Intermittent Fasting and Metabolic Syndrome

Kiara Heider, Dietetic Intern

Overview

1. Why this topic?

2. Diagnosing Metabolic Syndrome

3. Current MNT for Metabolic Syndrome

4. Types of Fasting

5. Current Research

6. Discussion

7. Questions

Why This Topic?

Metabolic Syndrome

Diagnosed by having 3 of the following criteria:1. Abdominal obesity (Waist circumference ≥ 40 inches in men and ≥ 35 inches in women)

2. Triglyceride level ( ≥ 150 mg/dL)

3. HDL cholesterol (< 40 mg/dL in men and < 50 mg/dL in women)

4. Systolic BP (≥ 130 mmHg) or diastolic BP (≥ 85 mmHg)

5. Fasting glucose (100 mg/dL or greater)

American Heart Association, 2016National Heart, Lung, and Blood Institute (NHLBI), n.d..

Importance?• Affects ~23% of the adult population• Increases the individual’s risk for heart disease, diabetes, and stroke.

Current MNT Promote heart healthy / Mediterranean diet

• Whole grains and beans

• Fruits and vegetables

• Low sodium

• Fish

• Reduced saturated fats, trans fat, and simple sugars.

Encourage physical activity—≥30 minutes 5 days/week

= Goal of reducing body weight by 7% to 10%.

American Heart Association, 2020

Academy of Nutrition and Dietetics, n.d. .

New Treatment Plan=Fasting?

Eating Window: a 12, 8, or 4 hour feeding window per day.

One meal a day: only eating once per day.

Alternate day fasting: eating every other day.

Extended fasting: fasting for 24 hours or more.

5:2 diet: Typical intake for five days and only 500-600 calories for two days.

Gordon, 2019.

Research Article 1

Effects of A One-week Fasting Therapy in Patients

with Type-2 Diabetes Mellitus and Metabolic

Syndrome – A Randomized

Controlled Explorative Study

Chenying Li, Badri Sadraie, Nico Steckhan, Christian Kessler, Rainer Stange, Michael Jeitler, Andreas Michalsen

Background

Study Type Randomized, Clinical control trial, Pilot Study

Purpose To determine if a 7 day fast has beneficial health effects on participants with metabolic syndrome and type 2 diabetes after 4 months.

Sample Size

Original – 46 participantsAnalyzed – 32 participants

Li, C., Sadraie, B., Steckhan, N., Kessler, C., Stange, R., Jeitler, M. and Michalsen, A., 2017

Criteria

Inclusion Criteria

• 25 - 75 years old

• Treated type 2 diabetes

• Abdominal obesity (waist circumference ≥ 94 cm [men] or ≥ 80 cm [women])

• Body mass index > 25 kg/m2

• Diagnosed metabolic syndrome

Exclusion Criteria

• Type-1 diabetes mellitus • Intense insulin treatment• MI, CVA, or pulmonary embolism in last 3 months• Diabetes due to corticosteroids• Renal failure with GFR < 60 • History or current eating disorder• Dementia• Etc.

Li, C., Sadraie, B., Steckhan, N., Kessler, C., Stange, R., Jeitler, M. and Michalsen, A., 2017

InterventionParticipants with Metabolic Syndrome

n = 46

- Baseline blood sample and anthropometric taken. -All participants were educated on the Mediterranean diet

7 Day Modified Fasting Diet (Buchinger)n = 23 (Final n = 16)

• 2 days pre-fast: low-salt diet w/ pure cooked rice and veg. (~ 1,200 kcal)

• 7 day fast: unlimited water, herbal tea; 200 ml fruit juice, light veg. soup (~300 kcal).

• 3 days post-fast: low-calorie diet w/ reintroduction of solids

• Mediterranean Diet for 4 months

Control Groupn = 23 (Final n=16)

• Mediterranean diet for entirety of study

- 4-month blood sample and anthropometric taken.

Randomized

Li, C., Sadraie, B., Steckhan, N., Kessler, C., Stange, R., Jeitler, M. and Michalsen, A., 2017

Results

Li, C., Sadraie, B., Steckhan, N., Kessler, C., Stange, R., Jeitler, M. and Michalsen, A., 2017

Insignificant Findings: Hgb A1C, Triglycerides, HDL/LDL, Total Cholesterol, HOMA-IR

ConclusionThe results of the pilot study point to beneficial metabolic effects of a one-week fasting therapy in persons with type 2 diabetes over 4 months.

