Metabolic and behavioral effects of time-restricted eating in women with overweight or obesity: Preliminary findings from a randomized study

Efficacy of time restricted eating and resistance training on body composition and mood profiles among young adults with overweight/obesity: a randomized controlled trial

BACKGROUND/OBJECTIVE

Dietary restriction or exercise regimens can promote weight loss or physical fitness among patients with obesity. However, intervention-associated adverse effects may impede patients' motivation to participate in dietary/exercise interventions. We examined the effects of time restricted eating (TRE) with or without resistance training (RT) on body composition, mood profile, and sleep quality in young college adults with overweight or obesity.

METHODS

Fifty-four young college students with overweight/obesity were randomized into control (CON), TRE, RT, and TRE plus RT (TRE+RT) trials. The TRE trials restricted to an eating window of 10-hour/day for 8-week. The RT trials performed supervised resistance exercise, while the control trial maintained a regular lifestyle. Changes in body composition variables, blood pressure, mood status, and sleep quality were measured before and after the intervention.

RESULTS

TRE intervention alone or in combination with RT significantly (p < 0.01) decreased body weight (>2 kg) and BMI (~1 kg/m2) in adults with overweight/obesity. Both RT alone and combined with TRE substantially decreased fat mass by 1.1 ± 0.5 and 3.2 ± 0.4 kg, respectively. The decreased fat mass was greater in the combination trial than in the RT trial, whereas TRE alone had no effect. In contrast, fat-free mass was significantly (p < 0.01) decreased with TRE (-2.3 ± 06 kg), increased with RT (1.6 ± 0.3 kg), and was stably maintained with combination interventions. The reduced waist and hip circumferences in the TRE (p < 0.01) were similar to those in the TRE+RT trials, however, RT alone had no effect. Time and group interaction showed a large effect size (partial eta squared) for all body composition variables. In addition, RT with or without TRE notably decreased diastolic blood pressure (RT: -5.5 ± 1.9 mmHg, TRE+RT: -4.1 ± 1.5 mmHg, p < 0.05). Mild anxiety levels at baseline in RT (4.8 ± 2.6) and TRE+RT (4.1 ± 3) trials were found to be normal at postintervention in TRE+RT (3.6 ± 1.7) but not in RT (5.6 ± 3.5). No depression or stress was recorded among the participants during the intervention. The reported poor sleep quality among participants at baseline was significantly improved with RT (4.8 ± 2.9; p < 0.05), and tended to improve with TRE+RT interventions (4.5 ± 1.9).

CONCLUSIONS

10-hour TRE is beneficial for weight/fat loss without affecting mood status. However, TRE combined with RT might be more effective for weight/fat loss, maintaining muscle mass, and good quality of sleep among young adults with overweight or obesity.

Time-restricted eating increases hunger in adults with overweight and obesity: A systematic review and meta-analysis of randomized controlled studies

Time-Restricted Eating (TRE) is an intermittent fasting approach that holds promise in managing obesity and appears to influence hunger. We hypothesized that the effects of TRE would be due to a lower caloric intake imposed, as with any other type of dietary intervention. However, it remains unclear whether these effects are attributed to the chrononutrition protocol itself or the caloric restriction resulting from the intervention. Our primary aim was to examine the impact of TRE on hunger compared to isocaloric strategies in adults with overweight or obesity. We conducted a systematic review of randomized clinical trials, with inclusion criteria comprising adults aged 18 years and older with overweight/obesity. A literature search was conducted from the earliest available article up to January 2025, with no restrictions on time, region, or language. The search encompassed major electronic databases, including CENTRAL, MEDLINE, LILACS, EMBASE, Google Scholar, and OpenGrey. Of the 14 studies included, four met the eligibility criteria for the primary meta-analysis, which evaluated hunger in 323 participants. The findings revealed that TRE resulted in an increase in hunger (MD 2.05, 95% CI 1.46, 2.64; I² = 0%) compared to the isocaloric control group. In conclusion, the TRE protocol was associated with elevated hunger compared to isocaloric strategies, which may warrant further investigation into its long-term feasibility in weight loss programs.

Systematic Review and Meta-analysis of Randomized Clinical Trials Comparing Time-Restricted Eating With and Without Caloric Restriction for Weight Loss

CONTEXT

Although it is well established that caloric restriction (CR) is the primary driver of weight loss, circadian-driven metabolic benefits have been recognized as possibly enhancing the effects of CR. Time-restricted eating (TRE) has emerged as a promising approach in this context.

OBJECTIVE

We conducted a systematic review and meta-analysis to compare the effects of TRE with isocaloric diet controls (analysis 1) and non-isocaloric controls (analysis 2) on anthropometric and body-composition parameters in adults with overweight or obesity.

