PERSPECTIVE

Perspective: Time-Restricted Eating—Integrating

the What with the When
Evelyn B Parr,1 Brooke L Devlin,2 and John A Hawley1
1 Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia; and
2 Department of Dietetics, Nutrition, and Sport, La Trobe University, Bundoora, Victoria, Australia

ABSTRACT
Time-restricted eating (TRE) is a popular dietary strategy that emphasizes the timing of meals in alignment with diurnal circadian rhythms, permitting
ad libitum energy intake during a restricted (∼8–10 h) eating window each day. Unlike energy-restricted diets or intermittent fasting interventions
that focus on weight loss, many of the health-related benefits of TRE are independent of reductions in body weight. However, TRE research to date
has largely ignored what food is consumed (i.e., macronutrient composition and energy density), overlooking a plethora of past epidemiological
and interventional dietary research. To determine some of the potential mechanisms underpinning the benefits of TRE on metabolic health, future
studies need to increase the rigor of dietary data collected, assessed, and reported to ensure a consistent and standardized approach in TRE research.
This Perspective article provides an overview of studies investigating TRE interventions in humans and considers dietary intake (both what and when
food is eaten) and their impact on selected health outcomes (i.e., weight loss, glycemic control). Integrating existing dietary knowledge about what
food is eaten with our recent understanding on when food should be consumed is essential to optimize the impact of dietary strategies aimed at
improving metabolic health outcomes. Adv Nutr 2022;13:699–711.

Statement of Significance: Time-restricted eating (TRE) is a dietary strategy that focuses on the timing of meals, but frequently neglects the
quality and quantity of food consumed. This Perspective challenges researchers in the field of TRE to incorporate rigorous dietary assessment
to unravel the complex relations between the type of food consumed and the timing of meals.

Keywords: diet, nutrition, timing, energy intake, fasting

Introduction intake (EI). Decades of research from nutrition scientists

Dietary advice for improving metabolic health in individuals have provided robust evidence of the metabolic responses to
with noncommunicable diseases such as obesity and type diets of differing macronutrient profiles (i.e., Mediterranean,
2 diabetes (T2D) has traditionally focused on what food is low-carbohydrate, high-fat, high-protein) as well reduced
consumed, with an emphasis on dietary quality and energy EIs (i.e., very-low-energy diets). Recently, there has been
growing recognition that the timing of meals is critical for
metabolic health and well-being, and that manipulating the
Supported by a 2018 Early Career Fellowship award from the European Society for Clinical feeding–fasting cycle carries important consequences for
Nutrition (ESPEN) to EBP, a Diabetes Australia Research Program (DARP; 2019) grant to EBP, and a number of physiological and metabolic processes (1–5).
by a Novo Nordisk Foundation Challenge grant (NNF14OC0011493) to JAH.
Author disclosures: The authors report no conflicts of interest.
Time-restricted eating (TRE), often called the 16:8 diet, is
Address correspondence to EBP (e-mail: [email protected]). a popular dietary strategy placing emphasis on the timing
Perspective articles allow authors to take a position on a topic of current major importance or of food but permits ad libitum EI during a restricted (∼8–
controversy in the field of nutrition. As such, these articles could include statements based on
author opinions or point of view. Opinions expressed in Perspective articles are those of the
10 h) eating window each day. Several recent reviews have
author and are not attributable to the funder(s) or the sponsor(s) or the publisher, Editor, or highlighted the potential for TRE to induce improvements in
Editorial Board of Advances in Nutrition. Individuals with different positions on the topic of a body weight (i.e., reduce obesity) and other cardiometabolic
Perspective are invited to submit their comments in the form of a Perspectives article or in a
Letter to the Editor.
health markers (6–9). Many of the benefits of TRE on
Abbreviations used: CER, chronic energy restriction; EI, energy intake; IF, intermittent fasting; metabolic health are independent of weight loss, but instead
TRE, time-restricted eating; TRF, time-restricted feeding; T2D, type 2 diabetes. are underpinned by the timing of meals in alignment with

C The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition. This is an Open Access article distributed under the terms of the Creative Commons

Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the
original work is properly cited. For commercial re-use, please contact [email protected]. Adv Nutr 2022;13:699–711; doi: https://doi.org/10.1093/advances/nmac015. 699
FIGURE 1 Categorization of popular diet practices. For CER (1), during which daily energy intake is reduced by up to 40%, but meal
frequency and timing remain unchanged; IF (2), where 1 d or several days of fasting are interspersed with normal ad libitum eating
patterns, such that total weekly energy intake is reduced, and meal frequency and timing remain unchanged on the days of food intake;
or TRE (3), in which food is consumed ad libitum throughout a set time period, and energy intake may or may not be reduced. In TRE, the
daily eating duration (i.e., the time between the first and last energy intake) is typically reduced from a 12–14-h/d “eating window” to
∼8-10 h/d. CER, chronic energy restriction; IF, intermittent fasting; TRE, time-restricted eating.

