Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes

Time-restricted feeding protects against septic liver injury by reshaping gut microbiota and metabolite 3-hydroxybutyrate

Liver injury is an independent risk factor for multiple organ dysfunction and high mortality in patients with sepsis. However, the pathological mechanisms and therapeutic strategies for sepsis-associated liver injury have not been fully elucidated. Time-restricted feeding (TRF) is a promising dietary regime, but its role in septic liver injury remains unknown. Using 16S rRNA gene sequencing, Q200 targeted metabolomics, transcriptomics, germ-free mice, Hmgcs2/Lpin1 gene knockout mice, and Aml12 cells experiments, we revealed that TRF can mitigate septic liver injury by modulating the gut microbiota, particularly by increasing Lactobacillus murinus (L. murinus) abundance, which was significantly reduced in septic mice. Further study revealed that live L. murinus could markedly elevate serum levels of metabolite 3-hydroxybutyrate (3-HB) and alleviate sepsis-related injury, while the knockout of the key enzyme for 3-HB synthesis (3-hydroxy-3-methylglutaryl-CoA synthase 2, Hmgcs2) in the liver negated this protective effect. Additionally, serum 3-HB levels were significantly positively correlated with L. murinus abundance and negatively correlated with liver injury indicators in septic patients, demonstrating a strong predictive value for septic liver injury (AUC = 0.8429). Mechanistically, 3-HB significantly inhibited hepatocyte ferroptosis by activating the PI3K/AKT/mTOR/LPIN1 pathway, reducing ACSL4, MDA, LPO, and Fe2+ levels. This study demonstrates that TRF reduces septic liver injury by modulating gut microbiota to increase L. murinus, which elevates 3-HB to activate PI3K/AKT/mTOR/LPIN1 and inhibit hepatocyte ferroptosis. Overall, this study elucidates the protective mechanism of TRF against septic liver injury and identifies 3-HB as a potential therapeutic target and predictive biomarker, thereby providing new insights into the clinical management and diagnosis of septic liver injury.

Time-restricted feeding promotes glucagon-like peptide-1 secretion and regulates appetite via tryptophan metabolism of gut Lactobacillus in pigs

Previous clinical trials have shown that time-restricted feeding can be involved in regulating the metabolic health of humans and animals. However, the underlying mechanism has not been fully explored. In this study, the pig model was employed to simulate four prevalent human eating habits, with the aim of investigating the impact of gut microbiota and microbial metabolites on gut hormone secretion and appetite regulation. Compared to the ad libitum feeding (ALF) pattern, three time-restricted feeding patterns reduced total food intake and eating time. Meanwhile, three time-restricted feeding patterns induced elevated levels of serum and hypothalamic glucagon-like peptide-1 (GLP-1), while suppressing reward-related circuits in the hypothalamus. It is noteworthy that the early time-restricted feeding (eTRF) pattern increased the number of intestinal enteroendocrine cells (EECs) compared to ALF. Metagenomic and metabonomic analyses revealed that three time-restricted feeding patterns induced colonization of Lactobacillus and significantly increased the levels of its metabolite, indole-3-lactic acid (ILA). Dietary supplementation with ILA exhibited an increasing trend in fasting serum GLP-1 level of piglets. In vitro studies with pig intestinal organoids showed the Lactobacillus metabolite ILA enhanced GLP-1 secretion through the promotion of intestinal stem cell differentiation into EECs, rather than activating the ability of EECs to secrete GLP-1. Overall, time-restricted feeding promoted GLP-1 secretion and affected long-term appetite regulation by promoting the colonization of Lactobacillus and modulating microbial tryptophan metabolism.

Exploring the Impact of Intermittent Fasting on Vascular Function and the Immune System: A Narrative Review and Novel Perspective

Vascular function is a critical determinant of cardiovascular health and all-cause mortality. Recent studies have suggested that intermittent fasting, a popular dietary strategy, elicits beneficial effects on vascular function. These studies also suggest that fasting-mediated improvements in vascular function coincide with reductions in systemic inflammation. However, the mechanisms that connect fasting, the immune system, and vascular function remain largely underexplored. The current review summarizes the effects of different intermittent fasting modalities on vascular health, focusing on endothelial dysfunction and arterial stiffness, 2 critical indices of vascular function. Improvements in vascular function are associated with reduced inflammation and are mechanistically linked to decreased circulating immune cells and their accumulation within the vascular wall and perivascular tissue. Recent data show that fasting redistributes circulating and tissue-resident immune cells to the bone marrow, affecting their inflammatory actions. However, there is no direct evidence relating immune cell redistribution to cardiovascular health. By relating fasting-induced immune cell redistribution to reduced inflammation and improved vascular function, we propose an exciting avenue of further exploration is determining whether fasting-induced immune cell redistribution impacts cardiovascular health.

Time-restricted feeding reduces inflammatory markers and downregulates JAG1 and NICD protein levels in the liver of aged mice

OBJECTIVES

The present study aimed to assess whether Time-Restricted Feeding (TRF) modulates inflammation and hepatic Notch1 signalling in C57BL/6J-aged mice.

METHODS

Adult mice submitted to the ad libitum diet, aged (24 months-old) submitted to the ad libitum diet and, aged-TRF (24 months-old) subjected to the TRF (12 hours fed in the active cycle and 12 hours fasting in the light cycle) for 8 weeks. We investigated metabolic parameters, liver histology, metabolic-dysfunction-associated fatty liver disease activity score, collagen fiber, hepatic mitochondrial respiration, and publicly available liver Rna-seq datasets from human livers in diverse clinical conditions to clarify Notch1 involvement in liver health.

RESULTS

Our results demonstrated that aged mice (24 months old) showed increases in body weight, liver mass, Notch1 intracellular domain (NICD), and inflammatory markers (NFκB and TLR4 protein levels) in the liver when compared to adult animals. On the other hand, aged mice submitted to a TRF protocol showed reductions in inflammation and collagen fibers, which was accompanied by lower protein content of JAGGED1 and NICD in the liver. Furthermore, aged-TRF mice demonstrated increased liver mitochondrial respiration coupled with ATP production compared to the aged groups. Publicly available liver RNA-seq datasets in humans support our findings, indicating the upregulation of NOTCH1 in fibrosis and inflammation development.

CONCLUSIONS

TRF can reduce inflammatory markers and protein content of JAGGED1 and NICD in the liver of aged mice, which can contribute to tissue health and cellular longevity.

Comparative study of time-restricted eating on body composition and metabolic parameters in climacteric women with obesity: analysis of a pre-post intervention

OBJECTIVE

The physiological changes inherent to the climacteric period can trigger or aggravate overweight/obesity, among several other health disorders. This study aimed to evaluate the effects of time-restricted eating (TRE) on body composition and cardiometabolic parameters in climacteric women with obesity submitted to caloric restriction (CR) through a hypocaloric diet.

METHODS

We conducted an analysis of a clinical trial in a pre-post design that included adult climacteric women with obesity. Participants were divided into two groups: hypocaloric diet control group (n = 30) - with hypocaloric diet and free meal times, and hypocaloric diet and time-restricted eating group (HTRE) (n = 27) - with hypocaloric diet and TRE (fasting from 7  pm to 7  am ), for 10 weeks. Anthropometric and biochemical parameters were evaluated before and after the intervention period. A significance level of P  < 0.05 was considered for all cases.

RESULTS

Both groups showed a reduction in all anthropometric parameters, but without significant difference ( P  = 0.34) between groups. However, some metabolic parameters were significantly highlighted in the HTRE such as cholesterol level normalization (HTRE, 181.76 ± 34.20 mg/dL) and a decrease in plasma atherogenicity ( P  = 0.02), glycated hemoglobin ( P  < 0.001), estimated mean glucose ( P  = 0.02), and alanine aminotransferase ( P  = 0.02), unlike the hypocaloric diet control group, which did not show such significance.

CONCLUSIONS

In this study, from the perspective of body composition, similar changes were observed between the group subjected to CR alone and the group subjected to CR combined with a 12-hour overnight fast. However, there was an indication of superior improvement in glycemic and lipid parameters in the group subjected to the 12-hour overnight fast. These findings suggest the potential for TRE, as implemented, to have positive effects on reducing cardiovascular risk and other chronic metabolic diseases.

Advancing Chrononutrition for Cardiometabolic Health: A 2023 National Heart, Lung, and Blood Institute Workshop Report

The circadian system maintains optimal biological functions at the appropriate time of day, and the disruption of this organization can contribute to the pathogenesis of cardiometabolic disorders. The timing of eating is a prominent external time cue that influences the circadian system. "Chrononutrition" is an emerging dimension of nutrition and active area of research that examines how timing-related aspects of eating and nutrition impact circadian rhythms, biological processes, and disease pathogenesis. There is evidence to support chrononutrition as a form of chronotherapy, such that optimizing the timing of eating may serve as an actionable strategy to improve cardiometabolic health. This report summarizes key information from the National Heart, Lung, and Blood Institute's virtual workshop entitled "Chrononutrition: Elucidating the Role of Circadian Biology and Meal Timing in Cardiometabolic Health," which convened on May 2 to 3, 2023, to review current literature and identify critical knowledge gaps and research opportunities. The speakers presented evidence highlighting the impact on cardiometabolic health of earlier and shorter eating windows and more consistent day-to-day eating patterns. The multidimensionality of chrononutrition was a common theme, as it encompasses multiple facets of eating along with the timing of other behaviors including sleep and physical activity. Advancing the emerging field of chrononutrition will require: (1) standardization of terminology and metrics; (2) scalable and precise tools for real-world settings; (3) consideration of individual differences that may act as effect modifiers; and (4) deeper understanding of social, behavioral, and cultural influences. Ultimately, there is great potential for circadian-based dietary interventions to improve cardiometabolic health.

