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Interventions and public health nutrition

Effects of intermittent versus continuous energy restriction for weight loss on diet quality and eating behavior. A randomized trial

European Journal of Clinical Nutrition (2018) | Download Citation



Weight loss diets affect food choices and control of eating. We evaluated the effects of intermittent energy restriction (IER) vs. continuous energy restriction (CER) on nutritional composition and eating behavior.


Individuals with BMI 30–45 kg/m2, abdominal obesity and ≥1 additional metabolic syndrome component were randomized to IER vs. CER with similar energy restriction. Of 112 participants, 98 completed weighed dietary records and the Three Factor Eating Questionnaire at baseline and three months. In statistical analysis, changes were adjusted for baseline values.


Weight loss, energy intake, and macronutrient composition were similar in the IER and CER groups. The CER group reported a greater increase in fruit and berries (45 g/day [95% CI 21, 71] vs. 2 g/day [−28, 33]; p = 0.047) and vegetables (135 g/day [91, 179] vs. 65 g/day [35, 96]; p = 0.010) than the IER group. Fiber intake increased in the CER compared to the IER group (1.0 g/MJ/day [0.8, 1.2] vs. 0.2 [0.0, 0.4]; p < 0.001). Sugar intake was reduced in the CER compared to the IER group (−2.2E% [−3.2, −2.2] vs. −0.1E% [−1.2, 1.0]; p = 0.007). Intakes of folate, potassium, and magnesium decreased more in the IER than the CER group, while vitamin C increased more in the CER group (all p-values <0.014). Both diets improved eating behavior scores, but cognitive restraint increased more in the CER than the IER group (34 [30, 39] vs. 17 [12, 22]; p = 0.013).


Men and women with obesity had more favorable changes in nutritional composition and eating behavior with CER than IER.

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We thank Merete Helgeland MS in Nutrition for assistance with dietary counseling, Hanna Frydenberg MS in Nutrition for help with analyzing the dietary records, Sasa Dusanov MD, Eli Heggen MD PhD and Tor Ole Klemsdal MD PhD for medical examinations, and Ragnhild Kleve and Lise Bergengen for assistance with study procedures.

Author information


  1. Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway

    • T. M. Sundfør
    • , S. Tonstad
    •  & M. Svendsen


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T.M.S., S.T., and M.S. designed the study; T.M.S. conducted the dietary counselling and project supervision; T.M.S. analyzed the data; and T.M.S., S.T., and M.S. wrote the paper. S.T. had primary responsibility for the final content. All authors read and approved the final manuscript.

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The authors declare that they have no conflict of interest.

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Correspondence to T. M. Sundfør.

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