circadian rhythms. To date, many of the interventional be broadly classified as follows: 1) chronic energy restriction
studies of TRE have largely ignored what food is consumed (CER), in which daily EI is reduced by up to 40%, but meal
and its quality and quantity (i.e., macronutrient composition frequency and timing remain unchanged; 2) intermittent
and energy density), with a sole focus on when food is fasting (IF), where 1 day or several days of fasting are
consumed. This Perspective article provides an overview of interspersed with normal ad libitum eating patterns, and
studies investigating TRE in humans highlighting both what meal frequency and timing remaining unchanged on the days
and when food is consumed. Our intent is to incorporate of food intake (e.g., alternate-day fasting and the 5:2 diet); or
the decades of dietary intake research of what is eaten (i.e., 3) TRE, in which food is consumed ad libitum but the eating
the premise of dietetics as a profession) into future TRE duration (i.e., the time between the first and last EI of the day)
investigations. Integrating dietary composition and quality is typically reduced from a 12–16-h “eating window” to <8–
with timing is key to unravel the complex relations between 12 h (7) (Figure 1).
the types of foods consumed and the timing of meals to Importantly, we and others (10, 11) regard TRE to be a
determine their unique roles underpinning improvements in distinct dietary intervention rather than a modified form of
metabolic health. Before providing an analysis of the dietary IF. Specifically, TRE interventions do not intend to reduce
components of TRE studies to date, we provide important EI, in contrast with all IF regimes. Furthermore, CER and
working definitions and a brief background of the evolution IF are not chrono-nutritive therapies per se, in that they
of TRE interventions. do not restrict food consumption to specified times of day
to play off chronobiology. Instead, their therapeutic value
and any positive health outcomes are mainly derived from
Current Dietary Strategies for Improving chronic or intermittent periods of energy restriction. TRE
Metabolic Health is a chrono-nutritional strategy offering a less food-focused
The majority of evidence-based dietary interventions pre- approach, where the timing of meals is closely aligned with
scribed to improve metabolic health and/or weight loss can typical metabolite and hormonal profiles over 24-h periods,

700 Parr et al.

FIGURE 2 The 3 different approaches to TRE. (A) TRE reduces energy intake as a result of an appropriately timed window of daily energy
intake, which reduces time-of-day discretionary foods consumption and induces weight loss; (B) TRE does not result in a change in energy
intake, but there is an appropriately timed window of energy intake, which contributes to improvements in metabolic health
independent of any weight loss; or (C) TRE does not change energy intake and, due to an inappropriately timed eating window, little or no
health benefits are observed. TRE, time-restricted eating.

in an ∼8–10-h eating window. A requirement for TRE to well-controlled (all food/meals provided) early and mid-
be considered a chrono-nutritional strategy is the alignment TRE human studies, this is the case (20–23), but far less
of meals with typical circadian oscillations of hormonal evidence is available from free-living interventions (24).
profiles, with insulin sensitivity declining during the day Further work is needed to corroborate that circadian-aligned
and cortisol and growth hormone peaking in the morning TRE intakes lead to beneficial outcomes irrespective of EI.
and evening, respectively (12, 13). Indeed, the TRE literature Additionally, “what” participants are consuming throughout
to date suggests that later or self-selected TRE periods the TRE period can have a significant impact on outcomes;
are less effective in improving markers of metabolic health yet, for the most part, dietary intake has been poorly reported
(Figure 2). Where TRE interventions have induced energy in TRE studies.
restriction, it is likely that the alignment of EI with circadian
patterns of hormones and metabolites is less important than
for energy-matched TRE. TRE: from preclinical to human intervention studies
Studies of TRE to date have exploited several different The concept of TRE and its basis in chronobiology originates
approaches, with such variations, in part, underpinning from preclinical studies of mice in which food availability
inconsistencies in their success or failure to improve health was synchronized to the diurnal rhythms of a cluster of
outcomes (Figure 2). Many short-term (<3 mo) TRE genes responsible for regulating 24-h circadian cycles and
protocols have been associated with moderate energy re- compared with energy-matched ad libitum food availability
striction (14–19), resulting in weight loss and associated throughout the day. When food was only available during
health benefits. Depending on the duration of the feeding– the animals’ waking hours (overnight) (25), or restricted to
fasting cycle, TRE can inadvertently reduce EI and/or alter a shorter window (26), mice gained less weight and body
macronutrient intakes via reductions in discretionary “time- fat, and displayed improved glucose tolerance and concentra-
of-day” foods such as alcohol and confectionary, that are tions of inflammatory markers. These animal studies of time-
typically consumed in the evening (i.e., outside the “eating restricted feeding (TRF) provide evidence that ad libitum
window” of TRE protocols). TRE protocols that do not food intake is associated with disrupted circadian rhythms
restrict EI but align the timing of meals and the eating and adverse health outcomes (25, 26). Furthermore, when
window to cycles in hormone and metabolite oscillations metabolically challenged with high-fat, high-sucrose diets
also elicit improvements in health outcomes. From the during TRE, mice lost more body weight and improved

