TABLE 3.

Overall certainty of evidence

Certainty assessment							No. of patients		Effect		Certainty	Importance
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Time-restricted eating combined with exercise	Control diet combined with exercise	Relative (95% CI)	Absolute (95% CI)
Body mass
18	Randomized trials	Serious1	Not serious	Not serious	Not serious	None	287	281	—	MD 1.86 kg lower (2.75 lower to 0.97 lower)	⊕⊕⊕◯ Moderate	—
Fat mass
14	Randomized trials	Serious1	Not serious	Not serious	Not serious	none	193	187	—	MD 1.52 kg lower (2.07 lower to 0.97 lower)	⊕⊕⊕◯ Moderate	—
Fat-free mass
13	Randomized trials	Serious1	Not serious	Not serious	Serious2	None	200	199	—	MD 0.34 kg lower (0.89 lower to 0.21 higher)	⊕⊕◯◯ Low	—
Adiponectin
5	Randomized trials	Serious1	Serious3	Not serious	Serious2,4	None	72	73	—	MD 1.5 μg/mL lower (0.32 lower to 3.33 higher)	⊕◯◯◯ Very low	—
Fasting glucose
9	Randomized trials	Serious1	Not serious	Not serious	Serious2	None	165	165	—	MD 0.41 mg/dL lower (2.04 lower to 1.22 higher)	⊕⊕◯◯ Low	—
Fasting insulin
9	Randomized trials	Serious1	Not serious	Not serious	Serious2,4	None	140	139	—	MD 0.42 μlU/mL lower (0.86 lower to 0.02 higher)	⊕⊕◯◯ Low	—
HDL
9	Randomized trials	Serious1	Serious3	Not serious	Serious2	None	156	160	—	MD 1.45 mg/dL higher (1.8 lower to 4.69 higher)	⊕◯◯◯ Very low	—
IGF-1
3	Randomized trials	Serious1	Not serious	Not serious	Serious4	None	35	35	—	MD 34.82 ng/mL lower (52.02 lower to 17.61 lower)	⊕⊕◯◯ Low	—
IL-6
3	Randomized trials	Serious1	Not serious	Not serious	Serious4	None	35	35	—	MD 0.21 ng/L lower (0.37 lower to 0.04 lower)	⊕⊕◯◯ Low	—
LDL
7	Randomized trials	Serious1	Not serious	Not serious	Serious4	None	127	131	—	MD 8.52 mg/dL lower (11.72 lower to 5.33 lower)	⊕⊕◯◯ Low	—
Leptin
4	Randomized trials	Serious1	Not serious	Not serious	Serious4	None	65	64	—	MD 0.67 ng/mL lower (1.02 lower to 0.33 lower)	⊕⊕◯◯ Low	—
TC
10	Randomized trials	Serious1	Seriousc	Not serious	Serious2	None	164	168	—	MD 2.2 mg/dL lower (8.02 lower to 3.61 higher)	⊕◯◯◯ Very low	—
TG
9	Randomized trials	Serious1	Not serious	Not serious	Not serious	None	150	151	—	MD 13.38 mg/dL lower (21.22 lower to 5.54 lower)	⊕⊕⊕◯ Moderate	—
TNF-α
3	Randomized trials	Serious1	Not serious	Not serious	Serious4	None	35	35	—	MD 0.72 ng/L lower (1.11 lower to 0.33 lower)	⊕⊕◯◯ Low	—

Abbreviations: CI, confidence interval; HDL, high-density lipoprotein; IGF-1, insulin-like growth factor 1; IL-6, interleukin 6; LDL, low-density lipoprotein; MD, mean difference, TC, total cholesterol; TG, triglyceride; TNF-α, tumor necrosis factor alpha.

¹Most of the included studies exhibited some concerns in the risk of bias assessment, which may have an impact on the certainty of the findings.

²Imprecise due to confidence intervals included potential for important harm or benefit.

³I² values showed high heterogeneity.

⁴Small sample size.