Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Feb;31 Suppl 1(Suppl 1):9-21.
doi: 10.1002/oby.23568. Epub 2022 Nov 8.

A meta-analysis comparing the effectiveness of alternate day fasting, the 5:2 diet, and time-restricted eating for weight loss

Paloma Elortegui Pascual  1 , Maryann R Rolands  1 , Alison L Eldridge  1 , Amira Kassis  2 , Fabio Mainardi  1 , Kim-Anne Lê  1 , Leonidas G Karagounis  3   4 , Philipp Gut  1 , Krista A Varady  5
Affiliations
Review

A meta-analysis comparing the effectiveness of alternate day fasting, the 5:2 diet, and time-restricted eating for weight loss

Paloma Elortegui Pascual et al. Obesity (Silver Spring). 2023 Feb.

Erratum in

Abstract

Objective: The objective of this meta-analysis was to compare the effectiveness of different intermittent fasting (IF) regimens on weight loss, in the general population, and compare these to traditional caloric energy restriction (CER).

Methods: Three databases were searched from 2011 to June 2021 for randomized controlled trials (RCTs) that assessed weight loss and IF, including alternate day fasting (ADF), the 5:2 diet, and time-restricted eating (TRE). A random effect network analysis was used to compare the effectiveness between the three regimens. Meta-regression analysis was presented as weighted mean differences of body weight loss.

Results: The exploratory random effects network analysis of 24 RCTs (n = 1768) ranked ADF as the most effective, followed by CER and TRE. The meta-analysis showed that IF regimens resulted in similar weight loss to CER (mean difference 0.26 kg, 95% CI: -0.31 to 0.84; p = 0.37). Compliance was generally high (>80%) in trials shorter than 3 months.

Conclusions: The present meta-analysis concludes that IF is comparable to CER and a promising alternative for weight loss. Among the three regimens, ADF showed the highest effectiveness for weight loss, followed by CER and TRE. Further well-powered RCTs with longer durations of intervention are required to draw solid conclusions.

PubMed Disclaimer

Conflict of interest statement

Paloma Elortegui Pascual, Maryann R. Rolands, Alison L. Eldridge, Philipp Gut, Kim Anne Lê, and Fabio Mainardi are employees of Société des Produits Nestlé S.A., a funder of the study. Leonidas G. Karagounis is an employee of Nestlé Health Science, Lausanne, Switzerland. Amira Kassis and Krista A. Varady have received financial support for this project from Société des Produits Nestlé S.A.

Figures

FIGURE 1
FIGURE 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) flowchart for RCTs selected for inclusion in the meta‐analysis. Full text studies were excluded for the following reasons: metabolic diseases other than obesity (n = 7), non‐RCTs (n = 7), non‐intermittent fasting regimen (n = 6), religious fasting (n = 2), no body weight (n = 3), no control (n = 8), review (n = 1), abstract only (n = 33), secondary analysis (n = 4), duration less than 1 week (n = 1). RCT, randomized controlled trial
FIGURE 2
FIGURE 2
Exploratory network analysis on the probability of ranking on the effectiveness of weight loss between the intermittent fasting regimens: MADF, ADF, 5:2, TRE, and comparator diets: CER and control. The table provides support to the interpretation of the network plot for the probabilities of each regimen's rankings. The highest probability for each rank is highlighted in bold. ADF, alternate day fasting; CER, caloric energy restriction; MADF, modified alternate day fasting; TRE, time‐restricted eating
FIGURE 3
FIGURE 3
Forest plot on the effect of weight loss between CER and the intermittent fasting regimens (ADF/MADF, 5:2, and TRE). The arrows in the forest plot imply the CI going beyond the numbers showed in the plot. ADF, alternate day fasting; CER, caloric energy restriction; MADF, modified alternate day fasting; MD, mean difference in body weight loss; RE, random effects; TRE, time‐restricted eating
See this image and copyright information in PMC

References

    1. He S, Wang J, Zhang J, Xu J. Intermittent versus continuous energy restriction for weight loss and metabolic improvement: a meta‐analysis and systematic review. Obesity (Silver Spring). 2021;29:108‐115. - PubMed
    1. Welton S, Minty R, O'Driscoll T, et al. Intermittent fasting and weight loss: systematic review. Can Fam Physician. 2020;66:117‐125. - PMC - PubMed
    1. Ryan D, Heaner M. Guidelines (2013) for managing overweight and obesity in adults. Preface to the full report. Obesity (Silver Spring). 2014;22(S2):S1‐S3. - PubMed
    1. Mattson MP, Longo VD, Harvie M. Impact of intermittent fasting on health and disease processes. Ageing Res Rev. 2017;39:46‐58. - PMC - PubMed
    1. Varady KA, Cienfuegos S, Ezpeleta M, Gabel K. Cardiometabolic benefits of intermittent fasting. Annu Rev Nutr. 2021;41:333‐361. - PubMed