Does the timing and frequency of meals impact caloric and macronutrient intake in pregnant women?

This study aimed to investigate the correlation between chrononutritional parameters and daily total energy as well as macronutrient intake throughout different stages of pregnancy. A prospective cohort study was conducted with 100 pregnant women. Data was collected at each gestational trimester. Food intake data was accessed through three 24-hour dietary recalls in every trimester. Chrononutritional parameters, such as meal and snack times, eating duration, number of eating episodes, caloric midpoint, sleep end-first meal interval, last meal-sleep onset interval, were used to infer meal timing. Linear regression modeling analyses, adjusted for confounding factors, were carried out to investigate associations between each chrononutritional parameter (independent variables) and total daily energy and macronutrient intake (dependent variables) during each gestational trimester. Positive associations were observed between total energy intake, proteins, and carbohydrates with dinner time during the first and third trimesters (with the exception of protein intake in the third trimester). Total fat intake and dinner time showed a positive association throughout all gestational trimesters. Additionally, positive associations were found between total energy intake, fat, and carbohydrates with eating duration and the number of eating episodes in all gestational trimesters. Furthermore, correlations of dinner time, eating duration and number of eating episodes with energy intake were found, suggesting that pregnant women who ate later and more frequently tended to consume higher calorie amounts. In conclusion, our findings suggest that chrononutritional parameters associated with late eating are linked to increased total energy intake during pregnancy. If these results are confirmed, nutritional guidelines should not only focus on what or how much is consumed during pregnancy but also consider the timing of meals.

Effect of Time-Restricted Eating on Sleep Quality and Body Composition: A Systematic Review

CONTEXT

Time-restricted eating (TRE) is a dietary approach that consolidates energy intake in a restricted period during the day. It is an alternative approach to weight loss and might be important to sleep quality.

OBJECTIVE

To review the current literature related to the effects of TRE on sleep quality and body composition in adults.

DATA SOURCES

A literature search of the PubMed, Scopus, Web of Science (Clarivate), and Biblioteca Virtual em Saúde/Bireme databases was carried out until May 2024.

DATA EXTRACTION

Reviewed articles included clinical, interventional (controlled or uncontrolled) studies including individuals older than 18 years, with no gender restriction. The interventions had to control feeding time, body composition could be assessed by any validated method, and sleep could be assessed by polysomnography, actigraphy, and validated sleep assessment questionnaires.

DATA ANALYSIS

Eleven studies were included in this systematic review. Study samples varied between 19 and 137 participants, with a predominance of female participants in 10 studies. Seven of the studies (58.3%) tested an intervention of 8 hours of TRE, with an intervention range of between 4 weeks and 12 months. All studies observed weight loss. Nine studies showed reductions in fat mass, including 2 studies that observed reductions in visceral fat mass. No studies, independently of weight loss or body composition changes, objectively observed changes in sleep duration after TRE interventions. However, in the subjective evaluation, 1 study found a reduction in sleep duration of 30 ± 13 minutes, an increase in latency of 7 ± 3 minutes, and a reduction in sleep efficiency of 2% ± 1% in the group treated with TRE compared with the control group.

CONCLUSION

Time-restricted eating seems to be effective in weight loss and fat mass reduction, but most studies found no effect on sleep parameters. There was a lack of standardized methods for sleep measurements in the reviewed studies. However, these results could provide valuable data for the design and formulation of new well-founded studies assessing sleep using objective methods and including different sleep parameters.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42024524598.

Association of 24-h Energy Intake Behavior With Depressive Symptoms: Findings From the National Health and Nutrition Examination Survey

Objective: Appetite changes are a significant clinical feature of depression, with circadian rhythms disruption being a crucial mechanism in depression. However, the specific role of eating rhythms in depression remains unclear. This study aimed to assess the relationship between energy intake rhythmicity and depressive symptoms. Methods: A total of 34,974 noninstitutionalized individuals were recruited from the National Health and Nutrition Examination Survey. To investigate the relationship between 24-h energy intake and depressive symptoms, covariate-adjusted sample-weighted regressions were employed. The study analyzed various aspects of energy intake rhythmicity, including the proportion of energy intake from non-meals and meal times, as well as the proportion of energy intake across meals and various time periods (morning, midday, afternoon, evening, night, and overnight). Results: A high proportion of energy intake from non-meals (adjusted odds ratio [OR] = 1.11, 95% confidence interval [CI]: 1.08-1.15) was associated with higher depressive symptoms. The proportion of breakfast energy intake in total daily energy intake was nonlinearly associated with depressive symptoms. In participants with a breakfast energy intake below 20%, the prevalence of depressive symptoms decreased by 15% (adjusted OR = 0.85, 95% CI: 0.75-0.96) per each 10% increment in the proportion of breakfast energy intake. A U-shaped relationship was identified between the timing of the day's last energy intake and depressive symptoms, with the lowest prevalence occurring at 7:48 PM (before 7:48 PM: adjusted [OR = 0.96, 95% CI: 0.94-0.98]; after 7:48 PM: adjusted [OR = 1.11, 95% CI: 1.03-1.20]). Conclusions: Among adults in the United States, the proportion of energy consumed from non-meals was associated with higher depressive symptoms. Adequate energy intake at breakfast and moderate end-times of energy intake were linked to reduced depressive symptoms. These results may contribute to designing of future studies on dietary rhythm interventions for managing depression.

Association of meal timing with adiposity measures and gut microbiome characteristics in a cohort study: the Hispanic Community Health Study/Study of Latinos

BACKGROUND

Time-restricted eating may help control weight through caloric restriction, circadian rhythm, or influence on the gut microbiome (GMB). Physical activity (PA) also plays a role, as people with a longer eating window (EW: time between first and last daily intake) may be more active. The associations between meal timing, adiposity, PA, sedentary behavior (SB) and GMB characteristics are of interest in Hispanic/Latino persons, who experience a high burden of cardiometabolic diseases.

OBJECTIVE

We explored the relationship of EW with energy intake and accelerometer-measured activity and assessed whether a longer EW and later midpoint of intake (MOI: midpoint time of intake) are associated with adiposity and GMB differences in Hispanic/Latino adults.

METHODS

Using data from the prospective Hispanic Community Health Study/Study of Latinos (n=11,778 participants with valid 24-hour dietary recall and accelerometer data, no unplanned weight loss, and BMI ≥18.5; n=1925 with GMB data) we explored the relationship between EW, SB and energy intake. We used multivariable linear regression models to study the relationship between EW or MOI and adiposity measures and GMB characteristics, adjusted for clinical, behavioral, and demographic characteristics.

RESULTS

Those with longer EW tended to have less SB and greater energy intake, suggesting that some individuals may balance greater intake with greater expenditure. After adjustments including energy balance, each hour of EW was associated with 0.29% higher BMI (95% CI 0.07, 0.51), p=0.011. Longer EW and caloric EW (EWC: EW, caloric meals only) were associated with several obesity-associated GMB taxa, such as Streptococcus (enriched, β [95% CI] 0.04 [0.01, 0.07] for EW). MOI was not significantly associated with adiposity or GMB characteristics.

CONCLUSIONS

Shorter EW may promote healthy weight, but some individuals with longer vs shorter EWs tend to have greater activity that could balance their greater energy intake. EW and EWC may influence GMB characteristics.

Early time-restricted eating with energy restriction has a better effect on body fat mass, diastolic blood pressure, metabolic age and fasting glucose compared to late time-restricted eating with energy restriction and/or energy restriction alone: A 3-month randomized clinical trial

BACKGROUND & AIMS

Time-restricted eating (TRE) has attracted increasing attention from researchers and the public. Recent studies suggest that the combination of TRE with energy restriction (ER) may have more favourable effects on both physical and biochemical aspects compared to ER alone. The aim of the present 3-month intervention study was to determine the effects of an 8-h early time-restricted eating and an 8-h late time-restricted eating with ER (eTRE + ER and lTRE + ER) compared to 12-h ER alone on body mass and other anthropometric and cardiometabolic risk factors in participants with overweight and obesity.

METHODS

Participants (n = 108) were allocated to three different groups according to their personal chronotype: eTRE + ER (37 participants), lTRE + ER (37 participants) and ER (34 participants). Ninety-three participants completed the entire 3-month intervention (34 in eTRE + ER, 28 in lTRE + ER and 31 in ER). Anthropometric and cardiometabolic risk factors were measured at baseline and after 1, 2 and 3 months of the intervention. Sleep quality and quality of life were assessed at baseline and after 3 months of the intervention. ER was determined based on the individual's resting metabolic rate. Effects were analyzed using the per-protocol approach.

