The Anxiety Burden in Patients with Chronic Intestinal Failure on Long-Term Parenteral Nutrition and in Their Caregivers.

Background and aims: Home parenteral nutrition (HPN) is a life-saving treatment for patients affected by chronic intestinal failure (CIF). Both this clinical condition and its therapy require radical lifestyle modifications, affecting life quality and psychological balance in patients as well as family members. Patient psychological burden has rarely been taken into consideration, not to mention that of caregivers. This study aims to evaluate the levels of anxiety in CIF patients on HPN, and their caregivers, consequently determining their impact on the psychological and physical aspects. Methods: After a brief introductory interview, adult patients on HPN for CIF and their caregivers were asked to fill in the HAMA-A questionnaire. Results: Fifty patients and their respective caregivers were enrolled. Mean HAMA-A scores were similar in patients and caregivers and testified the presence of a mild to severe impact of CIF and HPN in both groups, with a significantly higher impact on female patients and caregivers. After adjusting age, education level, duration of CIF and HPN dependence, and degree of kinship, no differences were revealed in the scores. Conclusions: The study confirms that CIF patients on HPN and their caregivers have a significant anxiety burden independently from the duration of the disease, therefore needing appropriate support.

Nutritional Screening and Anthropometry in Patients Admitted From the Emergency Department.

BACKGROUND: Due to the high prevalence of malnutrition among hospitalized patients, screening and assessment of nutritional status should be routinely performed upon hospital admission. The main objective of this observational study was to evaluate the prevalence of and the risk for malnutrition, as identified by using three nutritional screening tests, and to observe whether some anthropometric and functional parameters used for nutritional evaluation were related to these test scores. METHODS: This single-center observational study included 207 patients admitted from the emergency department for hospitalization in either the internal medicine or surgery units of our institution from September 2017 to December 2018. The prevalence of malnutrition among this patient sample was evaluated by using the Nutritional Risk Screening (NRS-2002), the Subjective Global Assessment (SGA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Body mass index (BMI), bioimpedance analysis (BIA), handgrip strength (HGS) and calf circumference (CC) assessments were also performed. RESULTS: According to the NRS-2002, 93% of the patients were at no risk or at low nutritional risk (NRS score < 3), and 7% were at a high nutritional risk (NRS score ≥ 3). On the other hand, according to the SGA, 46.3% of the patients were well-nourished (SGA-a), 49.8% were moderately malnourished (SGA-b), and 3.9% were severely malnourished (SGA-c). Finally, according to the GLIM criteria, 18% patients were malnourished. Body weight, body mass index (BMI), phase angle (PhA), CC and HGS were significantly lower in the patients with NRS scores ≥ 3, SGA-c and in patients with stage 1 and stage 2 malnutrition, according to the GLIM criteria. CONCLUSION: The NRS-2002, the SGA and the GLIM criteria appear to be valuable tools for the screening and assessment of nutritional status. In particular, the lowest NRS-2002, SGA and GLIM scores were associated with the lowest PhA and CC. Nevertheless, a weekly re-evaluation of patients with better screening and assessment scores is recommended to facilitate early detection of changes in nutritional status.

Nutritional indicators and metabolic alterations in outpatients with anorexia nervosa: a retrospective study.

PURPOSE: In patients living with Anorexia Nervosa (AN), dehydration and haemoconcentration, may prevent a correct interpretation of laboratory nutritional parameters. Our study aims to evaluate if some indicators of disease severity, as body mass index (BMI), Phase Angle (PhA) and months of amenorrhea may be predictors of metabolic alterations (serum albumin, liver enzymes). METHODS: In 154 outpatients with AN, case history was collected, and anthropometric and laboratory parameters measured. Patients were divided according to the following tertiles (T) of BMI, duration of amenorrhea and PhA: (1) BMI (T1 < 15.6; T2 15.6-16.8; T3 > 16.8 kg/m2); (2) Amenorrhea duration (T1 < 7; T2 7-14; T3 > 14 months); (3) PhA value (T1 < 4.64; T2 4.64-5.35; T3: > 5.35°). ROC curves were used to determine which of these three indicators (BMI, PhA and amenorrhea duration) might better identify patients belonging to Group A or B (less than 3 or more metabolic abnormalities). RESULTS: The most frequent registered metabolic alterations were for alkaline phosphatase (ALP), alanine aminotransferase, cholesterol and hemoglobin. Aspartate aminotransferase, ALP and gamma glutamyl transferase abnormalities were frequent in the first tertiles of all the three indicators. Albumin was low in the T1 of BMI and PhA. No differences in nutritional alterations emerged according to amenorrhea duration. PhA had the best performance (AUCs: 0.721) in identifying patients with 3 or more abnormalities, with the optimal cut-off value of 4.5°. CONCLUSIONS: Our data confirmed PhA as the more reliable predictor of metabolic alterations, followed by BMI and amenorrhea duration, especially in the first tertile. EVIDENCE-BASED MEDICINE: Level 2.

