Abstract
Background
Time-restricted eating (TRE), the most popular form of intermittent fasting, induces weight loss and may improve cardiometabolic health, but less is known about the effects in certain populations.
Objectives
We performed a secondary analysis to determine the effectiveness of early TRE (eTRE) in subgroups with elevated cardiometabolic risk factors and to determine whether the effects vary by age, sex, or race.
Methods
Adults aged 25–75 y with obesity (BMI: 30–60 kg/m2) undergoing weight-loss treatment were randomized to eat in an 8-h period from 07:00 to 15:00 (eTRE) or over a ≥12-h period (control) for 14 wk. We performed subgroup analyses to: 1) assess the effects of eTRE in individuals with hypertension, prediabetes, insulin resistance, hypercholesterolemia, and severe obesity, and 2) determine whether the effects differ by age, sex, or race.
Results
eTRE lowered diastolic blood pressure by 9 ± 4 mm Hg (P = 0.047) in adults with systolic blood pressure ≥130 mm Hg and by 4 ± 2 mm Hg (P = 0.04) in adults with hypertension relative to the control group. In prediabetic adults, eTRE lowered hemoglobin A1c by 0.3% ± 0.1% (P = 0.04), whereas in adults with hypercholesterolemia, it reduced HOMA-IR by 2.96 ± 1.46 (P = 0.04). Interestingly, in adults with severe obesity, eTRE increased total and low-density lipoprotein cholesterol by 21 ± 9 and 17 ± 7 mg/dL, respectively (P = 0.03). There were no differences by sex or age. eTRE improved blood pressure and glycemic endpoints more in Black participants than White participants, although the number of Black participants was small (n = 13).
Conclusions
The results of this exploratory analysis suggest eTRE may be a promising intervention to treat hypertension and prediabetes. Any differences by sex and age are likely minor. eTRE’s effects on cholesterol in adults with severe obesity and potential racial differences merit further investigation.
This trial was registered at clinicaltrials.gov as NCT03459703.
Keywords: early time-restricted eating, time-restricted eating, time-restricted feeding, intermittent fasting, chrononutrition, circadian rhythms, prediabetes, hypertension, obesity
Introduction
Intermittent fasting is the practice of cyclically fasting for ≤48 h at a time [1]. It has become widely popular as a dietary strategy to lose weight because of its simplicity. In animal studies, a wide range of intermittent fasting interventions reduce body weight, insulin resistance, glucose concentrations, blood pressure, total cholesterol, triglycerides, oxidative stress, inflammation, and hepatic steatosis; delay the progression of cancer and neurological disorders; and even extend lifespan [[2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]]. There is a growing body of literature showing these effects translate to humans as well. Meta-analyses of clinical trials show that intermittent fasting decreases body weight and oxidative stress and can improve some aspects of cardiometabolic health and cognitive function [[14], [15], [16], [17], [18], [19], [20]].
Among the various types of intermittent fasting, the most popular is time-restricted eating (TRE), which is defined as eating within a consistent daily window of ≤10 h and fasting for the rest of the day [21]. Meta-analyses find that TRE moderately reduces body weight [17,18,[22], [23], [24], [25], [26]], with the mechanism being reduced food intake [27]. Studies also report that TRE improves some cardiometabolic risk factors, such as blood pressure, insulin sensitivity, 24-h glucose concentrations, and oxidative stress, even in the absence of energy restriction [23,[28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43]]. However, the evidence base for these benefits is less strong, and the effects appear to vary by the time of day of the eating window and the specific population. For example, several studies report that eating earlier in the day to align with circadian rhythms in metabolism [early TRE (eTRE)] improves glycemic control and blood pressure, whereas later eating windows usually do not [21,24,[37], [38], [39]]. Moreover, a recent review of TRE found that cardiometabolic benefits are more consistently reported in populations with diabetes, prediabetes, and hypertension [21].
However, as of 2026, there have been very few clinical trials or subgroup analyses in these populations. For instance, only 4 randomized studies have investigated the effects of TRE in patients with prediabetes, and all 4 studies were ≤5 wk long [29,35,40,44]. Only a few randomized controlled trials have been conducted in patients with type 2 diabetes [36,[41], [42], [43],45,46], and only 2 studies have evaluated the effects of TRE in patients with hypertension, one of which lacked a control group, and the other tested the Dietary Approaches to Stop Hypertension (DASH) diet with or without TRE [47,48]. No studies have been conducted in patients with dyslipidemia or severe obesity. Moreover, there is substantial interest in determining whether the effects of TRE differ between males and females and by age and race. However, to our knowledge, only 1 study has looked into any of these demographic factors [39]. Therefore, there is a pressing need to understand the effects of TRE in various populations and whether it can be an effective treatment for certain chronic conditions.
We recently conducted a relatively large randomized controlled clinical trial comparing 8-h eTRE plus energy restriction to a control eating window of ≥12 h plus energy restriction for 14 wk [31]. Both groups received one-on-one and group counseling to facilitate energy restriction; the only difference between groups was the timing of eating. In the intention-to-treat analysis, we found that eTRE decreased body weight and reduced diastolic blood pressure (DBP), whereas in those who consistently adhered ≥5 d/wk, it additionally lowered fasting glucose, insulin resistance, heart rate, and body fat [31,49]. In this study, we performed a secondary analysis to explore the effects of eTRE in subgroups of patients with cardiometabolic conditions, namely hypertension, prediabetes, insulin resistance, hyperlipidemia, and severe obesity. Our second objective was to examine whether the effects varied by sex, age, and race. We hypothesized that: 1) eTRE would be effective for improving glycemic control in adults with prediabetes and blood pressure in patients with hypertension but would not affect cholesterol concentrations; and 2) the effects of eTRE on cardiometabolic risk factors would not differ by sex, age, or race.
Methods
Study population
The parent study is described in detail in the primary manuscript [31]. In brief, new patients with obesity (BMI between 30.0 and 60.0 kg/m2) were recruited from the Weight Loss Medicine Clinic at the University of Alabama at Birmingham (UAB) Hospital between August 2018 and January 2020. Patients between the ages of 25 and 75 years old were eligible. Applicants were excluded if they had diabetes, a severe or unstable medical condition, took weight-loss medication, performed overnight shift work, or already regularly ate within a 10-h period. Antihypertensive medications were allowed, provided that the dose was stable throughout the study. The study was approved by UAB’s Institutional Review Board (IRB-300001207), and all participants provided written informed consent.
