Effects of alternate day fasting and exercise on cholesterol metabolism in overweight or obese adults: A pilot randomized controlled trial

A. Ra Cho, Ju Yeon Moon, Sue Kim, Ki Yong An, Minsuk Oh, Justin Y. Jeon, Dong Hyuk Jung, Man Ho Choi, Ji Won Lee

Research output: Contribution to journalArticlepeer-review

50 Citations (Scopus)


Background and Purpose: The objective of this pilot randomized controlled trial was to investigate the effect of alternate day fasting (ADF) and exercise on serum sterol signatures, which are surrogate markers of cholesterol absorption and biosynthesis. Methods: We randomly assigned 112 overweight or obese participants to four groups: 1) ADF and exercise (E-ADF); 2) ADF; 3) exercise; and 4) control. We studied 31 completers in this exploratory analysis and measured their serum sterol signatures using gas chromatography–mass spectrometry. Results: After intervention, most serum sterol signatures that correspond to cholesterol metabolism were significantly different between groups (p < 0.05 by analysis of covariance [ANCOVA]). We found no differences in plant sterols, which are markers of cholesterol absorption. In the exercise group, desmosterol, cholesteryl esters, and oxysterols decreased significantly. Furthermore, only changes in physical activity levels negatively correlated with changes in the metabolic ratios of desmosterol and 7-dehydrocholesterol to cholesterol, which reflect cholesterol biosynthesis (r = −0.411; p = 0.030, and r = −0.540; p = 0.003, respectively). Conclusion: These findings suggest that exercise with or without ADF improves cholesterol metabolism as measured by serum sterol signatures, and increased physical activity has a greater effect on cholesterol biosynthesis than weight reduction or calorie restriction.

Original languageEnglish
Pages (from-to)52-60
Number of pages9
JournalMetabolism: Clinical and Experimental
Publication statusPublished - 2019 Apr

Bibliographical note

Funding Information:
This study was supported by a 2013 Faculty Research Grant from the Yonsei University College of Medicine ( 6-2013-0021 ) and the Bio & Medical Technology Development Program, through the National Research Foundation of Korea funded by the Ministry of Science and ICT ( NRF-2013M3A9B6046413 , NRF-2018R1D1A1B07049223 ).

Publisher Copyright:
© 2019 Elsevier Inc.

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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