Intermittent fasting for the prevention of cardiovascular disease
Open accessAbstract
BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide. Lifestyle changes are at the forefront of preventing the disease. This includes advice such as increasing physical activity and having a healthy balanced diet to reduce risk factors. Intermittent fasting (IF) is a popular dietary plan involving restricting caloric intake to certain days in the week such as alternate day fasting and periodic fasting, and restricting intake to a number of hours in a given day, otherwise known as time-restricted feeding. IF is being researched for its benefits and many randomised controlled trials have looked at its benefits in preventing CVD. OBJECTIVES: To determine the role of IF in preventing and reducing the risk of CVD in people with or without prior documented CVD. SEARCH METHODS: We conducted our search on 12 December 2019; we searched CENTRAL, MEDLINE and Embase. We also searched three trials registers and searched the reference lists of included papers. Systematic reviews were also viewed for additional studies. There was no language restriction applied. SELECTION CRITERIA: We included randomised controlled trials comparing IF to ad libitum feeding (eating at any time with no specific caloric restriction) or continuous energy restriction (CER). Participants had to be over the age of 18 and included those with and without cardiometabolic risk factors. Intermittent fasting was categorised into alternate-day fasting, modified alternate-day fasting, periodic fasting and time-restricted feeding. DATA COLLECTION AND ANALYSIS: Five review authors independently selected studies for inclusion and extraction. Primary outcomes included all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and heart failure. Secondary outcomes include the absolute change in body weight, and glucose. Furthermore, side effects such as headaches and changes to the quality of life were also noted. For continuous data, pooled mean differences (MD) (with 95% confidence intervals (CIs)) were calculated. We contacted trial authors to obtain missing data. We used GRADE to assess the certainty of the evidence. MAIN RESULTS: Our search yielded 39,165 records after the removal of duplicates. From this, 26 studies met our criteria, and 18 were included in the pooled analysis. The 18 studies included 1125 participants and observed outcomes ranging from four weeks to six months. No studies included data on all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and heart failure at any point during follow-up. Of quantitatively analysed data, seven studies compared IF with ab libitum feeding, eight studies compared IF with CER, and three studies compared IF with both ad libitum feeding and CER. Outcomes were reported at short term (≤ 3 months) and medium term (> 3 months to 12 months) follow-up. Body weight was reduced with IF compared to ad libitum feeding in the short term (MD -2.88 kg, 95% CI -3.96 to -1.80; 224 participants; 7 studies; low-certainty evidence). We are uncertain of the effect of IF when compared to CER in the short term (MD -0.88 kg, 95% CI -1.76 to 0.00; 719 participants; 10 studies; very low-certainty evidence) and there may be no effect in the medium term (MD -0.56 kg, 95% CI -1.68 to 0.56; 279 participants; 4 studies; low-certainty evidence). We are uncertain about the effect of IF on glucose when compared to ad libitum feeding in the short term (MD -0.03 mmol/L, 95% CI -0.26 to 0.19; 95 participants; 3 studies; very-low-certainty of evidence) and when compared to CER in the short term: MD -0.02 mmol/L, 95% CI -0.16 to 0.12; 582 participants; 9 studies; very low-certainty; medium term: MD 0.01, 95% CI -0.10 to 0.11; 279 participants; 4 studies; low-certainty evidence). The changes in body weight and glucose were not deemed to be clinically significant. Four studies reported data on side effects, with some participants complaining of mild headaches. One study reported on the quality of life using the RAND SF-36 score. There was a modest increase in the physical component summary score. AUTHORS' CONCLUSIONS: Intermittent fasting was seen to be superior to ad libitum feeding in reducing weight. However, this was not clinically significant. There was no significant clinical difference between IF and CER in improving cardiometabolic risk factors to reduce the risk of CVD. Further research is needed to understand the safety and risk-benefit analysis of IF in specific patient groups (e.g. patients with diabetes or eating disorders) as well as the effect on longer-term outcomes such as all-cause mortality and myocardial infarction.
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TRE demonstrates beneficial effects on cardiovascular metabolic parameters and lipid profiles.
“Furthermore, TRE demonstrates beneficial effects on cardiovascular metabolic parameters [87, 90] and lipid profiles [76, 83, 87].”
From Comparing caloric restriction regimens for effective weight management in adults: a systematic review and network meta-analysis (2024) · cites this paper as [83]
The Discussion (page unavailable) reports statistically favorable changes in total cholesterol, systolic blood pressure, and other measures for intermittent fasting versus unrestricted eating. But it says none met the review’s threshold for clinical significance, and it does not establish those benefits specifically for time-restricted eating (TRE). Compared with continuous energy restriction, it reports similar effects on lipids, blood pressure, and glucose rather than a distinct TRE benefit. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe STF lean mass drawback conclusion is supported by previous research.
