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The comparative effects of intermittent versus continuous energy restriction on anthropometry and cardiometabolic disease risk markers in obese patients utilizing weight loss support services provided by an NHS tier 3 weight management service

  • Visiting Senior Lecturer, KCL


The comparative effects of intermittent versus continuous energy restriction on anthropometry and cardiometabolic disease risk markers in obese patients utilizing weight loss support services provided by an NHS tier 3 weight management service - Volume 76 Issue OCE4 - R. Antoni, K.L. Johnston, C. Steele, D. Carter, M.D. Robertson, M. Capehorn
Summer Meeting, 1012 July 2017, Improving Nutrition in Metropolitan Areas
The comparative effects of intermittent versus continuous energy restriction
on anthropometry and cardiometabolic disease risk markers in obese
patients utilizing weight loss support services provided by an NHS tier 3
weight management service
R. Antoni
, K.L. Johnston
, C. Steele
, D. Carter
, M.D. Robertson
and M. Capehorn
Nutrition, Metabolism and Diabetes Research Group, Faculty of Health and Medical Sciences,
University of Surrey, Guildford, GU2 7WG,
Rotherham Institute for Obesity, Clifton Medical Centre, The Health Village, Doncaster Gate, Rotherham, S651DA
Lighterlife UK Ltd, Cavendish House, Parkway, Harlow Business Park, Essex, CM19 5QF
Weight loss through continuous energy restriction (CER) has notoriously poor outcomes. Intermittent energy restriction (IER) as a
method of weight loss has attracted considerable attention
due to its purported superior metabolic benets and because short spells
of severe energy restriction alternated with days of habitual intake may be easier to follow. However, ndings from previous weight
loss comparison studies have been variable
. This is the rst intervention trial comparing IER versus CER for weight loss and
improvement in cardiometabolic outcomes in obese patients registered with an NHS tier 3 weight management setting
Rotherham Institute for Obesity (RIO)
This trial was granted ethical approval by the South Yorkshire NRES committee (14 YH 0018). 200 (n = 47 male) obese patients
who had been referred via their GP to the RIO weight loss clinic, volunteered to participate and in accordance with standard RIO care
were allowed to choose which of the two dietary intervention they wished to follow. The IER intervention was a formula based very
low-energy diet (LighterLife Fast) consisting of 2638 kJ two days per week alongside ve days unrestricted healthy eating (n = 100)
and the CER intervention was a healthy daily diet 2510 kJ below estimated energy requirements (n = 100). Anthropometry and estab-
lished fasting cardiometabolic disease risk markers were measured before and after a six-month intervention period. Completer data
were analysed using analysis of covariance to compare changes between groups, with baseline levels, age, gender and co-morbidities
included as covariates. Paired t-tests were used for within-group comparisons.
27 IER patients and 39 CER patients completed the study. Mean (standard deviation) weight-loss loss was 5 (5·6) % in the IER group
and 3 (4·0) % in the CER group (p = 0·046). Weight-loss was accompanied by signicantly greater reductions in fat mass (bioimpedance)
in the IER group (11 [11·8] % vs. 2 [10·2] %, p = 0·010), as well as waist circumference (4 [5·2] % vs. 2 [4·0] %, p = 0·047).
In summary, both CER and IER groups achieved or surpassed, respectively, the clinically signicant weight-loss threshold iden-
tied by the National Institute of Clinical Excellence. Indeed, both groups exhibited improvements in at least one cardiometabolic
disease risk marker. Changes in body weight and adiposity were greater among IER patients and the superiority of IER in reducing
levels of fasting insulin and triacylglycerol is in line with some previous research
. The superior changes in HDL cholesterol and
systolic blood pressure observed with IER are novel to this study. Further research into how these ndings translate over the longer
term, as well as the factors inuencing the acceptability of and adherence to IER, are required.
1. Antoni R. et al. (2017) Proc Nutr Soc (in press)
2. Harvie MN, Pegington M, Mattson M et al. (2011) Int J Obes 35 714727
3. Varady K, Bhutani S, Klempel MC et al. (2011) Lipids Health Disease 10 119
Table 1. Changes in fasting parameters over six months. * Signicant within-group.
