Skip to main content

Intermittent v. continuous energy restriction: differential effects on postprandial glucose and lipid metabolism following matched weight loss in overweight/obese participants

  • Rona Antoni (a1), Kelly L. Johnston (a2) (a3), Adam L. Collins (a1) and M. Denise Robertson (a1)

The intermittent energy restriction (IER) approach to weight loss involves short periods of substantial (>70 %) energy restriction (ER) interspersed with normal eating. Studies to date comparing IER to continuous energy restriction (CER) have predominantly measured fasting indices of cardiometabolic risk. This study aimed to compare the effects of IER and CER on postprandial glucose and lipid metabolism following matched weight loss. In all, twenty-seven (thirteen male) overweight/obese participants (46 (sem 3) years, 30·1 (sem 1·0) kg/m2) who were randomised to either an IER intervention (2638 kJ for 2 d/week with an overall ER of 22 (sem 0·3) %, n 15) or a CER intervention (2510 kJ below requirements with overall ER of 23 (sem 0·8) %) completed the study. Postprandial responses to a test meal (over 360 min) and changes in anthropometry (fat mass, fat-free mass, circumferences) were assessed at baseline and upon attainment of 5 % weight loss, following a 7-d period of weight stabilisation. The study found no statistically significant difference in the time to attain a 5 % weight loss between groups (median 59 d (interquartile range (IQR) 41–80) and 73 d (IQR 48–128), respectively, P=0·246), or in body composition (P≥0·437). For postprandial measures, neither diet significantly altered glycaemia (P=0·266), whereas insulinaemia was reduced comparatively (P=0·903). The reduction in C-peptide tended (P=0·057) to be greater following IER (309 128 (sem23 268) to 247781 (sem20 709) pmol×360 min/l) v. CER (297 204 (sem25 112) to 301 655 (sem32 714) pmol×360 min/l). The relative reduction in TAG responses was greater (P=0·045) following IER (106 (sem30) to 68 (sem 15) mmol×360 min/l) compared with CER (117 (sem 43) to 130 (sem 31) mmol×360 min/l). In conclusion, these preliminary findings highlight underlying differences between IER and CER, including a superiority of IER in reducing postprandial lipaemia, which now warrant targeted mechanistic evaluation within larger study cohorts.

