
Characteristics of Included Studies
Study | Country/study design | Sample size (M/F) | Patient BMI | Age (years) | Treatment | Duration | Follow up | Outcome measurements | ||||
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Lee et al19) (2011) |
Korea/OS | 11 (6/5) | Normal: 2 Overweight: 1 Obese: 8 |
27.46±5.05 | Relief period | 7 days Progressive food intake reduction Low salt diet Balhyo-hwan 2 po QD |
Exercise 1 h at least, daily | 5 weeks | NR |
Body composition (BW, BMI, SMM, BFM, PBF, BMR, WHR, VFA) Adverse event |
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Fasting period | 10~14 days Diluted Jeonghwasu 1,500~2,500 mL Balhyo-hwan 2 po BID |
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Refeeding period | 10~14 days Stepwise reintroduction Low salt diet, small meal |
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Ke et al20) (2012) |
China/RCT (2 arm) 70 | T: 38 (12/16) C: 32 (14/18) |
Obese: 70 | T: 42.5±8.5 C: 42.1±8.2 |
Relief period | 1 day Appropriate amount of fruit | Exercise 2 h, daily | 6 months (once per 3 months) | NR |
Body composition (BW, BMI, WC) Lipid test (TC, TG, LDL, HDL) Blood sugar test (FPG, 2hPG) Diabetic scale (FINS, HOMA-IR) |
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Fasting period | 5 days | T: Modified Yeonggyechulgam-tang BID (total 300 mL) Others same as control |
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C: Water 3,000 mL ≤ 1 day Xumaing-powder 15 g |
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Refeeding period | 1 day Stepwise reintroduction |
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Ke et al21) (2012) | China/RCT (2 arm) | 65 T: 35 (16/19) C: 30 (14/16) |
Obese: 65 | T: 45.76±7.14 C: 46.13±8.73 |
Relief period | T: 1 day Appropriate amount of fruit |
Exercise 2h, daily | C: No fasting therapy | 4 weeks | NR |
Body composition (BW, BMI) Lipid test (TC, TG, LDL, HDL) Blood pressure (SBP, DBP) Others (AngⅡ) |
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Fasting period | T: 5 days Modified Yeonggyechulgam-tang Water 3,000 mL ≤ 1 day Xumaing-powder |
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Refeeding period | T: 1 day Stepwise reintroduction |
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Dietary period | T: 3 weeks Modified Yeonggyechulgam-tang Others same as control |
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C: 4 w eeks Calorie restricted diet Exercise (aerobic, 1 h, 3 times/1 W) |
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Ke et al22) (2013) | China/RCT (2 arm) | 78 T: 40 (18/22) C: 38 (18/20) |
Obese: 78 | T: 39.39±14.05 C: 38.43±10.12 |
Relief period | 1 day Appropriate amount of fruit |
Exercise 2 h, daily | 1 week | NR |
Body composition (BW, BMI, WC) Lipid test (TC, TG, LDL, HDL) Blood sugar test (FPG) Liver function test (AST, ALT, TB, DB) Renal function test (BUN) Complete blood count Others (UA) |
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Fasting period | 5 days | T: Modified Yeonggyechulgam-tang QD (total 150 mL) Others same as control |
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C: Water 3,000 mL ≤ 1 day Xumaing-powder |
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Refeeding period | 1 day Stepwise reintroduction |
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Oh et al23) (2015) |
Korea/OS | 3 (3/0) | Normal: 1 Obese: 2 |
43.3 | Relief period | Not implicated | Exercise (fast walking, 40 min) | 13 days | NR |
Body composition (BW, BMI, SMM, BFM, PBF, BMR, WHR, ED, FFM) Lipid test (TC) Blood sugar test (FPG) Liver function test (AST, ALT, GTP, ALP, TB, TP, ALB, GLB) Renal function test (BUN, Cr, BUN/Cr ratio) Complete blood count Differential count Inflammation (hs-CRP, CRP, ESR) Blood pressure (SBP) |
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Fasting period | 10 days Gamrosu 6 times/day (total 180 mL, 431 kcal) Water 2,000 mL ≤ |
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Refeeding period | 3 days Stepwise reintroduction No-salt diet, gruel 1,200 kcal, Low salt diet (day 2 1,500 kcal, day 3 2,400 kcal) |
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Kim et al24) (2016) | Korea/OS | 26 (9/17) | Obese: 26 | 39±9 | Relief period | 7 days Progressive food intake reduction Low salt diet |
Exercise (1 hour at least, daily) | 5 weeks | NR |
