Background/

Objective: Intermittent fasting (IF) shows promise for metabolic and mental health benefits, but evidence in older adults remains limited. This study systematically evaluated the safety and effectiveness of IF in adults aged ≥60 years, comparing different protocols using network meta-analysis.

Methods: Systematic review and network meta-analysis following Cochrane and PRISMA guidelines were conducted, producing a literature search until June 2025 across PubMed, Scopus, and ScienceDirect databases, with inclusion criteria comprising randomized controlled trials, clinical trials, and observational studies evaluating IF in adults ≥60 years. Network meta-analysis compared time-restricted eating (TRE), IF 5:2 method, Islamic Sunnah fasting (ISF), Healthy Living Diet and usual diet. The NMA was conducted exclusively using randomized controlled trials (RCTs; n = 7); pre-post trials and observational studies were included solely in the narrative systematic review component and did not contribute to any pooled NMA estimates. Observational data contributed exclusively to the narrative synthesis.

Results: Thirty-one studies were included; seven RCTs were eligible for network meta-analysis. ISF and TRE 16:8 were most effective for weight (ISF: -2.36 kg; TRE 16:8: -1.92 kg) and BMI reduction (-0.81 and -1.01 kg/m(2)) without lean mass loss. Findings on cardiometabolic parameters, mental health, and cognitive function are based on the narrative synthesis of individual studies. Long-term structured IF was associated with improvements in standardized cognitive performance assessed via validated instruments. However, very restrictive eating windows (≤10 h) and prolonged fasting (>12.38 h) were associated with adverse outcomes, including lower cognitive scores and 58% increased cardiovascular mortality.

Conclusions: TRE 16:8 and ISF showed the strongest comparative evidence for weight reduction in the RCT-based NMA, with acceptable short-term safety profiles in the included trials. In the narrative review, these protocols were associated with clinically meaningful improvements in body weight, metabolic markers, and blood pressure while generally preserving lean muscle mass in older adults. The cardiovascular mortality risk associated with very restrictive eating windows may emphasize the importance of moderate fasting approaches in this vulnerable population. Further long-term research is needed to confirm optimal protocols and identify at-risk subgroups.