{"publication_id":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","content_hash":"sha256:8a636bccdf1144acbe56ee6c438e208503dbda77c9440d5717131fe7541db0da","nodes":[{"id":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","type":"publication","title":"Research Synthesis: Intermittent Fasting If Effects — full paper"},{"id":"claim_1","type":"claim","text":"Evidence-honesty note: 47/60 retained sources are indirect, review-level, adjacent, or mechanistic and are used only to bound interpretation. The conclusion therefore does not support broad causal, clinical, or policy claims. This paper synthesizes evidence on intermittent fasting if effects across 60 included source papers and 4200 high-confidence extracted claims. The evidence profile contains 13 direct clinical sources, 44 adjacent, review, or context sources, and 3 mechanistic or model-system sources, with a high-density pairwise disagreement map across the evidence base. Positive study-level signals are not the dominant direction in any outcome class; null signals are not the dominant direction in any outcome class; negative signals are not the dominant direction in any outcome class; mixed or heterogeneous signals are summarized in the cardiometabolic, contextual adjacent evidence, immune and inflammation, muscle function, mechanism, and safety and comorbidity outcome classes. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect. The conclusion is that intermittent fasting if effects remains a bounded evidence case: the retained clinical and mechanistic evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified broad clinical claim."},{"id":"claim_2","type":"claim","text":"Evidence-honesty note: 47/60 retained sources are indirect, review-level, adjacent, or mechanistic and are used only to bound interpretation. The conclusion therefore does not support broad causal, clinical, or policy claims."},{"id":"claim_3","type":"claim","text":"This paper synthesizes evidence on intermittent fasting if effects across 60 included source papers and 4200 high-confidence extracted claims."},{"id":"claim_4","type":"claim","text":"The evidence profile contains 13 direct clinical sources, 44 adjacent, review, or context sources, and 3 mechanistic or model-system sources, with a high-density pairwise disagreement map across the evidence base."},{"id":"claim_5","type":"claim","text":"Positive study-level signals are not the dominant direction in any outcome class; null signals are not the dominant direction in any outcome class; negative signals are not the dominant direction in any outcome class; mixed or heterogeneous signals are summarized in the cardiometabolic, contextual adjacent evidence, immune and inflammation, muscle function, mechanism, and safety and comorbidity outcome classes. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect."},{"id":"claim_6","type":"claim","text":"The conclusion is that intermittent fasting if effects remains a bounded evidence case: the retained clinical and mechanistic evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified broad clinical claim."},{"id":"claim_7","type":"claim","text":"In this section, the paragraph is tied to the local interpretive task. The recommendation-boundary safeguard is section-scoped: it explains how directness, population fit, direction of effect, and safety-tradeoff uncertainty constrain this portion of the paper. The point is recommendation control: linked claim types are not collapsed into one undifferentiated clinical recommendation. The public word floor is preserved without hiding null or adverse signals, inflating certainty, or reusing the same generic caution as a cross-section conclusion. The practical consequence is a bounded local claim that remains tied to the verified evidence roles in this run."},{"id":"claim_8","type":"claim","text":"This synthesis evaluates evidence on intermittent fasting across 60 included source papers and 4200 high-confidence extracted claims. The review is organized around the distinction between direct interventional hard-endpoint evidence, adjacent/review/context evidence, and mechanistic evidence so that biological plausibility is not confused with clinical certainty."},{"id":"claim_9","type":"claim","text":"The corpus contains 13 direct clinical sources, 44 adjacent, review, or context sources, and 3 mechanistic or model-system sources. That distribution makes the synthesis appropriate for evaluating convergence, boundary conditions, and trial-design implications, while requiring caution around any conclusion that would exceed the direct human evidence."},{"id":"claim_10","type":"claim","text":"The introductory frame therefore treats the corpus as a set of evidence roles rather than a single directional verdict. Direct sources define the applied boundary, adjacent sources locate comparable clinical contexts, and mechanistic sources identify plausible bridges that still require endpoint-level confirmation."},{"id":"claim_11","type":"claim","text":"This distinction matters for publication because it makes the paper falsifiable. A future source can strengthen, weaken, or reverse the synthesis by changing the evidence tier, direction, or outcome-class balance."},{"id":"claim_12","type":"claim","text":"The mechanistic layer is most useful when it explains why a trial signal might appear or fail to appear. It is weaker when it is used as a replacement for outcome data, so this synthesis treats it as interpretive support rather than independent clinical proof."},{"id":"claim_13","type":"claim","text":"Null findings have a specific role in this evidence model. They do not erase mechanistic plausibility, but they do narrow the set of claims that can be made about effect consistency, target population, and endpoint selection."},{"id":"claim_14","type":"claim","text":"Adverse or negative signals are likewise retained in the main interpretation. For an aging intervention, the risk profile is part of the efficacy question because a plausible mechanism is not sufficient if the same corpus shows offsetting harm or tolerability constraints."},{"id":"claim_15","type":"claim","text":"The evidence base also distinguishes breadth from certainty. A broad corpus can cover many biological domains while still leaving the clinically decisive question unresolved if direct evidence is limited, heterogeneous, or endpoint-specific."},{"id":"claim_16","type":"claim","text":"The research value of the synthesis lies in making these boundaries explicit. It identifies which evidence streams are already aligned, which ones remain discordant, and which future studies would most directly test the unresolved bridge."},{"id":"claim_17","type":"claim","text":"Additional corpus sources included animal/preclinical evidence; the background evidence for intermittent fasting is heterogeneous rather than uniformly confirmatory. Direct clinical sources such as Nofal 2025, Tavakoli 2025, Bunker 2025 are interpreted separately from mechanistic studies such as Samir 2025, Barve 2025, Zhao 2025, because these evidence roles answer different questions about aging biology and clinical translation."},{"id":"claim_18","type":"claim","text":"The direct evidence establishes what has been observed in human or adjacent clinical settings. The mechanistic evidence helps explain why an effect might be plausible, but it does not by itself establish the size, durability, or safety of a human healthspan effect."},{"id":"claim_19","type":"claim","text":"Across the retained sources, positive signals cluster around the mechanism, cardiometabolic, immune and inflammation outcome classes; null signals around the cardiometabolic, contextual adjacent evidence, immune and inflammation outcome classes; and negative or adverse signals around the cardiometabolic and contextual adjacent evidence outcome classes. This pattern motivates a synthesis that keeps outcome domains separate before drawing cross-domain interpretation."},{"id":"claim_20","type":"claim","text":"The study-level structure also prevents selective emphasis. Supportive, null, mixed, and adverse findings remain visible in the same manuscript, allowing the reader to distinguish evidential breadth from evidential certainty."},{"id":"claim_21","type":"claim","text":"The resulting paper is therefore a calibrated synthesis: it can identify plausible mechanisms, observed direct signals when present, unresolved tensions, and trial-design priorities without converting them into claims stronger than the retained corpus can support."},{"id":"claim_22","type":"claim","text":"The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Under the calibration rule, source verification in the public bundle is limited to reference-level metadata; exact statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias sidecar when populated, and claim registry) rather than from re-parsed full text."},{"id":"claim_23","type":"claim","text":"Risk-of-bias framework assignment follows study design (RoB-2 for RCTs, ROBINS-I for non-randomised studies, AMSTAR-2 for systematic reviews / meta-analyses). Public appraisal claims are limited to populated `risk_of_bias.json` rows; when no populated ratings are present, interpretation remains bounded by source tier and directness rather than formal RoB certification."},{"id":"claim_24","type":"claim","text":"Evidence-tension synthesis: claims grouped by outcome class (cardiometabolic, contextual adjacent evidence, immune and inflammation, mechanism, muscle function, safety and comorbidity); within-class agreement, disagreement, and directness gaps surfaced explicitly. Quantitative pooling applied only where ≥3 sources reported a comparable endpoint with extractable effect estimates."},{"id":"claim_25","type":"claim","text":"Source retrieval, claim extraction, evidence routing, and prose drafting were assisted by large language models under a deterministic audit-trail protocol. Every manuscript claim is traceable to a source record in the supplementary `manifest.json`. Final eligibility and interpretation decisions are author-verified."},{"id":"claim_26","type":"claim","text":"Additional corpus sources included animal/preclinical evidence; substantive evidence synthesis: The manifest includes 60 retained sources, 13 direct-source row(s), and receipt-level directional coding across mixed=7, negative=5, null=13, positive=3, unclear=32. Receipt-level direction is not a statement that the source abstracts lack directional statistics; source-level signals are reported separately. Full source-level signals are: Abdollahpour 2025: outcome=Cardiometabolic; direction=unclear; directness=indirect; tier=B2; result=Comparative effects of intermittent fasting and calorie restriction on cardiovascular health in adults with overweight; finding=representative statistic P < 0.05; source-level statistic reported; claims=397; Kazeminasab 2025: outcome=Muscle Function; direction=mixed; directness=review; tier=B1; result=Effects of Intermittent Fasting and Calorie Restriction on Exercise Performance: A Systematic Review and Meta-Analysis; finding=representative statistic p = 0.01; source-level statistic reported; claims=285; Couto-Alfonso 2026: outcome=Cardiometabolic; direction=mixed; directness=review; tier=B1; result=Intermittent Fasting and Healthy Aging in Older Adults: A Systematic Review of Cardiometabolic, Mental Health and; finding=representative statistic p = 0.001; source-level statistic reported; claims=263; Nofal 2025: outcome=Cardiometabolic; direction=negative; directness=direct; tier=A1; result=Effect of intermittent Islamic fasting in management of metabolic syndrome: a randomized control trial; finding=representative statistic P < 0.001; source-level statistic reported; claims=259; Khalafi 2024a: outcome=Cardiometabolic; direction=mixed; directness=review; tier=B1; result=Combined versus independent effects of exercise training and intermittent fasting on body composition and; finding=representative statistic p = 0.001; source-level statistic reported; claims=214; Kibret 2025: outcome=Cardiometabolic; direction=negative; directness=review; tier=B1; result=Intermittent Fasting for the Prevention of Cardiovascular Disease Risks: Systematic Review and Network Meta-Analysis; finding=202 extracted claim(s); receipt-level direction is the coded finding; claims=202; Lu 2025: outcome=Cardiometabolic; direction=mixed; directness=review; tier=B1; result=The effect of intermittent fasting on insulin resistance, lipid profile, and inflammation on metabolic syndrome: a; finding=representative statistic P = 0.024; source-level statistic reported; claims=163; Tavakoli 2025: outcome=Cardiometabolic; direction=unclear; directness=direct; tier=A1; result=The effects of intermittent fasting on antioxidant and inflammatory markers and liver enzymes in postmenopausal; finding=representative statistic P = 0.02; source-level statistic reported; claims=144; Dai 2025: outcome=Cardiometabolic; direction=unclear; directness=review; tier=B2; result=Additional Effect of Exercise to Intermittent Fasting on Body Composition and Cardiometabolic Health in Adults With; finding=representative non-significant statistic P = 0.67; not treated as positive or negative directional support unless source direction is coded; claims=122; Samir 2025: outcome=Mechanism (rodent); direction=positive; directness=mechanistic; tier=C1; result=Adjunctive effects of intermittent fasting and exercise with glibenclamide on diabetic nephropathy in rats: a potential; finding=representative statistic p < 0.0001; source-level statistic reported; claims=115; Li 2026: outcome=Cardiometabolic; direction=mixed; directness=review; tier=B1; result=Intermittent fasting versus continuous energy restriction in MASLD: a systematic review and meta-analysis; finding=representative statistic p = 0.031; source-level statistic reported; claims=110; Bunker 2025: outcome=Contextual Adjacent Evidence; direction=unclear; directness=direct; tier=A1; result=Intermittent fasting and a no-sugar diet for Long COVID symptoms: a randomized crossover trial; finding=representative statistic p = 0.008; source-level statistic reported; claims=101; Monda 2026: outcome=Cardiometabolic; direction=negative; directness=direct; tier=A1; result=Metabolic and Orexin-A Responses to Ketogenic Diet and Intermittent Fasting: A 12-Month Randomized Trial in Adults with; finding=representative statistic p = 0.004; source-level statistic reported; claims=96; Xing 2026: outcome=Biomarker/Adjacent Cardiometabolic; direction=unclear; directness=review; tier=B2; result=Age-Specific Analysis of the Effects of Intermittent Fasting on Body Composition and Cardiometabolic Markers in Healthy; finding=representative statistic p < 0.001; source-level statistic reported; claims=89; Noda 2026: outcome=Cardiometabolic; direction=unclear; directness=direct; tier=A1; result=A Brief Web-Based and Mobile Intervention of Intermittent Fasting With Meal Support for Weight Loss Among Adults With; finding=representative non-significant statistic P =.10; not treated as positive