Strengths• Standardized kcals during fast• Restricted from caffeine and alcohol during fast• Usual daily activity• Mediterranean diet education

Limitations• Unclear demographics• Very specific fast regulations• Small sample• Did not assess dietary adherence

Grade: Plus/Positive (+)

Li, C., Sadraie, B., Steckhan, N., Kessler, C., Stange, R., Jeitler, M. and Michalsen, A., 2017

Research Article 2

Modified alternate-day fasting vs. calorie restriction in the treatment of patients with metabolic syndrome: A

randomized clinical trial Arefe Parvaresh, Roghaye Razavi, Behnood Abbasi, Khadijeh Yaghoobloo,

Akbar Hassanzadeh, Noushin Mohammadifard, Sayyed Morteza Safavi, Amir Hadi, Cain C.T. Clark

Background

Study Type Randomized, Clinical control trial

Purpose To compare the effect of calorie restriction diet versus a modified alternate-day fasting diet as a treatment for adults with metabolic syndrome.

Sample Size Original - 70 participants

Analyzed – 69 participants

Parvaresh A, Razavi R, Abbasi B, et al., 2019

Criteria

Inclusion Criteria

• 25 – 60 years old • Diagnosed metabolic syndrome • Overweight (≥ 25 BMI, ≥ 40 kg/m2).

Exclusion Criteria

• Weight changes ≥5% in last 3 months • History of liver, cardiovascular, renal, or

metabolic disease• Smoking• Taking any medication• Following special diet in last 6 months• Breast feeding, post-menopausal, and pregnant

women.

Parvaresh A, Razavi R, Abbasi B, et al., 2019

InterventionParticipants with Metabolic Syndrome

n = 70

- Baseline blood sample and anthropometric taken. - Physical activity questionnaire and 3-day dietary record was completed.

- Calorie needs calculated using Mifflin St. Jeor

Alternate Day Fasting Group (ADF)n = 35

• Consumed 25% of energy needs during 3 fast days (Saturday, Monday, Wednesday)

• 100% of needs on 3 feed days (Sunday, Tuesday, Thursday)

• Fridays ad-libitum

Calorie Restricted Group (CR) Groupn = 35 (Final n = 34)

• Consumed 75% of their energy needs each day

- 8-week blood sample and anthropometric taken. - Physical activity questionnaire and 3-day dietary record was completed.

Randomized

Parvaresh A, Razavi R, Abbasi B, et al., 2019

ResultsSignificance From

Baseline Between Groups

Insignificant Findings: HDL-C, LDL-CParvaresh A, Razavi R, Abbasi B, et al., 2019

ConclusionModified alternate-day fasting diet may be a more effective option compared to the typical calorie restriction diet.

Strengths• Males and Females• Taught to prepare meals• Control Group• Continue usual activity

Limitations• Dietary intake was self reported• Not blinded• Short study period• Unknown ethnic diversity

Grade: Plus/Positive (+)

Parvaresh A, Razavi R, Abbasi B, et al., 2019

Research Article 3

Ten-Hour Time-Restricted Eating Reduces Weight, Blood

Pressure, and Atherogenic Lipids in Patients with Metabolic

SyndromeMichael J. Wilkinson, Emily N.C. Manoogian, Adena Zadourian, Saket

Navlakha, Satchidananda Panda, Pam R. Taub

BackgroundStudy Type Single-arm, paired-sample, clinical control trial

Purpose Determine if a 10-hour time restricted eating period could improve the following in patients with Metabolic Syndrome:

Sample Size Original – 25 participants

Analyzed - 19 participants

• Inflammation• Fasting insulin• Hgb A1C• Sleep• Thyroid function• White blood cell count

• Weight • Blood pressure• Lipids• Glucose

Wilkinson, M., Manoogian, E., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., Wang, X., Fleischer, J., Navlakha, S., Panda, S. and Taub, P., 2020.

