Missing puzzle pieces of time-restricted-eating (TRE) as a long-term weight-loss strategy in overweight and obese people? A systematic review and meta-analysis of randomized controlled trials

The efficacy of using time restricted eating (TRE) for weight management and to mitigate metabolic disorders in overweight and obese people remains debatable. This meta-analysis quantified the impact of TRE on weight loss and metabolic health in overweight and obese people. The pooled results were subjected to a random-effects modeling using Hartung-Knapp-Sidik-Jonkman (HKSJ) method. Additionally, subgroup analysis was conducted based on study types, randomized controlled trials (RCTs) vs. non-randomized studies of interventions (NRSIs). Pooled results showed that subjects on TRE regimen (&gt; 4 weeks) achieved a significant weight loss in comparison with unrestricted time regimen (weighted mean difference: −2.32%; 95% CI: −3.50, −1.14%; <i>p</i> &lt; 0.01); however, weight loss was mainly attributed to the loss of lean mass rather than fat mass. The magnitude of weight loss was inversely correlated with daily fasting duration in RCTs. TRE significantly decreased the diastolic blood pressure and fasting insulin. An increase of low-density lipoprotein cholesterol (LDL-C) was observed in the TRE group. Favorable effect of TRE was observed on glucose metabolism but not on lipid profiles independent of weight loss. Hence TRE shall be administered with caution to overweight and obese people who have comorbidities such as dyslipidemia and sarcopenia. Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.1974335

限时进食（time restricted eating, TRE）用于超重与肥胖人群的体重管理、缓解代谢紊乱的疗效仍存在争议。本项荟萃分析量化了TRE对超重与肥胖人群体重减轻及代谢健康的影响。合并结果采用Hartung-Knapp-Sidik-Jonkman（HKSJ）法进行随机效应模型分析。此外，本研究依据研究类型进行亚组分析，即随机对照试验（randomized controlled trials, RCTs）与非随机干预研究（non-randomized studies of interventions, NRSIs）的对比分析。合并结果显示，采用TRE方案（时长＞4周）的受试者相较于不限时进食方案的受试者，体重减轻更为显著（加权均数差：-2.32%；95%置信区间：-3.50，-1.14%；p＜0.01）；但该体重减轻主要源于去脂体重的流失，而非脂肪量减少。在RCTs中，体重减轻的幅度与每日禁食时长呈负相关。TRE可显著降低舒张压与空腹胰岛素水平。TRE组受试者的低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）水平出现升高。在不依赖体重减轻的前提下，TRE对糖代谢具有积极影响，但对血脂谱无显著改善作用。因此，对于合并血脂异常、肌肉减少症等共病的超重与肥胖人群，应谨慎使用TRE干预方案。本文补充数据可在线获取：https://doi.org/10.1080/10408398.2021.1974335