Effects of 5:2 intermittent fasting meal replacement on body composition and abdominal fat distribution in overweight and obese adults with early type 2 diabetes.

BACKGROUND AND AIMS: The 5:2 intermittent fasting meal replacement (5:2 MR) improved glycemic control and weight loss in adults with type 2 diabetes mellitus (T2DM).

OBJECTIVE

This analysis further investigated the exploratory outcomes related to body composition and abdominal fat distribution.

METHODS

This was a single-center analysis of a randomized, active-controlled trial (EARLY), which enrolled overweight and obese patients with early T2DM. A total of 85 participants were randomly assigned to receive metformin (n = 28), empagliflozin (n = 28), or 5:2 MR (n = 29) for 16 weeks. Body composition was assessed using InBody device, and the energy spectrum CT was used to measure abdominal fat distribution. Spearman's correlation coefficient was used to evaluate the associations between change in body mass index (BMI) and change in the exploratory outcomes.

RESULTS

Compared with the metformin and empagliflozin groups, the 5:2 MR group showed the most significant reductions in BMI (least-squares mean, -3.41 kg/m2 [standard error, 0.31], P < 0.001), waist circumference (-8.83 cm [1.07], P < 0.001), waist-to-hip ratio (WHR) (-0.04 [0.01], P < 0.05), waist-to-height ratio (WHtR) (-0.05 [0.01], P < 0.001), body fat percentage (BF%) (-4.84 % [0.66], P < 0.05), abdominal cross-sectional area (ACSA) (-66.05 cm2 [9.46], P < 0.01), subcutaneous fat area (-58.27 cm2 [5.99], P < 0.001), and an increase in the liver-to-spleen (L/S) ratio) (0.43 [0.04], P < 0.01). In the 5:2 MR group, changes in BMI exhibited linear associations and significant positive correlations with changes in WHR (r = 0.411, P = 0.030), WHtR (r = 0.635, P < 0.001), BF% (r = 0.528, P = 0.020) and ACSA (r = 0.562, P = 0.003).

CONCLUSION

The 5:2 MR regimen may be more effective than metformin and empagliflozin in improving body composition and abdominal fat distribution in early T2DM, and is proposed as a therapeutic option.