Research Advances on the Effects of Intermittent Fasting on Cardiometabolic Diseases

doi:10.12114/j.issn.1007-9572.2025.0158

Abstract

Abstract:

This review summarizes the effects of intermittent fasting on cardiometabolic diseases in humans and examines various fasting regimens-including alternate-day fasting, the 5∶2 diet, time-restricted eating, and the 16∶8 diet. These approaches may confer benefits for cardiometabolic health by reducing blood pressure, insulin resistance, and oxidative stress. Although large-scale randomized controlled trials investigating the relationship between intermittent fasting and cardiovascular outcomes are lacking, and some studies suggest a potential increase in cardiovascular risk, the majority of existing clinical evidence indicates that this dietary pattern may reduce the risk of cardiovascular disease by improving weight control, hypertension, dyslipidemia, and diabetes. Intermittent fasting is thought to exert its effects through multiple mechanisms, including reduced oxidative stress, optimized circadian rhythms, and ketogenesis. It is generally safe and is not associated with disruptions in energy levels or increased disordered eating behaviors, while also offering additional health benefits. In conclusion, intermittent fasting represents a relatively safe dietary intervention whose potential cardiovascular implications warrant further investigation.

Key words: Cardiovascular metabolic diseases, Diabetes, Hypertension, Dyslipidemia, Intermittent fasting, Alternate day fasting, 5∶2 diet, 16∶8 diet

摘要：

本文综述了间歇性禁食对人体心血管代谢疾病的影响，回顾了部分禁食形式-交替日禁食、5∶2饮食、时间限制饮食和16∶8饮食法，这些方案可能通过降低血压、胰岛素抵抗和氧化应激来促进心脏代谢健康。尽管尚无大型随机对照试验来研究间歇性禁食与心血管结局之间的关系，以及个别研究显示禁食可能增高心血管疾病风险，但现有的大多数临床研究提示这种饮食模式可能通过改善体质量控制、高血压、血脂异常和糖尿病来降低心血管疾病的风险。间歇性禁食可能通过减少氧化应激、优化昼夜节律和生酮作用等多条途径发挥作用。间歇性禁食通常是安全的，不会导致能量水平紊乱或增加饮食紊乱行为，同时也有其他健康益处。总之，间歇性禁食是一种相对安全的饮食疗法，对心血管的潜在影响还需继续探究。

关键词: 心血管代谢疾病, 糖尿病, 高血压, 血脂异常, 间歇性禁食, 隔日禁食, 5∶2饮食, 限时饮食, 16∶8饮食法

MIAO Jingjie,ZHANG Jinwen,WU Qianhao, et al. Research Advances on the Effects of Intermittent Fasting on Cardiometabolic Diseases[J]. Chinese General Practice, 2026, 29(18): 2538-2545. DOI: 10.12114/j.issn.1007-9572.2025.0158.
苗境杰,张晋雯,吴千豪等. 间歇性禁食对心血管代谢疾病影响的研究进展[J]. 中国全科医学, 2026, 29(18): 2538-2545. DOI: 10.12114/j.issn.1007-9572.2025.0158.

