Vol 10, No 3 (2021)
Research paper
Published online: 2021-02-16

open access

Page views 2277
Article views/downloads 1085
Get Citation

Connect on Social Media

Connect on Social Media

The effect of intermittent fasting on mortality in patients with type 2 diabetes and metabolic disease with high cardiovascular risk: a systematic review

Lolita Matiashova1, Aparajeya Shanker2, Ganna Isayeva1
Clin Diabetol 2021;10(3):284-289.


Background. Intermittent fasting (IF) is a modern
method of modifying eating behavior in patients
who cannot tolerate calorie restriction. Intermittent
fasting is effective in weight loss and has different
types, which allows patients to adopt the type they
are most comfortable with. Intermittent fasting has
positive effects on human health, and this can lead IF
to be adopted in standard medical care. There is insufficient
data on the effect of IF on mortality and health
status in patients with comorbid pathology. The aims
of this systematic review are to analyze and summarize
data from original studies about IF and mortality in
patients with type 2 diabetes, metabolic disease and
high cardiovascular risk.

Methods. Original studies published in the last 5 years
were selected from MEDLINE via PubMed, Web of
Science, Scopus and Google Scholar using PRISMA

Results. Twenty-nine original articles were selected and
analyzed. Intermittent fasting showed a statistically
significant reduction in BMI, LDL, TG, HDL and HbA1C.
Data from this systematic review shows that IF is
a safe and effective way of reducing BMI in patients
with co-morbidities.

Conclusion. Further long-term studies examining the
effects of IF on mortality in co-morbid patients are