Body composition (BW, SMM, BFM) Lipid test (TC, TG) Liver function test (AST, ALT) |
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Fasting period | 14 days Fermented herbal medicine (signature) (total 200~300 mL, 400~600 kcal) Probiotic BID |
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Refeeding period | 14 days Stepwise reintroduction Low salt diet |
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Kim et al25) (2016) | Korea/OS | 6 (5/1) | Obese: 6 | 41.8 | Relief period | Not implicated | Exercise (fast walking, 40 min) | 13 days | NR |
Body composition (BW, BMI, SMM, BFM, PBF) Lipid test (TC) Blood sugar test (FPG) Liver function test (AST, ALT, GTP, ALP, TB, TP, ALB, GLB) Renal function test (BUN, Cr, BUN/Cr ratio) Blood pressure (SBP, DBP) Inflammation (hs-CRP, CRP, ESR) Complete blood count Differential count Electrolyte Oxidative stress Urine test |
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Fasting period | 10 days Gamrosu 6 times/day (total 180 mL, 420.6 kcal) Water 2,000mL ≤ |
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Refeeding period | 3 days Stepwise reintroduction No-salt diet, gruel 1,200 kcal, Low salt diet (day 2 1,500 kcal, day 3 1,800 kcal) |
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Shin et al26) (2016) | Korea/OS | 33 (17/16) | Overweight: 7 Obese: 26 |
20~29: 11 30~39: 6 40~49: 11 50~59: 5 |
Relief period | 2 days Food intake as usual Avoid heavy meal, alcohol, caffeine, and meat |
Exercise (aerobic, 40 min) | 15 days | NR |
Body composition (BW, WC, BMI, SMM, BFM, PBF, BMR, WHR, VFA) Lipid test (TC, TG, LDL, HDL) Blood sugar test (FPG) Liver function test (AST, ALT, GTP, ALP, TB, DB, TP, ALB, GLB) Renal function test (BUN, Cr, BUN/Cr ratio) Inflammation (hs-CRP, CRP, ESR) Blood pressure (SBP, DBP) Complete blood count Differential count Electrolyte Urine test RCFS, SSS |
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Fasting period | 10 days Gamrosu 6 times/day (total 180 mL, 420.6 kcal) Water 2,500 mL ≤ |
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Refeeding period | 3 days Stepwise reintroduction No-salt diet, gruel 1,200 kcal, Low salt diet (day 2 1,500 kcal, day 3 1,800 kcal) |
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Fan et al27) (2017) |
China/RCT (2 arm) | 86 T: 43 (24/19) C: 43 (23/20) |
Obese: 86 | T: 47.24±7.21 C: 47.01±7.52 |
Relief period | T: 1 day Appropriate amount of fruit |
Exercise 2 h, daily | C: No fasting therapy | 4 weeks | NR |
Body composition (BW, BMI) Lipid test (TC, TG, LDL, HDL) Blood pressure (SBP, DBP) Others (AngⅡ) |
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Fasting period | T: 5 days Modified Yeonggyechulgam-tang Water 3,000 mL ≤ 1 day Xumaing-powder |
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Refeeding period | T: 1 day Stepwise reintroduction |
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Dietary period | T: 3 weeks Modified Yeonggyechulgam-tang Others same as control |
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C: 4 weeks Calorie restricted diet Exercise (aerobic, 1 h, 3 times/1 W) |
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Shin et al28) (2017) | Korea/OS | (0/1) | Obese: 1 | 30 | Relief period | 2 days Food intake as usual Avoid heavy meal, alcohol, caffeine, and meat |
Exercise not implicated | 15 days | NR |
Body composition (BW, BMI, SMM, BFM, FFM, VFA) Lipid test (TC, TG, LDL, HDL) Liver function test (AST, ALT, TB, DB) |
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Fasting period | 10 days Gamrosu 6 times/day (total 180 mL, 431 kcal) Water 2,500 mL ≤ Beau’clean 2 po TID |
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Refeeding period | 3 days Stepwise reintroduction No-salt diet, gruel 1,200 kcal Low salt diet (day 2 1,500 kcal, day 3 1,800 kcal) |
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Huang et al29) (2018) |
China/RCT (2 arm) | 158 T: 79 (38/41) C: 79 (46/33) |
Obese: 158 | T: 43.2±8.1 C: 41.7±7.6 |
Relief period | T: 1 day Appropriate amount of fruit |
Exercise: (aerobic 1 h, daily) | C: No fasting therapy | 11 weeks | NR |
Body composition (BW, BMI, WC, AC, HC) Blood sugar test (FPG, 2hPG) Others (effective rate) |
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Fasting period | T: 5 days Modified Yeonggyechulgam-tang (total 500 mL) Water 3,000~5,000 mL Levocarnitine 2~3 g, IV, TID 1 day Xumaing-powder 15 g |
