The effect of 4-h versus 6-h time restricted feeding on sleep quality, duration, insomnia severity and obstructive sleep apnea in adults with obesity

BACKGROUND

Time restricted feeding (TRF) involves deliberately restricting the times during which energy is ingested. Preliminary findings suggest that 8-10-h TRF improves sleep. However, the effects of shorter TRF windows (4-6 h) on sleep, remain unknown.

AIMS

This study compared the effects of 4-h versus 6-h TRF on sleep quality, duration, insomnia severity and the risk of obstructive sleep apnea.

METHODS

Adults with obesity (n = 49) were randomized into one of three groups: 4-h TRF (eating only between 3 and 7 p.m.), 6-h TRF (eating only between 1 and 7 p.m.), or a control group (no meal timing restrictions) for 8 weeks.

RESULTS

After 8 weeks, body weight decreased (p < 0.001) similarly by 4-h TRF (-3.9 ± 0.4 kg) and 6-h TRF (-3.4 ± 0.4 kg), versus controls. Sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), did not change by 4-h TRF (baseline: 5.9 ± 0.7; week 8: 4.8 ± 0.6) or 6-h TRF (baseline: 6.4 ± 0.8; week 8: 5.3 ± 0.9), versus controls. Wake time, bedtime, sleep duration and sleep onset latency also remained unchanged. Insomnia severity did not change by 4-h TRF (baseline: 4.4 ± 1.0; week 8: 4.7 ± 0.9) or 6-h TRF (baseline: 8.3 ± 1.2; week 8: 5.5 ± 1.1), versus controls. Percent of participants reporting obstructive sleep apnea symptoms did not change by 4-h TRF (baseline: 44%; week 8: 25%) or 6-h TRF (baseline: 47%; week 8: 20%), versus controls.

CONCLUSION

These findings suggest that 4- and 6-h TRF have no effect on sleep quality, duration, insomnia severity, or the risk of obstructive sleep apnea.

Changes in subjective measures of appetite during 6 months of alternate day fasting with a low carbohydrate diet

OBJECTIVE

Alternate day fasting (ADF) has been shown to lower body weight and improve subjective appetite by increasing fullness. What remains unknown, however, is whether carbohydrate restriction during ADF would provide additional weight loss benefits by helping to lower hunger as well. Accordingly, this study examined the effect of 6-months of ADF combined with a low carbohydrate diet on fasting and postprandial appetite ratings.

METHODS

Adults with obesity (n = 31) participated in ADF (600 kcal "fast day" alternated with an ad libitum "feast day") with a low-carbohydrate background diet (30% carbohydrates, 35% protein, and 35% fat). The 6-month trial consisted of a 3-month weight loss period followed by a 3-month weight maintenance period.

RESULTS

After 6-months of an ADF-low carbohydrate diet, body weight decreased (P < 0.01) by 6.2 ± 1.0 kg, relative to baseline. Subjective hunger and fullness did not change throughout the study. Fasting insulin decreased (P < 0.05) by 3.3 ± 1.3 μlU/mL by month 6, relative to baseline. Fasting glucose and insulin resistance, remained unchanged over the course of the study. Hunger and fullness were not related to body weight, glucoregulatory factors or energy intake.

CONCLUSIONS

These findings suggest that ADF combined with a low carbohydrate diet is not associated with any changes in appetite, relative to baseline.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT03528317.

Alternate Day Fasting Combined with a Low Carbohydrate Diet: Effect on Sleep Quality, Duration, Insomnia Severity and Risk of Obstructive Sleep Apnea in Adults with Obesity

Background: Alternate day fasting combined with a low carbohydrate diet (ADF-LC) is an effective weight loss regimen. Whether the weight loss induced by ADF-LC can improve sleep, remains unknown. Objective: This study examined the effect an ADF-LC diet on sleep quality, duration, insomnia severity and the risk of obstructive sleep apnea. Methods: Adults with obesity (n = 31) participated in ADF (600 kcal “fast day”; ad libitum intake “feast day”) with a low-carbohydrate diet (30% carbohydrates, 35% protein, and 35% fat). The 6-month trial consisted of a 3-month weight loss period followed by a 3-month weight maintenance period. Results: Reductions in body weight (−5 ± 1 kg, p < 0.001) and fat mass (−4 ± 1 kg, p < 0.01) were noted during the weight loss period, and these reductions were sustained during the weight maintenance period. Lean mass and visceral fat remained unchanged. The Pittsburgh Sleep Quality Index (PSQI) score indicated poor sleep quality at baseline (6.4 ± 0.7) with no change by month 3 or 6, versus baseline. ISI score indicated subthreshold insomnia at baseline (8.5 ± 1.0), with no change by month 3 or 6, versus baseline. The percent of subjects with high risk of obstructive sleep apnea at baseline was 45%, with no change by month 3 or 6. Wake time, bedtime, and sleep duration remained unchanged. Conclusion: The ADF-LC diet does not impact sleep quality, duration, insomnia severity or the risk of obstructive sleep apnea in adults with obesity.

