For weight loss and heart disease risk reduction Krista Varady PhD Associate Professor of Nutrition University of Illinois Chicago 65 of Americans are overweight or obese Obesity greatly increases the risk of ID: 319913
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Slide1
Alternate day fasting
For weight loss and heart disease risk reduction
Krista Varady, Ph.D.
Associate Professor of Nutrition
University of Illinois, ChicagoSlide2
65% of Americans are overweight or obeseSlide3
Obesity greatly increases the risk of
coronary heart disease (CHD)Slide4
Losing
weight helps to lower the risk of CHDSlide5
Most commonly used weight loss intervention:
Calorie restriction (CR)Slide6
What is Calorie restriction (CR)?Slide7
Reducing energy intake
by 15-40% of daily needs
What is Calorie restriction (CR)?Slide8
Calorie restriction is effective for weight loss
Chaston
TB & Dixon JB,
Int
J Obesity. 2008.Slide9
Chaston
TB & Dixon JB, Int
J Obesity. 2008.
Weight loss 10-15% in 3 months
Calorie restriction is effective for weight lossSlide10
Problem with calorie restriction:
Dietary adherence begins to decline after 8 weeksSlide11
How can we increase adherence to calorie
restriction to ensure consistent weight loss?Slide12
Perhaps by only requiring calorie restriction
every other day?
Day of ad libitum feeding
Day of 75% restrictionSlide13
Feed day Fast day
Day of ad libitum feeding
Day of 75% restriction
Alternate day fasting (ADF)Slide14
In this way, the person always gets to look forward
to the day of eating anything they want
Fast day Feed daySlide15
How did the idea of ADF come about?Slide16
Fasting in the absence
of weight loss
How did the idea of ADF come about?Slide17
Fasting in the absence
of weight loss
Effect on cell proliferation rates
of various tissues (Cancer risk)
How did the idea of ADF come about?Slide18
But the mice always lost weight!Slide19
Would we see the same weight loss
in humans with ADF?
?Slide20
STUDY 1 – Pilot study
Study objectivesIs ADF an effective strategy for weight loss?
What is the effect of this diet on CHD risk parameters?
What dietary adaptations occur in individuals undergoing ADF?Slide21
Figure 1.1
Study design: Pilot study
Week 1-2
Week 3-6
Week 7-10
Body weight
Body composition
Blood draw
Body weight
Body composition
Blood draw
Body weight
Body composition
Blood draw
Body weight
Body composition
Blood drawSlide22
Table 1.1 Nutrient composition of
the fast day meals provided
Varady KA et al, AJCN. 2009.Slide23
Meals were prepared for individual subjects
in a metabolic kitchenSlide24
Table 1.2 Subject characteristics at baseline
who completed the study
Varady KA et al, AJCN. 2009.Slide25
Figure 1.2 Body weight changes
Varady KA et al, AJCN. 2009.
-5.6 kgSlide26
Table 1.3 Body composition changes
Bhutani et al, Obesity. 2010.
All values
reported as
mean
SEM.
* Significantly
different from baseline
(week 3)
,
P
< 0.05 (One-factor ANOVA with Bonferroni analysis
)Slide27
Is ADF effective for weight loss?
Bhutani et al, Obesity. 2010.
All values
reported as
mean
SEM.
* Significantly
different from baseline
(week 3)
,
P
< 0.05 (One-factor ANOVA with Bonferroni analysis
)
Table 1.3 Body composition changesSlide28
Bhutani et al, Obesity. 2010.
All values
reported as
mean
SEM.
* Significantly
different from baseline
(week 3)
,
P
< 0.05 (One-factor ANOVA with Bonferroni analysis
)
Table 1.3 Body composition changesSlide29
Is ADF cardio-protective?
What is the effect of
ADF on
CHD risk parameters?Slide30
Is ADF cardio-protective?
Figure 1.3 LDL cholesterol concentrations
Week 7 Week 10
Feed day Fast day Feed day Fast day
Bhutani et al, Obesity. 2010.Slide31
Figure 1.4 HDL cholesterol concentrations
Bhutani et al, Obesity. 2010.
