Time-Restricted Eating Not More Beneficial Than Calorie Restriction For Patients With NAFLD, Obesity

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Liver stiffness, body weight, and metabolic risk factors were significantly and comparably reduced in both groups.

New research shows time-restricted eating (TRE) is not necessarily more beneficial for patients with obesity and non-alcoholic fatty liver disease (NAFLD) than daily calorie restriction.1

A team, led by Xueyun Wei, MD, Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, compared the effects of time-restricted eating compared to daily calorie restriction on intrahepatic triglyceride (IHTG) content and metabolic risk factors among patients with obesity and NAFLD.

In the 12-month randomized clinical trial, the investigators examined patients with obesity and NAFLD at the Nanfang Hospital in Guangzhou, China, between April 9, 2019, and August 28, 2021.

Each of the 88 patients was randomly assigned to time-restricted eating of only eating between 8:00 AM and 4:00 PM (n = 45) or daily calorie restriction of habitual meal timing (n = 43). The mean age was 32 years.

“Dietary calorie restriction has been proven to be effective in reducing weight and intrahepatic lipid levels among patients with NAFLD,” the authors wrote. :Nevertheless, long-term adherence to lifestyle modification is difficult. Time-restricted eating is one of the most popular intermittent fasting regimens involving a specific eating period within a 24-hour cycle.”

Time-restricted eating has been popular because it is known to reduce weight, while increasing adherence.

Each participant was directed to maintain a diet of 1500 to 1800 kcal/d for men and 1200 to 1500 kcal/d for women for 12 months.

The investigators sought main outcomes of the change in IHTG content measured by magnetic resonance imaging; secondary outcomes were changes in body weight, waist circumference, body fat, and metabolic risk factors.

The results show at the 6 month assessment IHTG content was reduced by 8.3% (95% confidence interval [CI], −10.0% to −6.6%) in the time-restricted eating group, compared to 8.1% (95% CI, −9.8% to −6.4%) in the daily calorie restriction group.

At the 12 month assessment, IHTG content was reduced by 6.9% (95% CI, −8.8% to −5.1%) in the time-restricted eating group and 7.9% (95% CI, −9.7% to −6.2%) in the daily calorie restricted group.

Changes in IHTG content were comparable between the 2 groups at both 6 months (percentage point difference, −0.2; 95% CI, −2.7 to 2.2; P = .86) and 12 months (percentage point difference: 1.0; 95% CI, −1.6 to 3.5; P = .45), while liver stiffness, body weight, and metabolic risk factors were significantly and comparably reduced in both groups.

“Among adults with obesity and NAFLD, TRE did not produce additional benefits for reducing IHTG content, body fat, and metabolic risk factors compared with DCR,” the authors wrote. “These findings support the importance of caloric intake restriction when adhering to a regimen of TRE for the management of NAFLD.”


Wei X, Lin B, Huang Y, et al. Effects of Time-Restricted Eating on Nonalcoholic Fatty Liver Disease: The TREATY-FLD Randomized Clinical Trial. JAMA Netw Open. 2023;6(3):e233513. doi:10.1001/jamanetworkopen.2023.3513