Effects of early, late and self-selected time-restricted eating on visceral adipose tissue and cardiometabolic health in participants with overweight or obesity: a randomized controlled trial.

Summary

In a four-arm RCT (n=197), adding early, late, or self-selected 8-hour TRE to Mediterranean diet counseling did not reduce visceral adipose tissue versus counseling alone over 12 weeks. TRE was safe, well tolerated, and highly adherent, but conferred no VAT advantage regardless of timing.

Key Findings

• No significant differences in MRI-assessed VAT change between TRE (early, late, self-selected) and usual care Mediterranean diet counseling over 12 weeks.
• High adherence to TRE (85–88%) with no serious adverse events; only five mild events reported.
• Timing of the 8-hour eating window did not influence outcomes; all pairwise comparisons among TRE schedules were nonsignificant.

Clinical Implications

Prioritize sustainable dietary quality (e.g., Mediterranean diet) over restricting eating windows when targeting visceral fat in overweight/obesity. TRE can be offered for behavioral fit, but clinicians should not expect VAT reduction beyond that achieved by diet counseling.

Limitations

• 12-week duration may be insufficient to detect longer-term adipose or metabolic adaptations
• Generalizability to populations without Mediterranean diet counseling or with different cultural eating patterns is uncertain

Future Directions

Longer trials exploring TRE with and without structured diet quality interventions, mechanistic endpoints (e.g., energy expenditure, lipolysis flux), and patient-centered outcomes (sleep, adherence sustainability).