title: Effects of alternate-day fasting or daily calorie restriction on body composition, fat distribution, and circulating adipokines: Secondary analysis of a randomized controlled trial. Effect of Low-Energy-Dense Diet Rich in Multiple Functional Foods on Weight-Loss Maintenance, Inflammation, and Cardiovascular Risk Factors: A Randomized Controlled Trial Low energy density diet, weight loss maintenance, and risk of cardiovascular disease following a recent weight reduction program: A randomized control trial Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease The effects of moderate energy restriction on apnoea severity and CVD risk factors in obese patients with obstructive sleep apnoea. Effect of energy restriction and physical exercise intervention on phenotypic flexibility as examined by transcriptomics analyses of mRNA from adipose tissue and whole body magnetic resonance imaging Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial Biomarkers of Dietary Energy Restriction in Women at Increased Risk of Breast Cancer Effects of the amount and intensity of exercise on plasma lipoproteins. Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. Short-term very low calorie diet reduces oxidative stress in obese type 2 diabetic patients. Alternate day fasting increases LDL particle size independently of dietary fat content in obese humans Short term effects of energy restriction and dietary fat sub-type on weight loss and disease risk factors. A nonrandomized controlled clinical pilot trial on 8 wk of intermittent fasting (24 h/wk). Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial Avoiding holiday seasonal weight gain with nutrient-supported intermittent energy restriction: a pilot study A randomized controlled trial comparing effects of a low-energy diet with n-3 polyunsaturated fatty acid supplementation in patients with non-alcoholic fatty liver disease Time-restricted feeding plus resistance training in active females: a randomized trial
abstract: BACKGROUND & AIMS Indirect comparisons suggest that alternate-day fasting ( ADF ) may produce greater improvements in body composition , fat distribution , and /or the adipokine profile compared to daily calorie restriction ( CR ) , but this has not been tested directly . In a pre-planned secondary analysis of a r and omized controlled trial , we compared changes in the VAT : SAT ratio , FFM : total mass ratio , and the adipokine profile between ADF and CR . METHODS Overweight and obese participants ( n = 100 ) were r and omized to 1 ) ADF ( alternating every 24-h between consuming 25 % or 125 % of energy needs ) ; 2 ) CR ( consuming 75 % of needs every day ) ; or 3 ) control ( consuming 100 % of needs every day ) for 24 wk . RESULTS The VAT : SAT ratio did not change in any group . The FFM : total mass ratio increased in both ADF ( 0.03 ± 0.00 ) and CR ( 0.03 ± 0.01 ) compared to the control group ( P < 0.01 ) , with no differences between the intervention groups . Circulating leptin decreased in both the ADF group ( -18 ± 6 % ) and CR group ( -31 ± 10 % ) relative to the control group ( P < 0.05 ) , with no differences between the intervention groups . Circulating levels of adiponectin , resistin , IL-6 , and TNF-α did not change in either intervention group relative to the control group . CONCLUSION ADF and CR similarly improve the FFM : total mass ratio and reduce leptin after a 24-wk intervention . TRIAL REGISTRATION Clinical trials.gov , number NCT00960505 ABSTRACT Background : There are no investigations regarding the effects of consuming low-energy-dense diets rich in multiple functional foods on weight-loss maintenance , inflammatory markers , and cardiovascular disease ( CVD ) risk factors simultaneously . Method : This r and omized controlled trial design was conducted on 90 men and women who were under a previous weight loss diet . Three months of intervention with recruitment at Allzahra Hospital , Isfahan , Iran , was done . Intervention was conducted following achieving 7–11 kg weight loss . Participants were encouraged to consumed these three : an isocaloric control diet ( 50 % of energy from carbohydrate , 35 % from fat , 15 % from protein ) , a low-glycemic-index diet ( LE ) ( 60 % from carbohydrate , 25 % from fat , and 15 % from protein ) , and a low-glycemic-index diet rich in multiple functional foods ( LE + FF ) ( 60 % from carbohydrate , 25 % from fat , and 15 % from protein ) . Fasting blood glucose , serum insulin level , lipid profiles , inflammatory markers , adiponectin , systolic and diastolic blood pressure , and anthropometric measurements were