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Nutritional strategies for intervention of diabetes and improvement of β-cell function. Biosci Rep 2023; 43:232518. [PMID: 36714968 PMCID: PMC9939408 DOI: 10.1042/bsr20222151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
Diabetes mellitus, especially Type 2 diabetes (T2D), is caused by multiple factors including genetics, diets, and lifestyles. Diabetes is a chronic condition and is among the top 10 causes of death globally. Nutritional intervention is one of the most important and effective strategies for T2D management. It is well known that most of intervention strategies can lower blood glucose level and improve insulin sensitivity in peripheral tissues. However, the regulation of pancreatic β cells by dietary intervention is not well characterized. In this review, we summarized some of the commonly used nutritional methods for diabetes intervention. We then discussed the effects and the underlying mechanisms of nutritional intervention in improving the cell mass and function of pancreatic islet β cells. With emerging intervention strategies and in-depth investigation, we are expecting to have a better understanding about the effectiveness of dietary interventions in ameliorating T2D in the future.
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Varady KA, Cienfuegos S, Ezpeleta M, Gabel K. Clinical application of intermittent fasting for weight loss: progress and future directions. Nat Rev Endocrinol 2022; 18:309-321. [PMID: 35194176 DOI: 10.1038/s41574-022-00638-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 12/15/2022]
Abstract
Intermittent fasting diets have become very popular in the past few years, as they can produce clinically significant weight loss. These diets can be defined, in the simplest of terms, as periods of fasting alternating with periods of eating. The most studied forms of intermittent fasting include: alternate day fasting (0-500 kcal per 'fast day' alternating with ad libitum intake on 'feast days'); the 5:2 diet (two fast days and five feast days per week) and time-restricted eating (only eating within a prescribed window of time each day). Despite the recent surge in the popularity of fasting, only a few studies have examined the health benefits of these diets in humans. The goal of this Review is to summarize these preliminary findings and give insights into the effects of intermittent fasting on body weight and risk factors for cardiometabolic diseases in humans. This Review also assesses the safety of these regimens, and offers some practical advice for how to incorporate intermittent fasting diets into everyday life. Recommendations for future research are also presented.
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Affiliation(s)
- Krista A Varady
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA.
| | - Sofia Cienfuegos
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Mark Ezpeleta
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Kelsey Gabel
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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McDiarmid S, Harvie M, Johnson R, Vyas A, Aglan A, Moran J, Ruane H, Hulme A, Sellers K, Issa BG. Manchester Intermittent versus Daily Diet App Study (MIDDAS): A pilot randomized controlled trial in patients with type 2 diabetes. Diabetes Obes Metab 2022; 24:432-441. [PMID: 34726317 DOI: 10.1111/dom.14592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/20/2021] [Accepted: 10/31/2021] [Indexed: 11/27/2022]
Abstract
AIMS To test the feasibility and potential efficacy of remotely supported intermittent low-energy diets (ILEDs) and continuous low-energy diets (CLEDs) in people with type 2 diabetes (T2D) and the feasibility of a randomized controlled trial comparing the two approaches. MATERIALS AND METHODS Seventy-nine adults with overweight/obesity and T2D (≤8 years duration) were randomized 1:1 to CLED (8 weeks/56 days of daily Optifast 820 kcal (3430 kJ) diet) or isoenergetic ILED (2 days of Optifast and 5 days of a Mediterranean diet/week for 28 weeks). Weight maintenance/continued weight loss was undertaken for the remainder of the 52 weeks. Both groups received frequent telephone or the Oviva app support. Feasibility outcomes included study uptake, retention, app usage, dietary adherence, weight loss and change in glycated haemoglobin (HbA1c) at 52 weeks. RESULTS We enrolled 39 ILED and 40 CLED participants and 27 (69%) ILED and 30 CLED (75%) attended the 52-week follow-up. Eighty-nine per cent (70 of 79) started using the app and 86% (44 of 51) still used the app at 52 weeks. Intention-to-treat analysis at 52 weeks showed percentage weight loss was mean (95% confidence interval) -5.4% (-7.6, -3.1%) for ILED and -6.0% (-7.9, -4.0%) for CLED. HbA1c <48 mmol/mol was achieved in 42% of both groups. Mean (95% confidence interval) changes in the T2D medication effect score were 0.0008 (-0.3, 0.3) for ILED and -0.5 (-0.8, -0.3) for CLED. CONCLUSION The study shows the feasibility and potential efficacy of remotely delivered ILED and CLED programmes for weight loss and HbA1c reduction, and the feasibility of a randomized controlled trial comparing the two approaches.