DATA SOURCES

A search was carried out in the Medline, LILACS, Embase, and CENTRAL databases using Medical Subject Heading (MeSH) and similar terms such as "Obesity," "Obesity, Abdominal," "Time-restricted eating," "Body weight," "Changes in body weight," and others.

DATA EXTRACTION

We included 30 studies involving a total of 1341 participants. Studies were screened based on titles and abstracts followed by full-text reading, and data were extracted from eligible studies using a pre-established form. All these steps were performed by 2 authors independently and blinded, with discrepancies resolved by a third author.

DATA ANALYSIS

The results of main findings revealed that, in studies using non-isocaloric controls, the TRE group showed significant reductions in body weight (BW) (mean difference [MD]: -2.82 kg; 95% CI: -3.49, -2.15), fat mass (FM) (MD: -1.36 kg; 95% CI: -2.09, -0.63), and fat-free mass (FFM) (MD: -0.86 kg; 95% CI: -1.23, -0.49). In studies that used isocaloric control strategies, the TRE group showed significant reductions in BW (MD: -1.46 kg; 95% CI: -2.65, -0.26), FM (MD: -1.50 kg; 95% CI: -2.77, -0.24), and FFM (MD: -0.41 kg; 95% CI: -0.79, -0. 03).

CONCLUSION

TRE yields favorable anthropometric and clinical outcomes, even when intake is isocaloric between the intervention and control groups. This result suggests that circadian effects may enhance the impact of CR on excess weight.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022301594.

Cardiovascular disease and bipolar disorder: A review of pathophysiology and treatment implications

OBJECTIVE

Despite the well-established increased risk of cardiovascular mortality in individuals with bipolar disorder (BD), prevention and treatment of cardiovascular risk factors and diseases have been largely overlooked in this population. This manuscript reviews the pathophysiological basis of the connection between BD and cardiovascular diseases, highlighting their shared mechanisms, reciprocal interactions, and relevant prevention and treatment strategies.

METHODS

For this narrative review, a search was carried out on PubMed using the keywords bipolar disorder, cardiovascular diseases, and cardiovascular risk factors.

RESULTS

The increased frequency of cardiovascular morbidity in BD can be attributed to overlapping biological and psychosocial mechanisms. These mechanisms are complex and involve both direct effects of BD and indirect effects mediated by lifestyle and pharmacological factors. Cardiovascular diseases also significantly exacerbate the clinical course of BD and increase morbidity and healthcare costs; thus, their effective management can improve psychiatric outcomes and vice versa. However, patients with BD frequently encounter healthcare barriers.

CONCLUSION

Awareness initiatives and research on integrated care are needed to determine the best strategies for improving cardiovascular and psychiatric outcomes in individuals with BD.

Effects of time-restricted feeding (TRF)-model of intermittent fasting on adipose organ: a narrative review

Time-restricted feeding (TRF), an intermittent fasting approach involving a shortened eating window within 24 h, has gained popularity as a weight management approach. This review addresses how TRF may favor fat redistribution and the function of the adipose organ. TRF trials (mainly 16:8 model, with a duration of 5-48 weeks) reported a significant weight loss (1.2-10.2%, ~ 1.4-9.4 kg), with a considerable decrease in total fat mass (1.6-21%, ~ 0.5-7 kg) and visceral adipose compartment (VAC, 11-27%) in overweight and obese subjects. Experimental TRF in normal-fed and obesogenic-diet-fed mice and rats (with a fasting duration ranging between 9 and 21 h within 1-17 weeks) reported a significant reduction in body weight (~ 7-40%), total fat mass (~ 17-71%), and intrahepatic fat (~ 25-72%). TRF also improves VAC and subcutaneous adipose compartment (SAC) function by decreasing adipocyte size, macrophage infiltration, M1-macrophage polarity, and downregulating inflammatory genes. In conclusion, beyond its effect on body weight loss, total fat mass, and intrahepatic fat accumulation, TRF favors adipose organ fat redistribution in overweight and obese subjects by decreasing VAC and improving the function of VAC and SAC.

The Effects of Time-Restricted Eating on Fat Loss in Adults with Overweight and Obese Depend upon the Eating Window and Intervention Strategies: A Systematic Review and Meta-Analysis

Time-restricted eating (TRE) is a circadian rhythm-based intermittent fasting intervention that has been used to treat obesity. However, the efficacy and safety of TRE for fat loss have not been comprehensively examined and the influences of TRE characteristics on such effects are unknown. This systematic review and meta-analysis comprehensively characterized the efficacy and safety of TRE for fat loss in adults with overweight and obese, and it explored the influence of TRE characteristics on this effect.