Long-Term Outcomes from a 10-Year Follow-Up of Women Living with a Restrictive Eating Disorder: A Brief Report.

BACKGROUND: This study aimed to evaluate several socio-demographic and long-term clinical outcomes in a cohort of women living with a restrictive eating disorder. METHODS: Patients were asked to fill in a general data collection form aiming to investigate their current conditions and to attend the outpatient unit for a 10-year follow-up clinical and laboratory evaluation. RESULTS: Forty-four patients completed the follow-up general data collection form and 20 agreed to attend the outpatient unit for the 10 year-follow-up evaluation. In total, 52% of patients were single, 55% had achieved a university degree, and 55% had steady employment. After 10 years, there was a clear improvement in biochemical markers, but cholesterol levels were still slightly high. The prevalence of osteopenia in the whole sample was 70% when measured on the lumbar column and 20% on the total body, while osteoporosis was found in 10% of patients and only on the lumbar column. CONCLUSION: According to the collected data, women with a history of restrictive eating disorders appear to re-adapt well to social life by obtaining the level of their unaffected peers in terms of education and employment.

Acute assessment of subjective appetite and implicated hormones after a hypnosis-induced hallucinated meal: a randomized cross-over pilot trial.

The use of hypnosis can generate hallucinatory phenomena, which ranged from vivid/auditory imagery to fully developed "hallucinations" in selected people. The aim of this pilot trial was investigating the acute effects of a hypnosis-induced hallucinated breakfast (HB) compared to those of a real breakfast (RB) on subjective appetite and appetite-regulating hormones in highly hypnotizable individuals. Eight healthy post-menopausal women were recruited to consume two meals: the HB and the RB in a randomized crossover design. Participants underwent appetite sensations measurements (before meal and each 30-min until 270-min) and blood sample collection (at 0, 20, 60, 90, 180-min). A 3-day food-record was filled after each meal. The adjusted repeated measures ANCOVA did not show any meal×time interactions on subjective appetite postprandially. As expected, significantly higher glucose (p < 0.001), insulin (p < 0.001), and lower free fatty acid (p < 0.001) concentrations were found after the RB, but not following HB. Furthermore, RB significantly increased postprandial levels of glucagon-like-peptide-1 and peptide-YY at 20, 60, 90 and 180-min, whereas acylated-ghrelin and leptin levels did not differ. Postprandial neuropeptide-Y and orexin-A values significantly increased at different time-points after RB, but not following HB, while α-melanocyte-stimulating hormone levels enhanced after HB only. Energy intakes were significantly lower after HB on the test-day only (HB = 1146.6 ± 343.8 vs RB = 1634.7 ± 274.2 kcal/d; p = 0.003). Appetite sensation might be modulated by fully developed meal "hallucination" induced by hypnosis, likely affecting brain-peptides implicated in the appetite regulation. However, further studies are needed to verify these results obtained in a highly selected group of individuals. NCT03934580.

Macronutrients in Parenteral Nutrition: Amino Acids.

The right amount and quality of amino acids (AAs) supplied to patients on parenteral nutrition (PN) reduces muscle mass loss, may preserve or even increase it, with significant clinical benefits. Several industrial PN mixtures are available so that nutrition specialists can choose the product closest to the patient's needs. In selected cases, there is the possibility of personalizing compounded mixtures in a hospital pharmacy that completely meets the individual nutritional needs of PN patients. This narrative review deals with the AA solutions used in PN mixtures. The physiology, the methods to calculate the AA needs, and the AA and energy requirements suggested by scientific guidelines for each patient type are also reported.

Association between Health-Related Quality of Life and Nutritional Status in Adult Patients with Crohn's Disease.