Corresponding author
* Corresponding author: M. D. Robertson, email
Hide All
1. Leiter, LA, Fitchett, DH, Gilbert, RE, et al. (2011) Cardiometabolic risk in Canada: a detailed analysis and position paper by the Cardiometabolic Risk Working Group. Can J Cardiol 27, e1e33.
2. Magkos, F, Fraterrigo, G & Yoshino, J (2016) Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metab 23, 591601.
3. National Institute of Clinical Excellence (2014) Obesity: identification, assessment and management. (accessed October 2016).
4. Antoni, R, Johnston, KL, Collins, AL, et al. (2017) Effects of intermittent fasting on glucose and lipid metabolism. Proc Nutr Soc 76, 361368.
5. Harvie, MN, Pegington, M, Mattson, MP, et al. (2011) The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomised trial in young overweight women. Int J Obes 35, 714727.
6. Harvie, M, Wright, C, Pegington, M, et al. (2013) The effect of intermittent energy and carbohydrate restriction v. daily energy restriction on weight loss and metabolic disease risk markers in overweight women. Br J Nutr 110, 15341547.
7. Trepanowski, JF, Kroeger, CM, Barnosky, A, et al. (2017) Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults. A randomized clinical trial. JAMA Intern Med 177, 930938.
8. Levitan, E, Song, Y, Ford, E, et al. (2004) Is nondiabetic hyperglycemia a risk factor for cardiovascular disease? A meta-analysis of prospective studies. Arch Intern Med 164, 21472155.
9. Jackson, K, Poppitt, S & Minehane, A (2012) Postprandial lipemia and cardiovascular disease risk: Interrelationships between dietary, physiological and genetic determinants. Atherosclerosis 220, 2233.
10. Heilbronn, LK, Civitarese, AE, Bogacka, I, et al. (2005) Glucose Tolerance and Skeletal Muscle Gene Expression in Response to Alternate Day Fasting. Obes Res 13, 574581.
11. Antoni, R, Johnston, KL, Collins, AL, et al. (2016) Investigation into the acute effects of total and partial energy restriction on postprandial metabolism amongst overweight/obese participants. Br J Nutr 115, 951959.
12. Van Gaal, L, Mertens, I & Ballaux, D (2005) What is the relationship between risk factor reduction and degree of weight loss? Heart J Suppl 7, Suppl. L, L21L26.
13. Henry, CJ (2005) Basal metabolic rate studies in humans: measurement and development of new equations. Public Health Nutr 8, 11331152.
14. Department of Health (1991) Dietary Reference Values for Food, Energy and Nutrients for the United Kingdom. London: HMSO.
15. Robertson, M, Henderson, R, Vist, G, et al. (2002) Extended effects of evening meal carbohydrate-to-fat ratio on fasting and postprandial substrate metabolism. Am J Clin Nutr 75, 505510.
16. Compher, C, Frankenfield, D, Keim, N, et al. (2006) Best practice methods to apply to measurement of resting metabolic rate in adults: a systematic review. J Acad Nutr Diet 106, 881903.
17. Weir, JB (1949) New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol 109, 19.
18. Ravussin, E & Bogardus, C (1989) Relationship of genetics, age, and physical fitness to daily energy expenditure and fuel utilization. Am J Clin Nutr 49, 5 Suppl., 968975.
19. McKeown, N, Day, N, Welch, A, et al. (2001) Use of biological markers to validate self- reported dietary intake in a random sample of the European Prospective Investigation into Cancer United Kingdom Norfolk cohort. Am J Clin Nutr 74, 188196.
20. Friedewald, W, Levy, R & Fredrickson, D (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18, 499502.
21. Egbewale, B, Lewis, M & Sim, J (2014) Bias, precision and statistical power of analysis of covariance in the analysis of randomized trials with baseline imbalance: a simulation stud. BMC Medical Res Methodo 14, 49.
22. Bansal, S, Buring, JE, Rifai, N, et al. (2007) Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA 298, 309316.
23. Nordestgaard, B, Marianne, B, Schnohr, P, et al. (2007) Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA 293, 299308.
24. Lindman, A, Veierød, M, Tverdal, A, et al. (2010) Nonfasting triglycerides and risk of cardiovascular death in men and women from the Norwegian Counties Study. Eur J Epidemiol 25, 789798.
25. Patsch, J, Miesenbock, G & Hopferwieser, T (1992) Relation of triglyceride metabolism and coronary artery disease. Studies in the postprandial state. Arterioscl Thromb 12, 13361345.
26. Boquist, S, Ruotolo, G, Tang, R, et al. (1999) Alimentary lipemia, postprandial triglyceride- rich lipoproteins, and common carotid intima-media thickness in healthy, middle-aged men. Circulation 100, 723728.
27. Griffin, BA (2013) Lipid metabolism. Surgery (Oxford) 31, 267272.
28. Matikainen, N, Mantta, S, Westerbacka, J, et al. (2009) Postprandial lipemia associates with liver fat content. JCEM 92, 30523069.
29. Cummins, M, Watts, G, Pal, C, et al. (1995) Increased hepatic secretion of very-low-density lipoprotein apolipoprotein B-100 in obesity: A Stable Isotope Study. Clin Sci (Lond) 88, 225233.
30. Castillo, MJ, Scheen, AJ, Letiexhe, MR, et al. (1994) How to measure insulin clearance. Diabetes Metab 10, 119150.
31. Macdiarmid, J & Blundell, J (1998) Assessing dietary intake: who, what and why of under-reporting. Nutr Res Rev 11, 231251.
32. Catenacci, V, Pan, Z, Ostendorf, D, et al. (2016) A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity. Obesity 24, 18741883.
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

Antoni et al. supplementary material
Antoni et al. supplementary material 1

 PDF (53 KB)
53 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed