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BACKGROUND: Alternate-day fasting (ADF) has gained popularity in recent years. The diet consists of a "fast day" where an individual consumes 0-25% of their energy needs, alternated with a "feast day" where a person is permitted to eat ad libitum. AIM: This study examined eating behavior traits of successful weight losers during alternate day fasting. METHODS: Obese participants ( n = 34) took part in 12 months of ADF and were grouped into a high (≥5%) or low-weight-loss (<5%) group post-treatment. RESULTS: The high-weight-loss group demonstrated increased ( p = 0.04) fullness, decreased ( p = 0.03) hunger, increased dietary protein intake (15% to 20% of kcal, p = 0.04), and better adherence to fast-day calorie goals. CONCLUSIONS: Thus, individuals who achieve clinically significant weight loss with ADF demonstrate improved satiety, increased protein intake, and better adherence to fast-day calorie goals.
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Dieta Redutora , Proteínas Alimentares/administração & dosagem , Jejum , Comportamento Alimentar , Obesidade/dietoterapia , Cooperação do Paciente , Resposta de Saciedade , Actigrafia , Adulto , Índice de Massa Corporal , Restrição Calórica , Chicago , Ingestão de Energia , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autoeficácia , Autorrelato , Autocontrole , Redução de PesoRESUMO
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 randomized 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 randomized 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: Clinicaltrials.gov, number NCT00960505.
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Adipocinas/sangue , Composição Corporal/fisiologia , Restrição Calórica , Dieta Redutora/métodos , Jejum , Adulto , Peso Corporal , Exercício Físico , Feminino , Humanos , Leptina/sangue , Masculino , Pessoa de Meia-Idade , Obesidade/dietoterapia , Sobrepeso/dietoterapia , Resultado do Tratamento , Redução de PesoRESUMO
BACKGROUND: Alternate day fasting (ADF) is a novel diet therapy that reduces body weight, but its effect on bone health remains unknown. OBJECTIVE: This study examined the impact of ADF versus traditional daily calorie restriction (CR) on markers of bone metabolism in a 6-month randomized controlled trial. METHODS: Overweight and obese subjects (nâ=â100) were randomized to 1 of 3 groups for 6 months: 1) ADF (25% energy intake fast day, alternated with 125% intake feast day; 2) CR (75% intake every day); or 3) control (usual intake every day). RESULTS: Body weight decreased similarly (Pâ<â0.001) by ADF (-7.8±1.2%) and CR (-8.8±1.5%), relative to controls by month 6. Lean mass, total body bone mineral content and total body bone mineral density remained unchanged in all groups. Circulating osteocalcin, bone alkaline phosphatase, and C-terminal telopeptide type I collagen (CTX) did not change in any group. IGF-1 increased (Pâ<â0.01) in the CR group, with no change in the ADF or control group. When the data were sub-analyzed according to menopausal status, there were no differences between premenopausal or postmenopausal women for any marker of bone metabolism. CONCLUSION: These findings suggest that 6 months of ADF does not have any deleterious impact on markers of bone metabolism in obese adults with moderate weight loss.
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Importance: Alternate-day fasting has become increasingly popular, yet, to date, no long-term randomized clinical trials have evaluated its efficacy. Objective: To compare the effects of alternate-day fasting vs daily calorie restriction on weight loss, weight maintenance, and risk indicators for cardiovascular disease. Design, Setting, and Participants: A single-center randomized clinical trial of obese adults (18 to 64 years of age; mean body mass index, 34) was conducted between October 1, 2011, and January 15, 2015, at an academic institution in Chicago, Illinois. Interventions: Participants were randomized to 1 of 3 groups for 1 year: alternate-day fasting (25% of energy needs on fast days; 125% of energy needs on alternating "feast days"), calorie restriction (75% of energy needs every day), or a no-intervention control. The trial involved a 6-month weight-loss phase followed by a 6-month weight-maintenance phase. Main Outcomes and Measures: The primary outcome was change in body weight. Secondary outcomes were adherence to the dietary intervention and risk indicators for cardiovascular disease. Results: Among the 100 participants (86 women and 14 men; mean [SD] age, 44 [11] years), the dropout rate was highest in the alternate-day fasting group (13 of 34 [38%]), vs the daily calorie restriction group (10 of 35 [29%]) and control group (8 of 31 [26%]). Mean weight loss was similar for participants in the alternate-day fasting group and those in the daily calorie restriction group at month 6 (-6.8% [95% CI, -9.1% to -4.5%] vs -6.8% [95% CI, -9.1% to -4.6%]) and month 12 (-6.0% [95% CI, -8.5% to -3.6%] vs -5.3% [95% CI, -7.6% to -3.0%]) relative to those in the control group. Participants in the alternate-day fasting group ate more than prescribed on fast days, and less than prescribed on feast days, while those in the daily calorie restriction group generally met their prescribed energy goals. There were no significant differences between the intervention groups in blood pressure, heart rate, triglycerides, fasting glucose, fasting insulin, insulin resistance, C-reactive protein, or homocysteine concentrations at month 6 or 12. Mean high-density lipoprotein cholesterol levels at month 6 significantly increased among the participants in the alternate-day fasting group (6.2 mg/dL [95% CI, 0.1-12.4 mg/dL]), but not at month 12 (1.0 mg/dL [95% CI, -5.9 to 7.8 mg/dL]), relative to those in the daily calorie restriction group. Mean low-density lipoprotein cholesterol levels were significantly elevated by month 12 among the participants in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9-21.1 mg/dL]) compared with those in the daily calorie restriction group. Conclusions and Relevance: Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs daily calorie restriction. Trial Registration: clinicaltrials.gov Identifier: NCT00960505.