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Affiliation(s)
- Sarah McDiarmid
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Harvie
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Rhona Johnson
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
| | - Avni Vyas
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Azza Aglan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jacqui Moran
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen Ruane
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Amanda Hulme
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
| | - Katharine Sellers
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Basil G Issa
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
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Abstract
Type-2 diabetes (T2D) is a chronic condition, generally regarded as an irreversible, that is among the top 10 causes of death globally. The hallmark of T2D is hyperglycemia, which results from disturbances in insulin sensitivity, insulin secretion, β-cell dysfunction and insulin resistance. Several clinical and lifestyle factors are involved in the progression of T2D, such as obesity and physical inactivity. A high-calorie diet is the main contributor to the development of obesity, which results in T2D, as obesity or increased intra-abdominal adipose tissue is related to insulin resistance. Technological advances have contributed to individuals having a more sedentary lifestyle, leading to obesity and T2D. T2D can be treated with lifestyle interventions, such as diet and exercise. Herein, we highlight the positive impact of a very low-calorie diet (VLCD) and lifestyle modalities in the treatment and prevention of T2D. An inclusion of VLCD 400-800 kcal/day for 8 weeks and ≥ 150 minutes exercise 5 times a week as lifestyle interventions can decrease glucose levels to normal, reduce HbA1c and improve insulin resistance and sensitivity. Therefore, a potential mechanism in maintaining glucose homeostasis and remission of T2D by VLCD and exercise reduces body weight.
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McDiarmid S, Harvie M, Johnson R, Vyas A, Aglan A, Moran J, Ruane H, Hulme A, Sellers K, Issa B. Intermittent Versus Continuous Low-Energy Diet in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e21116. [PMID: 33739297 PMCID: PMC8088860 DOI: 10.2196/21116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Intensive face-to-face weight loss programs using continuous low-energy diets (CLEDs) providing approximately 800 kcal per day (3347 kJ per day) can produce significant weight loss and remission from type 2 diabetes (T2D). Intermittent low-energy diets (ILEDs) and remotely delivered programs could be viable alternatives that may support patient choice and adherence. OBJECTIVE This paper describes the protocol of a pilot randomized controlled trial to test the feasibility and potential efficacy of remotely supported isocaloric ILED and CLED programs among patients with overweight and obesity and T2D. METHODS A total of 79 participants were recruited from primary care, two National Health Service hospital trusts, and a voluntary T2D research register in the United Kingdom. The participants were randomized to a remotely delivered ILED (n=39) or CLED (n=40). The active weight loss phase of CLED involved 8 weeks of Optifast 820 kcal/3430 kJ formula diet, followed by 4 weeks of food reintroduction. The active weight loss phase of ILED (n=39) comprised 2 days of Optifast 820 kcal/3430 kJ diet and 5 days of a portion-controlled Mediterranean diet for 28 weeks. Both groups were asked to complete 56 Optifast 820 kcal/3430 kJ days during their active weight loss phase with an equivalent energy deficit. The diets were isocaloric for the remainder of the 12 months. CLED participants were asked to follow a portion-controlled Mediterranean diet 7 days per week. ILED followed 1-2 days per week of a food-based 820 kcal/3430 kJ diet and a portion-controlled Mediterranean diet for 5-6 days per week. Participants received high-frequency (weekly, fortnightly, or monthly depending on the stage of the trial) multidisciplinary remote support from a dietitian, nurse, exercise specialist, and psychologist via telephone or the Oviva smartphone app. The primary outcomes of the study were uptake, weight loss, and changes in glycated hemoglobin at 12 months. An outcome assessment of trial retention was retrospectively added. Secondary outcomes included an assessment of adherence and adverse events. A qualitative evaluation was undertaken via interviews with participants and health care professionals who delivered the intervention. RESULTS A total of 79 overweight or obese participants aged 18-75 years and diagnosed with T2D in the last 8 years were recruited to the Manchester Intermittent and Daily Diet Diabetes App Study (MIDDAS). Recruitment began in February 2018, and data collection was completed in February 2020. Data analysis began in June 2020, and the first results are expected to be submitted for publication in 2021. CONCLUSIONS The outcomes of the MIDDAS study will inform the feasibility of remotely delivered ILED and CLED programs in clinical practice and the requirement for a larger-scale randomized controlled trial. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN) 15394285; http://www.isrctn.com/ISRCTN15394285. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21116.
