Article type
Abstract
Background: Several meta-analyses of randomized clinical trials (RCTs) have demonstrated the many health benefits of intermittent fasting. However, a quantitative comparison of the benefits of different intermittent fasting regimens is lacking and in need to date.
Objective: We attempt to conduct a systematic review with network meta-analysis (NMA) to combine all available direct and indirect evidence to assess the benefits of different patterns of intermittent fasting in adults with overweight or obesity.
Methods: This systematic review and network meta-analysis included searches of PubMed, Embase, and Cochrane Library (CENTRAL) from inception to November, 2023, for RCTs of intermittent fasting regimens in adults with overweight and obesity. We performed frequentist random-effect NMAs to summarise the evidence and applied the Grading of Recommendations Assessment, Development, and Evaluation frameworks to rate the certainty of evidence. The study was registered with PROSPERO, CRD42023394790.
Results: A total of 49 articles involving 44 unique trials were identified with 4959 participants across five regimens (time-restricted feeding, Periodic Fasting or 5:2 diet, alternate day fasting, continuous energy restriction and regular diet/ad libitum feeding) . All intermittent fasting regimens significantly reduced bodyweight from baseline compared with regular diet/ad libitum feeding, with mean differences (MDs) ranging from 2.27 kg (95% confidence interval, CI: 1.55 to 2.98, low certainty) for time-restricted feeding to 3.74kg (95% CI: 2.85 to 4.64, high certainty) for (modified) alternate day fasting. Only time-restricted feeding was superior to regular diet/ad libitum feeding with moderate certainty for improving C reactive protein. We did not identify the effects of the regimens on diastolic blood pressure, low-density and high-density lipoprotein cholesterol with only low certainty evidence available. Evidence regarding systolic blood pressure, total cholesterol, and triacylglycerol was of low certainty, failing to provide compelling evidence of benefit.
Conclusion: In adults with overweight and obesity, high to moderate certainty evidence shows that intermittent fasting regimens, result in modest weight loss and BMI, especially (modified) alternate day fasting. More clinical trials with long-term follow-up are needed to investigate the effects of intermittent fasting regimens on cardiovascular risk factors.
Objective: We attempt to conduct a systematic review with network meta-analysis (NMA) to combine all available direct and indirect evidence to assess the benefits of different patterns of intermittent fasting in adults with overweight or obesity.
Methods: This systematic review and network meta-analysis included searches of PubMed, Embase, and Cochrane Library (CENTRAL) from inception to November, 2023, for RCTs of intermittent fasting regimens in adults with overweight and obesity. We performed frequentist random-effect NMAs to summarise the evidence and applied the Grading of Recommendations Assessment, Development, and Evaluation frameworks to rate the certainty of evidence. The study was registered with PROSPERO, CRD42023394790.
Results: A total of 49 articles involving 44 unique trials were identified with 4959 participants across five regimens (time-restricted feeding, Periodic Fasting or 5:2 diet, alternate day fasting, continuous energy restriction and regular diet/ad libitum feeding) . All intermittent fasting regimens significantly reduced bodyweight from baseline compared with regular diet/ad libitum feeding, with mean differences (MDs) ranging from 2.27 kg (95% confidence interval, CI: 1.55 to 2.98, low certainty) for time-restricted feeding to 3.74kg (95% CI: 2.85 to 4.64, high certainty) for (modified) alternate day fasting. Only time-restricted feeding was superior to regular diet/ad libitum feeding with moderate certainty for improving C reactive protein. We did not identify the effects of the regimens on diastolic blood pressure, low-density and high-density lipoprotein cholesterol with only low certainty evidence available. Evidence regarding systolic blood pressure, total cholesterol, and triacylglycerol was of low certainty, failing to provide compelling evidence of benefit.
Conclusion: In adults with overweight and obesity, high to moderate certainty evidence shows that intermittent fasting regimens, result in modest weight loss and BMI, especially (modified) alternate day fasting. More clinical trials with long-term follow-up are needed to investigate the effects of intermittent fasting regimens on cardiovascular risk factors.