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Restrição Calórica/métodos , Doenças Cardiovasculares/prevenção & controle , Jejum , Obesidade , Adulto , Glicemia/análise , Glicemia/metabolismo , Doenças Cardiovasculares/metabolismo , Dietoterapia/métodos , Jejum/fisiologia , Jejum/psicologia , Comportamento Alimentar/fisiologia , Feminino , Humanos , Insulina/análise , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/dietoterapia , Obesidade/metabolismo , Obesidade/psicologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Cooperação do Paciente , Fatores de Risco , Redução de PesoAssuntos
Diabetes Mellitus/tratamento farmacológico , Hipoglicemiantes , Insulina , Formas de Dosagem , Composição de Medicamentos/métodos , Humanos , Hipoglicemiantes/farmacocinética , Hipoglicemiantes/farmacologia , Insulina/farmacocinética , Insulina/farmacologia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND & AIMS: Alternate day fasting (ADF; 25% energy intake "fast day", alternated with an ad libitum intake "feed day") is effective for weight loss. Whether or not ADF modulates hunger, fullness and gut peptides in a way that enhances dietary compliance and weight loss, remains unknown. Accordingly, this study examined the effect of ADF on postprandial appetite ratings and gut peptides. METHODS: Obese subjects (n = 59) participated in an 8-week ADF protocol where food was provided on the fast day. RESULTS: Body weight decreased (P < 0.0001) by 3.9 ± 0.6 kg after 8 weeks of diet. Reductions (P < 0.05) in fat mass (-2.2 ± 0.2 kg), fat free mass (-1.4 ± 0.2 kg), visceral fat mass (-0.1 ± 0.1 kg), and resting metabolic rate (RMR; -104 ± 28 kcal/day) were also observed. Fasting leptin and insulin decreased (P < 0.05), while AUC ghrelin levels increased (P < 0.05). Despite these metabolic changes, there was no increase in subjective hunger by the end of the study. Furthermore, fullness and PYY increased (P < 0.05). Fat free mass and RMR were not related to hunger or ghrelin at any time point. CONCLUSION: These findings suggest that the absence of a compensatory increase in hunger in conjunction with an increase in sensations of fullness may contribute to the weight loss efficacy of an 8-week ADF regimen.
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Jejum , Grelina/sangue , Fome , Insulina/sangue , Leptina/sangue , Peptídeo YY/sangue , Saciação , Metabolismo Basal , Glicemia/metabolismo , Composição Corporal , Índice de Massa Corporal , Peso Corporal , Dieta , Registros de Dieta , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do PacienteRESUMO
The common insulin concentration in most preparations of insulin is 100 units per mL or U-100. Human regular U-500 insulin was the first concentrated insulin introduced and it has been available in the United States since the 1950s. Humulin R is the only human regular U-500 available on the market. Human regular U-500 is five times more concentrated than U-100 and because of its pharmacodynamic properties, works as both a basal and a bolus insulin. Human regular U500 allows for delivery of a larger insulin dose with a smaller volume leading to better absorption compared to U-100 and has traditionally been used in patients with moderate to severe insulin resistance. More recently other forms of concentrated insulin have become available and the newer concentrated insulin preparations can be used in diabetic patients with or without insulin resistance. Our intent is to provide primary care physicians with a review of the pharmacology and current literature on concentrated insulins as well as recommendations for patient selection, dose initiation, and dose adjustment.
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Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/farmacologia , Insulina/farmacologia , Gravidez em Diabéticas/tratamento farmacológico , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Composição de Medicamentos , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/química , Insulina/sangue , Insulina/química , Insulina Glargina/química , Insulina Glargina/farmacologia , Insulina Lispro/farmacologia , Resistência à Insulina , Insulina de Ação Prolongada/farmacologia , Seleção de Pacientes , GravidezRESUMO
This study examined what characteristics predict weight loss success with alternate day fasting (ADF). Four 8-week trials of ADF (n=121) were included in the analysis. Subjects aged 50-59 y achieved greater (P=0.01) weight loss than other age groups. Males and females achieved similar weight loss. Caucasian subjects achieved greater (P=0.03) weight loss than other races. Baseline body weight and baseline BMI did not predict degree of weight loss achieved with the diet. These findings may help clinicians to decide which population groups may benefit most from an ADF approach.
