels were not significantly different between the intervention groups, or relative to controls, at month 6 or month 12.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Plasma Lipids
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In the paper
“Moreover, weight regain from months 6 to 12 was not significantly different between the alternate-day fasting group and controls (0.8%; 95% CI, −1.8% to 3.3%)”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Weight Loss and Weight Maintenance
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In the paper
“There were also no significant differences in fasting insulin or the homeostasis model assessment of insulin resistance between the intervention groups at month 6 or month 12.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Glucoregulatory and Inflammatory Factors
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“On the fast day (Figure 2A), participants in the alternate-day fasting group exceeded their prescribed energy goal at months 3 and 6.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Prescribed vs Actual Energy Intake Determined via Food Records
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In the paper
“or the daily calorie restriction group and controls (1.5%; 95% CI, −0.8% to 3.9%).”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Weight Loss and Weight Maintenance
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In the paper
“High-sensitivity C-reactive protein and homocysteine levels did not differ significantly between the intervention groups, or relative to controls, at month 6 or month 12.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Glucoregulatory and Inflammatory Factors
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: The missing data mechanism is missing at random.
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In the paper
“At month 12, low-density lipoprotein cholesterol levels significantly increased in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9–21.1 mg/ dL]) (to convert to millimoles per liter, multiply by 0.0259) relative to the daily calorie restriction group.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Plasma Lipids
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- The authors state this as an assumption: The missing data mechanism is missing at random.
- Probably not a substantial claim. 17
- It may state two separate claims as one. 8
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In the paper
“Participants in the daily calorie restriction group (Figure 2C) met their prescribed energy goals at months 3, 6, and 12 but ate less than their prescribed goal at month 9.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Prescribed vs Actual Energy Intake Determined via Food Records
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- The authors state this as an assumption: The missing data mechanism is missing at random.
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In the paper
“who had previously been sedentary (<60 minutes per week of light activity for the 3 months prior to the study)”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Methods > Participants
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In the paper
“All participants were instructed not to change their physical activity habits throughout the trial (eg, not to join a gym) to avoid potential confounding.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Methods > Randomization and Intervention Groups
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In the paper
“Tests for normality were included in the model, and all data were found to be normally distributed.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Methods > Statistical Analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- The authors state this as an assumption: The missing data mechanism is missing at random.
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In the paper
“We calculated that 26 participants per group would provide 80% power to detect a significant difference of 5% in body weight between the alternate-day fasting group and the daily calorie restriction group at month 6, using a 2-tailed independent-samples t test with α = .05.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Methods > Statistical Analysis
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“The participants were primarily metabolically healthy obese women.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Participant Characteristics and Attrition
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In the paper
“images were analyzed using validated software.20”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Methods > Outcome Measures
What the sources say
- Not checked yetcites [20] Demerath EW Ritter KJ Couch WA Validity of a new automated software program for visceral adipose tissue estimation Int J Obes (Lond) 2007 31 2 285 291 16770332 PMC1783906
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In the paper
“We also performed a sensitivity analysis, in which sex and race/ethnicity were included as adjustment covariates in the intention-to-treat mixed model. The inclusion of sex and race/ethnicity did not affect any of the estimated treatment effects reported in Table 2.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Results > Glucoregulatory and Inflammatory Factors
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- The authors state this as an assumption: The missing data mechanism is missing at random.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“mean body mass index, 34”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Abstract > DESIGN, SETTING, AND PARTICIPANTS
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In the paper
“The first-line therapy prescribed to obese patients for weight loss is daily calorie restriction.1”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Abstract > TRIAL REGISTRATION
What the sources say
- Not checked yetcites [1] Jensen MD Ryan DH Apovian CM American College of Cardiology/American Heart Association, Task Force on Practice Guidelines; Obesity Society 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society Circulation 2014 129 25(suppl 2) S102 S138 24222017 PMC5819889
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In the paper
“Second, the control group was imperfect, in that they received no food, no counseling, and less attention from study personnel, relative to the intervention groups, which may have confounded our findings.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Discussion > Limitations
