Time-restricted eating is no better than calorie-reduction alone for NAFLD

The TREATY-FLD trial found that adding time restrictions to a calorie-restricted diet provided no additional benefits for non-alcoholic fatty liver disease (NAFLD).

Looking at the 88 participants with obesity and NAFLD, half that followed a calorie-restricted, time-restricted eating pattern — eating only between 8 a.m. and 4 p.m. each day — experienced a similar decrease in intrahepatic triglyceride (IHTG) content as did those who are under daily calorie restrictions without time restrictions, according to Huijie Zhang, MD, of Southern Medical University in China, and colleagues.

After 6 months, IHTG content decreased by 8.3% (95% CI -10.0 to -6.6) among the time-restricted dieters and 8.1% (95% CI -9.8 to -6.4) in the calorie-restricted group, the researchers said in JAMA Network is open.

Results for the one-year trials showed a similar picture, with IHTG content decreasing by 6.9% (95% CI -8.8 to -5.1) and 7.9% (95% CI -9.7 to -6.2), respectively.

These data support the importance of restricting caloric intake when adhering to the TRE regimen [time-restricted eating] for the management of NAFLD,” Zhang’s team wrote, adding, “The results indicate that caloric restriction explained most of the beneficial effects of the TRE regimen.” ”

While liver stiffness improved in both groups, no diet was better on this measure either. The time-restricted group experienced a decrease of 2.1 kPa (95% CI -2.7 to -1.6) versus 1.7 kPa (95% CI -2.3 to -1.2) in the calorie restriction-alone group at the 12-month mark.

By the end of the trial, 33% of the time-restricted group and 49% of the calorie-restricted group had resolved the NAFLD to reach an IHTG content of less than 5% (s= 0.31).

Both regimens also resulted in weight loss over the 12 months: 8.4 kg (18.5 lb) in the time-restricted group and 7.8 kg (17.2 lb) in the calorie-restricted only group. This result is in line with an experiment published in New England Journal of Medicine Last year, no difference was seen in weight loss when obese subjects followed a time-restricted diet in addition to calorie restriction. In that experiment, the time- and calorie-restricted group lost 8 kg (17.6 lbs) after 12 months, while the calorie-restricted dieters lost 6.3 kg (13.9 lbs).

Both groups in the TREATY-FLD trial also experienced significant improvements in waist circumference, body fat percentage, fat mass, lean mass, total abdominal fat, subcutaneous fat, visceral fat, and the ratio of visceral to subcutaneous fat. Similarly, both groups had significant decreases in liver enzymes, including serum alanine aminotransferase, aspartate aminotransferase, and beta-glutamyltransferase. Neither diet was superior to these measures.

Both regimens resulted in significant decreases in fasting plasma glucose, HbA1c, and HOMA-IR at month six. By the end of the trial, the time-restricted group experienced a significantly greater decrease in HOMA-IR.

All participants in the trial — conducted at Nanfang Hospital in Guangzhou, China — stuck to a diet of 1,500 to 1,800 calories/day for men and 1,200 to 1,500 calories/day for women, consisting of 40-55% carbohydrates. , 15-20% protein, 20-30% fat. Everyone also drank one Nutriease protein drink per day for the first six months along with dietary advice throughout the study period. Taking this calorie restriction one step further, the time-restricted group also had to keep their caloric intake within 8 am to 4 pm each day, with only non-calorie drinks allowed outside this window.

Changes in IHTG content were measured by magnetic resonance imaging, body fat mass, and lean mass using whole-body duplex X-rays; Abdominal visceral fat and subcutaneous fat were measured by computed tomography.

At baseline, the average age was 32 and the BMI was 32.2. Some of the exclusion criteria included acute or chronic viral hepatitis, drug-induced liver disease, autoimmune hepatitis, diabetes, serious liver dysfunction, and chronic kidney disease. A total of 92% of the participants completed the 6-month intervention, and 84% completed the full-year trial.

  • Christine Monaco is a staff writer, focusing on endocrinology, psychiatry, and nephrology news. She operates out of the New York City office, and has been with the company since 2015.


The study was supported by grants from the National Research and Development Project, the National Natural Science Foundation of China mutual funds, and the Southern Medical District Key Clinical Research Program.

Zhang and co-authors reported no disclosures.

primary source

JAMA Network is open

Source reference: Wei X, et al “Effects of time-restricted eating on non-alcoholic fatty liver disease” JAMA Network Open 2023; DOI: 10.1001/jamanetworkopen.2023.3513.