■在一系列随机对照试验(RCT)中发现了间歇性禁食(IF)对健康相关结局的益处。我们的总括审查旨在系统分析和综合有关IF的现有因果证据及其对特定健康相关结果的影响,同时评估其证据质量。
■我们全面搜索了PubMed,Embase,WebofScience,和Cochrane数据库(从开始到2024年1月8日),以确定相关的系统评价和荟萃分析RCT调查IF和人类健康结局之间的关联。我们将每个荟萃分析的效应大小重新计算为平均差(MD)或标准化平均差(SMD)以及相应的95%置信区间(CI)。根据三种特定状态对人群进行了亚组分析:糖尿病,超重或肥胖,和代谢综合征。使用评估系统评价的测量工具(AMSTAR)评估系统评价的质量,证据的确定性是使用建议分级来评估的,评估,发展,和评估(等级)系统。本研究在PROSPERO(CRD42023382004)注册。
■来自23个meta分析和34个健康结局的共351个关联被纳入研究。调查了广泛的结果,包括人体测量(n=155),血脂谱(n=83),血糖分布(n=57),循环系统指数(n=41),食欲(n=9),和其他人(n=6)。根据AMSTAR标准,有346个关联的21个(91%)荟萃分析被评为高置信度。在103个关联中,汇总效应估计值在p<0.05处显着,其中10人(10%)根据等级得到了高确定性证据的支持。具体来说,与超重或肥胖成人的非干预饮食相比,如果腰围减少(WC)(MD=-1.02cm;95%CI:-1.99至-0.06;p=0.038),脂肪质量(MD=-0.72kg;95%CI:-1.32至-0.12;p=0.019),空腹胰岛素(SMD=-0.21;95%CI:-0.40至-0.02;p=0.030),低密度脂蛋白胆固醇(LDL-C)(SMD=-0.20;95%CI:-0.38至-0.02;p=0.027),总胆固醇(TC)(SMD=-0.29;95%CI:-0.48至-0.10;p=0.003),和三酰基甘油(TG)(SMD=-0.23;95%CI:-0.39至-0.06;p=0.007),但无脂肪质量(FFM)增加(MD=0.98kg;95%CI:0.18-1.78;p=0.016)。值得注意的是,与非干预饮食相比,改良隔日禁食(MADF)可降低脂肪量(MD=-0.70kg;95%CI:-1.38至-0.02;p=0.044)。超重或肥胖的人,和2型糖尿病,与连续能量限制(CER)相比,IF会增加高密度脂蛋白胆固醇(HDL-C)水平(MD=0.03mmol/L;95%CI:0.01-0.05;p=0.010)。然而,在超重或肥胖的成年人中,IF在降低收缩压(SBP)方面的效果不如CER饮食(SMD=0.21;95%CI:0.05-0.36;p=0.008)。
■我们的研究结果表明,如果对超重或肥胖的成年人的一系列健康结果可能有有益的影响,与CER或非干预饮食相比。具体来说,如果可能会降低WC,脂肪量,LDL-C,TG,TC,空腹胰岛素,和SBP,同时增加HDL-C和FFM。值得注意的是,值得注意的是,IF降低SBP的作用似乎弱于CER。
■这项工作得到了国家重点研究发展计划(Q-JW)的支持,中国自然科学基金(Q-JW和T-TG),中国医科大学附属盛京医院优秀科学基金(Q-JW),中国医科大学附属盛京医院(T-TG)345人才项目。
UNASSIGNED: Benefits of Intermittent fasting (IF) on health-related outcomes have been found in a range of randomised controlled trials (RCTs). Our umbrella
review aimed to systematically analyze and synthesize the available causal evidence on IF and its impact on specific health-related outcomes while evaluating its evidence quality.
UNASSIGNED: We comprehensively searched the PubMed, Embase, Web of Science, and Cochrane databases (from inception up to 8 January 2024) to identify related systematic reviews and meta-analyses of RCTs investigating the association between IF and human health outcomes. We recalculated the effect sizes for each meta-analysis as mean difference (MD) or standardized mean difference (SMD) with corresponding 95% confidence intervals (CIs). Subgroup analyses were performed for populations based on three specific status: diabetes, overweight or obesity, and metabolic syndrome. The quality of systematic reviews was evaluated using A Measurement Tool to Assess Systematic Reviews (AMSTAR), and the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. This study is registered with PROSPERO (CRD42023382004).
UNASSIGNED: A total of 351 associations from 23 meta-analyses with 34 health outcomes were included in the study. A wide range of outcomes were investigated, including anthropometric measures (n = 155), lipid profiles (n = 83), glycemic profiles (n = 57), circulatory system index (n = 41), appetite (n = 9), and others (n = 6). Twenty-one (91%) meta-analyses with 346 associations were rated as high confidence according to the AMSTAR criteria. The summary effects estimates were significant at p < 0.05 in 103 associations, of which 10 (10%) were supported by high certainty of evidence according to GRADE. Specifically, compared with non-intervention diet in adults with overweight or obesity, IF reduced waist circumference (WC) (MD = -1.02 cm; 95% CI: -1.99 to -0.06; p = 0.038), fat mass (MD = -0.72 kg; 95% CI: -1.32 to -0.12; p = 0.019), fasting insulin (SMD = -0.21; 95% CI: -0.40 to -0.02; p = 0.030), low-density lipoprotein cholesterol (LDL-C) (SMD = -0.20; 95% CI: -0.38 to -0.02; p = 0.027), total cholesterol (TC) (SMD = -0.29; 95% CI: -0.48 to -0.10; p = 0.003), and triacylglycerols (TG) (SMD = -0.23; 95% CI: -0.39 to -0.06; p = 0.007), but increased fat free mass (FFM) (MD = 0.98 kg; 95% CI: 0.18-1.78; p = 0.016). Of note, compared with the non-intervention diet, modified alternate-day fasting (MADF) reduced fat mass (MD = -0.70 kg; 95% CI: -1.38 to -0.02; p = 0.044). In people with overweight or obesity, and type 2 diabetes, IF increases high-density lipoprotein cholesterol (HDL-C) levels compared to continuous energy restriction (CER) (MD = 0.03 mmol/L; 95% CI: 0.01-0.05; p = 0.010). However, IF was less effective at reducing systolic blood pressure (SBP) than a CER diet in adults with overweight or obesity (SMD = 0.21; 95% CI: 0.05-0.36; p = 0.008).
UNASSIGNED: Our findings suggest that IF may have beneficial effects on a range of health outcomes for adults with overweight or obesity, compared to CER or non-intervention diet. Specifically, IF may decreased WC, fat mass, LDL-C, TG, TC, fasting insulin, and SBP, while increasing HDL-C and FFM. Notably, it is worth noting that the SBP lowering effect of IF appears to be weaker than that of CER.
UNASSIGNED: This work was supported by the National Key Research and Development Program of China (Q-JW), the Natural Science Foundation of China (Q-JW and T-TG), Outstanding Scientific Fund of Shengjing Hospital of China Medical University (Q-JW), and 345 Talent Project of Shengjing Hospital of China Medical University (T-TG).