Effects of 4- and 6-h Time-Restricted Feeding on Weight and Cardiometabolic Health: A Randomized Controlled Trial in Adults with Obesity.

Beslenme desteği kritik yetişkin hastaların bakımında önemlidir. Fakat kritik hasta için uygun kalori hedefi net değildir. Hedeflenen kaloriye ulaşılması ile protein katabolizması ve malnutrisyonun iyileştirilmesi ve bununla ilişkili morbidite ve mortalitede azalma amaçlanmaktadır. Farklı kalori miktarına sahip enteral beslenme alımını inceleyen gözlemsel çalışmalar çelişkili sonuçlar ortaya koymuştur. Kritik hastalarda rutin enteral beslenme ile yüksek kalorili enteral beslenmeyi karşılaştıran iki randomize kontrollü çalışma (RKÇ) yüksek kalorili enteral beslenme ile mortalitede bir azalma göstermemiştir. Akut akciğer hasarı veya akut solunum yetmezlikli kritik hastalarda yapılan iki RKÇ mimimum ya da trofik enteral beslenme ile (hedeflenen kalorinin %15-25) standart enteral beslenmede (SEB) benzer sonuçlar göstermiştir. Mevcut kanıtlar erken kritik hastalık sırasında eş zamanlı kalori alımına bakılmaksızın belli bir düzeyde protein alımını desteklemesine rağmen protein dışı enerji kısıtlaması yapılan hastalarda protein ihtiyacının tamamının yerine konmasının sonuçlar üzerine etkisi bilinmemektedir. Sıçanlarda yapılan bir çalışma, glukoz verilmeden protein ile beslenmenin malnutrisyon ile azalmış olan mitokondriyal fonksiyonlarda düzelme sağladığını göstermiştir. Bu nedenle diyetle yeterli protein alımı sağlanırsa kalori kısıtlamasının yararlı olabileceği öne sürülmüştür. Bu çalışmanın hipotezi protein alımı korunurken protein dışı kalori kısıtlaması (permisif hipokalorik beslenme) yapılan kritik erişkin hastalarda, standart beslenme alan hastalara göre 90 günlük sağ kalımın daha iyi olduğunun gösterilmesidir.

http://www.dcyogunbakim.org/sayilar/18/buyuk/63-641.pdf

Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults

The current obesity epidemic is staggering in terms of its magnitude and public health impact. Current guidelines recommend continuous energy restriction (CER) along with a comprehensive lifestyle intervention as the cornerstone of obesity treatment, yet this approach produces modest weight loss on average. Recently, there has been increased interest in identifying alternative dietary weight loss strategies that involve restricting energy intake to certain periods of the day or prolonging the fasting interval between meals (i.e., intermittent energy restriction, IER). These strategies include intermittent fasting (IMF; >60% energy restriction on 2–3 days per week, or on alternate days) and time-restricted feeding (TRF; limiting the daily period of food intake to 8–10 h or less on most days of the week). Here, we summarize the current evidence for IER regimens as treatments for overweight and obesity. Specifically, we review randomized trials of ≥8 weeks in duration performed in adults with overweight or obesity (BMI ≥ 25 kg/m2) in which an IER paradigm (IMF or TRF) was compared to CER, with the primary outcome being weight loss. Overall, the available evidence suggests that IER paradigms produce equivalent weight loss when compared to CER, with 9 out of 11 studies reviewed showing no differences between groups in weight or body fat loss.

Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss

The long-term efficacy and safety of time-restricted eating for weight loss are not clear. Download a PDF of the Research Summary. We randomly assigned 139 patients with obesity to time-restricted eating (eating only between 8:00 a.m. and 4:00 p.m.) with calorie restriction or daily calorie restriction alone. For 12 months, all the participants were instructed to follow a calorie-restricted diet that consisted of 1500 to 1800 kcal per day for men and 1200 to 1500 kcal per day for women. The primary outcome was the difference between the two groups in the change from baseline in body weight; secondary outcomes included changes in waist circumference, body-mass index (BMI), amount of body fat, and measures of metabolic risk factors. Of the total 139 participants who underwent randomization, 118 (84.9%) completed the 12-month follow-up visit. The mean weight loss from baseline at 12 months was −8.0 kg (95% confidence interval [CI], −9.6 to −6.4) in the time-restriction group and −6.3 kg (95% CI, −7.8 to −4.7) in the daily-calorie-restriction group. Changes in weight were not significantly different in the two groups at the 12-month assessment (net difference, −1.8 kg; 95% CI, −4.0 to 0.4; P=0.11). Results of analyses of waist circumferences, BMI, body fat, body lean mass, blood pressure, and metabolic risk factors were consistent with the results of the primary outcome. In addition, there were no substantial differences between the groups in the numbers of adverse events. Among patients with obesity, a regimen of time-restricted eating was not more beneficial with regard to reduction in body weight, body fat, or metabolic risk factors than daily calorie restriction. (Funded by the National Key Research and Development Project [No. 2018YFA0800404] and others; ClinicalTrials.gov number, NCT03745612.) QUICK TAKE VIDEO SUMMARYTime-Restricted Eating for Weight Loss 01:44 

Calorie Restriction with or without Time-Restricted Eating in Weight Loss

https://www.gastrojournal.org/article/S0016-5085(20)35505-0/pdf

Metabolism and Metabolic Disorders and the Microbiome: The Intestinal Microbiota Associated With Obesity, Lipid Metabolism, and Metabolic Health: Pathophysiology and Therapeutic Strategies

Objective:
This study compared the effects of alternate day fasting (ADF) to daily calorie restriction (CR) on body weight and glucoregulatory factors in adults with overweight/obesity and insulin resistance.

Differential Effects of Alternate-Day Fasting Versus Daily Calorie Restriction on Insulin Resistance.

Clinical application of intermittent fasting for weight loss: progress and future directions

Background:Time restricted feeding is a form of intermittent fasting where participants shorten the daily window in which they eat.Aim:This is the first study to examine the effects of intermittent...

Effect of time restricted feeding on the gut microbiome in adults with obesity: A pilot study:

Time-restricted eating (TRE) is a form of intermittent fasting that involves confining the eating window to 4–10 h and fasting for the remaining hours of the day. The purpose of this review is to summarize the current literature pertaining to the effects of TRE on body weight and cardiovascular disease risk factors. Human trial findings show that TRE reduces body weight by 1–4% after 1–16 weeks in individuals with obesity, relative to controls with no meal timing restrictions. This weight loss results from unintentional reductions in energy intake (~350–500 kcal/day) that occurs when participants confine their eating windows to 4–10 h/day. TRE is also effective in lowering fat mass, blood pressure, triglyceride levels, and markers of oxidative stress, versus controls. This fasting regimen is safe and produces few adverse events. These findings suggest that TRE is a safe diet therapy that produces mild reductions in body weight and also lowers several key indicators of cardiovascular disease in participants with obesity.

Sofia Cienfuegos

Papers

Effects of 4- and 6-h Time-Restricted Feeding on Weight and Cardiometabolic Health: A Randomized Controlled Trial in Adults with Obesity.

Differential Effects of Alternate-Day Fasting Versus Daily Calorie Restriction on Insulin Resistance.

Clinical application of intermittent fasting for weight loss: progress and future directions

Effect of time restricted feeding on the gut microbiome in adults with obesity: A pilot study:

Time-Restricted Eating to Improve Cardiovascular Health