How to Create a Research Protocol

The Research Protocol is a statement of the researcher's project design and a description of

his/her responsibilities toward the human subjects involved in the research.

To ensure an effective review by the Institutional Review Board, a full description of the planned

research must be submitted with the Application for IRB Review. A research protocol provides

the reader with background information of the problem under study, including the study

rationale, a detailed plan for conducting the research involving human research participants, and

a discussion of the potential importance of the research.

1. Objectives

The purpose of the study (research questions and / or study objectives) should be clearly and

succinctly stated. In experimental designs, objectives may be stated as hypotheses to be tested.

2. Background and Rationale

Summarize and synthesize the available research (including published data) to provide

justification for the study. Evaluate prior research for relevance to the research question under

study. Describe the significance of the research including potential benefits for individual

subjects or society at large.

3. Procedures

The procedures should include the following:

a) Research Design

The research design should be identified and should be appropriate to answer the research

question(s) under study. Describe the type of research proposed (e.g. experimental, correlational,

survey, qualitative) and specific study design that will be used.

b) Sample

Describe the sampling approach to be used. Identify the procedures that will be used to recruit,

screen, and follow study volunteers. Specifically define the study sample (number of subjects to

be enrolled, characteristics of subjects to be included in and excluded from the research, and

whether this will be a random or convenience sample).

c) Measurement/Instrumentation

Identify the variables of interest and study endpoints (where applicable). Justify measurement

techniques selected. Provide information regarding the validity and reliability of selected

measures.

d) Detailed study procedures

Methods for collecting data and for avoiding / minimizing subject risks should be included.

Include a timeline for subject participation in the project. Identify how subject confidentiality

will be safeguarded (plans for coding data and for securing written and electronic subject

records). Indicate how long personal information will be stored once the study is completed.

Methods will vary with the research approach used (qualitative, quantitative). The selected

methods should be sufficiently described to justify the use of the approach for answering the

defined research question. Methods should also be described in adequate detail so that IRB

members may assess the potential study risks and benefits.

e) Internal Validity

Threats to internal / external validity should be considered. Describe measures that have been

taken to avoid study bias.

f) Data Analysis

Specify the analytic techniques the researcher will use to answer the study questions. Indicate the

statistical procedures (e.g. specific descriptive or inferential tests) that will be used and why the

procedures are appropriate. For qualitative data, specify the proposed analytic approaches.

4. Bibliography

Include a reference list of literature cited to support the protocol statement.

What does literature reports about anti-inflammatory, anti-oxidant dietary approaches to mitigate fibromyalgia symptoms? A literature Review

Lorraine M. Justiniano, RDN, MS Candidate

FDNT 680 – Research Seminar

Dr. Anjejo

Andrews University

April 24, 2020

image1.png

A Review On The Effect Of Intermittent Fasting On Weight Loss

Shelly Schick Andrews University

FDNT-680-999 Research Seminar July 1, 2020

Introduction: Epidemiology ● Obesity:

○ BMI =/> 30 & caused by genetic & environmental factors and behaviors like a poor diet & sedentary lifestyle

○ Leads to: HTN, Dyslipidemia, CVD, T2DM, Stroke, Sleep Apnea, Depression, Cancer, etc. (CDC, 2020)

○ Costs billions of $$ in medical expenses (CDC, 2020)

○ 2017-2018: 42.4% of adults in the US were obese (CDC, 2020)

Introduction ● Intermittent Fasting (IF):

○ Ramadan, Muslims fast between sunrise and sunset for religious purposes, rather than weight loss

○ Various versions: ■ Fasting from 6pm-10am and

feasting from 10am-6pm ■ Fast for 2 days/week and eat

regularly for the other 5 days ■ “Fast” = 25% of energy needs

or low calories (i.e. 500 calories)

Introduction: Aim of Review

To conduct a literature review looking at the relationship/effectiveness of IF on body weight (with a specific focus on weight loss) to see if IF can help

those who are obese lose weight

Methodology: Literature Search ● EBSCO, Google Scholar, and PubMed

○ Keywords: “intermittent fasting” “weight” “weight loss” “humans or people” and “BMI”

○ Peer-reviewed & within the past 15 years (from 2005-2020).

○ Inclusion criteria: (1) An experimental study design, (2) A study population of adults, (3) An exposure of intermittent fasting, and (4) An outcome of body weight.

○ Exclusion criteria: (1) Any study that was conducted on animals or (2) any study that was conducted more than 15 years ago (before 2005)

Methodology: Data Extraction ● 10 experimental studies (9 RCTs & 1 quasi-experimental) ● Many of the studies looked at other outcomes, like

changes in waist circumference, insulin sensitivity, blood pressure, & lipid levels (specifically, HDL cholesterol, LDL cholesterol, & triglycerides) ○ Only information pertaining to body weight was

included in the analysis ○ Information taken from the studies:

■ Main objective ■ Exposure/intervention ■ Main results/findings and conclusions ■ Study limitations

Results ● 10 experimental studies

○ 9 randomized control trials ○ 1 quasi-experimental

● Intervention time periods: 6 weeks to 6 months

● Sample size of the study population: 15 to 162 participants

● 9/10 studies included study population of participants who were obese ○ 1 study didn’t have any

comorbidities in its study population (Heilbronn et al., 2005)

Results Author (year)

Main Objective Exposure/Outcome Measured

Type of Analysis (α & p-value)

Bhutani (2013)

To investigate whether alternate day fasting (ADF) with exercise has a greater effect on body composition compared to ADF or exercise alone

ADF plus exercise vs. exercise alone vs. ADF alone / Body weight

One‐way ANOVA at baseline; repeated‐measures ANOVA for within‐group differences; Intention‐to‐treat analysis (α: 0.05; p: <0.05)

Bowen (2018)

To compare an energy restriction with ADF to a high-protein, meal replacement program with daily energy restriction (DER) on weight loss

High-protein, meal replacement program with DER vs. energy restriction with ADF / Body weight

Mixed effects linear models (α: 0.05; p: <0.05)

Byrne (2017)

To determine whether intermittent energy restriction (IER) had a greater impact on weight loss efficiency in comparison to continuous energy restriction (CER)

IER vs. CER / Weight loss efficiency

Mixed model repeated measures analyses (α: 0.05; p: <0.05)

Catenacci (2016)

To compare the effects of ADF versus a moderate daily caloric restriction (CR) on weight status

Zero-calorie ADF vs. calorie restriction (-400 kcal/day) / Body weight

Linear mixed‐effects model; Independent‐samples t ‐tests (α: 0.05; p: <0.05)

Eshghinia (2013)

To evaluate the effects of a modified ADF on body weight in obese women

Alternate-day fasting diet / Body weight

Paired T-test (α: 0.05; p: <0.05)

Results Author (year) Main Objective Exposure/Outcome Measured Type of Analysis (α & p-value)

Harvie (2011) To compare the effectiveness & practicality of IER vs. CER on weight loss

IER vs. CER / Weight loss Paired t-tests at baseline & LOCF analysis at 6 months (α: 0.05; p: <0.05)

Heilbronn (2005) To examine if ADF is a practical method of dietary restriction for weight loss in non-obese individuals

ADF / Body weight One- & two-factor repeated-measures analysis of variance (α: 0.05; p: <0.05)

Hoddy (2014) To compare the effects of ADF with three meal times on body weight

ADF with three meal times / Body weight

One way ANOVA, Tukey's post hoc test, & a paired t‐test (α: 0.05; p: <0.05)

Keogh (2014) To investigate the effect of IER versus CER on weight loss

IER vs. CER / Body weight Independent samples t-test at baseline; repeated-measures ANOVA (α: 0.05; p: <0.05)

Trepanowski (2017) To compare the effects of ADF vs. a DER on weight loss

ADF vs. DER / Weight loss Independent-samples t test; a linear mixed model (α: 0.05; p: <0.05)

Results Author Main Finding(s) Conclusion(s) Study Limitations

Bhutani (2013)

Body weight was reduced in all of the intervention groups after 12 weeks (P < 0.05). Body weight decreased by 6 ± 4 kg, 3 ± 1 kg, and 1 ± 0 kg in the ADF plus exercise, ADF, and exercise groups, respectively

ADF plus exercise produces greater amount of weight loss compared to ADF or exercise alone

Short intervention time frame (12 weeks); used BIA to measure fat mass & fat free mass instead of dual‐energy X‐ray absorptiometry (DXA); participants were only from the University of Illinois, Chicago campus (cannot generalized results); flawed randomization procedure

Bowen (2018)

There was a statistically significant decrease in body weight over time (p < 0.001); At week 16 of the intervention, weight decreased by 10.7 ± 0.5 kg & −11.2 ± 0.6 kg in the ADF + DER group and the DER group, respectively (no significant difference between groups)

Both a high-protein, meal replacement program with DER & a energy restriction with ADF support weight loss