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
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In the paper
“Since many of the participants had normal cholesterol levels and normal blood pressure at baseline, it is not surprising that most risk indicators for cardiovascular disease did not change in response to diet.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Discussion
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In the paper
“The protocol was approved by the Office for the Protection of Research Subjects at the University of Illinois at Chicago, and written informed consent was obtained from all participants.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Methods > Participants
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We also failed to include the control group in our initial power calculation.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Discussion > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“To our knowledge, the present study is the longest and largest trial of alternate-day fasting to date.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Discussion
What the sources say
- Not checked yetcites [7] Bhutani S Klempel MC Kroeger CM Trepanowski JF Varady KA Alternate day fasting and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans Obesity (Silver Spring) 2013 21 7 1370 1379 23408502
- Not checked yetcites [8] Hoddy KK Kroeger CM Trepanowski JF Barnosky A Bhutani S Varady KA Meal timing during alternate day fasting: impact on body weight and cardiovascular disease risk in obese adults Obesity (Silver Spring) 2014 22 12 2524 2531 25251676
- Not checked yetcites [9] Johnson JB Summer W Cutler RG Alternate day calorie restriction improves clinical findings and reduces markers of oxidative stress and inflammation in overweight adults with moderate asthma [published correction appears in Free Radic Biol Med. 2007;43(9):1348] Free Radic Biol Med 2007 42 5 665 674 17291990 PMC1859864
- Not checked yetcites [10] Klempel MC Kroeger CM Varady KA Alternate day fasting (ADF) with a high-fat diet produces similar weight loss and cardio-protection as ADF with a low-fat diet Metabolism 2013 62 1 137 143 22889512
- Not checked yetcites [11] Varady KA Bhutani S Church EC Klempel MC Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults Am J Clin Nutr 2009 90 5 1138 1143 19793855
- Not checked yetcites [12] Catenacci VA Pan Z Ostendorf D A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity Obesity (Silver Spring) 2016 24 9 1874 1883 27569118 PMC5042570
- Not checked yetcites [13] Alhamdan BA Garcia-Alvarez A Alzahrnai AH Alternate-day versus daily energy restriction diets: which is more effective for weight loss? a systematic review and meta-analysis Obes Sci Pract 2016 2 3 293 302 27708846 PMC5043510
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear? Based: unclearIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We conducted an intention-to-treat analysis, which included data from all 100 participants who underwent randomization.”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Methods > Statistical Analysis
Strength:plain· not yet calibratedn = 100Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- The authors state this as an assumption: The missing data mechanism is missing at random.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“clinicaltrials.gov Identifier: NCT00960505”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Abstract > TRIAL REGISTRATION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Participants were randomized in a 1:1:1 ratio to an alternate-day fasting group, daily calorie restriction group, or no-intervention control group. Randomization was performed by a stratified random sampling procedure by sex, age (18–42 years and 43–65 years), and body mass index (25.0–32.5 and 32.6–39.9).”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Methods > Randomization and Intervention Groups
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“obese adults (18 to 64 years of age; mean body mass index, 34)”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Abstract > DESIGN, SETTING, AND PARTICIPANTS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“First, the duration of the maintenance phase was short (6 months).”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Discussion > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Findings from short-term studies indicate that participants lose 3% to 7% of body weight after 2 to 3 months of alternate-day fasting and experience improvements in lipid profiles, blood pressure, and insulin sensitivity.7–13”
§ Effect of Alternate-Day Fasting onWeight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults > Abstract > TRIAL REGISTRATION
What the sources say
- Not checked yetcites [7] Bhutani S Klempel MC Kroeger CM Trepanowski JF Varady KA Alternate day fasting and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans Obesity (Silver Spring) 2013 21 7 1370 1379 23408502
- Not checked yetcites [8] Hoddy KK Kroeger CM Trepanowski JF Barnosky A Bhutani S Varady KA Meal timing during alternate day fasting: impact on body weight and cardiovascular disease risk in obese adults Obesity (Silver Spring) 2014 22 12 2524 2531 25251676
- Not checked yetcites [9] Johnson JB Summer W Cutler RG Alternate day calorie restriction improves clinical findings and reduces markers of oxidative stress and inflammation in overweight adults with moderate asthma [published correction appears in Free Radic Biol Med. 2007;43(9):1348] Free Radic Biol Med 2007 42 5 665 674 17291990 PMC1859864
- Not checked yetcites [10] Klempel MC Kroeger CM Varady KA Alternate day fasting (ADF) with a high-fat diet produces similar weight loss and cardio-protection as ADF with a low-fat diet Metabolism 2013 62 1 137 143 22889512
- Not checked yetcites [11] Varady KA Bhutani S Church EC Klempel MC Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults Am J Clin Nutr 2009 90 5 1138 1143 19793855
- Not checked yetcites [12] Catenacci VA Pan Z Ostendorf D A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity Obesity (Silver Spring) 2016 24 9 1874 1883 27569118 PMC5042570
- Not checked yetcites [13] Alhamdan BA Garcia-Alvarez A Alzahrnai AH Alternate-day versus daily energy restriction diets: which is more effective for weight loss? a systematic review and meta-analysis Obes Sci Pract 2016 2 3 293 302 27708846 PMC5043510
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The authors state this as an assumption.