“a conclusion supported by previous research [80, 83]”
From Comparing caloric restriction regimens for effective weight management in adults: a systematic review and network meta-analysis (2024) · cites this paper as [83]
The Background reports no significant difference in lean mass between alternate-day fasting, continuous energy restriction, and unrestricted feeding in one trial. The passages found do not establish a lean-mass drawback of STF; the review’s reported results focus on body weight rather than that claim (searched: lean mass loss, fat-free mass). (LLM, conf=0.73)
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Cites
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
Authors/Task Force Members:, Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Ž., Verschuren, M., Albus, C., Benlian, P., Boysen, G., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs092 · Cited by 8,490 · see citing works
Sterne, J. A. C., Sutton, A. J., Ioannidis, J. P. A., Terrin, N., Jones, D. R., Lau, J., Carpenter, J., Rucker, G., Harbord, R. M., Schmid, C. H., et al. (2011) · BMJ · doi:10.1136/bmj.d4002 · Cited by 7,709 · see citing works
2016 European Guidelines on cardiovascular disease prevention in clinical practice
Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M.-T., Corrà, U., Cosyns, B., Deaton, C., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw106 · Cited by 6,457 · see citing works
Type 2 diabetes as an inflammatory disease
Donath, M. Y., & Shoelson, S. E. (2011) · Nature Reviews Immunology · doi:10.1038/nri2925 · Cited by 3,737 · see citing works
Interpretation of random effects meta-analyses
Riley, R. D., Higgins, J. P. T., & Deeks, J. J. (2011) · BMJ · doi:10.1136/bmj.d549 · Cited by 2,884 · see citing works
A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management
Pi-Sunyer, X., Astrup, A., Fujioka, K., Greenway, F., Halpern, A., Krempf, M., Lau, D. C. W., le Roux, C. W., Violante Ortiz, R., Jensen, C. B., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1411892 · Cited by 2,724 · see citing works
Wood, L., Egger, M., Gluud, L. L., Schulz, K. F., Jüni, P., Altman, D. G., Gluud, C., Martin, R. M., Wood, A. J. G., & Sterne, J. A. C. (2008) · BMJ · doi:10.1136/bmj.39465.451748.ad · Cited by 2,538 · see citing works
Lean, M. E., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)33102-1 · Cited by 2,095 · see citing works
Hatori, M., Vollmers, C., Zarrinpar, A., DiTacchio, L., Bushong, E. A., Gill, S., Leblanc, M., Chaix, A., Joens, M., Fitzpatrick, J. A. J., et al. (2012) · Cell Metabolism · doi:10.1016/j.cmet.2012.04.019 · Cited by 1,986 · see citing works
Effects of intermittent fasting on health, aging, and disease
de Cabo, R., & Mattson, M. P. (2019) · New England Journal of Medicine · doi:10.1056/nejmra1905136 · Cited by 1,605 · see citing works
Impact of intermittent fasting on health and disease processes
Mattson, M. P., Longo, V. D., & Harvie, M. (2017) · Ageing Research Reviews · doi:10.1016/j.arr.2016.10.005 · Cited by 1,187 · see citing works
Diet and feeding pattern affect the diurnal dynamics of the gut microbiome
Zarrinpar, A., Chaix, A., Yooseph, S., & Panda, S. (2014) · Cell Metabolism · doi:10.1016/j.cmet.2014.11.008 · Cited by 926 · see citing works
Effect of fasting on serum leptin in normal human subjects
Boden, G. (1996) · Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.81.9.3419 · Cited by 809 · see citing works
Harvie, M. N., Pegington, M., Mattson, M. P., Frystyk, J., Dillon, B., Evans, G., Cuzick, J., Jebb, S. A., Martin, B., Cutler, R. G., et al. (2011) · International Journal of Obesity · doi:10.1038/ijo.2010.171 · Cited by 804 · see citing works
Moro, T., Tinsley, G., Bianco, A., Marcolin, G., Pacelli, Q. F., Battaglia, G., Palma, A., Gentil, P., Neri, M., & Paoli, A. (2016) · Journal of Translational Medicine · doi:10.1186/s12967-016-1044-0 · Cited by 732 · see citing works
Trepanowski, J. F., Kroeger, C. M., Barnosky, A., Klempel, M. C., Bhutani, S., Hoddy, K. K., Gabel, K., Freels, S., Rigdon, J., Rood, J., et al. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.0936 · Cited by 645 · see citing works
Salas-Salvadó, J., Díaz-López, A., Ruiz-Canela, M., Basora, J., Fitó, M., Corella, D., Serra-Majem, L., Wärnberg, J., Romaguera, D., Estruch, R., et al. (2019) · Diabetes Care · doi:10.2337/dc18-0836 · Cited by 445 · see citing works
Harris, L., Hamilton, S., Azevedo, L. B., Olajide, J., De Brún, C., Waller, G., Whittaker, V., Sharp, T., Lean, M., Hankey, C., et al. (2018) · JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2016-003248 · Cited by 319 · see citing works
Intermittent Fasting in Cardiovascular Disorders—An Overview
Malinowski, B., Zalewska, K., Węsierska, A., Sokołowska, M. M., Socha, M., Liczner, G., Pawlak-Osińska, K., & Wiciński, M. (2019) · Nutrients · doi:10.3390/nu11030673 · Cited by 290 · see citing works
Interleukin-6, C-reactive protein and biochemical parameters during prolonged intermittent fasting.
