Impact of intermittent vs. continuous energy restriction on weight and cardiometabolic factors: a 12-month follow-up.

BACKGROUND AND OBJECTIVE: Intermittent energy restriction continues to gain popularity as a weight loss strategy; however, data assessing it's long-term viability is limited. The objective of this study was to follow up with participants 12 months after they had completed a 12-month dietary intervention trial involving continuous energy restriction and two forms of intermittent energy restriction; a week-on-week-off energy restriction and a 5:2 programme, assessing long-term changes on weight, body composition, blood lipids and glucose. SUBJECTS AND METHODS: 109 overweight and obese adults, aged 18-72 years, attended a 12-month follow-up after completing a 12-month dietary intervention involving three groups: continuous energy restriction (1000 kcal/day for women and 1200 kcal/day for men), week-on-week-off energy restriction (alternating between the same energy restriction as the continuous group for one week and one week of habitual diet), or 5:2 (500 kcal/day on modified fast days each week for women and 600 kcal/day for men). The primary outcome was weight change at 24 months from baseline, with secondary outcomes of change in body composition, blood lipids and glucose. RESULTS: For the 109 individuals who completed the 12-month follow-up (82 female, 15 male, mean BMI 33 kg/m2), weight decreased over time with no differences between week-on and week-off and continuous energy restriction or 5:2 and continuous energy restriction with -4.5 ± 4.9 kg for continuous energy restriction, -2.8 ± 6.5 kg for week-on, week-off and -3.5 ± 5.1 kg for 5:2. Total cholesterol reduced over time and glucose, HDL, LDL and triglycerides were unchanged. DISCUSSION AND CONCLUSION: Intermittent energy restriction was as successful in achieving modest weight loss over a 24-month period as continuous energy restriction.

Correction: Effect of intermittent compared to continuous energy restriction on weight loss and weight maintenance after 12 months in healthy overweight or obese adults.

Table 4 is still missing from both versions. It was labeled Table 3 in the first version but a reviewer wanted an extra table in the methods which became Table 1.

Effect of intermittent compared to continuous energy restriction on weight loss and weight maintenance after 12 months in healthy overweight or obese adults.

BACKGROUND AND OBJECTIVE: Intermittent energy restriction (IER) is an alternative to continuous energy restriction (CER) for weight loss. There are few long-term trials comparing efficacy of these methods. The objective was to compare the effects of CER to two forms of IER; a week-on-week-off energy restriction and a 5:2 program, during which participants restricted their energy intake severely for 2 days and ate as usual for 5 days, on weight loss, body composition, blood lipids, and glucose. SUBJECTS AND METHODS: A one-year randomized parallel trial was conducted at the University of South Australia, Adelaide, Australia. Participants were 332 overweight and obese adults, ages 18-72 years, who were randomized to 1 of 3 groups: CER (4200 kJ/day for women and 5040 kJ/day for men), week-on-week-off energy restriction (alternating between the same energy restriction as the continuous group for one week and one week of habitual diet), or 5:2 (2100 kJ/day on modified fast days each week for women and 2520 kJ/day for men, the 2 days of energy restriction could be consecutive or non-consecutive). Primary outcome was weight loss, and secondary outcomes were changes in body composition, blood lipids, and glucose. RESULTS: For the 146 individuals who completed the study (124 female, 22 male, mean BMI 33 kg/m2) mean weight loss, and body fat loss at 12 months was similar in the three intervention groups, -6.6 kg for CER, -5.1 kg for the week-on, week-off and -5.0 kg for 5:2 (p = 0.2 time by diet). Discontinuation rates were not different (p = 0.4). HDL-cholesterol rose (7%) and triglycerides decreased (13%) at 12 months with no differences between groups. No changes were seen for fasting glucose or LDL-cholesterol. DISCUSSION AND CONCLUSION: The two forms of IER were not statistically different for weight loss, body composition, and cardiometabolic risk factors compared to CER.

Characteristics of Indigenous adults with poorly controlled diabetes in north Queensland: implications for services.

BACKGROUND: Indigenous Australian adults with diabetes continue to have suboptimal clinical control and poorer outcomes compared with non-Indigenous people although there is a paucity of data documenting the detailed health status of Indigenous people in Australia. To further investigate the characteristics of Indigenous Australian adults with poorly controlled diabetes we analysed baseline data from a cluster randomized trial aiming to deliver a program of integrated community-based intensive chronic disease management for Indigenous people in remote communities in far north Queensland, Australia. METHODS: Indigenous adults aged 18 to 65 years from 12 clinics in rural north Queensland with established type 2 diabetes and with HbA1c ≥ 8.5% were invited to participate. The primary outcome variable measured at baseline was HbA1c. Other variables measured included socio-demographic indicators, health literacy, BMI, blood pressure, lipids, renal function, smoking status and quality of life measures. Data were collected between December 2010 and July 2011. Analysis was performed by ethnicity - Aboriginal or Torres Strait Islander. RESULTS: One hundred and ninety three participants were included in the analysis. Very high rates of albuminuria, high rates of smoking, dyslipidaemia, hypertension and elevated BMI were recorded. Aboriginal participants reported higher levels of socio-economic disadvantage, higher smoking rates, lower BMI and worse self-reported health status than Torres Strait Islander participants. CONCLUSION: These results demonstrate a high potential for improved culturally sound community-based management of diabetes and other comorbid conditions in this very high risk population. They also provide further evidence for including albuminuria in cardiovascular risk calculation.

Weight loss on a structured hypocaloric diet with or without exercise improves emotional distress and quality of life in overweight and obese patients with type 2 diabetes.

AIMS/INTRODUCTION: To evaluate the effects of a caloric restricted weight loss program with or without supervised resistance exercise training (EX) on diabetes-related emotional distress and quality of life (QOL) in overweight and obese patients with type 2 diabetes. MATERIALS AND METHODS: In a parallel design, 106 men and women with type 2 diabetes were randomized to a prescriptive 16-week caloric restricted diet (D; 6,000-7,000 kJ/day), with (n = 65) or without (n = 41) EX (three times per week). Bodyweight, glycated hemoglobin, diabetes-specific emotional distress (Problem Areas in Diabetes [PAID] questionnaire) and QOL (Diabetes-39 [D-39] questionnaire) was assessed pre- and post-intervention. RESULTS: A total of 84 participants completed the study (D n = 33, D + EX n = 51). Weight loss was significantly greater in D + EX compared with D (-11.4 ± 5.8 vs -8.8 ± 5.8 kg, P = 0.04 time × diet). Overall, there were significant improvements in glycated hemoglobin, PAID total score and the D-39 dimensions of 'diabetes control', 'anxiety and worry', 'sexual functioning', 'energy and mobility', 'overall rating of QOL' and 'severity of diabetes' (P ≤ 0.01 for time). The D-39 dimension, 'social burden', did not change (P = 0.07 for time). There was no difference between groups in the response for any of these variables (P ≥ 0.10). CONCLUSION: A structured caloric restricted diet with or without EX improves emotional distress and QOL in overweight and obese patients with type 2 diabetes. This trial was registered with Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au; ACTR No: ACTRN12608000206325).