The missing data mechanism is missing at random.
“This model provides unbiased estimates of time and treatment effects under a missing-at-random assumption.”
The paper relies on this without support.
No long-term randomized clinical trials have evaluated the efficacy of alternate-day fasting or compared it with a conventional weight-loss diet.
“Despite the growing popularity of alternate-day fasting, to our knowledge, no long-term randomized clinical trials have evaluated its efficacy or compared this regimen with a conventional weight-loss diet.”
Claims other papers make about this one
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The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The superior weight loss in the INT group in the present study is in contrast with the majority of studies that have reported no advantage of intermittent over continuous ER.”
From Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study (2018) · cites this paper as [42]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“This trend is consistent with Trepanowski et al.'s findings [74], which also observed improvements in plasma lipids with ADF at 6 months.”
From Comparing caloric restriction regimens for effective weight management in adults: a systematic review and network meta-analysis (2024) · cites this paper as [74]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“A recent 12-month clinical trial42 and several recent reviews9,43, 44 have concluded that existing models of intermittent ER (largely versions of intermittent fasting), could be considered equivalent, but not superior, alternatives for weight loss.”
From Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study (2018) · cites this paper as [42]
In the citing paper
“It was demonstrated that although the two intervention groups lost weight, insulin sensitivity, blood lipid levels and blood glucose were not improved.”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [350]
In the citing paper
“A few studies have extended up to 52 weeks and show similar findings (152-155).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [153]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Trial phases total 13 months, not one year
MinorThe stated baseline, weight-loss, and maintenance phases add up to 13 months, although the active trial duration is described as one year (12 months).
Reported 12 · recomputed 13
“The active trial duration was 1 year and consisted of a baseline phase (1 month), a weight-loss phase (6 months), and a weight-maintenance phase (6 months)”
Citations
Cites
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Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., Hu, F. B., Hubbard, V. S., Jakicic, J. M., Kushner, R. F., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.11.004 · Cited by 4,058
A structural approach to selection bias
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Effects of intermittent fasting on health, aging, and disease
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“Table 3 presents findings from clinical trials that examined ADMF and ADF regimens (12,54,119,131-135).”
BackgroundMolecular mechanisms of dietary restriction promoting health and longevity
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“Previous work indicates that intermittent fasting regimens [4, 8, 10] and other lifestyle regimens [21, 22] have little effect on cardiometabolic disease risk factors in healthy obese subjects.”
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“…will be an interesting course of upcoming research, although a recent study suggests that the effects onweight loss and cardiovascular improvements are very similar between a mild form of ADF (25% calories on fast days, 125% on feast days) and 25% continuous CR (Trepanowski et al., 2017).”
BackgroundElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., et al. (2023) · Diabetes Care · doi:10.2337/dc23-s005 · Cited by 362
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“Most of the IMF studies used seven-day diet records [40,41,44,46,48,49] or diet checklists [43] to assess adherence, with the exception of Catenacci et al.”
BackgroundMethodInfluentialIntermittent Fasting in Cardiovascular Disorders—An Overview
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“Moreover, there were no significant differences between the ADF and CR groups in terms of heart rate, blood pressure, fasting glucose, fasting insulin, triglycerides, and CRP at both time-point assessments [66].”