References 57

[1]	VARADY K A, CIENFUEGOS S, EZPELETA M, et al. Cardiometabolic benefits of intermittent fasting[J]. Annu Rev Nutr, 2021, 41: 333-361. DOI: 10.1146/annurev-nutr-052020-041327.
[2]	NEMATY M, ALINEZHAD-NAMAGHI M, RASHED M M, et al. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study[J]. Nutr J, 2012, 11(1): 69. DOI: 10.1186/1475-2891-11-69.
[3]	国家心血管病中心, 中国心血管健康与疾病报告编写组, 胡盛寿. 中国心血管健康与疾病报告2024概要[J]. 中国循环杂志, 2025, 40(6): 521-559. DOI: 10.3969/j.issn.1000-3614.2025.06.001.
[4]	宋双, 孙大康, 李洋, 等. COVID-19相关性心血管疾病的研究进展[J]. 药学研究, 2021, 40(4): 239-243, 277. DOI: 10.13506/j.cnki.jpr.2021.04.008.
[5]	VASIM I, MAJEED C N, DEBOER M D. Intermittent fasting and metabolic health[J]. Nutrients, 2022, 14(3): 631. DOI: 10.3390/nu14030631.
[6]	DIAB R, DIMACHKIE L, ZEIN O, et al. Intermittent fasting regulates metabolic homeostasis and improves cardiovascular health[J]. Cell Biochem Biophys, 2024, 82(3): 1583-1597. DOI: 10.1007/s12013-024-01314-9.
[7]	TINSLEY G M, LA BOUNTY P M. Effects of intermittent fasting on body composition and clinical health markers in humans[J]. Nutr Rev, 2015, 73(10): 661-674. DOI: 10.1093/nutrit/nuv041.
[8]	ABDELLATIF M, RAINER P P, SEDEJ S, et al. Hallmarks of cardiovascular ageing[J]. Nat Rev Cardiol, 2023, 20(11): 754-777. DOI: 10.1038/s41569-023-00881-3.
[9]	CHANDRASEKAR B, NELSON J F, COLSTON J T, et al. Calorie restriction attenuates inflammatory responses to myocardial ischemia-reperfusion injury[J]. Am J Physiol Heart Circ Physiol, 2001, 280(5): H2094-H2102. DOI: 10.1152/ajpheart.2001.280.5.H2094.
[10]	PATTERSON R E, SEARS D D. Metabolic effects of intermittent fasting[J]. Annu Rev Nutr, 2017, 37: 371-393. DOI: 10.1146/annurev-nutr-071816-064634.
[11]	DONG T A, SANDESARA P B, DHINDSA D S, et al. Intermittent fasting: a heart healthy dietary pattern?[J]. Am J Med, 2020, 133(8): 901-907. DOI: 10.1016/j.amjmed.2020.03.030.
[12]	World Health Organisation. Cardiovascular diseases[EB/OL]. [2025-03-11].
[13]	CLIFTON K K, MA C X, FONTANA L, et al. Intermittent fasting in the prevention and treatment of cancer[J]. CA Cancer J Clin, 2021, 71(6): 527-546. DOI: 10.3322/caac.21694.
[14]	CARVAJAL V, MARÍN A, GIHARDO D, et al. El ayuno intermitente y sus efectos en la salud metabólica en humanos[J]. Rev Méd Chile, 2023, 151(1): 81-100. DOI: 10.4067/s0034-98872023000100081.
[15]	AHMET I, WAN R, MATTSON M P, et al. Chronic alternate day fasting results in reduced diastolic compliance and diminished systolic reserve in rats[J]. Journal of Cardiac Failure, 2010, 16(10): 843 853. DOI: 10.1016/j.cardfail.2010.05.007.
[16]	HARRIS E. Study examines intermittent fasting and cardiovascular mortality[J]. JAMA, 2024, 331(17): 1440. DOI: 10.1001/jama.2024.5158.
[17]	GUO Z, RIPOLL C V, PICATAGGI A, et al. Apolipoprotein M attenuates anthracycline cardiotoxicity and lysosomal injury[J]. JACC Basic Transl Sci, 2023, 8(3): 340-355. DOI: 10.1016/j.jacbts.2022.09.010.
[18]	OZCAN M, ABDELLATIF M, JAVAHERI A, et al. Risks and benefits of intermittent fasting for the aging cardiovascular system[J]. Can J Cardiol, 2024, 40(8): 1445-1457. DOI: 10.1016/j.cjca.2024.02.004.
[19]	CHEN M, ZHONG V W. Association between time-restricted eating and all-cause and cause-specific mortality[J]. Circulation, 2024, 149(Suppl_1): AP192. DOI: 10.1161/CIRC.149.SUPPL_1.P192.
[20]	American Heart Association. 8-hour time-restricted eating linked to a 91% higher risk of cardiovascular death[EB/OL]. [2025-03-11].
[21]	ZIMMERMANN A, MADEO F, DIWAN A, et al. Metabolic control of mitophagy[J]. Eur J Clin Invest, 2024, 54(4): e14138. DOI: 10.1111/eci.14138.
[22]	EZAKI J, MATSUMOTO N, TAKEDA-EZAKI M, et al. Liver autophagy contributes to the maintenance of blood glucose and amino acid levels[J]. Autophagy, 2011, 7(7): 727-736. DOI: 10.4161/auto.7.7.15371.