This study aimed to assess health related quality of life (HRQoL) in adult patients with Crohn's disease (CD), considering disease severity and gender differences, and also its relationship with nutritional status. Consecutive adult patients aged 18-65 years with CD were recruited. Disease activity was clinically defined by the Crohn's Disease Activity Index (CDAI) in active and quiescent phases. HRQoL was evaluated using the validated short form (SF)-36 questionnaire for the Italian population. Additionally, anthropometry, bioimpedance analysis, and handgrip-strength (HGS) were performed. Findings showed that 135 patients (79 men and 56 women) were included, having a mean age of 38.8 ± 14 years and a BMI of 23.2 ± 3.7 kg/m2. Overall, active CD patients had a lower perception of their QoL compared to those clinically quiescent, while gender differences emerged mostly in the quiescent group. Interestingly, HRQoL was significantly associated with many nutritional variables, and muscle strength was the main predictor. Therefore, HRQoL is perceived lower in active compared to quiescent patients, but women experienced poorer QoL than men, especially in the quiescent phase. Finally, higher QoL scores were found in subjects being in clinical remission phase with a preserved muscle function. However, further studies are still required to verify these findings.

Nutrition Transition and Cancer.

Urbanization, population aging, and climatic changes have mostly contributed to nutrition transition and, consequently, to effects of food habits on the epidemic of chronic non-communicable diseases (NCDs), especially cancer. Climatic changes are negatively affecting crop production, particularly biodiversity, leading to reduced food choices and, consequently, nutritional value and the protection conferred from consumption of a variety of nutrients essential in a healthy diet. This brief review analyzes the possible link between rapid demographic changes, climatic and environmental crises, and the current food system as possible factors contributing to the role of nutrition transition in the onset of cancer.

Evaluation of nutritional adequacy in adult patients with Crohn's disease: a cross-sectional study.

PURPOSE: Inadequate oral intake may play an important role in the onset of malnutrition in patients with Crohn's disease (CD). The aims of this cross-sectional study were: (1) to compare dietary intake in clinically active and quiescent CD patients, and (2) to assess patients' nutritional adequacy relative to the dietary reference values (DRVs) for the Italian population using LARN (Livelli di Assunzione di Riferimento di Nutrienti ed energia per la popolazione italiana). METHODS: Patients aged between 18 and 65 years with a diagnosis of CD were recruited. All participants underwent anthropometry and were instructed to fill in a 3-day food record. Disease activity was clinically defined using the Crohn's disease activity index (CDAI). RESULTS: Overall, 117 patients, 71 males and 46 females, with a mean age of 39.6 ± 13.8 years and a mean body weight of 65.4 ± 11.8 kg, were ultimately included. Our findings showed that the amount of nutrients was similar between patients with active and quiescent disease. The mean intake of macronutrients was adequate, except for fiber, while dietary micronutrients were insufficient. Median intakes of sodium, phosphorus, and fluorine met LARN recommendations in both sexes, and the DRVs were accomplished by many patients (53/117; 104/117 and 98/117, respectively). Interestingly, dietary amounts of iron and zinc were barely acceptable in males but not in females. However, a few of the patients (< 15) met the LARN for potassium, calcium, and magnesium, regardless of sex and CDAI. With respect to vitamins, no relevant difference was found between the active and quiescent groups, and none of them met recommended values in both sexes. CONCLUSIONS: This study showed that the assessment of dietary intake can be crucial for optimizing dietary intervention with focused nutrition counseling, to improve nutritional status in CD patients.

Assessment of bioelectrical phase angle as a predictor of nutritional status in patients with Crohn's disease: A cross sectional study.