RESULTS

Results showed a significant time main effect (p < 0.001), suggesting a decrease in body mass at the end of the 3-month intervention with a mean loss of -5.0 kg (95 % CI, -5.7, -4.3) for the eTRE + ER group, -4.4 kg (95 % CI, -5.2, -3.6) for the lTRE + ER group and -4.3 kg (95 % CI, -5.0, -3.6) for the ER group, with no significant difference between the groups (p = 0.319). eTRE + ER had greater improvements in fat mass (-1.2 % (95 % CI, -2.1, -0.2), p = 0.013) and fasting glucose (-0.35 mmol/L (95 % CI, -0.63, -0.06), p = 0.012) than participants in the lTRE + ER group and greater improvements in fat mass (-1.1 % (95 % CI, -2.0, -0.1), p = 0.022), metabolic age (-3 years (95 % CI, -5, -0), p = 0.028) and diastolic blood pressure (-4 mmHg (95 % CI, -8, -0), p = 0.033) than the participants in the ER group. No significant changes were found between the groups for the other parameters measured.

CONCLUSIONS

There was no difference in body mass between the eTRE + ER, lTRE + ER and ER groups after 3 months of intervention. However, eTRE + ER showed a greater benefit for fasting blood glucose, certain anthropometric parameters and diastolic blood pressure compared to lTRE + ER and/or ER alone. Other anthropometric, biochemical and health-related parameters were not affected by eating window.

TRIAL REGISTRATION

https://clinicaltrials.gov/study/NCT05730231.

The Impact of Dietary Interventions on Metabolic Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Comorbid Conditions, Including Obesity and Type 2 Diabetes

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a public health concern, linked with immune-metabolic dysfunction. While lifestyle and dietary modifications remain the cornerstone of MASLD management, the optimal dietary approach remains uncertain. Objectives: This systematic review aims to investigate the impact of model dietary patterns on metabolic outcomes in patients with MASLD and evaluate their effects in individuals with coexisting metabolic conditions, such as obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM). Methods: To conduct the review, PubMed, Scopus, Google Scholar, Cochrane CENTRAL, and ClinicalTrials.gov databases were searched for Randomized Controlled Trials (RCTs) on the adult population, published between January 2019 and September 2024, following PRISMA principles. The quality of the included RCTs was assessed qualitatively based on study characteristics. Results: The main findings of this review demonstrated that the use of interventions with dietary model based on Mediterranean diet (MED) and intermittent fasting (IF) approaches, such as alternative-day fasting (ADF) and time-restricted feeding regimens (TRF) may have potential in reducing body weight, BMI, and waist circumference, with additional benefits of improving glycemic control and reducing inflammation. The effects on hepatic functions, although limited, may be linked with reduced enzyme activity and liver stiffness. Additionally, the use of lacto-ovo-vegetarian diet (LOV-D) and the Dietary Approaches to Stop Hypertension (DASH) diet may offer additional health benefits, including blood pressure management. Conclusions: This review suggests that MED and IF-based strategies may reduce BW, improve glycemic control, and lower inflammation, with potential benefits for hepatic function. Further long-term studies are needed to confirm these effects and underlying mechanisms, which will allow for the optimization of protocols and ensure their safety in MASLD.

The cyclic metabolic switching theory of intermittent fasting

Intermittent fasting (IF) and ketogenic diets (KDs) have recently attracted much attention in the scientific literature and in popular culture and follow a longer history of exercise and caloric restriction (CR) research. Whereas IF involves cyclic metabolic switching (CMS) between ketogenic and non-ketogenic states, KDs and CR may not. In this Perspective, I postulate that the beneficial effects of IF result from alternating between activation of adaptive cellular stress response pathways during the fasting period, followed by cell growth and plasticity pathways during the feeding period. Thereby, I establish the cyclic metabolic switching (CMS) theory of IF. The health benefits of IF may go beyond those seen with continuous CR or KDs without CMS owing to the unique interplay between the signalling functions of the ketone β-hydroxybutyrate, mitochondrial adaptations, reciprocal activation of autophagy and mTOR pathways, endocrine and paracrine signalling, gut microbiota, and circadian biology. The CMS theory may have important implications for future basic research, clinical trials, development of pharmacological interventions, and healthy lifestyle practices.

Impact of preconceptional intermittent fasting on reflex ontogenesis, physical and somatic development of the offspring of Wistar rats

BACKGROUND

Intermittent fasting (IF) has health benefits; however, little is known about its effects on the offspring when practiced by dams in the preconception period. The aim of the study was to evaluate the impact of IF during the preconception period on physical and somatic parameters, as well as on the reflex ontogenesis of Wistar rat offspring.

METHODS

The female rats were randomized into two groups: control (CG) and intermittent fasting group (IF) submitted to a feed restriction of 16 h for four weeks during the preconception period. Reproductive performance, body weight, and energy intake were evaluated in dams. Reflex ontogeny, physical and somatic development, brain fatty acids and the brain histology were evaluated in the offspring.

RESULTS

IF did not change the reproductive performance or weight of dams during the preconception period. An acceleration of vibrissae placing and negative geotaxis parameters of reflex ontogenesis was observed, as well as anticipation of the following physical development indicators: ear unfolding, an eruption of upper incisor teeth, and inferior teeth in the IF offspring. Although the nervous tissue did not present histological changes, the content of some brain fatty acids was found in greater amounts in the IF offspring such as dihomo-γ-linolenic acid (0.66 ± 0.01 %) and eicotrienoic acid (0.58 ± 0.03 %).

CONCLUSION

IF during preconception did not change the body weight or reproductive performance of the dams, and promoted beneficial effects on the neurodevelopment of the offspring in the early life.

Time-restricted eating and autosomal dominant polycystic kidney disease: a pilot, randomized clinical trial

Background

Autosomal dominant polycystic kidney disease (ADPKD) is the most commonly inherited progressive kidney disease. Time-restricted eating (TRE) is a fasting regimen that restricts eating to a particular window (typically 8 hours/day), which could slow cyst growth based on preclinical models.

Methods

A 12-month, randomized, controlled, behavioral dietary intervention compared TRE with a control group given healthy eating advice without TRE (HE), without caloric restriction. Participants underwent baseline and 12-month measurements, including adherence (percentage of participants adhering to the 8-hour window; primary outcome), and MRI to determine height-adjusted total kidney volume (htTKV) and adiposity.

Results

Twenty-nine participants (23 females, mean standard ± deviation 48 ± 9 years) with a body mass index of 31.1±5 kg/m2 were randomized to TRE (n = 14) or HE (n = 15). Of the total participants, 71% (n = 10) of TRE and 87% (n = 13) of HE participants completed the intervention. The eating window was 9.6 ± 3.6 hours for TRE (60% achieving the 8-hour window) and 12.0 ± 2.0 for HE groups (P = .07). At month 12, both groups lost modest weight (-2.4 ± 6.4% and -3.6 ± 5.4% in the TRE and HE groups, respectively). Annual change in htTKV was 3.0 ± 8.5% and 4.6 ± 8.8% in the TRE and HE groups, respectively. Both change in weight (r = 0.67, P < .01) and change in visceral adiposity (r = 0.54, P < .01) were positively correlated with change in htTKV.

Conclusion

Both the TRE and HE group lost modest weight at 12 months. The targeted TRE adherence of ≥75% of participants was not achieved. Weight and adiposity loss may be more important drivers of kidney growth than the timing of eating.

Intermittent fasting inhibits platelet activation and thrombosis through the intestinal metabolite indole-3-propionate

Platelet hyperreactivity contributes significantly to thrombosis in acute myocardial infarction and stroke. While antiplatelet drugs are used, residual ischemic risk remains. Intermittent fasting (IF), a dietary pattern characterized by alternating periods of eating and fasting, has shown cardiovascular benefits, but its effect on platelet activation is unclear. This study demonstrates that IF inhibits platelet activation and thrombosis in both patients with coronary artery disease and apolipoprotein E (ApoE) knockout (ApoE -/- ) mice, by enhancing intestinal flora production of indole-3-propionic acid (IPA). Mechanistically, elevated IPA in plasma directly attenuates platelet activation by binding to the platelet pregnane X receptor (PXR) and suppressing downstream signaling pathways, including Src/Lyn/Syk and LAT/PLCγ/PKC/Ca2+. Importantly, IF alleviates myocardial and cerebral ischemia/reperfusion injury in ApoE -/- mice. These findings suggest that IF mitigates platelet activation and thrombosis risk in coronary atherosclerosis by enhancing intestinal flora production of IPA, which subsequently activates the platelet PXR-related signaling pathways.

Effects of Different Caloric Restriction Patterns on Blood Pressure and Other Cardiovascular Risk Factors: A Systematic Review and Network Meta-Analysis of Randomized Trials

CONTEXT

All types of caloric restriction are preventive against cardiovascular risk factors, but the best restriction method and most affected factors have not been identified.

OBJECTIVE

The objective of this study was to explore the effects of different caloric restriction methods on various cardiovascular risk factors by horizontally comparing program advantages and disadvantages via network meta-analysis.

