Intermittent Fasting And Metabolic Syndrome

IntermittentFasting andMetabolicSyndromeKiara Heider, Dietetic Intern

Overview1.2.3.4.5.6.7.Why this topic?Diagnosing Metabolic SyndromeCurrent MNT for Metabolic SyndromeTypes of FastingCurrent ResearchDiscussionQuestions

Why ThisTopic?

Metabolic SyndromeDiagnosed 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)Importance? Affects 23% of the adult population Increases the individual’s risk for heart disease, diabetes, and stroke.American Heart Association, 2016National Heart, Lung, and Blood Institute (NHLBI), n.d.

Current MNTPromote 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, 2020Academy of Nutrition and Dietetics, n.d. .

Eating Window: a 12, 8, or 4 hour feedingwindow per day.One meal a day: only eating once per day.New TreatmentPlan Fasting?Alternate day fasting: eating every other day.Extended fasting: fasting for 24 hours ormore.5:2 diet: Typical intake for five days and only500-600 calories for two days.Gordon, 2019.

ResearchArticle 1Effects of A One-weekFasting Therapy in Patientswith Type-2 DiabetesMellitus and MetabolicSyndrome – A RandomizedControlled ExplorativeStudyChenying Li, Badri Sadraie, Nico Steckhan, Christian Kessler, Rainer Stange,Michael Jeitler, Andreas Michalsen

BackgroundStudyTypePurposeSampleSizeRandomized, Clinical control trial, Pilot StudyTo determine if a 7 day fast has beneficial health effects on participants with metabolicsyndrome and type 2 diabetes after 4 months.Original – 46 participantsAnalyzed – 32 participantsLi, C., Sadraie, B., Steckhan, N., Kessler, C., Stange, R., Jeitler, M. and Michalsen, A., 2017

CriteriaInclusion Criteria 25 - 75 years old Exclusion Criteria Treated type 2 diabetesAbdominal obesity (waist circumference 94 cm [men] or 80 cm [women]) 2Body mass index 25 kg/m Diagnosed metabolic syndrome Li, C., Sadraie, B., Steckhan, N., Kessler, C., Stange, R., Jeitler, M. and Michalsen, A., 2017Type-1 diabetes mellitusIntense insulin treatmentMI, CVA, or pulmonary embolism in last 3 monthsDiabetes due to corticosteroidsRenal failure with GFR 60History or current eating disorderDementiaEtc.

InterventionParticipants with Metabolic Syndromen 46- Baseline blood sample and anthropometric taken.-All participants were educated on the Mediterranean dietRandomized 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 solidsMediterranean Diet for 4 monthsControl Groupn 23 (Final n 16) Mediterranean diet for entirety of study- 4-month blood sample and anthropometric taken.Li, C., Sadraie, B., Steckhan, N., Kessler, C., Stange, R., Jeitler, M. and Michalsen, A., 2017

ResultsInsignificant Findings: Hgb A1C, Triglycerides, HDL/LDL, Total Cholesterol, HOMA-IRLi, C., Sadraie, B., Steckhan, N., Kessler, C., Stange, R., Jeitler, M. and Michalsen, A., 2017

ConclusionThe results of the pilot study point to beneficial metabolic effects of a one-week fasting therapy inpersons with type 2 diabetes over 4 months.Strengths Standardized kcals during fast Restricted from caffeine and alcohol during fast Usual daily activity Mediterranean diet educationGrade: Plus/Positive ( )Li, C., Sadraie, B., Steckhan, N., Kessler, C., Stange, R., Jeitler, M. and Michalsen, A., 2017Limitations Unclear demographics Very specific fast regulations Small sample Did not assess dietary adherence

ResearchArticle 2Modified alternate-dayfasting vs. calorie restrictionin the treatment of patientswith metabolic syndrome: Arandomized clinical trialArefe Parvaresh, Roghaye Razavi, Behnood Abbasi, Khadijeh Yaghoobloo,Akbar Hassanzadeh, Noushin Mohammadifard, Sayyed Morteza Safavi, AmirHadi, Cain C.T. Clark

BackgroundStudyTypePurposeSampleSizeRandomized, Clinical control trialTo compare the effect of calorie restriction diet versus a modified alternate-day fastingdiet as a treatment for adults with metabolic syndrome.Original - 70 participantsAnalyzed – 69 participantsParvaresh A, Razavi R, Abbasi B, et al., 2019