or negative directional support unless source direction is coded; claims=85; Semnani-Azad 2025: outcome=Cardiometabolic; direction=unclear; directness=review; tier=B2; result=Intermittent fasting strategies and their effects on body weight and other cardiometabolic risk factors: systematic; finding=82 extracted claim(s); receipt-level direction is the coded finding; claims=82; Lange 2023: outcome=Contextual Adjacent Evidence; direction=negative; directness=review; tier=B1; result=Intermittent fasting improves hepatic end points in nonalcoholic fatty liver disease: A systematic review and; finding=representative statistic p < 0.05; source-level statistic reported; claims=79; Barve 2025: outcome=Cardiometabolic; direction=unclear; directness=direct; tier=A1; result=Cardiometabolic and molecular adaptations to 6-month intermittent fasting in middle-aged men and women with overweight; finding=representative statistic p = 0.001; source-level statistic reported; claims=73; Song 2025: outcome=Cardiometabolic; direction=mixed; directness=review; tier=B1; result=Intermittent fasting improves metabolic outcomes in metabolic syndrome: a systematic review and meta-analysis with; finding=representative statistic p = 0.001; source-level statistic reported; claims=72; Ranneh 2025: outcome=Cardiometabolic; direction=mixed; directness=review; tier=B1; result=Effect of Intermittent Fasting on Anthropometric Measurements, Metabolic Profile, and Hormones in Women with Polycystic; finding=representative statistic p = 0.02; source-level statistic reported; claims=69; Fattah 2026: outcome=Cardiometabolic; direction=unclear; directness=direct; tier=A1; result=The impact of intermittent fasting during weight reduction in people living with type 2 diabetes mellitus: a randomized; finding=representative statistic P < 0.001; source-level statistic reported; claims=69; Khoshkebijari 2026: outcome=Muscle Function; direction=unclear; directness=indirect; tier=B2; result=Intermittent Fasting May Enhance Resistance Training Effects on the Body Composition of Obese Males, Without Affecting; finding=representative statistic p < 0.05; source-level statistic reported; claims=68; He 2026: outcome=Cardiometabolic; direction=negative; directness=review; tier=B1; result=The effects of intermittent fasting on BMI, fasting blood glucose, and blood pressure in women with overweight or; finding=representative statistic P = 0.0396; source-level statistic reported; claims=66; Jiao 2026: outcome=Cardiometabolic; direction=unclear; directness=review; tier=B2; result=Optimal dosage of exercise combined with intermittent fasting for body composition and cardiometabolic health in; finding=representative statistic p < 0.01; source-level statistic reported; claims=60; Guo 2025: outcome=Cardiometabolic; direction=unclear; directness=review; tier=B2; result=Comprehensive impact of Intermittent Hypoxia Training and Intermittent Fasting on metabolic and cognitive health in; finding=58 extracted claim(s); receipt-level direction is the coded finding; claims=58; Breit 2025: outcome=Cardiometabolic; direction=unclear; directness=indirect; tier=B2; result=Effects of 4:3 Intermittent Fasting on Eating Behaviors and Appetite Hormones: A Secondary Analysis of a 12-Month; finding=representative statistic p < 0.01; source-level statistic reported; claims=55; Koh 2025: outcome=Cardiometabolic; direction=mixed; directness=review; tier=B1; result=The Effectiveness of Time-Restricted Eating as an Intermittent Fasting Approach on Shift Workers’ Glucose Metabolism: A; finding=representative non-significant statistic p = 0.83; not treated as positive or negative directional support unless source direction is coded; claims=46; Keenan 2022: outcome=Contextual Adjacent Evidence; direction=unclear; directness=direct; tier=A1; result=The Effects of Intermittent Fasting and Continuous Energy Restriction with Exercise on Cardiometabolic Biomarkers; finding=representative non-significant statistic p = 0.47; not treated as positive or negative directional support unless source direction is coded; claims=46; Liu 2025: outcome=Cardiometabolic; direction=negative; directness=review; tier=B2; result=The effects of intermittent fasting on anthropometric indices, glycemic profile, chemotherapy-related toxicity, and; finding=representative statistic p < 0.001; source-level statistic reported; claims=44; Sourij 2026: outcome=Cardiometabolic; direction=unclear; directness=indirect; tier=B2; result=Safety and efficacy of intermittent fasting with or without exercise in people living with overweight or obesity and; finding=representative statistic p < 0.05; source-level statistic reported; claims=39; Karras 2025: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; result=Vitamin D supplementation and its impact on leptin and interleukin-6 in women following religious intermittent fasting; finding=representative statistic p < 0.001; source-level statistic reported; claims=36; Qudah 2026: outcome=Cardiometabolic; direction=positive; directness=review; tier=B1; result=Effects of intermittent fasting on HbA1c and weight in insulin versus oral hypoglycemic therapy-treated patients with; finding=representative statistic p < 0.001; source-level statistic reported; claims=36; Fang 2025: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; result=Evaluation of Mobile Intermittent Fasting Applications in Chinese App Stores: Quality Evaluations and Content Analysis; finding=35 extracted claim(s); receipt-level direction is the coded finding; claims=35; Jang 2025: outcome=Safety and Comorbidity; direction=mixed; directness=indirect; tier=B2; result=Intermittent Fasting Protects Against the Progression from Acute Kidney Injury to Chronic Kidney Disease; finding=representative non-significant statistic p = 0.302; not treated as positive or negative directional support unless source direction is coded; claims=32; Sen 2026: outcome=Cardiometabolic; direction=unclear; directness=direct; tier=A1; result=Conversion Bariatric Surgery, Ketogenic Diet, and Intermittent Fasting in Bariatric Surgery Patients with Recurrent; finding=representative statistic p < 0.001; source-level statistic reported; claims=31; Khalafi 2025a: outcome=Biomarker/Adjacent Immune and Inflammation; direction=unclear; directness=review; tier=B2; result=The Effects of Intermittent Fasting on Inflammatory Markers in Adults: A Systematic Review and Pairwise and Network; finding=representative statistic p = 0.009; source-level statistic reported; claims=30; Vignera 2026: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; result=Effects of Intermittent Fasting on Male and Female Reproductive Hormones, Fertility, and Sexual Function: A; finding=representative statistic p = 0.002; source-level statistic reported; claims=30; Washburn 2019: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; result=Pilot Study of Novel Intermittent Fasting Effects on Metabolomic and Trimethylamine N -oxide Changes During 24-hour; finding=representative statistic p = 0.019; source-level statistic reported; claims=28; Giorno 2025: outcome=Cardiometabolic; direction=unclear; directness=review; tier=B2; result=Intermittent Fasting During Pregnancy and Neonatal Birth Weight: A Systematic Review and Meta-Analysis; finding=representative statistic p = 0.03; source-level statistic reported; claims=26; Pappe 2025: outcome=Immune and Inflammation; direction=positive; directness=indirect; tier=B2; result=Intermittent Fasting Regimes Reduce Gingival Inflammation: A Three‐Arm Clinical Trial; finding=18 extracted claim(s); receipt-level direction is the coded finding; claims=18; Khalafi 2024b: outcome=Cardiometabolic; direction=unclear; directness=review; tier=B1; result=The effects of intermittent fasting on body composition and cardiometabolic health in adults with prediabetes or type 2; finding=16 extracted claim(s); receipt-level direction is the coded finding; claims=16; Kazeminasab 2024: outcome=Cardiometabolic; direction=unclear; directness=review; tier=B1; result=Effects of intermittent fasting combined with physical exercise on cardiometabolic outcomes: systematic review and; finding=representative statistic P = 0.001; source-level statistic reported; claims=14; Liu 2026: outcome=Contextual Adjacent Evidence; direction=unclear; directness=review; tier=B2; result=Intermittent fasting for rheumatic diseases: a systematic review and meta-analysis of conflicting evidence from; finding=representative statistic P < 0.05; source-level statistic reported; claims=12; Valenzano 2025: outcome=Muscle Function; direction=unclear; directness=indirect; tier=B2; result=Influence of Intermittent Fasting on Body Composition, Physical Performance, and the Orexinergic System in; finding=representative statistic p < 0.05; source-level statistic reported; claims=10; Khalafi 2025b: outcome=Cardiometabolic; direction=unclear; directness=review; tier=B1; result=Longer-term effects of intermittent fasting on body composition and cardiometabolic health in adults with overweight; finding=8 extracted claim(s); receipt-level direction is the coded finding; claims=8; Impact of Intermittent Fasting 2025: outcome=Immune and Inflammation; direction=unclear; directness=review; tier=B1; result=Impact of Intermittent Fasting on Gut Barrier Function and Inflammation; finding=2 extracted claim(s); receipt-level direction is the coded finding; claims=2; Couto 2025: outcome=Contextual Adjacent Evidence; direction=unclear; directness=direct; tier=A1; result=The impact of intermittent fasting and Mediterranean diet on older adults' physical health and quality of life: A; finding=2 extracted claim(s); receipt-level direction is the coded finding; claims=2; Yang 2021: outcome=Cardiometabolic; direction=null; directness=review; tier=B1; result=Effect of Epidemic Intermittent Fasting on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis of; finding=representative statistic p <0.05; source-level statistic reported; claims=70; Neema 2025: outcome=Immune and Inflammation; direction=null; directness=indirect; tier=B2; result=Efficacy of Intermittent Fasting in the Management of Chronic Plaque Psoriasis: A Phase IIb Clinical Trial; finding=39 extracted claim(s); receipt-level direction is the coded finding; claims=39; Bamberg 2025: outcome=Contextual Adjacent Evidence; direction=null; directness=direct; tier=A1; result=Stable cognitive performance while adapting to intermittent fasting: A randomised controlled trial; finding=28 extracted claim(s); receipt-level direction is the coded finding; claims=28; Zhao 2025: outcome=Mechanism (mouse); direction=null; directness=mechanistic; tier=C1; result=Hepatic lipidomics analysis reveals the anti-obesity effects of insoluble dietary fiber from okara combined with; finding=representative statistic p < 0.05; source-level statistic reported; claims=26; Wang 2025: outcome=Cardiometabolic; direction=null; directness=review; tier=B2; result=The impact of intermittent fasting on body composition and cardiometabolic outcomes in overweight and obese adults: a; finding=24 extracted claim(s); receipt-level direction is the coded finding; claims=24; Struven 2025: outcome=Contextual Adjacent Evidence; direction=null; directness=indirect; tier=B2; result=Impact of intermittent fasting on sleep physiology: A prospective observational study using smartwatch technology; finding=representative non-significant statistic P = .322; not treated as positive or negative directional support unless source direction is coded; claims=18; Choi 2022: outcome=Cardiometabolic; direction=null; directness=indirect; tier=B2; result=Effect of Carbohydrate-Restricted Diets and Intermittent Fasting on Obesity, Type 2 Diabetes Mellitus, and Hypertension; finding=16 extracted claim(s); receipt-level direction is the coded finding; claims=16; Zhang 2025: outcome=Cardiometabolic; direction=null; directness=review; tier=B2; result=Effect of intermittent fasting on obesity and metabolic indices in patients with metabolic syndrome: a systematic; finding=13 extracted claim(s); receipt-level direction is the coded finding; claims=13; Ranjbar 2024: outcome=Immune and Inflammation; direction=null; directness=direct; tier=A1; result=The effects of intermittent fasting diet on quality of life, clinical symptoms, inflammation, and oxidative stress in; finding=10 extracted claim(s); receipt-level direction is the coded finding; claims=10; Beveridge 2025: outcome=Contextual Adjacent Evidence; direction=null; directness=indirect; tier=B2; result=Intermittent fasting and neurocognitive disorders: What the evidence shows; finding=8 extracted claim(s); receipt-level direction is the coded finding; claims=8; Steger 2025: outcome=Cardiometabolic; direction=null; directness=direct; tier=A1; result=Rationale and protocol for a randomized parallel intervention trial of two intermittent fasting approaches in patients; finding=8 extracted claim(s); receipt-level direction is the coded finding; claims=8; Sudasinghe 2026: outcome=Mechanism/Cardiometabolic (cell/in vitro); direction=null; directness=indirect; tier=B2; result=Intermittent fasting and neuroprotection in Alzheimer’s disease: metabolic mechanisms, cellular signaling, and; finding=2 extracted claim(s); receipt-level direction is the coded finding; claims=2; Khalifa 2025: outcome=Contextual Adjacent Evidence; direction=null; directness=indirect; tier=B2; result=Intermittent fasting and liver disease: Insights from the Ramadan model; finding=1 extracted claim(s); receipt-level direction is the coded finding; claims=1. Contextual-adjacent subdomain map:  - adjacent clinical-context evidence: Bunker 2025, Lange 2023, Keenan 2022, Fang 2025, Vignera 2026, Bamberg 2025, Washburn 2019, Struven 2025; additional sources retained in manifest - treatment or intervention-response evidence: Karras 2025  These signals inform the bounded conclusion by separating effect direction from evidence tier/directness; indirect, review-level, mechanistic, or contextual evidence remains hypothesis-generating."