assessed using st and ard guidelines . Results : The percent changes of weight , waist , and body mass index ( BMI ) , systolic and diastolic blood pressure , malondialdehyde ( MDA ) , high-sensitivity C-reactive protein ( hs-CRP ) , tumor necrosis factor ( TNF ) α , total cholesterol , low-density lipoprotein ( LDL ) cholesterol , triglyceride , and fasting blood glucose ( FBS ) were substantially more decreased in the LE + FF group compared to the LE and control groups ( p ≤ 0.03 ) . Percent change of adiponectin among the LE + FF group was significantly more enhanced ( 7.29 ± 0.10 ) compared with the LE group ( 1.28 ± 0.20 ) ( p = 0.001 ) . Significantly more increment in the percent change of total antioxidant capacity ( TAC ) ( 6.91 ± 0.10 ) was obtained among the LE + FF group compared to the LE group ( 1.79 ± 0.04 ) . Conclusions : This study provides established evidence supporting the beneficial effects of a low-energy-dense diet rich in multiple functional foods diet on improving weight-loss maintenance , inflammation , and cardiovascular risk factors Background : Little is known about the effects of a low energy dense diet on weight maintenance and cardiovascular risks following a recent weight reduction . Therefore , we assessed if weight maintenance , lipid profiles , and glycemic control differ between low energy density ( LED ) diet and usual diet consumers following a recent weight reduction . Material s and Methods : In this r and omized controlled clinical trial study in a parallel design , we recruited 70 patients with the history of weight reduction in the recent 1 year .  LED diet contained 30 % fat , 15 % protein , and 55 % carbohydrate was administered to the test group , and a usual diet including 35 % fat , 15 % protein , and 50 % carbohydrate was prescribed to the control group for 7 months . Dietary intake was assessed by using 3 days food records . Biochemical markers and anthropometric measures were done according to the st and ard protocol . Results : Weight reduced in LED diet consumers compared to usual diet consumers ( −0.3 ± 0.2 vs. 1.3 ± 0.4 % , P = 0.002 ) . The results was the same regarding waist circumference ( −0.4 ± 0.2 vs. 0.3 ± 0.1 % , P = 0.004 ) . Fasting blood sugar also decreased in LED diet group ( −9.5 ± 0.8 vs. 0.4 ± 1.0 % , P = 0.0001 ) . LED diet group had a drop in percent change of their total cholesterol ( −0.4 ± 0.5 vs. 2.05 ± 0.4 % , P = 0.04 ) and low-density lipoprotein-cholesterol ( 4.8 ± 0.9 vs. −0.3 ± 0.9 % , P = 0.002 ) . Conclusion : Our findings confirmed beneficial effects of LED diet on attenuating weight regain in subjects with history of recent weight reduction . It might be derived from higher consumption of fruits , vegetables , and fiber among LED diet than usual diet consumers A periodic fasting diet improves markers of metabolic dysfunction , particularly in people already at risk .  Fasting : More than a fad Mice that fast periodically are healthier , metabolically speaking . To explore whether fasting can help people as well , Wei et al. studied 71 people who either consumed a fasting-mimicking diet for 5 days each month for 3 months or maintained their normal diet for 3 months and then switched to the fasting schedule .  The fasting-like diet reduced body weight and body fat , lowered blood pressure , and decreased the hormone IGF-1 , which has been implicated in aging and disease . A post hoc analysis replicated these results and also showed that fasting decreased BMI , glucose , triglycerides , cholesterol , and C-reactive protein ( a marker for inflammation ) . These effects were generally larger in the subjects who were at greater risk of disease at the start of the study . A larger study is needed to replicate these results , but they raise the possibility that fasting may be a practical road to a healthy metabolic system . Calorie restriction or changes in dietary composition can enhance healthy aging , but the inability of most subjects to adhere to chronic and extreme diets , as well as potentially adverse effects , limits their application . We r and omized 100 generally healthy participants from the United States into two study arms and tested the effects of a fasting-mimicking diet (FMD)—low in calories , sugars , and protein but high in unsaturated fats — on markers/risk factors associated with aging and age-related diseases . We compared subjects who followed 3 months of an unrestricted diet to subjects who consumed the FMD for 5 consecutive days per month for 3 months . Three FMD cycles reduced body weight , trunk , and total body fat ; lowered blood