间歇性断食对超重或肥胖患者治疗效果的Meta分析

A Meta-analysis of the Therapeutic Effects of Intermittent Fasting on Overweight or Obesity

背景超重或肥胖是许多心血管疾病发生的危险因素,间歇性断食(IF)是治疗超重或肥胖的治疗方案之一,但目前国际临床指南不推荐常规使用IF治疗肥胖症,且临床研究发现IF治疗肥胖症存在较多不良反应。目的评价IF对超重或肥胖人群的治疗效果。方法计算机检索PubMed、Web of Science、中国知网(CNKI)、万方数据知识服务平台、维普网、中国生物医学文献数据库中关于IF治疗成年超重或肥胖患者的随机对照试验(RCT),试验组采用IF模式,对照组采用常规饮食疗法,检索时间为建库至2020-11-08。由2名研究者独立完成文献筛选和数据提取,并对文献进行质量评价。采用RevMan进行Meta分析。结果共纳入7篇RCT。Meta分析结果显示,试验组体质量、低密度脂蛋白(LDL)低于对照组〔均数差(MD)=-2.75,95%CI(-3.64,-1.86),P<0.00001;MD=0.58,95%CI(0,1.16),P<0.0001〕。试验组和对照组无脂肪量(FFM)、血糖比较,差异无统计学意义〔MD=-0.89,95%CI(-1.81,0.04),P=0.06;标准化均数差(SMD)=-0.56,95%CI(-1.40,0.28),P=0.19〕。运用GRADE工具对结局指标进行质量评价,结果显示,体质量为中等级,血糖为低等级,FFM和LDL为极低等级。结论根据目前的证据表明,IF在降低超重或肥胖人群的体质量和LDL水平方面具有一定的疗效;而对超重或肥胖人群血糖、FFM是否有效仍需要更多的研究支持,希望在后续研究中纳入更多多中心、大样本RCT研究。

Background Intermittent fasting(IF)is an option for overweight or obesity,a risk factor for many cardiovascular diseases,but it is not recommended as a usual treatment by current international clinical guidelines due to many treatment-emergent adverse reactions.Objective To evaluate the therapeutic effect of IF in overweight or obese people.Methods The electronic databases,PubMed,Web of Science,CNKI,Wanfang Data,CQVIP and SinoMed,were searched from inception to November 8,2020 for randomized control trials(RCTs)about adults with overweight or obesity receiving IF(experimental group)compared with those receiving usual diet(control group).RCTs enrollment,data extraction,and methodological quality assessment were performed by two reviewers independently.RevMan was used for meta-analysis.Results Seven RCTs were included.Analysis revealed that compared to the control group,the experimental group showed lower mean weight and low-density lipoprotein〔MD=-2.75,95%CI(-3.64,-1.86),P<0.00001;MD=0.58,95%CI(0,1.16),P<0.0001〕,but demonstrated insignificantly differences in fat free mass,and blood glucose〔MD=-0.89,95%CI(-1.81,0.04),P=0.06;SMD=-0.56,95%CI(-1.40,0.28),P=0.19〕.GRADE assessment indicated that the quality of evidence on improving weight,blood glucose,fat free mass and low-density lipoprotein was moderate,low,very low,and very low,respectively.Conclusion Current evidence suggests that IF is effective in reducing weight and low-density lipoprotein in overweight or obese people,but it needs to be verified whether it improves blood glucose and fat free mass.Further research is recommended to be conducted in more multi-center and large-sample RCTs.