Skip to main content
    • Aa
    • Aa

The effect of intermittent energy and carbohydrate restriction v. daily energy restriction on weight loss and metabolic disease risk markers in overweight women

  • Michelle Harvie (a1), Claire Wright (a2), Mary Pegington (a1), Debbie McMullan (a1), Ellen Mitchell (a1), Bronwen Martin (a3), Roy G. Cutler (a4), Gareth Evans (a1), Sigrid Whiteside (a5), Stuart Maudsley (a4), Simonetta Camandola (a3), Rui Wang (a3), Olga D. Carlson (a3), Josephine M. Egan (a3), Mark P. Mattson (a4) and Anthony Howell (a1)...

Intermittent energy restriction may result in greater improvements in insulin sensitivity and weight control than daily energy restriction (DER). We tested two intermittent energy and carbohydrate restriction (IECR) regimens, including one which allowed ad libitum protein and fat (IECR+PF). Overweight women (n 115) aged 20 and 69 years with a family history of breast cancer were randomised to an overall 25 % energy restriction, either as an IECR (2500–2717 kJ/d, < 40 g carbohydrate/d for 2 d/week) or a 25 % DER (approximately 6000 kJ/d for 7 d/week) or an IECR+PF for a 3-month weight-loss period and 1 month of weight maintenance (IECR or IECR+PF for 1 d/week). Insulin resistance reduced with the IECR diets (mean − 0·34 (95 % CI − 0·66, − 0·02) units) and the IECR+PF diet (mean − 0·38 (95 % CI − 0·75, − 0·01) units). Reductions with the IECR diets were significantly greater compared with the DER diet (mean 0·2 (95 % CI − 0·19, 0·66) μU/unit, P= 0·02). Both IECR groups had greater reductions in body fat compared with the DER group (IECR: mean − 3·7 (95 % CI − 2·5, − 4·9) kg, P= 0·007; IECR+PF: mean − 3·7 (95 % CI − 2·8, − 4·7) kg, P= 0·019; DER: mean − 2·0 (95 % CI − 1·0, 3·0) kg). During the weight maintenance phase, 1 d of IECR or IECR+PF per week maintained the reductions in insulin resistance and weight. In the short term, IECR is superior to DER with respect to improved insulin sensitivity and body fat reduction. Longer-term studies into the safety and effectiveness of IECR diets are warranted.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The effect of intermittent energy and carbohydrate restriction v. daily energy restriction on weight loss and metabolic disease risk markers in overweight women
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      The effect of intermittent energy and carbohydrate restriction v. daily energy restriction on weight loss and metabolic disease risk markers in overweight women
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      The effect of intermittent energy and carbohydrate restriction v. daily energy restriction on weight loss and metabolic disease risk markers in overweight women
      Available formats
Corresponding author
*Corresponding author: Dr M. Harvie, fax +44 161 291 4421, email
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1E Loveman , GK Frampton , J Shepherd , et al. (2011) The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review. Health Technol Assess 15, 1182.

2RR Henry , L Scheaffer & JM Olefsky (1985) Glycemic effects of intensive caloric restriction and isocaloric refeeding in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 61, 917925.

3TA Wadden , DA Anderson & GD Foster (1999) Two-year changes in lipids and lipoproteins associated with the maintenance of a 5 % to 10 % reduction in initial weight: some findings and some questions. Obes Res 7, 170178.

4RS Weinstock , H Dai & TA Wadden (1998) Diet and exercise in the treatment of obesity: effects of 3 interventions on insulin resistance. Arch Intern Med 158, 24772483.

5RJ de Souza , GA Bray , VJ Carey , et al. (2012) Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: results from the POUNDS LOST trial. Am J Clin Nutr 95, 614625.

6AG Tsai & TA Wadden (2006) The evolution of very-low-calorie diets: an update and meta-analysis. Obesity (Silver Spring) 14, 12831293.

7JW Anderson , S Vichitbandra , W Qian , et al. (1999) Long-term weight maintenance after an intensive weight-loss program. J Am Coll Nutr 18, 620627.

8I Greenberg , MJ Stampfer , D Schwarzfuchs , et al. (2009) Adherence and success in long-term weight loss diets: the dietary intervention randomized controlled trial (DIRECT). J Am Coll Nutr 28, 159168.

9FM Sacks , GA Bray , VJ Carey , et al. (2009) Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 360, 859873.

10I Shai , JD Spence , D Schwarzfuchs , et al. (2010) Dietary intervention to reverse carotid atherosclerosis. Circulation 121, 12001208.

11TP Wycherley , LJ Moran , PM Clifton , et al. (2012) Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials. Am J Clin Nutr 96, 12811298.

13H Sogawa & C Kubo (2000) Influence of short-term repeated fasting on the longevity of female (NZB (NZW) F1 mice. Mech Ageing Dev 115, 6171.

14MP Cleary & ME Grossmann (2011) The manner in which calories are restricted impacts mammary tumor cancer prevention. J Carcinog 10, 21.

15MJ Bonorden , OP Rogozina , CM Kluczny , et al. (2009) Intermittent calorie restriction delays prostate tumor detection and increases survival time in TRAMP mice. Nutr Cancer 61, 265275.

17MP Mattson & R Wan (2005) Beneficial effects of intermittent fasting and caloric restriction on the cardiovascular and cerebrovascular systems. J Nutr Biochem 16, 129137.