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Affiliation(s)
- Sarah McDiarmid
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Michelle Harvie
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Rhona Johnson
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Avni Vyas
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Azza Aglan
- Greater Manchester Mental Health Foundation Trust, Manchester, United Kingdom
| | - Jacqui Moran
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Helen Ruane
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Amanda Hulme
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Katharine Sellers
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Basil Issa
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Muñoz-Hernández L, Márquez-López Z, Mehta R, Aguilar-Salinas CA. Intermittent Fasting as Part of the Management for T2DM: from Animal Models to Human Clinical Studies. Curr Diab Rep 2020; 20:13. [PMID: 32166554 DOI: 10.1007/s11892-020-1295-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Diet is a pillar of type 2 diabetes mellitus (T2DM) management. Intermittent fasting (IF) is postulated as a novel approach, able to improve glucose control and potentially capable of reversing some of the pathophysiological alterations of this condition. In this review, the molecular and clinical evidence of diets based on intermittent energy restriction (IER) in laboratory animal models and subjects with type 2 diabetes is discussed. The mechanisms through which IF are thought to improve glucose homeostasis and reverse β cell failure are also reviewed. RECENT FINDINGS Studies derived from murine models suggest that IER is associated with improvements in β cell function and insulin resistance. Two main mechanisms have been demonstrated, one derived from the autophagy-lysosome pathway and, the other from an increase in neurogenin3 (Ngn3) levels (a marker for endocrine progenitor cells like β cells during development). Notably, IER also promotes reconstruction of gut microbiota. In mice, all effects were independent of weight loss. By contrast, in human studies, outcomes are widely attributable to weight loss. The more consistent results are reductions in body weight, visceral fat, and glucose and insulin levels. Increases in HDL cholesterol levels are also frequently reported. The decrease in insulin levels observed in humans is in opposition with the increase reported in mice, suggesting that the main mechanism in humans is an improvement in peripheral insulin action. Recommending diets based on intermittent fasting in humans is based on the promising results found in animal models where an improvement in β cell function has been recorded. β cell function after IF has not been assessed in human subjects with T2DM. This review provides information regarding different protocols for the implementation of IF in diabetic persons and also provides important safety advice in order to avoid adverse effects. Clinical studies do not show an increased risk of hypoglycemia, and a recent case series reported reversal of T2DM.
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Affiliation(s)
- Liliana Muñoz-Hernández
- Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico
- Consejo Nacional de Ciencia y Tecnología, Mexico City, Mexico
| | - Ziomara Márquez-López
- Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico
| | - Roopa Mehta
- Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico
| | - Carlos Alberto Aguilar-Salinas
- Metabolic Diseases Research Unit, Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico.
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Mexico.
- Division of Nutrition, Instituto Nacional de Ciencias Medicas y Nutricion, Vasco de Quiroga #15, Tlalpan, 14080, Mexico City, Mexico.
