Calorie restriction (caloric restriction or energy restriction) is a dietary regimen that reduces food intake without incurring malnutrition. "Reduce" can be defined relative to the subject's previous intake before intentionally restricting food or beverage consumption, or relative to an average person of similar body type.
Calorie restriction is typically adopted intentionally to reduce body weight. It is recommended as a possible regimen by US dietary guidelines and scientific societies for body weight control.
Caloric intake control, and reduction for overweight individuals, is recommended by US dietary guidelines and science-based societies. Calorie restriction is recommended for people with diabetes and prediabetes, in combination with physical exercise and a weight loss goal of 5-15% for diabetes and 7-10% for prediabetes to prevent progression to diabetes. and mild calorie restriction may be beneficial for pregnant women to reduce weight gain (without weight loss) and reduce perinatal risks for both the mother and child. For overweight or obese individuals, calorie restriction may improve health through weight loss, although a gradual weight regain of 1–2 kg (2.2–4.4 lb) per year may occur.
Risks of malnutrition
The term "calorie restriction" as used in the study of aging refers to dietary regimens that reduce calorie intake without incurring malnutrition. If a restricted diet is not designed to include essential nutrients, malnutrition may result in serious deleterious effects, as shown in the Minnesota Starvation Experiment. This study was conducted during World War II on a group of lean men, who restricted their calorie intake by 45% for six months and composed roughly 77% of their diet with carbohydrates. As expected, this malnutrition resulted in metabolic adaptations, such as decreased body fat, improved lipid profile, and decreased resting heart rate. The experiment also caused negative effects, such as anemia, edema, muscle wasting, weakness, dizziness, irritability, lethargy, and depression.
Decreasing caloric intake by 20-30%, while fulfilling nutrient requirements, has been found to remedy diseases of aging, including cancer, cardiovascular disease, dementia, and diabetes in humans, and result in an average loss of 7.9 kilograms (17 lb) in body weight, but because of the long lifespan of humans, evidence that caloric restriction could prevent age-related disease in humans is still emerging.
A calorie restriction study started in 1987 by the National Institute on Aging showed that calorie restriction did not extend years of life or reduce age-related deaths in non-obese rhesus macaques. It did improve certain measures of health, however.[example needed] These results were publicized as being different from the Wisconsin rhesus macaque calorie restriction study, which also started in 1987 and showed an increase in the lifespan of rhesus macaques following calorie restriction.
In a 2017 report on rhesus monkeys, caloric restriction in the presence of adequate nutrition was effective in delaying the effects of aging. Older age of onset, female sex, lower body weight and fat mass, reduced food intake, diet quality, and lower fasting blood glucose levels were factors associated with fewer disorders of aging and with improved survival rates. Specifically, reduced food intake was beneficial in adult and older primates, but not in younger monkeys. The study indicated that caloric restriction provided health benefits with fewer age-related disorders in elderly monkeys and, because rhesus monkeys are genetically similar to humans, the benefits and mechanisms of caloric restriction may apply to human health during aging.
According to scientific reviews, accumulating data suggests dietary restriction (DR) – mainly intermittent fasting and caloric restriction – results in many of the same beneficial changes in adult humans as in studied organisms, potentially increasing health- and lifespan beyond the benefits of healthy body weight. Which protocols of and combinations (e.g. see caloric restriction mimetic and AMPK) with DR are effective or most effective in humans is largely unknown and is being actively researched. A geroscience field of "precision nutrigeroscience" is proposed that also considers the potential need for adjustments of nutritional interventions per individual (e.g. due to differences in genetics and age). The mechanisms of these effects include autophagy and a decline in inflammaging. Intermittent fasting refers to periods with intervals during which no food but only e.g. water and tea/coffee are ingested – such as a period of daily time-restricted eating with a window of 8 to 12 hours for any caloric intake – and could be combined with overall caloric restriction and variants of the Mediterranean diet which usually has benefits of long-term cardiovascular health and longevity.
Calorie restriction preserves muscle tissue in nonhuman primates and rodents. Mechanisms include reduced muscle cell apoptosis and inflammation; protection against or adaptation to age-related mitochondrial abnormalities; and preserved muscle stem cell function. Muscle tissue grows when stimulated, so it has been suggested that the calorie-restricted test animals exercised more than their companions on higher calories, perhaps because animals enter a foraging state during calorie restriction. However, studies show that overall activity levels are no higher in calorie restriction than ad libitum animals in youth. Laboratory rodents placed on a calorie restriction diet tend to exhibit increased activity levels (particularly when provided with exercise equipment) at feeding time. Monkeys undergoing calorie restriction also appear more restless immediately before and after meals.
