ARALIKLI ORUCUN OBEZİTE TEDAVİSİNDEKİ YERİ

Öz

Obezite; yaşam kalitesini düşüren ve uzun süreli tıbbi müdahale gerektiren yüksek morbidite ve mortalite riskleriyle ilişkili, 21. yüzyılın en önemli toplumsal salgını olup, sıklığı yıldan yıla artan kronik bir hastalıktır. Dünya Sağlık Örgütü verilerine göre; dünya çapında obezite prevalansı 1975-2016 arasında yaklaşık üç katına çıkmıştır. Obezitenin tıbbi beslenme tedavisinin amacı, kişiye özgü enerji kısıtlaması içeren uygun beslenme programları oluşturmaktır. Ancak günlük kalori kısıtlama diyetlerinde enerji gereksinimi her gün kısıtlandığı için diyete bağlılık düşüktür. Geleneksel günlük enerji kısıtlama modeline bir alternatif olarak aralıklı oruç, insanlar tarafından büyük ilgi görmüştür. Aralıklı oruç; yemek yeme dönemleriyle birlikte dönüşümlü olarak yemek yememe (oruç) dönemlerini de kapsayan benzersiz bir diyet stratejisini oluşturmaktadır. Aralıklı oruç modelleri; alternatif gün orucu, düzenlenmiş aralıklı oruç (5:2 yöntemi) ve zaman kısıtlı aralıklı oruç yöntemi olmak üzere 3 ana başlıkta sınıflanmaktadır. Yapılan birçok çalışmada, aralıklı orucun klasik kalori kısıtlama diyetleriyle benzer oranda ağırlık kaybı sağladığı bulunmuştur. Bu derlemede aralıklı orucun obezitenin tıbbi beslenme tedavisinde etkin olup olmadığını tartışmak amaçlanmıştır.

Anahtar Kelimeler

• aralıklı oruç
• obezite
• beden kitle indeksi

THE PLACE OF INTERMITTENT FASTING IN OBESITY TREATMENT

Öz

Obesity is the most important social epidemic of the 21st century, which is associated with high morbidity and mortality risks that reduces the quality of life and requires long-term medical intervention, and is a chronic disease whose frequency is increasing year by year. According to the World Health Organization data; The prevalence of obesity worldwide nearly tripled between 1975 and 2016. The aim of medical nutrition therapy of obesity is to create appropriate nutrition programs that include energy restriction specific to the individual. However, adherence to the diet is low in daily calorie restriction diets, as the energy requirement is restricted every day. As an alternative to the traditional daily energy restriction model, intermittent fasting has received a lot of attention from people. intermittent fasting; It constitutes a unique dietary strategy that includes alternating periods of not eating (fasting) along with periods of eating. Intermittent fasting models; It is classified under 3 main headings as alternate day fasting, regulated intermittent fasting (5:2 method) and time-restricted intermittent fasting method. Many studies have found that intermittent fasting provides weight loss at a similar rate to conventional calorie restriction diets. In this review ıt is aimed to discuss whether intermittent fasting is effective in the medical nutrition treatment of obesity.

Anahtar Kelimeler

• intermittent fasting
• obesity
• body mass index

Kaynakça

1. 1. Liu B, Du Y, Wu Y, Snetselaar LG, Wallace RB, Bao W. Trends in obesity and adiposity measures by race or ethnicity among adults in the United States 2011–18: Population based study. BMJ 2021;372.
2. 2. Collaborators GO. Health effects of overweight and obesity in 195 countries over 25 years. New England Journal of Medicine. 2017; 377(1): 13-27.
3. 3. 3.Baysal YF. Obezitede Diyetin Düzenlenmesi. Klinik Tıp Bilimleri Dergisi, 2017;5(5):1-4.
4. 4. Trepanowski JF, Kroeger CM, Barnosky A, Klempel M, Bhutani S, Hoddy KK, et al. Efects of alternate-day fasting or daily calorie restriction on body composition, fat distribution, and circulating adipokines: secondary analysis of a randomized controlled trial. Clin Nutr. 2018;37(6):1871–8.
5. 5. Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Peters C, Zhyzhneuskaya S, Al-Mrabeh A, Hollingsworth KG, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): An open-label, cluster-randomised trial. Lancet 2018;391:541–51.
6. 6. Moreir a EAM, Most M, Howard J, Ravussin E. Dietary adherence to longterm controlled feeding in a calorie-restriction study in overweight men and women. Nutr Clin Pract. 2011;26(3):309–15.
7. 7. Antoni R, Robertson TM, Robertson MD, Johnston JD. A pilot feasibility study exploring the effects of a moderate timerestricted feeding intervention on energy intake, adiposity and metabolic physiology in free-living human subjects. J. Nutr. Sci. 2018;7(22):p 1 of 6
8. 8. Chow LS, Manoogian ENC, Alvear A, Fleischer J, Thor H. Dietsche K.et al. Time-Restricted Eating Effects on Body Composition and Metabolic Measures in Humans who are Overweight: A Feasibility Study. Obesity 2020;28:860-69.