Effects of 4- and 6-h Time-Restricted Feeding on Weight and Cardiometabolic Health: A Randomized Controlled Trial in Adults with Obesity

Time-restricted feeding (TRF) regimens have grown in popularity; however, very few studies have examined their weight-loss efficacy. We conducted the first human trial (Clinicaltrials.gov NCT03867773) to compare the effects of two popular forms of TRF (4 and 6 h) on body weight and cardiometabolic risk factors. Adults with obesity were randomized to 4-h TRF (eating only between 3 and 7 p.m.), 6-h TRF (eating only between 1 and 7 p.m.), or a control group (no meal timing restrictions). After 8 weeks, 4- and 6-h TRF produced comparable reductions in body weight (∼3%), insulin resistance, and oxidative stress, versus controls. Energy intake was reduced by ∼550 kcal/day in both TRF groups, without calorie counting. These findings suggest that 4- and 6-h TRF induce mild reductions in body weight over 8 weeks and show promise as interventions for weight loss. These diets may also improve some aspects of cardiometabolic health.

Alternate day fasting combined with a low-carbohydrate diet for weight loss, weight maintenance, and metabolic disease risk reduction

OBJECTIVE

Alternate day fasting (ADF) is a popular weight loss regimen. Whether carbohydrate restriction can enhance the weight loss achieved with ADF remains unclear. Accordingly, this study examined the effect of ADF combined with a low-carbohydrate diet on body weight and metabolic disease risk factors.

METHODS

Adults with obesity (n = 31) participated in ADF (600 kcal "fast day" alternated with an ad libitum "feast day") with a low-carbohydrate background diet (30% carbohydrates, 35% protein, and 35% fat). The 6-month trial consisted of a 3-month weight loss period followed by a 3-month weight maintenance period.

RESULTS

Body weight decreased (-5.5 ± 0.5%; P < .001) during the weight loss period (month 0-3) but remained stable (P = .57) during the weight maintenance period (month 4-6). Net weight loss by month 6 was -6.3 ± 1.0%. Fat mass was reduced (P < .01) by month 6, while lean mass and visceral fat mass remained unchanged. Total cholesterol and low-density lipoprotein (LDL) cholesterol levels decreased (P < .05) by -6 ± 2% and - 8 ± 3%, respectively, by month 6. Systolic blood pressure was also reduced (P = .03) by -7 ± 3 mm Hg. Fasting insulin decreased (P = .03) by -24 ± 8% by month 6 relative to baseline. High-density lipoprotein (HDL) cholesterol, triglycerides, diastolic blood pressure, heart rate, fasting glucose, homeostatic model assessment of insulin resistance (HOMA-IR), and haemoglobin A1C (HbA1c) remained unchanged.

CONCLUSIONS

These findings suggest that ADF combined with a low-carbohydrate diet is effective for weight loss, weight maintenance, and improving certain metabolic disease risk factors such as LDL cholesterol, blood pressure, and fasting insulin. While these preliminary findings are promising, they still require confirmation by a randomized control trial.

Longevity of Ceratomyxa shasta and Parvicapsula minibicornis actinospore infectivity in the Klamath River

Infectious Ceratomyxa shasta and Parvicapsula minibicornis actinospores were present in Klamath River samples collected in April, May, and June 2005. Juvenile Chinook salmon Oncorhynchus tshawytscha exposed to river water maintained at the ambient Klamath River temperature for 0, 4, 24, 72, and 168 h (7 d) developed asymptomatic infections from both parasites. Elevated water temperature (18 degrees C) in June may have reduced actinospore viability, as both C. shasta and P. minibicornis infection markedly declined in fish exposed for over 72 h. As judged by the prevalence of infection for both parasites, the number of infectious actinospores tended to increase or remain steady through the spring. Ceratomyxa shasta infections were characterized by the presence of a few trophozoites within granulomatous foci in mesentery adipose tissue and were consistently observed outside of the intestine. Similarly, low numbers of P. minibicornis were observed in kidney glomeruli and tubules but were not associated with inflammation. Parvicapsula minibicornis DNA was consistently detected by quantitative real-time polymerase chain reaction in filtered water samples collected each month and from each time posttransfer. These data and the high prevalence of infection observed in the exposed fish indicate that P. minibicornis actinospores were at a relatively high concentration in the river during the spring. In contrast, C. shasta DNA was only detected in half of the water sample sets and its detection did not correspond well to C. shasta infectivity. An approximately threefold increase in river flow from the April to the May water collection was not associated with a decline in either the detection of actinospores (particularly for P. minibicornis) or the prevalence of infection for both parasites. Actinospores of these myxosporean parasites have the potential to infect salmonids for at least 7 d after release from the alternate polychaete host.

