Effects of 5:2 intermittent fasting meal replacement on body composition and abdominal fat distribution in overweight and obese adults with early type 2 diabetes.
Yu D, Zou M, et al. • Clinical nutrition (Edinburgh, Scotland) • 2026
The 5:2 intermittent fasting meal replacement regimen may be more effective than metformin and empagliflozin in improving body composition and abdominal fat distribution in early T2DM, and is proposed as a therapeutic option.
Key Findings
Results
The 5:2 MR group showed significantly greater reductions in BMI compared with metformin and empagliflozin groups.
Least-squares mean BMI reduction was -3.41 kg/m2 (SE 0.31), P < 0.001
Single-center analysis of a randomized, active-controlled trial (EARLY) with 85 total participants
5:2 MR group n=29, metformin group n=28, empagliflozin group n=28
Treatment duration was 16 weeks
Participants were overweight and obese patients with early T2DM
Results
The 5:2 MR group demonstrated significantly greater reductions in multiple abdominal obesity indices compared to the medication groups.
Waist circumference reduction: -8.83 cm (SE 1.07), P < 0.001
Waist-to-hip ratio (WHR) reduction: -0.04 (SE 0.01), P < 0.05
Waist-to-height ratio (WHtR) reduction: -0.05 (SE 0.01), P < 0.001
All comparisons were versus both metformin and empagliflozin groups
Results
The 5:2 MR group showed significantly greater reductions in body fat percentage and abdominal fat areas compared to the other groups.
Body fat percentage (BF%) reduction: -4.84% (SE 0.66), P < 0.05
Abdominal cross-sectional area (ACSA) reduction: -66.05 cm2 (SE 9.46), P < 0.01
Subcutaneous fat area reduction: -58.27 cm2 (SE 5.99), P < 0.001
Body composition was assessed using InBody device; abdominal fat distribution was measured using energy spectrum CT
Results
The 5:2 MR group showed a significantly greater increase in the liver-to-spleen (L/S) ratio compared to the medication groups, suggesting reduction in hepatic fat.
L/S ratio increase: 0.43 (SE 0.04), P < 0.01
L/S ratio was measured using energy spectrum CT
This finding indicates improvement in hepatic steatosis in the 5:2 MR group
Results
In the 5:2 MR group, changes in BMI were positively correlated with changes in multiple body composition and abdominal fat measures.
BMI change correlated with WHR change: r = 0.411, P = 0.030
BMI change correlated with WHtR change: r = 0.635, P < 0.001
BMI change correlated with BF% change: r = 0.528, P = 0.020
BMI change correlated with ACSA change: r = 0.562, P = 0.003
Associations were evaluated using Spearman's correlation coefficient and described as linear associations
Yu D, Zou M, Cheng B, Yang P, Huang D, Pan Q, et al.. (2026). Effects of 5:2 intermittent fasting meal replacement on body composition and abdominal fat distribution in overweight and obese adults with early type 2 diabetes.. Clinical nutrition (Edinburgh, Scotland). https://doi.org/10.1016/j.clnu.2025.11.025