No biological data at 6 months; no long-term follow up; small number of male participants; no measurement for energy expenditure & physical activity monitoring

Byrne (2017)

The IER group lost more weight compared to the CER group (14.1±5.6 vs 9.1±2.9 kg; P<0.001); Both groups regained weight after the 6-month follow-up (IER: 3.5±5.9 vs. CER: 5.9±4.7 kg; P=0.24)

IER prodcued a higher amount of weight and fat loss compared to CER

Attrition in study population; small weight loss during baseline period; no measurements for body composition or resting energy expenditure during energy balance blocks in the IER group

Catenacci (2016)

At week 8, the ADF group had a greater energy deficient of 376 kcal/day compared to the CR group; however, no significant changes in weight were seen between the two groups (mean ±SE; ADF -8.2 ± 0.9 kg, CR -7.1 ± 1.0 kg). Finally, after week 24 of unsupervised follow-up, no significant differences in weight regain were seen

ADF & CR produced similar amount of weight loss after the 8 weeks

Pilot study; small sample size; randomization was arranged by sex; small male percentage; no measurements on physical activity; results cannot be generalized

Eshghinia (2013) ADF significantly reduced body weight from 84.3 ± 11.44 kg

to 78.3 ± 10.18 kg (P < 0.001) Short-term ADF is an effective intervention for weight loss

No control groups; small sample size; short intervention time frame (<8 weeks)

Results Author (year)

Main Finding(s) Conclusion(s) Study Limitations

Harvie (2011) IER & CER are equally effective (but not significantly different) for weight loss. The average weight change was -6.4 (-7.9 to -4.8) kg for IER and -5.6 (-6.9 to -4.4) kg for CER (P=0.4)

IER & CER are effective ways to lose weight; IER could be used as an alternative to CER for weight loss

Did not assess long term adherence to IER

Heilbronn (2005)

Participants significantly reduced their initial body weight by 2.5 ± 0.5% (P < 0.001)

ADF is a practical method of dietary restriction for weight loss

Small sample size (16), short intervention time frame (22 days)

Hoddy (2014) Body weight (P  < 0.001) reduction included: ADF‐Lunch: 3.5 ± 0.4 kg, ADF‐Dinner 4.1 ± 0.5 kg, ADF‐Small Meal 4.0 ± 0.5 kg, but there were no significant differences between groups

Consuming the fast day meal at D, L, or SM all produce similar weight loss results

No “breakfast” group; adherence to fasting was self-reported; no control group

Keogh (2014) Weight decreased significantly with time (P < 0.001). There was no significant difference in regard to weight loss between CER and IER after 8 weeks (-3.2 ± 2.1 kg for CER and -2.0 ± 1.9 kg for IER; P  = 0.06) or after 12 months (-4.2 ± 5.6 kg for CER and -2.1 ± 3.8 kg for IER; P  = 0.19); Weight loss between weeks 8-52 was -0.7 ± 49 kg for CER and -1± 1.1 kg for IER; P  = 0.6

Intermittent dieting is as effective as a continuous caloric restriction over a 8 week time frame, as well as for weight loss maintenance at 1 year

60% of participants dropped out (limited power to the study); protocol in the study is different than for IF & ADF

Trepanowski (2017)

At 6 months, the average weight loss between the two groups (ADF vs. DER) was not significantly different (–6.8% [–9.1% to –4.5%] vs. –6.8% [–9.1% to –4.6%], respectively). These same findings were seen after 12 months as well (–6.0% [–8.5% to –3.6%] vs. –5.3% [–7.6% to –3.0%], respectively). No significant weight changes were seen in the control group. Overall, the participants in the ADF group consumed more calories than prescribed on fasting days, however they consumed less calories than prescribed on feasting days. Participants in the DER group met their prescribed caloric intake goals.

ADF did not produce a greater weight loss compared to DER

Short maintenance phase (6 weeks); control group did not receive food/counseling; high dropout rate; limited generalizability; study population was metabolically healthy obese individuals

Results Author (year) Demographics of the study population (n= number of participants)

Bhutani (2013) n= 64; Comorbidities in study population: obesity; Average age (years): 44.5 (range: 25-65); % male: 3.6; % female: 96.4

Bowen (2018) n= 162; Comorbidities in study population: obesity; Average age (years): 40 (range: 25-60); % male: 19; % female: 81

Byrne (2017) n= 51; Comorbidities in study population: obesity; Average age (years): 40 (range: 25-54); % male: 100; % female: 0

Catenacci (2016) n= 26; Comorbidities in study population: obesity; Average age (years): 41.1 (range: 18-55); % male: 24; % female: 76

Eshghinia (2013) n= 15; Comorbidities in study population: obesity; Average age (years): 33.5 (range: 20-45); % male: 0; % female: 100

Harvie (2011) n= 107; Comorbidities in study population: obesity; Average age (years): 40 (range: 30-45); % male: 0; % female: 100

Heilbronn (2005) n= 16; Comorbidities in study population: none; Average age (years): 32 (range: 23-53); % male: 50; % female: 50

Hoddy (2014) n= 74; Comorbidities in study population: obesity; Average age (years): 45 (range: 25-65); % male: 15; % female: 85

Keogh (2014) n= 36; Comorbidities in study population: obesity; Average age (years): 60.2; % male: 0; % female: 100

Trepanowski (2017)

n= 100; Comorbidities in study population: obesity; Average age (years): 44 (range:18-65); % male: 14; % female: 86

Results ● All 10 studies found that following an IF

diet protocol lead to a reduction in weight; the weight loss for IF ranged from 4.4 pounds to 31.0 pounds

● More research needs to be conducted before recommending IF as a means to lose weight since long-term studies on IF have yet to be conducted, although the research does not present any harm in metabolic function in the short-term

Discussion: Overall Findings ● 10/10 studies found weight reduction when following a

IF diet protocol (but varied from article to article) ○ Differences may be due to the differences in study

durations and/or the differences in IF diet protocol. ■ Some had 2-3 fasting days/week where

participants consumed 25-30% of their daily energy needs (Bhutani, 2013, Eshghinia, 2013, Heilbronn, 2005, Hoddy, 2014, and Trepanowski, 2017)

■ Another study had participants fast for 1 week (-1,314.5 calories/day) followed by a regular week (Keogh, 2014)

Discussion: Overall Findings ● Most of the studies did not find any significant

differences in weight loss between IF and continuous energy restriction (CER) ○ Both found to be effective strategies for

weight loss within the obese population

● Heilbronn et. al (2005) noticed that participants’ hunger levels did not adapt to ADF, which may hinder the sustainability of the diet ○ People could add a small meal on the fasting

day to help make this diet more feasible over a long period of time

Discussion: Mechanisms ● Participants were not able to

consume enough calories on days they were eating to maintain their body weight, leading to weight loss

● Breaking fasting periods up with energy balance could decrease compensatory metabolic responses, which may improve the efficiency of weight loss (Byrne et al., 2017)

Discussion: Strengths & Limitations ● Strengths:

○ Experimental design (9/10 RCTs) ■ High internal validity &

reliability ○ All studies conducted within past

15 years ● Limitations:

○ 8/10 had small sample sizes (100 or less)

○ 6/10 had short interventions (3 months or less)

○ 3/10 studies the generalizability of the findings are limited

Discussion: Other Research ● Narrative review with 6 studies looked at

the effects of short-term IF found that IF is equivalent to CER in regard to weight loss in overweight & obese individuals and does not show any evidence of harmful effects (Harvie and Howell, 2017)

● A systematic review/meta-analysis of 6 studies with interventions =/> 6 months also found that there was no significant difference between IF & CER on weight loss (Headland, Clifton, Carter, & Keogh, 2016)

Conclusion ● ADF/IF is a safe & effective approach for short-term weight

reduction in obese ○ Even a 5-10% weight loss has been shown to have

various cardiometabolic improvements, like improved lipid levels, blood pressure, and glucose control and can help reduce healthcare costs (Ryan & Yockey, 2017)

● ADF/IF does not seem to have any adverse side effects in short-term

● Future research: ○ Larger & longer study duration (> 1 year) ○ Overweight/healthy BMI individuals with lipid/glucose

abnormalities, HTN, and/or high body fat percentage

References Bhutani, S., Klempel, M. C., Kroeger, C. M., Trepanowski, J. F., & Varady, K. A. (2013). Alternate day fasting and endurance exercise

combine to reduce body weight and favorably alter plasma lipids in obese humans. Obesity (Silver Spring, Md.), 21(7), 1370–1379. https://doi.org/10.1002/oby.20353

Bowen J, Brindal E, James-Martin G, Noakes M. (2018). Randomized trial of a high protein, partial meal replacement program with or without alternate day fasting: similar effects on weight loss, retention status, nutritional, metabolic, and behavioral outcomes. Nutrients, 10(9). https://doi.org/10.3390/nu10091145