Week 7 Week 10
Feed day Fast day Feed day Fast daySlide32
Bhutani et al, Obesity. 2010.
Figure 1.5 Triglyceride concentrations
Week 7 Week 10
Feed day Fast day Feed day Fast daySlide33
Figure 1.6 Systolic blood pressure changes
Varady KA et al, AJCN. 2009.
-6 mmHgSlide34
Figure 1.7 Heart rate changes
Varady KA et al, AJCN. 2009.
- 4 beats/minSlide35
Dietary adherence?
Amount of food consumed on feed day?Overall energy restriction?
What dietary adaptations occur
in
individuals undergoing ADF?Slide36
Adherence to fast day diet
assessed using an “Extra food log”Slide37
What dietary adaptations occur with ADF?
Figure 1.8 Adherence to fast day diet
Varady KA et al, AJCN. 2009.Slide38
Figure 1.9 Hyperphagic response on
feed day to lack of food on fast day
Klempel
MC et al,
Nutr
J. 2010.
Feed day intake:
110% of needsSlide39
Figure 1.10 Percent energy restriction
at each week of the trial
Klempel
MC et al,
Nutr
J. 2010.
37% restrictionSlide40
How are hunger and satiety affected?Slide41
Hunger was measured by
a validated visual analog scale (VAS)Slide42
Figure 1.11 Hunger during each week of the trial
Klempel
MC et al,
Nutr
J. 2010.Slide43
Figure 1.12 Satiety
during each week of the trial
Klempel
MC et al,
Nutr
J. 2010.Slide44
Is ADF potentially effective for weight loss?
YES
Slide45
All previous studies of ADF used a low-fat background diet (25% fat)Slide46
All previous studies of ADF used a low-fat background diet (25% fat)
But most Americans consume a diet high in fat (35-45% fat)Slide47
All previous studies of ADF used a low-fat background diet (25% fat)
But most Americans consume a diet high in fat (35-45% fat)
Is ADF still effective with
a high-fat background diet?Slide48
STUDY 2 – High fat/low fat study
Study objectivesDo similar changes in weight occur on an ADF high-fat diet?What is the effect of an ADF high-fat diet on CHD risk?Slide49
Figure 2.1 Study design: High fat study
ADF-LF group
ADF-HF groupSlide50
Table 2.1 Nutrient composition of
the feed and fast day meals provided
Klempel
MC et al, 2012. Metabolism.Slide51
Table 2.2 Subject
characteristics at baseline
Klempel
MC et al, 2012. Metabolism.Slide52
Figure 2.2 Body weight changes
-5.3 kg LF
-6.5 kg HF
Klempel
MC et al, 2012. Metabolism.Slide53
Figure 2.3 Body composition changes
Klempel
MC et al, 2012. Metabolism.Slide54
Figure 2.4 Waist circumference changes
-10.1 cm LF
-10.0 cm HF
Klempel
MC et al, 2012. Metabolism.Slide55
Figure 2.5 Plasma lipid changes
Klempel
MC et al, 2012. Metabolism.Slide56
Are the beneficial effects of ADF
still observed with a high fat background diet?
YES
Slide57
STUDY 3 – Exercise study
Study objectivesIs it possible to exercise on the fast day?What are the effects this combination therapy on body weight?
What are the effects
on CHD risk?Slide58
Figure 3.1 Study design: ADF
plus exerciseSlide59
Table 3.1
Subject characteristics at baseline
Combination
ADF
Exercise
Control
n
18
25
24
16
Age (y)
45
5
42
2
42
2
49
2
Body weight (kg)
91
6
94
3
93
2
93
5
BMI (kg/m2)
35
1
35
1
35
1
35
1
Waist
circum
(cm)
92
1
100
2
98
2
99
3
Total
-C (mg/dl)
190
10
171
8
181
6
185
7
LDL-C (mg/dl)
125
9
113
8
113
5
119
6
HDL-C
(mg/dl)
50
3
49
2
51
2
52
3
TG (mg/dl)
77
7
81
7
74
6
97
13
No significant differences between groups (One-way ANOVA)
Slide60
Figure 3.2 Percent exercise sessions
scheduled by subjects on feed/fast day
Bhutani S et al, 2013.