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“Overall, the authors concluded that alternate-day fasting did not improve health beyond calorie restriction [33].”
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“Of note, results of a 1-y RCT on another popular form of ICR, alternate day fasting (ADF), have recently been published (25).”
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“3% observed in the daily (isocaloric) restriction group (46).”
BackgroundCalorie Restriction and Aging in Humans
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Intermittent Fasting: A Heart Healthy Dietary Pattern?
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“, 100% energy restriction) followed by and a feed day (ad libitum food consumption), resulting in 36-h fasting [12,13].”
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“HDL cholesterol is also not affected by these diets, although one study observed a slight increase [40].”
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Spermidine is essential for fasting-mediated autophagy and longevity
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Self-citationIntermittent fasting in the prevention and treatment of cancer
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Developing dietary interventions as therapy for cancer
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Chrono-nutrition for the prevention and treatment of obesity and type 2 diabetes: from mice to men
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“Several short-term studies report that IF is as effective for weight loss as standard weight-loss diets (see [29]), whereas a 12 month study that compared IF (one day on, one day off), CER and a control diet found that, although the two intervention groups lost weight, insulin sensitivity, blood lipid levels and blood…”
BackgroundFitzgerald, K. C., Vizthum, D., Henry-Barron, B. J., Schweitzer, A., Cassard, S. D., Kossoff, E. H., Hartman, A. L., Kapogiannis, D., Sullivan, P. S., Baer, D. J., et al. (2018) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2018.05.002 · Cited by 150
Dietary Restrictions and Nutrition in the Prevention and Treatment of Cardiovascular Disease
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“Very few studies have examined the impact of intermittent fasting versus daily CR on inflammatory mediators (5,7,8).”
BackgroundMethodInfluentialSelf-citationClinical Management of Intermittent Fasting in Patients with Diabetes Mellitus
Grajower, M. M., & Horne, B. D. (2019) · Nutrients · doi:10.3390/nu11040873 · Cited by 170
“Early in the study of fasting’s health effects it was hypothesized that fasting could ameliorate some of the major undesirable effects of weight loss diets [10].”
BackgroundSchröder, J. D., Falqueto, H., Mânica, A., Zanini, D., de Oliveira, T., Sá, C. A. D., Cardoso, A. M., & Manfredi, L. H. (2021) · Journal of Translational Medicine · doi:10.1186/s12967-020-02687-0 · Cited by 160
Trepanowski, J. F., Kroeger, C. M., Barnosky, A., Klempel, M. C., Bhutani, S., Hoddy, K. K., Rood, J. C., Ravussin, É., & Varady, K. A. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2017.11.018 · Cited by 152
“First, these findings are from a secondary analysis; and in the primary analysis, which included all participants (including non-completers), insulin and HOMA-IR both changed similarly between the ADF and CR groups (2).”
BackgroundMethodResultInfluentialSelf-citationHutchison, A. T., Liu, B., Wood, R. E., Vincent, A. D., Thompson, C. H., O’Callaghan, N. J., Wittert, G., & Heilbronn, L. K. (2018) · Obesity · doi:10.1002/oby.22345 · Cited by 152
Time-Restricted Eating Without Calorie Counting for Weight Loss in a Racially Diverse Population
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“Statistical Analysis For the sample size calculation, we estimated that the TRE and CR groups would reduce body weight by 8 kg (extrapolated from our pilot data) and 5 kg (16), respectively, by month 12 versus the control group (no change in body weight).”
BackgroundMethodSelf-citationMoro, T., Tinsley, G. M., Longo, G., Grigoletto, D., Bianco, A., Ferraris, C., Guglielmetti, M., Veneto, A., Tagliabue, A., Marcolin, G., et al. (2020) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-020-00396-z · Cited by 153
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Impact of intermittent fasting on the lipid profile: Assessment associated with diet and weight loss
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Elortegui Pascual, P., Rolands, M. R., Eldridge, A. L., Kassis, A., Mainardi, F., Lê, K., Karagounis, L. G., Gut, P., & Varady, K. A. (2023) · Obesity · doi:10.1002/oby.23568 · Cited by 133
“In Varady et al. [15] and Trepanowski et al. [16], data on mean body weight loss were obtained by directly contacting the authors.”