Byrne, N. M., Sainsbury, A., King, N. A., Hills, A. P., & Wood, R. E. (2017). Intermittent energy restriction improves weight loss efficiency in obese men: The MATADOR study. International Journal of Obesity, 42(2), 129-138. doi:10.1038/ijo.2017.206

Catenacci, V. A., Pan, Z., Ostendorf, D., Brannon, S., Gozansky, W. S., Mattson, M. P., Martin, B., MacLean, P. S., Melanson, E. L., & Troy Donahoo, W. (2016). A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity. Obesity (Silver Spring, Md.), 24(9), 1874–1883. https://doi.org/10.1002/oby.21581

Centers of Disease Control and Prevention. (2020, April 10). Adult Overweight and Obesity. Retrieved May 28, 2020, from https://www.cdc.gov/obesity/adult/index.html

Eshghinia, S., & Mohammadzadeh, F. (2013). The effects of modified alternate-day fasting diet on weight loss and CAD risk factors in overweight and obese women. Journal of diabetes and metabolic disorders, 12(1), 4. https://doi.org/10.1186/2251-6581-12-4

Harvie M. & Howell A. (2017). Potential Benefits and Harms of Intermittent Energy Restriction and Intermittent Fasting Amongst Obese, Overweight and Normal Weight Subjects—A Narrative Review of Human and Animal Evidence. Behav. Sci., 7(1), 4. https://doi.org/10.3390/bs7010004

Harvie, M. N., Pegington, M., Mattson, M. P., Frystyk, J., Dillon, B., Evans, G., Cuzick, J., Jebb, S. A., Martin, B., Cutler, R. G., Son, T. G., Maudsley, S., Carlson, O. D., Egan, J. M., Flyvbjerg, A., & Howell, A. (2011). The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. International journal of obesity (2005), 35(5), 714–727. https://doi.org/10.1038/ijo.2010.171

References (con’t) Headland M., Clifton P.M., Carter S., & Keogh J.B. (2016). Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of

Intermittent Energy Restriction Trials Lasting a Minimum of 6 Months. Nutrients, 8(6), 354. https://doi.org/10.3390/nu8060354 Heilbronn, L. K., Smith, S. R., Martin, C. K., Anton, S. D., & Ravussin, E. (2005). Alternate-day fasting in nonobese subjects: effects on

body weight, body composition, and energy metabolism. The American Journal of Clinical Nutrition, 81(1), 69–73. https://doi.org/10.1093/ajcn/81.1.69

Hoddy, K. K., Kroeger, C. M., Trepanowski, J. F., Barnosky, A., Bhutani, S., & Varady, K. A. (2014). Meal timing during alternate day fasting: Impact on body weight and cardiovascular disease risk in obese adults. Obesity (Silver Spring, Md.), 22(12), 2524–2531. https://doi.org/10.1002/oby.20909

Keogh, J. B., Pedersen, E., Petersen, K. S., & Clifton, P. M. (2014). Effects of intermittent compared to continuous energy restriction on short-term weight loss and long-term weight loss maintenance. Clinical obesity, 4(3), 150–156. https://doi.org/10.1111/cob.12052

Ryan, D. H., & Yockey, S. R. (2017). Weight Loss and Improvement in Comorbidity: Differences at 5%, 10%, 15%, and Over. Current obesity reports, 6(2), 187–194. https://doi.org/10.1007/s13679-017-0262-y

Trepanowski, J. F., Kroeger, C. M., Barnosky, A., Klempel, M. C., Bhutani, S., Hoddy, K. K., . . . Varady, K. A. (2017). Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults. JAMA Internal Medicine, 177(7), 930. doi:10.1001/jamainternmed.2017.0936

Shelly Schick

A Review On The Effect Of Intermittent Fasting On Weight Loss

Andrews University

FDNT-680-999 Research Seminar

Summer 2020

Abstract

Obesity is a prominent disease in the United States, affecting millions of Americans and

costing billions of dollars in healthcare each year. Healthcare professionals recommend a

lifestyle change, including a healthy diet with calorie restriction along with daily physical

activity in order to promote weight loss. A relatively new approach to weight loss is intermittent

fasting, in which an individual goes a period of time without consuming calories. This literature

review was conducted via the databases EBSCO, Google Scholar, and PubMed and contains 10

experimental studies which looked at the relationship between intermittent fasting and body

weight. All 10 studies found that intermittent fasting led to weight loss, which ranged from 4.4

pounds to 31.0 pounds. Overall, intermittent fasting has been shown to be a safe and effective

way to lose weight, however long-term effects remain unknown.

Introduction

Obesity is a major health problem within the United States and leads to many different

chronic diseases and health conditions, like Hypertension, Dyslipidemia, Cardiovascular

Disease, Type 2 Diabetes Mellitus, Stroke, Sleep Apnea, Depression, and certain types of

cancers. This causes billions of dollars in medical expenses every year (Centers of Disease

Control and Prevention, 2020). Obesity is caused by genetic and environmental factors and

behaviors, like a poor diet and sedentary lifestyle. According to the Centers of Disease Control

and Prevention (CDC), from 2017-2018, 42.4% of adults in the United States were obese. A

person who has a body mass index (BMI) greater than or equal to 30.0 is considered obese

(Centers of Disease Control and Prevention, 2020).

Recently, Intermittent Fasting (IF) has become a popular method for people to try to lose

weight. However, IF it has been around for centuries; during Ramadan, Muslims fast between

sunrise and sunset, although they fast for religious purposes, rather than weight loss. There are

different versions of IF. One type is where a person fasts for a specific time frame (for example,

from 6:00 pm to 10:00 am) and then is allowed to eat for the remainder of the day (from 10:00

am to 6 pm). Another popular type is to fast for two days of the week and then eat normally the

other five days of the week. The fast can be defined as consuming no calories or consuming a

very low amount of calories (for example, 500 calories per day). With the recent increase in

popularity of IF, there have been many novel studies looking at IF and its benefits; the purpose

of this literature review was to conduct a literature review looking at the

relationship/effectiveness of IF on body weight (with a specific focus on weight loss) to see if IF

can help those who are obese lose weight.

Methodology

Literature Search

A literature review was conducted via the databases EBSCO, Google Scholar, and

PubMed by using the keywords: “intermittent fasting” “weight” “weight loss” “humans or

people” and “BMI.” Furthermore, the results were specified to be peer-reviewed and within the

past 15 years (from 2005-2020). The keyword “humans OR people” was used because only

studies conducted on humans were included in the review (as opposed to animals). After

reviewing the abstract of potential articles, the full-length text was reviewed to confirm inclusion

criteria of: (1) An experimental study design, (2) A study population of adults, (3) An exposure

of intermittent fasting, and (4) An outcome of body weight. Any study that was conducted on

animals, or any study that was conducted more than 15 years ago (before 2005) was excluded

from this analysis.

Data extraction

10 experimental studies (nine randomized control trials and one quasi-experimental) were

included in the final analysis, all of which investigated the association between IF on body

weight within the adult population. The 10 sources included in this review were: Bhutani,

Klempel, Kroeger, Trepanowski, & Varady (2013), Bowen, Brindal, James-Martin, & Noakes

(2018), Byrne, Sainsbury, King, Hills, & Wood (2017), Catenacci et al. (2016), Eshghinia &

Mohammadzadeh (2013), Harvie et al. (2011), Heilbronn, Smith, Martin, Anton, & Ravussin

(2005), Hoddy et al. (2014), Keogh, Pedersen, Petersen, & Clifton (2014), and Trepanowski et

al. (2017). Many of the studies looked at other outcomes, like changes in waist circumference,

insulin sensitivity, blood pressure, and lipid levels (specifically, HDL cholesterol, LDL

cholesterol, and triglycerides), however only information pertaining to body weight was included

in this analysis. The specific information taken from these studies included the main objective of

each study, the type exposure/intervention used in each study, the main results/findings and

conclusions (specifically findings related to body weight), as well as study limitations.

Results

This literature review included 10 experimental studies. Table 1.1 shows the study

design, main objective, type of exposure used and outcome measured within all of the articles

reviewed. Altogether, the intervention time periods ranged from six weeks to six months. Each

study had its own definition for what a “fasting” day looked like; one study defined its fasting

day by not consuming any calories, while most studies defined fasting days by allowing

participants to eat a certain percentage of their calorie needs (for example, 25% of their daily

calorie/energy needs).

Table 1.2 explains the main finding(s), conclusion(s), and the limitations of the studies

reviewed. All of the studies found that following an IF diet protocol caused a reduction in

weight; the weight loss for IF ranged from 4.4 pounds to 31.0 pounds.

