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Defining Prolonged and Intermittent Fasting: International Consensus on Fasting Terminology

33 Pages Posted: 18 Dec 2023 Publication Status: Published

See all articles by Daniela Koppold

Daniela Koppold

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics

Carolin Breinlinger

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics

Etienne Hanslian

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics

Christian Kessler

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics

Holger Cramer

University of Tübingen - Institute for General Practice and Interprofessional Care

Anika Rajput Khokhar

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics

Courtney M. Peterson

University of Alabama at Birmingham - Department of Nutrition Sciences

Grant M. Tinsley

Texas Tech University

Claudio Vernieri

Fondazione IRCCS Istituto Nazionale dei Tumori - Department of Medical Oncology

Richard J. Bloomer

University of Memphis - College of Health Sciences

Michael Boschmann

Helmholtz Association of German Research Centres - Max Delbrück Center for Molecular Medicine

Nicola Luigi Bragazzi

University of Parma

Sebastian Brandhorst

University of Southern California

Kelsey Gabel

University of Illinois at Chicago - Department of Kinesiology and Nutrition

Alan Goldhamer

TrueNorth Health Center

Martin M. Grajower

Yeshiva University - Albert Einstein College of Medicine

Michelle Harvie

The University of Manchester - Manchester University NHS Foundation Trust

Leonie Heilbronn

The University of Adelaide

Benjamin D. Horne

Intermountain Medical Center - Intermountain Medical Center Heart Institute

Spyridon N. Karras

Aristotle University of Thessaloniki

Jost Langhorst

Sozialstiftung Bamberg - Department for Internal and Integrative Medicine

Eva Lischka

Buchinger Wilhelmi Clinic

Frank Madeo

University of Graz - Institute of Molecular Biosciences

Sarah J. Mitchell

Princeton University; ETH Zürich - Department of Health Sciences and Technology

Ioannis-Eleemon Papagiannopoulos-Vatopaidinos

Vatopaidi Monastery Hospital

Maria Papagiannopoulou

Medical office for fasting therapy

Hanno Pijl

Leiden University - Department of Internal Medicine

Eric Ravussin

Louisiana State University, Baton Rouge - Pennington Biomedical Research Center

Martha Ritzmann-Widderich

Praxis für Ernährungsmedizin und Prävention in Rottweil

Krista Varady

University of Illinois at Chicago - Department of Kinesiology and Nutrition

Lilian Adamidou

AHEPA University Hospital - Department of Dietetics and Nutrition

Melika Chihaoui

University Hospital La Rabta - Department of Endocrinology

Rafael de Cabo

National Institute on Aging - Experimental Gerontology Section

Mohamed Hassanein

affiliation not provided to SSRN

Nader Lessan

Imperial College London - Division of Diabetes, Endocrinology and Metabolism

Valter Longo

University of Southern California

Emily N.C. Manoogian

Salk Institute for Biological Studies

Mark P. Mattson

Johns Hopkins University - Department of Neuroscience

J. Brent Muhlestein

Intermountain Medical Center

Satchidananda Panda

Salk Institute for Biological Studies

Sousana K. Papadopoulou

International Hellenic University - Department of Nutritional Sciences and Dietetics

Nikolaos E. Rodopaios

University of Crete - Department of Social Medicine, Preventive Medicine and Nutrition

Rainer Stange

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics

Andreas Michalsen

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics

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Abstract

Although fasting is increasingly applied to disease prevention and treatment, consensus on terminology is lacking. Using Delphi methodology, an international, multidisciplinary panel of researchers and clinicians standardized definitions of various fasting approaches. Five online surveys and a live online conference were conducted with 38 experts, 25 of whom completed all five surveys [Europe (n=12), North America (n=12), Australia (n=1)]. Consensus was achieved for the terms: ”fasting” (voluntary abstinence from some or all foods or foods and beverages), “modified fasting” (restriction of energy intake to max. 25% of energy needs), “fluid-only fasting”, “alternate-day fasting”, “short-term fasting” (lasting 1-3 days), “prolonged fasting” (≥4 consecutive days) and “religious fasting”. “Intermittent fasting” (repetitive fasting periods lasting ≤48 h), “time-restricted eating” and “fasting-mimicking diet” were discussed most. This study provides expert recommendations on fasting terminology for future research and clinical applications, facilitating communication and cross-referencing in the field.