Increased CSF volumes are associated with diminished subjective responses to cocaine infusion

We evaluated the hypothesis that ventricular and cortical CSF volume increases are associated with reductions in the magnitude of euphoric effects produced by intravenous IV cocaine infusion in cocaine dependent (CD) individuals. Eleven CD patients participating in a cocaine-infusion study and eleven control subjects underwent magnetic resonance imaging (MRI). Two CSF regions of interest (lateral ventricles and frontal cortex CSF) and two comparison regions (third ventricle and posterior cortex CSF) were measured. Self-reported ratings of the intensity of euphoric response ("high") were obtained from the CD subjects at 3, 10, and 30 minutes after IV administration of cocaine. A significant negative correlation was observed between the volume of the lateral ventricles and subjective ratings of the "high" experienced at 3 minutes, but not at 10 and 30 minutes after cocaine infusion. In contrast, a significant negative correlation between frontal cortex CSF volume and the intensity of euphoric response was observed at 30 minutes after IV cocaine. No significant associations were observed between the volumes of the two comparison regions and any subjective ratings of "high." No significant volume differences were observed between the CD and control groups in any region. The results suggest larger lateral ventricular volumes are associated with a decrease in immediate euphoria while larger frontal cortex CSF volumes are associated with a decrease in the duration of the euphoria induced by cocaine infusion. The age-related brain volume reductions underlying the volume increase in these two CSF spaces may be the neurobiological basis of the age-related reduction in the rates of addiction.

Age-related brain volume reductions in amphetamine and cocaine addicts and normal controls: implications for addiction research

The study evaluated the relationship between age and frontal and temporal lobe volumes in young cohorts of cocaine-dependent (CD), amphetamine-dependent (Am), and normal control subjects. Ten CD, nine Am, and 16 age- and gender-matched control subjects underwent magnetic resonance imaging (MRI). The volume of the frontal and temporal lobes was measured from an identically positioned slab of seven contiguous 3-mm-thick coronal images. Follow-up measures of the gray and white matter subcomponents of these volumes were also obtained. Both CD and Am groups had a significantly smaller temporal lobe volumes, but only the CD group demonstrated a significantly greater decline in temporal lobe volume with age (intracranial volume, education, and race were controlled for in all statistical analyses). Segmenting the brain regions into gray and white matter revealed that the negative correlation between age and temporal lobe volume of CD patients was mostly due to a significant age-related decline in the gray matter subcomponent. Negative trends between age and gray matter volumes were also observed in the Am and normal groups. In the frontal lobes, age was negatively correlated with gray matter volume in the control, CD, and Am groups. Unlike the consistent decreases in gray matter volumes, white matter showed non-significant increases in volume with age. The data suggest that CD patients may have an accelerated age-related decline in temporal lobe gray matter volume and a smaller temporal lobe volume compared to normal controls. In the frontal lobe, age-related gray matter volume reductions occur in all three groups. These age-related cortical gray matter volume reductions may be a biological marker for the risk of addictive behavior, which also decreases with age.

Controlling for selection bias in the evaluation of Alcoholics Anonymous as aftercare treatment

OBJECTIVE

The purpose of this research was to control for self-selection bias in the evaluation of Alcoholics Anonymous (AA) as aftercare treatment. Observational studies of alcoholism aftercare treatment are subject to selection bias whenever the self-selection process results in important differences in unobserved casemix dimensions between treatment groups.

METHOD

The sample included 118 male veterans discharged from inpatient alcohol treatment, 85% of whom were followed-up at 3 months. Drinking outcomes were measured by self-reported abstinence in the third month after discharge. The aftercare treatment effect of AA was estimated using standard logistic regression analysis and instrumental variables analysis. Instruments included the subject's ability to drive oneself to AA meetings and the presence/absence of an AA meeting in the subject's town of residence. A Hausman exogeniety test was used to determine whether the standard logistic regression results were subject to self-selection bias.

RESULTS

Estimates from the standard logistic regression yielded a positive (OR = 3.7) and significant (p = .018) treatment effect for AA attendance. However, the instrumental variables analysis yielded a smaller (OR* = 1.7) and insignificant treatment effect estimate (p = .782). The Hausman exogeniety test indicated that the treatment effect estimate from the standard logistic regression was subject to significant self-selection bias (chi2 = 83.9, 1 df, p <.01).

CONCLUSIONS

The AA aftercare treatment effect observed in this sample was due to differences in unobserved casemix factors between the treatment groups. Results suggest that previous AA aftercare research may have also been subject to self-selection bias. Researchers of substance abuse outcomes should consider analyzing nonexperimental data using instrumental variables methodologies.

AANA Journal course: advanced scientific concepts: update for nurse anesthetists--anesthesia for patients on anticholinesterase and antiepileptic drugs

Patients with neurologic diseases who require surgery may present the anesthetist with special challenges related to their pharmacotherapy. It is well established that such therapy may alter these patients' otherwise normal response to anesthesia. There are many classes of drugs utilized and this AANA Journal course addresses the pharmacokinetic, pharmacodynamic, and anesthetic implications of anticholinesterase and antiepileptic drugs.