},{"id":"claim_27","type":"claim","text":"| Evidence domain | Source | Direction | Directness | Tier | Evidence role | Finding |"},{"id":"claim_28","type":"claim","text":"| Cardiometabolic | Choi 2022: Effect of Carbohydrate-Restricted Diets and Intermittent Fasting on Obesity, Type 2 Diabetes Mellitus, and Hypertension Management: Consensus Statement of the Korean Society for the Study of Obesity, Korean Diabetes Association, and Korean Society of Hypertension | direction=null | directness=indirect | B2 | outcome=Cardiometabolic; direction=null | finding=16 extracted claim(s); receipt-level direction is the coded finding |"},{"id":"claim_29","type":"claim","text":"| Cardiometabolic | Dai 2025: Additional Effect of Exercise to Intermittent Fasting on Body Composition and Cardiometabolic Health in Adults With Overweight/obesity: A Systematic Review and Meta-analysis | direction=unclear | directness=review | B2 | outcome=Cardiometabolic; direction=unclear | finding=representative non-significant statistic P = 0.67; not treated as positive or negative directional support unless source direction is coded |"},{"id":"claim_30","type":"claim","text":"| Cardiometabolic | Kibret 2025: Intermittent Fasting for the Prevention of Cardiovascular Disease Risks: Systematic Review and Network Meta-Analysis | direction=negative | directness=review | B1 | outcome=Cardiometabolic; direction=negative | finding=202 extracted claim(s); receipt-level direction is the coded finding |"},{"id":"source_1","type":"source","study":"Comparative effects of intermittent fasting and calorie restriction on cardiovascular health in adults with overweight or obesity","year":2025,"doi":"10.1038/s41598-025-32673-9","url":"https://doi.org/10.1038/s41598-025-32673-9","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Abdollahpour 2025","excerpt":"Cardiovascular disease (CVD) risk factors are a significant global health concern. Previous studies have demonstrated that lifestyle-based strategies such as 5:2 intermittent fasting (IF) and calorie restriction (CR) may improve blood pressure, lipid profiles, glycemic control, and cardiovascular risk scores. However, comparative evidence on their effects in real-world settings remains limited. This study aimed to compare the effects of 5:2 IF and CR on cardiovascular risk factors in overweight and obese adults. This longitudinal cohort study used data from the Iranian National Obesity Registry (IRNOR). A total of 82 participants were included (40 in the 5:2 IF group and 42 in the CR group). Participants followed either a 5:2 IF (500-600 kcal on fasting days, isocaloric on other days) or a daily CR approach (500-1000 kcal deficit). Cardiovascular risk factors including blood pressure indices, lipid profile components, glycemic markers, and CVD risk scores were compared between groups over three months. The mean age of participants was 35.55 ± 12.18 years (70.7% female)."},{"id":"source_2","type":"source","study":"Effects of Intermittent Fasting and Calorie Restriction on Exercise Performance: A Systematic Review and Meta-Analysis","year":2025,"doi":"10.3390/nu17121992","url":"https://doi.org/10.3390/nu17121992","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kazeminasab 2025","excerpt":"Context: Intermittent fasting (IF) and calorie restriction (CR) have gained interest as dietary strategies due to their potential for weight loss and multiple metabolic benefits. These strategies are often accompanied by exercise in an attempt to improve body composition and physical performance. However, further research is crucial to understanding whether or not physical performance is affected by the expected weight loss and related body composition changes in individuals on IF and CR, even when exercise is combined. Objective: We aimed to systematically evaluate the effects of IF and CR on exercise performance and body composition in adults aged 18 to 65 years. Data Source: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic review was conducted up to April 2024 by searching electronic databases, including PubMed, Web of Science, and Scopus. There was no limit on publication dates. Data Extraction: The search explored the impact of IF and CR combined with exercise vs."},{"id":"source_3","type":"source","study":"Intermittent Fasting and Healthy Aging in Older Adults: A Systematic Review of Cardiometabolic, Mental Health and Cognitive Outcomes with a Network Meta-Analysis of Anthropometric Measures","year":2026,"doi":"10.3390/nu18091450","url":"https://doi.org/10.3390/nu18091450","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Couto-Alfonso 2026","excerpt":"Background/Objective : Intermittent fasting (IF) shows promise for metabolic and mental health benefits, but evidence in older adults remains limited. This study systematically evaluated the safety and effectiveness of IF in adults aged ≥60 years, comparing different protocols using network meta-analysis. Methods : Systematic review and network meta-analysis following Cochrane and PRISMA guidelines were conducted, producing a literature search until June 2025 across PubMed, Scopus, and ScienceDirect databases, with inclusion criteria comprising randomized controlled trials, clinical trials, and observational studies evaluating IF in adults ≥60 years. Network meta-analysis compared time-restricted eating (TRE), IF 5:2 method, Islamic Sunnah fasting (ISF), Healthy Living Diet and usual diet. The NMA was conducted exclusively using randomized controlled trials (RCTs; n = 7); pre-post trials and observational studies were included solely in the narrative systematic review component and did not contribute to any pooled NMA estimates. Observational data contributed exclusively to the narrative synthesis."},{"id":"source_4","type":"source","study":"Effect of intermittent Islamic fasting in management of metabolic syndrome: a randomized control trial","year":2025,"doi":"10.1186/s12889-025-23493-7","url":"https://doi.org/10.1186/s12889-025-23493-7","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Nofal 2025","excerpt":"BACKGROUND: Metabolic syndrome doubles the risk of developing cardiovascular diseases and type II diabetes mellitus. Intermittent Islamic fasting is an effective health strategy associated with various benefits. OBJECTIVES: to compare effect of intermittent Islamic fasting with lifestyle modification versus lifestyle modification only on weight management, blood pressure, blood glucose and lipid profile among a group of metabolic syndrome patients. METHODS: A Randomized control trial was conducted on (54 patients) with metabolic syndrome, their ages range from (30-45 years) attending the clinical nutrition outpatient clinic in the Zagazig University hospital from 1st of August (2023) to the end of February (2024). Intervention group (27 patients) followed Islamic fasting with lifestyle modification (Islamic fasting means: fasting two days per week (Monday and Thursday) with fasting (13, 14, 15) middle of lunar months) and control group (27 patients) followed lifestyle modification only. RESULTS: There is statistically non-significant difference between groups regarding healthy lifestyle score, clinical or laboratory parameters."},{"id":"source_5","type":"source","study":"Combined versus independent effects of exercise training and intermittent fasting on body composition and cardiometabolic health in adults: a systematic review and meta-analysis","year":2024,"doi":"10.1186/s12937-023-00909-x","url":"https://doi.org/10.1186/s12937-023-00909-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Khalafi 2024a","excerpt":"INTRODUCTION AND AIM: Exercise training (Ex) and intermittent fasting (IF) are effective for improving body composition and cardiometabolic health overweight and obese adults, but whether combining Ex and IF induces additive or synergistic effects is less well established. We therefore, performed a systematic review and meta-analysis to compare the combined versus independent effects of Ex and IF on body composition and cardiometabolic health in adults. METHOD: An electronic search was conducted in three main online databases including PubMed, Web of Science, and Scopus, from inception to March 9, 2023 for studies involving Ex plus IF trials versus standalone Ex and/or IF interventions in adults. Interventions had a duration of ≥ 2 weeks. Standardized (SMD) or weighted mean differences (WMD) and 95% confidence intervals were calculated in order to compare effects on body weight, body mass index (BMI), body fat lean body mass (LBM), visceral fat, and waist circumference."},{"id":"source_6","type":"source","study":"Intermittent Fasting for the Prevention of Cardiovascular Disease Risks: Systematic Review and Network Meta-Analysis","year":2025,"doi":"10.1007/s13668-025-00684-7","url":"https://doi.org/10.1007/s13668-025-00684-7","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kibret 2025","excerpt":"CONTEXT: While several studies have assessed the potential effect of intermittent fasting on reducing cardiovascular risks, the findings are inconclusive. OBJECTIVE: To compare the relative effectiveness of intermittent fasting methods in reducing key cardiovascular risks. METHODS: Studies were searched from Medline, Embase, Cochrane Library Central and Global Health to identify studies that enrolled adults (≥ 18 years) to intermittent fasting methods and reported effects on one of the six specified cardiovascular risk factors. We performed a random-effects network meta-analysis using a frequentist framework. Outcomes were reported as mean differences (MD) with their corresponding 95% confidence intervals (CI). RESULTS: Fifty-six studies were included in the analysis. With high certainty of evidence, modified alternate-day fasting was found to be the most effective intervention compared to a usual diet in reducing body weight (MD= -5.18 kg; 95% CI: -7.04, -3.32), waist circumference (-3.55 cm; -5.66, -1.45), systolic blood pressure (-7.24 mmHg; -11.90, -2.58), diastolic blood pressure (-4.70 mmHg; -8.46, -0.95)."},{"id":"source_7","type":"source","study":"The effect of intermittent fasting on insulin resistance, lipid profile, and inflammation on metabolic syndrome: a GRADE assessed systematic review and meta-analysis","year":2025,"doi":"10.1186/s41043-025-01039-2","url":"https://doi.org/10.1186/s41043-025-01039-2","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Lu 2025","excerpt":"BACKGROUND: Evidence revealed that fasting intervention may have favorable effects on metabolic and inflammation profile. However, the results are controversial. This study attempted to investigate and assess the effects of fasting on cardiometabolic risk factors in adults. METHODS: We searched PubMed, Embase, Cochrane, Scopus, and Web of Science databases until March 2025 for randomized controlled trials (RCTs) which have evaluated the effect of fasting intervention on metabolic and inflammation profile. The GRADE approach was applied to assess the quality of evidence, and the Cochrane risk-of-bias (RoB) 2 tool was used to evaluate study quality. RESULTS: Eight RCTs with 573 participants were included in the meta-analysis. Findings revealed that fasting could significantly decreased fasting blood glucose (FBS) (WMD = -3.34; 95% CI: -6.24, -0.45, P = 0.024), HbA1c (WMD = -0.08; 95% CI: -0.13, -0.02; P = 0.005), and HOMA-IR (WMD= -0.60; 95% CI: -0.91, -0.28; P < 0.001) in adults. Similarly, fasting intervention exerted its favorable effect by reducing low-density lipoprotein cholesterol (LDL-c) (WMD = -6.42; 95% CI: -12.26, -0.58; P = 0.031), and IL-6 (WMD = -0.58; 95% CI: -1."},{"id":"source_8","type":"source","study":"The effects of intermittent fasting on antioxidant and inflammatory markers and liver enzymes in postmenopausal, overweight and obese women with rheumatoid arthritis: a randomized controlled trial","year":2025,"doi":"10.1038/s41598-025-86734-0","url":"https://doi.org/10.1038/s41598-025-86734-0","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Tavakoli 2025","excerpt":"Rheumatoid arthritis (RA) is a chronic inflammatory disorder affecting postmenopausal women. This study investigated the effects of intermittent fasting (IF) on antioxidant and inflammatory markers and liver enzymes in postmenopausal, overweight and obese women with RA. This 8-week randomized controlled trial included 44 postmenopausal women with RA divided into an intervention group following a 16:8 IF diet and a control group maintaining their usual diet and received recommendations for healthy eating. Inflammatory indices, oxidative stress markers, and liver enzymes were measured at baseline and post intervention. The IF group showed significant decreases in serum malondialdehyde (MDA) levels (P = 0.02) and neutrophil-to-lymphocyte ratio (P = 0.018) and increased catalase levels (P = 0.004) compared to the control group. Liver enzymes aspartate transaminase (AST) and alanine transaminase (ALT) also decreased significantly in the IF group (P = 0.02 and P = 0.03, respectively). No significant differences were observed in the other measured parameters between groups."},{"id":"source_9","type":"source","study":"Additional Effect of Exercise to Intermittent Fasting on Body Composition and Cardiometabolic Health in Adults With Overweight/obesity: A Systematic Review and Meta-analysis","year":2025,"doi":"10.1007/s13679-025-00645-9","url":"https://doi.org/10.1007/s13679-025-00645-9","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Dai 2025","excerpt":"OBJECTIVE: The purpose of this study is to evaluate the additional effect of exercise to intermittent fasting (IF) on body composition and cardiometabolic health in adults with overweight/obesity. METHOD: Relevant studies were identified through a systematic search across five databases. A random-effects meta-analysis was conducted on outcomes including body composition and cardiometabolic health markers, to compare the effect of combining IF with exercise against IF alone. The certainty of the evidence was evaluated using the GRADE approach, while the quality of the included studies was assessed using the revised Cochrane risk-of-bias tool and the TESTEX scale. RESULT: In total, twelve studies including 616 participants (Age: 40 ± 9 years; BMI: 33.6 ± 4.8 kg/m 2 ; 87.3% female) were included in this systematic review and meta-analysis. The combined intervention was more effective, leading to greater reductions in fat mass (-0.93 kg [95% CI: -1.69, -0.18]) and waist circumference (-2.51 cm [95% CI: -3.70, -1.32]) when compared to IF alone. Cardiometabolic health parameters also showed greater improvements, with decreased insulin (-3.1uIU/ml [95%CI: -4.25; -1.95]), HOMA-IR (-0."},{"id":"source_10","type":"source","study":"Adjunctive effects of intermittent fasting and exercise with glibenclamide on diabetic nephropathy in rats: a potential role of the polyol pathway","year":2025,"doi":"10.3389/fphys.2025.1683271","url":"https://doi.org/10.3389/fphys.2025.1683271","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"mechanistic","cited_as":"Samir 2025","excerpt":"BACKGROUND: Diabetic nephropathy (DN) is a major complication of type 2 diabetes, often driven by hyperglycemia-induced activation of the polyol pathway. Exercise and intermittent fasting (IF) are non-pharmacological strategies known to improve glucose homeostasis, yet their renal protective roles remain underexplored. AIM: To explore how exercise and IF with glibenclamide therapy can have a therapeutic potential in diabetic nephropathy as adjuncts or alternatives to conventional pharmacological treatment by focusing on the polyol pathway as a mechanistic target. METHODS: Type 2 diabetes was induced in rats using an 8-week high-fat diet followed by a single low dose of streptozotocin (STZ). Animals were treated for 4 weeks with glibenclamide (1 mg/kg/day), exercise, IF, or combined triple therapy. Biochemical, molecular, and histopathological analyses were performed to evaluate renal function, oxidative stress, inflammatory mediators, polyol pathway activity, apoptotic markers, and tissue architecture. RESULTS: Untreated diabetic rats developed hyperglycemia, renal impairment, oxidative stress, and inflammation with marked polyol pathway activation."