DATA SOURCES

The PubMed, Web of Science, Cochrane Library, and Embase literature databases were searched (October 2013 to October 2023).

DATA EXTRACTION

Eligible randomized controlled trials involving participants who underwent caloric restriction and systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and high-density lipoprotein (HDL) cholesterol level measurements were included.

DATA ANALYSIS

Thirty-six of 13 208 records (0.27%) were included. Two researchers reviewed the articles, extracted data, and assessed article quality.

RESULTS

Alternate-day fasting (ADF) reduced SBP (4.88 mmHg; CI, 2.06-7.15) and DBP (5.10 mmHg; CI, 2.44-7.76). Time-restricted eating reduced SBP (2.46 mmHg; CI, 0.16-4.76) but not DBP. Continuous energy restriction (CER) significantly reduced BMI (1.11 kg/m2; CI = 0.16, 2.06) and waist circumference (3.28 cm; CI, 0.62-5.94).

CONCLUSIONS

This meta-analysis confirmed the preventive effect of CER and ADF on various cardiovascular risk factors. Additionally, CER is more likely to reduce obesity, and ADF is more likely to reduce blood pressure (BP). Based on this meta-analysis, CER is recommended to control obesity only for people who are obese and do not have elevated BP or other abnormal indicators. Additionally, ADF for early control or prevention is recommended for patients who have abnormal BP or other cardiovascular risk factors.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023455889.

Combined effects of time-restricted eating and exercise on short-term blood glucose management in individuals with Type 2 Diabetes Mellitus: The TREx study, a randomised controlled trial

AIMS

Time-restricted eating (TRE) is a chrono-nutrition strategy where the daily 'eating window' is reduced to 8-10 h. We investigated the acute (14-h) effects of TRE, with and without post-meal exercise, on blood glucose and insulin concentrations in people with type 2 diabetes mellitus.

METHODS

Fourteen participants (5 F, 9 M; HbA1c: 7.6 ± 1.0%) completed four conditions in this randomised crossover study: CON (eating window, 0800-2000 h), CON with exercise (CON + Ex; 0800-2000 h + 15 min walking at 60% VO2peak, 45 min post-meal), TRE (eating window 1000-1800 h), and TRE with exercise (TRE + Ex, 1000-1800 h + 15 min walking as per CON + Ex), with standardised meals. Venous blood samples were collected at 26-timepoints and analysed for glucose and insulin concentrations. Statistical analysis used linear mixed-effects models with P < 0.05.

RESULTS

Reducing the eating window had little effect on plasma glucose 14-h area under the curve (AUC). Exercise reduced insulin 14-h AUC (P=0.01) with no additive effect of TRE.

CONCLUSION

Post-meal exercise lowered 14-h insulin AUC, neither 8-h TRE nor post-meal exercise altered 14-h blood glucose compared with 12-h eating window. Future work should focus on long-term effects of TRE combined with exercise for enhancing blood glucose in people with type 2 diabetes mellitus.

Dietary therapy to halt the progression of diabetes to diabetic kidney disease

Diabetic Kidney Disease (DKD) is a common and serious complication of diabetes, particularly Type 2 Diabetes Mellitus (T2DM), which significantly contributes to patient morbidity and mortality. The limitations of traditional treatments like ACE inhibitors and ARBs in managing DKD progression highlight the need for innovative therapeutic strategies. This review examines the impact of various dietary patterns, such as the Mediterranean diet, ketogenic diet, intermittent fasting, DASH diet, and vegetarian diet, on the management of DKD. Evidence suggests these diets can halt the progression of DKD, although further research is needed to confirm their long-term effectiveness and safety. Personalized dietary approaches tailored to individual needs may enhance outcomes for DKD patients.

The metabolic significance of peripheral tissue clocks

The circadian clock is a transcriptional-translational feedback loop which oscillates in virtually all nucleated cells of the body. In the decades since its discovery, it has become evident that the molecular clockwork is inextricably linked to energy metabolism. Given the frequency with which metabolic dysfunction and clock disruption co-occur, understanding why and how clock and metabolic processes are reciprocally coupled will have important implications for supporting human health and wellbeing. Here, we discuss the relevance of molecular clock function in metabolic tissues and explore its role not only as a driver of day-night variation in gene expression, but as a key mechanism for maintaining metabolic homeostasis in the face of fluctuating energy supply and demand.

A multi-level approach to reduce exploding type 2 diabetes in Pakistan

Pakistan has the third-highest rate of type 2 diabetes globally, following China and India, making this a significant public health crisis. Despite the severity of the issue, efforts from health and policy practitioners to address it remain limited. With millions already diagnosed as pre-diabetic, the rising incidence of diabetes is rapidly becoming a public health emergency that demands immediate attention. This policy brief provides an accessible overview of diabetes, focusing on its types, mechanisms, and preventive measures. It also identifies key contributing factors, such as dietary habits, obesity, physical inactivity, and the influence of modern dietary trends, while proposing strategies for individuals, communities, and policymakers to combat this growing epidemic in Pakistan. The brief emphasizes the need for a multi-level approach that includes public awareness, education, behavioral and dietary changes, and policy interventions to reverse the trend. Strategies discussed include promoting healthy eating, increasing physical activity, managing obesity, and enhancing access to affordable, healthy food. Additionally, the brief highlights the importance of community and government support, such as public health campaigns, infrastructure improvements, and legislative efforts. By adopting this comprehensive approach, Pakistan can take meaningful steps to address the diabetes epidemic and improve public health outcomes.

Immune Memory: A New Frontier in Treating Recurrent Inflammatory Skin Diseases

The recurrence of inflammatory skin diseases represents a significant challenge in clinical practice, primarily mediated by immune memory. In inflammatory skin diseases, immune memory encompasses adaptive immune memory, trained immunity, and inflammatory memory, which are conducted by adaptive immune cells, innate immune cells, and structural cells, respectively. Adaptive immune memory is established through gene rearrangement, leading to antigen-specific immune memory. In contrast, trained immunity and inflammatory memory are formed through epigenetic and metabolic reprogramming, resulting in non-specific immune memory. Different types of immune memory work synergistically to aggravate localized inflammation in recurrent inflammatory skin diseases. However, immune memory in specific cells, such as macrophages, may also play an immunoregulatory role under certain conditions. We reviewed the immune memory mechanisms in different inflammatory skin diseases and discussed future strategies for targeted regulation of the molecular mechanisms underlying immune memory, such as targeted biological agents and epigenetic modifications. Additionally, we explored the potential for precise regulation of immune memory and its application in personalized treatment for recurrent inflammatory skin diseases.

Cardiometabolic and obesity risk outcomes of dawn-to-dusk, dry intermittent fasting: Insights from an umbrella review

BACKGROUND & AIMS

This umbrella review comprehensively and systematically summarizes meta-analyses on the impact of dawn-to-dusk, dry intermittent fasting of Ramadan (RIF) on cardiometabolic and glucose homeostasis indicators.

METHODS

Twenty meta-analyses were examined on the effects of RIF on body fat percentage (BFP), fat mass, fat-free mass, body mass index (BMI), body weight (BW), waist circumference (WC), systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG), and very low-density lipoprotein cholesterol (VLDL-C), fasting blood glucose (FBG), glycated hemoglobin (HbA1c), insulin resistance (HOMA-IR), serum insulin, leptin, and adiponectin. Results of continuous outcomes were pooled from included meta-analyses. We employed random-effects meta-analysis using the restricted maximum likelihood method to estimate heterogeneity. P-values were derived from standard meta-analytic tests, including Egger's test for small-study effects and the excess significance test for potential publication bias. Additionally, we applied criteria from Ioannidis' evidence classification to assess the credibility of the findings.

RESULTS

In healthy subjects, RIF was associated with significant reductions in BW (Hedges' G = -0.33; 95 % confidence interval (CI) = -0.37, -0.29; p-value = 2.63 × 10-52), WC (Hedges' G = -0.30; 95 % CI = -0.38, -0.23; p-value = 5.73 × 10-15), BFP (Hedges' G = -0.26; 95 % CI = -0.37, -0.14; p-value = 6.81 × 10-06), DBP (n = 3,456; Hedges' G = -0.26; 95 % CI = -0.38, -0.15; p-value = 9.18 × 10-06), TC (n = 9,314; Hedges' G = -0.16; 95 % CI = -0.25, -0.07; p-value = 6.27 × 10-04), and TG levels (n = 9,020; Hedges' G = -0.16; 95 % CI = -0.24, -0.08; p-value = 6.87 × 10-05). Moreover, in general population, TG (n = 16,688; Hedges' G = -0.15; 95 % CI = -0.22, -0.08; p-value <0.01) and FBG (n = 16,106; Hedges' G = -0.23; 95 % CI = -0.33, -0.13; p-value <0.01) were significantly reduced.

CONCLUSIONS

Dawn-to-dusk, dry RIF shows promise as a complementary therapy and preventive measure for reducing cardiometabolic and obesity-related risks. However, controlled studies are necessary to validate its effectiveness and fully understand its health implications.