BackgroundMethodResultInfluentialSelf-citationMORO, T., TINSLEY, G., PACELLI, F. Q., MARCOLIN, G., BIANCO, A., & PAOLI, A. (2021) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002738 · Cited by 134
“In a 12-month long-term study, Trepanowski and colleagues (49) compared the effect of an alternate day fasting protocol with daily CR diet on cardiometabolic risk factors in obese adults.”
BackgroundIntermittent Fasting and Metabolic Health: From Religious Fast to Time‐Restricted Feeding
Hoddy, K. K., Marlatt, K. L., Çetinkaya, H., & Ravussin, É. (2020) · Obesity · doi:10.1002/oby.22829 · Cited by 140
“Small studies (<20 participants per group) appear to report similar dropout rates (70,77,79), whereas, larger studies (>40 participants) are equivocal (81,83).”
BackgroundResultInfluentialSelf-citationIntermittent fasting: from calories to time restriction
Duregon, E., Pomatto, L. C. D., Bernier, M., Price, N. L., & de Cabo, R. (2021) · GeroScience · doi:10.1007/s11357-021-00335-z · Cited by 134
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“More recently, a study by Trepanowski et al.(7) of alternate day ER also reported a higher attrition rate among IER participants of 38 v. 29% among CER 100 200 300 –1.0 –0.5 0.0 0.5 1.0 1.5 IER P= 0.943* Time (min) G lu co se ( m m ol /l) C ha ng e fr om b as el in e 100 200 300 –1.0 –0.5 0.0 0.5 1.0 1.5 2.0 CER P= 0.…”
BackgroundInfluentialCharlot, A., Hutt, F., Sabatier, E., & Zoll, J. (2021) · Nutrients · doi:10.3390/nu13051405 · Cited by 125
“The evaluation of fasting efficacy during a year on obese adults also did not show improvement in risk indicators for cardiovascular disease [28].”
Backgroundde Toledo, F. W., Grundler, F., Sirtori, C. R., & Ruscica, M. (2020) · Annals of Medicine · doi:10.1080/07853890.2020.1770849 · Cited by 125
“These were randomised to adhere for 1 year (6-month intervention followed by 6-month weight maintenance) to one of the following regimens: (i) ADF (25% of energy needs on fasting days and 125% on alternating feast days), and (ii) 75% CR. Compared to the control group, no differences between interventions were found ei…”
BackgroundResultInfluentialAlbosta, M. S., & Bakke, J. (2021) · Clinical Diabetes and Endocrinology · doi:10.1186/s40842-020-00116-1 · Cited by 133
“Alternate Day Fasting One day of fasting/One day of ad libitum feeding Trepanowski et al [11].”
BackgroundNutrients in the Prevention of Alzheimer’s Disease
Cremonini, A. L., Caffa, I., Cea, M., Nencioni, A., Odetti, P. R., & Monacelli, F. (2019) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2019/9874159 · Cited by 121
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“Following the second six months of the study, where participants were instructed to maintain their dietary patterns but meet their energy needs in lieu of creating an energy deficit, similar between-group responses were seen with outcome measures (Trepanowski et al., 2017).”
BackgroundResultInfluentialIntermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study
Byrne, N. M., Sainsbury, A., King, N. A., Hills, A. P., & Wood, R. E. (2018) · International Journal of Obesity · doi:10.1038/ijo.2017.206 · Cited by 113
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The obesity-breast cancer link: a multidisciplinary perspective
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“Yet, another study showed that insulin decreased equally in CCR and ADMF, but 776 the C-peptide reduction was more pronounced after ADMF, suggesting a reduction in 777 postprandial insulin production [130,131].”
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“In the last decade, intermittent fasting (IF) has emerged as an increasingly common alternative to traditional dietary strategies in both healthy and at-risk populations (Anton et al. 2018; Patterson and Sears 2017; Trepanowski et al. 2017).”