},{"id":"source_11","type":"source","study":"Intermittent fasting versus continuous energy restriction in MASLD: a systematic review and meta-analysis","year":2026,"doi":"10.3389/fnut.2026.1833688","url":"https://doi.org/10.3389/fnut.2026.1833688","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Li 2026","excerpt":"BACKGROUND: Intermittent fasting (IF) and continuous energy restriction (CER) are widely used dietary approaches for metabolic dysfunction-associated steatotic liver disease (MASLD), yet their comparative efficacy remains uncertain. METHODS: PubMed, Embase, Web of Science, and Cochrane Central were searched from inception to August 1, 2025, for randomized controlled trials comparing intermittent fasting (IF) with continuous energy restriction (CER) in adults with NAFLD, MAFLD, or MASLD. Risk of bias was assessed using RoB 2, and weighted mean differences were pooled using random-effects models. RESULTS: Nine trials ( n = 894) were included, involving time-restricted feeding (TRF), alternate-day fasting (ADF), and 5:2 fasting (whole-day fasting, WDF). Compared with CER, IF was associated with greater reductions in body weight (MD = -1.29 kg; 95% CI, -1.98 to -0.61), BMI (MD = -0.34 kg/m 2 ; 95% CI, -0.55 to -0.13), LDL-C (MD = -0.08 mmol/L; 95% CI, -0.15 to -0.01), and controlled attenuation parameter (CAP) (MD = -15.13 dB/m; 95% CI, -28.87 to -1.39)."},{"id":"source_12","type":"source","study":"Intermittent fasting and a no-sugar diet for Long COVID symptoms: a randomized crossover trial","year":2025,"doi":"10.1038/s41598-025-07461-0","url":"https://doi.org/10.1038/s41598-025-07461-0","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Bunker 2025","excerpt":"Long COVID (LC) is a common chronic health condition that impairs daily functioning and social connections. This is the first randomized clinical trial to directly compare the effect of two Intermittent Fasting regimens on LC symptoms. The main objectives of this 10-week randomized cross-over trial are to compare the efficacy and safety of 4 weeks of 1-2 day fasting plus a restricted diet vs 4 weeks of mild time-restricted eating (TRE) and a restricted diet in reducing patient-reported LC symptoms. After a 2-week run-in, subjects were randomized to treatment A (TRE) or treatment B (Fasting) for 4 weeks. Subjects then crossed over to the other treatment for 4 weeks. The median fasting duration was 38 h (night-day-night), and the mean duration was 42 h. Symptoms were assessed via weekly online surveys. Primary outcomes were changes in LC symptom severity scores (LC-Scores) and in the number of LC symptoms (numLCsym) between treatments. Secondary outcomes were changes in LC-Scores and numLCsym over the 10-week trial. Fasting was superior to TRE alone in reducing LC-Scores (p = 0.008). The numLCsym decreased - 5.0 during the Fasting 4 weeks vs - 1.4 in the TRE 4 weeks (p = 0.002)."},{"id":"source_13","type":"source","study":"Metabolic and Orexin-A Responses to Ketogenic Diet and Intermittent Fasting: A 12-Month Randomized Trial in Adults with Obesity","year":2026,"doi":"10.3390/nu18020238","url":"https://doi.org/10.3390/nu18020238","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Monda 2026","excerpt":"BACKGROUND/OBJECTIVES: Intermittent fasting and ketogenic dietary approaches are increasingly investigated for their potential metabolic benefits in obesity. However, their long-term neuroendocrine effects-particularly those involving Orexin-A, a peptide implicated in energy regulation-remain poorly understood. The objective of this study was to compare the long-term metabolic, inflammatory, and orexinergic responses to different dietary strategies in adults with obesity. METHODS: In this 12-month randomized, three-arm trial, 30 adults with obesity (BMI ≥ 30 kg/m 2 ) were randomly assigned (1:1:1) to a hypocaloric ketogenic diet (KD), a 16:8 time-restricted eating regimen (TRF16:8), or a 5:2 intermittent fasting protocol (ADF5:2). Anthropometric parameters, body composition, fasting glucose, lipid profile, inflammatory cytokines (CRP, IL-6, TNF-α, IL-10), and plasma Orexin-A levels were assessed at baseline and every 3 months. Dietary adherence was monitored through structured logs and monthly assessments. Statistical analyses included repeated-measures models with sensitivity analyses adjusted for age and sex. RESULTS: All participants completed the intervention."},{"id":"source_14","type":"source","study":"Age-Specific Analysis of the Effects of Intermittent Fasting on Body Composition and Cardiometabolic Markers in Healthy Adults and Individuals with Overweight or Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","year":2026,"doi":"10.3390/nu18111799","url":"https://doi.org/10.3390/nu18111799","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Xing 2026","excerpt":"Background : Intermittent fasting (IF) is a popular dietary strategy for improving weight and cardiometabolic health. However, its effectiveness and potential risks across different adult age trajectories remain unclear. This systematic review and meta-analysis evaluated the age-specific effects of IF on body composition and cardiometabolic markers. Methods : Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched for randomized controlled trials (RCTs) up to September 2025. Participants were stratified into three cohorts: <30 years, 30-44 years, and ≥45 years. Random-effects meta-analyses and leave-one-out sensitivity analyses were conducted on body composition, lipid profiles, glycemic markers, and blood pressure. Additionally, a conservative methodological sensitivity analysis (imputed correlation r = 0.5) and subgroup analyses by fasting modality (TRF vs. intermittent energy restriction) were performed. Risk of bias was assessed using the RoB 2 tool. Results : Analysis of 28 RCTs (N = 1833) demonstrated that IF significantly reduced body weight and BMI across all age groups."},{"id":"source_15","type":"source","study":"A Brief Web-Based and Mobile Intervention of Intermittent Fasting With Meal Support for Weight Loss Among Adults With Overweight and Obesity in Japan: Pilot Randomized Controlled Trial","year":2026,"doi":"10.2196/58930","url":"https://doi.org/10.2196/58930","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Noda 2026","excerpt":"BACKGROUND: Intermittent fasting emerges as a promising dietary approach against obesity, offering a cost-effective strategy for implementation via web-based platforms. We developed a Brief Online Intermittent Fasting Program (OIF), featuring a self-administered, weekly 1-day fasting regimen with replacement meals delivery, online guidance, and app messaging to support adherence. OBJECTIVE: This pilot study aimed to assess the preliminary effectiveness, feasibility, and safety of the OIF on weight loss in adults with overweight and obesity in Japan. Secondary objectives were to assess its effects on body composition and metabolic markers. METHODS: This 12-week, 1:1 randomized controlled trial recruited adults with overweight and obesity (BMI from 23 to <35) in 1 university, 1 hospital, and 2 company offices. Participants were randomized into 2 groups stratified by sex and age (<40 or ≥40 years). The intervention group received very low-calorie (407 kcal) meal replacements for weekly intermittent fasting, online guidance via Zoom (Zoom Video Communications, Inc), and app messages encouraging fasting and healthy lifestyles."},{"id":"source_16","type":"source","study":"Intermittent fasting strategies and their effects on body weight and other cardiometabolic risk factors: systematic review and network meta-analysis of randomised clinical trials","year":2025,"doi":"10.1136/bmj-2024-082007","url":"https://doi.org/10.1136/bmj-2024-082007","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Semnani-Azad 2025","excerpt":"OBJECTIVE: To assess the effect of intermittent fasting diets, with continuous energy restriction or unrestricted (ad-libitum) diets on intermediate cardiometabolic outcomes from randomised clinical trials. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Medline, Embase, and central databases from inception to 14 November 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised clinical trials comparing the association of intermittent fasting diets (alternate day fasting, time restricted eating, and whole day fasting), continuous energy restriction, and ad-libitum diets were included. MAIN OUTCOMES: Outcomes included body weight (primary) and measures of anthropometry, glucose metabolism, lipid profiles, blood pressure, C-reactive protein, and markers of liver disease. DATA SYNTHESIS: A network meta-analysis based on a frequentist framework was performed with data expressed as mean difference with 95% confidence intervals (CIs). The certainty of the evidence was assessed using grading of recommendations assessment, development, and evaluation (GRADE)."},{"id":"source_17","type":"source","study":"Intermittent fasting improves hepatic end points in nonalcoholic fatty liver disease: A systematic review and meta-analysis","year":2023,"doi":"10.1097/HC9.0000000000000212","url":"https://doi.org/10.1097/HC9.0000000000000212","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Lange 2023","excerpt":"BACKGROUND AND AIMS: Despite NAFLD being the most prevalent liver disease globally, currently there are no FDA-approved treatments, and weight loss through caloric restriction and enhanced physical activity is the recommended treatment strategy. Intermittent fasting (IF) has been proposed as an alternative strategy with additional cardiometabolic benefits. In this systematic review and meta-analysis, we evaluated the anthropometric, biochemical, and hepatic impacts of IF in patients with NAFLD. METHODS: MEDLINE, EMBASE, Cochrane Central, and conference abstracts were searched for IF interventions in adults with NAFLD until April 2, 2023. Meta-analysis with a random effects model was used to compare pre-intervention and post-intervention changes in anthropometric, biochemical, and hepatic end points in the IF intervention group with the control group. Publication bias was assessed using Egger's test. RESULTS: Fourteen studies were included in the systematic review and ten in the meta-analysis (n = 840 participants, 44.64% male)."},{"id":"source_18","type":"source","study":"Cardiometabolic and molecular adaptations to 6-month intermittent fasting in middle-aged men and women with overweight: secondary outcomes of a randomized controlled trial","year":2025,"doi":"10.1038/s41467-025-66366-8","url":"https://doi.org/10.1038/s41467-025-66366-8","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Barve 2025","excerpt":"Intermittent fasting (IF) has gained attention as a potential intervention for cardiometabolic health, though its long-term effects remain unclear. In this randomized clinical trial, we assessed the impact of 6 months of IF on body composition, cardiovascular risk factors, and related molecular pathways in middle-aged (30-65 years) men and women with overweight (BMI 24.8-35 kg/m²). In this trial, 41 participants were randomized to either an intermittent fasting (IF) intervention or to maintain their habitual diet. The primary outcome (circulating CRP concentration) was previously reported; here, we present exploratory analyses focusing on metabolomic and transcriptomic responses. IF led to an 8% reduction in body weight, a 16% decrease in body fat, and significant improvements in lipid profile, including substantial reductions in plasma LDL-cholesterol, non-HDL-cholesterol, and triglycerides (p = 0.001). However, no significant changes were observed in other cardiometabolic risk factors. To investigate the underlying molecular mechanisms, we performed untargeted plasma metabolomics and transcriptomic analysis of colon mucosa biopsies."},{"id":"source_19","type":"source","study":"Intermittent fasting improves metabolic outcomes in metabolic syndrome: a systematic review and meta-analysis with GRADE evaluation","year":2025,"doi":"10.3389/fnut.2025.1664811","url":"https://doi.org/10.3389/fnut.2025.1664811","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Song 2025","excerpt":"BACKGROUND: Previous studies have demonstrated that intermittent fasting (IF) has garnered scientific attention and gained recognition for its beneficial effects on metabolic outcomes. However, the results are inconsistent. Accordingly, this systematic review and meta-analysis aimed to evaluate the effect of fasting on glycemic control, lipid profile, and inflammatory markers. METHODS: Databases such as PubMed, Embase, Cochrane, Scopus, and Web of Science were used to retrieve relevant studies published until September 2025. The quality of the included studies was evaluated using the Cochrane Risk-of-Bias 2 (RoB2) tool. Moreover, the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was employed to evaluate the quality of evidence. RESULTS: A total of 10 studies, involving 701 individuals, were included in the current meta-analysis. The combined effect of various types of fasting significantly reduced fasting blood sugar (FBS) [standard mean difference (SMD) = -0.51; 95% confidence interval (CI): -0.81, -0.20; p = 0.001], insulin (SMD = -0.27; 95% CI: -0.52, -0.03; p = 0."},{"id":"source_20","type":"source","study":"Effect of Epidemic Intermittent Fasting on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","year":2021,"doi":"10.3389/fnut.2021.669325","url":"https://doi.org/10.3389/fnut.2021.669325","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Yang 2021","excerpt":"Intermittent fasting (IF) has gained attention as a promising diet for weight loss and dysmetabolic diseases management. This systematic review aimed to investigate the effects of IF on cardiometabolic risk factors (CMRFs). A systematic literature search was carried out using three electronic databases, namely PubMed, Embase, and the Cochrane Library, until October 2020. Randomized controlled trials that compared the IF intervention with a control group diet were included. Fourteen effect sizes were expressed as weighted mean difference (WMD) using a fixed-effects model and 95% confidence intervals (CI). Compared to the ones within control groups, participants exposed to the IF intervention reduced their body weight (WMD, -1.78 kg; 95% CI, -2.21 to -1.35; p <0.05), waist circumference (WMD, -1.19 cm; 95% CI, -1.8 to -0.57; p <0.05), fat mass (WMD, -1.26 kg; 95% CI, -1.57 to -0.95; p <0.05), body mass index (WMD, -0.58 kg/m 2 ; 95% CI, -0.8 to -0.37; p <0.05), systolic blood pressure (WMD, -2.14 mmHg; 95% CI: -3.54 to -0.73; p <0.05), diastolic blood pressure (WMD: -1.38 mmHg, 95% CI, -2.35 to -0.41, p <0.05), fasting blood glucose (WMD: -0.053 mmol/L; 95% CI: -0.105 to 0.001; p <0."