Effect of calorie restriction on mood, quality of life, sleep, and sexual function in healthy nonobese adults: the CALERIE 2 randomized clinical trial

Authors: MARTIN, CORBY - Pennington Biomedical Research Center; BHAPKAR, MANJU - Duke University; PITTAS, ANASTASSIOS - Tufts University; PIEPER, CARL - Duke University; DAS, SAI KRUPA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; WILLIAMSON, DONALD - Pennington Biomedical Research Center; SCOTT, TAMMY - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; REDMAN, LEANNE - Pennington Biomedical Research Center; STEIN, RICHARD - Washington University; GILHOOLY, CHERYL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; STEWART, TIFFANY - Pennington Biomedical Research Center; ROBINSON, LISA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; ROBERTS, SUSAN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Internal Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/25/2016
Publication Date: 5/2/2016
Citation: Martin, C.K., Bhapkar, M., Pittas, A.G., Pieper, C.F., Das, S., Williamson, D.A., Scott, T., Redman, L.M., Stein, R., Gilhooly, C.H., Stewart, T., Robinson, L., Roberts, S.B. 2016. Effect of calorie restriction on mood, quality of life, sleep, and sexual function in healthy nonobese adults: the CALERIE 2 randomized clinical trial. Internal Medicine. 176(6):743-752. https://doi.org/10.1001/jamainternmed.2016.1189.
DOI: https://doi.org/10.1001/jamainternmed.2016.1189

Interpretive Summary: Calorie restriction is a promising intervention for preventing age-related declines in health and metabolism, but the potential for side effects has not been addressed. This study tracked changes in mood and psychological variables in normal-weight and overweight individuals randomized to a calorie-restriction regimen or ad libitum control for 2 years. Participants randomized to calorie restriction had small but significant improvements in symptoms of subclinical depression, tension, and sexual function. These results demonstrate that calorie restriction achieving 10% weight loss has no negative effects on a broad range of mood and psychological outcomes, and small positive effects on some factors, providing support for this new intervention to support healthy aging.

Technical Abstract: IMPORTANCE: Calorie restriction (CR) increases longevity in many species and reduces risk factors for chronic diseases. In humans, CR may improve health span, yet concerns remain about potential negative effects of CR. OBJECTIVE: To test the effect of CR on mood, quality of life (QOL), sleep, and sexual function in healthy nonobese adults. DESIGN, SETTING, AND PARTICIPANTS: A multisite randomized clinical trial (Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy Phase 2 [CALERIE 2]) was conducted at 3 academic research institutions. Adult men and women (N=220) with body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 22.0 to 28.0 were randomized to 2 years of 25% CR or an ad libitum (AL) control group in a 2:1 ratio favoring CR. Data were collected at baseline, 12 months, and 24 months and examined using intent-to-treat analysis. The study was conducted from January 22, 2007, to March 6, 2012. Data analysis was performed from July 18, 2012, to October 27, 2015. INTERVENTIONS: Two years of 25% CR or AL. MAIN OUTCOMES AND MEASURES: Self-report questionnaires were administered to measure mood (Beck Depression Inventory-II [BDI-II], score range 0-63, higher scores indicating worse mood, and Profile of Mood States [POMS], with a total mood disturbance score range of -32 to 200 and higher scores indicating higher levels of the constructs measured), QOL (Rand 36-Item Short Form, score range 0-100, higher scores reflecting better QOL, and Perceived Stress Scale, score range 0-40, higher scores indicating higher levels of stress), sleep (Pittsburgh Sleep Quality Index [PSQI], total score range 0-21, higher scores reflecting worse sleep quality), and sexual function (Derogatis Interview for Sexual Function-Self-report, total score range 24-188, higher scores indicating better sexual functioning). RESULTS: In all, 218 participants (152 women [69.7%]; mean [SD] age, 37.9 (7.2) years; mean [SD] BMI, 25.1 [1.6]) were included in the analyses. The CR and AL groups lost a mean (SE) of 7.6 (0.3) kg and 0.4 (0.5) kg, respectively, at month 24 (P<.001). Compared with the AL group, the CR group had significantly improved mood (BDI-II: between-group difference [BGD], -0.76; 95% CI, -1.41 to -0.11; effect size [ES], -0.35), reduced tension (POMS: BGD, -0.79; 95% CI, -1.38 to -0.19; ES, -0.39), and improved general health (BGD, 6.45; 95% CI, 3.93 to 8.98; ES, 0.75) and sexual drive and relationship (BGD, 1.06; 95% CI, 0.11 to 2.01; ES, 0.35) at month 24 as well as improved sleep duration at month 12 (BGD, -0.26; 95% CI, -0.49 to -0.02; ES, -0.32) (all P<.05). Greater percent weight loss in the CR group at month 24 was associated with increased vigor (Spearman correlation coefficient, p=-0.30) and less mood disturbance (p=0.27) measured with the POMS, improved general health (p=-0.27) measured with the SF-36, and better sleep quality per the PSQI total score (p=0.28) (all P<.01). CONCLUSIONS AND RELEVANCE: In nonobese adults, CR had some positive effects and no negative effects on health-related QOL.