Preliminary research indicates that sirtuins are activated by fasting and serve as "energy sensors" during metabolism. Sirtuins, specifically Sir2 (found in yeast) have been implicated in the aging of yeast, and are a class of highly conserved, NAD+-dependent histone deacetylase enzymes. Sir2 homologs have been identified in a wide range of organisms from bacteria to humans.
Some research has pointed toward hormesis as an explanation for the benefits of caloric restriction, representing beneficial actions linked to a low-intensity biological stressor such as reduced calorie intake. As a potential role for caloric restriction, the diet imposes a low-intensity biological stress on the organism, eliciting a defensive response that may help protect it against the disorders of aging. In other words, caloric restriction places the organism in a defensive state so that it can survive adversity.
As of 2019[update], current clinical guidelines recommend that hospitals ensure that the patients get fed with 80–100% of energy expenditure, the normocaloric feeding. A systematic review investigated whether people in hospitals' intensive care units have different outcomes with normocaloric feeding or hypocaloric feeding, and found no difference. However, a comment criticized the inadequate control of protein intake, and raised concerns that hypocaloric feeding safety should be further assessed with underweight critically ill people.
- CR Society International
- Intermittent fasting
- List of diets
- Luigi Cornaro
- Okinawa diet
- Very low calorie diet
- US Department of Health and Human Services. (2017). "2015–2020 Dietary Guidelines for Americans - health.gov". health.gov. Skyhorse Publishing Inc. Retrieved 30 September 2019.
- Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. (September 2019). "2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Circulation. 140 (11): e596–e646. doi:10.1161/CIR.0000000000000678. PMC 7734661. PMID 30879355.
- "Obesity: maintaining a healthy weight and preventing excess weight gain". pathways.nice.org.uk.
- Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. (June 2014). "2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society". Circulation. 129 (25 Suppl 2): S102-38. doi:10.1161/01.cir.0000437739.71477.ee. PMC 5819889. PMID 24222017.
- "Diet - NICE Pathways". pathways.nice.org.uk.
- Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. (July 2016). "American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity". Endocrine Practice. 22 Suppl 3: 1–203. doi:10.4158/EP161365.GL. PMID 27219496.
- American Diabetes Association (January 2019). "Standards of Medical Care in Diabetes-2019". Diabetes Care. 42 (Suppl 1): S46–S60. doi:10.2337/dc19-S005. PMID 30559231.
- Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KH, MacLeod J, et al. (May 2019). "Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report". Diabetes Care (Professional society guidelines). 42 (5): 731–754. doi:10.2337/dci19-0014. PMC 7011201. PMID 31000505.
- Glazier JD, Hayes DJ, Hussain S, D'Souza SW, Whitcombe J, Heazell AE, Ashton N (October 2018). "The effect of Ramadan fasting during pregnancy on perinatal outcomes: a systematic review and meta-analysis". BMC Pregnancy and Childbirth. 18 (1): 421. doi:10.1186/s12884-018-2048-y. PMC 6202808. PMID 30359228.
- Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, et al. (May 2012). "Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence". BMJ. 344: e2088. doi:10.1136/bmj.e2088. PMC 3355191. PMID 22596383.
- Everitt AV, Le Couteur DG (October 2007). "Life extension by calorie restriction in humans". Annals of the New York Academy of Sciences. 1114 (1): 428–33. Bibcode:2007NYASA1114..428E. doi:10.1196/annals.1396.005. PMID 17717102. S2CID 30275713.
- Keys A, Brozek J, Henschels A & Mickelsen O & Taylor H. The Biology of Human Starvation, 1950. University of Minnesota Press, Minneapolis
- Keys A 1950, p. 114.
- St Jeor ST, Howard BV, Prewitt TE, Bovee V, Bazzarre T, Eckel RH (October 2001). "Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association". Circulation. 104 (15): 1869–74. doi:10.1161/hc4001.096152. PMID 11591629.
- de Souza RJ, Swain JF, Appel LJ, Sacks FM (July 2008). "Alternatives for macronutrient intake and chronic disease: a comparison of the OmniHeart diets with popular diets and with dietary recommendations". The American Journal of Clinical Nutrition. 88 (1): 1–11. doi:10.1093/ajcn/88.1.1. PMC 2674146. PMID 18614716.
- Ma Y, Pagoto SL, Griffith JA, Merriam PA, Ockene IS, Hafner AR, Olendzki BC (October 2007). "A dietary quality comparison of popular weight-loss plans". Journal of the American Dietetic Association. 107 (10): 1786–91. doi:10.1016/j.jada.2007.07.013. PMC 2040023. PMID 17904938.