The circadian rhythm as therapeutic target in inflammatory bowel disease

The primary objectives of the management of patients with inflammatory bowel disease (IBD) are to prevent IBD flares, prevent/delay disease progression and improve patients' quality of life. To this end, one needs to identify risk factor(s) associated with flare-ups and disease progression. We posit that disruption of circadian rhythms is one of the key factors that is associated with risk of flare-up and disease progression. This hypothesis is based on published studies that show: (1) The circadian rhythm regulates many biological processes including multiple IBD-relevant biological processes that are critical in inflammatory/immune processes such as environment/microbe interaction, microbe/host interaction, intestinal barrier integrity and mucosal immunity-all central in the pathogenesis of IBD, and (2) Circadian machinery is the primary tool for the host to interact with the environment. Circadian misalignment results in a loss of preparedness of the host to respond and adjust to the environmental changes that could make the host more vulnerable to IBD flare-ups. In this review, we first provide an overview of circadian rhythms and its role in healthy and disease states. Then we present data to support our hypothesis that: (1) IBD patients have disrupted circadian rhythms ("social jet lag") and (2) circadian misalignment and associated disrupted sleep decreases the resiliency of IBD patients resulting in microbiota dysbiosis, more disrupted intestinal barrier integrity and a more aggressive disease phenotype. We also show that circadian-directed interventions have a potential to mitigate the deleterious impact of disrupted circadian and improve IBD disease course.

An updated review of popular dietary patterns during pregnancy and lactation: Trends, benefits, and challenges

This review examines nutritional needs during pregnancy and lactation, focusing on the critical nutrients required for both maternal and fetal health. Essential nutrients such as folic acid, vitamin D, iron, calcium, and omega-3 fatty acids play a significant role in supporting fetal development and minimizing the risk of complications like gestational diabetes, hypertension, and preterm birth. Various dietary patterns, including the Mediterranean, vegetarian/vegan, and gluten-free diets, were evaluated for their adequacy and potential benefits. The Mediterranean diet was highlighted for its protective effects against pregnancy-related health issues. In contrast, the review identified vegetarian and vegan diets as requiring careful planning to ensure sufficient intake of key nutrients. Additionally, the review explored the implications of gestational diabetes and dietary strategies for managing blood sugar levels. The effects of intermittent fasting during pregnancy were also discussed, with mixed evidence regarding its safety and impact on pregnancy outcomes. Overall, the review stresses the importance of tailored nutritional guidance to ensure optimal health for both the mother and the developing fetus during pregnancy and lactation.

Impact of eating duration on weight management, sleeping quality, and psychological stress: A pilot study

The daily eating window significantly impacts weight and metabolic health, yet its ideal duration remains uncertain. Thirty-four healthy middle-aged women were randomly assigned to two intervention groups: 8-h time-restricted eating (TRE) and 14-h time-extended eating (EXE). Each intervention lasted 4 wk, with a 16-d washout period before switching to the other intervention. Clinical biomarkers were collected before and after each intervention, and sleep quality was assessed using the Korean Version of the Pittsburgh Sleep Quality Index (PSQI-K). Additionally, a daily visual analogue scale (VAS) was used to evaluate psychological changes. The TRE group experienced significant weight reduction, lower fasting plasma glucose and total serum cholesterol levels compared to the EXE group, but with an increase in systolic blood pressure. The EXE group showed improved blood pressure. The TRE group reported higher stress levels on the VAS, but the PSQI-K indicated improved sleep quality during the second intervention. An 8-h TRE, without calorie restriction or diet composition changes, proves more beneficial for weight management and plasma glucose control compared to the 14-h EXE among Korean women. Implementation of this approach is recommended to be gradual to mitigate psychological fluctuations and adverse blood pressure changes. The trial was registered with ClinicalTrials.gov (ID: NCT05964179) and Clinical Research Information Service (CRIS, Korea) (ID: KCT0008640).

Unraveling the Health Benefits and Mechanisms of Time-Restricted Feeding: Beyond Caloric Restriction

Time-restricted feeding (TRF) is a lifestyle intervention that aims to maintain a consistent daily cycle of feeding and fasting to support robust circadian rhythms. Recently, it has gained scientific, medical, and public attention due to its potential to enhance body composition, extend lifespan, and improve overall health, as well as induce autophagy and alleviate symptoms of diseases like cardiovascular diseases, type 2 diabetes, neurodegenerative diseases, cancer, and ischemic injury. However, there is still considerable debate on the primary factors that contribute to the health benefits of TRF. Despite not imposing strict limitations on calorie intake, TRF consistently led to reductions in calorie intake. Therefore, while some studies suggest that the health benefits of TRF are primarily due to caloric restriction (CR), others argue that the key advantages of TRF arise not only from CR but also from factors like the duration of fasting, the timing of the feeding period, and alignment with circadian rhythms. To elucidate the roles and mechanisms of TRF beyond CR, this review incorporates TRF studies that did not use CR, as well as TRF studies with equivalent energy intake to CR, which addresses the previous lack of comprehensive research on TRF without CR and provides a framework for future research directions.

The Interplay of Genetic Predisposition, Circadian Misalignment, and Metabolic Regulation in Obesity

PURPOSE OF REVIEW

This review explores the complex interplay between genetic predispositions to obesity, circadian rhythms, metabolic regulation, and sleep. It highlights how genetic factors underlying obesity exacerbate metabolic dysfunction through circadian misalignment and examines promising interventions to mitigate these effects.

RECENT FINDINGS

Genome-wide association Studies (GWAS) have identified numerous Single Nucleotide Polymorphisms (SNPs) associated with obesity traits, attributing 40-75% heritability to body mass index (BMI). These findings illuminate critical links between genetic obesity, circadian clocks, and metabolic processes. SNPs in clock-related genes influence metabolic pathways, with disruptions in circadian rhythms-driven by poor sleep hygiene or erratic eating patterns-amplifying metabolic dysfunction. Circadian clocks, synchronized with the 24-h light-dark cycle, regulate key metabolic activities, including glucose metabolism, lipid storage, and energy utilization. Genetic mutations or external disruptions, such as irregular sleep or eating habits, can destabilize circadian rhythms, promoting weight gain and metabolic disorders. Circadian misalignment in individuals with genetic predispositions to obesity disrupts the release of key metabolic hormones, such as leptin and insulin, impairing hunger regulation and fat storage. Interventions like time-restricted feeding (TRF) and structured physical activity offer promising strategies to restore circadian harmony, improve metabolic health, and mitigate obesity-related risks.

Daytime-Restricted Feeding Alleviates D-Galactose-Induced Aging in Mice and Regulates the AMPK and mTORC1 Activities

Time-restricted feeding (TRF) is a distinct regimen of intermittent fasting advocated for health improving. Although nighttime TRF (NRF) in rodents is analogous to daytime TRF (DRF) in humans and has health benefits, the effects of DRF on rodent's health remain uncertain. The adverse health effects of DRF in rodents are primarily attributed to its implementation-induced temporal shift in the expression of circadian rhythm-related genes. However, studies also demonstrate the health-beneficial effect of restricted feeding itself on metabolic homeostasis, particularly in periphery tissues. Moreover, the direct effects of DRF on aging progression in rodents are underexplored, highlighting a gap in current research. To explore the overall health effects of long-term DRF in rodents, especially its influence on aging progression, we investigated the impact of long-term DRF on mice under a progeric aging condition. Results showed that both 4-h and 8-h DRF regimens exerted positive effects on aging retardation; these effects were manifested as improved physical and memory capacities, enhanced liver and kidney functions, and reduced oxidative damage and inflammatory response. These DRF regimens also lowered the manifestation of aging-related markers in peripheral tissues, with decreased SA-β-gal staining and p16 expression. Mechanistically, DRF regimens, especially DRF8, upregulated AMPK signaling and downregulated mTORC1 signaling. Interestingly, the health benefits of DRF are similar to those of metformin intervention. In conclusion, our study demonstrates for the first time that DRF effectively counteracts oxidative stress-induced aging progression in mice, supporting the viewpoint that TRF as a promising strategy for preventing aging and aging-related disorders.

The associations between irregular breakfast and late-night snacking with metabolic dysfunction-associated steatotic liver disease

BACKGROUND

The newly coined term Metabolic dysfunction-associated steatotic liver disease (MASLD) emphasizes the critical role of metabolic risk factors in the pathogenesis of fatty liver disease. The consumption of irregular breakfasts or late-night snacks has been identified as a factor closely associated with disruptions in the body's energy homeostasis and metabolic balance. However, the relationship between these behaviors and MASLD has not been previously examined.

METHODS

Participants in this study were recruited from the Kailuan cohort, a prospective cohort. All participants completed questionnaires regarding breakfast and late-night snack frequencies. The primary outcomes were MASLD and MASLD with increased alcohol intake (MetALD). Cox regression analysis was utilized to calculate the hazard ratios (HR) and 95 % confidence intervals (CI) for MASLD and MetALD in different groups. Mediation analysis was used to assess the mediating effect of BMI on this relationship.