Table 1.3 displays the demographics of the study population, as well as any comorbidities

in the study population. The sample size of the study population ranged from 15 to 162

participants. Nine out of the 10 studies included study population of participants who were obese

and one study did not have any comorbidities in its study population (Heilbronn et al., 2005).

In general, it is evident that more research needs to be conducted before recommending

IF as a means to lose weight since long-term studies on IF have yet to be conducted, although the

research does not present any harm in metabolic function in the short-term.

Discussion

Overall, most of the studies did not find any significant differences in weight loss

between IF and continuous energy restriction (CER)— both were found to be effective strategies

for weight loss within the obese population. However, there needs to be longer and larger studies

looking at the long-term effects of IF. For example, Heilbronn and colleagues (2005) noticed that

participants’ hunger levels did not adapt to alternate day fasting (ADF), which may hinder the

sustainability of the diet. The researchers suggest that people could add a small meal on the

fasting day to help make this diet more feasible over a long period of time.

All of the studies investigated in this literature review found changes in weight,

specifically weight reduction, when following a IF diet protocol. However, the amount of weight

loss varied from article to article. These differences in amount of weight loss between the studies

may be due to the differences in study durations and/or the differences in IF diet protocol. For

example, some studies had two or three fasting days each week where participants consumed

25-30% of their daily energy needs (Bhutani, 2013, Eshghinia, 2013, Heilbronn, 2005, Hoddy,

2014, and Trepanowski, 2017), while another study had participants fast for one week (-1,314.5

calories per day) followed by a regular week (Keogh, 2014).

Several other peer-reviewed articles have found similar findings seen in this literature

review. For example, in a narrative review conducted by Harvie and Howell (2017) included six

studies looking at the effects of short-term IF. The researchers found that IF is equivalent to CER

in regard to weight loss in overweight and obese individuals and does not show any evidence of

harmful effects. Furthermore, a systematic review and meta-analysis of nine studies with

interventions equal to or longer than six months also found that there was no significant

difference between IF and CER on weight loss (Headland, Clifton, Carter, & Keogh, 2016).

Mechanisms

The likely mechanism explaining the results found in this literature review suggests that

participants were not able to consume enough calories on days they were eating (as opposed to

fasting) to maintain their body weight, leading to weight loss. Furthermore, Byrne and colleagues

(2017) suggest that breaking fasting periods up with energy balance could decrease

compensatory metabolic responses, which may improve the efficiency of weight loss.

Strengths and Limitations

Like all studies, there were various strengths and limitations regarding the studies

reviewed. In regard to strengths, all of the studies reviewed were an experimental design, with

nine out of the 10 being randomized control trials (the gold standard for a research design); this

is a major strength regarding this literature review because experimental designs have high

internal validity and reliability. Furthermore, all of the studies reviewed were conducted within

the past 15 years, which means that the findings are from the most up-to-date data within the

field.

However, there were also various limitations that need to be addressed. First off, many of

the studies had a sample size of 100 or less (Bhutani et al. (2013), Byrne et al. (2017), Catenacci

et al. (2016), Eshghinia & Mohammadzadeh (2013), Heilbronn et al. (2005), Hoddy et al. (2014),

Keogh et al. (2014), and Trepanowski et al. (2017). Additionally some studies had short

intervention time frames of equal to or less than three months (Bhutani et al. (2013), Catenacci et

al. (2016), Eshghinia & Mohammadzadeh (2013), Heilbronn et al. (2005), Hoddy et al. (2014),

and Keogh et al. (2014)). Finally, in some of the studies, the generalizability of the findings were

limited (Bhutani et al. (2013), Catenacci et al. (2016), and Trepanowski et al. (2017)).

Conclusion

In conclusion, this review shows support that IF can aid in short-term weight loss,

especially in those who are obese. There seems to be no short-term adverse side effects

connected with IF/ADF. Researchers concluded that ADF can be as safe and effective as CER in

regard to losing weight; even a 5-10% weight loss has been shown to have various

cardiometabolic improvements, like improved lipid levels, blood pressure, and glucose control

and can help reduce healthcare costs (Ryan & Yockey, 2017).

Since many of the studies have short intervention time frames (less than one year), the

long-term health effects and effectiveness in weight loss/maintenance regarding IF remains

unknown. Future research studies looking at the association of IF and weight loss should have

longer durations (greater than one year) and larger sample sizes (greater than 100 participants) to

assess sustainability, as well as the long-term effects of IF. Additionally, there is limited

evidence looking at the impact of IF on weight loss in overweight individuals since most of the

studies conducted look at obese individuals. Future research should include a study population

with overweight individuals and/or individuals with a healthy BMI with other health

abnormalities (for example, a high body fat percentage, hypertension, abnormal glucose and/or

lipid panel levels) to assess if IF helps improve these cardiometabolic risk factors.

References

Bhutani, S., Klempel, M. C., Kroeger, C. M., Trepanowski, J. F., & Varady, K. A. (2013).

Alternate day fasting and endurance exercise combine to reduce body weight and

favorably alter plasma lipids in obese humans. ​Obesity​ (Silver Spring, Md.), 21(7),

1370–1379. ​https://doi.org/10.1002/oby.20353

Bowen J, Brindal E, James-Martin G, Noakes M. (2018). Randomized trial of a high protein,

partial meal replacement program with or without alternate day fasting: similar effects on

weight loss, retention status, nutritional, metabolic, and behavioral outcomes. ​Nutrients​,

10(9). ​https://doi.org/10.3390/nu10091145

Byrne, N. M., Sainsbury, A., King, N. A., Hills, A. P., & Wood, R. E. (2017). Intermittent

energy restriction improves weight loss efficiency in obese men: The MATADOR study.

International Journal of Obesity​, 42(2), 129-138. doi:10.1038/ijo.2017.206

Catenacci, V. A., Pan, Z., Ostendorf, D., Brannon, S., Gozansky, W. S., Mattson, M. P., Martin,

B., MacLean, P. S., Melanson, E. L., & Troy Donahoo, W. (2016). A randomized pilot

study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults

with obesity. ​Obesity​ (Silver Spring, Md.), 24(9), 1874–1883.

https://doi.org/10.1002/oby.21581

Centers of Disease Control and Prevention. (2020, April 10). Adult Overweight and Obesity.

Retrieved May 28, 2020, from https://www.cdc.gov/obesity/adult/index.html

Eshghinia, S., & Mohammadzadeh, F. (2013). The effects of modified alternate-day fasting diet

on weight loss and CAD risk factors in overweight and obese women. ​Journal of diabetes

and metabolic disorders​, 12(1), 4. https://doi.org/10.1186/2251-6581-12-4

Harvie M. & Howell A. (2017). Potential Benefits and Harms of Intermittent Energy Restriction

and Intermittent Fasting Amongst Obese, Overweight and Normal Weight Subjects—A

Narrative Review of Human and Animal Evidence. ​Behav. Sci., ​7(1), 4.

https://doi.org/10.3390/bs7010004

Harvie, M. N., Pegington, M., Mattson, M. P., Frystyk, J., Dillon, B., Evans, G., Cuzick, J., Jebb,

S. A., Martin, B., Cutler, R. G., Son, T. G., Maudsley, S., Carlson, O. D., Egan, J. M.,

Flyvbjerg, A., & Howell, A. (2011). The effects of intermittent or continuous energy

restriction on weight loss and metabolic disease risk markers: a randomized trial in young

overweight women. ​International journal of obesity​ (2005), 35(5), 714–727.

https://doi.org/10.1038/ijo.2010.171

Headland M., Clifton P.M., Carter S., & Keogh J.B. (2016). Weight-Loss Outcomes: A

Systematic Review and Meta-Analysis of Intermittent Energy Restriction Trials Lasting a

Minimum of 6 Months. ​Nutrients, ​8(6), 354. ​https://doi.org/10.3390/nu8060354

Heilbronn, L. K., Smith, S. R., Martin, C. K., Anton, S. D., & Ravussin, E. (2005). Alternate-day

fasting in nonobese subjects: effects on body weight, body composition, and energy

metabolism. ​The American Journal of Clinical Nutrition​, 81(1), 69–73.

https://doi.org/10.1093/ajcn/81.1.69

Hoddy, K. K., Kroeger, C. M., Trepanowski, J. F., Barnosky, A., Bhutani, S., & Varady, K. A.

(2014). Meal timing during alternate day fasting: Impact on body weight and

cardiovascular disease risk in obese adults. ​Obesity​ (Silver Spring, Md.), 22(12),

2524–2531. https://doi.org/10.1002/oby.20909

Keogh, J. B., Pedersen, E., Petersen, K. S., & Clifton, P. M. (2014). Effects of intermittent

compared to continuous energy restriction on short-term weight loss and long-term

weight loss maintenance. ​Clinical obesity​, 4(3), 150–156.

https://doi.org/10.1111/cob.12052

Ryan, D. H., & Yockey, S. R. (2017). Weight Loss and Improvement in Comorbidity:

Differences at 5%, 10%, 15%, and Over. ​Current obesity reports​, ​6​(2), 187–194.

https://doi.org/10.1007/s13679-017-0262-y

Trepanowski, J. F., Kroeger, C. M., Barnosky, A., Klempel, M. C., Bhutani, S., Hoddy, K. K., . .

