Likewise, Andriessen et al 7 showed that 9-hour TRE produced 1. The weight loss produced by our 8-hour TRE intervention was slightly greater 4.

In contrast, the weight loss by the CR group was not significant relative to the control or TRE group. Since CR is commonly prescribed as a first-line intervention in T2D, it is likely that our participants had already tried calorie counting in the past, without success.

Time-restricted eating may have served as a refreshing alternative to CR, in that it only required patients to count time instead of calories, which may have bolstered overall adherence and weight loss in the TRE group. Our findings for HbA 1c levels are comparable to other TRE trials in T2D 7 , 8 and the Look AHEAD Action for Health in Diabetes study, which implemented daily CR.

However, both TRE and CR led to comparable reductions in waist circumference a surrogate marker of visceral fat mass. Evidence suggests that visceral fat mass may be a stronger factor associated with changes in glycemic control than body weight alone. Our findings also show that TRE is safe in patients who are using either diet alone or medications to control their T2D.

Hispanic and non-Hispanic Black adults are among the racial and ethnic groups with the highest prevalence of T2D in the US. Time-restricted eating is an appealing approach to weight loss in that it can be adopted at no cost, allows patients to continue consuming familiar foods, and does not require complicated calorie counting.

Since the literature on TRE is still quite limited, 26 our trial may help to improve the health of groups with a high prevalence of T2D by filling in these critical knowledge gaps.

Our study has some limitations, which include the relatively short trial duration and the lack of blinding of participants. Moreover, a higher percentage of participants in the TRE group were using sodium-glucose transport protein 2 inhibitors and glucagonlike peptide-1 receptor agonists at baseline.

These medications could have influenced our body weight findings, 27 even though participants had stable weight before enrollment. To control for these confounding variables, we accounted for the use of these medications in the analyses of our primary and secondary outcomes.

In addition, we relied on self-reported dietary intake. Last, TRE itself can be associated with greater self-monitoring and lower caloric intake, so although these effects were noted in the TRE group, these are expected as part of the intervention.

This randomized clinical trial found that 8-hour TRE without calorie counting was an effective alternative diet strategy for weight loss and lowering of HbA 1c levels compared with daily calorie counting in a sample of adults with T2D and obesity.

Published: October 27, Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License. JAMA Network Open. Corresponding Author: Krista A. Varady, PhD, Department of Kinesiology and Nutrition, University of Illinois Chicago, W Taylor St, Chicago, IL varady uic.

Author Contributions: Dr Varady had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Acquisition, analysis, or interpretation of data: Pavlou, Cienfuegos, Ezpeleta, Ready, Corapi, Wu, Lopez, Tussing-Humphreys, Oddo, Alexandria, Sanchez, Unterman, Chow, Vidmar, Varady.

Critical review of the manuscript for important intellectual content: Pavlou, Cienfuegos, Lin, Ezpeleta, Ready, Corapi, Lopez, Gabel, Tussing-Humphreys, Oddo, Alexandria, Sanchez, Unterman, Chow, Vidmar, Varady.

Administrative, technical, or material support: Pavlou, Cienfuegos, Lin, Ready, Lopez, Sanchez, Unterman, Vidmar. Conflict of Interest Disclosures: Ms Ready reported being a member of the Certified Diabetes Care and Education Specialist for the Academy of Nutrition and Dietetics and being employed as a clinician at Ascension Medical Group Weight Loss Solutions and Diabetes Education outside the submitted work.

Dr Chow reported receiving nonfinancial support from DexCom Inc outside the submitted work. Dr Vidmar reported receiving consulting fees from Rhythm Pharmaceuticals Inc, Hippo Technologies Inc, and Guidepoint Inc and grant funding from DexCom Inc, outside the submitted work.

Dr Varady reported receiving grant funding from the National Institute of Diabetes and Digestive and Kidney Diseases NIDDK of the National Institutes of Health NIH during the conduct of the study; receiving personal fees from the NIH for serving on the data and safety monitoring boards for the Health, Aging and Later-Life Outcomes and Dial Health studies; receiving author fees from Pan MacMillan for The Fastest Diet ; and serving as the associate editor for nutrition reviews from Elsevier outside the submitted work.