Article available in PDF format

View PDF Download PDF file


  1. St-Onge MP, Ard J, Baskin ML, et al. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the american heart association. Circulation. 2017; 135(9): e96–e9e121.
  2. Zubrzycki A, Cierpka-Kmiec K, Kmiec Z, et al. The role of low-calorie diets and intermittent fasting in the treatment of obesity and type-2 diabetes. J Physiol Pharmacol. 2018; 69(5).
  3. Yan S, Wang C, Zhao H, et al. Effects of fasting intervention regulating anthropometric and metabolic parameters in subjects with overweight or obesity: a systematic review and meta-analysis. Food Funct. 2020; 11(5): 3781–3799.
  4. Armutcu F. Fasting may be an alternative treatment method recommended by physicians. Electronic Journal of General Medicine. 2019; 16(3): em138.
  5. Faris MAI, Jahrami HA, Alsibai J, et al. Impact of Ramadan Diurnal Intermittent Fasting on Metabolic Syndrome Components in Healthy, Non-Athletic Muslim People Aged Over 15 Years: A Systematic Review and Meta-Analysis. Br J Nutr. 2019 [Epub ahead of print]: 1–51.
  6. PRISMA flow chart. PRISMA flow chart. PLoS Med. Published online 2009. doi:10.1371/journal.pmed1000097.
  7. Higgins JPT, Altman DG, Gøtzsche PC, et al. Cochrane Bias Methods Group, Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928.
  8. Sterne JAc, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355: i4919.
  9. Domaszewski P, Konieczny M, Pakosz P, et al. Effect of a six-week intermittent fasting intervention program on the composition of the human body in women over 60 years of age. Int J Environ Res Public Health. 2020; 17(11).
  10. Zuo Li, He F, Tinsley GM, et al. Comparison of high-protein, intermittent fasting low-calorie diet and heart healthy diet for vascular health of the obese. Front Physiol. 2016; 7: 350.
  11. Erdem Y, Özkan G, Ulusoy Ş, et al. The effect of intermittent fasting on blood pressure variability in patients with newly diagnosed hypertension or prehypertension. J Am Soc Hypertens. 2018; 12(1): 42–49.
  12. Al-Ozairi E, El Samad A, Al Kandari J, et al. Continuous glucose monitoring of glycemic variability during fasting post-sleeve gastrectomy. Obes Surg. 2020; 30(10): 3721–3729.
  13. Clayton DJ, Biddle J, Maher T, et al. 24-h severe energy restriction impairs postprandial glycaemic control in young, lean males. Br J Nutr. 2018; 120(10): 1107–1116.
  14. Madkour MI, T El-Serafi A, Jahrami HA, et al. Ramadan diurnal intermittent fasting modulates SOD2, TFAM, Nrf2, and sirtuins (SIRT1, SIRT3) gene expressions in subjects with overweight and obesity. Diabetes Res Clin Pract. 2019; 155: 107801.
  15. Li C, Sadraie B, Steckhan N, et al. Effects of a one-week fasting therapy in patients with type-2 diabetes mellitus and metabolic syndrome — a randomized controlled explorative study. Exp Clin Endocrinol Diabetes. 2017; 125(9): 618–624.
  16. Stekovic S, Hofer SJ, Tripolt N, et al. Alternate day fasting improves physiological and molecular markers of aging in healthy, non-obese humans. Cell Metab. 2019; 30(3): 462–476.e6.
  17. Headland ML, Clifton PM, Keogh JB. Effect of intermittent energy restriction on flow mediated dilatation, a measure of endothelial function: a short report. Int J Environ Res Public Health. 2018; 15(6).
  18. Sundfør TM, Svendsen M, Tonstad S. Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: A randomized 1-year trial. Nutr Metab Cardiovasc Dis. 2018; 28(7): 698–706.
  19. Pinto AM, Bordoli C, Buckner LP, et al. Intermittent energy restriction is comparable to continuous energy restriction for cardiometabolic health in adults with central obesity: A randomized controlled trial; the Met-IER study. Clin Nutr. 2020; 39(6): 1753–1763.
  20. Ajabnoor GMA, Bahijri S, Shaik NA, et al. Ramadan fasting in Saudi Arabia is associated with altered expression of CLOCK, DUSP and IL-1alpha genes, as well as changes in cardiometabolic risk factors. PLoS One. 2017; 12(4): e0174342.
  21. Alghamdi AS, Alghamdi KA, Jenkins RO, et al. Impact of Ramadan on physical activity and sleeping patterns in individuals with type 2 diabetes: the first study using fitbit device. Diabetes Ther. 2020; 11(6): 1331–1346.
  22. Carter S, Clifton PM, Keogh JB. The effects of intermittent compared to continuous energy restriction on glycaemic control in type 2 diabetes; a pragmatic pilot trial. Diabetes Res Clin Pract. 2016; 122: 106–112.
  23. Corley BT, Carroll RW, Hall RM, et al. Intermittent fasting in type 2 diabetes mellitus and the risk of hypoglycaemia: a randomized controlled trial. Diabet Med. 2018; 35(5): 588–594.
  24. Hassanein M, Abdelgadir E, Bashier A, et al. The role of optimum diabetes care in form of Ramadan focused diabetes education, flash glucose monitoring system and pre-Ramadan dose adjustments in the safety of Ramadan fasting in high risk patients with diabetes. Diabetes Res Clin Pract. 2019; 150: 288–295.
  25. Tripolt NJ, Stekovic S, Aberer F, et al. Intermittent fasting (alternate day fasting) in healthy, non-obese adults: protocol for a cohort trial with an embedded randomized controlled pilot trial. Adv Ther. 2018; 35(8): 1265–1283.
  26. Carter S, Clifton PM, Keogh JB. Effect of intermittent compared with continuous energy restricted diet on glycemic control in patients with type 2 diabetes: a randomized noninferiority trial. JAMA Netw Open. 2018; 1(3): e180756.
  27. Jospe MR, Roy M, Brown RC, et al. Intermittent fasting, Paleolithic, or Mediterranean diets in the real world: exploratory secondary analyses of a weight-loss trial that included choice of diet and exercise. Am J Clin Nutr. 2020; 111(3): 503–514.
  28. Martens CR, Rossman MJ, Mazzo MR, et al. Short-term time-restricted feeding is safe and feasible in non-obese healthy midlife and older adults. Geroscience. 2020; 42(2): 667–686.
  29. Washburn RL, Cox JE, Muhlestein JB, et al. Pilot study of novel intermittent fasting effects on metabolomic and trimethylamine -oxide changes during 24-hour water-only fasting in the FEELGOOD trial. Nutrients. 2019; 11(2).
  30. Carter S, Clifton PM, Keogh JB. The effect of intermittent compared with continuous energy restriction on glycaemic control in patients with type 2 diabetes: 24-month follow-up of a randomised noninferiority trial. Diabetes Res Clin Pract. 2019; 151: 11–19.
  31. Sandhya AM, Shakunthala GK, et al. Suresh Kumar P, Alteration in baseline somatic DNA damage in patients with type 2 diabetes after a non-experimental intermittent fasting. Res J Pharm Biol Chem Sci. Published online 2016.
  32. Mindikoglu AL, Abdulsada MM, Jain A, et al. Intermittent fasting from dawn to sunset for 30 consecutive days is associated with anticancer proteomic signature and upregulates key regulatory proteins of glucose and lipid metabolism, circadian clock, DNA repair, cytoskeleton remodeling, immune system and cognitive function in healthy subjects. J Proteomics. 2020; 217: 103645.
  33. Arnason TG, Bowen MW, Mansell KD. Effects of intermittent fasting on health markers in those with type 2 diabetes: A pilot study. World J Diabetes. 2017; 8(4): 154–164.
  34. Kahleova H, Lloren JI, Mashchak A, et al. Meal frequency and timing are associated with changes in body mass index in adventist health study 2. J Nutr. 2017; 147(9): 1722–1728.
  35. Harder-Lauridsen NM, Rosenberg A, Benatti FB, et al. Ramadan model of intermittent fasting for 28 d had no major effect on body composition, glucose metabolism, or cognitive functions in healthy lean men. Nutrition. 2017; 37: 92–103.
  36. MacKinzie Smith, Alyssa Edwards, Kirsten Gateless BA, et al. The Impact of Intermittent Fasting and Exercise on Resting Metabolic Rate and Respiratory Quotient MacKinzie. J Exerc Physiol. 2019; 22(7): 22–29. .
  37. Araszkiewicz A, Bandurska-Stankiewicz E, Budzyński A, et al. 2019 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clinical Diabetology. 2019; 8(1): 1–95.
  38. Langsted A, Nordestgaard BG. Nonfasting versus fasting lipid profile for cardiovascular risk prediction. Pathology. 2019; 51(2): 131–141.