[23]	VAN ABEELEN A F M, ELIAS S G, BOSSUYT P M M, et al. Cardiovascular consequences of famine in the young[J]. Eur Heart J, 2012, 33(4): 538-545. DOI: 10.1093/eurheartj/ehr228.
[24]	SEBASTIAN S A, SHAH Y, ARSENE C. Intermittent fasting and cardiovascular disease: a scoping review of the evidence[J]. Dis Mon, 2024, 70(11): 101778. DOI: 10.1016/j.disamonth.2024.101778.
[25]	HARVIE M N, PEGINGTON M, MATTSON M P, et al. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women[J]. Int J Obes(Lond), 2011, 35(5): 714-727. DOI: 10.1038/ijo.2010.171.
[26]	HEILBRONN L K, SMITH S R, MARTIN C K, et al. Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolism[J]. Am J Clin Nutr, 2005, 81(1): 69-73. DOI: 10.1093/ajcn/81.1.69.
[27]	HODDY K K, KROEGER C M, TREPANOWSKI J F, et al. Meal timing during alternate day fasting: Impact on body weight and cardiovascular disease risk in obese adults[J]. Obesity (Silver Spring), 2014, 22(12): 2524-2531. DOI: 10.1002/oby.20909.
[28]	MALIK V S, WILLET W C, HU F B. Nearly a decade on—trends, risk factors and policy implications in global obesity[J]. Nat Rev Endocrinol, 2020, 16(11): 615-616. DOI: 10.1038/s41574-020-00411-y.
[29]	HEALTH-EUROPE T L R. Pandemic heightens the need to combat cardiovascular diseases[J]. Lancet Reg Health Eur, 2021, 8: 100217. DOI: 10.1016/j.lanepe.2021.100217.
[30]	POWELL-WILEY T M, POIRIER P, BURKE L E, et al. Obesity and cardiovascular disease: a scientific statement from the American heart association[J]. Circulation, 2021, 143(21): e984-1010. DOI: 10.1161/cir.0000000000000973
[31]	LEIKIN J B. Foreword for intermittent fasting and cardiovascular disease: a scoping review of the evidence[J]. Dis Mon, 2024, 70(11): 101777. DOI: 10.1016/j.disamonth.2024.101777.
[32]	SUTTON E F, BEYL R, EARLY K S, et al. Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes[J]. Cell Metab, 2018, 27(6): 1212-1221.e3. DOI: 10.1016/j.cmet.2018.04.010.
[33]	ELIOPOULOS A G, GKOUSKOU K K, TSIOUFIS K, et al. A perspective on intermittent fasting and cardiovascular risk in the era of obesity pharmacotherapy[J]. Front Nutr, 2025, 12: 1524125. DOI: 10.3389/fnut.2025.1524125.
[34]	KHALAFI M, MALEKI A H, EHSANIFAR M, et al. Longer-term effects of intermittent fasting on body composition and cardiometabolic health in adults with overweight and obesity: a systematic review and meta-analysis[J]. Obes Rev, 2025, 26(2): e13855. DOI: 10.1111/obr.13855.
[35]	CONRAD Z, KOWALSKI C, DUSTIN D, et al. Quality of popular diet patterns in the United States: evaluating the effect of substitutions for foods high in added sugar, sodium, saturated fat, and refined grains[J]. Curr Dev Nutr, 2022, 6(9): nzac119. DOI: 10.1093/cdn/nzac119.
[36]	VARADY K A, BHUTANI S, KLEMPEL M C, et al. Comparison of effects of diet versus exercise weight loss regimens on LDL and HDL particle size in obese adults[J]. Lipds Health Dis, 2011, 10(1): 119. DOI: 10.1186/1476-511X-10-119.
[37]	BHUTANI S, KLEMPEL M C, KROEGER C M, et al. Alternate day fasting and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans[J]. Obesity (Silver Spring), 2013, 21(7): 1370-1379. DOI: 10.1002/oby.20353.
[38]	CHÁVEZ-ALFARO L, SILVEIRA-SANGUINO V, PIERNAS C. Prevention of cardiometabolic diseases through dietary modifications[J]. Curr Opin Lipidol, 2025, 36(1): 14-20. DOI: 10.1097/MOL.0000000000000961.
[39]	RAJEWSKI P, CIEŚCIŃSKI J, RAJEWSKI P, et al. Dietary interventions and physical activity as crucial factors in the prevention and treatment of metabolic dysfunction-associated steatotic liver disease[J]. Biomedicines, 2025, 13(1): 217. DOI: 10.3390/biomedicines13010217.
[40]	WALSH M E, SHI Y, VAN REMMEN H. The effects of dietary restriction on oxidative stress in rodents[J]. Free Radic Biol Med, 2014, 66: 88-99. DOI: 10.1016/j.freeradbiomed.2013.05.037.
[41]	PÓVOA R. Intermittent fasting and blood pressure reduction: related mechanisms[J]. Arq Bras Cardiol, 2023, 120(5): e20230265. DOI: 10.36660/abc.20230265.
