intermittent fasting and metabolic syndrome€¦ · metabolic syndrome diagnosed by having 3 of the...
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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].