近日，加拿大多伦多大学John L Sievenpiper团队研究了间歇性禁食策略及其对体重和其他心脏代谢危险因素的影响。这一研究成果于2025年6月18日发表在《英国医学杂志》上。

为了从随机临床试验中评估间歇性禁食饮食，持续能量限制或无限制（随意）饮食对中间心脏代谢结局的影响，研究组检索Medline、Embase和中央数据库从成立到2024年11月14日中关于比较间歇性禁食饮食（隔日禁食、限时进食和全天禁食）、持续能量限制和随意饮食的随机临床试验，进行了一项系统评价和网络meta分析。

主要结局包括体重（主要）和人体测量、葡萄糖代谢、脂质谱、血压、C反应蛋白和肝脏疾病标志物。数据综合基于频率框架的网络meta分析，数据以95%置信区间（ci）的均值差表示。采用推荐评估、发展和评价分级（GRADE）来评估证据的确定性。

研究组纳入99项随机临床试验，涉及6582名不同健康状况的成年人（720人健康，5862人存在健康状况）。与随意饮食相比，所有间歇性禁食和持续能量限制饮食策略都能减轻体重。与持续能量限制相比，隔日禁食是间歇性禁食饮食策略中唯一显示出体重减轻益处的形式（平均差为1.29 kg (95% CI为1.99至0.59)，证据确定性中等）。此外，与限时进食和全天禁食相比，隔日禁食显示体重的轻微减少（平均差值分别为1.69 kg（2.49 - 0.88）和1.05 kg(1.90 - 0.19)，两者都具有中等确定性的证据）。

随访时间少于24周的试验（n=76）的估计值相似；然而，中远期试验（≥24周，n=17）仅显示与随意饮食相比，饮食策略在减轻体重方面的益处。此外，在间歇性禁食策略的比较中，与限时饮食相比，隔日禁食降低了总胆固醇、甘油三酯和非高密度脂蛋白。然而，与全天禁食相比，限时进食导致总胆固醇、低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇的小幅增加。间歇性禁食、持续能量限制和随意饮食对HbA1c和高密度脂蛋白的影响没有差异。

研究结果表明，在一些间歇性禁食饮食和持续能量限制之间存在微小差异，在较短时间的试验中，隔日禁食有一定的减肥效果。目前的证据提供了一些迹象表明，间歇性禁食饮食在减肥和心血管代谢风险因素方面与持续能量限制具有相似的益处。需要更长时间的试验来进一步证实这些发现。

附：英文原文

Title: Intermittent fasting strategies and their effects on body weight and other cardiometabolic risk factors: systematic review and network meta-analysis of randomised clinical trials

Author: Zhila Semnani-Azad, Tauseef A Khan, Laura Chiavaroli, Victoria Chen, Hardil Anup Bhatt, Alisia Chen, Nicholas Chiang, Julianah Oguntala, Stefan Kabisch, David CW Lau, Sean Wharton, Arya M Sharma, Leanne Harris, Lawrence A Leiter, James O Hill, Frank B Hu, Michael EJ Lean, Hana Kahleová, Dario Rahelic, Jordi Salas-Salvadó, Cyril WC Kendall, John L Sievenpiper

Issue&Volume: 2025/06/18

Abstract:

Objective

To assess the effect of intermittent fasting diets, with continuous energy restriction or unrestricted (ad-libitum) diets on intermediate cardiometabolic outcomes from randomised clinical trials.

Design

Systematic review and network meta-analysis.

Data sources

Medline, Embase, and central databases from inception to 14 November 2024.

Eligibility criteria for selecting studies

Randomised clinical trials comparing the association of intermittent fasting diets (alternate day fasting, time restricted eating, and whole day fasting), continuous energy restriction, and ad-libitum diets were included.

Main outcomes

Outcomes included body weight (primary) and measures of anthropometry, glucose metabolism, lipid profiles, blood pressure, C-reactive protein, and markers of liver disease.

Data synthesis

A network meta-analysis based on a frequentist framework was performed with data expressed as mean difference with 95% confidence intervals (CIs). The certainty of the evidence was assessed using grading of recommendations assessment, development, and evaluation (GRADE).

Results

99 randomised clinical trials involving 6582 adults of varying health conditions (720 healthy, 5862 existing health conditions) were identified. All intermittent fasting and continuous energy restriction diet strategies reduced body weight when compared with ad-libitum diet. Compared with continuous energy restriction, alternate day fasting was the only form of intermittent fasting diet strategy to show benefit in body weight reduction (mean difference 1.29 kg (95% CI 1.99 to 0.59), moderate certainty of evidence). Additionally, alternate day fasting showed a trivial reduction in body weight compared with both time restricted eating and whole day fasting (mean difference 1.69 kg (2.49 to 0.88) and 1.05 kg (1.90 to 0.19), respectively, both with moderate certainty of evidence). Estimates were similar among trials with less than 24 weeks follow-up (n=76); however, moderate-to-long-term trials (≥24 weeks, n=17) only showed benefits in weight reduction in diet strategies compared with ad-libitum. Furthermore, in comparisons between intermittent fasting strategies, alternate day fasting lowered total cholesterol, triglycerides, and non-high density lipoprotein compared with time restricted eating. Compared with whole day fasting, however, time restricted eating resulted in a small increase in total cholesterol, low density lipoprotein cholesterol, and non-high density lipoprotein cholesterol. No differences were noted between intermittent fasting, continuous energy restriction, and ad-libitum diets for HbA1c and high density lipoprotein.

Conclusions

Minor differences were noted between some intermittent fasting diets and continuous energy restriction, with some benefit of weight loss with alternate day fasting in shorter duration trials. The current evidence provides some indication that intermittent fasting diets have similar benefits to continuous energy restriction for weight loss and cardiometabolic risk factors. Longer duration trials are needed to further substantiate these findings.

DOI: 10.1136/bmj-2024-082007

Source: https://www.bmj.com/content/389/bmj-2024-082007