RESULTS

A total of 32,030 participants were included in the study. Both irregular breakfast consumption and late-night snacking were associated with an increased risk of MASLD. Compared to participants who consumed regular breakfast and no late-night snacks, the risk of MASLD was elevated in participants who consumed regular breakfast but late-night snacks (HR = 1.12, 95 % CI: 1.05-1.20), irregular breakfast but no late-night snacking (HR = 1.16, 95 % CI: 1.05-1.27), irregular breakfast and late-night snacking (HR = 1.26, 95 % CI: 1.13-1.42), never ate breakfast and no late-night snacking (HR = 1.33, 95 % CI: 1.23-1.44), and never ate breakfast and late-night snacking (HR = 1.52, 95 % CI: 1.30-1.77).

CONCLUSION

Irregular or skipped breakfast and late-night snacking were associated with an increased risk of MASLD and MetALD.

Chrononutrition in Critical Illness

Circadian rhythms in humans are biological rhythms that regulate various physiological processes within a 24-hour time frame. Critical illness can disrupt the circadian rhythm, as can environmental and clinical factors, including altered light exposure, organ replacement therapies, disrupted sleep-wake cycles, noise, continuous enteral feeding, immobility, and therapeutic interventions. Nonpharmacological interventions, controlling the ICU environment, and pharmacological treatments are among the treatment strategies for circadian disruption. Nutrition establishes biological rhythms in metabolically active peripheral tissues and organs through appropriate synchronization with endocrine signals. Therefore, adhering to a feeding schedule based on the biological clock, a concept known as "chrononutrition," appears to be vitally important for regulating peripheral clocks. Chrononutritional approaches, such as intermittent enteral feeding that includes overnight fasting and consideration of macronutrient composition in enteral solutions, could potentially restore circadian health by resetting peripheral clocks. However, due to the lack of evidence, further studies on the effect of chrononutrition on clinical outcomes in critical illness are needed. The purpose of this review was to discuss the role of chrononutrition in regulating biological rhythms in critical illness, and its impact on clinical outcomes.

Current and emerging strategies for the prevention of hepatocellular carcinoma

Liver cancer is the third leading cause of cancer-related deaths globally, with incident cases expected to rise from 905,700 in 2020 to 1.4 million by 2040. Hepatocellular carcinoma (HCC) accounts for about 80% of all primary liver cancers. Viral hepatitis and chronic excessive alcohol consumption are major risk factors for HCC, but metabolic dysfunction-associated steatotic liver disease is also becoming a dominant cause. The increasing numbers of cases of HCC and changes in risk factors highlight the urgent need for updated and targeted prevention strategies. Preventive interventions encompass strategies to decrease the burden of chronic liver diseases and their progression to HCC. These strategies include nutritional interventions and medications that have shown promise in preclinical models. Although prevailing approaches focus on treating chronic liver disease, leveraging a wider range of interventions represents a promising area to safeguard at-risk populations. In this Review, we explore existing evidence for preventive strategies by highlighting established and potential paths to reducing HCC risk effectively and safely, especially in individuals with chronic liver diseases. We categorize the preventive strategies by the mechanism of action, including anti-inflammatory, antihyperglycaemic, lipid-lowering, nutrition and dietary, antiviral, and antifibrotic pathways. For each category, we discuss the efficacy and safety information derived from mechanistic, translational, observational and clinical trial data, pinpointing knowledge gaps and directions for future research.

Intermittent fasting versus continuous caloric restriction for glycemic control and weight loss in type 2 diabetes: A traditional review

Type 2 Diabetes Mellitus (T2DM) represents a major global health issue, with its incidence anticipated to increase markedly in the forthcoming decades. Efficient non-pharmacological therapies, especially dietary approaches, are essential for regulating glycemic control and facilitating weight reduction. Intermittent Fasting (IF) and Continuous Caloric Restriction (CCR) are two well researched methodologies, but their relative effectiveness and enduring advantages continue to be topics of active discussion. This review systematically assesses and contrasts the impacts of intermittent fasting (IF) and continuous calorie restriction (CCR) on glycemic regulation and weight reduction in persons with type 2 diabetes mellitus (T2DM), highlighting their short-term and long-term effects, safety profiles, and adherence rates. A thorough literature analysis was performed utilizing PubMed and Google Scholar, concentrating on papers published from 2000 to 2024. The review encompassed randomized controlled trials and observational studies that investigated the effects of intermittent fasting (IF) and continuous calorie restriction (CCR) on glycemic indicators (HbA1c, fasting glucose) and body weight. IF shown substantial short-term advantages, encompassing marked decreases in HbA1c levels, fasting glucose, and body weight. Mechanistic discoveries emphasized better insulin sensitivity, augmented fat metabolism, and autophagy as key aspects. In contrast, CCR was linked to enduring metabolic enhancements, including decreased visceral fat and improved insulin sensitivity. Nevertheless, both dietary approaches demonstrated constraints.

Circadian Disruption and the Risk of Developing Obesity

PURPOSE OF THE REVIEW

This review summarizes recent evidence for a role of the clock in adipose tissue physiology and the impact of circadian desynchrony on the development of obesity.

RECENT FINDINGS

Circadian disruptions due to shift work, late time eating and nighttime light exposure are associated with obesity and its metabolic and cardiovascular consequences. Studies in mice harboring tissue-specific gain/loss of function mutations in clock genes revealed that the circadian clock acts on multiple pathways to control adipogenesis, lipogenesis/lipolysis and thermogenesis. Time-restricted eating (TRE), aligning feeding with the active period to restore clock function, represents a promising strategy to curb obesity. While TRE has shown clear benefits, especially in participants at higher cardiometabolic risk, current studies are limited in size and duration. Larger, well-controlled studies are warranted to conclusively assess the effects of TRE in relation to the metabolic status and gender. Field studies in shift-workers, comparing permanent night shift versus rotating shifts, are also necessary to identify the optimal time window for TRE.

Weight loss-independent changes in human growth hormone during water-only fasting: a secondary evaluation of a randomized controlled trial

Introduction

Water-only fasting for one day or more may provide health benefits independent of weight loss. Human growth hormone (HGH) may play a key role in multiple fasting-triggered mechanisms. Whether HGH changes during fasting are independent of weight loss and how basal HGH and HGH change relate to other fasting-induced changes are unknown.

Methods

Apparently healthy individuals (N=30) were randomized by Latin square to begin two days with either 24-hour water-only fasting or a control of 24-hour ad libitum eating. On day 2, subjects were crossed over to control (if day 1 was fasting) or fasting (if they ate on day 1). HGH, weight, and other parameters were measured at baseline and at the end of the first and second days.

Results

Baseline HGH had median 0.50 ng/mL for females (n=20) and 0.04 ng/mL for males (n=10), and correlated inversely with weight, glucose, insulin, and triglycerides and positively with changes in insulin and HOMA-IR. The 24-hour fasting-induced HGH change was uncorrelated with weight loss (r= 0.01, p=0.98), but correlated with changes in glucose, HGB, and IGF-1. The percent increase in HGH was greater (p<0.001) for lower (females ≤0.15 ng/mL, males ≤0.05 ng/mL) vs. higher baseline HGH (median: 1,225% vs. 50.3%, respectively). Subjects with lower baseline HGH had a trend to greater reduction of HOMA-IR (median: -6.15 vs. -1.35 for lower vs. higher HGH, respectively, p=0.08).

Conclusions

Fasting increased HGH and the HGH changes were independent of weight loss. Basal HGH and fasting-induced HGH changes correlated inversely with cardiometabolic risk factors.Clinical Trial Registration: clinicaltrials.gov, identifier NCT01059760.

Time Restricted Eating: A Valuable Alternative to Calorie Restriction for Addressing Obesity?

PURPOSE OF REVIEW

In this review, we summarize the molecular effects of time-restricted eating (TRE) and its possible role in appetite regulation. We also discuss the potential clinical benefits of TRE in obesity.

RECENT FINDINGS

TRE is an emerging dietary approach consisting in limiting food intake to a specific window of time each day. The rationale behind this strategy is to restore the circadian misalignment, commonly seen in obesity. Preclinical studies have shown that restricting food intake only during the active phase of the day can positively influence several cellular functions including senescence, mitochondrial activity, inflammation, autophagy and nutrients' sensing pathways. Furthermore, TRE may play a role by modulating appetite and satiety hormones, though further research is needed to clarify its exact mechanisms. Clinical trials involving patients with obesity or type 2 diabetes suggest that TRE can be effective for weight loss, but its broader effects on improving other clinical outcomes, such as cardiovascular risk factors, remain less certain. The epidemic proportions of obesity cause urgency to find dietary, pharmacological and surgical interventions that can be effective in the medium and long term. According to its molecular effects, TRE can be an interesting alternative to caloric restriction in the treatment of obesity, but the considerable variability across clinical trials regarding population, intervention, and follow-up duration makes it difficult to reach definitive conclusions.

Intermittent fasting as a dietary intervention with potential sexually dimorphic health benefits

Intermittent fasting (IF) has proven to be a feasible dietary intervention for the wider population. The recent increase in IF clinical trials highlights its potential effects on health, including changes in body composition, cardiometabolic status, and aging. Although IF may have clinical applications in different populations, studies suggest there may be sex-specific responses in parameters such as body composition or glucose and lipid metabolism. Here, the existing literature on IF clinical trials is summarized, the application of IF in both disease prevention and management is discussed, and potential disparities in response to this type of diet between men and women are assessed. Moreover, the potential mechanisms that may be contributing to the sexually dimorphic response, such as age, body composition, tissue distribution, or sex hormones are investigated. This review underscores the need to further study these sex-specific responses to IF to define the most effective time frames and length of fasting periods for men and women. Tailoring IF to specific populations with a personalized approach may help achieve its full potential as a lifestyle intervention with clinical benefits.