. Varady, K. A. (2017). Effect of alternate-day fasting on weight loss, weight

maintenance, and cardioprotection among metabolically healthy obese adults. ​JAMA

Internal Medicine​, 177(7), 930. doi:10.1001/jamainternmed.2017.0936

Appendices Table 1.1

Author (year)

Study Design

Main Objective Exposure Outcome Measured

Type of Analysis (α & p-value)

Bhutani (2013)

Randomized Control Trial

To investigate whether ADF with exercise has a greater effect on body composition compared to ADF or exercise alone

ADF plus exercise vs. exercise alone vs. ADF alone

Body weight

One-way ANOVA at baseline; repeated-measures ANOVA for within-group differences; Intention-to-treat analysis (α: 0.05; p: <0.05)

Bowen (2018)

Randomized Control Trial

To compare an energy restriction with ADF to a high-protein, meal replacement program with daily energy restriction (DER) on weight loss

High-protein, meal replacement program with DER vs. energy restriction with ADF

Body weight

Mixed effects linear models (α: 0.05; p: <0.05)

Byrne (2017)

Randomized Control Trial

To determine whether intermittent energy restriction (IER) had a greater impact on weight loss efficiency in comparison to continuous energy restriction (CER)

IER vs. CER Weight loss efficiency

Mixed model repeated measures analyses (α: 0.05; p: <0.05)

Catenacci (2016)

Randomized Control Trial

To compare the effects of ADF versus a moderate daily caloric restriction (CR) on weight status

Zero-calorie ADF vs. calorie restriction (-400 kcal/day)

Body weight

Linear mixed-effects model; Independent-sampl es ​t ​-tests (α: 0.05; p: <0.05)

Eshghinia (2013)

Quasi- experimenta l

To evaluate the effects of a modified ADF on body weight in obese women

Alternate-day fasting diet

Body weight

Paired ​T​-test (α: 0.05; p: <0.05)

Harvie (2011)

Randomized Control Trial

To compare the effectiveness & practicality of IER vs. CER on weight loss

IER vs. CER Weight loss

Paired ​t​-tests at baseline & LOCF analysis at 6

months (α: 0.05; p: <0.05)

Heilbronn (2005)

Randomized Control Trial

To examine if ADF is a practical method of dietary restriction for weight loss in non-obese individuals

ADF Body weight

One- & two-factor repeated-measures analysis of variance (α: 0.05; p: <0.05)

Hoddy (2014)

Randomized Control Trial

To compare the effects of ADF with three meal times on body weight

ADF with three meal times

Body weight

One way ANOVA, Tukey's ​post hoc test, & a paired t​-test (α: 0.05; p: <0.05)

Keogh (2014)

Randomized Control Trial

To investigate the effect of IER versus CER on weight loss

IER vs. CER Body weight

Independent samples t-test at baseline; repeated-measures ANOVA (α: 0.05; p: <0.05)

Trepanowski (2017)

Randomized Control Trial

To compare the effects of ADF vs. a DER on weight loss

ADF vs. DER Weight loss

Independent-sampl es ​t​ test; a linear mixed model (α: 0.05; p: <0.05)

Table 1.2

Author (year)

Main Finding(s) Conclusion(s) Study Limitations

Bhutani (2013)

Body weight was reduced in all of the intervention groups after 12 weeks (​P ​< 0.05). Body weight decreased by 6 ± 4 kg, 3 ± 1 kg, and 1 ± 0 kg in the ADF plus exercise, ADF, and exercise groups, respectively

ADF plus exercise produces greater amount of weight loss compared to ADF or exercise alone

Short intervention time frame (12 weeks); used BIA to measure fat mass & fat free mass instead of dual-energy X-ray absorptiometry (DXA); participants were only from the University of Illinois, Chicago campus (cannot generalized results); flawed randomization procedure

Bowen (2018)

There was a statistically significant decrease in body weight over time (​p​ < 0.001); At week 16 of the intervention, weight decreased by 10.7 ± 0.5 kg & −11.2 ± 0.6 kg in the ADF + DER group and the DER group, respectively (no significant difference between groups)

Both a high-protein, meal replacement program with DER & a energy restriction with ADF support weight loss

No biological data at 6 months; no long-term follow up; small number of male participants; no measurement for energy expenditure & physical activity monitoring

Byrne (2017) The IER group lost more weight compared to the CER group (14.1±5.6 vs 9.1±2.9 kg; P<0.001); Both groups regained weight after the 6-month follow-up (IER: 3.5±5.9 vs. CER: 5.9±4.7 kg; ​P​=0.24)

IER prodcued a higher amount of weight and fat loss.

Attrition in study population; small weight loss during baseline period; no measurements for body composition or resting energy expenditure during energy balance blocks in the IER group

Catenacci (2016)

At week 8, the ADF group had a greater energy deficient of 376 kcal/day compared to the CR group; however, no significant changes in weight were seen between the two groups (mean ±SE; ADF -8.2 ± 0.9 kg, CR -7.1 ± 1.0 kg). Finally, after week 24 of unsupervised follow-up, no significant differences in weight regain were seen

ADF & CR produced similar amount of weight loss after the 8 weeks

Pilot study; small sample size; randomization was arranged by sex; small male percentage; no measurements on physical activity; results cannot be generalized

Eshghinia (2013)

ADF significantly reduced body weight from 84.3 ± 11.44 kg to 78.3 ± 10.18 kg (P < 0.001)

Short-term ADF is an effective intervention for weight loss & reducing CAD risk in obese individuals

No control groups; small sample size; short intervention time frame (<8 weeks)

Harvie (2011)

IER & CER are equally effective (but not significantly different) for weight loss. The average weight change was -6.4 (-7.9 to -4.8) kg for IER and -5.6 (-6.9 to -4.4) kg for CER (P=0.4)

IER & CER are both effective ways to lose weight and produce similar results; IER could be used as an alternative to CER for weight & disease risk reduction

Did not assess long-term adherence to IER

Heilbronn (2005)

Participants significantly reduced their initial body weight by 2.5 ± 0.5% (​P​ < 0.001)

ADF is a practical method of dietary restriction for weight loss in non-obese individuals

Small sample size (16), short intervention time frame (22 days)

Hoddy (2014)

Body weight (​P ​ < 0.001) reduction included: ADF-Lunch: 3.5 ± 0.4 kg, ADF-Dinner 4.1 ± 0.5 kg, ADF-Small Meal 4.0 ± 0.5 kg, but there were no significant differences between groups

Consuming the fast day meal at dinner, lunch, or small meals all produce similar weight loss results, as well as cardio-protective benefits; the flexibility to choose the time of the fast day meal could increase tolerability & sustainability for adherence to ADF

No “breakfast” group to look at effects of consuming the fast day meal between 6:00-8:00am.; only 80% of data for participants’ activity in intervention group were collected because of malfunctioning activity monitors; adherence to fasting was self-reported; no control group

Keogh (2014)

Weight decreased significantly with time (P < 0.001). There was no significant difference in regard to weight loss between CER and IER after 8 weeks (-3.2 ± 2.1 kg for CER and -2.0 ± 1.9 kg for IER; ​P ​ = 0.06) or after 12 months (-4.2 ± 5.6 kg for CER and -2.1 ± 3.8 kg for IER; ​P  = 0.19); Weight loss between weeks 8-52 was -0.7 ± 49 kg for CER and -1± 1.1 kg for IER; ​P  = 0.6

Intermittent dieting is as effective as a continuous caloric restriction over a 8 week time frame, as well as for weight loss maintenance at 1 year

60% of participants dropped out (limited power to the study); protocol in the study is different than for IF & ADF

Trepanowski (2017)

At 6 months, the average weight loss between the two groups (ADF vs. DER) was not significantly different (–6.8% [–9.1% to –4.5%] vs. –6.8% [–9.1% to –4.6%], respectively). These same findings were seen after 12 months as well (–6.0% [–8.5% to –3.6%] vs. –5.3% [–7.6% to –3.0%], respectively). No significant weight changes were seen in the control group. Overall, the participants in the ADF group consumed more calories than prescribed on fasting days, however they consumed less calories than prescribed on feasting days. Participants in the DER group met their prescribed caloric intake goals.