pressure ; and decreased insulin-like growth factor 1 ( IGF-1 ) . No serious adverse effects were reported . After 3 months , control diet subjects were crossed over to the FMD program , result ing in a total of 71 subjects completing three FMD cycles . A post hoc analysis of subjects from both FMD arms showed that body mass index , blood pressure , fasting glucose , IGF-1 , triglycerides , total and low-density lipoprotein cholesterol , and C-reactive protein were more beneficially affected in participants at risk for disease than in subjects who were not at risk . Thus , cycles of a 5-day FMD are safe , feasible , and effective in reducing markers/risk factors for aging and age-related diseases . Larger studies in patients with diagnosed diseases or selected on the basis of risk factors are warranted to confirm the effect of the FMD on disease prevention and treatment Nutritional intervention for weight loss is one of the treatment options for  obstructive sleep apnoea ( OSA ) in patients with overweight or obesity . However , the effects of moderate energy restriction on OSA severity are not yet known . The present study aim ed to evaluate the effects of moderate energy restriction on OSA severity and CVD risk factors  in obese patients with OSA . In this 16-week r and omised clinical trial , twenty-one obese subjects aged 20 - 55 years and presenting an apnoea/hypopnoea index (AHI)≥5 events/h were r and omised into two groups : the energy restriction group ( ERG ) and the control group ( CG ) . The ERG was instructed to follow an energy-restricted diet -3347·2 kJ/d ( -800 kcal/d ) and the CG was advised not to change their food intake . At the beginning and at the end of the study , participants underwent evaluation of the following : OSA ( Watch-PAT200 ® ) , nutritional parameters , blood pressure , sympathetic activity , inflammatory biomarkers , metabolic profile and endothelial function . The ERG ( n 11 ) , compared with the CG ( n 10 ) , had a significantly greater reduction in body weight ( Cohen 's d=-1·19 ; P<0·001 ) , in AHI ( Cohen 's d=-0·95 ; P=0·04 ) and in plasma concentrations of adrenaline ( Cohen 's d=-1·02 ; P=0·04 ) as well as a significantly greater increase in minimum O2 saturation ( Cohen 's d=1·08 ; P=0·03 ) . Although energy restriction was not associated with significant improvements in CVD risk factors , medium-to-large effect sizes were observed , suggesting that the statistically non-significant difference between groups may be due to the small sample size . This study suggests that in obese patients with OSA , moderate energy restriction is able to reduce the parameters of OSA severity and sympathetic activity Abstract Overweight and obesity lead to changes in adipose tissue such as inflammation and reduced insulin sensitivity . The aim of this study was to assess how altered energy balance by reduced food intake or enhanced physical activity affect these processes . We studied sedentary subjects with overweight/obesity in two intervention studies , each lasting 12 weeks affecting energy balance either by energy restriction ( ~20 % reduced intake of energy from food ) in one group , or by enhanced energy expenditure due to physical exercise ( combined endurance‐ and strength‐training ) in the other group . We monitored mRNA expression by microarray and mRNA sequencing from adipose tissue biopsies . We also measured several plasma parameters as well as fat distribution with magnetic resonance imaging and spectroscopy . Comparison of microarray and mRNA sequencing showed strong correlations , which were also confirmed using RT‐PCR . In the energy restricted subjects ( body weight reduced by 5 % during a 12 weeks intervention ) , there were clear signs of enhanced lipolysis as monitored by mRNA in adipose tissue as well as plasma concentration of free‐fatty acids . This increase was strongly related to increased expression of markers for M1‐like macrophages in adipose tissue . In the exercising subjects ( glucose infusion rate increased by 29 % during a 12‐week intervention ) , there was a marked reduction in the expression of markers of M2‐like macrophages and T cells , suggesting that physical exercise was especially important for reducing inflammation in adipose tissue with insignificant reduction in total body weight . Our data indicate that energy restriction and physical exercise affect energy‐related pathways as well as inflammatory processes in different ways , probably related to macrophages in adipose tissue Background Alternate day fasting ( ADF ; ad libitum “ feed day ” , alternated with 25 % energy