Effect of intermittent versus continuous calorie restriction on body weight and cardiometabolic risk markers in subjects with overweight or obesity and mild-to-moderate hypertriglyceridemia: a randomized trial

Mahsa Maroofi, Javad Nasrollahzadeh, Mahsa Maroofi, Javad Nasrollahzadeh

Abstract

Background: Intermittent calorie restriction (ICR) is a novel method of dietary restriction for body weight control with the potential to improve obesity-related cardiometabolic markers, but the impact of this diet on subjects with hypertriglyceridemia (HTG) remains unknown.

Methods: Eighty-eight subjects with overweight or obesity and mild-to-moderate HTG were randomized to the continuous calorie restriction (CCR) group, or ICR group (a very low-calorie diet during 3 days of the week) for 8 weeks (44 patients in each group). Body composition, plasma lipids, glucose, insulin, adiponectin, and liver enzymes were measured at baseline and after 8 weeks. An intention-to-treat analysis was performed.

Results: The body weight decreased in both groups (4.07 ± 1.83 kg in the CCR group and 4.57 ± 2.21 kg in the ICR group) with no significant difference between the groups. There was no significant difference between the two groups in the reduced amount of fat mass, fat-free mass, and waist circumference. Both groups achieved a significant reduction in plasma triglycerides after 8 weeks (by 15.6 and 6.3% in ICR and CCR groups, respectively) with no difference between treatment groups. HOMA-IR improved significantly in ICR compared to the CCR group (P = 0.03). Plasma glucose, insulin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, liver enzyme, and adiponectin were not different between the two groups.

Conclusions: The results of this short-term study suggest that three-days a week of the ICR is comparable to a CCR diet for the reduction of triglycerides level in patients with HTG and in the short-term it appears to be more effective than continuous dieting in improving insulin resistance. However, longer-term studies are needed to confirm these findings.

Trial registration: Trial registration number: NCT04143971 .

Keywords: Body weight, intermittent, triglycerides; Calorie restriction; Hypertriglyceridemia; Insulin; Obesity.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the study