No other disclosures were reported. Data Sharing Statement: See Supplement 3. full text icon Full Text. Download PDF Comment. Top of Article Key Points Abstract Introduction Methods Results Discussion Conclusion Article Information References.

Visual Abstract. RCT: Efficacy of Time-Restricted Eating in Adults With Type 2 Diabetes. View Large Download. Figure 2. Change in Body Composition and Glycemic Control in the Study Groups. Table 1. Baseline Characteristics of the Study Participants a. Table 2. Body Weight, Glycemic Control, and Cardiometabolic Risk Factors a.

Table 3. Dietary Intake and Physical Activity. Supplement 1. Trial Protocol. Supplement 2. eTable 1. Medication Use at Baseline and Month 6 eTable 2. Multiple Imputation Sensitivity Analysis Results eTable 3.

Adverse Events During the Intervention eFigure 1. Experimental Design eFigure 2. Adherence to the Diet Interventions eFigure 3. Supplement 3. Data Sharing Statement. Centers for Disease Control and Prevention. Type 2 diabetes. Reviewed April 18, Accessed April 18, Evert AB, Dennison M, Gardner CD, et al.

Nutrition therapy for adults with diabetes or prediabetes: a consensus report. doi: Wilkinson MJ, Manoogian ENC, Zadourian A, et al. Ten-hour time-restricted eating reduces weight, blood pressure, and atherogenic lipids in patients with metabolic syndrome. Cienfuegos S, Gabel K, Kalam F, et al.

Effects of 4- and 6-h time-restricted feeding on weight and cardiometabolic health: a randomized controlled trial in adults with obesity. Gabel K, Hoddy KK, Haggerty N, et al. Effects of 8-hour time restricted feeding on body weight and metabolic disease risk factors in obese adults: a pilot study.

Liu D, Huang Y, Huang C, et al. Calorie restriction with or without time-restricted eating in weight loss. Andriessen C, Fealy CE, Veelen A, et al. Three weeks of time-restricted eating improves glucose homeostasis in adults with type 2 diabetes but does not improve insulin sensitivity: a randomised crossover trial.

Che T, Yan C, Tian D, Zhang X, Liu X, Wu Z. Time-restricted feeding improves blood glucose and insulin sensitivity in overweight patients with type 2 diabetes: a randomised controlled trial.

Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh YO. A new predictive equation for resting energy expenditure in healthy individuals. Carter S, Clifton PM, Keogh JB.

Effect of intermittent compared with continuous energy restricted diet on glycemic control in patients with type 2 diabetes: a randomized noninferiority trial. Grajower MM, Horne BD. Clinical management of intermittent fasting in patients with diabetes mellitus.

Mayer SB, Jeffreys AS, Olsen MK, McDuffie JR, Feinglos MN, Yancy WS Jr. Two diets with different haemoglobin A 1c and antiglycaemic medication effects despite similar weight loss in type 2 diabetes.

National Institutes of Health. Automated self-administered hour ASA24® dietary assessment tool. Huber PJ. The behavior of maximum likelihood estimates under nonstandard conditions.

daily energy restriction on weight loss and metabolic disease risk markers in overweight women. Keenan S, Cooke MB, Belski R. The effects of intermittent fasting combined with resistance training on lean body mass: a systematic review of human studies.

Kessler CS, Stange R, Schlenkermann M, et al. Moro T, Tinsley G, Bianco A, et al. Razavi R, Parvaresh A, Abbasi B, et al. The alternate-day fasting diet is a more effective approach than a calorie restriction diet on weight loss and hs-CRP levels.

Tinsley GM, Moore ML, Graybeal AJ, et al. Time-restricted feeding plus resistance training in active females: a randomized trial. Schübel R, Nattenmüller J, Sookthai D, et al. Effects of intermittent and continuous calorie restriction on body weight and metabolism over 50 wk: a randomized controlled trial.