intake “ fast day ” ) , is effective for weight loss and cardio-protection in obese individuals . Whether these effects occur in normal weight and overweight individuals remains unknown . This study examined the effect of ADF on body weight and coronary heart disease risk in non-obese subjects . Methods Thirty-two subjects ( BMI 20–29.9 kg/m2 ) were r and omized to either an ADF group or a control group for 12 weeks . Results Body weight decreased ( P < 0.001 ) by 5.2 ± 0.9 kg ( 6.5 ± 1.0 % ) in the ADF group , relative to the control group , by week 12 . Fat mass was reduced ( P < 0.001 ) by 3.6 ± 0.7 kg , and fat free mass did not change , versus controls . Triacylglycerol concentrations decreased ( 20 ± 8 % , P < 0.05 ) and LDL particle size increased ( 4 ± 1 Å , P < 0.01 ) in the ADF group relative to controls . CRP decreased ( 13 ± 17 % , P < 0.05 ) in the ADF group relative to controls at week 12 . Plasma adiponectin increased ( 6 ± 10 % , P < 0.01 ) while leptin decreased ( 40 ± 7 % , P < 0.05 ) in the ADF group versus controls by the end of the study . LDL cholesterol , HDL cholesterol , homocysteine and resistin concentrations remained unchanged after 12 weeks of treatment . Conclusion These findings suggest that ADF is effective for weight loss and cardio-protection in normal weight and overweight adults , though further research implementing larger sample sizes is required before solid conclusion can be reached Dietary energy restriction ( DER ) reduces risk of spontaneous mammary cancer in rodents . In humans , DER in premenopausal years seems to reduce risk of postmenopausal breast cancer . Markers of DER are required to develop acceptable DER regimens for breast cancer prevention . We therefore examined markers of DER in the breast , adipose tissue , and serum . Nineteen overweight or obese women at moderately increased risk of breast cancer ( lifetime risk , 1 in 6 to 1 in 3 ) ages between 35 and 45 were r and omly allocated to DER [ liquid diet , 3,656 kJ/d ( 864 kcal/d ) ; n = 10 ] or asked to continue their normal eating patterns  ( n = 9 ) for one menstrual cycle . Biopsies of the breast and abdominal fat were taken before and after the intervention . RNA was extracted from whole tissues and breast epithelium ( by laser capture microdissection ) and hybridized to Affymetrix GeneChips . Longitudinal plasma and urine sample s were collected before and after intervention , and metabolic profiles were generated using gas chromatography-mass spectrometry . DER was associated with significant reductions in weight [ −7.0 ( ±2.3 ) kg ] and in alterations of serum biomarkers of breast cancer risk ( insulin , leptin , total and low-density lipoprotein cholesterol , and triglycerides ) . In both abdominal and breast tissues , as well as isolated breast epithelial cells , genes involved in glycolytic and lipid synthesis pathways ( including stearoyl-CoA desaturase , fatty acid desaturase , and aldolase C ) were significantly down-regulated . We conclude that reduced expressions of genes in the lipid metabolism and glycolytic pathways are detectable in breast tissue following DER , and these may represent targets for DER mimetics as effective chemoprophylactic agents BACKGROUND Increased physical activity is related to reduced risk of cardiovascular disease , possibly because it leads to improvement in the lipoprotein profile . However , the amount of exercise training required for optimal benefit is unknown . In a prospect i ve , r and omized study , we investigated the effects of the amount and intensity of exercise on lipoproteins . METHODS A total of 111 sedentary , overweight men and women with mild-to-moderate dyslipidemia were r and omly assigned to participate for six months in a control group or for approximately eight months in one of three exercise groups : high-amount-high-intensity exercise , the caloric equivalent of jogging 20 mi ( 32.0 km ) per week at 65 to 80 percent of peak oxygen consumption ; low-amount-high-intensity exercise , the equivalent of jogging 12 mi ( 19.2 km ) per week at 65 to 80 percent of peak oxygen consumption ; or low-amount-moderate-intensity exercise , the equivalent of walking 12 mi per week at 40 to 55 percent of peak oxygen consumption . Subjects were encouraged to maintain their base-line body weight . The 84 subjects who complied with these guidelines served as the basis for the main analysis . Detailed lipoprotein profiling was performed by nuclear magnetic resonance spectroscopy with verification by measurement of cholesterol in lipoprotein subfractions . RESULTS There was a beneficial effect of exercise on a variety of lipid and lipoprotein variables , seen most clearly with the high amount of  high-intensity exercise .  