The health care costs of overweight, obesity, and type 2 diabetes are increasing,¹ and conventional weight-loss diets with daily energy restriction are difficult to adhere to in the long term.² Intermittent energy restriction, short periods of severe energy restriction followed by longer periods of habitual eating, has been suggested as a potential strategy because it offers a reduced burden of dietary restriction and may therefore be more acceptable.³ In animal studies, intermittent energy restriction appears to be equally effective as, if not more effective than, continuous energy restriction for the reduction of disease risk factors.⁴ Studies in the healthy overweight and obese population have determined that intermittent energy restriction is an effective method for achieving weight loss comparable to that achieved by continuous energy restriction, with weight loss of 3 to 5 kg after approximately 10 weeks.⁵ Other methods of intermittent energy restriction, such as alternate-day modified fasting, have also demonstrated similar weight loss compared with that achieved by continuous energy restriction.⁶ For individuals with type 2 diabetes, investigators have evaluated the effects of intermittent very-low-calorie diets used within a continuous energy restriction diet compared with continuous energy restriction alone,^7-9 but they have not compared intermittent dieting with continuous dieting. We previously published a pilot trial that demonstrated that a 2-day intermittent energy restriction diet provides an effective alternative method for both glycemic control and weight loss compared with a continuous energy restriction diet over a 3-month period.¹⁰ The objective of this randomized noninferiority trial was to ascertain the long-term effects of a 2-day intermittent energy restriction diet compared with continuous energy restriction during a 12-month period for patients with type 2 diabetes. We hypothesized that equal improvements to hemoglobin A_1c (HbA_1c) level and weight would occur, as seen in our 3-month pilot trial, thus offering a successful alternative treatment strategy for use in clinical practice.

The aim of this systematic review and meta-analysis is to summarise the effects of intermittent energy restriction on weight and biological markers in long term intervention studies of >6 months duration. An electronic search was performed using the MEDLINE, EMBASE and the Cochrane Library databases for intervention trials lasting 6 months or longer investigating the effects of intermittent energy restriction. A total of nine studies were identified as meeting the pre-specified criteria. All studies included an intermittent energy restriction arm, with six being directly compared to continuous energy restriction. A total of 981 subjects were enrolled and randomised, with weight loss observed in all intermittent energy restriction arms regardless of study duration or follow up length. Eight interventions in six trials were used for the meta-analyses, with results indicating neither intermittent or continuous energy restriction being superior with respect to weight loss, 0.084 ± 0.114 (overall mean difference between groups ± standard error; p = 0.458). The effects of intermittent energy restriction in the long term remain unclear. The number of long term studies conducted is very limited, and participant numbers typically small (less than 50 completers), indicating the need for larger, long term trials of 12 months or more, to be conducted in order to understand the impact of intermittent energy restriction on weight loss and long term weight management. Blood lipid concentrations, glucose, and insulin were not altered by intermittent energy expenditure in values greater than those seen with continuous energy restriction.

Purpose of Review: This review summarizes recent evidence published since a previous review in 2018 on the association between egg consumption and risk of cardiovascular disease (CVD) mortality, CVD incidence, and CVD risk factors. Recent Findings: No recent randomized controlled trials were identified. Evidence from observational studies is mixed, with studies reporting either an increased risk or no association of highest egg consumption with CVD mortality, and a similar spread of increased risk, decreased risk, or no association between egg intake and total CVD incidence. Most studies reported a reduced risk or no association between egg consumption and CVD risk factors. Included studies reported low and high egg intake as between 0 and 1.9 eggs/week and 2 and ≥14 eggs/week, respectively. Ethnicity may influence the risk of CVD with egg consumption, likely due to differences in how eggs are consumed in the diet rather than eggs themselves. Summary: Recent findings are inconsistent regarding the possible relationship between egg consumption and CVD mortality and morbidity. Dietary guidance should focus on improving the overall quality of the diet to promote cardiovascular health.

To discuss type 2 diabetes mellitus (T2DM) medication changes required during the popular 5:2 intermittent energy restriction (IER) diet. A search was conducted in MEDLINE, EMBASE, AMED, CINAHL and Cochrane library for original research articles investigating the use of very low calorie diets (VLCD) in people with T2DM. The search terms used included “VLCD” or “very low energy diet” or “very low energy restriction” or “IER” or “intermittent fasting” or “calorie restriction” or “diabetes mellitus type 2” and “type 2 diabetes”. Reference lists of selected articles were also screened for relevant publications. Only research articles written in English, which also included an explanation of medication changes were included. A recent pilot trial using the 5:2 IER method, conducted by our research group, will also be summarized. A total of 8 studies were found that investigated the use of VLCD in T2DM and discussed medication management. Overall these studies indicate that the use of a VLCD for people with T2DM usually require the cessation of medication to prevent hypoglycemia. Therefore, the 5:2 IER method will also require medication changes, but as seen in our pilot trial, may not require total cessation of medication, rather a cessation on the 2 IER days only. Guidelines outlined here can be used in the initial stages of a 2-d IER diet, but extensive blood glucose monitoring is still required to make the necessary individual reductions to medications in response to weight loss.