Skip to main content

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. 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 <service> 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 <service> 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
Hide All
1Loveman E, Frampton GK, Shepherd J, 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.
2Henry RR, Scheaffer L & Olefsky JM (1985) Glycemic effects of intensive caloric restriction and isocaloric refeeding in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 61, 917925.
3Wadden TA, Anderson DA & Foster GD (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.
4Weinstock RS, Dai H & Wadden TA (1998) Diet and exercise in the treatment of obesity: effects of 3 interventions on insulin resistance. Arch Intern Med 158, 24772483.
5de Souza RJ, Bray GA, Carey VJ, 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.
6Tsai AG & Wadden TA (2006) The evolution of very-low-calorie diets: an update and meta-analysis. Obesity (Silver Spring) 14, 12831293.
7Anderson JW, Vichitbandra S, Qian W, et al. (1999) Long-term weight maintenance after an intensive weight-loss program. J Am Coll Nutr 18, 620627.
8Greenberg I, Stampfer MJ, Schwarzfuchs D, 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.
9Sacks FM, Bray GA, Carey VJ, et al. (2009) Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 360, 859873.
10Shai I, Spence JD, Schwarzfuchs D, et al. (2010) Dietary intervention to reverse carotid atherosclerosis. Circulation 121, 12001208.
11Wycherley TP, Moran LJ, Clifton PM, 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.
12Harvie M & Howell A (2012) Energy restriction and the prevention of breast cancer. Proc Nutr Soc 71, 263275.
13Sogawa H & Kubo C (2000) Influence of short-term repeated fasting on the longevity of female (NZB (NZW) F1 mice. Mech Ageing Dev 115, 6171.
14Cleary MP & Grossmann ME (2011) The manner in which calories are restricted impacts mammary tumor cancer prevention. J Carcinog 10, 21.
15Bonorden MJ, Rogozina OP, Kluczny CM, et al. (2009) Intermittent calorie restriction delays prostate tumor detection and increases survival time in TRAMP mice. Nutr Cancer 61, 265275.
16Susan Lanza-Jacoby, Guang Yan, Glenn Radice, et al. (2011) Abstract B4: calorie restriction prevents the development of pancreatic cancer in Kras; Pdx-1Cre mice. Cancer Prev Res 4, B4.
17Mattson MP & Wan R (2005) Beneficial effects of intermittent fasting and caloric restriction on the cardiovascular and cerebrovascular systems. J Nutr Biochem 16, 129137.
18Stranahan AM & Mattson MP (2012) Recruiting adaptive cellular stress responses for successful brain ageing. Nat Rev Neurosci 13, 209216.
19Stote KS, Baer DJ, Spears K, et al. (2007) A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults. Am J Clin Nutr 85, 981988.
20Varady KA (2011) Intermittent versus daily calorie restriction: which diet regimen is more effective for weight loss? Obes Rev 12, e593e601.
21Ash S, Reeves MM, Yeo S, 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.
22Harvie 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 randomized trial in young overweight women. Int J Obes (Lond) 35, 714727.
23Hill JO, Schlundt DG, Sbrocco T, et al. (1989) Evaluation of an alternating-calorie diet with and without exercise in the treatment of obesity. Am J Clin Nutr 50, 248254.
24Tyrer J, Duffy SW & Cuzick J (2004) A breast cancer prediction model incorporating familial and personal risk factors. Stat Med 23, 11111130.
25Ainsworth BE, Haskell WL, Herrmann SD, et al. (2011) Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 43, 15751581.
26Schofield WN (1985) Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 39, Suppl. 1, 541.
27Shai I, Schwarzfuchs D, Henkin Y, et al. (2008) Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359, 229241.
28Buckland G, Bach A & Serra-Majem L (2008) Obesity and the Mediterranean diet: a systematic review of observational and intervention studies. Obes Rev 9, 582593.
29Mutrie N & Blamey A (2004) Thinking About Becoming More Active? Glasgow: NHS Greater Glasgow Clyde.
30Michie S, Ashford S, Sniehotta FF, 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.
31Matthews DR, Hosker JP, Rudenski AS, et al. (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412419.
32Friedewald WT, Levy RI & Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18, 499502.
33Selmeci L, Seres L, Antal M, 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.
34Grossmann ME, Ray A, Dogan S, et al. (2008) Balance of adiponectin and leptin modulates breast cancer cell growth. Cell Res 18, 11541156.