Intervention
The parent study was a 14-wk, parallel-arm, randomized controlled weight-loss trial. All participants received the standard of care for weight-loss treatment at the UAB Weight Loss Medicine Clinic (energy restriction). In addition, participants were randomized to practice eTRE by eating within an 8-h window from 07:00 to 15:00 or to follow a control (CON) schedule, which consisted of eating over a ≥12-h period. Both groups were instructed to follow their assigned eating schedules ≥6 d/wk. Participants were randomized using a 1:1 ratio in blocks of 2, with stratification by biological sex, race, and physical activity (≤2 compared with ≥3 d/wk of any exercise), and the allocation sequence was generated by the statistician in R (R Core Team). The study investigators, statistician, and healthcare providers at the Weight Loss Medicine Clinic were blinded, but the participants and registered dietitians were unblinded. As part of weight-loss treatment, participants were instructed to reduce their energy intake by 500 kcal/d below their resting metabolic rate and exercise 75–150 min/wk, as described in the primary manuscript. Participants in both groups also received regular weight-loss counseling, which entailed 4 one-on-one meetings with a registered dietitian and a minimum of 10 instructional group classes. The full protocol is available in the primary manuscript [31].
Outcome measures
In the parent study, the co-primary outcomes were weight loss and the percentage of weight lost as fat. Secondary outcomes included glucose, insulin, hemoglobin A1c (HbA1c), HOMA-IR, blood pressure, heart rate, and serum lipids. All outcomes were measured at baseline and post intervention. Body weight was measured in a hospital gown using a Seca mBCA 514 (Seca Corporation). Glucose, HbA1c, total cholesterol, HDL cholesterol, and triglycerides were measured using a Sirrus Clinical Chemistry Analyzer (Stanbio Laboratory, L.P), whereas insulin was measured using a Tosoh AIA-900 Analyzer (Tosoh Corporation). LDL cholesterol was calculated using the Friedewald equation. Data on race, age, and biological sex were collected by self-report.
Subgroups
We performed subgroup analyses to examine the effects of eTRE in patients with various cardiometabolic phenotypes, including hypertension, prediabetes, insulin resistance, hyperlipidemia, and severe obesity. For completeness, we assessed the effects of TRE on HbA1c, glucose, insulin, HOMA-IR, blood pressure, heart rate, and serum lipids within each subgroup. Hypertension was defined as systolic blood pressure (SBP) ≥130 mm Hg or DBP ≥80 mm Hg. Both unmedicated and medicated participants on stable doses of antihypertensive medications were included. As a post hoc analysis, we examined the additional subgroup of hypertensive participants with uncontrolled SBP (defined as SBP ≥130 mm Hg), after discovering that roughly two-thirds of our hypertensive participants had only marginally elevated DBP and did not have elevated SBP. Prediabetes was defined by either elevated HbA1c (5.7–6.4%) or impaired fasting glucose (100–125 mg/dL). Insulin resistance was defined as having a HOMA-IR value >3.70. Hypercholesterolemia and hypertriglyceridemia were defined as having total cholesterol ≥200 mg/dL and triglycerides ≥150 mg/dL, respectively. Severe obesity (class III obesity) was defined as a BMI ≥40 kg/m2, whereas nonsevere obesity (classes I and II) was defined as having a BMI between 30.0 and 39.9 kg/m2. We also explored whether the effects of TRE varied by key demographic variables, namely, age, biological sex, and race (Black or White). For these moderation analyses, we additionally assessed the effects on weight loss, as well as the above cardiometabolic risk factors.
Statistical analyses
We performed initial analyses in SPSS (version 29.0.0.0) and final analyses in R (version 4.3.2). All subgroup analyses were performed in completers using 2-sided tests, with a type I error rate of α = 0.05. Primary comparisons of change scores between groups were made using t-tests. If adjustment for baseline values in the equivalent linear model was statistically significant, we instead applied a linear model adjusting for baseline and a baseline × group interaction. Because insulin and HOMA-IR values were not normally distributed, they were log-transformed before being analyzed; however, we report raw between-group means and SEMs for data interpretation. Finally, we evaluated whether age, sex, and race moderated the effects of eTRE on cardiometabolic outcomes by testing the statistical significance of the age × group, sex × group, and race × group interaction terms in the full sample. Age was assessed as a continuous variable. As this is an exploratory analysis, no power or sample size calculations for subgroups were done a priori. Nonetheless, n = 20, 30, and 40 participants provide 80% power to detect effect sizes of d = 1.32, 1.06, and 0.91, which are all large effect sizes. Throughout this manuscript, we report baseline values as mean ± SD and change scores as mean ± SEM.
Results
Baseline characteristics
As previously reported, 656 people were screened, and 90 participants (n = 45 per group) were enrolled [31]. Nine and 11 participants withdrew from the control and eTRE groups, respectively, and an additional 11 patients were unable to complete the protocol because of the shutdown of our research facilities during the COVID-19 pandemic. All reported adverse events in both groups were mild and are summarized in the primary manuscript, with no significant differences by group [31]. Thus, 59 patients (eTRE: n = 29; CON: n = 30) completed all aspects of the study. Shown in Table 1 are their demographics and cardiometabolic risk factors. Eighty percent (n = 47) of completers were female, and 22% were Black (n = 13). At baseline, their mean BMI was 39.1 ± 6.6 kg/m2, fasting glucose was 108 ± 16 mg/dL, fasting cholesterol was 202 ± 37 mg/dL, and SBP and DBP were 125 ± 12 and 82 ± 8 mm Hg, respectively. At baseline, most participants had ≥1 of the following 5 cardiometabolic phenotypes: 69% had hypertension, 47% had impaired fasting glucose, 34% had elevated HbA1c concentrations, 63% had insulin resistance, 53% had high cholesterol, and 42% had severe obesity.
TABLE 1.
