禁食和能量限制饮食对人体瘦素和脂联素水平的影响：系统评价和荟萃分析。
The influence of fasting and energy-restricted diets on leptin and adiponectin levels in humans: A systematic review and meta-analysis.
机构信息
Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Science and Food Technology, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, United States.
出版信息
Clin Nutr. 2021 Apr;40(4):1811-1821. doi: 10.1016/j.clnu.2020.10.034. Epub 2020 Oct 24.
BACKGROUND & AIMS: Fasting and energy-restricted diets have been evaluated in several studies as a means of improving cardiometabolic biomarkers related to body fat loss. However, further investigation is required to understand potential alterations of leptin and adiponectin concentrations. Thus, we performed a systematic review and meta-analysis to derive a more precise estimate of the influence of fasting and energy-restricted diets on leptin and adiponectin levels in humans, as well as to detect potential sources of heterogeneity in the available literature.
METHODS
A comprehensive systematic search was performed in Web of Science, PubMed/MEDLINE, Cochrane, SCOPUS and Embase from inception until June 2019. All clinical trials investigating the effects of fasting and energy-restricted diets on leptin and adiponectin in adults were included.
RESULTS
Twelve studies containing 17 arms and a total of 495 individuals (intervention = 249, control = 246) reported changes in serum leptin concentrations, and 10 studies containing 12 arms with a total of 438 individuals (intervention = 222, control = 216) reported changes in serum adiponectin concentrations. The combined effect sizes suggested a significant effect of fasting and energy-restricted diets on leptin concentrations (WMD: -3.690 ng/ml, 95% CI: -5.190, -2.190, p ≤ 0.001; I = 84.9%). However, no significant effect of fasting and energy-restricted diets on adiponectin concentrations was found (WMD: -159.520 ng/ml, 95% CI: -689.491, 370.451, p = 0.555; I = 74.2%). Stratified analyses showed that energy-restricted regimens significantly increased adiponectin (WMD: 554.129 ng/ml, 95% CI: 150.295, 957.964; I = 0.0%). In addition, subsequent subgroup analyses revealed that energy restriction, to ≤50% normal required daily energy intake, resulted in significantly reduced concentrations of leptin (WMD: -4.199 ng/ml, 95% CI: -7.279, -1.118; I = 83.9%) and significantly increased concentrations of adiponectin (WMD: 524.04 ng/ml, 95% CI: 115.618, 932.469: I = 0.0%).
CONCLUSION
Fasting and energy-restricted diets elicit significant reductions in serum leptin concentrations. Increases in adiponectin may also be observed when energy intake is ≤50% of normal requirements, although limited data preclude definitive conclusions on this point.
背景与目的
禁食和能量限制饮食已在多项研究中被评估为改善与体脂损失相关的心脏代谢生物标志物的方法。然而，需要进一步研究以了解瘦素和脂联素浓度的潜在变化。因此，我们进行了系统评价和荟萃分析，以更准确地估计禁食和能量限制饮食对人体中瘦素和脂联素水平的影响，并发现可用文献中潜在的异质性来源。
方法
从 Web of Science、PubMed/MEDLINE、Cochrane、SCOPUS 和 Embase 全面系统地搜索了从成立到 2019 年 6 月的文献。纳入了所有研究禁食和能量限制饮食对成年人瘦素和脂联素影响的临床试验。
结果
12 项研究包含 17 个臂，共 495 人（干预组 249 人，对照组 246 人）报告了血清瘦素浓度的变化，10 项研究包含 12 个臂，共 438 人（干预组 222 人，对照组 216 人）报告了血清脂联素浓度的变化。联合效应大小表明，禁食和能量限制饮食对瘦素浓度有显著影响（WMD：-3.690ng/ml，95%CI：-5.190，-2.190，p≤0.001；I=84.9%）。然而，没有发现禁食和能量限制饮食对脂联素浓度有显著影响（WMD：-159.520ng/ml，95%CI：-689.491，370.451，p=0.555；I=74.2%）。分层分析表明，能量限制方案显著增加了脂联素（WMD：554.129ng/ml，95%CI：150.295，957.964；I=0.0%）。此外，随后的亚组分析表明，能量限制至≤50%正常所需的每日能量摄入导致瘦素浓度显著降低（WMD：-4.199ng/ml，95%CI：-7.279，-1.118；I=83.9%），脂联素浓度显著升高（WMD：524.04ng/ml，95%CI：115.618，932.469；I=0.0%）。
结论
禁食和能量限制饮食可显著降低血清瘦素浓度。当能量摄入≤50%正常需求时，脂联素也可能增加，尽管数据有限，无法对此得出明确结论。
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