- •Intermittent and continuous energy restriction resulted in similar weight loss after one year in men and women with obesity.
- •Both diets improved cardiovascular risk factors.
- •Feeling of hunger may limit long-term adherence to intermittent energy restriction.
Background & aims
Long-term adherence to conventional weight-loss diets is limited while intermittent fasting has risen in popularity. We compared the effects of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk factors in adults with abdominal obesity and ≥1 additional component of metabolic syndrome.
Methods & results
In total 112 participants (men [50%] and women [50%]) aged 21–70 years with BMI 30–45 kg/m2 (mean 35.2 [SD 3.7]) were randomized to intermittent or continuous energy restriction. A 6-month weight-loss phase including 10 visits with dieticians was followed by a 6-month maintenance phase without additional face-to-face counselling. The intermittent energy restriction group was advised to consume 400/600 kcal (female/male) on two non-consecutive days. Based on dietary records both groups reduced energy intake by ∼26–28%. Weight loss was similar among participants in the intermittent and continuous energy restriction groups (8.0 kg [SD 6.5] versus 9.0 kg [SD 7.1]; p = 0.6). There were favorable improvements in waist circumference, blood pressure, triglycerides and HDL-cholesterol with no difference between groups. Weight regain was minimal and similar between the intermittent and continuous energy restriction groups (1.1 kg [SD 3.8] versus 0.4 kg [SD 4.0]; p = 0.6). Intermittent restriction participants reported higher hunger scores than continuous restriction participants on a subjective numeric rating scale (4.7 [SD 2.2] vs 3.6 [SD 2.2]; p = 0.002).
Both intermittent and continuous energy restriction resulted in similar weight loss, maintenance and improvements in cardiovascular risk factors after one year. However, feelings of hunger may be more pronounced during intermittent energy restriction.
Acronyms:BMI (body mass index), TG (triglycerides), CRP (C-reactive protein), RMR (resting metabolic rate), PAL (physical activity level), IPAQ-SF (International Physical Activity Questionnaire-Short form), TDEE (total daily energy expenditure)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Nutrition, Metabolism and Cardiovascular Diseases
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Organizational update: the world health organization global status report on noncommunicable disease 2014; one more landmark step in the combat against stroke and vascular disease.Stroke J Cerebral Circ. 2015; 46: e 121-122
- Guidelines (2013) 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 published by the obesity Society and American College of Cardiology/American heart Association Task Force on practice guidelines. Based on a systematic review from the the obesity expert panel, 2013.Obesity (Silver Spring). 2014 Jul; 22: S5-S39https://doi.org/10.1002/oby.20821
- Lifestyle recommendations for the prevention and management of metabolic syndrome: an international panel recommendation.Nutr Rev. 2017 May 1; 75: 307-326https://doi.org/10.1093/nutrit/nux014
- Physiological adaptations to weight loss and factors favouring weight regain.Int J Obes. 2015; 39 (Epub 2015 Apr 21): 1188-1196https://doi.org/10.1038/ijo.2015.59
- The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women.Int J Obes. 2011; 35: 714-727https://doi.org/10.1038/ijo.2010.171
- Alternate-day fasting and chronic disease prevention: a review of human and animal trials.Am J Clin Nutr. 2007; 86: 7-13
- Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults.Am J Clin Nutr. 2009; 90: 1138-1143
- 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: 137-143
- 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: 293-302
- Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study.Int J Obes. 2017 Aug 17; ([Epub ahead of print])https://doi.org/10.1038/ijo.2017.206
- Weight-Loss Outcomes: a Systematic review and meta-analysis of intermittent energy restriction trials lasting a minimum of 6 months.Nutrients. 2016 Jun 8; 8 (pii: E354)https://doi.org/10.3390/nu8060354
- Short-term intermittent energy restriction interventions for weight management: a systematic review and meta-analysis.Obes Rev. 2017 Oct 4; ([Epub ahead of print])https://doi.org/10.1111/obr.12593
- Does sustained weight loss reverse the metabolic syndrome?.Curr Hypertens Rep. 2011 Dec; 13: 456-464https://doi.org/10.1007/s11906-011-0221-z
Kostholdsplanleggeren. https://www.kostholdsplanleggeren.no/[Accessed November 2017].
- A new predictive equation for resting energy expenditure in healthy individuals.Am J Clin Nutr. 1990; 51: 241-247
- Long-term weight loss maintenance for obesity: a multidisciplinary approach.Diabetes Metab Syndr Obes. 2016 Feb 26; 9 (eCollection 2016): 37-46https://doi.org/10.2147/DMSO.S89836
Waist circumference and waist-hip-ratio: report of a WHO expert consultation, Geneva, 8–11 December 2008. http://apps.who.int/iris/bitstream/10665/44583/1/9789241501491_eng.pdf.
- Physical activity in the United States measured by accelerometer.Med Sci Sports Exerc. 2008 Jan; 40: 181-188https://doi.org/10.1249/mss.0b013e31815a51b3
- Calibration of the computer Science and Applications, Inc. accelerometer.Med Sci Sports Exerc. 1998; 30: 777-781
- Best practice methods to apply to measurement of resting metabolic rate in adults: a systematic review.J Am Dietetic Assoc. 2006; 106: 881-903
- Effects of a low glycemic load diet versus a low-fat diet in subjects with and without the metabolic syndrome.Nutr Metab Cardiovasc Dis. 2010; : 195-201
- Sample sizes for clinical trials with normal data.Statist. Med. 2004; 23 (Sealed Envelope Ltd. 2012. Power calculator for continuous outcome non-inferiority trial. [Online] Available from:) ([Accessed Thu Jul 13 2017]): 1921-1986
- Statistical analysis quick reference guidebook with SPSS examples.1st ed. Sage Publications, London2007
- Best (but oft forgotten) practices: testing for treatment effects in randomized trials by separate analyses of changes from baseline in each group is a misleading approach.Am J Clin Nutr. 2015 Nov; 102 (Epub 2015 Sep 9): 991-994https://doi.org/10.3945/ajcn.115.119768
- Maintenance of weight loss after lifestyle interventions for overweight and obesity, a systematic review.Obes Rev. 2010 Dec; 11: 899-906https://doi.org/10.1111/j.1467-789X. 2010.00740.x
- Assessment and lifestyle management of patients with obesity: clinical recommendations from systematic reviews.JAMA. 2014 Sep 3; 312 (Review. Erratum in: JAMA. 2014 Oct 15;312(15):1593): 943-952https://doi.org/10.1001/jama.2014.10432
- Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults: a randomized clinical trial.JAMA Intern Med. 2017 Jul 1; 177: 930-938
- Do intermittent diets provide physiological benefits over continuous diets for weight loss? A systematic review of clinical trials.Mol Cell Endocrinol. 2015 Dec 15; 418 (Epub 2015 Sep. 16): 153-172https://doi.org/10.1016/j.mce.2015.09.014
- Compensatory mechanisms activated with intermittent energy restriction: a randomized control trial.Clin Nutr. 2017 Apr 7; (pii: S0261–5614(17)30125-5 [Epub ahead of print])https://doi.org/10.1016/j.clnu.2017.04.002
- Is two days of intermittent energy restriction per week a feasible weight loss approach in obese males? A randomised pilot study.Nutr Diet. 2017 Aug 9; ([Epub ahead of print])https://doi.org/10.1111/1747-0080.12372
Published online: March 29, 2018
Accepted: March 20, 2018
Received in revised form: March 19, 2018
Received: January 4, 2018Handling Editor: A. Siani
© 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.