Impact of Intermittent Fasting on Human Endocrine and Metabolic Physiology: A Systematic Review

Intermittent Fasting on Human Endocrine and Metabolic Physiology

Authors

  • Syed Soban Ahmed Tirimzi Department of Physiology, School of Medicine, Dentistry and Allied Sciences, Haripur, Pakistan
  • Maham Khalid Department of Physiology, Rehman Medical College, Peshawar, Pakistan
  • Ambar Shuaib Department of Physiology, Pak International Medical College, Peshawar, Pakistan
  • Asma Aziz Department of Physiology, Saidu Medical College, Swat, Pakistan
  • Ayesha Riaz Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
  • Misbah Aslam Department of Physiology, Quetta College of Dentistry, Quetta, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i3.3736

Keywords:

Intermittent Fasting, Time-Restricted Eating, Endocrine Physiology, Insulin Sensitivity, Metabolic Health, Hormones, Circadian Rhythm

Abstract

Intermittent fasting (IF) is increasingly recognized as a dietary approach that may improve endocrine and cardiometabolic health by aligning eating patterns with circadian rhythms. Objectives: To systematically evaluate recent human studies (2018–2024) investigating the effects of intermittent fasting on endocrine and metabolic physiology, with emphasis on insulin sensitivity, hormonal balance, and cardiometabolic outcomes. Methods: PubMed, Scopus, and the Cochrane Library were searched according to PRISMA 2020 guidelines. Randomized controlled, crossover, cohort, and observational studies reporting endocrine (insulin, leptin, ghrelin, cortisol) and metabolic (glucose, lipids, body composition) outcomes associated with intermittent fasting were included. Study quality was assessed using the Joanna Briggs Institute tools. Results: Eighteen studies (~1,250 participants) were included. Early time-restricted eating and alternate-day fasting were consistently associated with improved insulin sensitivity, glycemic control, lipid profiles, and blood pressure. Several trials reported endocrine benefits independent of major weight loss. Most randomized studies showed low risk of bias. Conclusions: Low-risk randomized evidence supports early time-restricted eating and alternate-day fasting as effective strategies for improving insulin sensitivity and glycemic control. Other hormonal outcomes remain associative and require further trials. Intermittent fasting is a promising, culturally adaptable approach for metabolic risk reduction.

Author Biographies

Syed Soban Ahmed Tirimzi, Department of Physiology, School of Medicine, Dentistry and Allied Sciences, Haripur, Pakistan

 

 

 

Maham Khalid, Department of Physiology, Rehman Medical College, Peshawar, Pakistan

   

 

Ambar Shuaib, Department of Physiology, Pak International Medical College, Peshawar, Pakistan

   

 

Asma Aziz, Department of Physiology, Saidu Medical College, Swat, Pakistan

     

Ayesha Riaz, Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan

     

Misbah Aslam, Department of Physiology, Quetta College of Dentistry, Quetta, Pakistan

   

References

Kazeminasab F, Behzadnejad N, Cerqueira HS, Santos HO, Rosenkranz SK. Effects of Intermittent Fasting Combined with Exercise on Serum Leptin and Adiponectin in Adults with or Without Obesity: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Frontiers In Nutrition. 2024 Jun; 11:1362731. doi: 10.3389/fnut.2024.1362731. DOI: https://doi.org/10.3389/fnut.2024.1362731

Silva AI, Direito M, Pinto-Ribeiro F, Ludovico P, Sampaio-Marques B. Effects of Intermittent Fasting on Regulation of Metabolic Homeostasis: A Systematic Review and Meta-Analysis in Health and Metabolic-Related Disorders. Journal of Clinical Medicine. 2023 May; 12(11): 3699. doi: 10.3389/fnut.2024.1362731. DOI: https://doi.org/10.3390/jcm12113699

Mayor E. Neurotrophic Effects of Intermittent Fasting, Calorie Restriction and Exercise: A Review and Annotated Bibliography. Frontiers In Aging. 2023 Jun; 4: 1161814. doi:10.3389/fragi.2023.1161814. DOI: https://doi.org/10.3389/fragi.2023.1161814

Vasim I, Majeed CN, Deboer MD. Intermittent Fasting and Metabolic Health. Nutrients. 2022 Jan; 14(3): 631. doi:10.3390/nu14030631. DOI: https://doi.org/10.3390/nu14030631

