5:2 intermittent fasting plus meal replacement improves glycemic control, weight loss
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Key takeaways:
- On average, patients assigned to the diet lost 9.7 kg and reduced their HbA1c by 1.9%.
- More research is needed to understand how the diet improved glycemic control, researchers said.
A 5:2 intermittent fasting diet combined with meal replacement resulted in greater weight loss and better glycemic control compared with antidiabetic medications in patients with early-stage type 2 diabetes, data from the EARLY study showed.
According to Lixin Guo, MD, from the Chinese Academy of Medical Sciences in China, and colleagues, past clinical trials on the 5:2 intermittent fasting diet — which consists of 2 nonconsecutive fasting days and 5 days of habitual intake per week — and meal replacement have shown either treatment to be effective in reducing HbA1c and weight.
Thus, combining both “could provide additional benefits to patients and is worthy of investigation,” they wrote in JAMA Network Open.
In the 16-week, randomized, open-label, active parallel controlled trial, the researchers assigned 405 Chinese adults (65.4% men) aged 18 to 65 years in a 1:1:1 ratio to either:
- a 5:2 intermittent fasting meal replacement diet (5:2 MR);
- metformin twice a day; or
- empagliflozin twice a day.
The participants were diagnosed with type 2 diabetes within 1 year of the study’s baseline period and also had overweight or obesity.
In the 5:2 MR group, participants replaced all three meals with a low-energy meal replacement product during the 2 nonconsecutive fasting days. During the remaining 5 days, participants chose their breakfast and lunch but again had a low-energy meal replacement product for dinner.
Overall, 332 participants completed treatment.
Guo and colleagues found that participants in the 5:2 MR group had the highest reduction in HbA1c (least-squares mean [LSM] = 1.9%) from baseline to week 16, greater than those experienced by participants given metformin (LSM = 1.6%) or empagliflozin (LSM = 1.5%).
Mean weight loss at 16 weeks was also higher in 5:2 MR participants (LSM = 9.7 kg) vs. those assigned metformin (LSM = 5.5 kg) or empagliflozin (LSM = 5.8 kg), whereas a greater proportion of 5:2 MR participants achieved weight loss.
The 5:2 MR also produced greater improvements in waist and hip circumference, systolic and diastolic BP and triglyceride and HDL cholesterol levels vs. the antidiabetic medications, according to the researchers.
Although the incidence of hypoglycemia was comparable across all three treatment groups, the 5:2 MR showed “favorable safety” compared with metformin and empagliflozin, Guo and colleagues noted.
Regarding possible mechanisms, the researchers explained that the 5:2 MR “may reshape the gut microbiota, promote white adipose tissue browning, and consequently reduce insulin resistance and the occurrence of obesity.”
They added that the meal replacement product used in the study contained omega-3 fatty acids and medium-chain fatty acids, which produce fat breakdown and reduce heterotopic fat, respectively.
Although the findings support evidence of 5:2 MR as an effective initial lifestyle intervention for those with obesity or overweight and early diabetes, Guo and colleagues said they were unable to determine whether glycemic improvement was due to weight loss or the diet itself, “requiring further investigation.”