BACKGROUND & AIMS: The assessment of body composition (BC) can be used to identify malnutrition in patients with Crohn's disease (CD). The aim of this study was to evaluate the nutritional status of CD patients by assessing BC, phase angle (PhA) and muscle strength. Differences in disease duration and medications were also considered. METHODS: Consecutive adult CD patients aged 18-65 years were enrolled in this cross-sectional study. Disease activity was clinically defined by the Crohn's Disease Activity Index (CDAI) in the active and quiescent phases. All participants underwent anthropometry, BC and handgrip-strength (HGS) measurements; additionally, blood samples were taken. Data from CD patients were also compared with age-, sex- and BMI-matched healthy people. RESULTS: A total of 140 CD patients with a mean age of 38.8 ± 13.9 years and a mean body weight of 64.9 ± 12 kg were recruited and compared to controls. The findings showed that all nutritional parameters, especially PhA and HGS, were lower in CD patients than in controls, and these parameters were substantially impaired as disease activity increased. Active CD patients had a lower body weight and fat mass than both the quiescent and control groups. PhA was negatively correlated with age (r = -0.362; p = 0.000) and CDAI (r = -0.135; p = 0.001) but was positively associated with fat free mass (FFM) (r = 0.443; p = 0.000) and HGS (r = 0.539; p = 0.000). Similarly, serum protein markers were lower in the active CD group than in the quiescent group (p < 0.05). Disease duration and medications did not significantly affect nutritional status. CONCLUSIONS: BIA-derived PhA is a valid indicator of nutritional status in CD patients, and its values decreased with increasing disease activity. Additionally, small alterations in BC, such as low FFM, and reduced HGS values can be considered markers of nutritional deficiency. Therefore, the assessment of BC should be recommended in clinical practice for screening and monitoring the nutritional status of CD patients.

Nutritional Rehabilitation in Patients with Malnutrition Due to Crohn's Disease.

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory bowel disease frequently associated with malabsorption and secondary protein-energy malnutrition (PEM). METHODS: Biochemical and clinical data of 63 (34 females, 29 males) patients with PEM due to CD sent to our outpatient unit for nutritional evaluation were retrospectively analyzed. Patients were divided into two groups, according to disease activity. Thirty-eight patients (group A) had the active disease, and 25 patients (group B) suffered from malabsorption resulting from past intestinal resections due to CD. After a physical and hemato-biochemical evaluation at the first visit, all patients received disease-specific personalized dietetic indications. When indicated, oral nutritional supplements, oral/parenteral vitamins, micronutrients, and electrolytes, up to parenteral nutrition, were prescribed. RESULTS: After 1, 3, and 6 months of nutritional therapy, body weight, body mass index (BMI), and serum butyryl-cholinesterase significantly improved in both groups. In 8 out of 13 (61.5%) patients with a cutaneous stoma, intestinal continuity was restored. CONCLUSIONS: This study confirms the effectiveness of nutritional rehabilitation and provides information on the time required for nutritional treatment in patients with CD, both during the acute phase and after malabsorption due to intestinal resection.

Assessment of Body Composition in Health and Disease Using Bioelectrical Impedance Analysis (BIA) and Dual Energy X-Ray Absorptiometry (DXA): A Critical Overview.

The measurement of body composition (BC) represents a valuable tool to assess nutritional status in health and disease. The most used methods to evaluate BC in the clinical practice are based on bicompartment models and measure, directly or indirectly, fat mass (FM) and fat-free mass (FFM). Bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA) (nowadays considered as the reference technique in clinical practice) are extensively used in epidemiological (mainly BIA) and clinical (mainly DXA) settings to evaluate BC. DXA is primarily used for the measurements of bone mineral content (BMC) and density to assess bone health and diagnose osteoporosis in defined anatomical regions (femur and spine). However, total body DXA scans are used to derive a three-compartment BC model, including BMC, FM, and FFM. Both these methods feature some limitations: the accuracy of BIA measurements is reduced when specific predictive equations and standardized measurement protocols are not utilized whereas the limitations of DXA are the safety of repeated measurements (no more than two body scans per year are currently advised), cost, and technical expertise. This review aims to provide useful insights mostly into the use of BC methods in prevention and clinical practice (ambulatory or bedridden patients). We believe that it will stimulate a discussion on the topic and reinvigorate the crucial role of BC evaluation in diagnostic and clinical investigation protocols.

Cardiac Changes in Patients on Long-Term Parenteral Nutrition.

Patients with short bowel syndrome (SBS) on long-term home parenteral nutrition (HPN) chronically receive high fluid volumes directly into the right atrium (RA) through the superior vena cava. We retrospectively evaluated cardiac function measured by routine transthoracic echocardiography (TTE) in a population of 26 SBS patients on long-term HPN and compared their data on echocardiograph-derived right heart structure and function, with those of a control group of 26 patients also bearing a central venous catheter (CVC) for other reasons. Results showed that body weight and BMI were significantly higher in the control group. The echocardiographic estimate of RA pressure was higher in HPN patients than in controls (p = 0.01). An increased estimate of RA pressure indicates the need to consider TTE in the follow-up of long-term HPN patients to detect functional impairment early.

Chronic inflammatory liver diseases and coffee intake.