- Marzetti E, Wohlgemuth SE, Anton SD, Bernabei R, Carter CS, Leeuwenburgh C (November 2009). "Cellular mechanisms of cardioprotection by calorie restriction: state of the science and future perspectives". Clinics in Geriatric Medicine. 25 (4): 715–32, ix. doi:10.1016/j.cger.2009.07.002. PMC 2786899. PMID 19944269.
- Roth, Lauren W.; Polotsky, Alex J. (April 2012). "Can we live longer by eating less? A review of caloric restriction and longevity". Maturitas. 71 (4): 315–319. doi:10.1016/j.maturitas.2011.12.017. PMID 22281163. Retrieved May 16, 2022.
- Caristia, Silvia; De Vito, Marta; Sarro, Andrea; Leone, Alessio; Pecere, Alessandro; Zibetti, Angelica; Filigheddu, Nicoletta; Zeppegno, Patrizia; Prodam, Flavia; Faggiano, Fabrizio; Marzullo, Paolo (July 30, 2020). "Is Caloric Restriction Associated with Better Healthy Aging Outcomes? A Systematic Review and Meta-Analysis of Randomized Controlled Trials". Nutrients. 12 (8): 2290. doi:10.3390/nu12082290. PMC 7468870. PMID 32751664.
- National Institutes of Health (2012-08-29). "NIH study finds calorie restriction does not affect survival". Retrieved May 17, 2016.
- Nicholas Wade (April 1, 2014). "Diet's Link to Longevity: After 2 Studies Diverge, a Search for Consensus". The New York Times. Retrieved May 17, 2016.
- Mattison JA, Colman RJ, Beasley TM, Allison DB, Kemnitz JW, Roth GS, et al. (January 2017). "Caloric restriction improves health and survival of rhesus monkeys". Nature Communications. 8 (1): 14063. Bibcode:2017NatCo...814063M. doi:10.1038/ncomms14063. PMC 5247583. PMID 28094793.
- "Calorie restriction lets monkeys live long and prosper". ScienceDirect. 17 January 2017. Retrieved 15 February 2017.
- Mattison JA, Roth GS, Beasley TM, Tilmont EM, Handy AM, Herbert RL, et al. (September 2012). "Impact of caloric restriction on health and survival in rhesus monkeys from the NIA study". Nature. 489 (7415): 318–21. Bibcode:2012Natur.489..318M. doi:10.1038/nature11432. PMC 3832985. PMID 22932268.
- Vaughan KL, Kaiser T, Peaden R, Anson RM, de Cabo R, Mattison JA (December 2017). "Caloric Restriction Study Design Limitations in Rodent and Nonhuman Primate Studies". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 73 (1): 48–53. doi:10.1093/gerona/glx088. PMC 5861872. PMID 28977341.
- Green, Cara L.; Lamming, Dudley W.; Fontana, Luigi (13 September 2021). "Molecular mechanisms of dietary restriction promoting health and longevity". Nature Reviews Molecular Cell Biology. 23 (1): 56–73. doi:10.1038/s41580-021-00411-4. ISSN 1471-0080. PMC 8692439. PMID 34518687. S2CID 237505615.
- Wilson, Kenneth A.; Chamoli, Manish; Hilsabeck, Tyler A.; Pandey, Manish; Bansal, Sakshi; Chawla, Geetanjali; Kapahi, Pankaj (22 September 2021). "Evaluating the beneficial effects of dietary restrictions: A framework for precision nutrigeroscience". Cell Metabolism. 33 (11): 2142–2173. doi:10.1016/j.cmet.2021.08.018. ISSN 1550-4131. PMC 8845500. PMID 34555343.
- O'Keefe, James H.; Torres-Acosta, Noel; O'Keefe, Evan L.; Saeed, Ibrahim M.; Lavie, Carl J.; Smith, Sarah E.; Ros, Emilio (September 2020). "A Pesco-Mediterranean Diet With Intermittent Fasting". Journal of the American College of Cardiology. 76 (12): 1484–1493. doi:10.1016/j.jacc.2020.07.049. PMID 32943166. S2CID 221787788. Archived from the original on 2021-05-25.
- McKiernan SH, Colman RJ, Aiken E, Evans TD, Beasley TM, Aiken JM, et al. (March 2012). "Cellular adaptation contributes to calorie restriction-induced preservation of skeletal muscle in aged rhesus monkeys". Experimental Gerontology. 47 (3): 229–36. doi:10.1016/j.exger.2011.12.009. PMC 3321729. PMID 22226624.