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Dieta Redutora/métodos , Ingestão de Energia , Jejum , Comportamento Alimentar , Obesidade/dietoterapia , Grupos Raciais , Redução de Peso , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População BrancaRESUMO
Increasing evidence, albeit small, suggests that testosterone replacement therapy can be cautiously considered in selected hypogonadal men treated with curative intent for low-risk prostate cancer and without evidence of active disease.
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BACKGROUND: Alternate day fasting (ADF; ad libitum intake "feed day" alternated with 75% restriction "fast day"), is effective for weight loss, but the safety of the diet has been questioned. Accordingly, this study examined occurrences of adverse events and eating disorder symptoms during ADF. FINDINGS: Obese subjects (n = 59) participated in an 8-week ADF protocol where food was provided on the fast day. Body weight decreased (P < 0.0001) by 4.2 ± 0.3%. Some subjects reported constipation (17%), water retention (2%), dizziness (<20%), and general weakness (<15%). Bad breath doubled from baseline (14%) to post-treatment (29%), though not significantly. Depression and binge eating decreased (P < 0.01) with ADF. Purgative behavior and fear of fatness remained unchanged. ADF helped subjects increase (P < 0.01) restrictive eating and improve (P < 0.01) body image perception. CONCLUSIONS: Therefore, ADF produces minimal adverse outcomes, and has either benign or beneficial effects on eating disorder symptoms.
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Dieta Redutora/efeitos adversos , Dieta Redutora/métodos , Jejum/efeitos adversos , Comportamento Alimentar/psicologia , Redução de Peso , Adulto , Idoso , Imagem Corporal/psicologia , Índice de Massa Corporal , Peso Corporal/fisiologia , Constipação Intestinal/epidemiologia , Constipação Intestinal/etiologia , Depressão/epidemiologia , Depressão/etiologia , Tontura/epidemiologia , Tontura/etiologia , Ingestão de Energia/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Alternate day fasting (ADF; 24-h feeding/24-h 25% energy intake at lunchtime), is effective for weight loss, but diet tolerability is questionable. Moving the fast day meal to dinnertime, or dividing it into smaller meals, may improve tolerability. Accordingly, this study compared the effects of ADF with three meal times on body weight and heart disease risk. METHODS: Obese subjects (n = 74) were randomized to 1 of 3 groups for 8 weeks: 1) ADF-L: lunch, 2) ADF-D: dinner, or 3) ADF-SM: small meals. RESULTS: Body weight decreased similarly (P < 0.001) in all groups (ADF-L: 3.5 ± 0.4 kg, ADF-D 4.1 ± 0.5 kg, ADF-SM 4.0 ± 0.5 kg). Reductions (P < 0.001) in fat mass and visceral fat were also comparable. Plasma lipids remained unchanged, and low density lipoprotein (LDL) particle size increased (P < 0.05) in all groups (1.3 ± 0.5 Å). Systolic blood pressure decreased (P < 0.05) by ADF-SM only. Fasting glucose, insulin, and HOMA-IR remained unchanged. CONCLUSIONS: Thus, allowing individuals to consume the fast day meal at dinner or small meals produces similar weight loss and cardio-protection as consuming the meal at lunch. This flexibility in meal timing may increase tolerability and long-term adherence to ADF protocols.
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Peso Corporal , Doenças Cardiovasculares/prevenção & controle , Dieta Redutora/métodos , Jejum/fisiologia , Obesidade/dietoterapia , Redução de Peso , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Intermittent fasting (IF) regimens have gained considerable popularity in recent years, as some people find these diets easier to follow than traditional calorie restriction (CR) approaches. IF involves restricting energy intake on 1-3 d/wk, and eating freely on the nonrestriction days. Alternate day fasting (ADF) is a subclass of IF, which consists of a "fast day" (75% energy restriction) alternating with a "feed day" (ad libitum food consumption). Recent findings suggest that IF and ADF are equally as effective as CR for weight loss and cardioprotection. What remains unclear, however, is whether IF/ADF elicits comparable improvements in diabetes risk indicators, when compared with CR. Accordingly, the goal of this review was to compare the effects of IF and ADF with daily CR on body weight, fasting glucose, fasting insulin, and insulin sensitivity in overweight and obese adults. Results reveal superior decreases in body weight by CR vs IF/ADF regimens, yet comparable reductions in visceral fat mass, fasting insulin, and insulin resistance. None of the interventions produced clinically meaningful reductions in glucose concentrations. Taken together, these preliminary findings show promise for the use of IF and ADF as alternatives to CR for weight loss and type 2 diabetes risk reduction in overweight and obese populations, but more research is required before solid conclusions can be reached.