CriteriaInclusion CriteriaExclusion Criteria 25 – 60 years old Diagnosed metabolic syndrome Overweight ( 25 BMI, 40 kg/m2). Weight changes 5% in last 3 months History of liver, cardiovascular, renal, ormetabolic disease Smoking Taking any medication Following special diet in last 6 months Breast feeding, post-menopausal, and pregnantwomen.Parvaresh A, Razavi R, Abbasi B, et al., 2019

InterventionParticipants with Metabolic Syndromen 70- Baseline blood sample and anthropometric taken.- Physical activity questionnaire and 3-day dietary record was completed.- Calorie needs calculated using Mifflin St. JeorRandomizedAlternate 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)Calorie Restricted Group (CR) Groupn 35 (Final n 34) Consumed 75% of their energy needs each day Fridays ad-libitum- 8-week blood sample and anthropometric taken.- Physical activity questionnaire and 3-day dietary record was completed.Parvaresh A, Razavi R, Abbasi B, et al., 2019

ResultsSignificance FromBaselineParvaresh A, Razavi R, Abbasi B, et al., 2019Insignificant Findings: HDL-C, LDL-CBetween Groups

ConclusionModified alternate-day fasting diet may be a more effective option compared to the typical calorierestriction diet.Strengths Males and Females Taught to prepare meals Control Group Continue usual activityLimitations Dietary intake was self reported Not blinded Short study period Unknown ethnic diversityGrade: Plus/Positive ( )Parvaresh A, Razavi R, Abbasi B, et al., 2019

ResearchArticle 3Ten-Hour Time-RestrictedEating Reduces Weight, BloodPressure, and AtherogenicLipids in Patients with MetabolicSyndromeMichael J. Wilkinson, Emily N.C. Manoogian, Adena Zadourian, SaketNavlakha, Satchidananda Panda, Pam R. Taub

BackgroundStudyTypePurposeSingle-arm, paired-sample, clinical control trialDetermine if a 10-hour time restricted eating period could improve the following inpatients with Metabolic Syndrome: SampleSizeWeightBlood pressureLipidsGlucose InflammationFasting insulinHgb A1CSleepThyroid functionWhite blood cell countOriginal – 25 participantsAnalyzed - 19 participantsWilkinson, M., Manoogian, E., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., Wang, X., Fleischer, J., Navlakha, S., Panda, S. and Taub, P., 2020.

CriteriaInclusion CriteriaExclusion Criteria Diagnosed metabolic syndrome 18 years old 14-hour daily eating intervalOwns and operates a smartphonePregnant or breast-feedingFrequent nocturnal interruptionsType 1 diabetesHistory of eating disorderStage 4 or 5 CKDWeight loss/management programPrescribed dietAppetite affecting medicationsBariatric surgeryEct.Wilkinson, M., Manoogian, E., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., Wang, X., Fleischer, J., Navlakha, S., Panda, S. and Taub, P., 2020.

Intervention12 Week intervention4 total visits 1-week baseline measurements 1-week result measurementsWilkinson, M., Manoogian, E., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., Wang, X., Fleischer, J., Navlakha, S., Panda, S. and Taub, P., 2020.

ResultsInsignificant Findings: Triglycerides, CRP, ALT, AST, blood glucose, Hgb A1C, HOMA-IR, WBCcount, 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 loggingLimitations No blinding Large age gap Various participant baseline measuresGrade: 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.

DiscussionStudy 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 measuresStart Slow: Make it a lifestyle change Don’t call it fasting/diet A simple form that is easy to implement

Questions?

ReferencesAcademy 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: ndrome/about-metabolic-syndrome [Accessed 26 March 2020].American Heart Association, 2020. What Is The Mediterranean Diet?. [online] www.heart.org. Available at: ing/eat-smart/nutrition-basics/mediterranean-diet [Accessed 4 April 2020].Gordon, B., 2019. What Is Intermittent Fasting. [online] Eatright.org. Available at: ets/what-is-intermittentfasting [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 DiabetesMellitus 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: yndrome [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 randomizedclinical 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 TimeRestricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patients with Metabolic Syndrome. Cell Metabolism, [online] 31(1), pp.92-104.e5.Available at: pii/S1550413119306114?via%3Dihub [Accessed 10 March 2020].

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 .