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OBJECTIVE The aim of present study was to compare the effect of calorie restriction and modified alternate-day fasting diet on treatment of adults with metabolic syndrome. DESIGN This randomized clinical trial was conducted on 70 participants diagnosed with metabolic syndrome. SETTING Patients were randomly allocated into 2 groups to follow either calorie restriction or a modified alternate-day fasting diet for 8 weeks. Diets was prescribed by dietitians and specialized for each participant. Anthropometric parameters, blood pressure, fasting plasma glucose, fasting insulin, HOMA-IR and lipid profile were measured at baseline and after trial conclusion. RESULTS 69, out of 70, participants completed the study and were included in the final analysis. The results showed that, compared with calorie restriction, following the modified alternate-day fasting diet significantly reduced body weight (P = 0.003), waist circumference (P = 0.026), systolic blood pressure (P = 0.029) and fasting plasma glucose (P = 0.009). However, no significant difference was observed between the 2 groups in triglyceride (P = 0.614), total cholesterol (P = 0.759), LDL-C (P = 0.289), HDL-C (P = 0.909), diastolic blood pressure (P = 0.262), HOMA- IR (P = 0.425) and fasting insulin concentrations (P = 0.496). In addition, the participants did not report any complaint due to difficulties with diet adherence when following calorie restriction or modified alternate-day fasting diet. CONCLUSIONS the present study suggests that modified alternate-day fasting diet may be a more effective option in managing body weight, waist circumference, systolic blood pressure, and fasting plasma glucose, compared with common calorie restriction. Further studies are needed to confirm the veracity of our results.