Department of Cardiovascular Medicine, Shandong Provincial Third Hospital, Jinan, Shandong Province, People's Republic of China.
Department of Endocrinology, Shandong Provincial Third Hospital, Shadowless Hill Road, Tianqiao District, Jinan, Shandong Province, People's Republic of China.
Nutrition. 2020 Sep;77:110801. doi: 10.1016/j.nut.2020.110801. Epub 2020 Mar 12.
To the best of our knowledge, no systematic review and meta-analysis has evaluated the cholesterol-lowering effects of intermittent fasting (IF) and energy-restricted diets (ERD) compared with control groups. The aim of this review and meta-analysis was to summarize the effects of controlled clinical trials examining the influence of IF and ERD on lipid profiles.
A systematic review of four independent databases (PubMed/Medline, Scopus, Web of Science and Google Scholar) was performed to identify clinical trials reporting the effects of IF or ERD, relative to non-diet controls, on lipid profiles in humans. A random-effects model, employing the method of DerSimonian and Laird, was used to evaluate effect sizes, and results were expressed as weighted mean difference (WMD) and 95% confidence intervals (CIs). Heterogeneity between studies was calculated using Higgins I, with values ≥50% considered to represent high heterogeneity. Subgroup analyses were performed to examine the influence of intervention type, baseline lipid concentrations, degree of energy deficit, sex, health status, and intervention duration.
For the outcomes of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triacylglycerols (TG), there were 34, 33, 35, and 33 studies meeting all inclusion criteria, respectively. Overall, results from the random-effects model indicated that IF and ERD interventions resulted significant changes in TC (WMD, -6.93 mg/dL; 95% CI, -10.18 to -3.67; P < 0.001; I = 78.2%), LDL-C (WMD, -6.16 mg/dL; 95% CI, -8.42 to -3.90; P ˂ 0.001; I = 52%), and TG concentrations (WMD, -6.46 mg/dL; 95% CI, -10.64 to -2.27; P = 0.002; I = 61%). HDL-C concentrations did not change significantly after IF or ERD (WMD, 0.50 mg/dL; 95% CI, -0.69 to 1.70; P = 0.411; I = 80%). Subgroup analyses indicated potentially differential effects between subgroups for one or more lipid parameters in the majority of analyses.
Relative to a non-diet control, IF and ERD are effective for the improvement of circulating TC, LDL-C, and TG concentrations, but have no meaningful effects on HDL-C concentration. These effects are influenced by several factors that may inform clinical practice and future research. The present results suggest that these dietary practices are a means of enhancing the lipid profile in humans.
据我们所知，尚无系统评价和荟萃分析评估间歇性禁食（IF）和能量限制饮食（ERD）与对照组相比的降胆固醇作用。本综述和荟萃分析的目的是总结检查 IF 和 ERD 对脂质谱影响的对照临床试验的结果。
对四个独立数据库（PubMed/Medline、Scopus、Web of Science 和 Google Scholar）进行系统回顾，以确定报告 IF 或 ERD 相对于非饮食对照影响脂质谱的临床试验。采用 DerSimonian 和 Laird 方法的随机效应模型评估效应大小，并以加权均数差（WMD）和 95%置信区间（CI）表示结果。使用 Higgins I 计算研究之间的异质性，值≥50%表示存在高度异质性。进行亚组分析以检查干预类型、基线血脂浓度、能量亏缺程度、性别、健康状况和干预持续时间的影响。
对于低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）和三酰甘油（TG）的结局，分别有 34、33、35 和 33 项研究符合所有纳入标准。总体而言，随机效应模型的结果表明，IF 和 ERD 干预可显著改变 TC（WMD，-6.93mg/dL；95%CI，-10.18 至-3.67；P<0.001；I=78.2%）、LDL-C（WMD，-6.16mg/dL；95%CI，-8.42 至-3.90；P<0.001；I=52%）和 TG 浓度（WMD，-6.46mg/dL；95%CI，-10.64 至-2.27；P=0.002；I=61%）。IF 或 ERD 后 HDL-C 浓度无显著变化（WMD，0.50mg/dL；95%CI，-0.69 至 1.70；P=0.411；I=80%）。亚组分析表明，在大多数分析中，一个或多个脂质参数的亚组间存在潜在的差异效应。
与非饮食对照相比，IF 和 ERD 可有效改善 TC、LDL-C 和 TG 浓度，但对 HDL-C 浓度无明显影响。这些影响受多种因素影响，可能为临床实践和未来研究提供信息。本研究结果表明，这些饮食方法是改善人体脂质谱的一种手段。