Kim BH, Joo Y, Kim MS, Choe HK, Tong Q, Kwon O. Effects of Intermittent Fasting on the Circulating Levels and Circadian Rhythms of Hormones. Endocrinology And Metabolism. 2021 Aug; 36(4): 745-56. doi: 10.3803/EnM.2021.405. DOI: https://doi.org/10.3803/EnM.2021.405

Yuan X, Wang J, Yang S, Gao M, Cao L, Li X et al. Effect of Intermittent Fasting Diet on Glucose and Lipid Metabolism and Insulin Resistance in Patients with Impaired Glucose and Lipid Metabolism: A Systematic Review and Meta‐Analysis. International Journal of Endocrinology. 2022; 2022(1): 6999907. doi: 10.1155/2022/6999907. DOI: https://doi.org/10.1155/2022/6999907

Arif M. The Effect of Intermittent Fasting on Insulin Resistance and Lipid Metabolism. The International Science of Health Journal. 2023; 1(3): 42-51. doi: 10.59680/ishel.v1i3.971. DOI: https://doi.org/10.59680/ishel.v1i3.971

Zeng L, Li HR, Liu MW, Rao WM, He QQ. Effects of Intermittent Fasting on Cardiometabolic Risk Factors in Patients with Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Asia Pacific Journal of Clinical Nutrition. 2022 Dec;31(4): 642-59.

Jayawardene W, Kosobud A, Carter S, Dickinson S, Chen X. Determining the Fasting Length in Time-Restricted Feeding: Analysis of Endocrine Function Among Young, Healthy, Normal Weight, European Men. Current Developments in Nutrition. 2020 Jun; 4: nzaa047_008. doi: 10.1093/cdn/nzaa047_008. DOI: https://doi.org/10.1093/cdn/nzaa047_008

Horne BD, Anderson JL, May HT, Bair TL, Le VT, Iverson L et al. Insulin Resistance Reduction, Intermittent Fasting, and Human Growth Hormone: Secondary Analysis of a Randomized Trial. Nature Partner Journal: Metabolic Health and Disease. 2024 Oct; 2(1): 26. doi: 10.1038/s44324-024-00025-2. DOI: https://doi.org/10.1038/s44324-024-00025-2

Ciastek B, Kapłon K, Domaszewski P. a Comprehensive Perspective on the Biological Effects of Intermittent Fasting and Periodic Short-Term Fasting: A Promising Strategy for Optimizing Metabolic Health. Nutrients. 2025 Jun; 17(13): 2061. doi: 10.3390/nu17132061.

Alsefri AM, Alowedhi H, Alqahtani T, Mansouri K, Bamashmous R, Shaheen N et al. The Effectiveness of Intermittent Fasting in Type 2 Diabetes Management. Journal of Healthcare Sciences. 2025; 5(7). DOI: https://doi.org/10.52533/JOHS.2025.50705

Krishna AV, Gandodi VS, Dev A, Chakravarthy A, Vidyadhara S, Begum SS. Intermittent Fasting: A Promising Tool for Controlling Diabetes. Indian Journal of Pharmacy Practice. 2024; 17(2). doi:10.5530/ijopp.17.2.21. DOI: https://doi.org/10.5530/ijopp.17.2.21

Sutton EF, Beyl R, Early KS, Cefalu WT, Ravussin E, Peterson CM. Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even Without Weight Loss in Men with Prediabetes. Cell Metabolism. 2018 Jun; 27(6): 1212-21. doi: 10.1016/j.cmet.2018.04.010. DOI: https://doi.org/10.1016/j.cmet.2018.04.010

Jamshed H, Beyl RA, Della Manna DL, Yang ES, Ravussin E, Peterson CM. Early Time-Restricted Feeding Improves 24-Hour Glucose Levels and Affects Markers of The Circadian Clock, Aging, and Autophagy in Humans. Nutrients. 2019 May; 11(6): 1234. doi: 10.3390/nu11061234. DOI: https://doi.org/10.3390/nu11061234