BackgroundIntermittent fasting for the prevention of cardiovascular disease
Allaf, M., Elghazaly, H., Mohamed, O. G., Fareen, M. F. K., Zaman, S., Salmasi, A.-M., Tsilidis, K., & Dehghan, A. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013496.pub2 · Cited by 98
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“A couple of studies of six months’ duration have used the American Heart Association (AHA) guidelines for the subjects’ diet (30% of energy as fat, 55% as carbohydrate and 15% as protein) but neither showed any improvement or difference between the intervention and control groups [37,52].”
BackgroundEffect of time restricted feeding on the gut microbiome in adults with obesity: A pilot study
Gabel, K., Hampton‐Marcell, J., Cares, K., Kalam, F., Cienfuegos, S., Ezpeleta, M., & Varady, K. A. (2020) · Nutrition and Health · doi:10.1177/0260106020910907 · Cited by 99
“Intermittent fasting has been shown to be an effective alternative to daily calorie restriction for weight loss and metabolic disease reduction in adults with obesity (Trepanowski et al., 2017).”
BackgroundMethodSelf-citationRandomized controlled trial for time-restricted eating in overweight and obese young adults
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“The caloric intake on the fasting day is 25% of the daily caloric intake (approximately 2090 kJ), and the subjects can eat freely on the feeding day [3].”
BackgroundExercise Training and Fasting: Current Insights
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The Role of Exercise, Diet, and Cytokines in Preventing Obesity and Improving Adipose Tissue
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“The authors [214] concluded that alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardio-protection vs.”
BackgroundInfluentialPureza, I. R. D. O. M., Macena, M. D. L., da Silva Junior, A. E., Praxedes, D. R. S., Vasconcelos, L. G. L., & Bueno, N. B. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2020.10.031 · Cited by 89
Nutrition Concepts for the Treatment of Obesity in Adults
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The role of intermittent fasting and meal timing in weight management and metabolic health
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Zhao, Y., Jia, M., Chen, W., & Liu, Z. (2022) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2022.02.021 · Cited by 89
Effects of Intermittent Fasting on Brain Metabolism
Brocchi, A., Rebelos, E., Dardano, A., Mantuano, M., & Daniele, G. (2022) · Nutrients · doi:10.3390/nu14061275 · Cited by 99
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Self-citationMolecular Decolonization: An Indigenous Microcosm Perspective of Planetary Health
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Metadata
- Authors
- Trepanowski, J. F., Kroeger, C. M., Barnosky, A., Klempel, M. C., Bhutani, S., Hoddy, K. K., Gabel, K., Freels, S., Rigdon, J., Rood, J., Ravussin, E., & Varady, K. A.
- Affiliations
- University of Illinois Chicago (US)
- University of Alabama at Birmingham (US)
- Stanford University (US)
- Pennington Biomedical Research Center (US)
- Nutrition Obesity Research Center, Pennington Biomedical Research Center, Baton Rouge, Louisiana
- Corresponding author
- Varady, Krista A.
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2017-07-01
- Volume
- 177
- Issue
- 7
- Pages
- 930
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC5680777
- OpenAlex
- W2611504779
- Semantic Scholar
- 90534c8b9843eb662b022d9e79d5b5143434d1c6
- Cited by
- 645
- References
- 32
- Citations by year
- 2026: 45 · 2025: 71 · 2024: 76 · 2023: 95 · 2022: 103 · 2021: 90 · 2020: 81 · 2019: 35 · 2018: 38 · 2017: 10
- FWCI
- 33.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL106228)
- National Institute of Diabetes and Digestive and Kidney Diseases (F32DK107157, P30DK072476)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Dietary Effects on Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Physiology (medical) › Diet and metabolism studies
- Keywords
- alternate-day fasting, caloric restriction, weight loss, weight maintenance, metabolically healthy obesity, cardiovascular risk factors, cardioprotection, dietary adherence, blood pressure, insulin resistance, fasting blood glucose, triglycerides, long-term weight management, heart rate, blood pressure variability, heart rate variability
- MeSH terms
- Adult, Blood Glucose, Cardiovascular Diseases, Diet Therapy, Fasting, Feeding Behavior, Female, Humans, Insulin, Male, Middle Aged, Obesity, Outcome and Process Assessment, Health Care, Patient Compliance, Risk Factors, Weight Loss, Caloric Restriction
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