Baseline characteristics of study completers. Data shown are either mean (SD) or number (%) of participants
| Characteristic or Risk Factor | All Participants (n = 59) | Control Group (n = 30) | eTRE Group (n = 29) |
|---|---|---|---|
| Demographics | |||
| Age (y) | 44 (11) | 43 (12) | 45 (10) |
| Sex [n (%)] | |||
| Female | 47 (80) | 24 (80) | 23 (79) |
| Male | 12 (20) | 6 (20) | 6 (21) |
| Race [n (%)] | |||
| Asian | 1 (2) | 1 (3) | 0 |
| Black | 13 (22) | 7 (23) | 6 (21) |
| White | 43 (73) | 21 (70) | 22 (76) |
| More than 1 race | 2 (3) | 1 (3) | 1 (3) |
| Ethnicity [n (%)] | |||
| Hispanic | 2 (3) | 1 (3) | 1 (3) |
| Not Hispanic | 54 (92) | 26 (87) | 28 (97) |
| Unknown or not reported | 3 (5) | 3 (10) | 0 |
| Cardiometabolic phenotypes | |||
| Prediabetic HbA1c [n (%)] | 20 (34) | 8 (27) | 12 (41) |
| Impaired fasting glucose [n (%)] | 28 (47) | 14 (47) | 14 (48) |
| Insulin resistant [n (%)] | 37 (63) | 15 (50) | 22 (76) |
| Hypertension [n (%)] | 41 (69) | 18 (60) | 23 (79) |
| SBP ≥130 mm Hg [n (%)] | 18 (31) | 6 (20) | 12 (41) |
| Hypercholesterolemia [n (%)] | 31 (53) | 14 (47) | 17 (59) |
| Severe obesity [n (%)] | 25 (42) | 10 (33) | 15 (52) |
| Cardiometabolic risk factors | |||
| Weight (kg) | 108.1 (20.8) | 102.6 (19.0) | 113.8 (21.3) |
| BMI (kg/m2) | 39.1 (6.6) | 37.8 (5.5) | 40.5 (7.4) |
| Glucose (mg/dL) | 108 (16) | 106 (15) | 110 (18) |
| Insulin (mU/L) | 20.4 (14.7) | 18.2 (10.8) | 22.7 (17.7) |
| HOMA-IR | 5.53 (4.40) | 4.82 (3.23) | 6.27 (5.31) |
| HbA1c (%) | 5.6 (0.4) | 5.5 (0.4) | 5.6 (0.3) |
| SBP (mm Hg) | 125 (12) | 123 (10) | 126 (14) |
| DBP (mm Hg) | 82 (8) | 80 (8) | 84 (9) |
| Heart rate (beats/min) | 74 (9) | 73 (10) | 75 (7) |
| Total cholesterol (mg/dL) | 202 (37) | 201 (34) | 204 (40) |
| LDL cholesterol (mg/dL) | 117 (26) | 116 (24) | 117 (28) |
| HDL cholesterol (mg/dL) | 61 (15) | 61 (16) | 61 (14) |
| Triglycerides (mg/dL) | 126 (70) | 123 (65) | 128 (75) |
Abbreviations: DBP, diastolic blood pressure; eTRE, early time-restricted eating ; HbA1c, hemoglobin A1c; No., number; SBP, systolic blood pressure.
Prediabetes and insulin resistance
We examined the effects of eTRE in patients with prediabetes or insulin resistance (Figure 1). In participants with prediabetic HbA1c concentrations (n = 20), eTRE lowered HbA1c by 0.3% ± 0.1% compared with the control group (P = 0.04) but did not affect fasting glucose, insulin, or HOMA-IR (P ≥ 0.10). In participants with impaired fasting glucose (n = 28), eTRE did not affect fasting glucose, insulin, HOMA-IR, or HbA1c (P ≥ 0.10). Results were similarly insignificant in patients with insulin resistance (n = 37; P ≥ 0.25; data not shown). There were no significant differences in other cardiometabolic risk factors in any of the subgroups (P ≥ 0.14).
FIGURE 1.
Prediabetes. In adults with prediabetic HbA1c concentrations (5.7–6.4%; n = 20), eTRE (n = 12) reduced (A) HbA1c compared with the control eating schedule (CON; n = 8) but did not affect (B) fasting glucose concentrations. In patients with impaired fasting glucose (100–125 mg/dL; n = 28), eTRE (n = 14) did not affect (C) fasting glucose or (D) fasting insulin concentrations compared with CON (n = 14). ∗P < 0.05. eTRE, early time-restricted eating; HbA1c, hemoglobin A1c.
Hypertension
In patients with hypertension (n = 41; Figure 2), eTRE lowered DBP by 4 ± 2 mm Hg compared with the control eating schedule (P = 0.04), though there was no significant change in SBP (-4 ± 3 mm Hg; P = 0.10). There were no differences in other cardiometabolic endpoints (P ≥ 0.09). As a post hoc analysis, we also examined the effect of eTRE in hypertensive patients with uncontrolled SBP (n = 18). eTRE decreased DBP by 9 ± 4 mm Hg (P = 0.047) and HDL cholesterol by 5.7 ± 2.5 mg/dL (P = 0.04), whereas changes in SBP (-8 ± 4 mm Hg; P = 0.057) and heart rate (-8 ± 4 beats/min; P = 0.08) fell short of significance. There were no other notable differences (P ≥ 0.19).
FIGURE 2.
Hypertension. In patients with hypertension (n = 41), eTRE (n = 23) had no effect on (A) SBP but was more effective than the control eating schedule (CON; n = 8) at decreasing (B) diastolic blood pressure. In patients with hypertension and SBP ≥130 mm Hg (n = 18), eTRE (n = 12) reduced (D) diastolic blood pressure but not (C) SBP compared with CON (n = 6). ∗P < 0.05. eTRE, early time-restricted eating; SBP, systolic blood pressure.
Hypercholesterolemia
We also investigated the effects of eTRE in participants with hypercholesterolemia (n = 31; Figure 3). Similar to the parent study, eTRE did not affect total cholesterol, LDL cholesterol, or triglyceride concentrations (P ≥ 0.82). However, eTRE reduced HOMA-IR by 2.96 ± 1.46 (P = 0.04) relative to the control eating schedule, whereas changes in fasting insulin fell short of significance (-3.9 ± 5.0 mU/L; P = 0.058; data not shown). There were no significant between-group differences in any other cardiometabolic endpoints (P ≥ 0.18). In a post hoc analysis, there were no effects in patients with hypertriglyceridemia (P ≥ 0.23; data not shown).
FIGURE 3.
Hypercholesterolemia. In the patients with hypercholesterolemia (n = 31), early time-restricted eating (eTRE; n = 17) did not affect (A) total cholesterol concentration compared with the control eating schedule (CON; n = 14). However, eTRE decreased (B) insulin resistance as measured by the HOMA-IR relative to CON. ∗P < 0.05. eTRE, early time-restricted eating.