- Colman RJ, Beasley TM, Allison DB, Weindruch R (June 2008). "Attenuation of sarcopenia by dietary restriction in rhesus monkeys". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 63 (6): 556–9. doi:10.1093/gerona/63.6.556. PMC 2812805. PMID 18559628.
- Dirks Naylor AJ, Leeuwenburgh C (January 2008). "Sarcopenia: the role of apoptosis and modulation by caloric restriction". Exercise and Sport Sciences Reviews. 36 (1): 19–24. doi:10.1097/jes.0b013e31815ddd9d. PMID 18156949. S2CID 4596744. Archived from the original on 2021-12-02.
- Bua E, McKiernan SH, Aiken JM (March 2004). "Calorie restriction limits the generation but not the progression of mitochondrial abnormalities in aging skeletal muscle". FASEB Journal. 18 (3): 582–4. doi:10.1096/fj.03-0668fje. PMID 14734641. S2CID 24598148.
- Cerletti M, Jang YC, Finley LW, Haigis MC, Wagers AJ (May 2012). "Short-term calorie restriction enhances skeletal muscle stem cell function". Cell Stem Cell. 10 (5): 515–9. doi:10.1016/j.stem.2012.04.002. PMC 3561899. PMID 22560075.
- Faulks SC, Turner N, Else PL, Hulbert AJ (August 2006). "Calorie restriction in mice: effects on body composition, daily activity, metabolic rate, mitochondrial reactive oxygen species production, and membrane fatty acid composition". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 61 (8): 781–94. doi:10.1093/gerona/61.8.781. PMID 16912094.
- Vitousek KM, Manke FP, Gray JA, Vitousek MN (2004). "Caloric Restriction for Longevity: II--The Systematic Neglect of Behavioural and Psychological Outcomes in Animal Research" (PDF). European Eating Disorders Review. 12 (6): 338–360. CiteSeerX 10.1.1.575.7875. doi:10.1002/erv.604. Archived from the original on 2021-12-02.
- Chang HC, Guarente L (March 2014). "SIRT1 and other sirtuins in metabolism". Trends in Endocrinology and Metabolism. 25 (3): 138–45. doi:10.1016/j.tem.2013.12.001. hdl:1721.1/104067. PMC 3943707. PMID 24388149.
- Guarente L (2007). "Sirtuins in aging and disease". Cold Spring Harbor Symposia on Quantitative Biology. 72: 483–8. doi:10.1101/sqb.2007.72.024. PMID 18419308.
- Lin SJ, Ford E, Haigis M, Liszt G, Guarente L (January 2004). "Calorie restriction extends yeast life span by lowering the level of NADH". Genes & Development. 18 (1): 12–6. doi:10.1101/gad.1164804. PMC 314267. PMID 14724176.
- Kaeberlein M, McVey M, Guarente L (October 1999). "The SIR2/3/4 complex and SIR2 alone promote longevity in Saccharomyces cerevisiae by two different mechanisms". Genes & Development. 13 (19): 2570–80. doi:10.1101/gad.13.19.2570. PMC 317077. PMID 10521401.
- Nikolai S, Pallauf K, Huebbe P, Rimbach G (December 2015). "Energy restriction and potential energy restriction mimetics". Nutrition Research Reviews. 28 (2): 100–120. doi:10.1017/S0954422415000062. PMID 26391585.
- Martins I, Galluzzi L, Kroemer G (September 2011). "Hormesis, cell death and aging". Aging. 3 (9): 821–8. doi:10.18632/aging.100380. PMC 3227447. PMID 21931183.
- Marik PE, Hooper MH (March 2016). "Normocaloric versus hypocaloric feeding on the outcomes of ICU patients: a systematic review and meta-analysis". Intensive Care Medicine. 42 (3): 316–323. doi:10.1007/s00134-015-4131-4. PMID 26556615. S2CID 37653149.
- Bitzani M (April 2016). "Comments on Marik and Hooper: Normocaloric versus hypocaloric feeding on the outcomes of ICU patients: a systematic review and meta-analysis". Intensive Care Medicine. 42 (4): 628–629. doi:10.1007/s00134-016-4248-0. PMID 26880090. S2CID 34072936.
- Everitt AV, Heilbronn LK, Le Couteur DG (2010). "Food Intake, Life Style, Aging and Human Longevity". In Everitt AV, Rattan SI, Le Couteur DG, de Cabo R (eds.). Calorie Restriction, Aging and Longevity. New York: Springer. ISBN 978-90-481-8555-9.
- Keys A, Brozek J, Henschel A, Mickelsen O, Taylor HL (1950). The Biology of Human Starvation. Vol. I. University of Minnesota Press. ISBN 9780816672349.