Editorial
Intermittent fasting diet and health
La dieta del ayuno intermitente y la salud
a Grupo de investigación en Epidemiología Social y Nutricional, Farmacoepidemiología y Salud Pública. Departamento de Medicina Preventiva y Salud Pública, Ciencias de la Alimentación, Toxicología y Medicina Legal. Facultad de Farmacia. Universitat de València, Burjassot (Valencia), Spain
b Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
c Universidad Alfonso X el Sabio, Villanueva de la Cañada, Spain
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Departamento de Medicina Preventiva y Salud Pública, Ciencias de la Alimentación, Toxicología y Medicina Legal. Facultad de Farmacia. Universitat de València, Burjassot (Valencia), Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad Alfonso X el Sabio, Villanueva de la Cañada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La dieta del ayuno intermitente y la salud" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Long-term calorie restriction without malnutrition is one of the most consistent dietary interventions for improving health and extending survival in multiple species. In recent decades, interest in studying the effects of intermittent dieting on health has been increasing. Intermittent fasting (IF) diet refers to the practice of limiting or eliminating food and fluid intake for regular periods of time. This involves voluntary abstinence from energy and is achieved through food deprivation methods.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The IF diet has multiple options. The best known are the “16/8” (16 h fasting/8 h eating window), “12/12” (12 h fasting/12 h eating window), “5/2” (5 days of normal diet and 2 days of fasting), fasting on alternate days, periodic fasting or intermittent energy restriction of 2–6 days per week, among others.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Calorie intake during the fasting period usually varies from 0% to 25% of the regular calorie requirements. On the other hand, on non-fasting days, <span class="elsevierStyleItalic">ad libitum</span> consumption is allowed, limited to a certain dietary composition or reserved to reach a specific caloric intake of up to 125% of the regular caloric needs. In addition, intermittent fasting can be combined with other dietary approaches and unrestricted non-fasting consumption.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Human beings have a great capacity for metabolic adaptation to extreme situations, such as surviving several weeks of fasting, which implies a superb metabolism regulation called “metabolic flexibility”.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Energy balance is based on the interplay between calorie intake, energy expenditure and the dynamic storage of triglycerides in adipose tissue. The brain is the main regulator of intake management, through 2 types of control: homeostatic control, located in the brainstem and hypothalamus, and non-homeostatic control, in corticolimbic circuits.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Homeostatic control regulates the appetite/satiety process through orexigenic neuron circuits, mainly proopiomelacortin.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There are numerous substances produced outside the central nervous system that are involved in appetite regulation; most are peptides, and among the most studied are gut peptide Y (PYY), GLP-1, insulin, cholecystokinin, leptin and ghrelin. Ghrelin is a hormone released after several hours of fasting, also called the “hunger hormone”, which is involved in stimulating anabolic hormones, signalling the absence of nutrients, reducing satiety and calorie expenditure. It has short-term effects on food intake and long-term effects on weight regulation by stimulating appetite and promoting fat storage, energy savings, reduced basal metabolism and the search for high-calorie foods. It is also involved in the immune system, motility and the functioning of the digestive system, choice metabolism, memory and sleep quality, among others. Therefore, increasing ghrelin or reducing its expression in the body helps to maintain controlled levels of hunger and helps to achieve a healthy weight. Extreme diets, such as the IF diet, which involves very low-calorie intake, long periods of fasting or severe restrictions produce a drop in weight and activate the body’s “saving mode”, stimulating the release of ghrelin, which informs the brain that it is time to save the few calories consumed and minimise energy expenditure, which casts doubt on the usefulness of this diet in reducing weight.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In recent years, the IF diet has gained a great deal of public notoriety due to its potential usefulness in weight control. However, it is important to note that this practice has been carried out for thousands of years for health and religious reasons.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This popularity begins following the broadcast of a <span class="elsevierStyleItalic">BBC Horizon</span> documentary in the UK about the so-called “5/2” diet (5 days of regular eating combined with 2 days of “fasting” [with a maximum daily intake of 500 kcal for women and 600 kcal for men] per week) claiming to increase life expectancy, improve cognitive function and reduce the risk of chronic disease.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The fight against overweight and obesity is considered one of the top priorities worldwide. Increasing obesity (body mass index ≥ 30 kg/m<span class="elsevierStyleSup">2</span> or increased body fat) has a multifactorial origin and correlates with life-limiting and life-shortening chronic diseases such as cardiovascular disease and type 2 diabetes,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> musculoskeletal disorders and some cancers,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> with calorie reduction being the key to successful weight loss and improved glycaemic control.