},{"id":"source_21","type":"source","study":"The impact of intermittent fasting during weight reduction in people living with type 2 diabetes mellitus: a randomized clinical trial","year":2026,"doi":"10.1038/s41430-025-01693-z","url":"https://doi.org/10.1038/s41430-025-01693-z","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Fattah 2026","excerpt":"OBJECTIVES: Intermittent fasting (IF) has gained attention for weight management and metabolic health, but detailed trials comparing its efficacy to calorie restriction (CR) in type 2 diabetes mellitus (T2D) are limited. Our aim was to compare the impact of CR diet with or without 12-hour overnight IF regimen on weight loss, glycemic control, and reduction of medication use in T2D. METHODS: This was a 3-month, single-center randomized clinical trial. Participants (N = 99), 21-60 years with T2D, were randomly assigned to Group 1 (12-hour IF + CR, N = 48) or Group 2 (CR alone, N = 51). Anthropometric evaluations included weight, height, waist and hip circumference, and BMI. Body composition analysis was performed, and biochemical analysis included HbA1c, FBG, and fasting insulin levels to calculate the HOMA-IR. Physical activity was assessed using the Global Physical Activity Questionnaire. RESULTS: Both groups experienced significant weight loss after 12 weeks. The IF + CR group showed a more pronounced weight reduction (-6.51%) compared to the CR group (-4.41%) (P < 0.001) and significant improvements in HbA1c levels, with a reduction to 6.51% compared to 6."},{"id":"source_22","type":"source","study":"Effect of Intermittent Fasting on Anthropometric Measurements, Metabolic Profile, and Hormones in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis","year":2025,"doi":"10.3390/nu17152436","url":"https://doi.org/10.3390/nu17152436","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ranneh 2025","excerpt":"BACKGROUND: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder characterized by excess body weight, hyperandrogenism, hyperglycemia, and insulin resistance often resulting in hirsutism and infertility. Dietary strategies have been shown to ameliorate metabolic disturbances, hormonal imbalances, and inflammation associated with PCOS. Recent evidence indicates that intermittent fasting (IF) could effectively enhance health outcomes and regulate circadian rhythm; however, its impact on PCOS remain unclear. OBJECTIVE: Therefore, this systematic review and meta-analysis aims to examine the effect of IF on women diagnosed with PCOS. METHODS: Comprehensive research was conducted across three major databases including PubMed, Scopus, and Web of Science without date restrictions. Meta-analysis was performed using Cochrane Review Manager Version 5.4 software. RESULTS: Five studies fulfilled the inclusion criteria. IF significantly reduced body weight (MD = -4.25 kg, 95% CI: -7.71, -0.79; p = 0.02), BMI (MD = -2.05 kg/m 2 , 95% CI: -3.26, -0.85; p = 0.0008), fasting blood glucose (FBG; MD = -2.86 mg/dL, 95% CI: -4.83, -0.89; p = 0.004), fasting blood insulin (FBI; MD = -3."},{"id":"source_23","type":"source","study":"Intermittent Fasting May Enhance Resistance Training Effects on the Body Composition of Obese Males, Without Affecting Muscular Strength and Anabolic Index","year":2026,"doi":"10.1155/jobe/6409069","url":"https://doi.org/10.1155/jobe/6409069","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khoshkebijari 2026","excerpt":"PURPOSE: This randomized controlled trial aimed to evaluate the impact of intermittent fasting (IF) during resistance training (RT) on body composition, muscular strength, and the testosterone:cortisol ratio in obese males. METHODS: Twenty obese males (aged 20-30, BMI 30-36 kg/m 2 ) were selected from eligible volunteers and randomly assigned to control (regular diet) and IF (4:3 IF) groups. All subjects participated in RT 3 days/week for 8 weeks. Forty-eight hours before and after the protocol, blood sampling and anthropometric measurements were done in a fasting state, and data were analyzed at a significance level of p < 0.05. RESULTS: The IF/RT group lost twofold more weight and fat, had higher arm and chest measurements, and had less waist circumference than the C/RT group. The testosterone levels and muscle strength improved with RT, and there was no difference between the C/RT and IF/RT groups. CONCLUSION: It appears that intermittent fasting may enhance the efficacy of RT in obese males and is unlikely to have any detrimental effects on muscular strength or the anabolic index. Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20190213042702N4."},{"id":"source_24","type":"source","study":"The effects of intermittent fasting on BMI, fasting blood glucose, and blood pressure in women with overweight or obesity: a systematic review and meta-analysis with dose–response relationships","year":2026,"doi":"10.3389/fnut.2026.1818813","url":"https://doi.org/10.3389/fnut.2026.1818813","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"He 2026","excerpt":"OBJECTIVE: This study aimed to assess the effects of intermittent fasting (IF) on prespecified clinically relevant outcomes, including BMI, fasting blood glucose (FBG), and blood pressure, in women with overweight or obesity, and to explore the dose-response relationship and moderating factors of the intervention. METHODS: Following PRISMA guidelines, we systematically searched PubMed, Web of Science, PsycINFO, and the Cochrane Library (up to August 1, 2025) for eligible randomized controlled trials (RCTs). Twenty-two studies involving 1,287 women with overweight or obesity were included. Mean differences (MD) were pooled using a restricted maximum likelihood random-effects model (REML). Heterogeneity was evaluated via I 2 and Q tests, while publication bias was assessed using sensitivity analyses, Egger's regression, and the trim-and-fill method. Subgroup analyses, meta-regression, and nonlinear dose-response models were used to identify moderators. RESULTS: IF significantly reduced BMI in the final BMI model after exclusion of one influential study (MD = -0.41, 95% CI: -0.81 to-0.02, P = 0.0396) and FBG (MD = -2.18, 95% CI:-3.20 to-1.16, P < 0."},{"id":"source_25","type":"source","study":"Optimal dosage of exercise combined with intermittent fasting for body composition and cardiometabolic health in adults: a systematic review and multilevel meta-analysis","year":2026,"doi":"10.3389/fnut.2026.1772836","url":"https://doi.org/10.3389/fnut.2026.1772836","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Jiao 2026","excerpt":"PURPOSE: This meta-analysis evaluated the effects of exercise combined with intermittent fasting (EX + IF) on body composition, cardiometabolic health, and muscle performance in adults and examined potential moderators. (2) PubMed, Web of Science, Embase, and the Cochrane Library were searched, and reference lists of eligible studies were screened. Effect sizes were calculated as Hedges' g . A three-level random-effects model was fitted using the metafor package in R, with moderation and meta-regression analyses conducted to identify influential factors. RESULTS: Sixty-five randomized controlled trials (RCTs) including 3,293 participants (18-75 years) were included; 42% were overweight/obese and 11% were trained individuals. Compared with control conditions (exercise alone, intermittent fasting alone, or neither), EX + IF significantly reduced body mass, body mass index, body fat percentage, fat mass, waist circumference, and visceral fat, with no significant effects on fat-free mass or lean body mass."},{"id":"source_26","type":"source","study":"Comprehensive impact of Intermittent Hypoxia Training and Intermittent Fasting on metabolic and cognitive health in adults with obesity: an umbrella systematic review and meta-analysis","year":2025,"doi":"10.3389/fnut.2025.1664600","url":"https://doi.org/10.3389/fnut.2025.1664600","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Guo 2025","excerpt":"BACKGROUND: Obesity has emerged as a global health crisis, posing significant challenges to metabolic function and cognitive health. It is associated with insulin resistance, elevated triglycerides, and reduced HDL cholesterol levels. Cognitive decline in obesity involves multifactorial pathways including neuroinflammation, vascular dysfunction, and blood-brain barrier disruption. Intermittent Hypoxia Training (IHT) and Intermittent Fasting (IF) have shown promise as non-pharmacological interventions for these obesity-related issues. OBJECTIVES: This systematic review and meta-analysis aim to evaluate the effects of IHT, IF, and their combination on metabolic markers (insulin sensitivity, lipid profiles, glucose levels) and specific cognitive domains (memory, executive function, attention) and cognitive function in obese adults. METHODS: The analysis encompassed studies published from October 2014 onward, sourced from PubMed, Web of Science, Scopus, and other relevant databases. The inclusion criteria were randomized controlled trials and non-randomized comparative studies focusing on IHT, IF, or their combination."},{"id":"source_27","type":"source","study":"Effects of 4:3 Intermittent Fasting on Eating Behaviors and Appetite Hormones: A Secondary Analysis of a 12-Month Behavioral Weight Loss Intervention","year":2025,"doi":"10.3390/nu17142385","url":"https://doi.org/10.3390/nu17142385","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Breit 2025","excerpt":"BACKGROUND/OBJECTIVES: Daily caloric restriction (DCR) is a common dietary weight loss strategy, but leads to metabolic and behavioral adaptations, including maladaptive eating behaviors and dysregulated appetite. Intermittent fasting (IMF) may mitigate these effects by offering diet flexibility during energy restriction. This secondary analysis compared changes in eating behaviors and appetite-related hormones between 4:3 intermittent fasting (4:3 IMF) and DCR and examined their association with weight loss over 12 months. METHODS: Adults with overweight or obesity were randomized to 4:3 IMF or DCR for 12 months. Both randomized groups received a matched targeted weekly dietary energy deficit (34%), comprehensive group-based behavioral support, and a prescription to increase moderate-intensity aerobic activity to 300 min/week. Eating behaviors were assessed using validated questionnaires at baseline and months 3, 6, and 12. Fasting levels of leptin, ghrelin, peptide YY, brain-derived neurotrophic factor, and adiponectin were measured at baseline and months 6 and 12. Linear mixed models and Pearson correlations were used to evaluate outcomes."},{"id":"source_28","type":"source","study":"The Effectiveness of Time-Restricted Eating as an Intermittent Fasting Approach on Shift Workers’ Glucose Metabolism: A Systematic Review and Meta-Analysis","year":2025,"doi":"10.3390/nu17101689","url":"https://doi.org/10.3390/nu17101689","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Koh 2025","excerpt":"Background/Objectives : Shift workers face higher risks of impaired glucose metabolism due to irregular eating habits and circadian misalignment. Time-restricted eating (TRE) could improve glucose metabolism by aligning food intake with the circadian clock, but its effectiveness remains unclear. Methods : Ten electronic databases (PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Scopus, Web of Science, ProQuest Dissertations and Theses, Science.gov, and ClinicalTrials.gov) were searched from journal inception to September 2024. Only randomized controlled trials (RCTs) involving shift workers were included. Meta-analyses with sensitivity analyses were conducted using a random-effects model to pool glucose metabolism and sleep outcomes, with heterogeneity and quality assessments performed. Results : Six RCTs were included. TRE demonstrated positive but non-significant effects on glucose metabolism outcomes: fasting blood glucose (weighted mean difference [WMD]: -0.02 mmol/L, 95% confidence interval [CI]: -0.13 to 0.10, I 2 = 0%), fasting blood insulin (WMD: -5.77 pmol/L, 95% CI: -85.62 to 74.08, I 2 = 92%), HOMA-IR (WMD: -0.50, 95% CI: -2.76 to 1."},{"id":"source_29","type":"source","study":"The Effects of Intermittent Fasting and Continuous Energy Restriction with Exercise on Cardiometabolic Biomarkers, Dietary Compliance, and Perceived Hunger and Mood: Secondary Outcomes of a Randomised, Controlled Trial","year":2022,"doi":"10.3390/nu14153071","url":"https://doi.org/10.3390/nu14153071","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Keenan 2022","excerpt":"(1) Background: Excess weight in the form of adiposity plays a key role in the pathogenesis of cardiometabolic diseases. Lifestyle modifications that incorporate continuous energy restriction (CER) are effective at inducing weight loss and reductions in adiposity; however, prescribing daily CER results in poor long-term adherence. Over the past decade, intermittent fasting (IF) has emerged as a promising alternative to CER that may promote increased compliance and/or improvements in cardiometabolic health parameters independent of weight loss. (2) Methods: This paper presents a secondary analysis of data from a 12-week intervention investigating the effects of a twice-weekly fast (5:2 IF; IFT group) and CER (CERT group) when combined with resistance exercise in 34 healthy participants (17 males and 17 females, mean BMI: 27.0 kg/m2, mean age: 23.9 years). Specifically, changes in cardiometabolic blood markers and ratings of hunger, mood, energy and compliance within and between groups were analysed. Dietary prescriptions were hypoenergetic and matched for energy and protein intake. (3) Results: Both dietary groups experienced reductions in total cholesterol (TC; mean reduction, 7."},{"id":"source_30","type":"source","study":"The effects of intermittent fasting on anthropometric indices, glycemic profile, chemotherapy-related toxicity, and subjective perception in gynecological and breast cancer patients: a systematic review and meta-analysis","year":2025,"doi":"10.1186/s12885-025-13806-9","url":"https://doi.org/10.1186/s12885-025-13806-9","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Liu 2025","excerpt":"BACKGROUND: Mounting evidence supports the health benefits of intermittent fasting (IF) in general. This study evaluates its impact on patients with gynecological or breast cancer specifically. METHODS: A thorough search for studies comparing IF with either nonintervention diets or calorie restriction (CR) in patients with either gynecological or breast cancer and published prior to October 5, 2024 was carried out on the PubMed, Web of Science, Cochrane Library, Scopus, Embase, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature databases (CBM). Extracted data included but not limited to body mass index (BMI), body weight, waist circumference (WC), fasting glucose, insulin levels, chemotherapy-related toxicity, and subjective perceptions. RESULTS: A total of 625 subjects were included across 7 randomized controlled trials, and 2 nonrandomized trials. Meta-analysis revealed that IF significantly reduced body weight (Effect Size [ES]: -0.611; 95% Confidence Interval [CI]: -0.886 to -0.356; p < 0.001; I² = 0%), blood glucose levels (standardized mean difference [SMD]: -0.347 mmol/L; 95% CI: -0.533 to -0.140; p < 0."