间歇性禁食和肥胖相关的健康结果

Abstract

Importance  Several meta-analyses of randomized clinical trials (RCTs) have demonstrated the many health benefits of intermittent fasting (IF). However, there has been little synthesis of the strength and quality of this evidence in aggregate to date.

Objective  To grade the evidence from published meta-analyses of RCTs that assessed the associations of IF (zero-calorie alternate-day fasting, modified alternate-day fasting, the 5:2 diet, and time-restricted eating) with obesity-related health outcomes.

Evidence Review  PubMed, Embase, and Cochrane database of systematic reviews were searched from database inception to January 12, 2021. Data analysis was conducted from April 2021 through July 2021. Meta-analyses of RCTs investigating effects of IF in adults were included. The effect sizes of IF were recalculated using a random-effects model. We assessed the quality of evidence per association by applying the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluations) as high, moderate, low, and very low.

Findings  A total of 11 meta-analyses comprising 130 RCTs (median [IQR] sample size, 38 [24-69] participants; median [IQR] follow-up period, 3 [2-5] months) were included describing 104 unique associations of different types of IF with obesity-related health outcomes (median [IQR] studies per association, 4 [3-5]). There were 28 statistically significant associations (27%) that demonstrated the beneficial outcomes for body mass index, body weight, fat mass, low-density lipoprotein cholesterol, total cholesterol, triglycerides, fasting plasma glucose, fasting insulin, homeostatic model assessment of insulin resistance, and blood pressure. IF was found to be associated with reduced fat-free mass. One significant association (1%) supported by high-quality evidence was modified alternate-day fasting for 1 to 2 months, which was associated with moderate reduction in body mass index in healthy adults and adults with overweight, obesity, or nonalcoholic fatty liver disease compared with regular diet. Six associations (6%) were supported by moderate quality evidence. The remaining associations found to be significant were supported by very low (75 associations [72%]) to low (22 associations [21%]) quality evidence.

Conclusions and Relevance  In this umbrella review, we found beneficial associations of IF with anthropometric and cardiometabolic outcomes supported by moderate to high quality of evidence, which supports the role of IF, especially modified alternate-day fasting, as a weight loss approach for adults with overweight or obesity. More clinical trials with long-term follow-up are needed to investigate the effects of IF on clinical outcomes such as cardiovascular events and mortality.

摘要翻译（仅供参考）

重要性  随机临床试验 (RCT) 的几项荟萃分析证明了间歇性禁食 (IF) 的许多健康益处。然而，迄今为止，几乎没有对该证据的强度和质量进行综合综合。

目的  对已发表的 RCT 荟萃分析的证据进行分级，这些荟萃分析评估了 IF（零卡路里隔日禁食、改良隔日禁食、5:2 饮食和限时饮食）与肥胖相关健康的关联结果。

证据审查  PubMed、Embase 和 Cochrane 的系统评价数据库从数据库建立到 2021 年 1 月 12 日进行了搜索。数据分析从 2021 年 4 月到 2021 年 7 月进行。包括调查 IF 对成人影响的 RCT 的荟萃分析。使用随机效应模型重新计算 IF 的效应大小。我们通过将 GRADE 标准（推荐分级、评估、发展和评估）应用为高、中、低和非常低来评估每个协会的证据质量。

发现  总共包括 11 项荟萃分析，包括 130 项 RCT（中位数 [IQR] 样本量，38 [24-69] 名参与者；中位数 [IQR] 随访期，3 [2-5] 个月）描述了 104不同类型的 IF 与肥胖相关的健康结果（每个协会的中位数 [IQR] 研究，4 [3-5]）。有 28 个具有统计学意义的关联 (27%) 证明了体重指数、体重、脂肪量、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、空腹血糖、空腹胰岛素、胰岛素抵抗的稳态模型评估的有益结果，和血压。发现 IF 与减少的无脂肪质量有关。一项由高质量证据支持的显着关联 (1%) 是改良的隔日禁食 1 至 2 个月，与常规饮食相比，这与健康成人和超重、肥胖或非酒精性脂肪肝疾病成人的体重指数适度降低有关。六个关联 (6%) 得到中等质量证据的支持。其余被发现显着的关联得到了非常低（75 个关联 [72%]）到低（22 个关联 [21%]）质量证据的支持。

结论和相关性  在本综述中，我们发现 IF 与人体测量学和心脏代谢结果的有益关联得到了中等至高质量证据的支持，这支持 IF 的作用，尤其是改良的隔日禁食，作为成人减肥的一种方法超重或肥胖，需要更多的长期随访临床试验来研究 IF 对心血管事件和死亡率等临床结果的影响。