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Various approaches to weight management in people with obesity involve a variety of lifestyle interventions, including dietary changes, physical activity and psychological approaches to modify unhealthy behaviours, promote weight loss and prevent chronic weight gain. However, many methods achieve only modest changes in body weight, which may not have a significant clinical impact on health. It is therefore essential to investigate new approaches to weight management and evaluate their potential efficacy in the treatment of obesity.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The IF diet is claimed to be more effective than continuous energy restriction in preserving lean body mass during weight loss.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,8</span></a> It has been found that people following a daily calorie restriction diet for weight loss often find it difficult to stick to it as they experience daily hunger, and are more likely to suffer from anxiety and end up eating more than the diet allows, making it difficult to achieve their goal. On the other hand, IF offers the advantage of alternate days, which reduces the likelihood of non-compliance compared to daily calorie restriction diets.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> However, other studies have found that adherence to IF is lower than adherence to daily calorie restriction diets, as people are better able to withstand a lower daily calorie intake in their diet than alternate-day fasting.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In addition, some adverse effects observed with IF include tiredness, especially at the beginning, headache, moodiness, dizziness and fatigue,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and in people who have had an eating disorder it may not be advisable. In such cases, a more structured dietary pattern may be better.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> However, differences in the dietary regimes of the various IF diets make it difficult to determine the frequency of meals or the level of calorie restriction applied, which together with differences in animal and human studies make it difficult to compare them and draw robust conclusions.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Both short-term IF and calorie-restricted diets have been found to produce similar weight loss in people with obesity and type 2 diabetes.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> Although most studies have low numbers of participants over short periods of time. The few long-term clinical trials have shown that IF is superior to calorie-restricted diets in reducing waist circumference and central fat distribution, which is beneficial in reducing cardiovascular risk<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,10</span></a> and in controlling obesity.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, another study<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> did not identify differences in weight reduction, amount of fat and long-term metabolic risk factor control.</p><p id="par0055" class="elsevierStylePara elsevierViewall">IF has been found to play an important role in regulating protein levels, such as apolipoprotein A4 (APOA4), which has been associated with multiple beneficial phenotypes, including promoting reverse cholesterol transport, favouring satiety and decreasing oxidation of low-density lipoprotein cholesterol particles, with a combined regulatory effect that increases triglyceride lipolysis in chylomicrons and increases the production of mature spherical high-density lipoprotein cholesterol (HDL-C) particles, resulting in a significant decrease in plasma total triglyceride levels after a period of IF.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> However, no significant differences in HDL-C levels were observed after IF, suggesting the need for further trials with a larger sample size to validate these findings.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Time-restricted dietary regimes, a form of IF that involves having a longer daily fasting than intake period, has been found to improve cardiometabolic health, slow tumour progression and delay ageing,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,16</span></a> especially when food intake is limited to the beginning of the day or midday. These time-of-day effects may be explained by the circadian system, as eating in accordance with circadian metabolic rhythms may have benefits for cardiometabolic health.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Numerous experimental studies and clinical trials have found similarities and differences in the effects of IF diets. The similarities include reduced insulin levels and increased insulin sensitivity, making IF an effective preventive measure against type 2 diabetes.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> In addition, in both animals and humans it has been observed that fat loss is not accompanied by loss of lean mass, and that it improves obesity-related metabolic parameters, reduces resting heart rate and oxidative stress, and attenuates blood pressure in response to stress.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,19</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Interestingly, a similarity in the changes in gut microbiota brought about by IF has recently been demonstrated, with an increase in bacteria that release different short-chain fatty acids and have an anti-inflammatory effect.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> These findings suggest that IF may be beneficial for gut health, which could have important implications for the prevention of inflammatory and chronic diseases.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In general, more research with more representative population samples and longer follow-up time is needed to determine how different IF diets act on the metabolism of healthy and diseased adults, how they interact with the circadian cycle, and possible differences by sex, age and individual genetics. Comparisons with other calorie-restricted diets are also needed.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nothing to declare.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">Nothing to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intermittent fasting and weight loss: systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. 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