| BackgroundIn the context of rapid social and economic development,people’s living standards are improving.The high-calorie diet and sedentary lifestyle make the prevalence of overweight and obesity among Chinese residents show a significant upward trend.Obesity is a metabolic disease caused by the long-term imbalance between energy intake and energy consumptio,manifested by heavy and excessive accumulation of body fat(mainly triglycerides).Since obesity has become an essential factor affecting people’s everyday life,it is imperative to find economical and efficient interventions to prevent and control obesity and related metabolic diseases.Nowadays,there are various intervention methods for obesity,such as lifestyle and behavior interventions,weight reduction drugs and surgery,etc.Lifestyle interventions mainly include diet and exercise control.Reducing energy and food intake is both the key to weight reduction treatment,and the basis of drug and surgery treatment.Although current studies in higher organisms have shown significant health improvement benefits of either calorie restriction or intermittent fasting,subjects must face months or even more extended periods of low-calorie dieting or fasting,which are longer and may not be easily adhered to,so studies of complete fasting over a range of time frames can help explore dietary intervention options that are more suitable for clinical application.There are still legitimate concerns in the medical community about possible protein catabolism and muscle loss during fasting.Focusing on the patterns of fat and muscle changes during fasting may be more useful in assessing the potential clinical application of fasting protocols.ObjectiveThe 14-day probiotic-assisted total fasting program was used to observe the changes in body morphology,fat,and muscle change-related indicators,and safety indicators in the target population,to explore the specificity of its effects on human fat and skeletal muscle,to further evaluate the potential clinical value of total fasting for an appropriate period,and to provide evidence-based medical evidence for the clinical application of dietary interventions to control overweight or obesity,to propose new programs for healthy dietary interventions based on the results of the study.MethodsIn this study,48 overweight or obese volunteers recruited through the platform of the First Affiliated Hospital of Henan University were subjected to total fasting intervention.The study process was divided into three stages: first,continuous probiotic-assisted total fasting intervention for 14 days.Second,resumption of diet for 14 days.And third,follow-up at three months of resumption of diet,through five-time points: before the start of fasting(Control 0D),on the 7th day of fasting(A total of 23 tests were performed at five-time points: before fasting(Control 0D),on fasting day 7(Fasting 7D),on fasting day 14(Fasting 14D),on resumption of diet day 14(Refeed 14D),and at 3-month follow-up(Refeed 3M),to analyze and evaluate the effects of the 14-day total fasting program on weight loss,its impact on fat and skeletal muscle,and its safety feasibility.SPSS 25.0 and Graph Pad Prism 8.0 software were used for statistical and analysis of the experimental data as well as for plotting.Results(1)After 14 days of total fasting,the subject’s body weight,BMI,waist circumference,and body fat percentage decreased significantly(each P < 0.01)and remained lower than the pre-fasting levels at 14 days and 3-month follow-up after the resumption of fasting(each P < 0.01);basal metabolic rate decreased slightly during fasting(P < 0.01)and gradually rebounded after the resumption of fasting,and was no difference compared with the pre-fasting level at 3-month follow-up(P=0.806).(2)After 14 days of total fasting,the subjects’ body fat mass and visceral fat area decreased(each P <0.01)and remained lower than pre-fasting levels at 14 days and 3-month follow-up after the resumption of fasting(each P < 0.01);for blood lipids,TG and HDL-C decreased significantly during fasting(each P <0.01)and returned to pre-fasting levels and maintained after the resumption of fasting(each P > 0.05),TC and LDL-C showed a transient increase at seven days of fasting(each P < 0.01),followed by a decrease,with no difference from pre-fasting levels at 14 days of fasting,14 days of resumption of fasting and3-month follow-up(each P > 0.05).(3)After 14 days of total fasting,total muscle mass and trunk muscle mass decreased in subjects(each P < 0.01),and were slightly lower than before fasting at 14 days of resumption(each P < 0.01),and did not differ from before fasting at the 3-month follow-up(each P > 0.05);grip strength significantly improved(P< 0.01),and decreased at 14 days of resumption(P = 0.084)and the 3-month follow-up(P < 0.05),but was higher than before fasting.The MSTN decreased persistently(P < 0.01)and remained low at 14 days of resumption of fasting(P < 0.05)and at the 3-month follow-up(P < 0.01).Further subgroup analysis by gender showed that the differences in baseline levels between the two different gender groups were not statistically significant in body fat,visceral fat area,and MSTN(each P > 0.05),while the differences in skeletal muscle mass,trunk muscle mass,and grip strength were statistically significant(each P < 0.001),but the trends in fat-and muscle-related indicators within both groups were consistent with the changes in the overall population.(4)Fasting blood glucose was significantly lower after 14 days of total fasting(P < 0.01),rebounded after 14 days of resumption(P < 0.01),and did not differ from pre-fasting at the 3-month follow-up(P =0.241);ALT and AST were transiently elevated during fasting(each P < 0.01)and did not differ from pre-fasting levels at 14 days of resumption and 3-month follow-up(each P > 0.05).GGT continued to decrease during fasting(P < 0.01)and remained lower than pre-fasting levels at 14 days of resumption(P <0.01)and at follow-up(P < 0.05);BUN continued to decrease,Cr continued to increase,and UA increased transiently during fasting(each P < 0.01),and all tended to return to pre-fasting levels after the resumption of fasting,with no difference from pre-fasting at follow-up(each P > 0.05);CK(P < 0.01)gradually increased during fasting and rapidly returned to the pre-fasting level after the resumption of fasting(each P > 0.05),and all indexes were basically within the physiological range.(5)During the 14 days of total fasting,27.08% of the subjects did not report adverse effects.The main negative impact reported were decreased frequency of bowel movements(62.50%)and fatigue(47.92%),while the rest,such as stronger hunger(16.67%),dry mouth(6.25%),dizziness(4.17%),chilliness(2.08%),and insomnia(2.08%),were less frequent.All of these symptoms disappeared after the resumption of the diet,and there was no discomfort at follow-up feedback.Conclusion(1)Prebiotic-assisted total fasting for 14 days effectively reduced adiposity in overweight/obese subjects without causing excessive loss of muscle mass,while effectively suppressing MSTN levels after re-feeding.(2)Probiotic-assisted total fasting for 14 days did not cause significant hypoglycemic symptoms and liver and kidney function damage,and most volunteers could tolerate the adverse effects and complete the whole fast. |
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