Aksungar, F. B., Topkaya, A. E., & Akyildiz, M. (2007) · Annals of Nutrition and Metabolism · doi:10.1159/000100954 · Cited by 230 · see citing works
Corley, B. T., Carroll, R. W., Hall, R. M., Weatherall, M., Parry‐Strong, A., & Krebs, J. D. (2018) · Diabetic Medicine · doi:10.1111/dme.13595 · Cited by 217 · see citing works
Cioffi, I., Evangelista, A., Ponzo, V., Ciccone, G., Soldati, L., Santarpia, L., Contaldo, F., Pasanisi, F., Ghigo, E., & Bo, S. (2018) · Journal of Translational Medicine · doi:10.1186/s12967-018-1748-4 · Cited by 190 · see citing works
Ketogenic diets and physical performance
Phinney, S. D. (2004) · Nutrition & Metabolism · doi:10.1186/1743-7075-1-2 · Cited by 122 · see citing works
Effects of fasting on insulin action and glucose kinetics in lean and obese men and women
Bergman, B. C., Cornier, M.-A., Horton, T. J., & Bessesen, D. H. (2007) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00613.2006 · Cited by 87 · see citing works
Keogh, J. B., Pedersen, E., Petersen, K. S., & Clifton, P. M. (2014) · Clinical Obesity · doi:10.1111/cob.12052 · Cited by 70 · see citing works
Harder-Lauridsen, N. M., Nielsen, S. T., Mann, S. P., Lyngbæk, M. P., Benatti, F. B., Langkilde, A. R., Law, I., Wedell-Neergaard, A.-S., Thomsen, C., Møller, K., et al. (2017) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00846.2016 · Cited by 27 · see citing works
Flagged first, then by citations
Research works printed but not linked: 4
- Wilhelmi de Toledo F, Grundler F, Bergouignan A, Drinda S, Michalsen A. Safety, health improvement and well-being during a 4 to 21-day fasting period in an observational study including 1422 subjects. PLOS One 2019;14(1):e0209353. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Williamson DA, Bray GA, Ryan DH. Is 5% weight loss a satisfactory criterion to define clinically significant weight loss? Obesity 2015;23(12):2319-20. [DOI] [PubMed] [Google Scholar]
- Wirth MD, Burch J, Shivappa N, Steck SE, Hurley TG, Vena JE, et al. Dietary inflammatory index scores differ by shift work status: NHANES 2005 to 2010. Journal of Occupational and Environmental Medicine 2014;56(2):145-8. [PMID: ] [DOI] [PMC free article] [PubMed] [Google Scholar]
- Allaf M, Elghazaly H, Mohamed OG, Fareen MF, Zaman S, Salmasi AM, et al. Intermittent fasting for the prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2019, Issue 11. Art. No: CD013496. [DOI: 10.1002/14651858.CD013496] [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
Cited by
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Circadian disruption and human health
Fishbein, A. B., Knutson, K. L., & Zee, P. C. (2021) · Journal of Clinical Investigation · doi:10.1172/jci148286 · Cited by 468 · see citing works
Silverii, G. A., Cresci, B., Benvenuti, F., Santagiuliana, F., Rotella, F., & Mannucci, E. (2023) · Nutrition, Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2023.05.005 · Cited by 34 · see citing works
Huang, J., Li, Y., Chen, M., Cai, Z., Cai, Z., & Jiang, Z. (2024) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-024-01657-9 · Cited by 25 · see citing works
Nutrition, dietary recommendations, and supplements for patients with congenital heart disease
Lorente, M., Azpiroz, M. J., Guedes, P., Burgos, R., Lluch, A., & Dos, L. (2023) · International Journal of Cardiology Congenital Heart Disease · doi:10.1016/j.ijcchd.2023.100449 · Cited by 9 · see citing works
- Authors
- Allaf, M., Elghazaly, H., Mohamed, O. G., Fareen, M. F. K., Zaman, S., Salmasi, A.-M., Tsilidis, K., & Dehghan, A.
- Affiliations
- Imperial College London (GB)
- London North West Healthcare NHS Trust (GB)
- Department of Epidemiology and Biostatistics, School of Public Health; Imperial College London; London UK
- ORCID
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2021-01-29
- Volume
- 2021
- Issue
- 3
- Pages
- CD013496-CD013496
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC8092432
- OpenAlex
- W2991261186
- Cited by
- 98
- References
- 26
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 25 · 2023: 23 · 2022: 19 · 2021: 10 · 2020: 1
- FWCI
- 2.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Keywords
- intermittent fasting, cardiovascular disease prevention, alternate-day fasting, time-restricted feeding, continuous energy restriction, cardiometabolic risk factors, body weight, blood glucose, cardiovascular mortality, stroke, myocardial infarction, heart failure, all-cause mortality, adverse effects, quality of life, lifestyle intervention, dietary restriction, physical activity, sleep duration, sleep quality
- MeSH terms
- Adult, Blood Glucose, Body Weight, Cardiovascular Diseases, Fasting, Feeding Behavior, Humans, Quality of Life, Time Factors, Bias, Randomized Controlled Trials as Topic, Caloric Restriction
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