ADF did not produce a greater weight loss compared to DER

Short maintenance phase (6 weeks); control group did not receive food or counseling and received less attention; high dropout rate (this decreased the power); generalizability of the study is limited; study population was metabolically healthy obese individuals (improvements might have been greater in metabolically unhealthy individuals)

Table 1.3

Author (year) Demographics of the study population (n= number of participants)

Bhutani (2013) n= 64; Comorbidities in study population: obesity Average age (years): 44.5 (range: 25-65) % male: 3.6; % female: 96.4

Bowen (2018) n= 162; Comorbidities in study population: obesity Average age (years): 40 (range: 25-60) % male: 19; % female: 81

Byrne (2017) n= 51; Comorbidities in study population: obesity Average age (years): 40 (range: 25-54) % male: 100; % female: 0

Catenacci (2016) n= 26; Comorbidities in study population: obesity Average age (years): 41.1 (range: 18-55) % male: 24; % female: 76

Eshghinia (2013) n= 15; Comorbidities in study population: obesity Average age (years): 33.5 (range: 20-45) % male: 0; % female: 100

Harvie (2011) n= 107; Comorbidities in study population: obesity Average age (years): 40 (range: 30-45) % male: 0; % female: 100

Heilbronn (2005) n= 16; Comorbidities in study population: none Average age (years): 32 (range: 23-53) % male: 50; % female: 50

Hoddy (2014) n= 74; Comorbidities in study population: obesity Average age (years): 45 (range: 25-65) % male: 15; % female: 85

Keogh (2014) n= 36; Comorbidities in study population: obesity Average age (years): 60.2 % male: 0; % female: 100

Trepanowski (2017) n= 100; Comorbidities in study population: obesity Average age (years): 44 (range:18-65) % male: 14; % female: 86

SySllyalblaubsus FDNT680

Page 1

Dr. Dixon Anjejo

FDNT 680-999: Research Seminar

Spring 2020

FDNT 680-999: Research Seminar

Spring 2025

Dr. Dixon Anjejo Assistant: Eugenie Mukamunana

FDNT680 Syllabus

Page 2

Spring 2025

FDNT 680: RESEARCH SEMINAR (1 Credit Hour)

Course Descriptions

The Research Seminar allows MPH students to prepare and present scientific information on

nutrition, wellness, health promotion, and health education to MPH/MS students and/or public

health professionals.

Instructor Contact

Professor: Dixon Anjejo, MPH, DrPH

Assistant: Eugenie Mukamunana

Office: Marsh Hall 313

Office Hours: Wednesdays & Thursdays 12 pm – 2 pm

EST Email: [email protected]

Office Phone: 269-471-3386

Interactive Online Format

This course follows an interactive online format delivered online through Learning Hub

https://learninghub.andrews.edu/. You are expected to log in regularly during the course to

participate in the online discussions, post research documents, and communicate with classmates

and the instructor. The technical requirements include weekly access to an internet connection

(DSL, LAN, or cable connection desirable). Please plan accordingly. Your username and

password are your Andrews’ username and password. You must activate your username and

password to access Learning Hub:

https://vault.andrews.edu/vault/pages/activation/information.jsp.

Username and password

assistance

[email protected] (269) 471-6016

Bookstore http://bookstore.mbsdirect.net/andrews.htm

Library – Silas Marques,

Off-campus Services

Librarian

https://www.andrews.edu/library/offcamp.html 269-471-6263

Technical assistance with

Learning Hub

[email protected] (269) 471-3960

Exam requests and

proctoring assistance

[email protected] (269) 471-6566

FDNT680 Syllabus

Page 3

Course Methods and Delivery Methods of Instruction

Methods of instruction include assigned readings from articles in peer-reviewed journals related

to the students’ Interactive Learning Experience (ILE), the course material and selected videos, as

well as feedback from peers and instructor. This course is delivered online through Learning Hub

at http://learninghub.andrews.edu. Your username and password are your Andrews’ username and

password. You need to activate your username and password to access LearningHub. Please do

this online here: https://vault.andrews.edu/vault/pages/activation/information.jsp if you haven’t

already. (269) 471- 6016 or email [email protected] if you need assistance. If you need

technical assistance at any time during the course or to report a problem with Learning Hub,

please email [email protected] or call 269-471-3960.

Part 1: Course Objectives & Schedule

FDNT 680 Research Seminar meets the following requirements:

Course Competencies for CEPH Accreditation

The course reinforces the following foundational and concentration competencies to meet the

CEPH requirements:

1. Review literature of evidence-based education initiatives designed to address diet and

lifestyle issues focusing on preventing chronic diseases and health promotion by applying

knowledge acquired from courses emphasizing vegetarian nutrition and physical activities.

2. Review the literature on a wellness program for a specific population to decrease the

prevalence and incidence of chronic disease related to inactivity using relevant

evidence-based recommendations on physical activity.

3. Review the literature on a health and wellness education initiative/program to educate

and motivate people about health.

4. Review literature on developing and evaluating research (methods) designs using

public health methodology, biostatistics, and/or epidemiology to address research

questions in public health.

5. Systematically and critically evaluate peer-reviewed research articles on nutritional

wellness, physical activities, and general lifestyle.

6. Apply epidemiological methods to the breadth of settings and situations in public

health practice

7. Select quantitative and qualitative data collection methods appropriate for a given

public health context

8. Analyze quantitative and qualitative data using biostatistics, informatics, computer-

based programming and software as appropriate

FDNT680 Syllabus

Page 4

9. Interpret results of data analysis for public health research, policy or practice

10. Select communication strategies for different audiences and sectors

11. Communicate audience-appropriate public health content, both in writing and

through oral presentation

Course Learning Outcomes (Objectives) (LO) from Andrews University:

1. Learn how to search scientific data using different library databases.

2. Learn how to select and gather relevant and sound scientific data.

3. Critically analyze and evaluate scientific literature.

4. Summarize and interpret relevant scientific literature.

5. Create a formal scientific PowerPoint presentation.

6. Present scientific information for graduate level and professional audiences.

7. Enhance verbal and written communication skills.

8. Lead a research discussion using data-backed evidence to defend own conclusions.

FDNT680 Syllabus

Page 5

Course Schedule

Week Activity Assignment CC LO

Week 1

Choose your research topic. This topic may be

something you choose to explore further in your

ILE or other culminating research activity. Discuss

your topic with the course instructor. The instructor

must approve the topic before you post.

Post your

research topic.

1, 2

1,2

Week 2

Search scientific databases (Pub Med, Science

Direct, EBSCO, Google Scholar, etc.). Create an

annotated bibliography that includes at least 12

articles relevant to your topic. Ideally, those

papers should be the backbone for the literature

review section of your Interactive Learning

Experience (ILE) or Research Project.

Post an annotated

bibliography with

at least 12

relevant articles

to your topic.

1,2, 3

1,2

Week 3-5

Critically and systematically review the 12

selected articles from week 2. Please remember

how you did your review in Research Methods

and other courses like Current Issues in

Nutrition.

Submit

your

reviews.

1, 2

3

Week 6 Read the 12 selected articles. Write a (200-250

words) abstract of your reviews.

Post your revised

title and the

abstract.

1, 2 3

Week 7

Create and prepare the PowerPoint slides for your

oral presentation of the reviews. You may consult

with your instructor for further guidance.

Present your

research via

Zoom

conference.

8,

9,

10

5,6,7,8

Week 8

Oral presentations.

Present your

research via

Zoom conference.

Upload the

research

presentation

slides and the

research paper

after revising

based on instructor

feedback.

8, 9, 10

5, 6,7,8

FDNT680 Syllabus

Page 6

KEY: CC – Concentration Competency

LO – Course Learning Outcome

Part 2: Course Requirements

Topic Selection: 5%

Bibliography: 10%

Critical and Systematic of Literature 35%

Students are required to prepare a focused literature review paper and a PowerPoint presentation.

Then, write a short abstract summarizing the presentation. See the rubrics for the evaluation in

the syllabus appendix. In addition, the student will research and critically review the scientific

literature to prepare a 30-minute PowerPoint culminating presentation summarizing a selected

topic of nutrition and wellness, highlighting the most salient finding of their research, and

critically analyzing the literature used for the research presentation. In addition, each student will

prepare a 4-6 research paper summarizing the key research topic and critically analyzing the data

of the research topic articles.

The research topic must be approved in advance by the instructor early in the course. NOTE: To

expedite the completion of the ILE, each student can research the literature relevant to their ILE

project. The research seminar can help students meet the course requirements and, at the same

time, can be used to gather background information relevant to the ILE.

The content of the literature review paper:

1) Title.

2) Abstract.

3) Literature review—focused systematic and critical review

4) Summary of results.

5) Discussion

6) Conclusion

7) Recommendations

Timely Submission of Assignments: 5%

The assignments must be submitted before or on the due date. Students who submit past the due date

will lose points.