Severe obesity
In participants with severe obesity (n = 25; Figure 4), eTRE increased total and LDL cholesterol by 21 ± 9 and 17 ± 7 mg/dL, respectively, relative to the control eating schedule (both P = 0.03). There were no between-group differences in other cardiometabolic risk factors (P ≥ 0.28). By comparison, in participants with nonsevere obesity, eTRE did not affect total cholesterol (-8 ± 10 mg/dL; P = 0.40) or LDL cholesterol (-6 ± 8 mg/dL; P = 0.49; data not shown).
FIGURE 4.
Severe Obesity. In patients with severe obesity (n = 25), eTRE (n = 15) increased (A) total cholesterol and (B) LDL cholesterol relative to the control eating schedule (CON; n = 10). No such effects were observed in participants with nonsevere obesity. ∗P < 0.05. eTRE, early time-restricted eating.
Sex
We also explored whether the effects of eTRE varied between males (n = 12) and females (n = 47). Compared with the control eating schedule, males and females lost similar amounts of weight from following eTRE (-0.6 kg difference; P = 0.84). Furthermore, there were no statistically significant differences in any cardiometabolic outcome between male and female participants (P ≥ 0.38; data not shown).
Age
Similarly, there was no effect of age on any cardiometabolic outcomes (P ≥ 0.14; data not shown).
Race
Supplemental Figure 1 shows race-specific effects (Black: n = 13; White: n = 44). The per-group sample sizes for Black participants were very small (eTRE: n = 6; control: n = 7). As such, the following results should be treated with caution and as hypothesis-generating. Race moderated the effects of eTRE on SBP (P = 0.003), heart rate (P = 0.005), HOMA-IR (P = 0.007; data not shown), fasting glucose (P = 0.02), and fasting insulin (P = 0.02), with eTRE numerically improving these risk factors more in Black participants than in White participants. There were no significant effects of race on other cardiometabolic risk factors (P ≥ 0.07), including weight loss (P = 0.07). These race-specific effects remained statistically significant, even after adjusting for weight loss and/or baseline values (data not shown), suggesting that they were not solely due to differences in weight loss or cardiometabolic risk factors at baseline.
Discussion
We previously conducted a relatively large randomized controlled trial comparing eTRE plus energy restriction with eating over a ≥12-h window (control eating schedule) plus energy restriction in adults with obesity. eTRE was superior for losing weight, lowering diastolic blood pressure, and improving mood. In this study, we performed a subgroup analysis to explore whether the effects of eTRE vary by cardiometabolic phenotype, age, sex, and race.
eTRE lowered DBP by 4 ± 2 mm Hg in hypertensive adults and by 9 ± 4 mm Hg in hypertensive adults with SBP ≥130 mm Hg. In both subgroups, the improvements in SBP were numerically similar to the improvements in DBP but were not statistically significant. Antihypertensive medications typically lower DBP by 5 to 10 mm Hg, making eTRE roughly as effective as many common antihypertensive medications. Our results also suggest that eTRE is more effective in hypertensive patients with elevated SBP, making eTRE particularly effective for uncontrolled SBP. For context, only 2 prior studies examined the effects of TRE in patients with hypertension [47,48]. In a study lacking a non-TRE control group by Fanaroff et al. [47], self-selected 8-h TRE lowered SBP by 7 mm Hg over 18 wk relative to baseline. A second study by Zhou et al. [48] found that 6 wk of the DASH diet plus TRE lowered SBP and DBP by an additional 3 and 4 mm Hg, respectively, relative to the DASH diet alone in patients with stage 1 primary hypertension. Several studies in other populations also report improvements in blood pressure. An isocaloric controlled feeding study in males with prediabetes reported that 6-h eTRE reduced SBP and DBP by 11 and 10 mm Hg, respectively, compared with eating over a 12-h period [29]. Furthermore, 2 meta-analyses concluded that TRE decreases blood pressure in adults with obesity [23,50]. Collectively, our data and previous data suggest that eTRE improves blood pressure in people with hypertension. Although the exact mechanisms are not completely understood, multiple mechanisms are likely involved. Zhou et al. [48] found that TRE increases urinary sodium excretion, which decreases blood volume and hence blood pressure. Furthermore, a meta-analysis found that weight loss decreases SBP and DBP by ∼1 mm Hg/kg of weight lost [51]. In our study, the decreases in SBP and DBP exceeded what would be expected from weight loss alone, suggesting that eTRE lowers blood pressure through both weight-loss–dependent and independent mechanisms. Collectively, these findings underscore the need for large randomized controlled trials to test whether eTRE can be used to treat hypertension or prevent it in patients with prehypertension.
We also found that eTRE improves glycemic control in people with prediabetes. In participants with prediabetic HbA1c concentrations, eTRE improved HbA1c by 0.3%, which is equivalent to about a 10 mg/dL drop in mean 24-h glucose concentrations and meets the Food and Drug Administration's minimum target for antidiabetic drugs. Although the effects of eTRE on glycemic endpoints were not statistically significant in participants with impaired fasting glucose or insulin resistance, the improvements in insulin and insulin resistance were clinically meaningful and in line with values reported in other studies, suggesting we may have been underpowered to detect an effect [29,41,52]. For comparison, nearly all studies in adults with prediabetes or diabetes—regardless of whether they have been eucaloric or free-living—have found that TRE improves HbA1c, fasting glucose, 24-h glucose, glycemic excursions, and/or insulin resistance [29,35,36,40,41,[44], [45], [46],53]. In another isocaloric study in weight-stable adults with overweight, Jamshed et al. [30] found that eTRE lowered 24-h glucose but not fasting glucose. This aligns with our findings and suggests that eTRE lowers postprandial glucose but not fasting glucose in nondiabetic populations. In the future, it would be interesting to test whether TRE can prevent the progression to type 2 diabetes.
Unexpectedly, eTRE increased total and LDL cholesterol by 21 ± 9 and 17 ± 7 mg/dL, respectively, in adults with severe obesity, yet had no such effect in adults with nonsevere obesity or adults with hypercholesterolemia. For comparison, about three-quarters of prior studies report that TRE does not affect total, LDL, or HDL cholesterol relative to the control group [23,26,50,54]. Meta-analyses on the topic are mixed. Although most meta-analyses report no effect on lipids, 2 meta-analyses found that TRE increases LDL cholesterol in participants with overweight or obesity [22,55], whereas a third meta-analysis found that adhering to TRE decreases total and LDL cholesterol, regardless of BMI [25]. One possible explanation for the increase in LDL cholesterol in those with severe obesity could be that it is a byproduct of an increased short-term dependence on fat oxidation during periods of fasting as the body adapts [27]. Another possibility is that TRE may shift the timing of diurnal or daily rhythms in lipids, as a large number of plasma lipids undergo diurnal oscillations. It will be important to measure cholesterol efflux in the future, as one study in primates found that eTRE did not affect fasting cholesterol concentrations but did improve cholesterol efflux [56]. Further studies are needed to determine whether our intriguing findings can be replicated and to uncover the underlying mechanisms.