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Vemuganti R, Arumugam TV. Molecular Mechanisms of Intermittent Fasting-induced Ischemic Tolerance. CONDITIONING MEDICINE 2020; 3:9-17. [PMID: 34278242 PMCID: PMC8281895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Diet is a significant factor in determining human well-being. Excessive eating and/or diets with higher than needed amounts of carbohydrates, salt, and fat are known to cause metabolic disorders and functional changes in the body. To compensate the ill effects, many designer diets including the Mediterranean diet, the Okinawa diet, vegetarian/vegan diets, keto diet, anti-inflammatory diet, and the anti-oxidant diet have been introduced in the past 2 decades. While these diets are either enriched or devoid of one or more specific components, a better way to control diet is to limit the amount of food consumed. Caloric restriction (CR), which involves limiting the amount of food consumed rather than eliminating any specific type of food, as well as intermittent fasting (IF), which entails limiting the time during which food can be consumed on a given day, have gained popularity because of their positive effects on human health. While the molecular mechanisms of these 2 dietary regimens have not been fully deciphered, they are known to prolong the life span, control blood pressure, and blood glucose levels. Furthermore, CR and IF were both shown to decrease the incidence of heart attack and stroke, as well as their ill effects. In particular, IF is thought to promote metabolic switching by altering gene expression profiles leading to reduced inflammation and oxidative stress, while increasing plasticity and regeneration.
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Affiliation(s)
- Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
- William S. Middleton VA Hospital, Madison, WI, USA
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Welton S, Minty R, O'Driscoll T, Willms H, Poirier D, Madden S, Kelly L. Intermittent fasting and weight loss: Systematic review. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:117-125. [PMID: 32060194 PMCID: PMC7021351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine the evidence for intermittent fasting (IF), an alternative to calorie-restricted diets, in treating obesity, an important health concern in Canada with few effective office-based treatment strategies. DATA SOURCES A MEDLINE and EMBASE search from January 1, 2000, to July 1, 2019, yielded 1200 results using the key words fasting, time restricted feeding, meal skipping, alternate day fasting, intermittent fasting, and reduced meal frequency. STUDY SELECTION Forty-one articles describing 27 trials addressed weight loss in overweight and obese patients: 18 small randomized controlled trials (level I evidence) and 9 trials comparing weight after IF to baseline weight with no control group (level II evidence). Studies were often of short duration (2 to 26 weeks) with low enrolment (10 to 244 participants); 2 were of 1-year duration. Protocols varied, with only 5 studies including patients with type 2 diabetes. SYNTHESIS All 27 IF trials found weight loss of 0.8% to 13.0% of baseline weight with no serious adverse events. Twelve studies comparing IF to calorie restriction found equivalent results. The 5 studies that included patients with type 2 diabetes documented improved glycemic control. CONCLUSION Intermittent fasting shows promise for the treatment of obesity. To date, the studies have been small and of short duration. Longer-term research is needed to understand the sustainable role IF can play in weight loss.
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Affiliation(s)
- Stephanie Welton
- Researcher for the Anishinaabe Bimaadiziwin Research Program in Sioux Lookout, Ont
| | - Robert Minty
- Family physician practising at the Sioux Lookout Meno Ya Win Health Centre and Assistant Professor in the Division of Clinical Sciences at the Northern Ontario School of Medicine
| | - Teresa O'Driscoll
- Assistant Professor in the Division of Clinical Sciences at the Northern Ontario School of Medicine in Sioux Lookout
| | - Hannah Willms
- Research assistant in the Anishinaabe Bimaadiziwin Research Program
| | - Denise Poirier
- Primary care nurse at the Hugh Allan Clinic in Sioux Lookout
| | - Sharen Madden
- Associate Professor in the Division of Clinical Sciences at the Northern Ontario School of Medicine in Sioux Lookout
| | - Len Kelly
- Research consultant for the Sioux Lookout Meno Ya Win Health Centre.