References

    1. Fava MC, Agius R, Fava S. Obesity and cardio-metabolic health. Br J Hosp Med (Lond) 2019;80:466–471. doi: 10.12968/hmed.2019.80.8.466.
    1. Fan W, Philip S, Granowitz C, Toth PP, Wong ND. Prevalence of US Adults with Triglycerides >/= 150 mg/dl: NHANES 2007-2014. Cardiol Ther. 2020;9(1):207–13.
    1. Nordestgaard BG. Triglyceride-rich lipoproteins and atherosclerotic cardiovascular disease: new insights from epidemiology, genetics, and biology. Circ Res. 2016;118:547–563. doi: 10.1161/CIRCRESAHA.115.306249.
    1. Toth PP, Philip S, Hull M, Granowitz C. Elevated triglycerides (>/=150 mg/dL) and high triglycerides (200-499 mg/dL) are significant predictors of new heart failure diagnosis: a real-world analysis of high-risk statin-treated patients. Vasc Health Risk Manag. 2019;15:533–538. doi: 10.2147/VHRM.S221289.
    1. Hansen SEJ, Madsen CM, Varbo A, Nordestgaard BG. Low-grade inflammation in the association between mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis: a study of more than 115000 individuals from the general population. Clin Chem. 2019;65:321–332. doi: 10.1373/clinchem.2018.294926.
    1. Guerrero-Romero F, Rodriguez-Moran M. Hypertriglyceridemia is associated with development of metabolic glucose disorders, irrespective of glucose and insulin levels: a 15-year follow-up study. Eur J Intern Med. 2014;25:265–269. doi: 10.1016/j.ejim.2014.01.015.
    1. Kametani T, Koshida H, Nagaoka T, Miyakoshi H. Hypertriglyceridemia is an independent risk factor for development of impaired fasting glucose and diabetes mellitus: a 9-year longitudinal study in Japanese. Intern Med. 2002;41:516–521. doi: 10.2169/internalmedicine.41.516.
    1. Jaacks LM, Vandevijvere S, Pan A, McGowan CJ, Wallace C, Imamura F, Mozaffarian D, Swinburn B, Ezzati M. The obesity transition: stages of the global epidemic. Lancet Diabetes Endocrinol. 2019;7:231–240. doi: 10.1016/S2213-8587(19)30026-9.
    1. Schwartz GG, Abt M, Bao W, DeMicco D, Kallend D, Miller M, Mundl H, Olsson AG. Fasting triglycerides predict recurrent ischemic events in patients with acute coronary syndrome treated with statins. J Am Coll Cardiol. 2015;65:2267–2275. doi: 10.1016/j.jacc.2015.03.544.
    1. Yamanaka M, Sakuma M, Matsushita A, Tanaka S, Yamamoto Y, Asai T, Arai H. The effects of long-term dietary therapy on patients with hypertriglyceridemia. J Atheroscler Thromb. 2019;26:39–49. doi: 10.5551/jat.42440.
    1. Harris L, Hamilton S, Azevedo LB, Olajide J, De Brun C, Waller G, Whittaker V, Sharp T, Lean M, Hankey C, Ells L. Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis. JBI Database System Rev Implement Rep. 2018;16:507–547. doi: 10.11124/JBISRIR-2016-003248.
    1. Ma M, Liu H, Yu J, He S, Li P, Ma C, Zhang H, Xu L, Ping F, Li W, et al. Triglyceride is independently correlated with insulin resistance and islet beta cell function: a study in population with different glucose and lipid metabolism states. Lipids Health Dis. 2020;19:121. doi: 10.1186/s12944-020-01303-w.
    1. Boden G. Obesity, insulin resistance and free fatty acids. Curr Opin Endocrinol Diabetes Obes. 2011;18:139–143. doi: 10.1097/MED.0b013e3283444b09.
    1. Wing RR, Blair EH, Bononi P, Marcus MD, Watanabe R, Bergman RN. Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients. Diabetes Care. 1994;17:30–36. doi: 10.2337/diacare.17.1.30.
    1. Harris L, McGarty A, Hutchison L, Ells L, Hankey C. Short-term intermittent energy restriction interventions for weight management: a systematic review and meta-analysis. Obes Rev. 2018;19:1–13. doi: 10.1111/obr.12593.
    1. Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh YO. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr. 1990;51:241–247. doi: 10.1093/ajcn/51.2.241.
    1. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Food and Nutrition Board IoMotNAo, Sciences . Dietary Reference Intake for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: National Academies Press; 2002.
    1. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–419. doi: 10.1007/BF00280883.
    1. Keogh JB, Pedersen E, Petersen KS, Clifton PM. Effects of intermittent compared to continuous energy restriction on short-term weight loss and long-term weight loss maintenance. Clin Obes. 2014;4:150–156. doi: 10.1111/cob.12052.