FDNT680 Syllabus

Page 7

PowerPoint Presentation-Instructor Evaluation 45%

The PowerPoint presentations follow a research conference format. The abstracts will be printed

and circulated to all participants in the presentation. The instructor will announce the conference

time after discussing it in class. Each student will consult with the instructor at least once to review

their presentation before presenting. As the rubric indicates, faculty will react to several aspects of

each presentation. This is an interactive presentation, and the presenters will have the opportunity

to answer questions about their research and to receive feedback from students and faculty. This

culminating presentation will enhance the presentation skills of each participant. The culminating

presentation will target graduate public health students and health professionals, not lay audiences.

Therefore, we expect the student to demonstrate an in-depth understanding of the topic presented.

The presentation should provide the following:

• a clear overview of the topic

• a solid and relevant background about the topic being presented and key findings of

the papers reviewed in the selected research area

• methodological issues that might explain discrepancies between similar studies

• gaps in knowledge

• Recommendations for future research in the topic of study

Students must consult with the course instructor before their oral

presentations.

FDNT680 Syllabus

Page 8

Credit Hour and Commitment

This course is offered for 1 credit; therefore, it is expected that you will spend averagely 22 hours

per week during the 8-week duration of this class. There are no quizzes or exams for this course.

MS students will take an additional credit of Research Seminar the following semester. The

additional credit will focus on clinical aspects.

Part 4: Grading Policy

Key Assignments and Evaluations

Percent

%

Description

5% Topic of the Review

10% Annotated Bibliography

35% Critical and systematic review of Literature - This literature review can be

used in the student’s ILE research project.

Peer Evaluation - Average of all the peer evaluations for each presentation

45% PowerPoint Presentation - Instructor Evaluation - Course instructor

evaluation

4% Timely submission of assignments

1% Course Evaluation

100% Total Percent Possible

Letter Grade Assignment

Letter Grade Percentage

A 94-100%

A- 90-93%

B+ 88-89%

B 83-87%

B- 80-82%

C+ 78-79%

C 73-77%

C- 70-72%

D 60-69%

F 0-59%

FDNT680 Syllabus

Page 9

Completing Assignments

All assignments for this course will be submitted electronically through Learning Hub unless

otherwise instructed.

Part 5: Course Policies

Late Work

Each student is expected to turn in all the assignments promptly. The deadline for submissions

and reviews is Sunday at midnight the following week. If I need to modify those deadlines, I will

notify the students.

Withdrawal and Incomplete Policies

The current withdrawal policy can be found online at

http://www.andrews.edu/distance/students/withdrawal.html. The incomplete policy is found online

at http://www.andrews.edu/weblmsc/moodle/public/incompletes.html.

ACADEMIC INTEGRITY:

“Andrews University, as a Seventh-day Adventist institution, expects students to demonstrate the

ability to think clearly and exhibit personal moral integrity in every sphere of life. Honesty in all

academic matters is a vital component of personal integrity. Breaches in academic integrity

principles are taken seriously by the University. Acts of academic dishonesty, as described in the

University Bulletin, are subject to incremental disciplinary penalties with redemptive intent. Such

acts are tracked in the office of the Provost. Repeated and/or serious offenses will be referred to

the Committee on Academic Integrity for further recommendations on penalties.”

ARTIFICIAL INTELLIGENCE (AI) USE POLICY

This policy applies to generative AI tools like ChatGPT, Elicit, etc. Suppose you include material generated

by an AI program in your work; it must be cited as you would with any other reference material,

considering the reference quality, which might be subpar. No more than 25% of an assignment should

consist of AI-created content. For guidance on proper APA formatting for these citations, please refer to the

article in the link below How to cite ChatGPT

In this course my policy will be that any student who:

(a) submits work done by another student as their own

(b) engages in or contributes to plagiarism

(c) engages in or contributes to cheating on a test or assignment

(d) deliberately misleads the instructor through falsehood (i.e. lying)

(e) falsifies data etc.

The student may receive a grade of zero for that assignment. Depending on the severity of the

offense, and at the discretion of the instructor, further disciplinary measures may be pursued at the

college level. Repeat offenses may result in a zero for the course. Please note again that all

FDNT680 Syllabus

Page 10

instances of academic honesty must and will be reported to the office of the Provost, where a

record will be kept on file. As noted above, the University uses these records to track repeat

offenders

FDNT680 Syllabus

Page 11

In order to protect academic integrity the following policies will be followed:

(a) A student may be given an oral examination on any assignment at any time.

(b) All electronic equipment must be turned off and placed out of sight during tests. The

presence of active electronic equipment may be considered as an attempt to engage in

cheating. (c) The provision of materials used in plagiarism or cheating will be

considered as serious an offense as the plagiarism or cheating itself.

Plagiarism is defined as:

(a) The use of works produced by another without indicating that a source is being copied

and without citation

(b) The use of ideas produced by another without citation

(c) The use of a structure for making an argument or describing a finding without citation

(d) Any of the above, no matter what the type of material that is used – drawings,

written text, and spoken presentations, may all be plagiarism

EMAIL ETIQUETEE

• Answer ASAP – within 24 to 48 hours. A month in email feels like 20 years. A day feels

like a week. Not returning emails or phone calls is communicating that you view the caller

or sender as unimportant. Be brief in your communication – Most people don’t

thoroughly read anything much longer than a memo.

• Don’t forget punctuation, capitalization, and spelling – How many emails have you

received with poor spelling or grammar? How many have you sent with poor spelling and

grammar? It sends what communication theorists call a meta-message or “message around

a message.” The meta message is that you don’t care enough to proofread. Use the spell-

check feature.

• Respond to the sender’s question when returning the email - Isn’t it frustrating when

you purposefully ask a question via email only to ignore it? You then have to resubmit

the question in the next email. Use a greeting and a salutation – They are friendlier.

Every e-mail sounds better with a “Dear Bill” and a “Thanks, Sue.” The greeting and the

closing set an important tone for your message.

• Email is a written work – There is a finality to an email message. Never use email to

send sensitive information.

USING TECHNOLOGY:

Many assignments in this class will require you to complete assignments on computers or the

internet. If you submit an assignment electronically, be sure to keep a backup copy. At a

minimum, this should be an electronic copy; however, you may find it to your advantage to print

a copy for your records.

EMERGENCY PROTOCOLS

FDNT680 Syllabus

Page 12

Andrews University takes the safety of its student seriously. Signs identifying emergency protocol

are posted throughout buildings. Instructors will provide guidance and direction to students in the

classroom in the event of an emergency affecting that specific location. It is important that you

follow these instructions and stay with your instructor during any evacuation or sheltering

emergency.

DISABILITY:

Andrews University accepts and appreciates diversity in its students, including students with

disabilities. Accordingly, students with documented disabilities are encouraged to inform the

University of their disability and enter into a dialogue regarding ways in which the University

might reasonably accommodate them. If you qualify for the accommodations under the Americans

with Disabilities Act, please see the instructor as soon as possible for referral and assistance in

arranging such accommodations.

Academic Accommodations

Students who require accommodations may request an academic adjustment as follows:

1. Read the Andrews University Disability Accommodation information at

https://www.andrews.edu/services/sscenter/disability/

2. Download and fill in the disability form at

http://www.andrews.edu/services/sscenter/disability/accommodationsreqform.pdf .

Preferably type answers. To save a digital copy, 1) print to file and save or 2) print and

scan. Email the completed form and disability documentation (if any) to

[email protected] or fax it to 269471-8407.

3. Email [email protected] to inform the School of Distance Education that a

disability has been reported to Student Success.

4. Please note that you cannot revise a paper you have not written. If you fail to turn in an

assigned essay, you cannot submit a revision of that paper. You are encouraged to revise

any paper with which you are not satisfied. Unfortunately, you can only revise your

essays. You cannot revise discussion board postings, journal entries, midterm exam, or

final exam.

Commit to Integrity

As a student in this course (and at this university) you are expected to maintain high degrees of

professionalism, commitment to active learning and participation in this class and also integrity in

your behavior in and out of the classroom.

Commit to Excellence

You deserve a standing ovation based on your decision to enroll in, and effectively complete this

course.

FDNT680 Syllabus

Page 13

Along with your pledge of “commitment to Integrity” you are expected to adhere to a

“Commitment to excellence.” Andrews University has established high academic standards that

will truly enhance your writing and communication skills across the disciplines and in diverse

milieu with many discourse communities in the workplace.

Honesty

Using the work of another student or allowing work to be used by another student jeopardizes not

only the teacher-student relationship but also the student’s academic standing. Lessons may be

discussed with other students, tutors may help to guide a student’s work, and textbooks,

encyclopedias and other resource materials may be used for additional assistance, but the actual

response must be the student’s own work. A student who gives information to another student to

be used in a dishonest way is equally guilty of dishonesty.

