Jan 30, 2017 - ide levels decreased by 33% in the high-calorie breakfast group but ...... Taylor MA, Garrow JS. Compared
AHA SCIENTIFIC STATEMENT
Meal Timing and Frequency: Implications for Cardiovascular Disease Prevention A Scientific Statement From the American Heart Association
T
he patterns of meal and snack eating behavior in American adults have changed over the past 40 years. Based on NHANES (National Health and Nutrition Examination Survey) data from 1971 to 1974 to 2009 to 2010 (n=62 298), women 20 to 74 years of age reported a decrease in 24-hour meal-derived total energy intake (TEI) from 82% in the 1970s to 77% in 2009 to 2010 and an increase in the proportion of TEI consumed from snacks from 18% to 23%.1 Similar trends were reported among men. The proportion of men and women who reported consuming all 3 standard meals declined over this period (from 73% to 59% in men; from 75% to 63% in women),1 reflecting changes in eating patterns rather than changes in eating frequency. Indeed, the traditional breakfast-lunch-dinner pattern was not observed in a population of healthy, non–shift-working adults.2 In that study, the number of eating occasions, defined as consumption of any food or beverage providing at least 5 kcal, was ≈4.2 times a day in the lowest decile and 10.5 times a day for the top decile. There were only 5 hours during the 24-hour day when 110 mg/dL).82–84,87–89 HDL cholesterol concentrations remained unchanged in most of the studies reviewed here (Table 1). Triglyceride concentrations decreased in the majority of intermittent-fasting studies, with reductions ranging from 16% to 42% (Table 1). The greatest decreases in triglycerides were generally observed in studies with the greatest weight loss. For instance, in studies that achieved 1-kg/wk weight loss, triglycerides decreased by ≈30% to 40%,82,83 whereas in the studies that achieved 0.25- to 0.5-kg/wk weight loss,84,87–89 triglycerides decreased by ≈10% to 20%. Thus, both alternateday fasting and periodic-fasting regimens appear to be effective in lowering triglyceride levels, but the effect is dependent on the amount of weight lost. Systolic and diastolic blood pressures decreased only in the intermittent-fasting studies that achieved 6% to 7% weight loss.81,83,87,89 In these trials, systolic blood pressure reductions ranged from 3% to 8% and diastolic blood pressure reductions ranged from 6% to 10% after 6 to 24 weeks of treatment.81,83,87,89 Participants in these studies81,83,87,89 all had borderline prehypertension, Circulation. 2017;135:00–00. DOI: 10.1161/CIR.0000000000000476
Circulation. 2017;135:00–00. DOI: 10.1161/CIR.0000000000000476
TBD, 2017
n=16, M and F Age, 23–53 y Overweight Race/ethnicity: NR n=15, F Age, 34±6 y Obese Race/ethnicity: NR n=10, M and F Age: NR Obese Race/ethnicity: NR n=16, M and F Age, 46±2 y Obese Prediabetic Race/ethnicity: 6–H 8–B 2–W n=32, F Age, 42±2 y Obese Race/ethnicity: 8–H 24–B 0–W
3
6
8
8
8
Eshghinia and Mohammadzadeh,81 2013
Johnson et al,82 2007
Varady et al,83 2009
Klempel et al,84 2012
Subjects
Heilbronn et al,80 2005
Alternate-day fasting (fasting 3–4 d/wk)
Reference
Duration, wk
Fast day: 25% intake, high fat Feed day: ad libitum intake, high fat Fast day: 25% intake, low fat Feed day: ad libitum intake, low fat Food provided all days in all groups
Fast day: 25% intake Feed day: ad libitum intake Food provided on fast day