Importantly, we found no significant differences between males and females, though we were likely underpowered to detect an effect. It is often feared that females benefit less from intermittent fasting than males or need different fasting windows, based on animal studies, which sometimes report greater benefits in male compared with female rodents [57]. However, we found no evidence of this, and males and females lost comparable amounts of weight. Our null findings concord with a recent large study published in Nature Medicine by Dote-Montero et al. [39]. Similarly, age did not moderate the effects of eTRE on cardiometabolic outcomes. To our knowledge, no prior study has examined the effect of age on TRE outcomes. TRE has cardiometabolic benefits in older animals, but because human circadian rhythms are attenuated with age, it will be interesting to test in larger studies if the effect of TRE changes over the lifespan [58,59]. Lastly, we found that race moderated the effects of eTRE on some outcomes, with Black participants who followed eTRE tending to have greater reductions in SBP, heart rate, and glycemic outcomes than White participants. An analysis of the National Health and Nutrition Examination Survey (NHANES) data found that Black adults typically have a shorter and later eating window than White adults, so it is possible that differences in eating times could lead to some differences in the response to eTRE [60]. In our study, Black participants had a numerically longer eating window by 0.5 h (P = 0.43), primarily because of eating ∼45 min later at night (P = 0.11). Although neither difference was statistically significant; the numerically longer and later eating windows could explain some of the benefits we observed. The closest study to our subgroup analysis is a study of TRE in a diverse population (33% Black, 46% Hispanic, 14% White), which found that TRE was effective for weight loss, though racial differences were not examined [32]. Given our very small sample size of Black participants and the lack of prior literature, our finding of race-specific differences could be a false positive. Therefore, our observations should be treated as hypothesis-generating, rather than a finding, and are worth retesting in future studies to determine the generalizability and heterogeneity of responses to TRE.
The strengths of this study include the novelty of performing a subgroup analysis by cardiometabolic phenotype, the assessment of multiple endpoints, and the rigor of the original study. Limitations of this study include modest-to-small sample sizes that varied among cardiometabolic phenotypes, which limited our statistical power to detect differences between groups. Also, males and Black participants were less well-represented, dramatically limiting our statistical power to detect any differences by biological sex and race. This may also limit the generalizability to males and minority populations, although neither males nor Black adults appeared to benefit any less from eTRE, and in fact, Black adults may have benefited to a greater degree. Future examinations by race and ethnicity are greatly needed, including in Latinx and Asian populations. Also, because this is a subgroup analysis, the strength of evidence for causality is weaker; however, we had approximately an equal number of participants in the eTRE and control groups for most subgroups. In addition, we cannot rule out sampling and other sources of bias in this secondary analysis. However, we note that the between-group difference in weight loss was identical in the per-protocol and intention-to-treat analyses, suggesting that attrition bias is not an issue. Finally, we tested eTRE compared with a control schedule in combination with energy restriction, and having both groups undergo a program of energy restriction likely introduced additional variability in our data and reduced statistical power. There are only a few studies testing TRE in combination with energy restriction, and the data are mixed on whether TRE confers additional benefits in this context [31,[61], [62], [63], [64]].
In conclusion, our exploratory analyses suggest eTRE may be an effective treatment for adults with prediabetes or hypertension and especially those with uncontrolled SBP, and the effects of eTRE may be on par with common medications for both conditions. By comparison, some caution may be merited in patients with severe obesity, who may experience increases in LDL cholesterol. Importantly, we found no major differences between males and females or young and older adults. The differential effects of eTRE based on obesity class and the moderating effects of race warrant further investigation. Future large randomized controlled trials should test the effects of TRE in populations with cardiometabolic disease or elevated risk factors.
Author contributions
The authors’ responsibilities were as follows – CMP: designed and supervised the research and had primary responsibility for final content; CMP, FLS, HJ, AHW: conducted the research and collected data; ZR, OMA, CMP, JSR: analyzed data; ZR, OMA, CMP: wrote the paper; and all authors: read and approved the final manuscript.
Data availability
Deidentified data will be made available upon request to the corresponding author and receipt of a signed data access agreement.
Funding
This study was supported by UL1 TR001419 from the National Center for Advancing Translational Sciences,P30 DK056336 from the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH, and a start-up package to CMP. Resources and support were also provided by a Nutrition Obesity Research Center grant (P30 DK056336), a Diabetes Research Center grant (P30 DK079626), and an NIH Postdoctoral T32 Obesity Fellowship to OMA (T32 DK062710). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Declaration of generative AI and AI-assisted technologies in the writing process
The author(s) declare that no generative AI or AI-assisted technologies were used in the writing of this manuscript.
Conflicts of interest
Starting in late spring 2026, CMP will receive consulting fees from WndrHLTH Club, Inc., for providing content knowledge on intermittent fasting, circadian rhythms, and nutrition. All other authors report no conflicts of interest.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.tjnut.2026.101526.