“Andrews University, as a Seventh-day Adventist institution, expects students to demonstrate the

ability to think clearly and exhibit personal moral integrity in every sphere of life. Honesty in all

academic matters is a vital component of personal integrity. Breaches in academic integrity

principles are taken seriously by the University. Acts of academic dishonesty as described in the

University Bulletin are subject to incremental disciplinary penalties with redemptive intent. Such

acts are tracked in the office of the Provost. Repeated and/or serious offenses will be referred to

the Committee on Academic Integrity for further recommendations on penalties.”

In this course my policy will be that any student who:

(a) submits work done by another student as their own

(b) engages in or contributes to plagiarism

(c) engages in or contributes to cheating on a test or assignment

(d) deliberately misleads the instructor through falsehood (i.e., lying) (e)

falsifies that may receive a grade of zero for that assignment.

Depending on the severity of the offense and at the instructor's discretion, further disciplinary

measures may be pursued at the college level. Repeat offenses may result in a zero for the course.

Please note again that all instances of academic honesty must and will be reported to the office of

the Provost, where a record will be kept on file. As noted above, the University uses these records

to track repeat offenders.

In order to protect academic integrity, the following policies will be followed:

(a) A student may be given an oral examination on any assignment at any time.

(b) All electronic equipment must be turned off and placed out of sight during tests. The presence

of active electronic equipment may be considered as an attempt to engage in cheating.

(c) The provision of materials used in plagiarism or cheating will be considered as serious an

offense as the plagiarism or cheating itself.

FDNT680 Syllabus

Page 14

Any violation of this policy will be taken before the Higher Education Academic and Curriculum

Committee for appropriate punitive action.

Copyright © 2024 by Andrews University. Update the year if necessary and this should always be

at the bottom of the last page. All rights reserved. No part of these course materials may be

reproduced, stored in a retrieval system, or transmitted by any form or by any means-electronic,

mechanical, photocopying, recording, or otherwise except as may be expressly permitted by the

applicable copyright statutes or in writing by Andrews University.

FDNT680 Syllabus

Page 15

Appendix 1

15 POINTS TITLE OR TOPIC

Perfect Title with EDP: 15

points

Title with 2 of the required

contents: 10 points

Title with the one required

content: 5 points

FDNT680 Syllabus

Page 16

Appendix 2

30 POINTS ANNOTADATED BIBLIOGRAPHY RUBRIC

Illegible or inaccurate annotations score a 0

Rubric

Categories:

30 points

Thorough &

Insightful: 27

points

Acceptable &

Literal: 21 points

Attempted &

Gaps: 15 points

Partial &

Incomplete: 9

points

Confused &

Inaccurate: 3

points

Number of

Annotations:

10 points

Ample margin

Notes: 9 points

Sufficient margin

notes: 7 points

Some margin

notes: 5 points

Few margin notes:

3 points

Very few

margin notes; 1

point

Quality of

Annotations:

10 points

Insightful margin

notes with many

connections made

beyond the text;

outstanding effort:

9 points

Literal margin

notes show

understanding of

the text; sufficient

effort: 7 points

Some margin

notes show

confusion: some

effort: 5 points

Many margin

notes show

confusion: little

effort: 3 points

Most margin

notes show

confusion or

inaccurate;

very little

effort: 1 point

Quality of

Writing: 10

points

Very neat writing;

very easy to read:

9 points

Neat writing

readable: 7 points

Attempted to

write neatly, some

areas require

effort to read: 5

points

Struggled to write

neatly; many areas

require effort to

read: 3 points

Really

Struggled to

write neatly;

most areas are

difficult to

read: 1 point

30 27 21 15 9 3

FDNT680 Syllabus

Page 17

Appendix 3

Systematic and Review Literature: 100 points

Criterion Excellent: (100) Good: (90) Satisfactory: (80) Needs Improvement

(70)

Unsatisfactory:

(50)

Research

Quality and

Relevance

Sources are scholarly,

credible, and highly

relevant to the topic; a

variety of perspectives

are well-integrated.

Sources are credible

and mostly relevant;

minor gaps in

coverage, but overall

sufficient.

Sources are somewhat

relevant but lack

depth or variety;

several sources lack

credibility.

Sources are minimally

relevant or mostly not

credible; coverage of

topic is lacking.

Sources are

irrelevant, outdated,

or lacking

credibility; topic is

insufficiently

addressed.

Depth of

Analysis and

Synthesis

Demonstrates in-depth

analysis and synthesis of

research; integrates

multiple perspectives

seamlessly.

Shows good synthesis

and some analysis;

integrates different

perspectives, but some

may lack depth.

Basic synthesis with

limited analysis;

perspectives are

presented without

strong integration.

Minimal synthesis or

analysis; perspectives are

mostly summarized

rather than analyzed.

Lacks synthesis and

analysis;

perspectives are

presented without

critical insight.

Clarity and

Organization

Literature review is

well-organized, flows

logically, and uses clear,

professional language;

follows assignment

format.

Organization is

generally clear and

logical; minor issues

with flow or clarity;

mostly follows

assignment format.

Organization is

adequate but lacks

cohesion in some

areas; language and

structure require

improvement.

Organization is unclear or

illogical; language and

structure are inconsistent

or difficult to follow.

Disorganized and

difficult to

understand; lacks

adherence to

assignment format.

Referencing

and Citation

References and citations

are accurate and

complete, following the

required citation style

consistently.

References and

citations are mostly

accurate, with few

minor errors; generally

follows the required

style.

Several references or

citations contain

errors; style is

inconsistent in places.

Significant errors in

referencing and citation;

does not consistently

follow required style.

Referencing is

inaccurate or

missing; lacks

adherence to

required citation

style.

Argument

Structure

and

Coherence

Presents a clear,

coherent argument

throughout; supports

claims with relevant

evidence and logical

progression.

Presents a generally

coherent argument;

supports claims well

but may lack depth in

some areas.

Argument is mostly

clear, though parts

lack coherence or

sufficient support.

Argument is unclear or

inconsistent; lacks logical

progression and sufficient

supporting evidence.

No clear argument

is presented; lacks

coherence and

necessary support

for claims.

FDNT680 Syllabus

Page 18

Appendix 4

Evaluation of Oral Presentation

Criteria Excellent Very Good Good Poor

Content

Opening

Opening

captivates the

audience with

interest and/or

intrigue. 10 points

Interesting

opening; engages

audience. 8 points

Opening is

minimally

engaging. 6 points

Opening is not

engaging. 4 points

Organization

Information/ideas

are presented in a

consistently

logical sequence.

Transition/conne

ctions are

eloquent. A

strong sense of

wholeness is

conveyed.

Conclusion

leaves the

audience with a

strong sense of

closure. 10

points

Important ideas

and information

are identified for

the audience.

Information/ideas

are presented in a

logical sequence

with few lapses.

Transitions and

connections are

made. Closing

effectively

summarizes the

presentation. 8

points

Irrelevant,

unnecessary

information

detracts. Big

ideas are not

specifically

identified. There

are significant

lapses in the

order of ideas.

Transitions are

inconsistent and

weak or missing.

Closing

demonstrates an

attempt to

summarize. 6

points

No clear

organization.

Ideas do not

connect with one

another. There are

no clear

transitions.

No closing is

evident. 4 points

FDNT680 Syllabus

Page 19

Presentation

Speech

Commands

audience politely

using eye contact,

making sure the

audience is ready.

Can be heard by

all members of

the audience

without

assistance. Uses

visual aid as a

guide or outline

for speaking.

Consistently

maintains eye

contact. 20 points

Makes sure the

audience is ready

before starting.

May need

reminders from the

audience to speak

up; generally,

consistently

maintains eye

contact and

minimizes reliance

on notes. 15 points

Makes occasional

eye contact, makes

few attempts to

command the

audience; may

start speaking

before an audience

is ready. Needs

reminders from

the audience to

speak up. Mostly

reads from notes.

10 points

The audience

hears with great

difficulty. Reads

notes and seldom

establishes eye

contact. 5 points

FDNT680 Syllabus

Page 20

Visual Aid

Visual aid

readable and

attractive from all

parts of the room.

Graphic is clear

and professional

looking,

enhancing the

message. 10

points.

Visual aid

readable from all

parts of the room.

Graphic is neat.

Appropriate

subject chosen to

depict message. 8

points

Visual aid is not

completely

accessible to all

audience

members.

Graphic may be

messy. Visual may

not be most

appropriate to

support

presentation. 6

points

Visual aid is

indecipherable.

The graphic

detracts from

the message.

Messy or

inappropriate

visual. 4 points

Content

The content of the

presentation

reflects extensive

research and is

based on strong

scientific

evidence. 40

points

The content of the

presentation

reflects some

supportive

research. 30 points

The content of the

presentation

reflects limited

research to

support it. 20

points

The content of the

presentation

reflects limited

research. 10 points

Time Frame

The presentation

falls within the

required time

frame.

The presentation

falls within the

required time

frame.

Presentation is

less than the

minimum time.

Presentation is

more than the

maximum time.

Total Points /100 points