Antoni R, Johnston KL, Steele C, Carter D, Robertson MD, Capehorn MS. Efficacy of an intermittent energy restriction diet in a primary care setting.

Davoodi SH, Ajami M, Ayatollahi SA, Dowlatshahi K, Javedan G, Pazoki-Toroudi HR. Calorie shifting diet versus calorie restriction diet: a comparative clinical trial study.

PubMed Google Scholar. Cai H, Qin Y-L, Shi Z-Y, et al. Effects of alternate-day fasting on body weight and dyslipidaemia in patients with non-alcoholic fatty liver disease: a randomised controlled trial.

Lin YJ, Wang YT, Chan LC, Chu NF. Effect of time-restricted feeding on body composition and cardio-metabolic risk in middle-aged women in Taiwan. Sutton EF, Beyl R, Early KS, Cefalu WT, Ravussin E, Peterson CM.

Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Hatori M, Vollmers C, Zarrinpar A, et al. Time-restricted feeding without reducing caloric intake prevents metabolic diseases in mice fed a high-fat diet.

Chaix A, Zarrinpar A, Miu P, Panda S. Time-restricted feeding is a preventative and therapeutic intervention against diverse nutritional challenges.

Sherman H, Genzer Y, Cohen R, Chapnik N, Madar Z, Froy O. Timed high-fat diet resets circadian metabolism and prevents obesity. Gabel K, Hoddy KK, Haggerty N, et al. Effects of 8-hour time restricted feeding on body weight and metabolic disease risk factors in obese adults: a pilot study.

Anton SD, Lee SA, Donahoo WT, et al. The effects of time restricted feeding on overweight, older adults: a pilot study. Chow LS, Manoogian ENC, Alvear A, et al. Time-restricted eating effects on body composition and metabolic measures in humans who are overweight: a feasibility study.

Gill S, Panda S. A smartphone app reveals erratic diurnal eating patterns in humans that can be modulated for health benefits.

Cienfuegos S, Gabel K, Kalam F, et al. Effects of 4- and 6-h time-restricted feeding on weight and cardiometabolic health: a randomized controlled trial in adults with obesity. Kesztyüs D, Cermak P, Gulich M, Kesztyüs T.

Adherence to time-restricted feeding and impact on abdominal obesity in primary care patients: results of a pilot study in a pre-post design. Wilkinson MJ, Manoogian ENC, Zadourian A, et al. Ten-hour time-restricted eating reduces weight, blood pressure, and atherogenic lipids in patients with metabolic syndrome.

McAllister MJ, Pigg BL, Renteria LI, Waldman HS. Time-restricted feeding improves markers of cardiometabolic health in physically active college-age men: a 4-week randomized pre-post pilot study.

Che T, Yan C, Tian D, Zhang X, Liu X, Wu Z. Time-restricted feeding improves blood glucose and insulin sensitivity in overweight patients with type 2 diabetes: a randomised controlled trial.

Adafer R, Messaadi W, Meddahi M, et al. Chen JH, Lu LW, Ge Q, et al. 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. Published online September 23, Moon S, Kang J, Kim SH, et al. Beneficial effects of time-restricted eating on metabolic diseases: a systemic review and meta-analysis.

Ravussin E, Beyl RA, Poggiogalle E, Hsia DS, Peterson CM. Early time-restricted feeding reduces appetite and increases fat oxidation but does not affect energy expenditure in humans.

Martens CR, Rossman MJ, Mazzo MR, et al. Short-term time-restricted feeding is safe and feasible in non-obese healthy midlife and older adults. Hutchison AT, Regmi P, Manoogian ENC, et al. Time-restricted feeding improves glucose tolerance in men at risk for type 2 diabetes: a randomized crossover trial.

Jones R, Pabla P, Mallinson J, et al. Two weeks of early time-restricted feeding eTRF improves skeletal muscle insulin and anabolic sensitivity in healthy men. Poggiogalle E, Jamshed H, Peterson CM.

Circadian regulation of glucose, lipid, and energy metabolism in humans. Marinac CR, Nelson SH, Breen CI, et al. Prolonged nightly fasting and breast cancer prognosis. Harris PA, Taylor R, Minor BL, et al; REDCap Consortium.

