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Reply published on 12 July 2024, see J. Clin. Med. 2024, 13(14), 4094.
Comment of J. Clin. Med. 2023, 12(11), 3699.
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Comment

Challenges in Providing an Overview of Results of Intermittent Fasting Interventions on Diabetes Parameters. Comment on Silva et al. Effects of Intermittent Fasting on Regulation of Metabolic Homeostasis: A Systematic Review and Meta-Analysis in Health and Metabolic-Related Disorders. J. Clin. Med. 2023, 12, 3699

by
Carmen Dietvorst
1,†,
Jur Kroon
2,†,
Romy Slebe
3,
Mireille J. Serlie
2,4,
Kirsten A. Berk
1 and
Femke Rutters
3,*
1
Department of Internal Medicine, Division of Dietetics, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
2
Department of Endocrinology and Metabolism and Amsterdam Gastroenterology Metabolism Endocrinology Institute, Amsterdam University Medical Center, 1081 BT Amsterdam, The Netherlands
3
Department of Epidemiology and Data Science, Amsterdam University Medical Centre, 1105 AZ Amsterdam, The Netherlands
4
Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2024, 13(14), 4091; https://doi.org/10.3390/jcm13144091
Submission received: 8 April 2024 / Accepted: 18 June 2024 / Published: 12 July 2024
(This article belongs to the Section Endocrinology & Metabolism)
Versions Notes
We hereby comment on the systematic review “Effects of Intermittent Fasting on Regulation of Metabolic Homeostasis: A Systematic Review and Meta-Analysis in Health and Metabolic-Related Disorders” by Silva et al., 2023 [1]. We appreciate the herculean effort undertaken to summarize the extended research on effects of intermittent fasting on several metabolic parameters. Intermittent fasting was defined by Silva et al., 2023 as Alternate-Day Fasting, Time-Restricted Fasting a.k.a. time-restricted eating, fasting-mimicking diet as well as Religious Fasting. However, there are also some concerns. While performing an umbrella review on the topic of intermittent fasting and (parameters of) diabetes, we encountered the following problems; first, there is a large amount of available reviews on a seemingly small amount of original papers. Within the same timeframe, we identified 116 original studies on intermittent fasting and diabetes, compared to 51 reviews. Table 1 provides an overview of all the reviews identified to date for our umbrella review and the % inclusion of the original studies.
The systematic review by Silva et al. [1] included only 30% of available original studies, which is more than the other reviews, which included on average 10%. We think the review of Silva et al., 2023 [1] is incomplete due to:
  • The different forms and definitions of intermittent fasting: intermittent fasting can refer to Time-Restricted Fasting/Time-Restricted Eating, Alternate-Day Fasting, Modified Alternate-Day Fasting regimes, Fasting-Mimicking diets as well as fasting for religious reasons. In the Silva et al. [1] review Fasting-Mimicking diets were not included;
  • A lack of alternative search strategies, such as checking references. We were surprised that the authors identified no papers through manual searching [52], while about one-fourth of the included papers in our umbrella review were identified through reference checking;
  • Selection of outcomes: the review of Silva et al. included a variety of metabolic outcomes, but, for diabetes parameters only insulin homeostasis, fasting glucose, fasting insulin, insulin resistance (HOMA-IR) and diabetes status were considered. However, there are other important diabetes parameters to be considered when studying the effects of intermittent fasting. These include HbA1c, OGTT (1 h and 2 h post-load glucose), Time in Range, glucose variation, hyperglycemia and hypoglycemia, postprandial glucose, insulin responses, C-reactive protein, glucagon, other insulin resistance indexes (ISI, OGIS, MCR, Matsuda) and hyperglycemic as well as euglycemic clamps to assess beta-cell function and insulin sensitivity respectively;
  • The exclusion criteria, excluding studies that combined IF with other diets or interventions, which presumably led to a selection of studies.
The other reviews summarized in Table I have more missing studies, compared to Silva et al. [1]. This might be caused by the reasons outlined above and by the strict inclusion and exclusion criteria applied in some of those reviews. For example only including studies in specific subgroups like women with PCOS [51] or only studies on Ramadan fasting [39], which limits the generalizability of those reviews.
Although, the systematic review by Silva et al., 2023 [1] adds valuable information to the literature on the effects of intermittent fasting on metabolic parameters, we feel that a complete review, which includes all original studies on the topic of intermittent fasting and diabetes is still missing from the literature. The lack of such a complete systematic overview on the effect of all forms of intermittent fasting on all relevant diabetes related outcomes and with emphasis on a comprehensive evidence synthesis of the outcomes per type of intermittent fasting refrains researchers and health care professionals from implementing the best intermittent fasting diet for people with diabetes.

Funding

J.K., R.S., M.J.S. and F.R. are partly funded by the TIMED project (The Netherlands Organization for Health Research and Development (ZonMw) [459001021], Dutch Diabetes Research Foundation (Diabetes Fonds) [2019.11.101]), and the Canadian Institutes of Health Research (CIHR) [TNC-174963], Health-Holland [LSHM20107]. This collaborative project is co-financed with PPP-allowance made available by Health-Holland, Topsector Life Sciences & Health, to stimulate public-private partnerships.

Conflicts of Interest

The authors declare no conflict of interest.

