Fasting mimicking diet cycles versus a Mediterranean diet and cardiometabolic risk in overweight and obese hypertensive subjects: a randomized clinical trial.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 40604264 · doi:10.1038/s44324-023-00002-1
What was done
A single-center randomized clinical trial evaluated hypertensive patients with overweight or obesity (BMI ≥ 28, baseline reactive hyperemia index [RHI] ≤ 2.0, and/or small-resistance artery compliance [AC2] ≤ 5.0). Participants were allocated to either 4 months of a continuous Mediterranean diet (MD) or 4 cycles of a fasting mimicking diet (FMD) consumed for 5 consecutive days per month. Outcomes assessed included endothelial function (RHI, AC1/AC2 compliance), PULS cardiac risk scores, anthropometrics, glycemic markers, lipids, and a 3-month post-intervention follow-up.
What was found
Both diets produced comparable reductions in body weight, BMI, waist circumference, total body fat mass, % body fat, total cholesterol, and leptin, with no significant differences between groups at the end of the intervention. Both groups improved PULS cardiac scores, and neither group showed significant changes in AC1 or AC2 arterial compliance compared to baseline. Within groups, FMD reduced RHI (p = 0.0023), HbA1c (p = 0.0059), and IGF-1 (p = 0.0427), whereas MD reduced glucose (p = 0.0488), HOMA-IR (p = 0.0476), and HDL-C (p = 0.0419). At the 3-month follow-up, both groups sustained weight and BMI reductions, but the MD group lost fat-free mass compared to the FMD group (p = 0.0498). Exact numerical values for baseline and endpoint metrics were not reported in the abstract.
Why it matters
Periodic 5-day cycles of an FMD offer cardiometabolic and risk-score improvements similar to a daily continuous Mediterranean diet, with potential advantages in preserving lean body mass after cessation.
Limits
The abstract does not disclose the sample size, dropout rates, or exact baseline/endpoint numerical values and confidence intervals. It was a single-center trial, and the reduction in RHI observed with FMD represents an ambiguous vascular finding.
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