Fast day: 20% intake Feed day: ad libitum intake Food provided on fast day
Fast day: 30% intake Feed day: ad libitum intake Food not provided
Fast day: 0% intake Feed day: ad libitum intake Food not provided
Intervention
CLINICAL STATEMENTS AND GUIDELINES
↓5* ↓4*
↓6*
↓8*
↓7*
↓3*
Weight, % Change
↓13* ↓16*
↓21*
↓9*
↓6
…
TC
↓18* ↓25*
↓32*
↓10
↓12
…
LDL
↓1 ↑5
↑9
↑4
↑19
↑VNR in women only*
HDL
↓14* ↓24*
↓35*
↓42*
↓11
↓VNR*
TG
↓2 ↓2
↓6*
…
↓8*
…
SBP
↓3 ↑3
↓6*
…
↓10*
…
DBP
↓2 ↓2
↓4*
↑6
↓6
↓1
Glucose
CHD Risk Parameters, % Change
Downloaded from http://circ.ahajournals.org/ by guest on October 25, 2017
Table 1. Intermittent Fasting: Effect on CHD Risk Parameters
…
↓20*
↓37*
…
↓57*
Insulin
(Continued )
…
↓19*
↓33*
…
…
HOMA-IR
Meal Timing and Frequency and CVD Prevention
e7
e8 Subjects
TBD, 2017
12
n=32, M and F Age, 47±4 y Normal weight and overweight Prediabetic Race/ethnicity: 3–H 13–B 14–W
n=32, M and F Age, 43±3 y Obese Race/ethnicity: 18–H 41–B 21–W 3–Other
12
Bhutani et al,86 2013
Varady et al,87 2013
n=74, M and F Age, 45±3 y Obese Race/ethnicity: NR
8
Hoddy et al,85 2014
Alternate-day fasting (fasting 3–4 d/wk) Continued
Reference
Duration, wk
Fast day: 25% intake Feed day: ad libitum intake Food provided on fast day Control: ad libitum fed every day Food not provided
Fast day: 25% intake Feed day: ad libitum intake Food provided on fast day Control: ad libitum fed every day Food not provided
Fast day: 25% intake as lunch Feed day: ad libitum intake Fast day: 25% intake as dinner Feed day: ad libitum intake Fast day: 25% intake as small meals Feed day: ad libitum intake Food provided on fast day in all groups
Intervention
↓7* ↓1
↓4* 0
↓4* ↓4* ↓4*
Weight, % Change
↓13* ↓4
↑7 ↑1
↓1 ↓3 0
TC
↓16* ↓7
↓1 ↑3
↓1 0 0
LDL
↓4 ↑2
0 ↑8
↓4 0 ↓2
HDL
↓2* ↑9
↑3 ↑5
↓6 ↓8 ↓1
TG
↓6* ↑1
↓3* ↓2
↓2 ↓4 ↓5*
SBP
↓6* ↑1
↓2 ↓2
↓1 ↓4 ↓1
DBP
↓8* ↑2
↓3 ↑2
↓2 ↓1 ↓1
Glucose
CHD Risk Parameters, % Change
Downloaded from http://circ.ahajournals.org/ by guest on October 25, 2017
Table 1. Continued
↓31† ↑2
↓11† ↑1
0 ↓18 ↓12
Insulin
(Continued )
↓28† ↑2
↓9† ↑2
↓10 ↓26 ↓19
HOMA-IR
St-Onge et al
Circulation. 2017;135:00–00. DOI: 10.1161/CIR.0000000000000476
24
Harvie et al,89 2011
n=53, F Age, 30–45 y Overweight and obese Race/ethnicity: 2–B 103–W 2–Other
n=54, F Age, 48±2 y Obese Prediabetic Race/ethnicity‡: 9–H 34–B 6–W 5–A
Subjects
2 d/wk: 25% intake 5 d/wk: ad libitum intake Food not provided
1 d/wk: 0% intake 6 d/wk: 70% intake, liquid diet Food provided 1 d/wk: 0% intake 6 d/wk: 70% intake, food diet Food not provided
Intervention
↓7*
↓4* ↓3*
Weight, % Change
CLINICAL STATEMENTS AND GUIDELINES
Circulation. 2017;135:00–00. DOI: 10.1161/CIR.0000000000000476
↓6*
↓19* ↓8*
TC
↓10*
↓20* ↓7*
LDL
0
↓5 ↓2
HDL
↓16*
↓17* ↓3
TG
↓3*
↓2 ↓5
SBP
↓6*
↓5 0
DBP
↓2
↓3* ↓2
Glucose
CHD Risk Parameters, % Change
↓29*
↓21* ↓13
Insulin
↓27*
↓23* ↓12
HOMA-IR
A indicates Asian; B, black, African American, or Afro-Caribbean; CHD, coronary heart disease; DBP, diastolic blood pressure; F, female; H, Hispanic; HDL, high-density lipoprotein cholesterol; HOMA-IR, homeostatic model assessment of insulin resistance; LDL, low-density lipoprotein cholesterol; M, male; NR, not reported; SBP, systolic blood pressure; TC, total cholesterol; TG, triglycerides; VNR, value not reported; and W, white. *Posttreatment value significantly different from baseline value (P