Funding Information: Financial support for this project was provided by Immanuel Hospital Berlin.

Conflict of Interests: Daniela A. Koppold and Andreas Michalsen are members of the steering committee of the Medical Association for Fasting and Nutrition (ÄGHE). D.A.K. has co-founded the Academy of Integrative Fasting (AIF), an institution for the qualification of medical staff in clinical fasting applications. D.A.K. serves as a consultant for a mobile application on intermittent fasting (FASTIC) as well as a company producing plant-based supplements (EVERYYIN). A.M. is also Co-founder of the SALUFAST company. A.M. serves as a consultant for Lanserhof. Etienne Hanslian and Anika Rajput-Khokhar are members of the steering committee of the Medical Association for Fasting and Nutrition (ÄGHE). Courtney Peterson has no conflicts of interest. C.P. receives grant funding from the National Institutes of Health and the Department of Defense to study intermittent fasting. Grant Tinsley is an inventor on the international patent “Compositions and methods of use of beta-hydroxy beta-methylbutyrate (HMB) associated with intermittent fasting.” Claudio Vernieri is on the advsory board for Novartis, Eli Lilly, Pfizer, Menarini and Daiichi Sankyo. He receives honoraria as a speaker from Novartis, Eli Lilly, Istituto Gentili, Accademia di Medicina and research grants from Roche.C.V. is supported by AIRC (Associazione Italiana per la ricerca sul Cancro) MFAG 22977, ERC (European Research Council) METABALANCANCER - 101117893, Giuliani Foundation: Fondazione Gianmaria e Sabrina Giuliani Richard J. Bloomer is a consultant to CalerieHealth and Tecton, and coauthor of The Daniel Cure: The Daniel Fast Way to Vibrant Health. Kelsey Gabel has no conflict of interest. K.G. disclosed receipt of the following financial support: the National Institutes of Health [12HD101373 and 5P30AG022849] Alan C. Goldhamer owns a facility that offers fasting supervision. He is on the board of a non-profit that performs research on fasting in humans and he is the owner of TrueNorth Health Center and the president of the board of the TrueNorth Health Foundation. Michelle Harvie has co-authored three self-help books for the public to follow intermittent diets. All author proceeds are paid directly to the charity Prevent Breast Cancer (registered charity number 1109839) to fund breast cancer research. M.H. undertakes paid webinars for Nestlé Health Science and Oviva. All payments are made to Manchester University Foundation Trust. Benjamin D. Horne is a member of the advisory boards of Opsis Health and Lab Me Analytics, a consultant to Pfizer regarding risk scores (funds paid to Intermountain), and site PI of grants (not related to fasting) from the Patient-Centered Outcomes Research Institute, the NIH RECOVER initiative, and the Task Force for Global Health. Jost Langhorst offers consulting and expert activities to Medizinverlage Stuttgart; Ferring Arzneimittel GmbH; Repha GmbH; Dr. Willmar Schwabe. He receives honoraria as a speaker from Falk Foundation; Repha GmbH biologische Arzneimittel; Dr. Willmar Schwabe; Galapagos Pharma, Takeda Pharmaceutical, Janssen Cilag, Dr. Pfleger Arzneimittel, Bristol-Myers Squibb GmbH, Bionorica, Luvos Just GmbH, Pfitzer Pharma GmbH and Enterosan Labordiagnostik. J.L. receives research funding from Falk Foundation, Dr. Willmar Schwabe, Repha GmbH biologische Arzneimittel, TechLab. Frank Madeo has equity interests in and is advisor of The Longevity Labs (TLL) and is a scientific cofounder of Samsara Therapeutics. F.M. is grateful to the Austrian Science Fund FWF (F3012, W1226, P31727, P37016, P 37278) and the Austrian Federal Ministry of Education, Science and Research as well as the University of Graz for grants ‘Unkonventionelle Forschung-InterFast and Fast4Health'. We acknowledge the support of the Field of Excellence BioHealth of NAWI Graz and the BioTechMed-Graz flagship project ‘EPIAge'. Ioannis-Eleemon Papagiannopoulos-Vatopaidinos has no conflicts of interest. Martha Ritzmann-Widderich is a member of the board of the Medical Association for Fasting and Nutrition (ÄGHE). Krista Varady received author fees from Hachette Book Group for The Every Other Day Diet. Rafael de Cabo has no conflicts of interest. R.d.C. is supported in part by the Intramural Research Program at the NIA, National Institutes of Health. Valter Longo has equity interest in L-Nutra Inc., a company that markets and sells the FMD. USC has licensed intellectual property to L-Nutra and as part of this license agreement, the University has the potential to receive royalty payments from L-Nutra. One-hundred percent of V.D.L.’s equity is assigned to the nonprofit foundation Create Cures. Satchidananda Panda is the author of the books "The Circadian Code" and "The Circadian Diabetes Code". Rainer Stange is member of Medical Association for Fasting and Nutrition (ÄGHE), president of National Association of Physicians for Natural Medicine (ZAEN), has received honoraries for conduct of clinical trials, consulting and lectures from Repha GmbH Biologische Arzneimittel, Langenhagen, germany, mediconomics GmbH, Hannover, Germany S.A. Vogel, Roggwil, Switzerland, Clinica Holistica Engiadina, Susch, Switzerland, Roleca Pharma GmbH, Hannover, Germany. Remaining authors have no conflict of interest.