The influence of time-restricted eating/feeding on Alzheimer's biomarkers and gut microbiota

OBJECTIVES

Alzheimer's disease (AD) is a progressive neurodegenerative disorder affecting approximately 55 million individuals globally. Diagnosis typically occurs in advanced stages, and there are limited options for reversing symptoms. Preventive strategies are, therefore, crucial. Time Restricted Eating (TRE) or Time Restricted Feeding (TRF) is one such strategy. Here we review recent research on AD and TRE/TRF in addition to AD biomarkers and gut microbiota.

METHODS

A comprehensive review of recent studies was conducted to assess the impact of TRE/TRF on AD-related outcomes. This includes the analysis of how TRE/TRF influences circadian rhythms, beta-amyloid 42 (Aß42), pro-inflammatory cytokines levels, and gut microbiota composition.

RESULTS

TRE/TRF impacts circadian rhythms and can influence cognitive performance as observed in AD. It lowers beta-amyloid 42 deposition in the brain, a key AD biomarker, and reduces pro-ininflammatory cytokines. The gut microbiome has emerged as a modifiable factor in AD treatment. TRE/TRF changes the structure and composition of the gut microbiota, leading to increased diversity and a decrease in harmful bacteria.

DISCUSSION

These findings underscore the potential of TRE/TRF as a preventive strategy for AD. By reducing Aß42 plaques, modulating pro-inflammatory cytokines, and altering gut microbiota composition, TRE/TRF may slow the progression of AD. Further research is needed to confirm these effects and to understand the mechanisms involved. This review highlights TRE/TRF as a promising non-pharmacological intervention in the fight against AD.

Prevention of cardiometabolic diseases through dietary modifications

PURPOSE OF REVIEW

Cardiometabolic diseases (CMDs) increasingly contribute to the cumulative burden of morbidity and mortality worldwide. Here, we reviewed intervention studies using a randomized controlled trial (RCT) design as well as meta-analyses of RCTs aimed at testing the effectiveness of different dietary approaches for CMD prevention.

RECENT FINDINGS

Recent studies testing dietary approaches for CMD prevention were summarized narratively, with a focus on interventions based on caloric restriction and fasting, healthy dietary patterns and food-based dietary modifications. Evidence supports intermittent fasting, Mediterranean, Nordic, DASH, low-carbohydrate/ketogenic and plant-based diets as effective strategies for improving cardiometabolic health. However, the benefits observed with some of these dietary patterns are linked to energy restriction, and the independent effects beyond weight loss remain unclear. The effectiveness of some strategies may also depend on the overall dietary quality and adherence to the programme.

SUMMARY

Recent findings highlight the importance of focusing on overall dietary patterns, rather than isolated nutrients, for preventing CMD. Future research should prioritize long-term intervention studies to assess the sustained effects of these dietary patterns on CMD outcomes.

Ketogenic diet combined with intermittent fasting: an option for type 2 diabetes remission?

With increasing attention to diabetes remission, various special dietary patterns have been found to be effective in achieving diabetes remission. The effect of a single dietary pattern on lowering blood glucose is clear, but studies on the synergistic effects of different dietary patterns are limited. This article describes the types of intermittent fasting and ketogenic diets, potential mechanisms, contraindications of combination diets, recommendations for combination diets, and their health outcomes. This paper aims to illustrate the evidence for intermittent fasting combined with a ketogenic diet on outcomes of diabetes remission and effect on blood glucose control. Knowledge of these findings can help doctors and patients determine dietary patterns for achieving diabetes remission and understanding their application.

The impact of time-restricted eating on health-related quality of life: a systematic literature review

CONTEXT

Time-restricted eating (TRE) is a novel dietary intervention shown to facilitate weight loss and improve metabolic health. However, like any dietary intervention, long-term success largely depends on individual adherence, which can be influenced by whether the intervention impacts the individual's health-related quality of life (HR-QoL). Despite the growing body of research investigating TRE as a dietary approach and its potential impact on HR-QoL in adults, to date there has been no systematic review to summarize these findings.

OBJECTIVE

To examine the impact of TRE on HR-QoL in adults.

DATA SOURCES

All randomized controlled trials, pre-post and pilot/feasibility studies were searched in PubMed, EMBASE via Ovid, CINAHL, Cochrane Library, and PsycINFO via Ovid until March 20, 2023.

DATA EXTRACTION

Two researchers were involved in the screening and paper selection process. A single researcher extracted all relevant data from eligible studies.

CONCLUSION

Overall, 10 studies were eligible for inclusion in this systematic review. Four studies reported improvements in overall HR-QoL scores among participants with type 2 diabetes, middle-aged women with obesity, generally healthy adults, and generally healthy adult employees. Three studies reported significant and nonsignificant improvements in some domains of HR-QoL assessment tools among overweight, sedentary older adults, overweight or obese adults, and 24-hour shift workers. No studies reported that TRE adversely affected HR-QoL. Improvements in HR-QoL appeared to occur primarily at 12 weeks/3 months. There was no clear relationship between HR-QoL scores and TRE protocol, additional study outcomes, participant health status, age, or adherence. Although further research is required to elucidate the impact of TRE on HR-QoL, the findings reveal that no studies show that TRE adversely affects HR-QoL.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework (OSF) (The Impact of Time-Restricted Eating on Health-Related Quality of Life: A Systematic Review; https://doi.org/10.17605/OSF.IO/9NK45).

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

The optimal eating window for time-restricted eating (TRE) remains unclear, particularly its impact on visceral adipose tissue (VAT), which is associated with cardiometabolic morbidity and mortality. We investigated the effects of three TRE schedules (8 h windows in the early day, late day and participant-chosen times) combined with usual care (UC, based on education about the Mediterranean diet) versus UC alone over 12 weeks in adults with overweight or obesity. The primary outcome was VAT changes measured by magnetic resonance imaging. A total of 197 participants were randomized to UC (n = 49), early TRE (n = 49), late TRE (n = 52) or self-selected TRE (n = 47). No significant differences were found in VAT changes between early TRE (mean difference (MD): -4%; 95% confidence interval (CI), -12 to 4; P = 0.87), late TRE (MD: -6%; 95% CI, -13 to 2; P = 0.31) and self-selected TRE (MD: -3%; 95% CI, -11 to 5; P ≥ 0.99) compared with UC, nor among the TRE groups (all P ≥ 0.99). No serious adverse events occurred; five participants reported mild adverse events. Adherence was high (85-88%) across TRE groups. These findings suggest that adding TRE, irrespective of eating window timing, offers no additional benefit over a Mediterranean diet alone in reducing VAT. TRE appears to be a safe, well-tolerated and feasible dietary approach for adults with overweight or obesity. ClinicalTrials.gov registration: NCT05310721 .

The Effect of Intermittent Fasting Combined with Ad Libitum Days on Adults' Elevated Blood Pressure: A Systematic Review of Human Studies

Background

Diets utilizing intermittent fasting as an alternative method to promote weight loss have grown in popularity. However, the efficacy of intermittent among elevated blood pressure remains unclear. This review systematically analyses studies investigating the effects of intermittent variations among elevated blood pressure on changes in systolic blood pressure and diastolic blood pressure. Changes in body weight, body mass index, waist circumference, and energy intake were assessed as a secondary objective.

Methods

The American Search Elite, CINAHL, Cochrane, MEDLINE, ProQuest, PubMed, Scopus, and grey literature databases were searched for articles investigating intermittent fasting with ad libitum among adults with elevated blood pressure from Jan 2010 to Jun 2022.

Results

Twelve studies met the eligibility criteria. Systolic and diastolic blood pressure generally decreased, between -2.0 to -0.04 mmHg and -3 to -0.01 mmHg, respectively. The body weight and body mass index reduced significantly (-2.85 to -0.09 kg and -1.05 to -0.03 kg/m2, respectively). The review found a waist circumference reduction of -0.67 to -0.21 cm and an energy intake reduction of -263.89 to -2.58 kcal.

Conclusion

Intermittent fasting reduces systolic and diastolic blood pressure in 2-24 wk while decreasing body weight, body mass index, and energy intake. However, needs 48 wk to reduce waist circumference. This implies that it is critical to perform intermittent fasting on elevated blood pressure before the development of high blood pressure as part of a program to prevent hypertension in adults.