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Carter S, Clifton PM, Keogh JP. Flash glucose monitoring for the safe use of a 2-day intermittent energy restriction in patients with type 2 diabetes at risk of hypoglycaemia: An exploratory study. Diabetes Res Clin Pract 2019; 151:138-145. [PMID: 30959146 DOI: 10.1016/j.diabres.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
AIMS Two medication change protocols were tested, both based on haemoglobin A1c (HbA1c), with one protocol also accounting for hypoglycaemic events. The aim was to compare the two protocols during intermittent energy restriction (5:2 diet). METHODS Forty-two adults with type 2 diabetes (HbA1c ≥ 7% [53 mmol/mol], BMI of ≥27 kg/m2) treated with sulphonylureas and/or insulin were recruited and randomised 1:1 to fixed or adjusted medication protocols. Participants experiencing hypoglycaemia during a 2-week usual diet period then followed the 5:2 diet for 2 weeks (2 non-consecutive very-low-calorie days [500-600 kcal] and 5 habitual eating days/week), following the allocated medication protocol. The primary outcome was to determine if the adjusted protocol was superior to the fixed protocol at reducing hypoglycaemic events during the 5:2 diet. Flash glucose monitoring was used throughout to detect hypoglycaemia. RESULTS There was a significant difference in change in the number of hypoglycaemic events between fixed and adjusted protocols (-1.0 vs. -3.5; P = 0.04). Over 60% of participants on the adjusted protocol had no hypoglycaemic events. CONCLUSIONS This pilot study demonstrates the importance of assessing the risk of hypoglycaemia before starting a 5:2 diet and that the adjusted medication protocol is likely the best option for patients at risk. CLINICAL TRIAL REGISTRY This study has been registered with the Australia New Zealand Clinical Trial Registry (ANZCTR) www.anzctr.org.au and given the registration number ACTRN12617000512325.
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Affiliation(s)
- S Carter
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - P M Clifton
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia.
| | - J P Keogh
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
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Zhan C, Dai X, Shen G, Lu X, Wang X, Lu L, Qian X, Rao J. Preoperative short-term fasting protects liver injury in patients undergoing hepatectomy. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:449. [PMID: 30603637 DOI: 10.21037/atm.2018.10.64] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Our previous study demonstrated that preoperative short-term fasting attenuates mice hepatic ischemia/reperfusion injury (IRI), which greatly piqued our interest in verifying if fasting produces similar protective effects in patients undergoing hepatectomy. Methods Eighty patients with liver tumors were randomized into control (Ctrl, n=40, preoperative fasting for 6 h) or fasting group (Fasting, n=40, preoperative fasting for 24 h). Serum was collected at pre-operation (Pre-Op), post-operation 1 day (POD-1), post-operation 3 days (POD-3), and post-operation 7 days (POD-7). Liver tissue was removed from the resected specimen. Results Sixty-three patients were eventually enrolled, with 33 in Ctrl and 30 in Fasting group. Our data showed that 24 h fasting effectively attenuated elevated sALT and sAST levels after operation (P<0.05), but serum total bilirubin was significantly lower at only POD-3 (P<0.05); and serum albumin was not markedly different in either of the groups. Interestingly, 24 h fasting partially attenuates expression of pro-inflammatory cytokine (TNF-α) and improves oxidative stress (MDA and SOD). Our data further showed short-term fasting triggered Nrf2 signaling pathway. Conclusions This study demonstrates preoperative short-term fasting effectively improves clinical outcomes and markedly attenuates inflammatory responses and oxidative stress in patients undergoing hepatectomy, and Nrf2 signaling pathway may play a key role in fasting against inflammatory responses and oxidant stress.