The high amount of exercise result ed in greater improvements than did the lower amounts of exercise ( in 10 of 11 lipoprotein variables ) and was always superior to the control condition ( 11 of 11 variables ) . Both lower-amount exercise groups always had better responses than the control group ( 22 of 22 comparisons ) . CONCLUSIONS The highest amount of weekly exercise , with minimal weight change , had widespread beneficial effects on the lipoprotein profile . The improvements were related to the amount of activity and not to the intensity of exercise or improvement in fitness Consecutive survivors of a myocardial infa rct ion from the Southern Hospital , below 70 years of age , were r and omized into a  Control group ( n = 276 ) and a Treatment group ( n = 279 ) . The latter was openly prescribed the combination of clofibrate and nicotinic acid for serum lipid lowering . Each patient should remain in the study for 5 years and be seen regularly every 4 months at a special IHD outpatient clinic within the hospital . The concentration of serum cholesterol and triglyceride was lowered by 13 % and 19 % , respectively , in the Treatment group compared to the Control group . Total mortality was 82 cases in the Control group and 61 in the Treatment group , a 26 % reduction ( p less than 0.05 ) . For patients above 60 years of age in the Treatment group the reduction in mortality was 28 % ( p less than 0.05 ) . IHD mortality was reduced by 36 % ( p less than 0.01 ) in the Treatment group compared to the Control group . The beneficial effect of the serum lipid lowering treatment was related to the serum triglyceride concentration in two ways . First , it only occurred in patients with a triglyceride level greater than 1.5 mmol/l ( n = 216 ) . Secondly , it was most pronounced in the 44 % of the treated patients who had a lowering of the serum triglyceride by 30 % or more , and in this subgroup the reduction of IHD mortality was 60 % ( p less than 0.01 ) . For serum cholesterol there were no such relations . The difference between serum triglycerides and cholesterol concerning these relations to the treatment outcome may be due to the fact that hypertriglyceridaemia was the most common hyperlipidaemia among our patients , occurring in 50 % , while hypercholesterolaemia only occurred in 13 % . Caution should be exercised in the interpretation of the results as the trial was not blind . However , the fact that the decrease in IHD deaths was directly related to the degree of serum triglyceride lowering indicates that it was the drug effect on serum lipids that was responsible for the beneficial effect of the treatment Oxidative stress is higher in obese diabetic than in non-diabetic subjects . This pilot study evaluates oxidative stress during short-term administration of a very low calorie diet in obese persons . Nine obese Type 2 diabetic patients ( age 55+/-5 years , BMI 35.9+/-1.9 kg/m2 ) and nine obese non-diabetic control subjects ( age 52+/-6 years , BMI 37.3+/-2.1 kg/m2 ) were treated by a very low calorie diet ( 600 kcal daily ) during 8 days stay in the hospital . Serum cholesterol , triglycerides , non-esterified fatty acids ( NEFA ) , beta-hydroxybutyrate ( B-HB ) , ascorbic acid ( AA ) , alpha-tocopherol ( AT ) , plasma malondialdehyde ( MDA ) and superoxide dismutase ( SOD ) activity in erythrocytes were measured before and on day 3 and 8 of very low calorie diet administration . A decrease of serum cholesterol and triglyceride concentrations on day 8 was associated with a significant increase of NEFA ( 0.30+/-0.13 vs. 0.47+/-0.11 micromol/l , p<0.001 ) and B-HB ( 0.36+/-.13 vs. 2.23+/-1.00 mmol/l , p<0.001 ) in controls but only of B-HB ( 1.11+/-0.72 vs. 3.02+/-1.95 mmol/l , p<0.001 ) in diabetic patients . A significant decrease of plasma MDA and serum AT together with an increase of SOD activity and AA concentration ( p<0.01 ) was observed in control persons , whereas an increase of SOD activity ( p<0.01 ) was only found in diabetic patients after one week of the very low calorie diet . There was a significant correlation between NEFA or B-HB and SOD activity ( p<0.01 ) . We conclude that one week of a very low calorie diet administration decreases oxidative stress in obese non-diabetic but only partly in diabetic persons . Diabetes mellitus causes a greater resistance to the effects of a low calorie diet on oxidative stress Alternate day fasting ( ADF ) with a low-fat ( LF ) diet increases low-density lipoprotein ( LDL ) particle size . Whether these beneficial effects can be reproduced by a high-fat ( HF ) ADF diet is unclear . This study compared an ADF – HF to an ADF – LF diet on plasma lipids , LDL size and high-density lipoprotein ( HDL ) size .  