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      The Effect of a Combined Intermittent Fasting Healthy Plate Intervention on Anthropometric Outcomes and Body Composition Among Adults With Overweight and Obesity: Nonrandomized Controlled Trial

      research-article
      , MPH, DrPH 1 , , , BSc 1 , , MBBS 1 , , MPH, DrPH 1 , , MSc 1 , , MSc 1 , , MB BCh BAO 1 , , PhD 1 , , MD 1 , , MSc 1 , , MD 1 , , MCommHealth 2 , , MSc 2 , , PhD 3 , , MSc, PhD 1
      (Reviewer), (Reviewer), (Reviewer)
      JMIR Formative Research
      JMIR Publications
      intermittent fasting, dry fasting, healthy plate, obesity, overweight

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          Abstract

          Background

          Adult obesity and overweight pose a substantial risk to global public health and are associated with various noncommunicable diseases. Although intermittent fasting (IF) is increasingly used as a relatively new dietary strategy for weight loss, the effectiveness of 2 days per week of dry fasting remains unknown.

          Objective

          This study aims to evaluate the effectiveness of a combined dry IF and healthy plate (IFHP) and healthy plate (HP) intervention in improving anthropometric outcomes and body composition.

          Methods

          This nonrandomized controlled trial involved 177 adults who were overweight and obese. Among them, 91 (51.4%) were allocated to the IFHP group and 86 (48.6%) were allocated to the HP group. The overall study duration was 6 months (October 2020 to March 2021). The intervention was divided into 2 phases: supervised (3 months) and unsupervised (3 months). The data were collected at baseline, after the supervised phase (month 3), and after the unsupervised phase (month 6). Anthropometric (weight, height, waist circumference, and hip circumference) and body composition (body fat percentage, body fat mass, skeletal muscle mass, and visceral fat area) data were measured at all 3 data collection points. Sociodemographic data were obtained using a questionnaire at baseline.

          Results

          Most participants were female (147/177, 83.1%) and Malay (141/177, 79.7%). After 3 months, there were significant reductions in weight (difference −1.68; P<.001), BMI (difference −0.62; P<.001), body fat percentage (difference −0.921; P<.001), body fat mass (difference −1.28; P<.001), and visceral fat area (difference −4.227; P=.008) in the IFHP group, whereas no significant changes were observed in the HP group. Compared to baseline, participants in the IFHP group showed a significant decrease in weight (difference −1.428; P=.003), BMI (difference −0.522; P=.005), body fat percentage (difference −1.591; P<.001), body fat mass (difference −1.501; P<.001), visceral fat area (difference −7.130; P<.001), waist circumference (difference −2.304; P=.001), and hip circumference (difference −1.908; P=.002) at month 6. During the unsupervised phase, waist (IFHP difference −3.206; P<.001, HP difference −2.675; P=.004) and hip (IFHP difference −2.443; P<.001; HP difference −2.896; P<.001) circumferences were significantly reduced in both groups ( P<.01), whereas skeletal muscle mass (difference 0.208; P=.04) and visceral fat area (difference −2.903; P=.003) were significantly improved in the IFHP group only. No significant difference in the between-group comparison was detected throughout the intervention (all P>.05).

          Conclusions

          A combined IFHP intervention was effective in improving anthropometric outcomes and body composition in adults with overweight and obesity.

          International Registered Report Identifier (IRRID)

          RR2-10.2196/33801.

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          Most cited references51

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          International physical activity questionnaire: 12-country reliability and validity.

          Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.
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            Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.

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            A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (> or =25 kg/m2). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22 kg/m2 to 25 kg/m2 in different Asian populations; for high risk it varies from 26 kg/m2 to 31 kg/m2. No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23.0, 27.5, 32.5, and 37.5 kg/m2) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.
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              Dietary assessment methods in epidemiologic studies

              Diet is a major lifestyle-related risk factor of various chronic diseases. Dietary intake can be assessed by subjective report and objective observation. Subjective assessment is possible using open-ended surveys such as dietary recalls or records, or using closed-ended surveys including food frequency questionnaires. Each method has inherent strengths and limitations. Continued efforts to improve the accuracy of dietary intake assessment and enhance its feasibility in epidemiological studies have been made. This article reviews common dietary assessment methods and their feasibility in epidemiological studies.
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                Author and article information

                Contributors
                Journal
                JMIR Form Res
                JMIR Form Res
                JFR
                JMIR Formative Research
                JMIR Publications (Toronto, Canada )
                2561-326X
                2024
                10 April 2024
                : 8
                : e51542
                Affiliations
                [1 ] Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research National Institutes of Health, Ministry of Health Shah Alam Malaysia
                [2 ] Sector for Biostatistic and Data Repository National Institutes of Health, Ministry of Health Shah Alam Malaysia
                [3 ] Department of Social and Preventive Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia
                Author notes
                Corresponding Author: Shazana Rifham Abdullah shazana.a@ 123456moh.gov.my
                Author information
                https://orcid.org/0000-0002-7503-5895
                https://orcid.org/0000-0002-9267-9035
                https://orcid.org/0000-0003-1443-1074
                https://orcid.org/0000-0002-2342-4012
                https://orcid.org/0000-0002-3310-1305
                https://orcid.org/0000-0002-8285-1612
                https://orcid.org/0000-0002-1856-407X
                https://orcid.org/0000-0003-4047-3999
                https://orcid.org/0000-0003-1989-7754
                https://orcid.org/0000-0002-5014-282X
                https://orcid.org/0000-0003-2107-3543
                https://orcid.org/0000-0002-5171-851X
                https://orcid.org/0000-0002-1044-1876
                https://orcid.org/0000-0001-9158-415X
                https://orcid.org/0000-0001-6960-0774
                Article
                v8i1e51542
                10.2196/51542
                11043932
                38598283
                63579daf-0f0f-4361-bb40-145a13f78038
                ©Shazana Rifham Abdullah, Ruziana Mona Wan Mohd Zin, Nur Hayati Azizul, Nur Suffia Sulaiman, Norhayati Mustafa Khalid, Roshan Jahn Mohd Salim Mullahi Jahn, Muhamad Khairul Nazrin Khalil, Norhashimah Abu Seman, Nur Azlin Zainal Abidin, Azizan Ali, You Zhuan Tan, Azahadi Omar, Zamtira Seman, Abqariyah Yahya, Mohd Fairulnizal Md Noh. Originally published in JMIR Formative Research (https://formative.jmir.org), 10.04.2024.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

                History
                : 3 August 2023
                : 16 January 2024
                : 5 February 2024
                : 6 February 2024
                Categories
                Original Paper
                Original Paper

                intermittent fasting,dry fasting,healthy plate,obesity,overweight

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