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  • Systematic Review
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Epidemiology and Population Health

Effectiveness and safety of intermittent fasting on blood pressure in adults with overweight or obesity: a systematic review

International Journal of Obesity volume 49, pages 1240–1251 (2025)Cite this article

Subjects

Abstract

Background

Previous intermittent fasting (IF) studies have reported inconsistent findings regarding its antihypertensive effects and safety.

Objective

This study aimed to assess the effects and safety of IF on blood pressure (BP), anthropometrics, and cardiometabolic risk markers in individuals with overweight or obesity compared to a no-intervention control group.

Methods

Relevant studies were retrieved from multiple databases, including CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, the Cochrane Library, and Web of Science, up to April 30, 2024. A meta-analysis was performed using Stata version 18.0 and RevMan 5.4, calculating mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI) via the Knapp-Hartung modified random-effects model. Publication bias was evaluated using a contour-enhanced funnel plot and Egger’s test.

Results

Fifteen studies (n = 929) were included. IF significantly reduced systolic blood pressure (SBP) (MD = –4.43 mmHg, 95% CI: –5.83 to –3.03, p < 0.001) and diastolic blood pressure (DBP) (MD = –2.00 mmHg, 95% CI: –3.23 to –0.78, p < 0.001) compared to control. IF also improved anthropometric measures, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and Triglycerides (TG). Seven studies reported minor adverse effects. Although the IF group showed a higher risk of vomiting (RR = 1.11, 95% CI: 1.04–1.19, p = 0.01) and irritability (RR = 1.22, 95% CI: 1.13–1.31, p < 0.001) compared to the control group, these reactions were predominantly observed during the initial phase of the intervention and were self-resolving.

Conclusions

IF significantly lowered SBP and DBP in individuals with overweight or obesity, particularly in high-risk subgroups (obesity, age ≥45 years, and prehypertension/hypertension), with a favorable safety profile. Due to heterogeneity, future trials should standardize IF regimens and target these subgroups to confirm generalizability.

Clinical trial registration

The review protocol has been registered on PROSPERO (CRD42024540777).

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Fig. 1
Fig. 2: Forest plots of IF vs. no intervention based on SBP changes.
Fig. 3: Forest plots of IF vs no intervention based on DBP changes.

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Data availability

The original contributions presented in the study are included in the article; further inquiries can be directed to the corresponding authors.

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Acknowledgements

This research was supported by the Haidian District Health Development Research and Cultivation Program (No: HP2024-52-504002) and Xiyuan Hospital CACMS Enhancement Fund (NO. XYZX0101-14). The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript.

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Authors and Affiliations

  1. State Key Laboratory of Traditional Chinese Medicine Syndrome/Xiyuan Hospital, China Academy of Chinese Medical Sciences, National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China

    Yaxin Guo, Lijie Lu, Luying Chen, Yaojian Wang, Fangfang Zhao & Yuerong Jiang

  2. Shanxi University of Chinese Medicine, Taiyuan, China

    Yaxin Guo & Lijie Lu

  3. Chinese Journal of Integrated Traditional and Western Medicine Press, Beijing, China

    Fangfang Zhao

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  1. Yaxin Guo
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YXG, study design, data interpretation, and writing – original draft. LJL, literature search, screening, extraction, and quality assessment. LYC, literature search, screening, extraction, and quality assessment. YJW, literature search, screening, literature extraction, and quality assessment. FFZ, study design, methodology, and writing – review & editing; YRJ, study design, funding acquisition, supervision, and writing – review & editing. All authors contributed to the article and approved the final manuscript.

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Guo, Y., Lu, L., Chen, L. et al. Effectiveness and safety of intermittent fasting on blood pressure in adults with overweight or obesity: a systematic review. Int J Obes 49, 1240–1251 (2025). https://doi.org/10.1038/s41366-025-01823-4

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