METHODS

A search strategy based on the PICOS principle was used to find relevant publications in seven databases. The outcomes were body composition, anthropometric indicators, and blood lipid metrics. Twenty publications (20 studies) with 1288 participants, covering the period from 2020 to 2024, were included.

RESULTS

Compared to the control group, TRE safely and significantly reduced body fat percentage, fat mass, lean mass, body mass, BMI, and waist circumference (MDpooled = -2.14 cm, 95% CI = -2.88~-1.40, p < 0.001), and increased low-density lipoprotein (LDL) (MDpooled = 2.70, 95% CI = 0.17~5.22, p = 0.037), but it did not alter the total cholesterol, high-density lipoprotein, and triglycerides (MDpooled = -1.09~1.20 mg/dL, 95% CI -4.31~5.47, p > 0.05). Subgroup analyses showed that TRE only or TRE-caloric restriction with an eating window of 6 to 8 h may be appropriate for losing body fat and overall weight.

CONCLUSIONS

This work provides moderate to high evidence that TRE is a promising dietary strategy for fat loss. Although it may potentially reduce lean mass and increase LDL, these effects do not pose significant safety concerns. This trial was registered with PROSPERO as CRD42023406329.

Comparing caloric restriction regimens for effective weight management in adults: a systematic review and network meta-analysis

BACKGROUND

Randomized controlled trials have confirmed the effectiveness of four prevalent caloric restriction regimens in reducing obesity-related health risks. However, there is no consensus on the optimal regimen for weight management in adults.

METHODS

We systematically searched PubMed, Embase, Web of Science, and Cochrane CENTRAL up to January 15, 2024, for randomized controlled trials (RCT) involving adults, evaluating the weight-loss effects of alternate day fasting (ADF), short-term fasting (STF), time-restricted eating (TRE), and continuous energy restriction (CER). The primary outcome was body weight, with secondary outcomes including BMI, fat mass, lean mass, waist circumference, fasting glucose, HOMA-IR, and adverse events. Bayesian network meta-analysis was conducted, ranking regimens using the surface under the cumulative ranking curve and the probability of being the best. Study quality was assessed using the Confidence in Network Meta-Analysis tool.

RESULTS

Data from 47 RCTs (representing 3363 participants) were included. ADF showed the most significant body weight loss (Mean difference (MD): -3.42; 95% Confidence interval (CI): -4.28 to -2.55), followed by TRE (MD: -2.25; 95% CI: -2.92 to -1.59). STF (MD: -1.87; 95% CI: -3.32 to -0.56) and CER (MD: -1.59; 95% CI: -2.42 to -0.79) rank third and fourth, respectively. STF lead to decline in lean mass (MD: -1.26; 95% CI: -2.16, -0.47). TRE showed benefits on fasting glucose (MD: -2.98; 95% CI: -4.7, -1.26). Subgroup analysis revealed all four caloric restriction regimens likely lead to modest weight loss after 1-3 months, with ADF ranked highest, but by 4-6 months, varying degrees of weight regain occur, particularly with CER, while interventions lasting 7-12 months may result in effective weight loss, with TRE potentially ranking first during both the 4-6 months and 7-12 months periods. ADF showing fewer and shorter-lasting physical symptoms.

CONCLUSION

All four included regiments were effective in reducing body weight, with ADF likely having the most significant impact. Each regimen likely leads to modest weight loss after 1-3 months, followed by weight regain by 4-6 months. However, interventions lasting 7-12 months achieve greater weight loss overall.

TRIAL REGISTRATION

PROSPERO: CRD42022382478.

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

This meta-analysis compared the effectiveness of different energy-restricted diets on body composition, glucose metabolism, and lipid metabolism in overweight and obese populations. Five databases were searched to identify relevant studies in English from inception until July 20, 2023, for randomized controlled trials of at least 2 weeks duration assessing the effects of continuous energy-restricted diets compared with any intermittent energy-restricted diet in obesity adults. The risk of bias was assessed using the Cochrane Risk of Bias Tool version 2.0, while the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system was used to assess the certainty of the evidence. A non-informative prior distribution Bayesian network meta-analysis was conducted. Thirty-eight studies (3039 participants) assessing four energy-restricted diets were included. Three RCTs were at high risk of bias with a very low to moderate certainty of evidence. Combined with pairwise comparisons and surface under the cumulative ranking curve, alternate-day fasting may be the best energy restriction regimen with the potential to have the most beneficial effects on various aspects of the obesity population. More rigorously designed and long-term follow-up studies are warranted.

