The optimal time restricted eating interventions for blood pressure, weight, fat mass, glucose, and lipids: A meta-analysis and systematic review (original) (raw)

Elsevier

Trends in Cardiovascular Medicine

Highlights

Abstract

Background

No previous systematic review or meta-analysis has evaluated the effect of optimal time-restricted eating (TRE) interventions on cardiovascular (CVD) risk factors. This meta-analysis aimed to illustrate the effect of a suitable TRE on CVD risk factors.

Methods

A systematic review was performed to identify trials reporting the effects of TRE, relative to non-diet controls, on CVD risk factors in humans. A random-effects model was used to evaluate the effect sizes, and the results are expressed as the mean difference (MD) and 95% confidence intervals (CIs). Subgroup analyses were performed to examine the influence of the study population, age, duration of intervention, and baseline mean BMI on the CVD indexes.

Results

TRE intervention significantly reduced systolic pressure (SBP) (MD: -3.45 mmHg; 95%CI:(-6.20,-0.71) mmHg; P = 0.01), body weight (MD: -1.63 Kg; 95%CI:(-2.09,-1.17) Kg; P<0.001), body mass index (BMI) (MD: -0.47 Kg/m2; 95% CI: (-0.72, -0.22) Kg/m2; P<0.001), and fat mass (MD: -0.98 Kg; 95% CI: (-1.51,-0.44) Kg; P<0.001), and reduced blood glucose levels. Based on the results of subgroup analysis, this meta-analysis identified the optimal TRE for BP (with a 6 h feeding window, last eating time point at 6–8 PM, and male participants with obesity and aged ≥ 45 years), obesity (with a 6 h feeding window, last eating time point at 6–8 PM, and female participants aged ≥ 45 years), lipids (with an 8 h feeding window, last eating time point at 6–8 PM, and male participants aged < 45 years), and glucose (with a 10–12 h feeding window, last eating time point before 6 PM, and female participants aged < 45years).

Conclusions

Relative to a non-diet control, TRE is effective for the improvement of CVD risks. Moreover, individual TRE interventions should be developed for different populations to achieve the most effective health improvement for CVD risk factors.

Introduction

Time-restricted eating (TRE), also known as a type of intermittent fasting (IF), is a novel dietary intervention strategy that allows a limited period as a feeding window and the remaining time as a fasting window. It has been reported [1] that the median American eats over 12 h, and a study [2] also reported that more than 50% of adults eat for more than 15 h. Eating over prolonged periods a day contributes to circadian rhythm disruption and may be related to chronic diseases, such as type 2 diabetes [3], [4], [5]. Therefore, TRE has gained increasing popularity as a weight loss method in recent years [6]. This method is simpler and more convenient than other conventional weight loss methods. It has been shown that TRE benefits weight loss and lipid metabolism [7,8]. Furthermore, TRE has also been reported to improve markers of cardio metabolic health, including blood pressure and circulating lipids [9,10]. TRE acts through altered liver metabolism and ketones produced by the liver to replace glucose as an alternative energy source for tissues in the fasting period [11], which could improve metabolic circadian rhythms and diminish oxidative stress and inflammation, as well as other health benefits [9,12].

Several systematic reviews and meta-analyses [13], [14], [15] have reported the effect of IF on body weight and metabolic markers. However, few meta-analyses and systematic reviews have focused specifically on the effect of TRE on both BP and other cardiovascular disease (CVD) risk factors. There are differences between IF and TRE. IF involves a complete or partial restriction in energy intake (i.e.,50–100% restriction) on one to three days per week [16]. Recent reports indicated that IF produces substantial weight loss in short duration's (8–12 weeks) [16]. However, approximately 20% of individuals cannot adhere to the dietary restriction of IF [17]. As such, TRE was an alternative form of IF, which may be used to increase compliance. TRE allows individuals to consume ad libitum (AL) energy intake within a set window of the time duration (3–4 h, 7–9 h, or 10–12 h), which induces a fasting window of 12–21 h per day. A meta-analysis [18] reported that TRE significantly reduced systolic blood pressure (with only 97 subjects), which had not illustrated the optimal TRE interventions for blood pressure control. Previous meta-analysis studies [19,20] have investigated the effect of IF on BP, and the side effects of IF were greater than those of TRE. In addition, the most suitable target population for TRE regimens differs due to different health aims and outcomes. However, to the best of our knowledge, few meta-analyses have focused on the impact of TRE on both BP levels and other CVD risk factors, and no previous study has explored the most suitable TRE schedules for improving cardio metabolic markers and the most suitable target population for TRE regimens.

