Friday, April 22, 2022

Intermittent fasting is no more beneficial than daily calorie restriction

 Intermittent fasting, a practice on the rise, is tested in a randomized study published by 'The New England'.



Intermittent fasting in obese patients was no more beneficial than daily calorie restriction, according to work published this week in The New England Journal of Medicine . The researchers, from Nanfang Hospital in Guangzhou, China, and the Department of Epidemiology at Tulane University in New Orleans, United States, randomly assigned 139 obese patients to intermittent fasting - eating only between 8 a.m. and 4 p.m. 4 pm - with caloric restriction or only daily caloric restriction. for a year, the participants followed a diet consisting of 1,500-1,800 kilocalories per day for men and 1,200-1,500 kilocalories per day for women.

The primary endpoint of the study was the difference in weight loss in the two groups . Secondary endpoints were waist diameter, body mass index, amount of body fat, and measures of metabolic risk factors.

The patients received a daily protein shake to improve adherence to the allowed calorie intake. They also received dietary advice from professionals trained in nutrition, recipes and sample menus, phone calls and app messages twice a week, as well as individual meetings every fortnight with their nutritional coach to ensure they did not drop out.

In total, 118 (84.9%) completed the follow-up. The mean weight loss was 8 kilograms in the intermittent fasting arm and 6.3 kilograms in the calorie restriction arm. Therefore, changes in weight were not significantly different in both groups and the same was true for both secondary endpoints and adverse events.

In addition, The New England Journal of Medicine publishes an editorial, by Blandine Laferrere and Satchidananda Panda, which indicates the limitations of this work: the time that patients had to eat was scarce , the sample was small and the application of this test to a larger population is debatable, among other things.

UTILITY OF DIGITAL PLATFORMS

However, the editorial authors stress that, despite its limitations, "the study provides an important benchmark for lifestyle dietary intervention , combining quality, quantity and timing of nutrition. And it shows that the increasing use of digital platforms that incorporate self-monitoring by patients and frequent feedback to complete the intervention".

Finally, they point out that the concept of intermittent fasting is evolving and that future studies will determine the correct length of the window of time to eat , who will benefit most from this approach, how to apply it and the potential mechanisms to do it, in addition to the effects of intermittent fasting during the day , compared to doing it in the afternoon or at night . "From a public health standpoint, intermittent fasting could become an approach to achieving calorie restriction and improving metabolic health, without the resource-intensive approach of intentional calorie restriction ," they conclude.

FEWER DROPOUTS, SIMILAR RESULT

Francisco Botella , coordinator of the Nutrition area of ​​the Spanish Society of Endocrinology and Nutrition (SEEN), highlights that the work methodology achieves few dropouts. "Until now, in all intermittent fasting studies, we had dropout rates of approximately 40%. But, despite having a lower rate, the results are similar: it is one more way to lose weight that is as effective -or as ineffective- as the tools currently available, it adds nothing," he stresses.

Another aspect that he points out is that the available studies , to date, are short-term . The reason, from his point of view, is that it is an eating habit that is not very compatible with social or family life. "And, if we add to adherence problems the contraindications of intermittent fasting in liver and kidney diseases, types of diabetes, eating behavior disorders, in pregnant women... intermittent fasting is restricted to people with a little overweight , with slightly elevated cholesterol levels or high blood pressure. And with a great social cost in the changes of habit to achieve the same results of a traditional diet", he emphasizes.

In his opinion, the ideal trial should be a long-term one, with a higher n, that quantifies the association of intermittent fasting with reductions in heart attacks, aging, atherosclerosis, inflammation, cancer or Alzheimer's. As he concludes, "these are very preliminary lines that basic research is addressing."

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