Cienfuegos S, Gabel K, Kalam F, Ezpeleta M, Wiseman E, Pavlou V et al. Effects Of 4-And 6-H Time-Restricted Feeding on Weight and Cardiometabolic Health: A Randomized Controlled Trial in Adults with Obesity. Cell Metabolism. 2020 Sep; 32(3): 366-78. doi: 10.1016/j.cmet.2020.06.018 DOI: https://doi.org/10.1016/j.cmet.2020.06.018

Wilkinson MJ, Manoogian EN, Zadourian A, Lo H, Fakhouri S, Shoghi A et al. Ten-Hour Time-Restricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patients with Metabolic Syndrome. Cell Metabolism. 2020 Jan; 31(1): 92-104. doi: 10.1016/j.cmet.2019.11.004. DOI: https://doi.org/10.1016/j.cmet.2019.11.004

Radhakrishnan J. Ten-Hour Time-Restricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patients with Metabolic Syndrome. Kidney International. 2020; 98: 817-8.

Lowe DA, Wu N, Rohdin-Bibby L, Moore AH, Kelly N, Liu YE et al. Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men with Overweight and Obesity: The TREAT Randomized Clinical Trial. Journal of the American Medical Association Internal Medicine. 2020 Nov; 180(11): 1491-9. doi: 10.1001/jamainternmed.2020.4153. DOI: https://doi.org/10.1001/jamainternmed.2020.4153

Liu D, Huang Y, Huang C, Yang S, Wei X, Zhang P et al. Calorie Restriction with or Without Time-Restricted Eating in Weight Loss. New England Journal of Medicine. 2022 Apr; 386(16): 1495-504. doi: 10.1056/NEJMoa2114833. DOI: https://doi.org/10.1056/NEJMoa2114833

Xie Z, Sun Y, Ye Y, Hu D, Zhang H, He Z et al. Randomized Controlled Trial for Time-Restricted Eating in Healthy Volunteers Without Obesity. Nature Communications. 2022 Feb; 13(1): 1003. doi: 10.1038/s41467-022-28662-5. DOI: https://doi.org/10.1038/s41467-022-28662-5

Moro T, Tinsley G, Pacelli FQ, Marcolin G, Bianco A, Paoli A. Twelve Months of Time-Restricted Eating and Resistance Training Improves Inflammatory Markers and Cardiometabolic Risk Factors. Medicine And Science in Sports and Exercise. 2021 Jul; 53(12): 2577. doi: 10.1249/MSS.0000000000002738. DOI: https://doi.org/10.1249/MSS.0000000000002738

Cai H, Qin YL, Shi ZY, Chen JH, Zeng MJ, Zhou W et al. Effects of Alternate-Day Fasting on Body Weight and Dyslipidaemia in Patients with Non-Alcoholic Fatty Liver Disease: A Randomized Controlled Trial. BMC Gastroenterology. 2019 Dec;19(1): 219. doi:10.1186/s12876-019-1132-8. DOI: https://doi.org/10.1186/s12876-019-1132-8

Parvaresh A, Razavi R, Abbasi B, Yaghoobloo K, Hassanzadeh A, Mohammadifard N et al. Modified Alternate-Day Fasting Vs. Calorie Restriction in the Treatment of Patients with Metabolic Syndrome: A Randomized Clinical Trial. Complementary Therapies in Medicine. 2019 Dec; 47: 102187. doi: 10.1016/j.ctim.2019.08.021. DOI: https://doi.org/10.1016/j.ctim.2019.08.021

Ezpeleta M, Gabel K, Cienfuegos S, Kalam F, Lin S, Pavlou V et al. Effect of Alternate Day Fasting Combined with Aerobic Exercise on Non-Alcoholic Fatty Liver Disease: A Randomized Controlled Trial. Cell Metabolism. 2023 Jan; 35(1): 56-70. doi: 10.1016/j.cmet.2022.12.001. DOI: https://doi.org/10.1016/j.cmet.2022.12.001

Antoni R, Johnston KL, Collins AL, Robertson MD. Intermittent V. Continuous Energy Restriction: Differential Effects on Postprandial Glucose and Lipid Metabolism Following Matched Weight Loss in Overweight/Obese Participants. British Journal of Nutrition. 2018 Mar; 119(5): 507-16. doi:10.1017/S0007114517003890. DOI: https://doi.org/10.1017/S0007114517003890