Criteria

Inclusion Criteria

• Diagnosed metabolic syndrome • ≥ 18 years old• ≥ 14-hour daily eating interval • Owns and operates a smartphone

Exclusion Criteria

• Pregnant or breast-feeding• Frequent nocturnal interruptions• Type 1 diabetes• History of eating disorder• Stage 4 or 5 CKD • Weight loss/management program• Prescribed diet• Appetite affecting medications• Bariatric surgery• Ect.

Wilkinson, M., Manoogian, E., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., Wang, X., Fleischer, J., Navlakha, S., Panda, S. and Taub, P., 2020.

Intervention

12 Week intervention4 total visits• 1-week baseline measurements• 1-week result measurements

Wilkinson, M., Manoogian, E., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., Wang, X., Fleischer, J., Navlakha, S., Panda, S. and Taub, P., 2020.

Results

Insignificant Findings: Triglycerides, CRP, ALT, AST, blood glucose, Hgb A1C, HOMA-IR, WBC count, TSH, Sleep Duration, Etc.

Wilkinson, M., Manoogian, E., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., Wang, X., Fleischer, J., Navlakha, S., Panda, S. and Taub, P., 2020.

ConclusionA 10-hour, time restricted eating window is beneficial in improving metabolic syndrome factors.

Strengths• Subjects were their own control• Daily meal and sleep logging

Limitations• No blinding• Large age gap• Various participant baseline measures

Grade: Plus/Positive (+)

Wilkinson, M., Manoogian, E., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., Wang, X., Fleischer, J., Navlakha, S., Panda, S. and Taub, P., 2020.

Discussion

Study Factors

• All studies included healthy diet modifications

• Each group had attrition

• Fasting regimen too intense?

• All studies showed improvement in cholesterol, weight, and blood pressure

Implementing Fasting into MNT?

RDs should have knowledge of:

• The different kinds

• Types that are most effective

• Commitment required for results

• Safety measures

Start Slow:

• Make it a lifestyle change

• Don’t call it fasting/diet

• A simple form that is easy to implement

Questions?

References

Academy of Nutrition and Dietetics, n.d. - Nutrition Care Manual. [online] Nutritioncaremanual.org. Available at: <https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=12829&lv2=268185&ncm_toc_id=268185&ncm_heading=Nutrition%20Care> [Accessed 4 April 2020].

American Heart Association, 2016. About Metabolic Syndrome. [online] www.heart.org. Available at: <https://www.heart.org/en/health-topics/metabolic-syndrome/about-metabolic-syndrome> [Accessed 26 March 2020].

American Heart Association, 2020. What Is The Mediterranean Diet?. [online] www.heart.org. Available at: <https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/mediterranean-diet> [Accessed 4 April 2020].

Gordon, B., 2019. What Is Intermittent Fasting. [online] Eatright.org. Available at: <https://www.eatright.org/health/weight-loss/fad-diets/what-is-intermittent-fasting> [Accessed 4 April 2020].

Li, C., Sadraie, B., Steckhan, N., Kessler, C., Stange, R., Jeitler, M. and Michalsen, A., 2017. Effects of A One-week Fasting Therapy in Patients with Type-2 Diabetes Mellitus and Metabolic Syndrome – A Randomized Controlled Explorative Study. Experimental and Clinical Endocrinology & Diabetes, 125(09), pp.618-624.

National Heart, Lung, and Blood Institute (NHLBI), n.d. Metabolic Syndrome. [online] Nhlbi.nih.gov. Available at: <https://www.nhlbi.nih.gov/health-topics/metabolic-syndrome> [Accessed 4 April 2020].

Parvaresh A, Razavi R, Abbasi B, et al. Modified alternate-day fasting vs. calorie restriction in the treatment of patients with metabolic syndrome: A randomized clinical trial. Complementary Therapies in Medicine. 2019;47:102187. doi:10.1016/j.ctim.2019.08.021.

Wilkinson, M., Manoogian, E., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., Wang, X., Fleischer, J., Navlakha, S., Panda, S. and Taub, P., 2020. Ten-Hour Time-Restricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patients with Metabolic Syndrome. Cell Metabolism, [online] 31(1), pp.92-104.e5. Available at: <https://www.sciencedirect.com/science/article/abs/pii/S1550413119306114?via%3Dihub> [Accessed 10 March 2020].