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

Abstract

Background:

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

Objective:

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.

Design:

Randomized comparison of a 25% energy restriction as IER (2710 kJ/day for 2 days/week) or CER (6276 kJ/day for 7 days/week) in 107 overweight or obese (mean (±s.d.) body mass index 30.6 (±5.1) kg m−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.

Results:

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) μU ml−1 and for insulin resistance was −1.2 (−1.5 to −1.0) μU mmol−1 l−1 (both P=0.04).

Conclusion:

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.

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Acknowledgements

Michelle N Harvie: study conception and design, trial management and manuscript preparation. Mary Pegington: running the trial, statistical analysis and manuscript preparation. Mark P Mattson: consultation, assays at NIH and manuscript preparation. Jan Frystyk and Allan Flyvbjerg: consultation, IGF-1 assays and manuscript preparation. Bernice Dillon: GEE modelling. Jack Cuzick: design of the trial, statistical advice and manuscript preparation. Gareth Evans: recruitment of subjects, consultation and manuscript preparation. Susan Jebb: MRC HNR assays, consultation and manuscript preparation. Bronwen Martin: BDNF and ghrelin assays and manuscript preparation. Roy G Cutler: AOPP and total ketone bodies assays. Tae G Son: AOPP and total ketone bodies assays. Stuart Maudsley: BDNF and ghrelin assay validation. Olga D Carlson: technical assistance with NIH assays. Josephine M Egan: BDNF and ghrelin assay validation and manuscript preparation. Anthony Howell: study conception and design, manuscript preparation. We thank Julie Morris for her invaluable statistical advice, Helen Sumner for coordinating sample storage and processing, Rosemary Greenhaugh and Jenny Affen for assisting in recruitment and sample collection, Emma Campbell for quality-of-life analysis, Lorraine Darmody, Angela Foster, Jane Eaton and Philippa Quirk for clerical support, Padraig McQuaid for help with dietary analysis. Aram Rudenski for advice on the HOMA model. We dedicate this paper to Andrew Shenton (database manager) who died tragically at a young age on 19 February 2008. Funding: Breast Cancer Campaign, World Cancer Research Fund, Genesis Appeal Manchester UK, Intramural Research Program of the National Institute on Aging of the NIH, the Danish Research Council for Health and Disease, Tanita Europe BV Middlesex UK for provision of Tanita TBF-300.

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Harvie, M., Pegington, M., Mattson, M. 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 35, 714–727 (2011). https://doi.org/10.1038/ijo.2010.171

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  • DOI: https://doi.org/10.1038/ijo.2010.171

Keywords

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

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