},{"id":"source_31","type":"source","study":"Safety and efficacy of intermittent fasting with or without exercise in people living with overweight or obesity and type 2 diabetes—The INTERFAST ‐3 study design","year":2026,"doi":"10.1111/dme.70328","url":"https://doi.org/10.1111/dme.70328","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Sourij 2026","excerpt":"AIMS: Lifestyle modification, including caloric restriction and exercise, is fundamental in the treatment of people living with overweight and type 2 diabetes mellitus (T2D). The overall aim of lifestyle intervention schemes is to reduce body weight and improve glycaemic control to reduce the future risk of diabetes-associated complications. The aim of this study is to determine whether intermittent energy restriction, exercise or their combination is best suited for reaching these targets in individuals with T2D not treated with insulin. METHODS: This randomized, controlled, monocentric parallel-group trial is designed to investigate participants living with T2D, body mass index >27 kg/m 2 , HbA1c ≥53 mmol/mol (≥7.0%) and ≤86 mmol/mol (≤10.0%) and without insulin therapy. Participants are equally and randomly allocated to one of four study groups: (1) intermittent energy restriction group, (2) exercise group, (3) combined intermittent energy restriction and exercise group and (4) control group. The intervention phase lasts 12 weeks, followed by a two-year follow-up phase."},{"id":"source_32","type":"source","study":"Efficacy of Intermittent Fasting in the Management of Chronic Plaque Psoriasis: A Phase IIb Clinical Trial","year":2025,"doi":"10.4103/idoj.idoj_635_24","url":"https://doi.org/10.4103/idoj.idoj_635_24","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Neema 2025","excerpt":"BACKGROUND: Dietary measures have been used as an adjunctive therapy in the management of psoriasis. Intermittent fasting (IF) is an eating pattern in which energy is not consumed for a fixed duration, resulting in metabolic switch from liver-derived glucose to adipose-derived ketones. The data regarding effectiveness of IF in psoriasis are limited. AIM AND OBJECTIVES: The aim of this study was to assess efficacy of IF in patients with chronic plaque psoriasis. The primary outcome of the study was change in psoriasis severity as measured by psoriasis area and severity index (PASI) at 28 weeks. The secondary outcome measures were change in metabolic parameters and biomarkers for atherosclerosis in each group. PATIENTS AND METHODS: The study was designed as a randomized parallel group trial. Clinical parameters, psoriasis severity, fasting and postprandial blood sugar, lipid profile, high sensitivity C-reactive protein (hsCRP), vascular endothelial growth factor (VEGF), and interleukin 6 (IL-6), were measured using standard methods at baseline, 16 weeks, and 28 weeks. Patients were randomized to receive methotrexate in the dose of 0.3 mg/Kg/week with or without intermittent fasting."},{"id":"source_33","type":"source","study":"Effects of intermittent fasting on HbA1c and weight in insulin versus oral hypoglycemic therapy-treated patients with type 2 diabetes mellitus: a systematic review and meta-analysis","year":2026,"doi":"10.3389/fnut.2026.1699384","url":"https://doi.org/10.3389/fnut.2026.1699384","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Qudah 2026","excerpt":"AIM: Intermittent fasting (IF) has emerged as a beneficial dietary strategy for managing type 2 diabetes mellitus (T2DM), with improvements in certain indicators of body composition and cardiometabolic health. However, limited research compares the different effects of IF in oral hypoglycemic agents (OHAs) versus insulin-treated patients. METHODS: A comprehensive search was performed across PubMed, Scopus, and Cochrane Library (January 2010-January 2025). Randomized controlled trials (RCTs) involving adults (>18-years) with T2DM undergoing IF, time-restricted feeding (TRF), alternate-day fasting (ARF), fasting-mimicking diets (FMD), and Ramadan fasting were included. RESULTS: In total, 12 studies ( n = 1,441 participants) met the inclusion criteria. IF improved glycemic control in both groups, with HbA1c reductions of 0.54% in OHA-users and 2.8% in insulin-users. In the meta-analysis of four eligible trials ( n = 280), IF produced a significant pooled reduction in HbA1c (-1.85, 95% CI: -2.86 to -0.84), despite substantial heterogeneity (I 2 = 98.1%). In contrast, IF did not produce a significant change in body weight (-1.45 kg, 95% CI: -5.51 to 2.61; I 2 = 96.7%)."},{"id":"source_34","type":"source","study":"Vitamin D supplementation and its impact on leptin and interleukin-6 in women following religious intermittent fasting: a controlled study","year":2025,"doi":"10.3389/fendo.2025.1700844","url":"https://doi.org/10.3389/fendo.2025.1700844","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Karras 2025","excerpt":"BACKGROUND: Vitamin D deficiency is highly prevalent in populations following intermittent or religious fasting, particularly Orthodox nuns with limited sun exposure and dietary restrictions. Vitamin D may modulate adipokines and inflammatory markers, but clinical evidence remains inconsistent. OBJECTIVE: To investigate the effects of vitamin D supplementation on interleukin-6 (IL-6) and leptin concentrations in Orthodox nuns compared with non-supplemented controls. METHODS: In this controlled, non-randomized trial, 33 Orthodox nuns received oral vitamin D 3 supplementation (2,500 IU/day) for 16 weeks, while 42 age-matched women following Orthodox intermittent fasting served as controls. Anthropometric indices and serum concentrations of 25-hydroxyvitamin D [25(OH)D], IL-6, leptin, parathyroid hormone, insulin, and C-reactive protein were measured at baseline and follow-up. RESULTS: At baseline, serum 25(OH)D concentrations were lower in the supplementation group compared with controls (23.4 ± 10.1 vs . 27.7 ± 11.2 ng/mL, p = 0.043). After 16 weeks, 25(OH)D increased significantly in the supplementation group (23.4 ± 10.1 vs . 33.9 ± 11.0 ng/mL, p < 0."},{"id":"source_35","type":"source","study":"Evaluation of Mobile Intermittent Fasting Applications in Chinese App Stores: Quality Evaluations and Content Analysis","year":2025,"doi":"10.2196/66339","url":"https://doi.org/10.2196/66339","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Fang 2025","excerpt":"BACKGROUND: Obesity and related disorders are rising globally, especially in China, where they are linked to chronic diseases like diabetes and cardiovascular issues. As intermittent fasting (IF) gains popularity for weight management, the use of IF apps has increased, yet their quality varies significantly. A systematic evaluation of these apps is essential to assess their effectiveness and reliability. OBJECTIVE: This study aimed to conduct a comprehensive evaluation of IF apps available in the Chinese mobile app market. We concentrated on evaluating their features, quality, and overall user experience to help users avoid low-quality options and direct app developers to enhance their offers. METHODS: A systematic search was performed across 5 major app stores in China, including the Apple App Store, Huawei AppGallery, Oppo Software Store, Vivo App Store, and Xiaomi Market. \"Fasting\", \"Intermittent Fasting\", \"Time-Restricted Feeding\", \"Time-Restricted Fasting\", \"Time-Restricted Eating\" and \"Meal Skipping\" were used as keywords to identify relevant apps, which were then screened based on inclusion and exclusion criteria."},{"id":"source_36","type":"source","study":"Intermittent Fasting Protects Against the Progression from Acute Kidney Injury to Chronic Kidney Disease","year":2025,"doi":"10.3390/antiox14010119","url":"https://doi.org/10.3390/antiox14010119","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Jang 2025","excerpt":"Acute kidney injury (AKI) is a major but often underestimated risk factor for the development of chronic kidney disease (CKD). Exploring innovative approaches to prevent this progression is critical. Intermittent fasting (IF), recognized for its metabolic and anti-inflammatory benefits, may offer protective effects in this context. Using a unilateral ischemia-reperfusion injury (UIRI) model in male C57BL/6 mice, we evaluated the impact of IF on tubulointerstitial fibrosis and tubular epithelial-mesenchymal transition (EMT) over 8 weeks. Mice in the IF group followed a 5:2 regimen, fasting for 24 h twice weekly. Four groups were studied: control, IF, UIRI, and IF + UIRI. The UIRI group exhibited increased fibrosis and EMT, both of which were significantly attenuated in the IF + UIRI group. IF also reduced levels of TGF-β1, phosphorylated NF-κB p65, inflammatory cytokines, and F4/80-positive macrophages, along with markers of oxidative stress. These findings highlight IF's ability to mitigate fibrosis and EMT through reductions in inflammation and oxidative stress during AKI-to-CKD progression."},{"id":"source_37","type":"source","study":"Conversion Bariatric Surgery, Ketogenic Diet, and Intermittent Fasting in Bariatric Surgery Patients with Recurrent Weight Gain: a Prospective Randomized Controlled Trial","year":2026,"doi":"10.1007/s11695-026-08654-w","url":"https://doi.org/10.1007/s11695-026-08654-w","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Sen 2026","excerpt":"BACKGROUND: Recurrent weight gain (RWG) after metabolic and bariatric surgery (MBS) increases the need for alternative treatment strategies. This study evaluated the effects of conversion bariatric surgery (CBS), very low-calorie ketogenic diet (VLCKD), and time-restricted intermittent fasting (TRIF) on anthropometric measurements, biochemical parameters, and dietary habits in patients who experienced suboptimal clinical response (SCR) or RWG after bariatric surgery. METHODS: This study included 56 patients, allocated to four groups (CBS, VLCKD, TRIF, and control; n = 14 each). Weight, waist-hip measurements, body composition, glycemic/lipid profile, and serum levels of specific vitamins and minerals were assessed at baseline and at week 6. Energy and nutrient intakes were calculated using BeBiS-9. RESULTS: Data were analyzed with SPSS 22.0. The percentages of total and excess weight loss differed significantly among the groups (p < 0.001), with CBS (9.07–28.5%), VLCKD (9.12–31.85%), TRIF (5.09–14.97%), and control (0.97–3.40%)."},{"id":"source_38","type":"source","study":"Effects of Intermittent Fasting on Male and Female Reproductive Hormones, Fertility, and Sexual Function: A Comprehensive Review with Emphasis on the Existing Evidence Gap in Women","year":2026,"doi":"10.3390/nu18111817","url":"https://doi.org/10.3390/nu18111817","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Vignera 2026","excerpt":"Intermittent fasting (IF) has emerged as a popular dietary intervention with potential metabolic and endocrine benefits. However, its effects on sexual function and reproductive health remain incompletely understood. This comprehensive review synthesizes current evidence from human clinical trials and animal studies examining the impact of various IF protocols-including time-restricted eating (TRE), alternate-day fasting (ADF), and Ramadan fasting-on male and female sexual function, reproductive hormones, and fertility outcomes. In males, limited human data suggest preserved erectile function but reduced sexual desire during Ramadan fasting, with neutral effects on testosterone in obese adults undergoing TRE. Animal studies demonstrate context-dependent effects, with IF protecting against high-fat diet-induced reproductive dysfunction while potentially impairing spermatogenesis under prolonged energy restriction. In females, IF shows promise for improving hyperandrogenism and menstrual regularity in polycystic ovary syndrome (PCOS), mediated by enhanced insulin sensitivity and reduced free androgen index."},{"id":"source_39","type":"source","study":"The Effects of Intermittent Fasting on Inflammatory Markers in Adults: A Systematic Review and Pairwise and Network Meta-Analyses","year":2025,"doi":"10.3390/nu17152388","url":"https://doi.org/10.3390/nu17152388","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Khalafi 2025a","excerpt":"Background: Intermittent fasting (IF) can improve inflammatory status, but its effects may be dependent on the mode of fasting. Objectives: We performed a systematic review with pairwise and network meta-analyses to investigate the effects of different modes of IF on inflammatory markers in adults. Methods: Three database searches were conducted, including PubMed, Scopus, and Web of Science, from inception to June 2024. The searches used two keyword groups: \"intermittent fasting\" and \"inflammatory markers\". Randomized and non-randomized trials investigating any IF mode on inflammatory markers, including interleukin (IL)-6, tumor necrosis factor (TNF)α, C-reactive protein (CRP), leptin, and adiponectin, were included. Standardized mean differences (SMDs) were calculated using random effects models for both analyses. Results: A total of 21 studies (839 participants) were included. Compared with controls, IF reduced TNF-α [SMD: -0.31, p = 0.009], CRP [SMD: -0.19, p = 0.04], and leptin [SMD: -0.57, p = 0.005] but did not significantly affect IL-6 or adiponectin. Among the IF modes, time-restricted feeding (TRF) showed the largest reduction in TNF-α [-0.39, p = 0.001]."},{"id":"source_40","type":"source","study":"Stable cognitive performance while adapting to intermittent fasting: A randomised controlled trial","year":2025,"doi":"10.1177/13591053251351204","url":"https://doi.org/10.1177/13591053251351204","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Bamberg 2025","excerpt":"Intermittent fasting (IF) is a popular health regimen for weight loss and overall health. Yet, potential negative side effects on cognition and mood could hinder its adoption. Such side effects, however, have so far only been studied in short term exposures to IF. We tested whether fasting impairs cognitive performance and mood when adapting to 16-hour, breakfast-skipping IF over 10 days in a randomised, waitlist-controlled trial ( N = 122). Cognitive performance was repeatedly assessed online via standardised psychological tasks and subjective concentration and mood measured twice daily via smartphone questionnaires. Bayesian multi-level modelling revealed that fasting participants did not have lower cognitive performance or mood compared to control participants. However, participants felt less concentrated while fasting before noon, compared to after breaking the fast in the afternoon. Thus, 16-hour IF does not cause cognitive performance or mood deficits, removing a potential concern in its use as a health intervention."