PURPOSE OF REVIEW: To review the healthy protective effects of coffee against several metabolic diseases and some types of cancer. In this short review, the possible preventive and/or therapeutic actions of coffee on liver function is focused. RECENT FINDINGS: The protective mechanisms of coffee are various and because of several components with anti-inflammatory and antioxidant properties in addition to caffeine.As a matter of the fact, polyphenols in decaffeinated coffee have a similar effect on liver fibrosis and on serum levels of liver enzymes as those in caffeinated coffee.Furthermore, diterpenes may exert a detoxifying action and antioxidant activity, with benefits on liver fibrosis, cirrhosis and cancer. SUMMARY: A regular coffee consumption may have preventive healthy effects, especially if consumed without added sugars. Certainly, coffee consumption should not be prohibited in individuals with chronic inflammatory liver diseases, including hepatocellular carcinoma.

Food-Based Dietary Guidelines around the World: Eastern Mediterranean and Middle Eastern Countries.

In Eastern Mediterranean countries, undernutrition and micronutrient deficiencies coexist with overnutrition-related diseases, such as obesity, heart disease, diabetes and cancer. Many Mediterranean countries have produced Food-Based Dietary Guidelines (FBDGs) to provide the general population with indications for healthy nutrition and lifestyles. This narrative review analyses Eastern Mediterranean countries' FBDGs and discusses their pictorial representations, food groupings and associated messages on healthy eating and behaviours. In 2012, both the WHO and the Arab Center for Nutrition developed specific dietary guidelines for Arab countries. In addition, seven countries, representing 29% of the Eastern Mediterranean Region population, designated their national FBDGs. At the moment several of these guidelines are available only in the English language. In summary, Eastern Mediterranean FBDGs mainly focus on food safety, not all are available in the local Arabic language, and they do not provide specific suggestions for the large number of foreign workers and migrants.

Home Parenteral Nutrition in Patients with Intestinal Failure: Possible Undetected Complications.

BACKGROUND: Septic pulmonary embolism (SPE) may be a frequently undetected complication of central venous catheter (CVC)-related bloodstream infections (CRBSIs). MATERIALS AND METHODS: The incidence of SPE was evaluated in a cohort of non-oncological patients on home parenteral nutrition (HPN) who were hospitalized for a CRBSI from January 2013 to December 2017. The main clinical, microbiological, and radiological features and the therapeutic approach were also described. RESULTS: Twenty-three infections over 51,563 days of HPN therapy were observed, corresponding to an infection rate of 0.45/1000. In 10 out of the 23 cases (43.5%), pulmonary lesions compatible with SPE were identified. CONCLUSION: Our results demonstrated that a CRBSI can produce asymptomatic SPE with lung infiltrates in 43.5% of the cases, suggesting the need to check for secondary lung infections to choose the most appropriate antimicrobial therapy.

Resting Energy Expenditure, Body Composition and Phase Angle in Anorectic, Ballet Dancers and Constitutionally Lean Males.

BACKGROUND: The prevalence of anorexia nervosa among males is increasing but few data are available in the literature. This cross sectional study aims to evaluate resting energy expenditure (REE) and phase angle as a marker of qualitative changes of fat free mass (FFM) in three leanness groups as compared with control subjects. METHODS: 17 anorectic (AN) males, 15 constitutionally lean (CL) individuals, 12 ballet dancers (DC), and 18 control (CTR) subjects were evaluated. REE was measured by indirect calorimetry (V max29- Sensormedics), and body composition was evaluated by bioimpedance analysis (BIA) at 50 kHz (DS Medica). Phase angle (a bioimpedance variable related to nutritional status) was used to evaluate differences in FFM characteristics between these three types of leanness. RESULTS: REE, adjusted for FFM and fat mass (FM), were significantly higher in CL and lower in AN individuals (1783 ± 47 vs. 1291 ± 58 kcal, p < 0.05) compared to the other groups. Body composition was similar in AN and CL whereas dancers had the highest FFM (58.9 ± 4.8 kg, p < 0.05); anorectic males showed the lowest phase angle (5.8 ± 1.2 degrees vs. other groups, p < 0.05) and dancers the highest phase angle (7.9 ± 0.7 degree vs. other group, p < 0.05). CONCLUSIONS: Our findings confirm that phase angle could be a useful marker of qualitative changes, above all in the field of sport activities. On the other hand, there is the need to further evaluate the relationship between resting energy expenditure, body composition and endocrine status in different conditions of physical activity and dietary intake.

