The effects of time‐restricted eating and weight loss on bone metabolism and health: a 6‐month randomized controlled trial

Abstract

Objective: This study explored the impact of time-restricted eating (TRE) versus standard dietary advice (SDA) on bone health.Methods: Adults with ≥1 component of metabolic syndrome were randomized to TRE (ad libitum eating within 12 hours) or SDA (food pyramid brochure). Bone turnover markers and bone mineral content/density by dual energy x-ray absorptiometry were assessed at baseline and 6-month follow-up. Statistical analyses were performed in the total population and by weight loss response.Results: In the total population (n = 42, 76% women, median age 47 years [IQR: 31-52]), there were no between-group differences (TRE vs. SDA) in any bone parameter.Among weight loss responders (≥0.6 kg weight loss), the bone resorption marker β-carboxyterminal telopeptide of type I collagen tended to decrease after TRE but increase after SDA (between-group differences p = 0.041), whereas changes in the bone formation marker procollagen type I N-propeptide did not differ between groups. Total body bone mineral content decreased after SDA (p = 0.028) but remained unchanged after TRE (p = 0.31) in weight loss responders (between-group

Intermittent fasting and bone health: a bone of contention?

“…In line with these findings, a longer-term (6 months) TRE intervention (employing a 12-h ad libitum eating window) had no unfavourable effects on bone metabolism (BTMs and bone-related hormones) or bone loss (total body BMC/BMD by DXA) compared with the provision of standard dietary advice for healthy eating, in individuals with at least one component of the metabolic syndrome (64) . Additional sub-analysis in participants who lost weight with either TRE or standard dietary advice (based on median body weight changes: ≥ 0•6 kg weight loss) found that those who lost weight by following SDA experienced a modest loss of total body BMC, which was supported by small, albeit non-significant increases in bone resorption (CTX).…”

“…This study found that TRE had no impact on participants' body mass, lean mass, total body or . The primary outcomes of the included studies were changes in body weight (n 3; Barnosky et al (60) ; Lowe et al (61) ; Kotarsky et al (67) ), changes in body composition (n 1; Templeman et al (30) ), changes in insulin sensitivity (n 1; Stekovic et al (57) ), changes in components of energy balance and post-prandial metabolism (n 1; Templeman et al (30) ), change in the metabolic syndrome components (n 1; Papageorgiou et al (64) ) and changes in endothelium-dependent dilation (n 1; Martens et al (63) ).…”

“…This is because a complete cycle of bone remodelling takes 4–6 months; thus, studies are proposed to have a duration of ≥ 6 months to allow the detection of clinically meaningful changes in bone structure (by DXA or other imaging modalities) (7) . The very few studies that have assessed BTM responses to IF interventions suggest no changes after ADF (60) or some favourable effects of TRE (62,64) , with these findings indicating no major bone breakdown at least in the short/medium term. Bone assessments : It is of note that all available studies have reported total body and/or regional BMC/BMD based on total body DXA assessments but have not performed scans at clinically relevant sites, that is, the hip or the lumbar spine, or evaluations of bone microstructure and fracture risk. Lack of power to detect changes/differences in bone outcomes : None of the available studies has assessed bone parameters as a priori outcomes (Table 1). Conversely, since most of the available trials had small sample sizes, it is likely that these studies were not powered to detect differences in bone parameters assessed as secondary outcome measures. Population at high risk for bone fragility : Overall, existing studies have been conducted in small mixed population samples, with the effects of IF regimens on bone outcomes in groups at high risk for bone fragility (i.e.…”

Time-Restricted Eating and Bone Health: A Systematic Review with Meta-Analysis

“…Sensitivity analyses were carried out to assess the robustness of the summary estimates via the leave-one-out method [ 34 ]. Furthermore, additional analyses were conducted while upholding the prevailing health status of the participants included in the RCTs (i.e., overweight and/or obesity) [ 42 , 43 , 44 , 45 ] and the predominant TRE protocol (i.e., fasting window 16:8) [ 42 , 43 , 44 , 46 ].…”

“…When RCTs reported results for different parameters of bone health [ 42 , 44 , 45 , 47 ], data were included according to the appropriate analysis. Where between-group MDs were displayed only graphically [ 43 ], data were extracted using online software (WebPlotDigitizer, assessed on 2 December 2023) [ 48 ].…”