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Refeeding period | T: 1 day Stepwise reintroduction |
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Dietary period | T: 10 weeks Same as control |
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C: 11 weeks Normal diet Exercise (aerobic 1 h) |
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Baek et al30) (2018) |
Korea/OS | 11 (0/11) | Normal: 2 Overweight: 1 Obese: 8 |
44.82±13.29 | Relief period | 2 days Progressive food intake reduction Jangkwae-hwan 4 g TID |
Exercise (aerobic, 40 min) | 7 days | NR |
Body composition (BW, BMI, SMM, BFM, VFA, ECW, BMR, AC, ASF) |
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Fasting period | 3 days Gamrosu 5 times/day (total 150 mL, 350.4 kcal) Water 2,500 mL ≤ |
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Refeedin g period | 2 days Stepwise reintroduction Day 1: No salt diet, gruel 1,200 kcal Day 2: Low salt diet, 1,500 kcal Galgeun-tang granule 2.5 g TID |
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Zhang et al31) (2022) |
China/OS | 34 (18/16) | Overweight: 16 Obese: 18 |
<30: 2 30~45: 18 46~60: 12 >60: 2 |
Relief period | T: 1 day Fruit 1,500 g Water 3,000 mL ≤ |
Exercise not implicated | 1 week | 6 months |
Body composition (BW, BMI) Liver function test (AST, ALT, GTP) Blood sugar test (FPG) Blood pressure (SBP, DBP) Diabetic scale (FINS, HOMA-IR, HbA1c) Others (UA, β-HB) |
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Fasting period | T: 5 days Modified Yeonggyechulgam-tang TID (total 600 mL) Levocarnitine IV, BID 1 day Xumaing-powder 20 g |
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Refeedin g period | T: 1 day Stepwise reintroduction |
M: male, F: female, T: treatment group, C: control group, OS: observational study, RCT: randomized controlled trial, NR: not reported, BW: b ody weight, BMI : body mass index, SMM: skeletal muscle mass, BFM: body fat mass, PBF: percent body fat, BMR: basal metabolic rate, WHR: waist-hip ratio, VFA: visceral fat area, AE: adverse effect, WC: waist circumflex, TC: total cholesterol, TG: triglyceride, LDL: low density lipoprotein, HDL: high density lipoprotein, FPG: fast plasma glucose, 2hPG: 2 hours postprandial glucose, FINS: fasting insulin, HOMA-IR: homeostasis model assessment-insulin resistance, SBP: systolic blood pressure, DBP: diastolic blood pressure, ANGⅡ: angiotensin 2, AST: aspartate aminotransferase, ALT: alanine aminotransferase, GTP: guanosine triphosphate, TB: total bilirubin, DB: direct bilirubin, BUN: blood urea nitrogen, FFM: fat free mass, ED: edema, TP: total protein, ALB: albumin, GLB: globulin, Cr: creatine, hs-CRP: high sensitive C-reactive protein, CRP: C-reactive protein, ESR: erythrocyte sedimentation, RCFS: revised Chalder’s fatigue scale, SSS: subjective symptom scale, ECW: extracellular water, AC: abdominal circumference, ASF: thickness of abdominal subcutaneous fat, UA: uric acid, β-HB: β-hydroxybutyric acid, QD: quaque die, BID: bis in die, TID: ter in die, W: week, h: hour, min: minute.
*Three clinical studies were excluded for quantitative analysis. Lee et al.19) included participants with normal BMI, which data could not be selectively extracted from overweight and obese participants. Ke et al.20) conducted MFTs twice at 3-month intervals and reported only the final results, which may induce heterogeneity in quantitative analysis when synthesized with other studies that conducted MFT only once. Also, the study showed discrepancy between the total number of participants and total participants by gender, which may have possibility of attrition bias. Huang et al.29) only reported the final results of 10 week dietary period after 5 days of fasting, making it difficult to regard them as an effect of fasting therapy.
†Oh et al.23) and Baek et al.30) included participants with normal BMI. Therefore data of overweight or obese participants were selectively extracted for quantitative analysis.
‡The lipid test indices from Fan et al.27) were excluded for quantitative analysis as those were only reported in the post-trial results.
§Only FPG were extracted from Zhang et al.31), as results of other indices except for diabetes were reported in graphs without specific value.