Appendix A. Supplementary data
The following is the Supplementary data to this article:
References
- 1.Koppold D.A., Breinlinger C., Hanslian E., Kessler C., Cramer H., Khokhar A.R., et al. International consensus on fasting terminology. Cell Metab. 2024;36(8):1779–1794 e4. doi: 10.1016/j.cmet.2024.06.013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Camelo L., Marinho T.S., Aguila M.B., Souza-Mello V., Barbosa-da-Silva S. Intermittent fasting exerts beneficial metabolic effects on blood pressure and cardiac structure by modulating local renin-angiotensin system in the heart of mice fed high-fat or high-fructose diets. Nutr. Res. 2019;63:51–62. doi: 10.1016/j.nutres.2018.12.005. [DOI] [PubMed] [Google Scholar]
- 3.Crupi A.N., Haase J., Brandhorst S., Longo V.D. Periodic and intermittent fasting in diabetes and cardiovascular disease. Curr. Diab. Rep. 2020;20(12):83. doi: 10.1007/s11892-020-01362-4. [DOI] [PubMed] [Google Scholar]
- 4.Mattson M.P., Longo V.D., Harvie M. Impact of intermittent fasting on health and disease processes. Ageing Res. Rev. 2017;39:46–58. doi: 10.1016/j.arr.2016.10.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.de Cabo R., Mattson M.P. Effects of intermittent fasting on health, aging, and disease. N. Engl. J. Med. 2019;381(26):2541–2551. doi: 10.1056/NEJMra1905136. [DOI] [PubMed] [Google Scholar]
- 6.Longo V.D., Mattson M.P. Fasting: molecular mechanisms and clinical applications. Cell Metab. 2014;19(2):181–192. doi: 10.1016/j.cmet.2013.12.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Mitchell S.J., Bernier M., Mattison J.A., Aon M.A., Kaiser T.A., Anson R.M., et al. Daily fasting improves health and survival in male mice independent of diet composition and calories. Cell Metab. 2019;29(1):221–228 e3. doi: 10.1016/j.cmet.2018.08.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Acosta-Rodríguez V., Rijo-Ferreira F., Izumo M., Xu P., Wight-Carter M., Green C.B., et al. Circadian alignment of early onset caloric restriction promotes longevity in male C57BL/6J mice. Science. 2022;376(6598):1192–1202. doi: 10.1126/science.abk0297. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Dong H., Wang S., Hu C., Wang M., Zhou T., Zhou Y. Neuroprotective effects of intermittent fasting in the aging brain. Ann. Nutr. Metab. 2024;80(4):175–185. doi: 10.1159/000538782. [DOI] [PubMed] [Google Scholar]
- 10.Shi D., Fang G., Chen Q., Li J., Ruan X., Lian X. Six-hour time-restricted feeding inhibits lung cancer progression and reshapes circadian metabolism. BMC Med. 2023;21(1):417. doi: 10.1186/s12916-023-03131-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Son D.S., Done K.A., Son J., Izban M.G., Virgous C., Lee E.S., et al. Intermittent fasting attenuates obesity-induced triple-negative breast cancer progression by disrupting cell cycle, epithelial-mesenchymal transition, immune contexture, and proinflammatory signature. Nutrients. 2024;16(13):2101. doi: 10.3390/nu16132101. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Gallage S., Ali A., Barragan Avila J.E., Seymen N., Ramadori P., Joerke V., et al. A 5:2 intermittent fasting regimen ameliorates NASH and fibrosis and blunts HCC development via hepatic PPARα and PCK1. Cell Metab. 2024;36(6):1371–1393 e7. doi: 10.1016/j.cmet.2024.04.015. [DOI] [PubMed] [Google Scholar]
- 13.Ulgherait M., Midoun A.M., Park S.J., Gatto J.A., Tener S.J., Siewert J., et al. Circadian autophagy drives iTRF-mediated longevity. Nature. 2021;598(7880):353–358. doi: 10.1038/s41586-021-03934-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Yang F., Liu C., Liu X., Pan X., Li X., Tian L., et al. Effect of epidemic intermittent fasting on cardiometabolic risk factors: a systematic review and meta-analysis of randomized controlled trials. Front. Nutr. 2021;8 doi: 10.3389/fnut.2021.669325. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Khalafi M., Maleki A.H., Ehsanifar M., Symonds M.E., Rosenkranz S.K. Longer-term effects of intermittent fasting on body composition and cardiometabolic health in adults with overweight and obesity: a systematic review and meta-analysis. Obes. Rev. 2025;26(2) doi: 10.1111/obr.13855. [DOI] [PubMed] [Google Scholar]
- 16.Kapogiannis D., Manolopoulos A., Mullins R., Avgerinos K., Delgado-Peraza F., Mustapic M., et al. Brain responses to intermittent fasting and the healthy living diet in older adults. Cell Metab. 2024;36(8):1900–1904. doi: 10.1016/j.cmet.2024.07.012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Liu L., Chen W., Wu D., Hu F. Metabolic efficacy of time-restricted eating in adults: a systematic review and meta-analysis of randomized controlled trials. J. Clin. Endocrinol. Metab. 2022;107(12):3428–3441. doi: 10.1210/clinem/dgac570. [DOI] [PubMed] [Google Scholar]
- 18.Elortegui Pascual P., Rolands M.R., Eldridge A.L., Kassis A., Mainardi F., Lê K.A., et al. A meta-analysis comparing the effectiveness of alternate day fasting, the 5:2 diet, and time-restricted eating for weight loss, Obesity. Silver Spring) 2023;31(Suppl 1):9–21. doi: 10.1002/oby.23568. Suppl 1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Semnani-Azad Z., Khan T.A., Chiavaroli L., Chen V., Bhatt H.A., Chen A., et al. Intermittent fasting strategies and their effects on body weight and other cardiometabolic risk factors: systematic review and network meta-analysis of randomised clinical trials. BMJ. 2025;389 doi: 10.1136/bmj-2024-082007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Sun M.L., Yao W., Wang X.Y., Gao S., Varady K.A., Forslund S.K., et al. Intermittent fasting and health outcomes: an umbrella review of systematic reviews and meta-analyses of randomised controlled trials. EClinicalMedicine. 2024;70 doi: 10.1016/j.eclinm.2024.102519. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Peterson C.M. In: Intermittent and periodic fasting, aging and disease. Varady K.M., Emily E.N.C., Longo V.D., editors. Springer; Cham, Switzerland: 2024. Time-restricted eating: effects on body weight and cardiometabolic health; pp. 87–118. [Google Scholar]