9. 9. Tinsley GM, La Bounty PM. Effects of intermittent fasting on body composition and clinical health markers in humans. Nutr Rev. 2015;73(10):661-74.
10. 10. Pischon T, Boeing H, Hoffmann K, Bergman M, Schulze MB,, K Overvad K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008;359:2105-20
11. 11. Bray GA, Kim KK, Wilding JPH; World ObesityFederation. Obesity: a chronic relapsing progressiveisease process. A positionstatement of the World Obesity Federation. Obes Rev. 2017;18(7):715-23
12. 12. Gómez LA. Abdeen ZA, , AbdulHamid Z, Abu-Rmeileh NM , Cazares B , Acuin C, et al. World wide trends in body-massindex, under weight, over weight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet 2017;390:2627-42 .
13. 13. Birinci Basamak Sağlık Kurumları için Obezite ve Diyabet Klinik Rehberi 2017. Ankara; T.C. Sağlık Bakanlığı Yayın No:1070; s.28
14. 14. World Health Organization. European Regional Obesity Report 2022. p.13-17. Erişim tarihi: 20.07.2023 https://apps. who.int/iris/bitstream/handle/10665/353747/9789289057738-eng.pdf
15. 15. TÜİK, Türkiye Sağlık Araştırması, 2022. Türkiye. Erişim tarihi: 20.07.2023 https://data.tuik.gov.tr/Bulten/Index?p=Turkiye-Saglik-Arastirmasi-2022-4974716.
16. 16. Akbulut, G, Mortaş H, Türközü D, (2016a). Obezite tedavisi, Bariatrik ve Metabolik Cerrahide Tıbbi Beslenme Tedavisi III. Ankara Nobel Tıp Kitabevleri; 2016. s.1-4.
17. 17. Cappuccio FP. et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep 2008;31, 619-26.
18. 18. Noh J. The effect of circadian and sleep disruptions on obesity risk. J. Obes. Metab. Syndr. 2018;27:78–83.
19. 19. Scott KA, Melhorn SJ. & Sakai RR. Effects of chronicsocialstress on obesity. Curr. Obes. Rep. 2012;1:16–25.
20. 20. Ness-Abramof, R. & Apovian CM. Drug-induced weight gain. DrugsToday. 2005;41:547–555
21. 21. Hoddy KK, Marlatt KL, Çetinkaya H, Ravussin E. Intermittent fasting and metabolic health: from religious fast to time-restricted feeding. Obesity. 2020;28:29–37
22. 22. de Cabo R, Mattson MP. Effects of Intermittent Fasting on Health, Aging, and Disease. N Engl J Med. 2019;381(26):2541-51.
23. 23. Patterson RE, Sears DD. Metabolic Effects of Intermittent Fasting. Annu Rev Nutr. 2017;37:371-9
24. 24. Varady KA, Cienfuegos S, Ezpeleta M, Gabel K. Cardio metabolic benefits of intermittent fasting. Annu Rev Nutr. 2021;41(1):333-61.
25. 25. Rui L. Energy Metabolism in the Liver. In: Terjung R, editor. Comprehensive Physiology. 1st ed. Wiley; 2014;p. 177–97.
26. 26. Dong TA, Sandesara PB, Dhindsa DS, Mehta A, Arneson LC, Dollar AL, Taub PR, Sperling LS. Intermittent fasting: A heart healthy dietary pattern? Am. J. Med. 2020;133:901-7.
27. 27. Hutchison AT, Regmi P, Manoogian ENC, Fleischer JG, Wittert GA, Panda S, et al. Time-restricted feeding improves glucose tolerance in men at risk for type 2 diabetes: A randomized crossover trial. Obesity 2019;27, 724-32.
28. 28. Nencioni A, Caffa I, Cortellino S, Longo VD. Fasting and cancer: Molecular mechanisms and clinical application. Nat. Rev. Cancer 2018; 18: 707-19
29. 29. Tallis J, James RS, Seebacher F. The effects of obesity on skeletal muscle contractile function. J. Exp. Biol. 2018;221:jeb163840.
30. 30. Anton SD, Moehl K, Donahoo WT, Marosi K, Lee SA, Mainous III AG, et al. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting. Obesity (Silver Spring). 2018;26(2):254- 68.
31. 31. Sundfør TM, Svendsen M, Tonstad S. Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardio metabolic risk: a randomized 1-year trial. Nutr Metab Cardiovasc Dis. 2018;28(7):698- 706.
32. 32. Byrne NM, Sainsbury A, King NA, Hills AP, Wood RE. Intermittent energy restriction improves weight loss efficiency in obese men: The Matador study. Int. J. Obes. 2018; 42:129-38.
33. 33. Patterson RE, Laughlin GA, Sears DD, LaCroix AZ, Marinac C, Gallo LC, et al. Intermittent Fasting and Human Metabolic Health. J Acad Nutr Diet. 2015;115(8):1203-12.
34. 34. Gabel K, Hoddy KK., Varady KA. Safety of 8-h time restricted feeding in adults with obesity. Appl. Physiol. Nutr. Metab. 2019;44:107-9.
