Implications for further research - DISCUSSION 4.1. Summary of main results

CHAPTER 4: DISCUSSION 4.1. Summary of main results

4.7. Implications for further research

This systematic review advocates the need for further high-quality, more adequately powered, large-scale RCTs conducted in different countries with a more diverse population and free-living conditions when possible. A clear definition of what ADF actually constitutes needs to be

established. It should also be mentioned that both the feelings of appetite and body weight measurements are different in feed and fast days. Hence, future trials of ADF should average measurements taken from consecutive feed and fast days throughout the day to attain more accurate assessments. Examining the adherence to ADF in relation to cognitive, environmental, psychological, and/or physiological factors, identifying barriers and facilitators to this approach, and defining which populations may gain the most benefit and why will help to better

comprehend the effects of this intervention and assess the feasibility. Evaluating the impact of

ADF on appetite hormones such as ghrelin, PYY, or GLP-1, and ketone bodies during weight loss and weight maintenance is needed. As clinical guidelines require interventions that are deemed both clinically and cost effective, economic evaluations of this approach are also required. Long-term trials are needed to fully investigate the effects of ADF on appetite, weight loss, weight management, diet sustainability, and safety. As the growing interest accumulates over IER practices, it is important that future studies build on the findings of this review.

4.8. Conclusion

This systematic review summarizes and presents the effects of ADF on subjective feelings of appetite and weight loss. The findings suggest that the intervention has small or no effect on feelings of hunger, fullness, satisfaction, and desire to eat and has a small effect on body weight.

The quality of evidence is too low to draw robust conclusions and it is hard to justify the generalization of the results. While this systematic review gives promises, more rigorous, large-scale, long-term studies are needed to support the evidence in this review.

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62 APPENDICES Appendix 1. PRISMA 2020 Checklist

Section and

Title 1 Identify the report as a systematic review. Cover

ABSTRACT

Abstract 2 See the PRISMA 2020 for Abstracts checklist. v

INTRODUCTION

Rationale 3 Describe the rationale for the review in the context of existing knowledge. 13

Objectives 4 Provide an explicit statement of the objective(s) or question(s) the review addresses. 15 METHODS

Eligibility criteria 5 Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses. 16 Information

sources

6 Specify all databases, registers, websites, organisations, reference lists and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted.

18, 69 Search strategy 7 Present the full search strategies for all databases, registers and websites, including any filters and limits used. 69 Selection

process

8 Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process.

Data collection process

9 Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.

Data items 10a List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome domain in each study were sought (e.g. for all measures, time points, analyses), and if not, the methods used to decide which results to collect.

10b List and define all other variables for which data were sought (e.g. participant and intervention characteristics, funding sources). Describe any assumptions made about any missing or unclear information.

73 Study risk of

bias assessment

11 Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process.

Effect measures 12 Specify for each outcome the effect measure(s) (e.g. risk ratio, mean difference) used in the synthesis or presentation of results.

13a Describe the processes used to decide which studies were eligible for each synthesis (e.g. tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)).

20, 21 13b Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary

statistics, or data conversions.

19 13c Describe any methods used to tabulate or visually display results of individual studies and syntheses. 20, 21 13d Describe any methods used to synthesize results and provide a rationale for the choice(s). If meta-analysis was

performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used.

13e Describe any methods used to explore possible causes of heterogeneity among study results (e.g. subgroup analysis, meta-regression).

20, 21 13f Describe any sensitivity analyses conducted to assess robustness of the synthesized results. 45 Reporting bias

assessment

14 Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases). 21 Certainty

assessment

15 Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome. 21, 22 RESULTS

Study selection 16a Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram.

24 16b Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were

excluded.

129 Study

characteristics

17 Cite each included study and present its characteristics. 25, 26

Risk of bias in studies

18 Present assessments of risk of bias for each included study. 30-35

Results of individual studies

19 For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g. confidence/credible interval), ideally using structured tables or plots.

35-44

Results of syntheses

20a For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies. 35-44 20b Present results of all statistical syntheses conducted. If meta-analysis was done, present for each the summary

In document A Systematic Review on the Effects of Alternate Day Fasting on Subjective Feelings of Appetite and Body Weight for Overweight and Obese Adults (sider 64-87)