Obesity and malnutrition in children and adults: A clinical review

Background

In the U.S., children and adults are consuming more low-nutrient foods with added sugar and excess fats as compared to healthy, high-quality calories and micronutrients. This diet is increasing the prevalence of malnutrition and nutritional deficiencies, despite high calorie intake. This is a review of the common micronutrient deficiencies, the risk factors for malnutrition, dietary plans, and the health consequences in children and adults with obesity in the U.S.

Methods

This clinical review of literature was performed on the MEDLINE (PubMed) search engine. A total of 1391 articles were identified and after review, a total of 130 were found to be most pertinent.

Discussion

The most common micronutrient deficiencies found in patients with obesity were vitamin A, thiamine (B1), folate (B9), cobalamin (B12), vitamin D, iron, calcium, and magnesium, especially prior and after bariatric surgery. Diets that produced the most weight reduction also further puts these individuals at risk for worsening malnutrition. Malnutrition and micronutrient deficiencies can worsen health outcomes if not properly managed.

Conclusion

Adequate screening and awareness of malnutrition can improve the health outcomes in patients with obesity. Physiologic changes in response to increased adiposity and inadequate intake increase this population's risk of adverse health effects. Malnutrition affects the individual and contributes to worse public health outcomes. The recommendations for screening for malnutrition are not exclusive to individuals undergoing bariatric procedures and can improve the health outcomes of any patient with obesity. However, clearly, improved nutritional status can assist with metabolism and prevent adverse nutritional outcomes post-bariatric surgery. Clinicians should advise on proper nutrition and be aware of diets that worsen deficiencies.

Effect of Time-Restricted Eating versus Daily Calorie Restriction on Mood and Quality of Life in Adults with Obesity

The purpose of this secondary analysis is to compare the effects of two popular weight loss regimens, time-restricted eating (TRE) and daily calorie restriction (CR), on mood and quality-of-life measures in adults with obesity. Ninety participants were randomized to one of three interventions for 12 months: 8 h TRE (eating only between 12:00 and 8:00 p.m., with no calorie counting); CR (25% energy restriction daily); or no-intervention control group. Questionnaires were administered to measure mood (Beck Depression Inventory-II (BDI-II), and Profile of Mood States (POMS)) and quality of life (Rand 36-Item Short Form) at baseline and month 12. Body weight decreased in the TRE group (-4.87%, 95%CI: -7.61, -2.13) and CR group (-5.30%, 95%CI: -9.06, -1.54) versus controls, with no difference between TRE and CR. The BDI-II depression score did not change in the TRE or CR group, versus controls, by month 12. Likewise, there were no changes in any of the POMS subscales (tension, depression, anger, fatigue, anger, confusion, or vigor) or the total mood disturbance score in the TRE or CR group versus controls. As for quality of life, there were no significant changes in the SF-36 constructs of mental health, bodily pain, and general physical health in the TRE or CR group versus controls. However, there was a trend towards increased vitality in the TRE group (7.77 [95% CI: 0.15, 15.39] p = 0.05) relative to controls. There were no associations between changes in body weight, physical activity, mood, and quality of life in any group by the end of the study. These findings suggest that TRE and CR produce similar degrees of weight loss, but impact neither mood nor quality of life in adults with obesity over 12 months. Future well-powered studies will be needed to confirm these findings.

Association between lower urinary tract symptoms and polycystic ovary syndrome

OBJECTIVE

The aim of this study was to analyze the association between lower urinary tract symptoms and polycystic ovary syndrome.

METHODS

A total of 180 women were enrolled in this prospective study. Demographic data, body mass index, waist circumference, modified Ferriman-Gallwey scores, biochemical parameters, ultrasonographic findings, and maximum urinary flow rate (Q max) were analyzed. In addition, the Beck Depression Inventory, Beck Anxiety Inventory, and Bristol Female Lower Urinary Tract Symptom Scored Form questionnaires were evaluated for each subject.

RESULTS

The mean age of patients was calculated as 23.78±3.04 years, which was similar for both groups (p=0.340). Body mass index, waist circumference, Beck Depression Inventory, Beck Anxiety Inventory, Bristol Female Lower Urinary Tract Symptom Scored Form, and modified Ferriman-Gallwey scores were significantly higher in group 2 (p<<0.001). Hyperandrogenism, lipid profile, and glucose metabolism disorders were more frequent in group 2 (p<<0.05). Bladder capacity (Q max), bladder wall thickness, and post-void residual volume values were similar in both groups (p>>0.05).

CONCLUSION

In our study, a close relationship was observed between polycystic ovary syndrome and lower urinary tract symptoms. In this context, we think that a detailed urinary system evaluation of women with polycystic ovary syndrome is extremely important.