Are Raw BIA Variables Useful for Predicting Resting Energy Expenditure in Adults with Obesity?

This study aimed to develop and validate new predictive equations for resting energy expenditure (REE) in a large sample of subjects with obesity also considering raw variables from bioimpedance-analysis (BIA). A total of 2225 consecutive obese outpatients were recruited and randomly assigned to calibration (n = 1680) and validation (n = 545) groups. Subjects were also split into three subgroups according to their body mass index (BMI). The new predictive equations were generated using two models: Model 1 with age, weight, height, and BMI as predictors, and Model 2 in which raw BIA variables (bioimpedance-index and phase angle) were added. Our results showed that REE was directly correlated with all anthropometric and raw-BIA variables, while the correlation with age was inverse. All the new predictive equations were effective in estimating REE in both sexes and in the different BMI subgroups. Accuracy at the individual level was high for specific group-equation especially in subjects with BMI > 50 kg/m². Therefore, new equations based on raw-BIA variables were as accurate as those based on anthropometry. Equations developed for BMI categories did not substantially improve REE prediction, except for subjects with a BMI > 50 kg/m². Further studies are required to verify the application of those formulas and the role of raw-BIA variables for predicting REE.

Time trend prevalence of artificial nutrition counselling in a university hospital.

OBJECTIVES: The negative effects of malnutrition on the prognosis of hospitalized patients are well documented; however, less known is the awareness and knowledge of health care professionals about this complication. The aim of this study was to evaluate the trend of the requests for nutritional consultation in years and the prescription of artificial nutrition (AN), for adult patients at a university hospital in southern Italy in the years 2004, 2008, 2012, and 2016 to assess the progress of medical teams concerning awareness of hospital malnutrition. METHODS: This was a retrospective study that evaluated the time trend of nutritional consultation requests and related prescription of AN, for adult patients at a university hospital in southern Italy in the years 2004, 2008, 2012, and 2016. Of 112 233 inpatients, 2505 received a nutritional consultation with the prescription of AN. RESULTS: The number of patients on AN increased from 507 of 33 240 (1.52%) in 2004 to 730 of 29 195 (2.5%) in 2008 (P < 0.001), remaining almost stable in 2012 and 2016. The request for AN was quite equally distributed between surgical (51.5%) and medical wards (48.5%), with a prevalence among patients with oncologic diseases (806 patients [65.6%]). As for nononcologic diseases, 20.4% involved the gastrointestinal tract and 6.3% the nervous system. Throughout the 12 y of observation, parenteral nutrition was the main prescribed support (59.8%) followed by oral nutritional supplements (26.1%) and enteral nutrition (9.3%). Mean nutritional intervention duration was 11 d (±10.8 d). CONCLUSIONS: The request of AN for hospitalized patients increased over time, probably owing to improved medical consciousness of the potential risks for malnutrition and the availability of a specialized clinical nutrition team.

Intermittent versus continuous energy restriction on weight loss and cardiometabolic outcomes: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: This systematic review and meta-analysis summarized the most recent evidence on the efficacy of intermittent energy restriction (IER) versus continuous energy restriction on weight-loss, body composition, blood pressure and other cardiometabolic risk factors. METHODS: Randomized controlled trials were systematically searched from MEDLINE, Cochrane Library, TRIP databases, EMBASE and CINAHL until May 2018. Effect sizes were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). RESULTS: Eleven trials were included (duration range 8-24 weeks). All selected intermittent regimens provided ≤ 25% of daily energy needs on "fast" days but differed for type of regimen (5:2 or other regimens) and/or dietary instructions given on the "feed" days (ad libitum energy versus balanced energy consumption). The intermittent approach determined a comparable weight-loss (WMD: - 0.61 kg; 95% CI - 1.70 to 0.47; p = 0.87) or percent weight loss (WMD: - 0.38%, - 1.16 to 0.40; p = 0.34) when compared to the continuous approach. A slight reduction in fasting insulin concentrations was evident with IER regimens (WMD = - 0.89 µU/mL; - 1.56 to - 0.22; p = 0.009), but the clinical relevance of this result is uncertain. No between-arms differences in the other variables were found. CONCLUSIONS: Both intermittent and continuous energy restriction achieved a comparable effect in promoting weight-loss and metabolic improvements. Long-term trials are needed to draw definitive conclusions.