• Shaoyong Xu, Yuxin Jiang, Yuhai Zhang, Wenlei Xu, Hao Zhang, Qiongjie Yan, Ling Gao, and Lei Shang.
• Department of Health Statistics, Shaanxi Key Laboratory of Free Radical Biology and Medicine and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Shaanxi, China; Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
• Nutrition. 2022 Oct 1; 102: 111735.

ObjectivesThe aims of this study were to explore the safety and effectiveness of alternate-day fasting in Chinese people and to compare weight loss outcomes and safety when consuming a high-protein (HP) versus a normal protein (NP) diet versus a nutritional meal replacement (MR) on fasting days.MethodsThis was a randomized, open, parallel-controlled, interventional, exploratory trial, that included a 3-d run-in period and a 28-d intervention period. Adult participants without restriction of body mass index (N = 60) were randomly assigned to three alternative-day fasting (ADF) intervention groups: group HP, group NP, and group MR. The primary outcome was weight change from baseline at 28 d.ResultsOverall participants lost an average of 2.53 kg. Mean triacylglycerols, total cholesterol, and low-density lipoprotein were significantly reduced by 0.10, 0.15, and 0.11 mmol/L, respectively. The mean hunger scale on day 1 of fasting was 18.73 at breakfast and 45.25 at dinner. The mean hunger scale on the last day of fasting decreased significantly, to 10.89 at breakfast and 18.93 at dinner. Weight loss of groups HP, NP, and MR were 2.16, 2.63, and 2.94 kg, respectively; groups did not differ significantly (P = 0.841). The most common adverse events were dizziness, heart palpitations, and fatigue.ConclusionsADF is an effective, short-term weight loss strategy that was tolerated by most Chinese participants. We suggest that dietary patterns during fasting days is less important, and that calorie restriction during those days should be the focus.Copyright © 2022 Elsevier Inc. All rights reserved.

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