20KA Varady (2011) Intermittent versus daily calorie restriction: which diet regimen is more effective for weight loss? Obes Rev 12, e593e601.

21S Ash , MM Reeves , S Yeo , et al. (2003) Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type II diabetes: a randomised trial. Int J Obes Relat Metab Disord 27, 797802.

22MN Harvie , M Pegington , MP Mattson , et al. (2011) The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. Int J Obes (Lond) 35, 714727.

24J Tyrer , SW Duffy & J Cuzick (2004) A breast cancer prediction model incorporating familial and personal risk factors. Stat Med 23, 11111130.

25BE Ainsworth , WL Haskell , SD Herrmann , et al. (2011) Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 43, 15751581.

27I Shai , D Schwarzfuchs , Y Henkin , et al. (2008) Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359, 229241.

28G Buckland , A Bach & L Serra-Majem (2008) Obesity and the Mediterranean diet: a systematic review of observational and intervention studies. Obes Rev 9, 582593.

30S Michie , S Ashford , FF Sniehotta , et al. (2011) A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health 26, 14791498.

31DR Matthews , JP Hosker , AS Rudenski , et al. (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412419.

33L Selmeci , L Seres , M Antal , et al. (2005) Advanced oxidation protein products (AOPP) for monitoring oxidative stress in critically ill patients: a simple, fast and inexpensive automated technique. Clin Chem Lab Med 43, 294297.

34ME Grossmann , A Ray , S Dogan , et al. (2008) Balance of adiponectin and leptin modulates breast cancer cell growth. Cell Res 18, 11541156.

35FM Finucane , J Luan , NJ Wareham , et al. (2009) Correlation of the leptin:adiponectin ratio with measures of insulin resistance in non-diabetic individuals. Diabetologia 52, 23452349.

36A McTiernan , KB Rajan , SS Tworoger , et al. (2003) Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol 21, 19611966.

37AM Johnstone , P Faber , ER Gibney , et al. (2002) Effect of an acute fast on energy compensation and feeding behaviour in lean men and women. Int J Obes Relat Metab Disord 26, 16231628.

40TM Wallace , JC Levy & DR Matthews (2004) Use and abuse of HOMA modeling. Diabetes Care 27, 14871495.

42CD Gardner , S Kim , A Bersamin , et al. (2010) Micronutrient quality of weight-loss diets that focus on macronutrients: results from the A TO Z study. Am J Clin Nutr 92, 304312.

43L Schwingshackl , B Strasser & G Hoffmann (2011) Effects of monounsaturated fatty acids on glycaemic control in patients with abnormal glucose metabolism: a systematic review and meta-analysis. Ann Nutr Metab 58, 290296.

44SA Jebb , JA Lovegrove , BA Griffin , et al. (2010) Effect of changing the amount and type of fat and carbohydrate on insulin sensitivity and cardiovascular risk: the RISCK (Reading, Imperial, Surrey, Cambridge, and Kings) trial. Am J Clin Nutr 92, 748758.

45E Kirk , DN Reeds , BN Finck , et al. (2009) Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction. Gastroenterology 136, 15521560.

46J Stanford , M Kaiser , E Ablah , et al. (2012) The effect of weight loss on fasting blood sugars and hemoglobin A1c in overweight and obese diabetics and non-diabetics. J Diabetes Mellitus 2, 126130.

47A Chalkiadaki & L Guarente (2012) Sirtuins mediate mammalian metabolic responses to nutrient availability. Nat Rev Endocrinol 8, 287296.

48B Kiens , TJ Alsted & J Jeppesen (2011) Factors regulating fat oxidation in human skeletal muscle. Obes Rev 12, 852858.

50KA Varady , S Bhutani , EC Church , et al. (2009) Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults. Am J Clin Nutr 90, 11381143.

51JB Johnson , W Summer , RG Cutler , et al. (2007) Alternate day calorie restriction improves clinical findings and reduces markers of oxidative stress and inflammation in overweight adults with moderate asthma. Free Radic Biol Med 42, 665674.

55ML Dansinger , JA Gleason , JL Griffith , et al. (2005) Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 293, 4353.

56CD Summerbell , C Watts , JP Higgins , et al. (1998) Randomised controlled trial of novel, simple, and well supervised weight reducing diets in outpatients. BMJ 317, 14871489.

58AB Leichtle , C Helmschrodt , U Ceglarek , et al. (2011) Effects of a 2-y dietary weight-loss intervention on cholesterol metabolism in moderately obese men. Am J Clin Nutr 94, 11891195.

59IR Reid & MJ Bolland (2012) Calcium supplements: bad for the heart? Heart 98, 895896.

60GD Brinkworth , M Noakes , JD Buckley , et al. (2009) Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. Am J Clin Nutr 90, 2332.

61DD Alexander , DL Weed , CA Cushing , et al. (2011) Meta-analysis of prospective studies of red meat consumption and colorectal cancer. Eur J Cancer Prev 20, 293307.

64L Anttila , P Koskinen , K Irjala , et al. (1991) Reference intervals for serum sex steroids and gonadotropins in regularly menstruating women. Acta Obstet Gynecol Scand 70, 475481.

65R Thomson , GD Brinkworth , JD Buckley , et al. (2007) Good agreement between bioelectrical impedance and dual-energy X-ray absorptiometry for estimating changes in body composition during weight loss in overweight young women. Clin Nutr 26, 771777.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary Materials

Harvie et al. supplementary material
Supplementary tables and figure

 Word (448 KB)
448 KB


Altmetric attention score