[42]	TINSLEY G M, FORSSE J S, BUTLER N K, et al. Time-restricted feeding in young men performing resistance training: a randomized controlled trial[J]. Eur J Sport Sci, 2017, 17(2): 200-207. DOI: 10.1080/17461391.2016.1223173.
[43]	MENSAH E O, DANYO E K, ASASE R V. Exploring the effect of different diet types on ageing and age-related diseases[J]. Nutrition, 2025, 129: 112596. DOI: 10.1016/j.nut.2024.112596.
[44]	PARROTTA M E, COLANGELI L, SCIPIONE V, et al. Time restricted eating: a valuable alternative to calorie restriction for addressing obesity?[J]. Curr Obes Rep, 2025, 14(1): 17. DOI: 10.1007/s13679-025-00609-z.
[45]	MINARI T P, MANZANO C F, YUGAR L B T, et al. The effect of breakfast skipping and sleep disorders on glycemic control, cardiovascular risk, and weight loss in type 2 diabetes[J]. Clin Nutr ESPEN, 2025, 65: 172-181. DOI: 10.1016/j.clnesp.2024.11.026.
[46]	LV T T, LIU C Y, GUO S T, et al. Targeting ketone body metabolism improves cardiac function and hemodynamics in patients with heart failure: a systematic review and meta-analysis[J]. Nutr Rev, 2025, 83(7): e1521-e1532. DOI: 10.1093/nutrit/nuae179.
[47]	HO K L, KARWI Q G, WANG F Q, et al. The ketogenic diet does not improve cardiac function and blunts glucose oxidation in ischaemic heart failure[J]. Cardiovasc Res, 2024, 120(10): 1126-1137. DOI: 10.1093/cvr/cvae092.
[48]	ZHOU J, WU X L, XIANG T Y, et al. Dynamical alterations of brain function and gut microbiome in weight loss[J]. Front Cell Infect Microbiol, 2023, 13: 1269548. DOI: 10.3389/fcimb.2023.1269548.
[49]	GUO Y, LUO S Y, YE Y X, et al. Intermittent fasting improves cardiometabolic risk factors and alters gut microbiota in metabolic syndrome patients[J]. J Clin Endocrinol Metab, 2021, 106(1): 64-79. DOI: 10.1210/clinem/dgaa644.
[50]	CHAJADINE M, LAURANS L, RADECKE T, et al. Harnessing intestinal tryptophan catabolism to relieve atherosclerosis in mice[J]. Nat Commun, 2024, 15(1): 6390. DOI: 10.1038/s41467-024-50807-x.
[51]	HU X W, XIA K, DAI M H, et al. Intermittent fasting modulates the intestinal microbiota and improves obesity and host energy metabolism[J]. NPJ Biofilms Microbiomes, 2023, 9: 19. DOI: 10.1038/s41522-023-00386-4.
[52]	CHEN B C, HUNG M Y, WANG H F, et al. GABA tea attenuates cardiac apoptosis in spontaneously hypertensive rats(SHR)by enhancing PI3K/Akt-mediated survival pathway and suppressing Bax/Bak dependent apoptotic pathway[J]. Environ Toxicol, 2018, 33(7): 789-797. DOI: 10.1002/tox.22565.
[53]	ABDELRAHIM D, FARIS M E, HASSANEIN M, et al. Impact of Ramadan diurnal intermittent fasting on hypoglycemic events in patients with type 2 diabetes: a systematic review of randomized controlled trials and observational studies[J]. Front Endocrinol (Lausanne), 2021, 12: 624423. DOI: 10.3389/fendo.2021.624423.
[54]	CHENG W L, MENG X, GAO J, et al. Relationship between circadian eating behavior (daily eating frequency and nighttime fasting duration) and cardiovascular mortality[J]. Int J Behav Nutr Phys Act, 2024, 21(1): 22. DOI: 10.1186/s12966-023-01556-5.
[55]	SKAZNIK-WIKIEL M E, POLOTSKY A J. The health pros and cons of continuous versus intermittent calorie restriction: more questions than answers[J]. Maturitas, 2014, 79(3): 275-278. DOI: 10.1016/j.maturitas.2014.08.007.
[56]	BILLINGSLEY H E. The effect of time of eating on cardiometabolic risk in primary and secondary prevention of cardiovascular disease[J]. Diabetes Metab Res Rev, 2024, 40(2): e3633. DOI: 10.1002/dmrr.3633.
[57]	SHAFIEE M, SADEGHI A, GHAFOURI-TALEGHANI F, et al. Effects of time restricted feeding combined with Lacto Ovo vegetarian diet on metabolic associated fatty liver disease management: a randomized clinical trial[J]. Sci Rep, 2025, 15(1): 4463. DOI: 10.1038/s41598-025-88773-z.