Int
J Sports
Nutr
.Slide61
Figure 3.3
Percent cheating on the fast day in relation
to
timing of the exercise session
Bhutani S et al, 2013.
Int
J Sports
Nutr
.Slide62
Figure 3.4 Changes in body weight
and body composition after 12 weeks
Means with different letters significantly different (P < 0.05; One
-way
ANOVA).
Bhutani S et al, 2013. Obesity.Slide63
Table 3.2 C
hange in plasma lipids and LDL particle size after 12 weeks
Combination
ADF
Exercise
Control
Total
-C (% change
)
-2
5
7
4
0
3
1
4
LDL-C (% change)
-12
5
-1
6
0
5
3
5
HDL-C
(% change)
18
9
a
0
4
b
2
3
b
8
5
b
TG (% change)
13
11
6
6
7
6
5
7
LDL size
(
Å
)
4
1
a
5
1
a
1
1
b
0
1
b
Large LDL (% change)
7
5
15
3
1
5
1
4
Small LDL (% change)
-7
2
a
-12
3
a
-1
4
b
1
3
b
Means with different letters significantly different for each parameter (P < 0.05; One
-way
ANOVA).
Bhutani S et al, 2013. Obesity.Slide64
Table 3.2 C
hange in plasma lipids and LDL particle size after 12 weeks
Combination
ADF
Exercise
Control
Total
-C (% change
)
-2
5
7
4
0
3
1
4
LDL-C (% change)
-12
5
-1
6
0
5
3
5
HDL-C
(% change)
18
9
a
0
4
b
2
3
b
8
5
b
TG (% change)
13
11
6
6
7
6
5
7
LDL size
(
Å
)
4
1
a
5
1
a
1
1
b
0
1
b
Large LDL (% change)
7
5
15
3
1
5
1
4
Small LDL (% change)
-7
2
a
-12
3
a
-1
4
b
1
3
b
Means with different letters significantly different for each parameter (P < 0.05; One
-way
ANOVA).
Bhutani S et al, 2013. Obesity.Slide65
Weight loss
ADF produces a 3-7 kg weight loss after 8-12 weeks
ADF-HF diets are just as effective as ADF-LF diets for weight loss
Adding endurance exercise may enhance weight loss
Body composition
Fat mass decreased, with potential retention of lean mass
Waist circumference decreases by 4-10 cm
Summary of findingsSlide66
Coronary heart disease risk
LDL cholesterol reduced by 0-25%
Triglycerides lowered by
0
-30%
Systolic blood pressure also decreased
ADF-HF
is just
as effective as ADF-LF for CHD risk
reduction
Adding endurance exercise may increase HDL cholesterol levels
Summary of findingsSlide67
Dietary adaptations
Approximately 110% of energy needs consumed on the feed day to compensate for the lack of food on the fast day80-90% of subjects can adhere to ADF short-termHunger decreases after 2 weeks of diet
Summary of findingsSlide68
Goal is to examine whether ADF is effective for weight maintenance,
and to compare ADF to daily calorie restriction
Hypothesized findings (from grant application)
Year-long ADF study currently underway…Slide69
All of these findings are summarized in the book:
US version
UK versionSlide70
Many thanks to my students…
FacultySurabhi Bhutani (PhD Student)
Dr. Shane Phillips
Monica
Klempel
(PhD Student)
Dr. Daniel
Corcos
John
Trepanowski
(PhD Student)
Dr. Carol
Braunschweig
Cynthia Kroeger (PhD Student)
Dr. Eric
Ravussin
Kristin Hoddy (PhD Student)
Dr.
Sally Freels
Adrienne Barnosky (Postdoc)
Dr.
Marian Fitzgibbon
Funding
NIH National Heart Lung and Blood Institute
R01HL106228
-01
American Heart
Association 09SDG2170077 and
12PRE8350000
International
Life Sciences Institute
UIC Chancellor’s Discovery Fund (Co-PI Shane Phillips)
Acknowledgements