Elsevier

Physiology & Behavior

Volume 104, Issue 5, 24 October 2011, Pages 1059-1064
Physiology & Behavior

Efficacy of fasting calorie restriction on quality of life among aging men

https://doi.org/10.1016/j.physbeh.2011.07.007Get rights and content

Abstract

Calorie restriction (CR) has been promoted to increase longevity. Previous studies have indicated that CR can negatively affect mood and therefore the effect of CR on mood and quality of life (QOL) becomes crucial when considering the feasibility of CR in humans. We conducted a three month clinical trial on CR (reduction of 300 to 500 kcal/day) combined with two days/week of Muslim sunnah fasting (FCR) to determine the effectiveness of FCR on QOL among aging men in Klang Valley, Malaysia. A total of 25 healthy Malay men (age 58.8 ± 5.1 years), with no chronic diseases and a BMI of 23.0 to 29.9 kg/m2 were randomized to FCR (n = 12) and control (n = 13) groups. Body composition measurements and QOL questionnaires were ascertained at baseline, week 6 and week 12. QOL was measured using the Short-Form 36, sleep quality was determined using the Pittsburgh Sleep Quality Index, the Beck Depression Inventory II was used to measure mood and the Perceived Stress Scale was used to measure depression. The FCR group had a significant reduction in body weight, BMI, body fat percentage and depression (P < 0.05). The energy component of QOL was significantly increased in FCR group (p < 0.05). There were no significant changes in sleep quality and stress level between the groups as a result of the intervention. In conclusion, FCR resulted in body weight and fat loss and alleviated depression with some improvement in the QOL in our study and has the potential to be implemented on a wider scale.

Highlights

► Fasting calorie restriction (FCR) is a new model of controlling eating. ► It is feasible to practice in free living people. ► It may improve body composition and quality of life.

Introduction

Aging is a non-reversible process, which results in deterioration in organ and functional status. Currently, calorie restriction (CR) is the only non genetic intervention [1] shown to decrease the biological rate of aging. CR has been shown to also produce numerous health and longevity benefits. A randomized controlled study, called CALERIE (Comprehensive Assessment of Long-term Effect of Reducing Intake of Energy) which included a pilot phase, is ongoing to investigate the effect of CR in humans on markers of longevity. The early studies in humans show that CR may reduce the risk of cardiovascular disease and diabetes [2], oxidative stress to DNA [3] and may improve cognitive performance [4]. An alternative to CR, which is called intermittent fasting (IF) or alternate day fasting (ADF) is also suggested to have similar benefits. ADF involves fast days on which subjects need to fast for 20–24 h, followed by feast days on which food intake may be ad libitum [5]. However, this model of controlling eating seems impractical, considering the difficulties of long term adherence to such a regimen.

Fasting is practiced worldwide, usually as part of religion. The Muslim fast is a practice by which all foods and drinks are strictly refrained from dawn to dusk. Ramadan fasting is one of the pillars in Islam, where Muslims fast during the whole month of Ramadan, the ninth month of the lunar calendar. Besides, Muslims also practice Sunnah (the practice of Prophet Muhammad) fasting. Sunnah fasting involves fasting on both Monday and Thursday of each week and six days of fasting in the Shawwal month (the month of Eid festival). Muslim Sunnah fasting is practiced year round and when combined with a moderate CR regimen on the five non fasting days of the week it provides a CR regimen that is both habitual and potentially sustainable. While there are studies about Ramadan fasting in human health [6], [7], [8], [9], there is no scientific study done on the Muslim Sunnah fasting combined with a moderate CR regimen as proposed in this study.

We conducted a three month pilot study to investigate the feasibility of this new fasting calorie restriction (FCR) model and its effect on the quality of life (QOL), food intake and body composition in Malay elderly. Malay elderly were chosen as subjects since they are more likely to comply with Sunnah fasting. Further we were interested in determining the feasibility of the FCR regimen and its effects in this population before we extend it to the younger age groups. We hypothesized that three months of FCR will improve both nutritional and QOL status.

Section snippets

Study design and subjects

Health screening was conducted in the community to identify eligible subjects. This program was advertised through posters and fliers to the residential areas around Klang Valley, Malaysia. Healthy (defined as absence of uncontrolled chronic diseases) Malay men, 50–70 years of age, BMI 23.0–29.9 kg/m², with no history of mental or physical disabilities were eligible to participate in the study. Individuals who regularly practiced Muslim Sunnah fasting for the past three months prior to

Sample characteristics

A total of 124 Malay men participated in the health screening but only 35 subjects were eligible for participation in this study. Of the 35 subjects who were invited, 28 agreed and consented to participate. Subjects were randomized to the FCR (n = 14) or control (CO) groups (n = 14).

Three subjects dropped out of the study at the 1st follow up, (two subjects from FCR group who were unable to follow the regime) and one subject from CO group (due to personal reasons). Thus, 25 subjects with mean age

Discussion

Muslim fasting is practiced by believers worldwide and no adverse effects have been reported in healthy adults. However, to our knowledge the Sunnah Muslim fasting although widely practiced has never been examined as a model for CR. This is the first randomized controlled trial to examine this new model of controlling eating, as an alternative and more sustainable lifestyle for achieving CR and benefits of improved health.

Our study showed that in the three months subjects in intervention group

Conclusion

In conclusion, a three month Muslim Sunnah fasting combined with moderate calorie restriction is feasible and was effective in reducing energy intake, body weight and showed improvements in body composition without compromising the quality of life among elderly Malay men in this study. This model needs to be replicated and tested in larger populations and for longer duration.

Acknowledgment

We are grateful to the participants, fieldworkers, health staff and others involved in the data collection. Financial support was received from the research university grant of Universiti Kebangsaan Malaysia (UKM-AP-TKP-09-2009). We acknowledge the input from other researchers in the team during the development of the FCR regime.

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