The REDCap consortium: building an international community of software platform partners. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture REDCap —a metadata-driven methodology and workflow process for providing translational research informatics support.

Martin CK, Nicklas T, Gunturk B, Correa JB, Allen HR, Champagne C. Measuring food intake with digital photography. Hall KD, Sacks G, Chandramohan D, et al.

Quantification of the effect of energy imbalance on bodyweight. Lowe DA, Wu N, Rohdin-Bibby L, et al. Effects of time-restricted eating on weight loss and other metabolic parameters in women and men with overweight and obesity: the TREAT randomized clinical trial.

Kesztyüs D, Vorwieger E, Schönsteiner D, Gulich M, Kesztyüs T. Applicability of time-restricted eating for the prevention of lifestyle-dependent diseases in a working population: results of a pilot study in a pre-post design. Przulj D, Ladmore D, Smith KM, Phillips-Waller A, Hajek P.

Time restricted eating as a weight loss intervention in adults with obesity. Domaszewski P, Konieczny M, Pakosz P, Bączkowicz D, Sadowska-Krępa E. Effect of a six-week intermittent fasting intervention program on the composition of the human body in women over 60 years of age.

Antoni R, Robertson TM, Robertson MD, Johnston JD. A pilot feasibility study exploring the effects of a moderate time-restricted feeding intervention on energy intake, adiposity and metabolic physiology in free-living human subjects.

Karras SN, Koufakis T, Adamidou L, et al. Similar late effects of a 7-week orthodox religious fasting and a time restricted eating pattern on anthropometric and metabolic profiles of overweight adults.

Stratton MT, Tinsley GM, Alesi MG, et al. Four weeks of time-restricted feeding combined with resistance training does not differentially influence measures of body composition, muscle performance, resting energy expenditure, and blood biomarkers.

Kotarsky CJ, Johnson NR, Mahoney SJ, et al. Time-restricted eating and concurrent exercise training reduces fat mass and increases lean mass in overweight and obese adults. Moro T, Tinsley G, Pacelli FQ, Marcolin G, Bianco A, Paoli A.

Twelve months of time-restricted eating and resistance training improves inflammatory markers and cardiometabolic risk factors. Brady AJ, Langton HM, Mulligan M, Egan B. Effects of 8 wk of time-restricted eating in male middle- and long-distance runners.

Liu D, Huang Y, Huang C, et al. Calorie restriction with or without time-restricted eating in weight loss. Moro T, Tinsley G, Longo G, et al. Time-restricted eating effects on performance, immune function, and body composition in elite cyclists: a randomized controlled trial.

Tinsley GM, Forsse JS, Butler NK, et al. Time-restricted feeding in young men performing resistance training: a randomized controlled trial.

PubMed Google Scholar Crossref. Tovar AP, Richardson CE, Keim NL, Van Loan MD, Davis BA, Casazza GA. Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women.

Madjd A, Taylor MA, Delavari A, Malekzadeh R, Macdonald IA, Farshchi HR. Effects of consuming later evening meal v. earlier evening meal on weight loss during a weight loss diet: a randomised clinical trial. Dashti HS, Gómez-Abellán P, Qian J, et al. Late eating is associated with cardiometabolic risk traits, obesogenic behaviors, and impaired weight loss.

Keim NL, Van Loan MD, Horn WF, Barbieri TF, Mayclin PL. Weight loss is greater with consumption of large morning meals and fat-free mass is preserved with large evening meals in women on a controlled weight reduction regimen. Lombardo M, Bellia A, Padua E, et al. Morning meal more efficient for fat loss in a 3-month lifestyle intervention.

Allison KC, Hopkins CM, Ruggieri M, et al. Prolonged, controlled daytime versus delayed eating impacts weight and metabolism. Kelly KP, McGuinness OP, Buchowski M, et al.

Eating breakfast and avoiding late-evening snacking sustains lipid oxidation. Appel LJ, Moore TJ, Obarzanek E, et al; DASH Collaborative Research Group.

