{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:36:17Z","timestamp":1771929377446,"version":"3.50.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intermittent energy restriction (IER) shows metabolic promise, but real-world evidence for its impact on clinically meaningful outcomes is lacking. This study evaluated the effect of IER on a novel composite endpoint of early, physician-diagnosed diabetes progression (PDDP), which includes microvascular complications (retinopathy, nephropathy, neuropathy), acute metabolic decompensation (diabetic ketoacidosis, hyperosmolar hyperglycemic state), and peripheral arterial disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      In a large real-world retrospective cohort study, 1,069 participants following a structured 5:10 IER regimen were compared with 1,099 controls. The primary outcome was the incidence of PDDP, a composite of the progression of diabetes-related events diagnosed by clinical doctors. Secondary outcomes included fasting plasma glucose (FPG) change and diabetes medication reduction. Inverse probability weighting (IPW) and multivariate models were used to control for confounders. A sensitivity analysis was restricted to patients without PDDP at baseline (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1,788).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The IER group demonstrated a substantially lower incidence of PDDP compared to controls (2% vs. 10%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). After IPW adjustment, the IER cohort demonstrated a significantly lower incidence of PDDP (Estimate: \u22120.09; 95% CI: \u22120.12 to \u22120.07;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and a greater reduction in antidiabetic medication use (OR: 6.26; 95% CI: 5.61 to 6.99;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), no statistically significant difference in FPG change was detected between groups (Estimate: \u22120.07; 95% CI: \u22120.46 to 0.32;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.740). Sensitivity analysis confirmed the robustness of these benefits in the population without PDDP at baseline.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a real-world setting, IER was associated with a dramatically lower risk of PDDP, independent of its glucose-lowering effect. These findings position IER as a potent, scalable non-pharmacological strategy to improve patient-centered outcomes in diabetes care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1744017","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T05:33:59Z","timestamp":1770183239000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intermittent energy restriction and risk of physician-diagnosed diabetes progression: a propensity-weighted real-world cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhiyong","family":"Xiao","sequence":"first","affiliation":[{"name":"Horticulture College, Hunan Agricultural University","place":["Changsha, China"]},{"name":"School of Nursing, University of South China","place":["Hengyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Horticulture College, Hunan Agricultural University","place":["Changsha, China"]},{"name":"Yuelushan Laboratory","place":["Changsha, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongliang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Education Courses, Cangzhou Medical College","place":["Cangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xihu","family":"Lai","sequence":"additional","affiliation":[{"name":"Xincheng Smart Internet Hospital","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yewu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Chinese Center for Disease Control and Prevention","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruiyu","family":"Wu","sequence":"additional","affiliation":[{"name":"Horticulture College, Hunan Agricultural University","place":["Changsha, China"]},{"name":"Hunan Provincial Engineering Research Centre of Medical Nutrition Intervention Technology for Metabolic Diseases","place":["Changsha, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huiqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Hepatobiliary and Pancreatic Surgery Department, First Hospital of University of South China","place":["Hengyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiali","family":"Zhou","sequence":"additional","affiliation":[{"name":"Horticulture College, Hunan Agricultural University","place":["Changsha, China"]},{"name":"Hunan Provincial Engineering Research Centre of Medical Nutrition Intervention Technology for Metabolic Diseases","place":["Changsha, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"Yang","sequence":"additional","affiliation":[{"name":"Horticulture College, Hunan Agricultural University","place":["Changsha, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Xu","sequence":"additional","affiliation":[{"name":"Three Gorges University Hospital of Traditional Chinese Medicine & Yichang Hospital of Traditional Chinese Medicine","place":["Yichang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wu","family":"Luo","sequence":"additional","affiliation":[{"name":"Horticulture College, Hunan Agricultural University","place":["Changsha, China"]},{"name":"Yuelushan Laboratory","place":["Changsha, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Horticulture College, Hunan Agricultural University","place":["Changsha, China"]},{"name":"Yuelushan Laboratory","place":["Changsha, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The Central Hospital of Shaoyang","place":["Shaoyang, Hunan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinhong","family":"Yin","sequence":"additional","affiliation":[{"name":"School of Nursing, University of South China","place":["Hengyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongbo","family":"Liu","sequence":"additional","affiliation":[{"name":"Horticulture College, Hunan Agricultural University","place":["Changsha, China"]},{"name":"Yuelushan Laboratory","place":["Changsha, China"]},{"name":"Hunan Provincial Engineering Research Centre of Medical Nutrition Intervention Technology for Metabolic Diseases","place":["Changsha, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the global burden of disease study 2021","volume":"402","year":"2023","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.clnu.2025.03.016","article-title":"A comprehensive comparison of two commonly used BMI thresholds for non-communicable diseases and multimorbidity in the Chinese population","volume":"48","author":"Fan","year":"2025","journal-title":"Clin Nutr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e076410","DOI":"10.1136\/bmj-2023-076410","article-title":"Comparative effectiveness of GLP-1 receptor agonists on glycaemic 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