Thirty-five obese subjects were r and omized to an ADF – HF or ADF – LF diet for 10 weeks . Body weight decreased ( P<0.0001 ) by 4.3±1.0 kg ( 4.8±1.1 % ) and 3.7±0.7 kg ( 4.2±0.8 % ) in the ADF – HF and ADF – LF group , respectively . LDL cholesterol was reduced ( P<0.0001 ) by 19±8 mg/dl ( 18±5 % ) by ADF – HF and 28±7 mg/dl ( 25±3 % ) by ADF – LF . LDL particle size increased ( P<0.005 ) by 3±1 Å in both groups . The proportion of small LDL particles decreased ( P<0.005 ) by 8±2 % and 11±3 % in the ADF – HF and ADF – LF groups , respectively . HDL cholesterol and HDL size remained unchanged . Thus , our results suggest that the ADF – HF diet is equally as effective as the ADF – LF diet in improving LDL particle size and distribution BACKGROUND AND AIMS Decreasing energy intake relative to energy expenditure is the indisputable tenet of weight loss . In addition to caloric restriction modification of the type of dietary fat may provide further benefits . The aim of the present study was to examine the effect of energy restriction alone and with dietary fat modification on weight loss and adiposity , as well as on risk factors for obesity related disease . METHODS AND RESULTS One-hundred and fifty overweight men and women were r and omized into a 3month controlled trial with four low fat ( 30 % energy ) dietary arms : ( 1 ) isocaloric ( LF ) ; ( 2 ) isocaloric with 10 % polyunsaturated fatty acids ( LF-PUFA ) ; ( 3 ) low calorie ( LF-LC ) ( -2MJ ) ; ( 4 ) low calorie with 10 % PUFA ( LF-PUFA-LC ) . Primary outcomes were changes in body weight and body fat and secondary outcomes were changes in fasting levels of leptin , insulin , glucose , lipids and erythrocyte fatty acids . Changes in dietary intake were assessed using 3day food records . One-hundred and twenty-two participants entered the study and 95 completed the study . All groups lost weight and body fat ( P<0.0001 time effect for both ) , but the LC groups lost more weight ( P=0.026 for diet effect ) . All groups reduced total cholesterol levels ( P<0.0001 time effect and P=0.017 intervention effect ) , but the LC and PUFA groups were better at reducing triacylglycerol levels ( P=0.056 diet effect ) . HDL increased with LF-LC and LF-PUFA but not with LF-PUFA-LC ( 0.042 diet effect ) . The LF and LF-LC groups reported greater dietary fat reductions than the two PUFA groups ( P=0.043 ) . CONCLUSION Energy restriction has the most potent effect on weight loss and lipids , but fat modification is also beneficial when energy restriction is more modest OBJECTIVE The aim of the study was to evaluate whether intermittent fasting ( IF ) is an effective preventive measure , and whether it is feasible for healthy volunteers under every day conditions . METHODS A nonr and omized controlled clinical trial on IF was performed with healthy volunteers over a period of 8 wk , and a subsequent 4-mo follow-up . Outcomes were assessed at baseline , after 8 wk , and after 6 mo . Volunteers who were not interested in fasting  served as a control group . Participants in the fasting group were asked to continue their regular nutritional habits on the nonfasting days , whereas the control group maintained their habitual nutrition throughout the whole period . Outcomes included changes of metabolic parameters ( insulin , glucose , insulin resistance , insulin-like growth factor-1 , brain-derived neurotropic factor , lipids , liver enzymes , hemoglobin A1c ) and coagulation markers ; bioelectrical impedance analysis ; body mass index ; abdominal girth ; blood pressure ; general quality of life ( five-item World Health Organization Well-Being Index [ WHO-5 ] question naire ) , as well as mood and anxiety ( Hospital Anxiety and Depression Scale [ HADS ] , Profile of Mood States , Flourishing-Scale , visual analog scale , Likert scales ) . The intervention consisted of a fasting day , which was repeated every week for 8 wk , with abstinence from solid food between 00:00 and 23:59 at minimum and a maximum caloric intake of 300 kcal on each fasting day . A per- protocol analysis was performed . P < 0.05 was considered significant . RESULTS Thirty-six volunteers were included ; 22 allocated themselves to the fasting group , and 14 to the control group . Thirty-three data sets were included in the final analysis . Although significant in-group changes were