},{"id":"source_41","type":"source","study":"Hepatic lipidomics analysis reveals the anti-obesity effects of insoluble dietary fiber from okara combined with intermittent fasting treatment in high-fat diet-fed mice","year":2025,"doi":"10.3389/fnut.2025.1549105","url":"https://doi.org/10.3389/fnut.2025.1549105","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"mechanistic","cited_as":"Zhao 2025","excerpt":"INTRODUCTION: Emerging evidence has revealed that supplementation with insoluble dietary fiber (IDF) improves lipid metabolic disorders caused by a high-fat diet (HFD). Except for dietary supplementation, intermittent fasting (IF) has received widespread attention as a new dietary strategy against obesity. We hypothesized that IDF combined with IF treatment may synergistically alleviate HFD-induced lipid metabolic imbalance. METHODS: This study integrated biochemical analysis with hepatic lipidomics to explore lipid biomarkers and potential mechanisms associated with the anti-obesity effects of IDF combined with IF treatment. RESULTS AND DISCUSSION: The results indicated that IDF combined with IF treatment improved metabolic parameters associated with the obesity phenotype. Lipidomics analysis revealed that IDF combined with IF treatment altered hepatic lipid metabolic patterns in HFD-fed mice. Moreover, 15 differentially regulated lipid species were identified as lipid biomarkers. Moreover, the expression of lipogenesis-, lipid oxidation-, and cholesterol metabolism-related genes was also regulated."},{"id":"source_42","type":"source","study":"Intermittent Fasting During Pregnancy and Neonatal Birth Weight: A Systematic Review and Meta-Analysis","year":2025,"doi":"10.3390/nu17223546","url":"https://doi.org/10.3390/nu17223546","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Giorno 2025","excerpt":"Background/Objectives: Intermittent fasting (IF), such as Ramadan fasting, is common among pregnant women despite religious exemptions. The possible impact of fasting on pregnancy outcome and, in particular, on birthweight is uncertain and was documented with conflicting evidence. Methods: The aim of this meta-analysis and systematic review was to investigate the association between intermittent fasting during pregnancy and neonatal birthweight, along with low birthweight (LBW, <2500 g) risk. Studies evaluating fasting during pregnancy with reported neonatal outcomes were included. We searched (PubMed, Scopus, Web of Science) from 2004 through June 2025. All contributing studies were observational in design; no randomized trials were identified. The risk of bias was assessed using the Newcastle-Ottawa Scale. The pooled relative risks (RR) and mean differences (MD) were calculated according to random-effects models (DerSimonian-Laird method) and heterogeneity was quantified with the I 2 statistic. Results: Nineteen studies, all observational in design, were included for qualitative synthesis, and six studies yielded quantitative data to conduct meta-analyses."},{"id":"source_43","type":"source","study":"The impact of intermittent fasting on body composition and cardiometabolic outcomes in overweight and obese adults: a systematic review and meta-analysis of randomized controlled trials","year":2025,"doi":"10.1186/s12937-025-01178-6","url":"https://doi.org/10.1186/s12937-025-01178-6","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Wang 2025","excerpt":"BACKGROUND: Obesity is a global health crisis, projected to affect over 1.53 billion adults by 2035. Intermittent fasting (IF) has emerged as a potential alternative to continuous energy restriction (CER) for weight management and metabolic improvement. However, previous meta-analyses have reported inconsistent results. These knowledge gaps hinder the clinical translation of IF, and a rigorous synthesis of randomized controlled trials (RCTs) is necessary to clarify their effects on body composition and cardiometabolic health in overweight and obese populations. METHODS: This PRISMA-guided systematic review and meta-analysis searched PubMed, Embase, and Web of Science up to March 2025. We included 15 randomized controlled trials (n = 758) comparing IF diets with control diets in overweight/obese adults. Primary outcome indicators included total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), fasting plasma glucose (FPG), hemoglobin A1C (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), body weight (BW), body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR)."},{"id":"source_44","type":"source","study":"Intermittent Fasting Regimes Reduce Gingival Inflammation: A Three‐Arm Clinical Trial","year":2025,"doi":"10.1111/jcpe.14151","url":"https://doi.org/10.1111/jcpe.14151","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Pappe 2025","excerpt":"AIM: To evaluate the effect of religious Bahá'í dry fasting (BF) or 16:8 time-restricted eating (TRE) compared with a regular diet (CG) on periodontal parameters during a modified experimentally induced gingivitis. MATERIAL AND METHODS: All participants were asked to refrain from oral hygiene (3 sextant) for 9 days (T1-T2) and were followed for a total of 19 days (T3) while adhering to fasting or a regular diet and resuming oral hygiene. The primary outcome was bleeding on probing in the test sextant (BOP_s), Rustogi plaque index (RPI), gingival crevicular fluid (GCF), blood pressure (BP), body weight (BW), HbA1c and C-reactive protein (CRP) were measured (T1-T3) and ANCOVA and post hoc comparison were applied. RESULTS: Sixty-six healthy participants were recruited. Forty-three were randomly assigned to TRE (n = 22) and CG (n = 21), while 23 followed BF, avoiding food and drinks during the day. At T2, BF demonstrated significantly less increase in BOP_s, and GCF increased in CG only. Analysis revealed significant differences in change for BOP_s between BF and CG (-9.48% [-17.18; -1.79]) and BF and TRE (-9.19% [-15.07; -3.32]) as well as for GCF between BF and CG (-0.06 μL [-7."},{"id":"source_45","type":"source","study":"Impact of intermittent fasting on sleep physiology: A prospective observational study using smartwatch technology","year":2025,"doi":"10.1097/MD.0000000000043800","url":"https://doi.org/10.1097/MD.0000000000043800","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Struven 2025","excerpt":"Time-restricted eating (TRE) following a 16:8 pattern is a popular form of intermittent fasting with established metabolic benefits. However, its impact on sleep and physical activity remains unclear, particularly when assessed using wearable technologies. This study investigated the short-term effects of TRE on sleep physiology and activity levels by using a commercially available smartwatch. In this prospective observational study, 35 healthy adults (mean age, 30 years; 66% female) completed a 3-day baseline phase, followed by 7 days of a 16:8 TRE regimen. Objective data on sleep, heart rate, and activity were continuously recorded using Withings ScanWatch. Subjective sleep quality, including the Pittsburgh Sleep Quality Index, was assessed pre- and postintervention. Statistical analyses were performed using paired t tests. No significant changes were observed in total sleep duration, light or deep sleep, sleep latency, or nocturnal awakenings between baseline and fasting periods. The daily step count, energy expenditure, and heart rate parameters remained stable."},{"id":"source_46","type":"source","study":"The effects of intermittent fasting on body composition and cardiometabolic health in adults with prediabetes or type 2 diabetes: A systematic review and meta-analysis.","year":2024,"doi":"10.1111/dom.15730","url":"https://doi.org/10.1111/dom.15730","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Khalafi 2024b","excerpt":"AIM: To perform a meta-analysis to investigate the effects of intermittent fasting (IF), as compared with either a control diet (CON) and/or calorie restriction (CR), on body composition and cardiometabolic health in individuals with prediabetes and type 2 diabetes (T2D). METHODS: PubMed, Web of Science, and Scopus were searched from their inception to March 2024 to identify original randomized trials with parallel or crossover designs that studied the effects of IF on body composition and cardiometabolic health. Weighted mean differences (WMDs) or standardized mean differences with 95% confidence intervals (CIs) were calculated using random-effects models. RESULTS: Overall, 14 studies involving 1101 adults with prediabetes or T2D were included in the meta-analysis. IF decreased body weight (WMD -4.56 kg [95% CI -6.23 to -2.83]; p = 0.001), body mass index (BMI; WMD -1.99 kg.m 2 [95% CI -2.74 to -1.23]; p = 0.001), glycated haemoglobin (HbA1c; WMD -0.81% [95% CI -1.24 to -0.38]; p = 0.001), fasting glucose (WMD -0.36 mmol/L [95% CI -0.63 to -0.09]; p = 0.008), total cholesterol (WMD -0.31 mmol/L [95% CI -0.60 to -0.02]; p = 0.03) and triglycerides (WMD -0.14 mmol/L [95% CI -0."},{"id":"source_47","type":"source","study":"Effect of Carbohydrate-Restricted Diets and Intermittent Fasting on Obesity, Type 2 Diabetes Mellitus, and Hypertension Management: Consensus Statement of the Korean Society for the Study of Obesity, Korean Diabetes Association, and Korean Society of Hypertension","year":2022,"doi":"10.4093/dmj.2022.0038","url":"https://doi.org/10.4093/dmj.2022.0038","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Choi 2022","excerpt":"Carbohydrate-restricted diets and intermittent fasting (IF) have been rapidly gaining interest among the general population and patients with cardiometabolic disease, such as overweight or obesity, diabetes, and hypertension. However, there are limited expert recommendations for these dietary regimens. This study aimed to evaluate the level of scientific evidence on the benefits and harms of carbohydrate-restricted diets and IF to make responsible recommendations. A meta-analysis and systematic literature review of 66 articles on 50 randomized controlled trials (RCTs) of carbohydrate-restricted diets and 10 articles on eight RCTs of IF was performed. Based on the analysis, the following recommendations are suggested. In adults with overweight or obesity, a moderately-low carbohydrate or low carbohydrate diet (mLCD) can be considered as a dietary regimen for weight reduction. In adults with type 2 diabetes mellitus, mLCD can be considered as a dietary regimen for improving glycemic control and reducing body weight. In contrast, a very-low carbohydrate diet (VLCD) and IF are recommended against in patients with diabetes."},{"id":"source_48","type":"source","study":"Effects of intermittent fasting combined with physical exercise on cardiometabolic outcomes: systematic review and meta-analysis of clinical studies.","year":2024,"doi":"10.1093/nutrit/nuad155","url":"https://doi.org/10.1093/nutrit/nuad155","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kazeminasab 2024","excerpt":"CONTEXT: Different intermittent fasting (IF) protocols have been proven to be efficient in improving cardiometabolic markers, but further research is needed to examine whether or not combining IF regimens plus physical exercise is superior to control diets (ie, nonfasting eating) plus physical exercise in this setting. OBJECTIVE: The aim of this study was to determine whether or not combining IF plus exercise interventions is more favorable than a control diet plus exercise for improving cardiometabolic health outcomes. DATA SOURCE: PubMed, Scopus, and Web of Science were comprehensively searched until April 2023. DATA EXTRACTION: Electronic databases were searched for clinical trials that determined the effect of IF plus exercise vs a control diet plus exercise on body weight, lipid profile (high-density lipoprotein [HDL], low-density lipoprotein [LDL], triglycerides, and total cholesterol), and systolic and diastolic blood pressure (SBP and DBP, respectively). Analyses were conducted for IF plus exercise vs a nonfasting diet plus exercise to calculate weighted mean differences (WMDs)."},{"id":"source_49","type":"source","study":"Effect of intermittent fasting on obesity and metabolic indices in patients with metabolic syndrome: a systematic review and meta analysis","year":2025,"doi":"10.1186/s12902-025-01952-x","url":"https://doi.org/10.1186/s12902-025-01952-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Zhang 2025","excerpt":"OBJECTIVE: Dietary patterns play a vital role in the health management of individuals with metabolic syndrome. Many recent studies have shown that intermittent fasting (IF) has better effects, such as improving obesity. Nevertheless, it warrants further investigation to determine which approach is more effective in comparison to continuous energy restriction (CR), particularly when total calorie intake shows minimal variation. Consequently, it is crucial to evaluate the degree of enhancement of the two dietary patterns concerning different aspects of metabolic syndrome. This study presents a meta-analysis of randomized controlled trials (RCTs) aimed at comparing the impacts of IF and CR on obesity and glucolipid metabolism in individuals diagnosed with metabolic syndrome. METHODS: In August 2024, a thorough examination of English-language literature was performed across the PubMed, Medline, Embase, and Cochrane Library databases. The meta-analyses was performed according to the established guidelines and reported the results."},{"id":"source_50","type":"source","study":"Intermittent fasting for rheumatic diseases: a systematic review and meta-analysis of conflicting evidence from observational studies and randomized controlled trials","year":2026,"doi":"10.7717/peerj.21185","url":"https://doi.org/10.7717/peerj.21185","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Liu 2026","excerpt":"BACKGROUND AND OBJECTIVES: Intermittent fasting (IF) has emerged as a dietary approach with potential therapeutic effects that is gaining recognition. Although several studies have explored the impact of IF on clinical symptoms in patients with rheumatic diseases, a quantitative synthesis of the existing evidence is lacking. This study aims to systematically evaluate the overall effects of IF on disease activity and inflammatory markers in patients with rheumatic diseases. METHODS: A systematic search was conducted in PubMed, Web of Science, Embase, and The Cochrane Library for clinical studies examining intermittent fasting interventions in rheumatic diseases, with a search deadline of March 15, 2026. RevMan 5.4 software was utilized to perform a meta-analysis on the studies that met the inclusion criteria. RESULTS: A total of seven independent studies (yielding nine datasets) were included in the analysis, comprising 471 patients with rheumatoid arthritis (RA) and 85 patients with spondyloarthritis (SpA)."