Therefore, based on previous evidence, this study aimed to investigate the effects of TRE on the main risk factors for cardiovascular disease, and most importantly, to find the best TRE schedules for improving different cardio-metabolic markers and to find the most suitable target population for different health outcomes. This study hypothesizes that TRE could improve metabolic markers, including BP, obesity indexes, glucose, and serum lipids, and individual TRE regimens should be implemented for people with different CVD risk factors.

Section snippets

Methods

This review has already been registered on PROSPERO with ID: 351801. We will upload the materials for registration in PDF form.

Included studies

A total of 22,830 studies were searched from an electronic database, and 22,243 were excluded as they were not correlated with the aim of this study. Finally, 506 records were excluded by reading the abstract among 587 records, and 81 articles may meet our inclusion criteria (7 articles are not available in full text). Then, after reading through the full text in detail of articles, 45 studies were excluded according to the characteristics shown in Fig. 1. In addition, four papers were

Discussion

The current evidence summarized in this meta-analysis suggests that TRE intervention significantly reduced SBP, body weight, BMI, and fat mass and reduced blood glucose levels. Subgroup analyses showed that for individuals aged ≥ 45 years with obesity traits, a 4–6 h feeding window and the last meal scheduled at 6–8 pm were most effective in lowering BP levels. For weight control, the most effective TRE intervention was the last mealtime point at 6–8 pm, which had the greatest impact on females

Conclusion

The current meta-analysis illustrated that TRE has a significant effect on decreasing BP, reducing weight, and improving blood glucose. Moreover, depending on the characteristics of the participants, the best TRE intervention programs for individuals were designed. Further, large-sample, long-term, and high-quality RCT trials are needed to validate the effects of TRE interventions and continue optimizing the TRE intervention program based on our results.

Ethical statement

We the undersigned declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere.

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.

We confirm that all authors are responsible for the content and

All of the authors reviewed and approved the publication of this paper.

CRediT authorship contribution statement

Xiaohua Liang: Conceptualization, Writing – review & editing. Jingyu Chen: Conceptualization, Formal analysis, Writing – review & editing. Xizou An: Writing – review & editing. Yanling Ren: Investigation, Data curation, Formal analysis, Writing – original draft. Qin Liu: Writing – original draft. Lan Huang: Writing – original draft. Ping Zhang: Formal analysis. Ping Qu: . Jianxin Li: .

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Cited by (1)

Funding: This work was supported by the National Natural Science Foundation of China (82373590), Major Health Project of Chongqing Science and Technology Bureau (no. CSTC2021jscx-gksb-N0001), Program for Youth Innovation in Future Medicine from Chongqing Medical University (no. W0088), National Key Research and Development Project (no. 2017YFC0211705), Intelligent Medicine Project (no. ZHYX202109), the Basic Research Project of Key Laboratory of Ministry of Education of China in 2021 (GBRP-202106), Joint Medical Research Project of Chongqing Municipal Health Commission and Chongqing Science and Technology Bureau (no. 2020MSXM062). The funders had no role in the whole study research process, including the study design, the data collection, and analysis, the decision to publish, or the preparation of the manuscript.

Declaration of Competing Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

1

Xiaohua liang and Jingyu Chen have the same contribution.

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