A clinical trial of the effects of dietary patterns on blood pressure. A person on a time-restricted eating TRE plan will only eat during specific hours and will fast at all other times.

In this article, we look at what TRE is, whether or not it works, and what effect it has on muscle gain. TRE means that a person eats all of their meals and snacks within a particular window of time each day.

Typically though, the eating window in time-restricted programs ranges from 6—12 hours a day. Outside of this period, a person consumes no calories.

They may drink water or no-calorie beverages to remain hydrated. In some TRE plans, people may also consume unsweetened coffee or tea with no cream. TRE is a type of intermittent fasting.

This refers to any eating plan that alternates between periods of restricting calories and eating normally. Although TRE will not work for everyone, some may find it beneficial. Recent studies have shown that it can aid weight loss and may lower the risk of metabolic diseases, such as diabetes.

TRE may help a person eat less without counting calories. It may also be a healthy way to avoid common diet pitfalls, such as late-night snacking. However, people with diabetes or other health issues can consider speaking with a doctor before trying this type of eating pattern.

No single eating plan will work for everyone to lose weight. While some people are likely to meet weight loss goals with TRE, others may not benefit from it.

It is best for a person to speak with a doctor before trying TRE or any other eating plan. Recent studies involving people of different ages and in different research settings show that TRE has the potential to lead to weight loss and health improvement:.

Some research notes that health benefits may happen even if people do not lose weight as a result of trying TRE. Cell Metabolism has published one of the most rigorously conducted randomized controlled trials to date.

It found that when eight males with prediabetes who were overweight followed early-TRE for 5 weeks, several markers of heart health were improved, including:.

The observed improvements in heart health occured even when the TRE group did not lose weight, and they reported a lower desire to eat in the evening.

Researchers need further studies done on more people over longer periods of time to confirm these findings. Accumulating research suggests that TRE has potential, but not all studies show it is more effective for weight loss than daily regular calorie restriction.

A review concluded that intermittent calorie restriction, including TRE, offers no significant advantage over limiting calorie intake each day. More recently, a randomized controlled clinical trial in the New England Journal of Medicine showed TRE had no weight loss benefit after 12 months. In the trial, people with obesity followed TRE while also eating fewer calories or followed daily calorie restriction alone.

When the study ended, there were no differences between the groups for weight loss. Studies from and note that TRE results in equal weight loss to regular daily calorie restriction in people who are overweight or have obesity. Because of this, it is possible for TRE to be an option for people who want an alternate solution to daily calorie restriction for weight loss.

Other research does not show any benefit of TRE for weight loss compared with eating regularly throughout the day with no calorie restriction. This includes when study participants receive no instruction to change their food choices or activity levels.

As the science on TRE for weight loss advances, some researchers have expressed the need for caution around who might consider following TRE. Among people who are overweight or have obesity, some studies have found that weight loss in TRE may be due to the loss of lean mass muscle versus fat mass adipose tissue.

Therefore, it is especially important for people who are overweight or have obesity and who also have comorbidities such as sarcopenia to talk with a doctor before trying TRE.

The current evidence base shows promise for the role of TRE in weight loss in the short term from studies lasting less than 6 months. However, researchers need longer-term studies with larger numbers of more diverse participants to determine whether TRE can lead to clinically meaningful weight loss that a person can maintain over time.

A study from the journal Appetite aimed to look at the barriers to or facilitators of following TRE over the long term. It used 20 middle-aged adults who were overweight or had obesity and were at risk of type 2 diabetes.

The researchers assessed how easily people could incorporate TRE into daily life following a 3-month study with structured interviews. Seven study participants kept up with their instructions on TRE from the study, 10 adjusted their approach to follow a different version of their original instructions, and three did not follow through with their instructions.

Researchers need more work to understand how TRE influences the biological, behavioral, psychosocial, and environmental facilitators of and barriers to successful long-term weight maintenance.

One study investigated TRE in 11 adults who were overweight. They followed early-TRE for 4 days, where they ate between 8 a.