Horne Benjamin D, Anderson Jeffrey L, May Heidi T, Le Viet T, Bair Tami L, Bennett Sterling T, Knowlton Kirk U, Muhlestein Joseph B
Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA.
Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.
Int J Cardiol Cardiovasc Risk Prev. 2023 Sep 11;19:200209. doi: 10.1016/j.ijcrp.2023.200209. eCollection 2023 Dec.
Intermittent fasting may increase longevity and lower cardiometabolic risk. This study evaluated whether fasting modifies clinical risk scores for mortality [i.e., Intermountain Mortality Risk Score (IMRS)] or chronic diseases [e.g., Pooled Cohort Risk Equations (PCRE), Intermountain Chronic Disease score (ICHRON)].
Subjects (N = 71) completing the WONDERFUL trial were aged 21-70 years, had ≥1 metabolic syndrome criteria, elevated cholesterol, and no anti-diabetes medications, statins, or chronic diseases. The intermittent fasting arm underwent 24-h water-only fasting twice-per-week for 4 weeks and once-per-week for 22 weeks (26 weeks total). Analyses examined the IMRS change score at 26 weeks vs. baseline between intermittent fasting (n = 38) and controls (n = 33), and change scores for PCRE, ICHRON, HOMA-IR, and a metabolic syndrome score (MSS). Age averaged 49 years; 65% were female. Intermittent fasting increased IMRS (0.78 ± 2.14 vs. controls: -0.61 ± 2.56; p = 0.010) but interacted with baseline IMRS (p-interaction = 0.010) to reduce HOMA-IR (but not MSS) more in subjects with higher baseline IMRS (median HOMA-IR change: fasters, -0.95; controls, +0.05) vs. lower baseline IMRS (-0.29 vs. -0.32, respectively). Intermittent fasting reduced ICHRON (-0.92 ± 2.96 vs. 0.58 ± 3.07; p = 0.035) and tended to reduce PCRE (-0.20 ± 0.22 vs. -0.14 ± 0.21; p = 0.054).
Intermittent fasting increased 1-year IMRS mortality risk, but decreased 10-year chronic disease risk (PCRE and ICHRON). It also reduced HOMA-IR more in subjects with higher baseline IMRS. Increased IMRS suggests fasting may elevate short-term mortality risk as a central trigger for myriad physiological responses that elicit long-term health improvements. Increased IMRS may also reveal short-term fasting-induced safety concerns.
间歇性禁食可能会延长寿命并降低心血管代谢风险。本研究评估了禁食是否会改变死亡率的临床风险评分[即山间死亡率风险评分（IMRS）]或慢性疾病的风险评分[例如，合并队列风险方程（PCRE）、山间慢性病评分（ICHRON）]。
完成WONDERFUL试验的受试者（N = 71）年龄在21至70岁之间，符合≥1项代谢综合征标准，胆固醇升高，且未服用抗糖尿病药物、他汀类药物或患有慢性疾病。间歇性禁食组每周进行两次24小时仅饮水禁食，持续4周，之后每周进行一次，持续22周（共26周）。分析比较了间歇性禁食组（n = 38）和对照组（n = 33）在26周时与基线相比的IMRS变化评分，以及PCRE、ICHRON、HOMA-IR和代谢综合征评分（MSS）的变化评分。平均年龄为49岁；65%为女性。间歇性禁食增加了IMRS（0.78±2.14，对照组为-0.61±2.56；p = 0.010），但与基线IMRS存在交互作用（p交互作用 = 0.010），在基线IMRS较高的受试者中，HOMA-IR降低得更多（但MSS未降低）（HOMA-IR变化中位数：禁食组为-0.95，对照组为+0.05），而基线IMRS较低的受试者中HOMA-IR变化分别为-0.29和-0.32。间歇性禁食降低了ICHRON（-0.92±2.96，对照组为0.58±3.07；p = 0.035），并且有降低PCRE的趋势（-0.20±0.22，对照组为-0.14±0.21；p = 0.054）。
间歇性禁食增加了1年IMRS死亡率风险，但降低了10年慢性疾病风险（PCRE和ICHRON）。在基线IMRS较高的受试者中，它还能更显著地降低HOMA-IR。IMRS升高表明禁食可能会提高短期死亡率风险，这是引发多种生理反应从而带来长期健康改善的核心触发因素。IMRS升高也可能揭示了短期禁食引起的安全性问题。