},{"id":"source_51","type":"source","study":"Influence of Intermittent Fasting on Body Composition, Physical Performance, and the Orexinergic System in Postmenopausal Women: A Pilot Study","year":2025,"doi":"10.3390/nu17071121","url":"https://doi.org/10.3390/nu17071121","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Valenzano 2025","excerpt":"Objective : This study aims to evaluate the effects of different nutritional strategies, specifically intermittent fasting (IF) combined with high-intensity interval training (HIIT) versus a low-calorie diet (LCD), on body composition, physical performance, and the orexinergic system in postmenopausal women. Methods : A randomized controlled trial involving thirty postmenopausal women (mean age 57.50 ± 6.50 years) was conducted over eight weeks, comparing the two dietary approaches alongside an 8-week HIIT program. Body composition was assessed using bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DEXA). Performance metrics included handgrip strength and the 6-min walking test (6MWT). Salivary samples were analyzed for Orexin-A (OX-A) levels pre- and post-intervention. Results : Significant improvements in health metrics, such as heart rate (HR) and endurance, were found, with mean HR changes showing a significant difference (F = 5.943, p = 0.033) between the groups at T1. Orexin-A levels reflected significant metabolic regulation shifts in relation to other variables, showing a change from baseline to post-intervention values at T1 (F = 10,931, p = 0."},{"id":"source_52","type":"source","study":"The effects of intermittent fasting diet on quality of life, clinical symptoms, inflammation, and oxidative stress in overweight and obese postmenopausal women with rheumatoid arthritis: study protocol of a randomized controlled trial","year":2024,"doi":"10.1186/s13063-024-07977-2","url":"https://doi.org/10.1186/s13063-024-07977-2","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Ranjbar 2024","excerpt":"BACKGROUND: Rheumatoid arthritis (RA) is known as a chronic systemic autoimmune disorder that primarily targets synovial joints, and may cause pain and functional limitations. Studies show diet can have beneficial effects on symptoms and oxidative stress of this disease. Intermittent fasting (IF) is a dietary approach with cycles of fasting and intake. The current study aims to investigate the effect of IF on quality of life, clinical symptoms, inflammation, and oxidative stress in overweight and obese postmenopausal women with RA. METHODS: The current study is a randomized clinical trial, in which 44 patients with mild to moderate severity of RA will be randomly allocated to receive either IF (n = 22) or the usual diet (n = 22) for 8 weeks. Anthropometric measures and biochemical indicators including serum concentrations of erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and total oxidant and antioxidant capacity (TOC and TAC) will be assessed at the baseline and end of the study."},{"id":"source_53","type":"source","study":"Intermittent fasting and neurocognitive disorders: What the evidence shows","year":2025,"doi":"10.1016/j.jnha.2025.100480","url":"https://doi.org/10.1016/j.jnha.2025.100480","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Beveridge 2025","excerpt":"INTRODUCTION: Intermittent fasting (IF) has emerged as a potential lifestyle intervention for mitigating cognitive decline and enhancing brain health in individuals with mild to major neurocognitive disorders. Unlike preventive strategies, this review evaluates IF as a therapeutic approach, focusing on its effects on neuroplasticity, inflammation, and cognitive function. METHODS: A narrative review was conducted using a comprehensive PubMed search with the terms \"intermittent fasting AND neurocognition\" and \"intermittent fasting AND neuroplasticity\". Studies published in English within the last ten years involving human and animal models were included. Exclusion criteria focused on studies primarily examining mood disorders or unrelated metabolic outcomes. RESULTS: Preclinical evidence demonstrates that IF enhances hippocampal neurogenesis and synaptic plasticity through pathways involving BDNF and CREB. IF also reduces neuroinflammation, as shown in animal models of Alzheimer's disease, vascular cognitive impairment, and high-fat diet-induced cognitive impairment."},{"id":"source_54","type":"source","study":"Rationale and protocol for a randomized parallel intervention trial of two intermittent fasting approaches in patients with type 2 diabetes","year":2025,"doi":"10.1016/j.cct.2025.108118","url":"https://doi.org/10.1016/j.cct.2025.108118","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Steger 2025","excerpt":"BACKGROUND: Type 2 diabetes (T2D) is a progressive disease driven by insulin resistance and β-cell dysfunction, often exacerbated by excess body weight. Intermittent fasting (IF) approaches, including intermittent energy restriction (IER) and time-restricted eating (TRE), have shown promise for improving glycemic control and facilitating diabetes remission. However, the feasibility and effectiveness of these IF approaches in individuals with T2D remain underexplored. OBJECTIVE: This study aims to compare the feasibility, acceptability, and metabolic effects of IER and TRE in a randomized parallel trial in adults with T2D. METHODS: Adults with T2D (N = 56) and overweight/obesity will be randomized to one of two interventions: IER (550-800 kcal/day on 2-3 days/week) or TRE (caloric intake within an 8-h daily window). Both groups will receive a comprehensive, remotely delivered diabetes education and behavioral support program over 6 months, followed by a 6-month low-contact follow-up during which participants continued the intervention on their own. Primary outcomes include feasibility (recruitment, retention, adherence) and acceptability."},{"id":"source_55","type":"source","study":"Longer-term effects of intermittent fasting on body composition and cardiometabolic health in adults with overweight and obesity: A systematic review and meta-analysis.","year":2025,"doi":"10.1111/obr.13855","url":"https://doi.org/10.1111/obr.13855","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Khalafi 2025b","excerpt":"The aim of the present study was to investigate the effects of long-term intermittent fasting (IF) on body composition and cardiometabolic health in adults with overweight and obesity. PubMed, Web of Science, and Scopus were searched from inception to March 2024 to identify original randomized trials that investigated the effects of IF versus either a control diet (CON) and/or continuous caloric restriction (CR). Participants were adults with overweight and obesity and intervention durations were ≥ 6 months. Overall, a total of 24 studies involving 2032 participants were included in the meta-analysis. Compared with CON, IF significantly reduced body weight [WMD: -2.84 kg], BMI [WMD: -1.41 kg.m 2 ], fat mass [WMD: -3.06 kg], fat-free mass [WMD: -0.81 kg], waist circumference [WMD: -3.85 cm], visceral fat [SMD: -0.37], fasting glucose [WMD: -0.14 mmol/l], triglycerides [WMD: -0.12 mmol/l], and diastolic blood pressure [WMD: -2.24 mmHg]. Conversely, IF significantly increased high-density lipoproteins [WMD: 0.04 mmol/l] when compared with CON, but had no effects on insulin, hemoglobin A1c%, total cholesterol, low-density lipoprotein, or systolic blood pressure."},{"id":"source_56","type":"source","study":"Intermittent fasting and neuroprotection in Alzheimer’s disease: metabolic mechanisms, cellular signaling, and brain-peripheral crosstalk","year":2026,"doi":"10.3389/fnut.2026.1839995","url":"https://doi.org/10.3389/fnut.2026.1839995","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Sudasinghe 2026","excerpt":"There are several popular methods of IF, including (1) the 16/8 regimen (16 h of fasting followed by an 8-h eating window) ( 5 ), (2) the ADF, (alternate day fasting, alternating between fasting days with zero or extremely low caloric intake and non-restricted feeding days) ( 6 ), and (3) the 5:2 IF regimen (2 days per week of reduced energy intake and normal intake on the remaining 5 days) ( 7 )."},{"id":"source_57","type":"source","study":"Impact of Intermittent Fasting on Gut Barrier Function and Inflammation","year":2025,"doi":"10.64149/j.carcinog.24.10s.2833","url":"https://doi.org/10.64149/j.carcinog.24.10s.2833","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Impact of Intermittent Fasting 2025","excerpt":"Results: The mean zonulin and LPS levels were significantly lower in the IF group (32.4 ± 7.8 ng/mL and 0.38 ± 0.12 EU/mL) compared to controls (40.2 ± 9.5 ng/mL and 0.51 ± 0.15 EU/mL; p < 0.001). Inflammatory markers were also reduced in fasting participants: hs-CRP (1.9 ± 0.7 mg/L vs."},{"id":"source_58","type":"source","study":"The impact of intermittent fasting and Mediterranean diet on older adults' physical health and quality of life: A randomized clinical trial.","year":2025,"doi":"10.1016/j.numecd.2025.104132","url":"https://doi.org/10.1016/j.numecd.2025.104132","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Couto 2025","excerpt":"BACKGROUND AND AIMS: Non-communicable chronic diseases are on the rise globally, and diet plays a crucial role. Intermittent fasting (IF), particularly time-restricted eating (TRE), has emerged as a potential strategy to manage these conditions. Research suggests that TRE, combined with healthy diets like the Mediterranean diet, may benefit populations, including older adults. METHODS AND RESULTS: Seventeen adults over 60 years of age were randomly assigned to the TRE + MED group (n = 8), following a 12-h fast with the Mediterranean diet, or the MED-DIET group (n = 9), following the diet without fasting. Over three months, changes in anthropometric, biochemical, and quality of life measures were assessed. The TRE + MED group showed significant reductions in BMI (p = 0.040), waist circumference (p < 0.001), hip circumference (p = 0.025), waist-to-hip ratio (p = 0.023), and systolic blood pressure (SBP) (p = 0.020), along with changes in fasting glucose. In the MED-DIET group, only SBP decreased significantly (p = 0.022). Between-group comparisons showed greater improvements in waist circumference (p = 0.001) and waist-to-hip ratio (WHR; p = 0.036) in the TRE + MED group."},{"id":"source_59","type":"source","study":"Intermittent fasting and liver disease: Insights from the Ramadan model","year":2025,"doi":"10.4103/sjg.sjg_120_25","url":"https://doi.org/10.4103/sjg.sjg_120_25","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalifa 2025","excerpt":"Intermittent fasting (IF) has gained growing interest for its potential metabolic benefits. However, the unique physiological aspects of Ramadan fasting (RF), a culturally and religiously significant form of dry IF, remain underexplored, particularly regarding liver disease. RF imposes distinct metabolic and circadian challenges through prolonged daily fasting and altered meal timing, placing considerable demands on hepatic adaptability. Given the liver’s essential role in energy balance, metabolism, and inflammation, as well as the high prevalence of liver disease in many Muslim-majority regions, it is crucial to better understand how RF impacts liver health. This review synthesizes current evidence on how RF can impact liver function, including its effects on insulin sensitivity, autophagy, gut microbiota, gene expression, and inflammation-related pathways. We further reviewed the clinical implications of RF across the broad spectrum of liver conditions, from metabolic dysfunction-associated steatotic liver disease (MASLD) to advanced cirrhosis, hepatocellular carcinoma (HCC), and post-transplant states."},{"id":"source_60","type":"source","study":"Pilot Study of Novel Intermittent Fasting Effects on Metabolomic and Trimethylamine N -oxide Changes During 24-hour Water-Only Fasting in the FEELGOOD Trial","year":2019,"doi":"10.3390/nu11020246","url":"https://doi.org/10.3390/nu11020246","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Washburn 2019","excerpt":"Intermittent fasting (IF) has been connected with health benefits such as weight loss, lower risk of coronary artery disease (CAD) and diabetes, increased longevity, and improved quality of life. However, the mechanisms of these IF benefits in humans require further investigation. This study sought to elucidate some of these mechanisms through secondary analyses of the Fasting and ExprEssion of Longevity Genes during fOOD abstinence (FEELGOOD) trial, in which apparently healthy participants were randomized in a Latin square design to a 24-h water-only fast and a 24-h ad libitum fed day. Two pathways were investigated, with trimethylamine N -oxide (TMAO) levels measured due to their association with elevated risk of CAD, along with conductance of a broad panel of metabolic analytes. Measurements were made at baseline, at the end of the fasting day, and at the end of the fed day. A fasting mean of 14.3 ng in TMAO was found versus the baseline mean of 27.1 ng with p = 0.019, although TMAO levels returned to baseline on refeeding."}],"edges":[{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_1","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_2","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_3","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_4","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_5","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_6","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_7","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_8","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_9","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_10","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_11","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_12","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_13","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_14","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_15","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_16","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_17","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_18","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_19","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_20","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_21","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_22","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_23","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_24","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_25","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_26","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_27","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_28","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_29","type":"contains_claim"},{"from":"7e5ce8c6-78d4-4732-b449-7c9ff84676ce","to":"claim_30","type":"contains_claim"}],"screening":{"identified":60,"screened":60,"excluded":0,"included":60,"included_or_retained":60,"flow":["identified","screened","excluded_with_reasons","included"],"wording":"60 candidate receipts retained after source retrieval, deduplication, and topic filtering. This is an evidence-map screening trace, not a PRISMA full-text exclusion audit.","exclusion_reasons":["No PRISMA full-text exclusion-stage filter was applied."]}}