- 22.Xie Y., Zhou K., Shang Z., Bao D., Zhou J. The effects of time-restricted eating on fat loss in adults with overweight and obese depend upon the eating window and intervention strategies: a systematic review and meta-analysis. Nutrients. 2024;16(19):3390. doi: 10.3390/nu16193390. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Wang W., Wei R., Pan Q., Guo L. Beneficial effect of time-restricted eating on blood pressure: a systematic meta-analysis and meta-regression analysis. Nutr. Metab. (Lond.). 2022;19(1):77. doi: 10.1186/s12986-022-00711-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Liu J., Yi P., Liu F. The effect of early time-restricted eating vs later time-restricted eating on weight loss and metabolic health. J. Clin. Endocrinol. Metab. 2023;108(7):1824–1834. doi: 10.1210/clinem/dgad036. [DOI] [PubMed] [Google Scholar]
- 25.Panagiotou K., Stefanou G., Kourlaba G., Athanasopoulos D., Kassari P., Charmandari E. The effect of time-restricted eating on cardiometabolic risk factors: a systematic review and meta-analysis. Nutrients. 2024;16(21):3700. doi: 10.3390/nu16213700. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Huang L., Chen Y., Wen S., Lu D., Shen X., Deng H., et al. Is time-restricted eating (8/16) beneficial for body weight and metabolism of obese and overweight adults? A systematic review and meta-analysis of randomized controlled trials. Food Sci. Nutr. 2022;11(3):1187–1200. doi: 10.1002/fsn3.3194. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Ravussin E., Beyl R.A., Poggiogalle E., Hsia D.S., Peterson C.M. Early time-restricted feeding reduces appetite and increases fat oxidation but does not affect energy expenditure in humans. Obesity (Silver Spring) 2019;27(8):1244–1254. doi: 10.1002/oby.22518. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Moro T., Tinsley G., Pacelli F.Q., Marcolin G., Bianco A., Paoli A. Twelve months of time-restricted eating and resistance training improves inflammatory markers and cardiometabolic risk factors. Med. Sci. Sports Exerc. 2021;53(12):2577–2585. doi: 10.1249/MSS.0000000000002738. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Sutton E.F., Beyl R., Early K.S., Cefalu W.T., Ravussin E., Peterson C.M. Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Cell Metab. 2018;27(6):1212–1221 e3. doi: 10.1016/j.cmet.2018.04.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Jamshed H., Beyl R.A., Della Manna D.L., Yang E.S., Ravussin E., Peterson C.M. Early time-restricted feeding improves 24-hour glucose levels and affects markers of the circadian clock, aging, and autophagy in humans. Nutrients. 2019;11(6):1234. doi: 10.3390/nu11061234. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Jamshed H., Steger F.L., Bryan D.R., Richman J.S., Warriner A.H., Hanick C.J., et al. Effectiveness of early time-restricted eating for weight loss, fat loss, and cardiometabolic health in adults with obesity: a randomized clinical trial. JAMA Intern. Med. 2022;182(9):953–962. doi: 10.1001/jamainternmed.2022.3050. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Lin S., Cienfuegos S., Ezpeleta M., Gabel K., Pavlou V., Mulas A., et al. Time-restricted eating without calorie counting for weight loss in a racially diverse population: a randomized controlled trial. Ann. Intern. Med. 2023;176(7):885–895. doi: 10.7326/m23-0052. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Cienfuegos S., Gabel K., Kalam F., Ezpeleta M., Wiseman E., Pavlou V., et al. Effects of 4- and 6-h time-restricted feeding on weight and cardiometabolic health: a randomized controlled trial in adults with obesity. Cell Metab. 2020;32(3):366–378 e3. doi: 10.1016/j.cmet.2020.06.018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Jones R., Pabla P., Mallinson J., Nixon A., Taylor T., Bennett A., et al. Two weeks of early time-restricted feeding (eTRF) improves skeletal muscle insulin and anabolic sensitivity in healthy men. Am. J. Clin. Nutr. 2020;112(4):1015–1028. doi: 10.1093/ajcn/nqaa192. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Bruno J., Walker J.M., Nasserifar S., Upadhyay D., Ronning A., Vanegas S.M., et al. Weight-neutral early time-restricted eating improves glycemic variation and time in range without changes in inflammatory markers. iScience. 2024;27(12) doi: 10.1016/j.isci.2024.111501. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Andriessen C., Fealy C.E., Veelen A., van Beek S.M.M., Roumans K.H.M., Connell N.J., et al. Three weeks of time-restricted eating improves glucose homeostasis in adults with type 2 diabetes but does not improve insulin sensitivity: a randomised crossover trial. Diabetologia. 2022;65(10):1710–1720. doi: 10.1007/s00125-022-05752-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Zhang L.M., Liu Z., Wang J.Q., Li R.Q., Ren J.Y., Gao X., et al. Randomized controlled trial for time-restricted eating in overweight and obese young adults. iScience. 2022;25(9) doi: 10.1016/j.isci.2022.104870. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Xie Z., Sun Y., Ye Y., Hu D., Zhang H., He Z., et al. Randomized controlled trial for time-restricted eating in healthy volunteers without obesity. Nat. Commun. 2022;13(1):1003. doi: 10.1038/s41467-022-28662-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Dote-Montero M., Clavero-Jimeno A., Merchán-Ramírez E., Oses M., Echarte J., Camacho-Cardenosa A., et al. Effects of early, late and self-selected time-restricted eating on visceral adipose tissue and cardiometabolic health in participants with overweight or obesity: a randomized controlled trial. Nat. Med. 2025;31(2):524–533. doi: 10.1038/s41591-024-03375-y. [DOI] [PubMed] [Google Scholar]
- 40.Chair S.Y., Cai H., Cao X., Qin Y., Cheng H.Y., Ng M.T. Intermittent fasting in weight loss and cardiometabolic risk reduction: a randomized controlled trial. J. Nurs. Res. 2022;30(1) doi: 10.1097/jnr.0000000000000469. [DOI] [PubMed] [Google Scholar]
- 41.Che T., Yan C., Tian D., Zhang X., Liu X., Wu Z. Time-restricted feeding improves blood glucose and insulin sensitivity in overweight patients with type 2 diabetes: a randomised controlled trial. Nutr. Metab. (Lond.). 2021;18(1):88. doi: 10.1186/s12986-021-00613-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Pavlou V., Cienfuegos S., Lin S., Ezpeleta M., Ready K., Corapi S., et al. Effect of time-restricted eating on weight loss in adults with type 2 diabetes: a randomized clinical trial. JAMA Netw. Open. 2023;6(10) doi: 10.1001/jamanetworkopen.2023.39337. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Parr E.B., Radford B.E., Hall R.C., Steventon-Lorenzen N., Flint S.A., Siviour Z., et al. Comparing the effects of time-restricted eating on glycaemic control in people with type 2 diabetes with standard dietetic practice: a randomised controlled trial. Diabetes Res. Clin. Pract. 2024;217 doi: 10.1016/j.diabres.2024.111893. [DOI] [PubMed] [Google Scholar]
