Efficacy of fasting calorie restriction on quality of life among aging men
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.
References (38)
- et al.
Calorie restriction in humans: potential pitfall and health concerns
Mech Ageing Dev
(2006) - et al.
Caloric restriction and intermittent fasting: two potential diets for successful brain aging
Ageing Res Rev
(2006) - et al.
Alternate-day fasting and chronic disease prevention: a review of human and animal trials
Am J Clin Nutr
(2007) - et al.
Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research
Psychiatry Res
(1989) - et al.
Appetite changes under free-living conditions during Ramadan fasting
Appetite
(1998) - et al.
Measurements of total energy ependiture provide insights into the validity of dietary measurements of energy intake
J Am Diet Assoc
(1993) - et al.
Alternate-day fasting in nonobese susbjects: effects on body weight, body composition, and energy metabolism
Am J Clin Nutr
(2005) - et al.
Weight loss and health-related quality of life: results at 1-year follow-up
Eat Behav
(2004) - et al.
Effect of caloric restriction in non-obese humans on physiological, psychological and behavioral outcomes
Physiol Behav
(2008) - et al.
Effect of calorie restriction with or without exercise on insulin sensitivity, beta-cell function, fat cell size, and ectopic lipid in overweight subjects
Diabetes Care
(2006)
Effect of 6-month calorie restriction on biomarkers of longevity, metabolic adaptation, and oxidative stress in overweight individuals: a randomized controlled trial
JAMA
The impact of religious fasting on human health
Nutr J
Research in Islamic fasting and health
Ann Saudi Med
Effect of Ramadan fasting on clinical and biochemical parameters in healthy adults
Ann Saudi Med
Effect of Ramadan fasting on markers of oxidative stress and serum biochemical markers of cellular damage in healthy subjects
Ann Nutr Metab
Validation of a Dietary History Questionnaire against a 7-day weight record for estimating nutrient intake among rural elderly Malays
Malaysia J Nutr
Assessment of change in body fat percentage with DXA and eight-electrode BIA in centrally obese women
Med Sci Sports Exerc
SF-36 Health Survey manual and interpretation guide
Manual for the Beck Depression Inventory—II
Cited by (61)
Signaling pathways of dietary energy restriction and metabolism on brain physiology and in age-related neurodegenerative diseases
2020, Mechanisms of Ageing and DevelopmentCitation Excerpt :However, while studies focusing primarily on Caucasians detected generally a profound fat mass decrement ranging from -15.1 % to -23.9 % (Das et al., 2009; Redman et al., 2018; Villareal et al., 2011; Weiss et al., 2006), only mild effects on fat mass reduction were observed in one study performed in a Malaysian population (Teng et al., 2011). This suggests that ethnic background and local dietary habits should be taken into consideration when studying CER effects; in the Malaysian study, for instance, it was found that the baseline average calorie intake was only 1691 kcal/day and as such substantially lower than what is observed in many other populations (Teng et al., 2011). Consistent effects across studies were found with regards to some blood lipid measures (total cholesterol, LDL-cholesterol, triglycerides), while effects on other parameters (such as HDL-cholesterol levels) showed greater variation between studies (Fontana et al., 2004; Kaukua et al., 2003; Walford et al., 1992).
Alternate day fasting on subjective feelings of appetite and body weight for adults with overweight or obesity: a systematic review
2022, Journal of Nutritional Science