Insulin Prevents Fat Loss and Promotes Muscle Loss During Intermittent Fasting in Obesity

Abstract Elevated blood glucose, insulin, and insulin resistance are associated with obesity and type 2 diabetes (T2D). High blood insulin levels blunt lipolysis and promote lipogenesis, and thus weight gain. Intermittent fasting (IF) has emerged as a weight loss strategy that also lowers blood glucose and improves insulin resistance. However, some people with obesity, or T2D have less fat loss and more lean mass loss after IF. It is not known why some people lose more fat or muscle during IF. We hypothesized that features of obesity, such as high insulin and insulin action in adipocytes dictate less adipose loss and more muscle loss during IF. In humans, we found that people living with obesity and higher blood insulin lost more lean mass after a 48-hour fast. Chronic elevation of insulin in obese mice lowered adipose loss and promoted muscle loss after 10 weeks of 5:2 IF in obese mice, while concurrently lowering adipose tissue interferon regulatory factor 4 (IRF4) expression. Whole-body and adipocyte-specific deletion of Irf4 in mice phenocopied chronic hyperinsulinemia, resulting in less fat loss and greater muscle loss after 10 weeks of 5:2 IF, which occurred in mouse models of equal and reduced caloric intake during IF. Therefore, hyperinsulinemia and suppression of adipocyte IRF4 promote muscle loss over fat loss during IF. Significance Statement It is not known why some people lose muscle during IF. In humans, we found that high blood insulin during obesity correlated with increased lean mass loss after one 48-hour fast. Mechanistically, we found that hyperinsulinemia and the insulin responsive factor IRF4 within adipocytes as regulators of adipose and muscle loss during chronic IF obese mice. Therefore, insulin status and regulation of adipocyte IRF4 may be important factors to consider before prescribing IF for weight loss as lower muscle mass is known to be detrimental to metabolic and overall health status.