Gao Y, Tsintzas K, Macdonald IA, Cordon SM, Taylor MA. Effects of Intermittent (5: 2) Or Continuous Energy Restriction on Basal and Postprandial Metabolism: A Randomized Study in Normal-Weight, Young Participants. European Journal of Clinical Nutrition. 2022 Jan; 76(1): 65-73. doi: 10.1038/s41430-021-00909-2. DOI: https://doi.org/10.1038/s41430-021-00909-2

Schroor MM, Joris PJ, Plat J, Mensink RP. Effects of Intermittent Energy Restriction Compared with Those of Continuous Energy Restriction on Body Composition and Cardiometabolic Risk Markers–A Systematic Review and Meta-Analysis of Randomized Controlled Trials in Adults. Advances In Nutrition. 2024 Jan; 15(1): 100130. doi: 10.1016/j.advnut.2023.10.003. DOI: https://doi.org/10.1016/j.advnut.2023.10.003

Manoogian EN, Wilkinson MJ, O’Neal M, Laing K, Nguyen J, Van D, Rosander A et al. Time-Restricted Eating in Adults with Metabolic Syndrome: A Randomized Controlled Trial. Annals of Internal Medicine. 2024 Nov; 177(11): 1462-70. doi: 10.7326/M24-0859. DOI: https://doi.org/10.7326/M24-0859

Al-Rawi N, Madkour M, Jahrami H, Salahat D, Alhasan F, Bahammam A et al. Effect of Diurnal Intermittent Fasting During Ramadan on Ghrelin, Leptin, Melatonin, And Cortisol Levels Among Overweight and Obese Subjects: A Prospective Observational Study. Plos One. 2020 Aug; 15(8): e0237922. doi: 10.1371/journal.pone.0237922. DOI: https://doi.org/10.1371/journal.pone.0237922

Zouhal H, Bagheri R, Triki R, Saeidi A, Wong A, Hackney AC et al. Effects of Ramadan Intermittent Fasting on Gut Hormones and Body Composition in Males with Obesity. International Journal of Environmental Research and Public Health. 2020 Aug; 17(15): 5600. doi: 10.3390/ijerph17155600. DOI: https://doi.org/10.3390/ijerph17155600

Gaeini Z, Mirmiran P, Bahadoran Z. Effects of Ramadan Intermittent Fasting on Leptin and Adiponectin: A Systematic Review and Meta-Analysis. Hormones. 2021 Jun; 20(2): 237-46. doi: 10.1007/s42000-021-00285-3. DOI: https://doi.org/10.1007/s42000-021-00285-3

Chen YE, Tsai HL, Tu YK, Chen LW. Effects of Different Types of Intermittent Fasting on Metabolic Outcomes: An Umbrella Review and Network Meta-Analysis. BioMed Central Medicine. 2024 Nov; 22(1): 529. doi: 10.1186/s12916-024-03716-1. DOI: https://doi.org/10.1186/s12916-024-03716-1

Joaquim L, Faria A, Loureiro H, Matafome P. Benefits, Mechanisms, and Risks of Intermittent Fasting in Metabolic Syndrome and Type 2 Diabetes. Journal of Physiology and Biochemistry. 2022 May; 78(2): 295-305. doi: 10.1007/s13105-021-00839-4. DOI: https://doi.org/10.1007/s13105-021-00839-4

Ciastek B, Kapłon K, Domaszewski P. A Comprehensive Perspective on the Biological Effects of Intermittent Fasting and Periodic Short-Term Fasting: A Promising Strategy for Optimizing Metabolic Health. Nutrients. 2025 Jun; 17(13): 2061. doi:10.3390/nu17132061. DOI: https://doi.org/10.3390/nu17132061

Downloads

Published

2026-03-31
CITATION
DOI: 10.54393/pjhs.v7i3.3736
Published: 2026-03-31

How to Cite

Tirimzi, S. S. A., Khalid, M., Shuaib, A., Aziz, A., Riaz, A., & Aslam, M. (2026). Impact of Intermittent Fasting on Human Endocrine and Metabolic Physiology: A Systematic Review: Intermittent Fasting on Human Endocrine and Metabolic Physiology. Pakistan Journal of Health Sciences, 7(3). https://doi.org/10.54393/pjhs.v7i3.3736

Issue

Section

Systematic Review

Plaudit

Most read articles by the same author(s)