Effects of Time-Restricted Eating on Nonalcoholic Fatty Liver Disease

Abstract

ImportanceThe efficacy and safety of time-restricted eating (TRE) on nonalcoholic fatty liver disease (NAFLD) remain uncertain.ObjectiveTo compare the effects of TRE vs daily calorie restriction (DCR) on intrahepatic triglyceride (IHTG) content and metabolic risk factors among patients with obesity and NAFLD.Design, Setting, and ParticipantsThis 12-month randomized clinical trial including participants with obesity and NAFLD was conducted at the Nanfang Hospital in Guangzhou, China, between April 9, 2019, and August 28, 2021.InterventionsParticipants with obesity and NAFLD were randomly assigned to TRE (eating only between 8:00 am and 4:00 pm) or DCR (habitual meal timing). All participants were instructed to maintain a diet of 1500 to 1800 kcal/d for men and 1200 to 1500 kcal/d for women for 12 months.Main Outcomes and MeasuresThe primary outcome was change in IHTG content measured by magnetic resonance imaging; secondary outcomes were changes in body weight, waist circumference, body fat, and metabolic risk factors. Intention-to-treat analysis was used.ResultsA total of 88 eligible patients with obesity and NAFLD (mean [SD] age, 32.0 [9.5] years; 49 men [56%]; and mean [SD] body mass index, 32.2 [3.3]) were randomly assigned to the TRE (n = 45) or DCR (n = 43) group. The IHTG content was reduced by 8.3% (95% CI, −10.0% to −6.6%) in the TRE group and 8.1% (95% CI, −9.8% to −6.4%) in the DCR group at the 6-month assessment. The IHTG content was reduced by 6.9% (95% CI, −8.8% to −5.1%) in the TRE group and 7.9% (95% CI, −9.7% to −6.2%) in the DCR group at the 12-month assessment. Changes in IHTG content were comparable between the 2 groups at 6 months (percentage point difference: −0.2; 95% CI, −2.7 to 2.2; P = .86) and 12 months (percentage point difference: 1.0; 95% CI, −1.6 to 3.5; P = .45). In addition, liver stiffness, body weight, and metabolic risk factors were significantly and comparably reduced in both groups.Conclusions and RelevanceAmong adults with obesity and NAFLD, TRE did not produce additional benefits for reducing IHTG content, body fat, and metabolic risk factors compared with DCR. These findings support the importance of caloric intake restriction when adhering to a regimen of TRE for the management of NAFLD.Trial RegistrationClinicalTrials.gov Identifiers: NCT03786523 and NCT04988230

Comparative efficacy of energy‐restricted dietary interventions in overweight and obese populations: A systematic review and network meta‐analysis

“…He et al, 2021;M. He et al, 2022;Headland et al, 2016;Hooshiar et al, 2023;Hutchison et al, 2019;Isenmann et al, 2021;Kunduraci & Ozbek, 2020;Liu et al, 2022;Maroofi & Nasrollahzadeh, 2020;McDiarmid et al, 2022;Panizza et al, 2019;Parvaresh et al, 2019;Peeke et al, 2021;Pinto et al, 2020;Pureza et al, 2020;Razavi et al, 2021;Schübel et al, 2018;Steger et al, 2021;Sundfør et al, 2018;Thomas et al, 2022;Trepanowski et al, 2017;X. Wei et al, 2023).…”

“…This study identified 1805 records, of which 38 RCTs involving 3039 participants were included in the NMA (Figure 1) (Antoni et al, 2018; Beaulieu et al, 2021; Bowen et al, 2018; H. Cai et al, 2019; Carter et al, 2016, 2018; Castela et al, 2022; Catenacci et al, 2016; Conley et al, 2018; Coutinho et al, 2018; Erdem et al, 2022; Fagundes et al, 2023; Gabel et al, 2019; Gray et al, 2021; Harvie et al, 2011, 2013; C. J. He et al, 2021; M. He et al, 2022; Headland et al, 2016; Hooshiar et al, 2023; Hutchison et al, 2019; Isenmann et al, 2021; Kunduraci & Ozbek, 2020; Liu et al, 2022; Maroofi & Nasrollahzadeh, 2020; McDiarmid et al, 2022; Panizza et al, 2019; Parvaresh et al, 2019; Peeke et al, 2021; Pinto et al, 2020; Pureza et al, 2020; Razavi et al, 2021; Schübel et al, 2018; Steger et al, 2021; Sundfør et al, 2018; Thomas et al, 2022; Trepanowski et al, 2017; X. Wei et al, 2023).…”

Effects of time‐restricted eating on intrahepatic fat and metabolic health among patients with nonalcoholic fatty liver disease

“…Intervention studies have shown that TRE could prominently reduce weight and improve metabolic health among people with obesity [10][11][12], metabolic syndrome [13], and diabetes [14,15]. However, trials in patients with NAFLD have been sparse [16,17]. Only one study compared the impacts of TRE (eating only between 8:00 a.m. and 4:00 p.m.) and caloric restriction (CR) on intrahepatic fat and metabolic health among patients with obesity and NAFLD [17].…”

“…However, trials in patients with NAFLD have been sparse [16,17]. Only one study compared the impacts of TRE (eating only between 8:00 a.m. and 4:00 p.m.) and caloric restriction (CR) on intrahepatic fat and metabolic health among patients with obesity and NAFLD [17].…”

Time-restricted feeding alleviates metabolic implications of circadian disruption by regulating gut hormone release and brown fat activation

“…14,15 Several studies have demonstrated that tRF exerts powerful therapeutic effects on chronic diseases, including obesity, diabetes, cardiovascular diseases, cancer, and neurodegenerative diseases, both in animal models 2,16,17 and humans. 18–21 Moreover, tRF is considered an external cue that profoundly affects the stability of daily biological rhythms, collectively adjusting the circadian rhythm. 22 Continuous glucose monitoring has demonstrated that patients with type-2 diabetes (T2D) adhering to a tRF schedule for 5 days a week can improve blood sugar control.…”