Original Article

International Journal of Obesity (2011) 35, 714–727; doi:10.1038/ijo.2010.171; published online 5 October 2010

The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women

M N Harvie1, M Pegington1, M P Mattson2, J Frystyk3, B Dillon4, G Evans1, J Cuzick5, S A Jebb6, B Martin2, R G Cutler2, T G Son2, S Maudsley2, O D Carlson2, J M Egan2, A Flyvbjerg3 and A Howell1

  1. 1Genesis Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  2. 2Laboratory of Neurosciences, National Institute on Aging Intramural Research Program, Baltimore, USA
  3. 3Clinical Institute of Medicine & Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
  4. 4Department of Statistics University Hospital of South Manchester, Manchester, UK
  5. 5CRUK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine, London, UK
  6. 6MRC Human Nutrition Research Group, Cambridge, UK

Correspondence: Dr MN Harvie, Senior Research Dietitian, Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK. E-mail: michelle.harvie@manchester.ac.uk

Received 5 May 2010; Revised 15 July 2010; Accepted 19 July 2010; Published online 5 October 2010.





The problems of adherence to energy restriction in humans are well known.



To compare the feasibility and effectiveness of intermittent continuous energy (IER) with continuous energy restriction (CER) for weight loss, insulin sensitivity and other metabolic disease risk markers.



Randomized comparison of a 25% energy restriction as IER (~2710kJ/day for 2 days/week) or CER (~6276kJ/day for 7 days/week) in 107 overweight or obese (mean (±s.d.) body mass index 30.6 (±5.1)kgm−2) premenopausal women observed over a period of 6 months. Weight, anthropometry, biomarkers for breast cancer, diabetes, cardiovascular disease and dementia risk; insulin resistance (HOMA), oxidative stress markers, leptin, adiponectin, insulin-like growth factor (IGF)-1 and IGF binding proteins 1 and 2, androgens, prolactin, inflammatory markers (high sensitivity C-reactive protein and sialic acid), lipids, blood pressure and brain-derived neurotrophic factor were assessed at baseline and after 1, 3 and 6 months.



Last observation carried forward analysis showed that IER and CER are equally effective for weight loss: mean (95% confidence interval ) weight change for IER was −6.4 (−7.9 to −4.8)kg vs −5.6 (−6.9 to −4.4)kg for CER (P-value for difference between groups=0.4). Both groups experienced comparable reductions in leptin, free androgen index, high-sensitivity C-reactive protein, total and LDL cholesterol, triglycerides, blood pressure and increases in sex hormone binding globulin, IGF binding proteins 1 and 2. Reductions in fasting insulin and insulin resistance were modest in both groups, but greater with IER than with CER; difference between groups for fasting insulin was −1.2 (−1.4 to −1.0)μUml−1 and for insulin resistance was −1.2 (−1.5 to −1.0)μUmmol−1l−1 (both P=0.04).



IER is as effective as CER with regard to weight loss, insulin sensitivity and other health biomarkers, and may be offered as an alternative equivalent to CER for weight loss and reducing disease risk.


intermittent; continuous energy restriction; randomized; premenopausal women; insulin sensitivity

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