35. 35. Rynders CA, Thomas EA, Zaman A, Pan Z, Catenacci VA, Melanson EL. Effectiveness of intermittent fasting and time-restricted feeding compared to continuous energy restriction for weight loss. Nutrients 2019;11:2442.
36. 36. Longo VD, Panda S. Fasting, circadian rhythms, and time-restricted feeding in healthy lifespan. Cell Metab. 2016;23:1048-59.
37. 37. Ravussin E, Beyl RA, Poggiogalle E, Hsia D, Peterson CM. Early Time-Restricted Feeding Reduces Appetite and Increases Fat Oxidation But Does Not Affect Energy Expenditure in Humans. Obesity 2019;27:1244-54.
38. 38. Stockman MC, Thomas D, Burke J, Apovian CM. Is The Wait Worth The Weight? Curr Obes Rep. 2018;7(2):172-85.
39. 39. Varady KA, Cienfuegos S, Ezpeleta M. & Gabel K. Clinical application of intermittent fasting for weight loss: progress and future directions. Nat. Rev. Endocrinol. 2022;18:309-21
40. 40. Barnosky AR, Hoddy KK, Unterman,TK, Varady KA. Intermittent fasting vs daily calorie 336 restriction for type 2 diabetes prevention: a review of human findings. Transl. Res.,2014;164(4):302-11.
41. 41. Parr EB, Devlin BL, Radford BE, & Hawley JA. A Delayed Morning and Earlier Evening Time-Restricted Feeding Protocol for Improving Glycemic Control and Dietary Adherence in Men with Overweight/Obesity: A Randomized Controlled Trial. Nutrients. 2020;12(2):505.
42. 42. Catenacci VA, Pan Z, Ostendorf D, Brannon S, Gozansky WS, Mattson MP, Martin B, MacLean PS, Melanson EL, Troy Donahoo WA. Randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity. Obesity 2016;24:1874-83.
43. 43. Harvie M. Wright C, Pegington M, McMullan D , Mitchell E , Martin B , et al. The effect of intermittent energy and carbohydrate restriction v. daily energy restriction on weight loss and, metabolic disease risk markers in overweight women. Br. J. Nutr. 2013;110:1534-47.
44. 44. Cho AR. Ay JY, Kim S, An KY , Ah M, Jeon JY, et al. Effects of alternate day fasting and exercise on cholesterol metabolism in overweight or obese adults: a pilot randomized controlled trial. Metabolism. 2019;93;52-60
45. 45. Xiangwei Hu, Kai Xia, Minhui Dai, Xiaofeng Han, Peng Yuan, Jia Liu et all, Intermittent fasting modulates the intestinal microbiota and improves obesity and host energy metabolism. Biofilms and Microbiomes 2023; 9:19 ; https://doi.org/10.1038/s41522-023-00386-4
46. 46. Schubel R. Nattenmüller J, Sookthai D,, Nonnenmacher T, Graf ME , Ried Ll et al. Effects of intermittent and continuous calorie restriction on body weight and metabolism over 50 wk: a randomized controlled trial. Am. J. Clin. Nutr.2018; 108:933–45.
47. 47. Razavi R, Parvaresh A, Abbasi B, Yaghoobloo K, Hassanzadeh A, Mohammadifard N, et al. Alternate-day fasting is a more effective approach to weight loss and hs-CRP levels than a calorie restriction diet. Int J Vitamin Nutr Res. 2021; 91:242–50.
48. 48. Lowe DA. Wu N, Rohdin-Bibby L,2, Moore BH , Kelly N, Liu YE, 5, et al. Effects of time-restricted eating on weight loss and other metabolic parameters in women and men with overweight and obesity: the TREAT randomized clinical trial. JAMA Intern. Med. 2020;180:1491–99.
49. 49. Kotarsky CJ, Johnson NR, Mahoney SJ, Mitchell SL, Schimek RL, Stastny SN, et al. Time-restricted eating and concurrent exercise training reduces fat mass and increases lean mass in overweight and obese adults. Physiol Rep. 2021; 9:e14868.
50. 50. Patikorn C, PharmD, Roubal K, PharmD, Veettil SK, Chandran V, et al. Intermittent Fasting and Obesity-Related Health Outcomes. An Umbrella Review of Meta-analyses of Randomized Clinical Trials. JAMA Network Open. 2021;4(12):e2139558.
51. 51. Xueting Wei, Ashley Cooper, Irene Lee, Christine A. Cernoch, Ginny Huntoon, et al. Intermittent Energy Restriction for Weight Loss: A Systematic Review of Cardiometabolic, Inflammatory and Appetite Outcomes. Biological Research For Nursing. 2022; Vol. 24(3) 410–28
52. 52. Alhamdan BA, Garcia-Alvarez A, Alzahrnai AH, Karanxha J, Stretchberry DR, Contrera KJ, et al. Alternate-Day versus Daily Energy Restriction Diets: Which Is More Effective for Weight Loss? A Systematic Review and Meta-Analysis. Obes. Sci. Pract. 2016; 2: 293–302.