observed in both groups for a number of outcomes after 8 wk and 6 mo , no significant between-group differences were observed for any outcome other than overall body fat mass after 8 wk as well as for the HADS total score and the WHO-5 total score after 6 mo , all in favor of the fasting group . However , none of the between-group differences were clinical ly relevant . CONCLUSIONS We did not find any clinical ly relevant differences between groups in this controlled clinical pilot trial of 8 wk of IF in healthy volunteers . Further clinical research in this field is warranted to further analyze mechanisms and effects of IF Abstract Objective To test the effectiveness and safety of a total diet replacement ( TDR ) programme for routine treatment of obesity in a primary care setting . Design Pragmatic , two arm , parallel group , open label , individually r and omised controlled trial . Setting 10 primary care practice s in Oxfordshire , UK . Participants 278 adults who were obese and seeking support to lose weight : 138 were assigned to the TDR programme  and 140 to usual care . 73 % of participants were re-measured at 12 months . Interventions The TDR programme comprised weekly behavioural support for 12 weeks and monthly support for three months , with formula food products providing 810 kcal/day ( 3389 kJ/day ) as the sole food during the first eight weeks followed by re introduction of food . Usual care comprised behavioural support for weight loss from a practice nurse and a diet programme with modest energy restriction . Main outcome measures The primary outcome was weight change at 12 months analysed as intention to treat with mixed effects models . Secondary outcomes included biomarkers of cardiovascular and metabolic risk . Adverse events were recorded . Results Participants in the TDR group lost more weight ( −10.7 kg ) than those in the usual care group ( −3.1 kg ) : adjusted mean difference −7.2 kg ( 95 % confidence interval −9.4 to −4.9 kg ) . 45 % of participants in the TDR group and 15 % in the usual care group experienced weight losses of 10 % or more . The TDR group showed greater improvements in biomarkers of cardiovascular and metabolic risk than the usual care group . 11 % of participants in the TDR group and 12 % in the usual care group experienced adverse events of moderate or greater severity . Conclusions Compared with regular weight loss support from a practice nurse , a programme of weekly behavioural support and total diet replacement providing 810 kcal/day seems to be tolerable , and leads to substantially greater weight loss and greater improvements in the risk of cardiometabolic disease . Trial registration International St and ard R and omised Controlled Trials No IS RCT N75092026 This pilot r and omised controlled study evaluated the effects of a nutrient-supported intermittent energy restriction nutrition programme to prevent weight gain in healthy overweight adults during the 6-week winter holiday period between Thanksgiving and New Year . For 52 d , twenty-two overweight adults ( mean age 41·0 years , BMI 27·3 kg/m2 ) were assigned to either the nutrition programme ( n 10 ; two fasting days of 730 kcal/d ( 3050 kJ/d ) of balanced shake and dietary supplements to support weight management efforts , followed by 5 d of habitual diet ) or a control group ( n 12 ; habitual diet ) . A significant weight loss from baseline ( pre-holiday 10 d before Thanksgiving ) to day 52 ( post-holiday 3 January ) was observed in the nutrition programme ( 75·0 ( sd 9·8 ) v. 76·3 ( sd 9·8 ) kg ; P < 0·05 ) . Body weight did not significantly change in the control group and there was no between-group difference . Increases from baseline in fasting insulin ( 42·9 % ; P = 0·0256 ) , up date d homoeostasis model assessment ( HOMA2 ) ( 43 % ; P = 0·025 ) , LDL-cholesterol ( 8·4 % ; P = 0·0426 ) and total cholesterol ( 7·1 % ; P = 0·0154 ) levels were also reported in the control group . In the nutrition programme group , baseline HDL-cholesterol and TAG levels measured after two fasting days increased ( 13 % ; P = 0·0245 ) and decreased ( 22·8 % ; P = 0·0416 ) , respectively . There was no significant change in HOMA2 . Between-group differences in changes in insulin levels ( P = 0·0227 ) , total cholesterol : HDL-cholesterol ratio ( P = 0·0419 ) and HOMA2 ( P = 0·0210 ) were significant . Overall compliance rate was 98 % and no severe adverse events were reported . These preliminary findings suggest that this intermittent energy restriction intervention might support weight management efforts and help promote metabolic health during