Pre Post Pre Post
P valueMean SD Mean SD Mean SD Mean SD
Glucose mmol/L 5·10·74·90·75·31·25·31·50·120
Insulin uU/mL 24·210·819·111·428·620·225·311·80·019
Total chol mmol/L 4·70·94·60·74·71·04·71·00·824
LDL mmol/L 2·90·72·90·72·91·02·81·00·486
HDL mmol/L 1·16 0·31·25 0·2* 1·16 0·31·18 0·30
TAG mmol/L 1·40·51·20·4* 1·40·61·40·70·006
Systolic BP mmHg 129 11 122 11* 117 11 123 12* <0·001
Diastolic BP mmHg 77 8 73 7* 74 9 71 7* 0·937
Proceedings of the Nutrition Society (2017), 76 (OCE4), E143 doi:10.1017/S0029665117003056
Proceedings of the Nutrition Society
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Full-text available
Obesity is associated with an atherogenic lipid profile characterized by a predominance of small LDL and HDL particles. Weight loss, by dietary restriction or exercise, increases LDL particle size. Whether these interventions can augment HDL size in conjunction with LDL size remains unknown. This study compared the effects of alternate day fasting (ADF), calorie restriction (CR), and endurance exercise on LDL and HDL particle size in overweight and obese subjects. In a 12-week parallel-arm trial, adult subjects (n = 60) were randomized to 1 of 4 groups: 1) ADF (75% energy restriction for 24-h alternated with ad libitum feeding for 24-h), 2) CR (25% energy restriction every day), 3) exercise (moderate intensity training 3 x/week), or 4) control. Body weight was reduced (P < 0.001) by ADF, CR, and exercise (5.2 ± 1.1%, 5.0 ± 1.4%, 5.1 ± 0.9%, respectively). Plasma LDL cholesterol decreased (P < 0.05) with ADF (10 ± 4%) and CR (8 ± 4%), whereas HDL cholesterol increased (P < 0.05) with exercise (16 ± 5%). Integrated LDL particle size was augmented (P = 0.01) by ADF and CR. The proportion of small LDL particles decreased (P = 0.04) with ADF only, and the proportion of large HDL particles increased (P = 0.03) with exercise only. These results indicate that dietary restriction increases LDL particle size, while endurance training augments HDL particle size, with minimal weight loss. None of these interventions concomitantly increased both LDL and HDL particle size, however.
Full-text available
The problems of adherence to energy restriction in humans are well known. To compare the feasibility and effectiveness of intermittent continuous energy (IER) with continuous energy restriction (CER) for weight loss, insulin sensitivity and other metabolic disease risk markers. Randomized comparison of a 25% energy restriction as IER (∼ 2710 kJ/day for 2 days/week) or CER (∼ 6276 kJ/day for 7 days/week) in 107 overweight or obese (mean (± s.d.) body mass index 30.6 (± 5.1) kg m(-2)) premenopausal women observed over a period of 6 months. Weight, anthropometry, biomarkers for breast cancer, diabetes, cardiovascular disease and dementia risk; insulin resistance (HOMA), oxidative stress markers, leptin, adiponectin, insulin-like growth factor (IGF)-1 and IGF binding proteins 1 and 2, androgens, prolactin, inflammatory markers (high sensitivity C-reactive protein and sialic acid), lipids, blood pressure and brain-derived neurotrophic factor were assessed at baseline and after 1, 3 and 6 months. Last observation carried forward analysis showed that IER and CER are equally effective for weight loss: mean (95% confidence interval ) weight change for IER was -6.4 (-7.9 to -4.8) kg vs -5.6 (-6.9 to -4.4) kg for CER (P-value for difference between groups = 0.4). Both groups experienced comparable reductions in leptin, free androgen index, high-sensitivity C-reactive protein, total and LDL cholesterol, triglycerides, blood pressure and increases in sex hormone binding globulin, IGF binding proteins 1 and 2. Reductions in fasting insulin and insulin resistance were modest in both groups, but greater with IER than with CER; difference between groups for fasting insulin was -1.2 (-1.4 to -1.0) μU ml(-1) and for insulin resistance was -1.2 (-1.5 to -1.0) μU mmol(-1) l(-1) (both P = 0.04). IER is as effective as CER with regard to weight loss, insulin sensitivity and other health biomarkers, and may be offered as an alternative equivalent to CER for weight loss and reducing disease risk.