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Table 1. Overview of identified (systematic) reviews on intermittent fasting and per review included single studies, ordered from highest number of original studies included to lowest.
Table 1. Overview of identified (systematic) reviews on intermittent fasting and per review included single studies, ordered from highest number of original studies included to lowest.
Table of Reviews
AuthorReview TypeNumber of Studies IncludedPercentage of Total
Silva et al., 2023 [1]Systematic review and meta-analysis3530.17%
Yang et al., 2021 [2]Systematic review3328.45%
Gu et al., 2022 [3]Systematic review and meta-analysis3025.86%
Sharma et al., 2023 [4]Systematic review and meta-analysis2118.10%
Tsitsou et al., 2022 [5]Systematic review2017.24%
Allaf et al., 2021 [6]Systematic review and meta-analysis1916.38%
Liu et al., 2023 [7]Systematic review and meta-analysis1916.38%
Wang et al., 2022 [8]Systematic review and meta-analysis1916.38%
Sun et al., 2023 [9]Systematic review and meta-analysis1916.38%
de Oliveira Maranhão Pureza 2021 [10]Systematic review and meta-analysis1815.52%
Chen et al., 2023 [11]Systematic review and meta-analysis1815.52%
Parr et al., 2022 [12]Perspective1815.52%
Kyoung-Kon Kim et al., 2022 [13]Systematic review and meta-analysis1714.66%
Chen et al., 2021 [14]Systematic review and meta-analysis1714.66%
van den Burg et al., 2023 [15]Systematic review and meta-analysis1714.66%
He et al., 2020 [16]Systematic review and meta-analysis1512.93%
Ezzati et al., 2023 [17]Systematic review1512.93%
Moon et al., 2020 [18]Systematic review and meta-analysis1412.07%
Liu et al., 2022 [19]Systematic review and meta-analysis1412.07%
Borgundvaag 2021 [20]Systematic review and meta-analysis1311.21%
Cioffi et al., 2018 [21]Systematic review and meta-analysis1210.34%
Schwingshackl et al., 2021 [22]Systematic review and meta-analysis1210.34%
Cho et al., 2019 [23]Systematic review and meta-analysis1210.34%
Meng et al., 2020 [24]Systematic review and meta-analysis1210.34%
Fatahi et al., 2021 [25]Systematic review and meta-analysis1210.34%
Wang et al., 2021 [26]Systematic review and meta-analysis119.48%
Nowosad et al., 2021 [27]Systematic review119.48%
Ciu et al., 2020 [28]Systematic review and meta-analysis97.76%
Santos et al., 2022 [29]Scoping review97.76%
Kirkham et al., 2022 [30]Narrative review97.76%
Bórquez et al., 2022 [31]Narrative review97.76%
Navea-Cuadra et al., 2022 [32]Systematic review82.59%
Yuan et al., 2022 [33]Systematic review and meta-analysis86.90%
Park et al., 2020 [34]Systematic review and meta-analysis76.03%
Roman et al., 2018 [35]Systematic review and meta-analysis76.03%
Barnosky et al., 2014 [36]Systematic review76.03%
Lin et al., 2022 [37]Systematic review76.03%
Morales-Suarez-Varela et al., 2021 [38]Systematic review76.03%
Pellegrini et al., 2020 [39]Systematic review and meta-analysis65.17%
Anton et al., 2021 [40]Systematic review65.17%
Zaki et al., 2022 [41]Systematic review and meta-analysis65.17%
Harris et al., 2018 [42]Systematic review and meta-analysis54.31%
Chew et al., 2023 [43]Systematic review and meta-analysis54.31%
Zeng et al., 2022 [44]Systematic review and meta-analysis54.31%
Vitale et al., 2020 [45]Systematic review54.31%
Bitsanis et al., 2021 [46]Systematic review54.31%
Ganesan et al., 2020 [47]Systematic review54.31%
Osses-Carrasco et al., 2022 [48]Systematic review43.45%
Uldal et al., 2022 [49]Systematic review43.45%
Patikorn et al., 2021 [50]Umbrella review21.72%
Floyd et al., 2022 [51]Systematic review10.86%
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Dietvorst, C.; Kroon, J.; Slebe, R.; Serlie, M.J.; Berk, K.A.; Rutters, F. Challenges in Providing an Overview of Results of Intermittent Fasting Interventions on Diabetes Parameters. Comment on Silva et al. Effects of Intermittent Fasting on Regulation of Metabolic Homeostasis: A Systematic Review and Meta-Analysis in Health and Metabolic-Related Disorders. J. Clin. Med. 2023, 12, 3699. J. Clin. Med. 2024, 13, 4091. https://doi.org/10.3390/jcm13144091

AMA Style

Dietvorst C, Kroon J, Slebe R, Serlie MJ, Berk KA, Rutters F. Challenges in Providing an Overview of Results of Intermittent Fasting Interventions on Diabetes Parameters. Comment on Silva et al. Effects of Intermittent Fasting on Regulation of Metabolic Homeostasis: A Systematic Review and Meta-Analysis in Health and Metabolic-Related Disorders. J. Clin. Med. 2023, 12, 3699. Journal of Clinical Medicine. 2024; 13(14):4091. https://doi.org/10.3390/jcm13144091

Chicago/Turabian Style

Dietvorst, Carmen, Jur Kroon, Romy Slebe, Mireille J. Serlie, Kirsten A. Berk, and Femke Rutters. 2024. "Challenges in Providing an Overview of Results of Intermittent Fasting Interventions on Diabetes Parameters. Comment on Silva et al. Effects of Intermittent Fasting on Regulation of Metabolic Homeostasis: A Systematic Review and Meta-Analysis in Health and Metabolic-Related Disorders. J. Clin. Med. 2023, 12, 3699" Journal of Clinical Medicine 13, no. 14: 4091. https://doi.org/10.3390/jcm13144091

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