35Finucane FM, Luan J, Wareham NJ, et al. (2009) Correlation of the leptin:adiponectin ratio with measures of insulin resistance in non-diabetic individuals. Diabetologia 52, 23452349.
36McTiernan A, Rajan KB, Tworoger SS, et al. (2003) Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol 21, 19611966.
37Johnstone AM, Faber P, Gibney ER, 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.
38Bouchard C, Tremblay A, Leblanc C, et al. (1983) A method to assess energy expenditure in children and adults. Am J Clin Nutr 37, 461467.
39Mc Nair DM, Lorr M & Droppleman LF (1971) Profile of Mood States Manual. San Diego, CA: Educational and Industrial Testing Service.
40Wallace TM, Levy JC & Matthews DR (2004) Use and abuse of HOMA modeling. Diabetes Care 27, 14871495.
41Alberti KG, Eckel RH, Grundy SM, et al. (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120, 16401645.
42Gardner CD, Kim S, Bersamin A, 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.
43Schwingshackl L, Strasser B & Hoffmann G (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.
44Jebb SA, Lovegrove JA, Griffin BA, 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.
45Kirk E, Reeds DN, Finck BN, et al. (2009) Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction. Gastroenterology 136, 15521560.
46Stanford J, Kaiser M, Ablah E, 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.
47Chalkiadaki A & Guarente L (2012) Sirtuins mediate mammalian metabolic responses to nutrient availability. Nat Rev Endocrinol 8, 287296.
48Kiens B, Alsted TJ & Jeppesen J (2011) Factors regulating fat oxidation in human skeletal muscle. Obes Rev 12, 852858.
49Acharya SD, Elci OU, Sereika SM, et al. (2009) Adherence to a behavioral weight loss treatment program enhances weight loss and improvements in biomarkers. Patient Prefer Adherence 3, 151160.
50Varady KA, Bhutani S, Church EC, 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.
51Johnson JB, Summer W, Cutler RG, 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.
52Krieger JW, Sitren HS, Daniels MJ, et al. (2006) Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression 1. Am J Clin Nutr 83, 260274.
53Veldhorst MA, Westerterp KR, van Vught AJ, et al. (2010) Presence or absence of carbohydrates and the proportion of fat in a high-protein diet affect appetite suppression but not energy expenditure in normal-weight human subjects fed in energy balance. Br J Nutr 104, 13951405.
54Macdiarmid J & Blundell J (1998) Assessing dietary intake: Who, what and why of under-reporting. Nutr Res Rev 11, 231253.
55Dansinger ML, Gleason JA, Griffith JL, 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.
56Summerbell CD, Watts C, Higgins JP, et al. (1998) Randomised controlled trial of novel, simple, and well supervised weight reducing diets in outpatients. BMJ 317, 14871489.
57Johnstone AM, Horgan GW, Murison SD, et al. (2008) Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am J Clin Nutr 87, 4455.
58Leichtle AB, Helmschrodt C, Ceglarek U, 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.
59Reid IR & Bolland MJ (2012) Calcium supplements: bad for the heart? Heart 98, 895896.
60Brinkworth GD, Noakes M, Buckley JD, 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.
61Alexander DD, Weed DL, Cushing CA, et al. (2011) Meta-analysis of prospective studies of red meat consumption and colorectal cancer. Eur J Cancer Prev 20, 293307.
62Johnstone AM (2012) Safety and efficacy of high-protein diets for weight loss. Proc Nutr Soc 71, 339349.
63Tonolo G, Ciccarese M, Brizzi P, et al. (1995) Cyclical variation of plasma lipids, apolipoproteins, and lipoprotein(a) during menstrual cycle of normal women. Am J Physiol 269, E1101E1105.
64Anttila L, Koskinen P, Irjala K, et al. (1991) Reference intervals for serum sex steroids and gonadotropins in regularly menstruating women. Acta Obstet Gynecol Scand 70, 475481.
65Thomson R, Brinkworth GD, Buckley JD, 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.
66Jebb SA, Siervo M, Murgatroyd PR, et al. (2007) Validity of the leg-to-leg bioimpedance to estimate changes in body fat during weight loss and regain in overweight women: a comparison with multi-compartment models. Int J Obes (Lond) 31, 756762.
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

Full text views

Total number of HTML views: 804
Total number of PDF views: 1894 *
Loading metrics...

Abstract views

Total abstract views: 4590 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th February 2018. This data will be updated every 24 hours.