Ethical Approval: The study protocol was approved by the institutional review board of Charité - Universitätsmedizin Berlin (Charitéplatz 1, 10117 Berlin) in February 2022 (ID: EA4/028/22). The study was registered with ClinicalTrials.gov (ClinicalTrials ID: NCT05668156) and conducted according to the standards of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to study entry.

Keywords: Delphi method, fasting, periodic fasting, intermittent fasting, fasting-mimicking diet, dry fasting, therapeutic fasting, intermittent energy restriction, time-restricted eating, alternate-day fasting

Suggested Citation

Koppold, Daniela and Breinlinger, Carolin and Hanslian, Etienne and Kessler, Christian and Cramer, Holger and Rajput Khokhar, Anika and Peterson, Courtney M. and Tinsley, Grant M. and Vernieri, Claudio and Bloomer, Richard J. and Boschmann, Michael and Bragazzi, Nicola Luigi and Brandhorst, Sebastian and Gabel, Kelsey and Goldhamer, Alan and Grajower, Martin M. and Harvie, Michelle and Heilbronn, Leonie and Horne, Benjamin D. and Karras, Spyridon N. and Langhorst, Jost and Lischka, Eva and Madeo, Frank and Mitchell, Sarah J. and Papagiannopoulos-Vatopaidinos, Ioannis-Eleemon and Papagiannopoulou, Maria and Pijl, Hanno and Ravussin, Eric and Ritzmann-Widderich, Martha and Varady, Krista and Adamidou, Lilian and Chihaoui, Melika and de Cabo, Rafael and Hassanein, Mohamed and Lessan, Nader and Longo, Valter and Manoogian, Emily N.C. and Mattson, Mark P. and Muhlestein, J. Brent and Panda, Satchidananda and Papadopoulou, Sousana K. and Rodopaios, Nikolaos E. and Stange, Rainer and Michalsen, Andreas, Defining Prolonged and Intermittent Fasting: International Consensus on Fasting Terminology. Available at SSRN: https://ssrn.com/abstract=4665168 or http://dx.doi.org/10.2139/ssrn.4665168
This version of the paper has not been formally peer reviewed.