Chronotype and Cancer: Emerging Relation Between Chrononutrition and Oncology from Human Studies

Fasting-feeding timing is a crucial pattern implicated in the regulation of daily circadian rhythms. The interplay between sleep and meal timing underscores the importance of maintaining circadian alignment in order to avoid creating a metabolic environment conducive to carcinogenesis following the molecular and systemic disruption of metabolic performance and immune function. The chronicity of such a condition may support the initiation and progression of cancer through a variety of mechanisms, including increased oxidative stress, immune suppression, and the activation of proliferative signaling pathways. This review aims to summarize current evidence from human studies and provide an overview of the potential mechanisms underscoring the role of chrononutrition (including time-restricted eating) on cancer risk. Current evidence shows that the morning chronotype, suggesting an alignment between physiological circadian rhythms and eating timing, is associated with a lower risk of cancer. Also, early time-restricted eating and prolonged nighttime fasting were also associated with a lower risk of cancer. The current evidence suggests that the chronotype influences cancer risk through cell cycle regulation, the modulation of metabolic pathways and inflammation, and gut microbiota fluctuations. In conclusion, although there are no clear guidelines on this matter, emerging evidence supports the hypothesis that the role of time-related eating (i.e., time/calorie-restricted feeding and intermittent/periodic fasting) could potentially lead to a reduced risk of cancer.

Comparison of the impact of intermittent fasting diet alone or in conjunction with probiotic supplementation versus calorie-restricted diet on inflammatory, oxidative stress, and antioxidant capacity biomarkers in women with polycystic ovary syndrome: A randomized placebo-controlled trial

Background

The objective of this study was to compare the effects of early time-restricted eating (eTRE) and eTRE plus probiotic supplementation to daily caloric restriction (DCR) alone in terms of biomarkers of oxidative stress (OS), antioxidant capacity, inflammation, and blood pressure (BP) in obese women with polycystic ovary syndrome (PCOS).

Materials and Methods

The research was conducted as a randomized, parallel, placebo-controlled clinical trial with an 8-week follow-up period. Participants were randomly assigned to one of three groups: 14:10 eTRE with probiotic supplementation (n = 30), 14:10 eTRE with placebo supplementation (n = 30), or DCR with placebo supplementation (n = 30). At the beginning and 8 weeks of the intervention, systolic blood pressure (SBP) and diastolic BP, inflammation, and OS parameters were evaluated.

Results

A total of 90 participants (mean age, 30.49 years and mean weight, 81.45 kg) were enrolled in this trial. After 8-week intervention, we observed SBP significantly decreased in both the eTRE + probiotic group (-0.31 mmHg [95% confidence interval (CI): -0.55, -0.07]) and the eTRE + placebo group (-0.24 mmHg [95% CI: -0.43, 0.04]), with no significant differences observed between groups. Moreover, C-reactive protein (CRP) levels were significantly reduced in all groups (P < 0.005). Total antioxidant capacity (TAC) also showed notable improvement in both the eTRE + probiotic group (P = 0.012) and the DCR group (P = 0.032). However, there were no significant differences between the three groups regarding BP, OS, TAC, and CRP markers.

Conclusion

It was not found that eTRE alone or eTRE with probiotics intervention resulted in improving BP, inflammatory, OS, and antioxidant capacity biomarkers than a standard DCR diet among obese women with PCOS. The present study did not reveal significant improvements in BP, inflammatory markers, OS, or antioxidant capacity with either eTRE alone or eTRE combined with probiotics compared to a standard DCR among obese women diagnosed with PCOS.Trial Register no: IRCT20121110011421N5.

Dietary Restrictions and Cancer Prevention: State of the Art

Worldwide, almost 10 million cancer deaths occurred in 2022, a number that is expected to rise to 16.3 million by 2040. Primary prevention has long been acknowledged as a crucial approach to reducing cancer incidence. In fact, between 30 and 50 percent of all tumors are known to be preventable by eating a healthy diet, staying active, avoiding alcohol, smoking, and being overweight. Accordingly, many international organizations have created tumor prevention guidelines, which underlie the importance of following a diet that emphasizes eating plant-based foods while minimizing the consumption of red/processed meat, sugars, processed foods, and alcohol. However, further research is needed to define the relationship between the effect of specific diets or nutritional components on cancer prevention. Interestingly, reductions in food intake and dietetic restrictions can extend the lifespan of yeast, nematodes, flies, and rodents. Despite controversial results in humans, those approaches have the potential to ameliorate health via direct and indirect effects on specific signaling pathways involved in cancer onset. Here, we describe the latest knowledge on the cancer-preventive potential of dietary restrictions and the biochemical processes involved. Molecular, preclinical, and clinical studies evaluating the effects of different fasting strategies will also be reviewed.

Physiological rhythms and metabolic regulation: Shining light on skeletal muscle

Metabolic regulation is essential for maintaining homeostasis in response to fluctuating dietary nutrient availability. In this review, we explore how metabolic health can be affected by the temporal alignment between daily behavioural patterns (e.g., eating, physical activity and sleep) and recurring cycles in underlying physiology (e.g., 'circadian' rhythms). Misalignment within and/or between these patterns and cycles can lead to metabolic dysregulation, increasing the risk of chronic disease states such as obesity, type 2 diabetes and cardiovascular disease. Conversely, metabolic health can be improved by strategically aligning certain behavioural patterns with endogenous rhythms in physiology. Dietary interventions based upon this reasoning are referred to as chrono-nutrition strategies. Skeletal muscle is an important tissue in relation to both whole-body metabolism and behaviour and plays a central role in how physiological rhythms respond to the timing of nutrient delivery/availability. Few studies have examined rhythms in metabolism within human skeletal muscle, providing opportunities to advance current understanding of how nutrient timing affects muscle metabolism.

Nutritional state-dependent modulation of insulin-producing cells in Drosophila

Insulin plays a key role in metabolic homeostasis. Drosophila insulin-producing cells (IPCs) are functional analogues of mammalian pancreatic beta cells and release insulin directly into circulation. To investigate the in vivo dynamics of IPC activity, we quantified the effects of nutritional and internal state changes on IPCs using electrophysiological recordings. We found that the nutritional state strongly modulates IPC activity. IPC activity decreased with increasing periods of starvation. Refeeding flies with glucose or fructose, two nutritive sugars, significantly increased IPC activity, whereas non-nutritive sugars had no effect. In contrast to feeding, glucose perfusion did not affect IPC activity. This was reminiscent of the mammalian incretin effect, where glucose ingestion drives higher insulin release than intravenous application. Contrary to IPCs, Diuretic hormone 44-expressing neurons in the pars intercerebralis (DH44PINs) responded to glucose perfusion. Functional connectivity experiments demonstrated that these DH44PINs do not affect IPC activity, while other DH44Ns inhibit them. Hence, populations of autonomously and systemically sugar-sensing neurons work in parallel to maintain metabolic homeostasis. Accordingly, activating IPCs had a small, satiety-like effect on food-searching behavior and reduced starvation-induced hyperactivity, whereas activating DH44Ns strongly increased hyperactivity. Taken together, we demonstrate that IPCs and DH44Ns are an integral part of a modulatory network that orchestrates glucose homeostasis and adaptive behavior in response to shifts in the metabolic state.

Time-restricted feeding improves metabolic syndrome by activating thermogenesis in brown adipose tissue and reducing inflammatory markers

Background

Obesity and metabolic syndrome (MetS) have become increasingly significant global health issues. Time-restricted feeding (TRF), as a novel dietary intervention, has garnered attention in recent years. However, there is limited research focusing on the effects of TRF on energy expenditure and systemic low-grade inflammation. This study aims to investigate the impact of TRF on weight management, glucose metabolism, insulin resistance, and lipid metabolism in male C57BL/6J mice, particularly in the context of metabolic disorders induced by a high-fat diet (HFD).

Methods

C57BL/6J mice were divided into two groups: a normal diet (ND) group and a high-fat diet (HFD) group. The study duration was 12 weeks. Key parameters observed included body weight, glucose tolerance (via glucose tolerance tests), insulin resistance (HOMA-IR), and insulin secretion under glucose stimulation. Additionally, liver tissue was subjected to Oil Red O staining to assess lipid accumulation, and white and brown adipose tissues were stained with hematoxylin and eosin (HE) to evaluate adipocyte size. The expression of hepatic lipogenesis-related genes (Srebp-c, Chrebp, Fasn, and Acc1) and thermogenic genes in brown adipose tissue (UCP1 and PGC-1α) were also measured. Furthermore, temperature changes in the interscapular brown adipose tissue (BAT) were monitored.

Results

In the ND group: TRF improved insulin resistance and reduced circulating levels of the pro-inflammatory cytokine IL-6, with a slight reduction in body weight.In the HFD group: TRF significantly mitigated weight gain, improved glucose tolerance and insulin resistance, and enhanced insulin secretion under glucose stimulation. Additionally, TRF reduced hepatic steatosis by downregulating the expression of lipogenesis-related genes in the liver. TRF also increased thermogenesis by upregulating the expression of thermogenic genes (UCP1 and PGC-1α) in BAT, while lowering serum levels of pro-inflammatory cytokines IL-6 and TNF-α, though IL-1β levels remained unchanged.

Conclusion

This study demonstrates that TRF can activate thermogenesis in brown adipose tissue and reduce inflammation maker, leading to an improvement in hepatic steatosis and a reduction in white adipose tissue accumulation. These findings suggest that TRF may be a promising intervention for mitigating metabolic disturbances associated with obesity and metabolic syndrome. The study provides mechanistic insights into the beneficial effects of TRF, highlighting its potential in modulating lipid metabolism and exerting anti-inflammatory effects.