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The most studied IER approaches are either two consecutive days of ER per week (“two day”) or alternate days of ER (ADER), typically with a restriction which is 60%–70% below estimated requirements, or a total fast on alternate days.
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IER may also provide metabolic benefits for normal weight subjects, although this requires further investigation. It is therefore possible that repeated spells of marked ER for short spells during the week could provide metabolic benefits to post obese individuals beyond the period of weight loss who are no longer in negative energy balance. IER is of potential interest to manage obesity and its metabolic sequelae and also for normal weight subjects hoping to optimise their health independent of weight loss for two main reasons: firstly, IER only requires the individual to focus on ER for defined days during the week which is potentially more achievable than the standard approach of CER which is associated with poor compliance and, secondly, many beneficial metabolic effects achieved with weight loss and energy restriction are related to the energy restriction per se and are attenuated when the individual is no longer in negative energy balance. More recently, interest has focussed on intermittent energy restriction (IER) defined as periods of energy restriction interspersed with normal energy intake. Most human and animal studies on weight loss have involved continuous energy restriction (CER) administered on a daily basis. The health benefits of weight loss and energy restriction in these human clinical trials are supported by a century of laboratory research in rodents, which has established that energy restriction (ER) prevents age-related disease including tumours, cardiovascular disease, diabetes and dementia retards aging-related functional decline and increases lifespan. Randomised trials demonstrate that intentional weight loss reduces type 2 diabetes, all-cause mortality and increases cognitive and physical function. The longer term benefits or harms of IER amongst people who are overweight or obese, and particularly amongst normal weight subjects, is not known and is a priority for further investigation.Įxcess energy intake, weight gain and subsequent adiposity are consistently linked to illness, disability and mortality. Studies amongst normal weight subjects and different animal models highlight the potential beneficial and adverse effects of intermittent compared to continuous energy restriction on ectopic and visceral fat stores, adipocyte size, insulin resistance, and metabolic flexibility. Six small short term (<6 month) studies amongst overweight or obese individuals indicate that intermittent energy restriction is equal to continuous restriction for weight loss, with one study reporting greater reductions in body fat, and two studies reporting greater reductions in HOMA insulin resistance in response to IER, with no obvious evidence of harm. It also summarises the potential beneficial or adverse effects of IER on body composition, adipose stores and metabolic effects from human studies, including studies amongst normal weight subjects and relevant animal experimentation. This review summarises randomised comparisons of intermittent and isoenergetic continuous energy restriction for weight loss to manage overweight and obesity.
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Intermittent energy restriction (IER) has become popular as a means of weight control amongst people who are overweight and obese, and is also undertaken by normal weight people hoping spells of marked energy restriction will optimise their health.