    1. Vickers AJ. The use of percentage change from baseline as an outcome in a controlled trial is statistically inefficient: a simulation study. BMC Med Res Methodol. 2001;1:6. doi: 10.1186/1471-2288-1-6.
    1. Varady KA, Bhutani S, Klempel MC, Kroeger CM. Comparison of effects of diet versus exercise weight loss regimens on LDL and HDL particle size in obese adults. Lipids Health Dis. 2011;10:119. doi: 10.1186/1476-511X-10-119.
    1. Carter S, Clifton PM, Keogh JB. Effect of intermittent compared with continuous energy restricted diet on glycemic control in patients with type 2 diabetes: a randomized noninferiority trial. JAMA Netw Open. 2018;1:e180756. doi: 10.1001/jamanetworkopen.2018.0756.
    1. Trepanowski JF, Kroeger CM, Barnosky A, Klempel MC, Bhutani S, Hoddy KK, Gabel K, Freels S, Rigdon J, Rood J, et al. 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;177:930–938. doi: 10.1001/jamainternmed.2017.0936.
    1. Harvie MN, Pegington M, Mattson MP, Frystyk J, Dillon B, Evans G, Cuzick J, Jebb SA, Martin B, Cutler RG, et al. 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;35:714–727. doi: 10.1038/ijo.2010.171.
    1. Headland ML, Clifton PM, Keogh JB. Effect of intermittent compared to continuous energy restriction on weight loss and weight maintenance after 12 months in healthy overweight or obese adults. Int J Obes. 2019;43:2028–2036. doi: 10.1038/s41366-018-0247-2.
    1. Davis CS, Clarke RE, Coulter SN, Rounsefell KN, Walker RE, Rauch CE, Huggins CE, Ryan L. Intermittent energy restriction and weight loss: a systematic review. Eur J Clin Nutr. 2016;70:292–299. doi: 10.1038/ejcn.2015.195.
    1. Cioffi I, Evangelista A, Ponzo V, Ciccone G, Soldati L, Santarpia L, Contaldo F, Pasanisi F, Ghigo E, Bo S. Intermittent versus continuous energy restriction on weight loss and cardiometabolic outcomes: a systematic review and meta-analysis of randomized controlled trials. J Transl Med. 2018;16:371. doi: 10.1186/s12967-018-1748-4.
    1. Varady KA, Bhutani S, Klempel MC, Kroeger CM, Trepanowski JF, Haus JM, Hoddy KK, Calvo Y. Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial. Nutr J. 2013;12:146. doi: 10.1186/1475-2891-12-146.
    1. Cai H, Qin YL, Shi ZY, Chen JH, Zeng MJ, Zhou W, Chen RQ, Chen ZY. Effects of alternate-day fasting on body weight and dyslipidaemia in patients with non-alcoholic fatty liver disease: a randomised controlled trial. BMC Gastroenterol. 2019;19:219. doi: 10.1186/s12876-019-1132-8.
    1. Bhutani S, Klempel MC, Kroeger CM, Trepanowski JF, Varady KA. Alternate day fasting and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans. Obesity (Silver Spring) 2013;21:1370–1379. doi: 10.1002/oby.20353.
    1. Parks EJ. Effect of dietary carbohydrate on triglyceride metabolism in humans. J Nutr. 2001;131:2772S–2774S. doi: 10.1093/jn/131.10.2772S.
    1. Lemieux I, Lamarche B, Couillard C, Pascot A, Cantin B, Bergeron J, Dagenais GR, Despres JP. Total cholesterol/HDL cholesterol ratio vs LDL cholesterol/HDL cholesterol ratio as indices of ischemic heart disease risk in men: the Quebec cardiovascular study. Arch Intern Med. 2001;161:2685–2692. doi: 10.1001/archinte.161.22.2685.
    1. Gabel K, Kroeger CM, Trepanowski JF, Hoddy KK, Cienfuegos S, Kalam F, Varady KA. Differential effects of alternate-day fasting versus daily calorie restriction on insulin resistance. Obesity (Silver Spring) 2019;27:1443–1450.
    1. Catenacci VA, Pan Z, Ostendorf D, Brannon S, Gozansky WS, Mattson MP, Martin B, MacLean PS, Melanson EL, Troy Donahoo W. A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity. Obesity (Silver Spring) 2016;24:1874–1883. doi: 10.1002/oby.21581.
    1. Trepanowski JF, Kroeger CM, Barnosky A, Klempel M, Bhutani S, Hoddy KK, Rood J, Ravussin E, Varady KA. Effects of alternate-day fasting or daily calorie restriction on body composition, fat distribution, and circulating adipokines: secondary analysis of a randomized controlled trial. Clin Nutr. 2018;37:1871–1878. doi: 10.1016/j.clnu.2017.11.018.
    1. Klempel MC, Varady KA. Reliability of leptin, but not adiponectin, as a biomarker for diet-induced weight loss in humans. Nutr Rev. 2011;69:145–154. doi: 10.1111/j.1753-4887.2011.00373.x.
    1. Berglund L, Brunzell JD, Goldberg AC, Goldberg IJ, Stalenhoef A. Treatment options for hypertriglyceridemia: from risk reduction to pancreatitis. Best Pract Res Clin Endocrinol Metab. 2014;28:423–437. doi: 10.1016/j.beem.2013.10.002.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