- 44.Suthutvoravut U., Anothaisintawee T., Boonmanunt S., Pramyothin S., Siriyothin S., Attia J., et al. Efficacy of time-restricted eating and behavioral economic intervention in reducing fasting plasma glucose, hba1c, and cardiometabolic risk factors in patients with impaired fasting glucose: a randomized controlled trial. Nutrients. 2023;15(19):4233. doi: 10.3390/nu15194233. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Siddiqi M.M., Farhan M.M., Siddiqi M.M., Amaan M.A.S., Farhan A.A., Sufian A. Impact of intermittent fasting on glycemic control in type 2 diabetes: an original research. J. Pharm. Bioallied Sci. 2025;17(Suppl 3):S2410–S2412. doi: 10.4103/jpbs.jpbs_1582_24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Kramer C.K., Zinman B., Feig D.S., Retnakaran R. Effect of time-restricted eating on β-cell function in adults with type 2 diabetes. J. Clin. Endocrinol. Metab. 2025;110(6):e2045–e2053. doi: 10.1210/clinem/dgae594. [DOI] [PubMed] [Google Scholar]
- 47.Fanaroff A.C., Coratti S., Halaby R., Sanghavi M., O'Quinn R.P., Krishnan S., et al. Feasibility and outcomes from using a commitment device and text message reminders to increase adherence to time-restricted eating: a randomized trial. Am. Heart J. 2023;258:85–95. doi: 10.1016/j.ahj.2022.12.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 48.Zhou X., Lin X., Yu J., Yang Y., Muzammel H., Amissi S., et al. Effects of DASH diet with or without time-restricted eating in the management of stage 1 primary hypertension: a randomized controlled trial. Nutr. J. 2024;23(1):65. doi: 10.1186/s12937-024-00967-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 49.Steger F.L., Jamshed H., Bryan D.R., Richman J.S., Warriner A.H., Hanick C.J., et al. Early time-restricted eating affects weight, metabolic health, mood, and sleep in adherent completers: a secondary analysis. Obesity (Silver Spring). 2023;31(Suppl 1):96–107. doi: 10.1002/oby.23614. Suppl 1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 50.Chen W., Liu X., Bao L., Yang P., Zhou H. Health effects of the time-restricted eating in adults with obesity: a systematic review and meta-analysis. Front. Nutr. 2023;10 doi: 10.3389/fnut.2023.1079250. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 51.Neter J.E., Stam B.E., Kok F.J., Grobbee D.E., Geleijnse J.M. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2003;42(5):878–884. doi: 10.1161/01.Hyp.0000094221.86888.AE. [DOI] [PubMed] [Google Scholar]
- 52.Kahleova H., Belinova L., Malinska H., Oliyarnyk O., Trnovska J., Skop V., et al. Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study. Diabetologia. 2014;57(8):1552–1560. doi: 10.1007/s00125-014-3253-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 53.Parr E.B., Devlin B.L., Lim K.H.C., Moresi L.N.Z., Geils C., Brennan L., et al. Time-restricted eating as a nutrition strategy for individuals with type 2 diabetes: a feasibility study. Nutrients. 2020;12(11):3228. doi: 10.3390/nu12113228. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 54.Wilkinson M.J., Manoogian E.N.C., Zadourian A., Lo H., Fakhouri S., Shoghi A., et al. Ten-hour time-restricted eating reduces weight, blood pressure, and atherogenic lipids in patients with metabolic syndrome. Cell Metab. 2020;31(1):92–104.e5. doi: 10.1016/j.cmet.2019.11.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 55.Chen J.H., Lu L.W., Ge Q., Feng D., Yu J., Liu B., et al. Missing puzzle pieces of time-restricted-eating (TRE) as a long-term weight-loss strategy in overweight and obese people? A systematic review and meta-analysis of randomized controlled trials. Crit. Rev. Food Sci. Nutr. 2023;63(15):2331–2347. doi: 10.1080/10408398.2021.1974335. [DOI] [PubMed] [Google Scholar]
- 56.Kavanagh K., Bashore A.C., Davis M.A., Jorgensen M.J., McClouth C.J., Beavers D.A., et al. Early time-restricted feeding improves high-density lipoprotein amount and function in nonhuman primates, without effects on body composition. Obesity (Silver Spring) 2023;31(Suppl 1):75–84. doi: 10.1002/oby.23564. Suppl 1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 57.Chaix A., Deota S., Bhardwaj R., Lin T., Panda S. Sex- and age-dependent outcomes of 9-hour time-restricted feeding of a Western high-fat high-sucrose diet in C57BL/6J mice. Cell Rep. 2021;36(7) doi: 10.1016/j.celrep.2021.109543. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 58.Duncan M.J. In: Biological implications of circadian disruption: a modern health challenge. Fonken L.K., Nelson R.J., editors. Cambridge University Press; Cambridge: 2023. Circadian rhythm disruption in aging and Alzheimer’s disease; pp. 165–182. [Google Scholar]
- 59.Yang Y., Liu D. Impacts of time-restricted feeding on middle-aged and old mice with obesity. J. Physiol. 2024;602(22):6109–6123. doi: 10.1113/jp285462. [DOI] [PubMed] [Google Scholar]
- 60.Ansu Baidoo V.Y., Zee P.C., Knutson K.L. Racial and ethnic differences in eating duration and meal timing: findings from NHANES 2011-2018. Nutrients. 2022;14(12):2428. doi: 10.3390/nu14122428. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 61.Liu D., Huang Y., Huang C., Yang S., Wei X., Zhang P., et al. Calorie restriction with or without time-restricted eating in weight loss. N. Engl. J. Med. 2022;386(16):1495–1504. doi: 10.1056/NEJMoa2114833. [DOI] [PubMed] [Google Scholar]
- 62.Wei X., Lin B., Huang Y., Yang S., Huang C., Shi L., et al. Effects of time-restricted eating on nonalcoholic fatty liver disease: the TREATY-FLD randomized clinical trial. JAMA Netw. Open. 2023;6(3) doi: 10.1001/jamanetworkopen.2023.3513. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 63.Lin Y.J., Wang Y.T., Chan L.C., Chu N.F. Effect of time-restricted feeding on body composition and cardio-metabolic risk in middle-aged women in Taiwan. Nutrition. 2022;93 doi: 10.1016/j.nut.2021.111504. [DOI] [PubMed] [Google Scholar]
- 64.Kunduraci Y.E., Ozbek H. Does the energy restriction intermittent fasting diet alleviate metabolic syndrome biomarkers? A randomized controlled trial. Nutrients. 2020;12(10):3213. doi: 10.3390/nu12103213. [DOI] [PMC free article] [PubMed] [Google Scholar]
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