the winter holiday season Background : Weight loss is the cornerstone of NAFLD management , but weight maintenance is difficult . Some studies have suggested that n-3 polyunsaturated fatty acid ( n-3 PUFA ) might have beneficial effects in NAFLD . We aim to compare the effects of a low-energy diet with n-3 PUFA supplementation on liver enzymes , body composition , and cardiometabolic risk factors in NAFLD . Material s and Methods : The study was a r and omized controlled trial conducted in Urmia in Iran from October 2016 to May 2017 . One hundred and fourteen eligible patients were r and omly assigned to one of the three following groups : low-energy diet group , n-3 PUFA supplementation ( fish oil ) group ( 1500 mg/d ) , or control group for 12 weeks . Liver enzymes , lipid profile , insulin resistance , and body composition were assessed before and after the intervention . Results : One hundred and four patients completed the study . All groups lost weight , but the reductions were greater in the diet group ( −2.97 ± 2.79 kg , P = 0.001 ) . The diet group had significant decreases in fat mass compared to other groups . Insulin resistance , total cholesterol , and low-density lipoprotein cholesterol significantly decreased only in the diet group , and patients who lost weight ≥4 % showed significantly larger decreases in serum liver enzymes . N-3 PUFA had no beneficial effects on the study outcomes . Conclusion : We found that 1500 mg/d n-3 PUFA supplied for 12 weeks , in contrast to 3.40 ± 2.98 % weight loss , does not improve liver enzymes , body composition , and cardiometabolic risk factors in NAFLD patients ABSTRACT Background A very limited amount of research has examined intermittent fasting ( IF ) programs , such as time-restricted feeding ( TRF ) , in active population s. Objective Our objective was to examine the effects of TRF , with or without β-hydroxy β-methylbutyrate ( HMB ) supplementation , during resistance training ( RT ) . Methods This study employed a r and omized , placebo-controlled , reduced factorial design and was double-blind with respect to supplementation in TRF groups . Resistance-trained females were r and omly assigned to a control diet ( CD ) , TRF , or TRF plus 3 g/d HMB ( TRFHMB ) . TRF groups consumed all calories between 1200 h and 2000 h , whereas the CD group ate regularly from breakfast until the end of the day . All groups completed 8 wk of supervised RT and consumed supplemental whey protein .  Body composition , muscular performance , dietary intake , physical activity , and physiological variables were assessed . Data were analyzed prior to unblinding using mixed models and both intention-to-treat ( ITT ) and per protocol ( PP ) frameworks . Results Forty participants were included in ITT , and 24 were included in PP . Energy and protein intake ( 1.6 g/kg/d ) did not differ between groups despite different feeding duration s ( TRF and TRFHMB : ∼7.5 h/d ; CD : ∼13 h/d ) . Comparable fat-free mass ( FFM ) accretion ( + 2 % to 3 % relative to baseline ) and skeletal muscle hypertrophy occurred in all groups . Differential effects on fat mass ( CD : + 2 % ; TRF : −2 % to −4 % ; TRFHMB : −4 % to −7 % ) were statistically significant in the PP analysis , but not ITT . Muscular performance improved without differences between groups . No changes in physiological variables occurred in any group , and minimal side effects were reported . Conclusions IF , in the form of TRF , did not attenuate RT adaptations in resistance-trained females .  Similar FFM accretion , skeletal muscle hypertrophy , and muscular performance improvements can be achieved with dramatically different feeding programs that contain similar energy and protein content during RT . Supplemental HMB during fasting periods of TRF did not definitively improve outcomes . This study was prospect ively registered at clinical trials.gov as NCT03404271
target: Relative to a non-diet control , IF and ERD are effective for the improvement of circulating TC , LDL-C , and TG concentrations , but have no meaningful effects on HDL-C concentration .
  The present results suggest that these dietary practice s are a means of enhancing the lipid profile in humans
background: OBJECTIVES To the best of our knowledge , no systematic review and meta- analysis has evaluated the cholesterol-lowering effects of intermittent fasting ( IF ) and energy-restricted diets ( ERD ) compared with control groups .
  The aim of this review and meta- analysis was to summarize the effects of controlled clinical trials examining the influence of IF and ERD on lipid profiles .