Effects of different degrees of insulin resistance on endothelial function in obese adults undergoing alternate day fasting

BACKGROUND: Obesity can have deleterious effects on insulin sensitivity leading to endothelial dysfunction. Whether alternate day fasting (ADF) can ameliorate insulin sensitivity in a way that improves endothelial function remains unknown. OBJECTIVE: This study examined the impact of ADF on endothelium dependent flow mediated dilation (FMD) in obese subjects with different degrees of insulin resistance. METHODS: Obese non-diabetic adults (n = 54) participated in an 8-week ADF protocol (25% energy intake "fast day", alternated with ad libitum intake "feast day"). Subjects were divided into tertiles according to degree of insulin resistance based on HOMA-IR (Homeostatic model assessment-Insulin resistance): tertile 1 (0.8-2.4), tertile 2 (2.5-3.6), tertile 3 (3.7-12.4). RESULTS: Body weight decreased (P < 0.001) by 4% in each tertile. Fat mass, lean mass, and visceral fat mass also decreased (P < 0.001) similarly in each tertile. After 8 weeks of ADF, FMD and adiponectin differed (P < 0.05) between tertile 1 (3±0%; 26±23%) versus tertile 3 (-3±0%; -13±10%). Changes in leptin did not differ between tertiles (tertile 1: -23±7%; tertile 2: -20±7%; tertile 3: -9±7%). Fasting glucose did not change in any tertile. Fasting insulin and HOMA-IR differed (P < 0.05) between tertile 1 (10±11%; 11±11%) versus tertile 3 (-27±8%; -30±9%). Plasma lipids, blood pressure and heart rate did not change in any tertile. CONCLUSION: Our data suggest that ADF may be effective for decreasing insulin resistance in insulin resistant subjects, but these changes have no effect on endothelial function.