Daniela Koppold (Contact Author)

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics ( email )

Carolin Breinlinger

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics ( email )

Etienne Hanslian

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics ( email )

Christian Kessler

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics ( email )

Holger Cramer

University of Tübingen - Institute for General Practice and Interprofessional Care ( email )

Anika Rajput Khokhar

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics ( email )

Courtney M. Peterson

University of Alabama at Birmingham - Department of Nutrition Sciences ( email )

Grant M. Tinsley

Texas Tech University ( email )

2500 Broadway
Lubbock, TX 79409
United States

Claudio Vernieri

Fondazione IRCCS Istituto Nazionale dei Tumori - Department of Medical Oncology ( email )

Richard J. Bloomer

University of Memphis - College of Health Sciences ( email )

Michael Boschmann

Helmholtz Association of German Research Centres - Max Delbrück Center for Molecular Medicine ( email )

Nicola Luigi Bragazzi

University of Parma ( email )

Sebastian Brandhorst

University of Southern California ( email )

2250 Alcazar Street
Los Angeles, CA 90089
United States

Kelsey Gabel

University of Illinois at Chicago - Department of Kinesiology and Nutrition ( email )

Alan Goldhamer

TrueNorth Health Center ( email )

Martin M. Grajower

Yeshiva University - Albert Einstein College of Medicine ( email )

Jack and Pearl Resnick Campus
1300 Morris Park Avenue
Bronx, NY 10461
United States

Michelle Harvie

The University of Manchester - Manchester University NHS Foundation Trust ( email )

Oxford Road
Manchester, M13 9PL
United Kingdom

Leonie Heilbronn

The University of Adelaide ( email )

Adelaide, 5005
Australia

Benjamin D. Horne

Intermountain Medical Center - Intermountain Medical Center Heart Institute ( email )

5121 S. Cottonwood St.
Salt Lake City, UT 84107
United States
801-507-4701 (Phone)
801-507-4792 (Fax)

Spyridon N. Karras

Aristotle University of Thessaloniki ( email )

Thessaloniki
Greece

Jost Langhorst

Sozialstiftung Bamberg - Department for Internal and Integrative Medicine ( email )

Eva Lischka

Buchinger Wilhelmi Clinic ( email )

Frank Madeo

University of Graz - Institute of Molecular Biosciences ( email )

Humboldtstraße 50/EG
Graz, 8010
Austria

Sarah J. Mitchell

Princeton University ( email )

22 Chambers Street
Princeton, NJ 08544-0708
United States

ETH Zürich - Department of Health Sciences and Technology ( email )

Ioannis-Eleemon Papagiannopoulos-Vatopaidinos

Vatopaidi Monastery Hospital ( email )

Maria Papagiannopoulou

Medical office for fasting therapy ( email )

Hanno Pijl

Leiden University - Department of Internal Medicine ( email )

Eric Ravussin

Louisiana State University, Baton Rouge - Pennington Biomedical Research Center ( email )

Baton Rouge, LA
United States

Martha Ritzmann-Widderich

Praxis für Ernährungsmedizin und Prävention in Rottweil ( email )

Krista Varady

University of Illinois at Chicago - Department of Kinesiology and Nutrition ( email )

Lilian Adamidou

AHEPA University Hospital - Department of Dietetics and Nutrition ( email )

Melika Chihaoui

University Hospital La Rabta - Department of Endocrinology ( email )

Rafael De Cabo

National Institute on Aging - Experimental Gerontology Section ( email )

Mohamed Hassanein

affiliation not provided to SSRN ( email )

No Address Available

Nader Lessan

Imperial College London - Division of Diabetes, Endocrinology and Metabolism ( email )

Valter Longo

University of Southern California ( email )

2250 Alcazar Street
Los Angeles, CA 90089
United States

Emily N.C. Manoogian

Salk Institute for Biological Studies ( email )

10010 North Torrey Pines Road
La Jolla, CA 92037
United States

Mark P. Mattson

Johns Hopkins University - Department of Neuroscience ( email )

J. Brent Muhlestein

Intermountain Medical Center ( email )

Murray, UT
United States

Satchidananda Panda

Salk Institute for Biological Studies ( email )

Sousana K. Papadopoulou

International Hellenic University - Department of Nutritional Sciences and Dietetics ( email )

Nikolaos E. Rodopaios

University of Crete - Department of Social Medicine, Preventive Medicine and Nutrition ( email )

Rainer Stange

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics ( email )

Andreas Michalsen

Charité - Universitätsmedizin Berlin - Institute for Social Medicine, Epidemiology, and Health Economics ( email )

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