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Affiliation(s)
- Chuanfei Zhan
- Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Xinzheng Dai
- Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Gefengqiang Shen
- Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Xu Lu
- Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Xuehao Wang
- Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Ling Lu
- Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Xiaofeng Qian
- Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Jianhua Rao
- Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
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Carter S, Clifton PM, Keogh JB. Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Noninferiority Trial. JAMA Netw Open 2018; 1:e180756. [PMID: 30646030 PMCID: PMC6324303 DOI: 10.1001/jamanetworkopen.2018.0756] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Intermittent energy restriction is an alternative weight loss method that is becoming popular; however, to date, there are no long-term clinical trials of intermittent energy restriction in patients with type 2 diabetes. OBJECTIVE To compare the effects of intermittent energy restriction (2 days per week) with those of continuous energy restriction on glycemic control and weight loss in patients with type 2 diabetes during a 12-month period. DESIGN, SETTING, AND PARTICIPANTS Adult participants (N = 137) with type 2 diabetes were randomized 1:1 to parallel diet groups (intermittent energy restriction [n = 70] or continuous energy restriction [n = 67]) between April 7, 2015, and September 7, 2017, at the University of South Australia. Medications likely to cause hypoglycemia were reduced at baseline according to the medication management protocol. INTERVENTIONS An intermittent energy restriction diet (500-600 kcal/d) followed for 2 nonconsecutive days per week (participants followed their usual diet for the other 5 days) or a continuous energy restriction diet (1200-1500 kcal/d) followed for 7 days per week for 12 months. MAIN OUTCOMES AND MEASURES The primary outcome was change in hemoglobin A1c (HbA1c) level, with equivalence prespecified by a 90% CI margin of ±0.5%. The secondary outcome was weight loss with equivalence set at ±2.5 kg (±1.75 kg for fat mass loss and ±0.75 kg for fat-free mass loss). All other outcomes were tested for superiority. RESULTS Of the 137 randomized participants (77 women and 60 men; mean [SD] age, 61.0 [9.1] years; mean [SD] body mass index, 36.0 [5.8] [calculated as weight in kilograms divided by height in meters squared]; and mean [SD] HbA1c level, 7.3% [1.3%]), 97 completed the trial. Intention-to-treat analysis showed similar reductions in mean (SEM) HbA1c level between the continuous and intermittent energy restriction groups (-0.5% [0.2%] vs -0.3% [0.1%]; P = .65), with a between-group difference of 0.2% (90% CI, -0.2% to 0.5%) meeting the criteria for equivalence. Mean (SEM) weight change was similar between the continuous and intermittent energy restriction groups (-5.0 [0.8] kg vs -6.8 [0.8] kg; P = .25), but the between-group difference did not meet the criteria for equivalence (-1.8 kg; 90% CI, -3.7 to 0.07 kg), nor did the between-group difference in fat mass (-1.3 kg; 90% CI, -2.8 to 0.2 kg) or fat-free mass (-0.5 kg; 90% CI, -1.4 to 0.4 kg). There were no significant differences between groups in final step count, fasting glucose levels, lipid levels, or total medication effect score at 12 months. Effects did not differ using completers analysis. Hypoglycemic or hyperglycemic events in the first 2 weeks of treatment were similar between the continuous and intermittent energy restriction groups (mean number [SEM] of events, 3.2 [0.7] vs 4.9 [1.4]; P = .28), affecting 35% of participants (16 of 46) using sulfonylureas and/or insulin. CONCLUSIONS AND RELEVANCE Intermittent energy restriction is an effective alternative diet strategy for the reduction of HbA1c and is comparable with continuous energy restriction in patients with type 2 diabetes. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12615000383561.
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Affiliation(s)
- Sharayah Carter
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Peter M. Clifton
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Jennifer B. Keogh
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
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Clifton P. Assessing the evidence for weight loss strategies in people with and without type 2 diabetes. World J Diabetes 2017; 8:440-454. [PMID: 29085571 PMCID: PMC5648990 DOI: 10.4239/wjd.v8.i10.440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/15/2017] [Accepted: 09/01/2017] [Indexed: 02/05/2023] Open
Abstract
This review will examine topical issues in weight loss and weight maintenance in people with and without diabetes. A high protein, low glycemic index diet would appear to be best for 12-mo weight maintenance in people without type 2 diabetes. This dietary pattern is currently being explored in a large prevention of diabetes intervention. Intermittent energy restriction is useful but no better than daily energy restriction but there needs to be larger and longer term trials performed. There appears to be no evidence that intermittent fasting or intermittent severe energy restriction has a metabolic benefit beyond the weight loss produced and does not spare lean mass compared with daily energy restriction. Meal replacements are useful and can produce weight loss similar to or better than food restriction alone. Very low calorie diets can produce weight loss of 11-16 kg at 12 mo with persistent weight loss of 1-2 kg at 4-6 years with a very wide variation in long term results. Long term medication or meal replacement support can produce more sustained weight loss. In type 2 diabetes very low carbohydrate diets are strongly recommended by some groups but the long term evidence is very limited and no published trial is longer than 12 mo. Although obesity is strongly genetically based the microbiome may play a small role but human evidence is currently very limited.
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Affiliation(s)
- Peter Clifton
- Division of Health Sciences, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5001, Australia
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