Time-restricted eating: integrating what with when 701

circulating metabolites compared with ad libitum intake to practice in maximizing health outcomes from TRE
(i.e., no TRE) (26). The mechanisms underlying the ben- interventions.
eficial effect of TRF are complex and are likely to act on In contrast to the robust laboratory-controlled TRE
multiple pathways that impinge on the circadian clock and studies, many of the human studies of TRE conducted in
improve robustness of oscillation of clock components and free-living conditions have simultaneously manipulated both
downstream targets (4). An evaluation of the mechanistic the time of day and the duration of the eating window,
bases of preclinical data conducted in rodents has been making it difficult to determine which of these perturbations
reviewed previously (27–29). The translation of preclinical to normal eating habits is responsible for any changes in
TRF data has several limitations: the length of time spent health outcomes (20–23, 31). Based on the results of studies
feed deprived (i.e., fasting) for most animal models varies where EI has been estimated (14–17, 32), the notion that
substantially compared with humans, with the time of a shortened eating window might lead to a reduction in
eating for mice/rodents generally confined to nocturnal daily EI has gained credibility. However, the majority of free-
hours. In contrast, humans consume the majority of daily living TRE interventions have neither quantified or estimated
energy during the day, with light being a major photopic EI, and have not consistently reported improved health
signal to the body’s central pacemaker, the superchiasmatic outcomes after TRE protocols (18, 24, 33–39). Most studies
nucleus, influencing circadian oscillations. In humans, the that fail to report the dietary intake of their participants are
few energy-matched studies in which meal timing has been either late or delayed TRE (e.g., first eating occasion after
rigorously controlled confirm earlier observations in animal 12:00 h) or have required participants to self-select their
models, providing “proof of concept” that the timing of meals individual eating windows, with the caveat that there have
has profound consequences on physiology, and can be used been more late-TRE and self-selected TRE studies conducted
as an intervention to treat or prevent obesity and other to date. Further, many studies investigating TRE omit, or
metabolic conditions. conduct only limited, dietary analysis (i.e., baseline and end
The results of several well-controlled studies in humans of intervention only).
(i.e., interventions where all meals were quantified and The lack of dietary information reported in many studies
provided to participants) provide strong evidence that TRE is, in part, due to a focus on TRE interventions being about
is an efficacious intervention for improving metabolic health the timing of food intake, and not the types or amounts of
outcomes (20–23). In a proof-of-concept study using a food consumed. However, the lack of detailed dietary intake
crossover design, Sutton et al. (20) reported that 5 wk of assessments and reported data makes it unclear whether
isoenergetic early TRE (08:00–14:00 h, 3 meals of 33% the health benefits from TRE are derived from changing
EI with 50% from carbohydrate) improved measures of the timing of food intake, reducing the energy content
insulin sensitivity, blood pressure, B-cell responsiveness, of food consumed, altering the types of foods consumed
and markers of oxidative stress in men with prediabetes (i.e., macronutrient composition), or a combined effect.
compared with when they consumed the same dietary intake Of course, changing both the timing and amount/types
over 12 h (08:00–20:00 h). That study (20) provided the of food consumed may have synergistic or additive effects
first evidence to suggest that some of the health benefits and further work will be required to tease out potential
of TRE may be independent of EI and weight loss. These mechanisms responsible for some of the improved metabolic
researchers also collected preliminary data on the feasibility health outcomes observed after TRE protocols.
and acceptability of early TRE, with participants reporting
that the challenge of eating within a 6-h window was Improving the quality of dietary assessment in future
more difficult than the requirement to fast for 18 h each TRE interventions
day (20). In another short-term intervention of early TRE The current literature of human interventions of TRE is
(4 d, eating window of 08:00–14:00 h, 3 meals of 33% EI limited and impacted by a lack of reliable and comprehensive
with 50% from carbohydrate), isoenergetic TRE reduced dietary analysis. To present the dietary analysis of TRE
24-h glucose concentrations and glycemic variability in studies to date, we conducted a literature search using
individuals with prediabetes compared with a 12-h eating PubMed, Google Scholar, and cross-checking of citations of
window (08:00–20:00 h) (21). Similarly, reduced nocturnal other research studies to summarize human TRE studies
glucose concentrations are observed after only 5 d of (Table 1). We divided investigations into early-TRE (eating
isoenergetic TRE (10:00–18:00 h, 3 meals of 25:35:40% EI window finishing by 17:00 h), mid-TRE (delayed first eating
with 30% from carbohydrate) in men with obesity (23). The occasion and eating window finishing by 19:00 h), and late-
mechanisms by which early- and mid-TRE protocols induce TRE (TRE beginning from 12:00 h), as well as those that
beneficial outcomes in the absence of energy restriction had self-selected (i.e., unspecified) TRE eating windows. Of
are likely related to a combination of improved circadian the 26 free-living TRE interventions summarized in Table 1,
glucose homeostasis, reduced oxidative stress, improved more than one-third had no analysis of either dietary intake
B-cell function, increased autophagic flux, and increased or dietary quality. Most studies that report reductions in
ketone body production (30). From the evidence to date, body weight had a concomitant decrease in total EI (14, 16,
both the start and finish time and the duration of the 40, 41), but many provided little or no dietary analysis (18,
eating window are important considerations for translation 35, 37–39). One might assume that participants undertaking

702 Parr et al.

 TABLE 1 Summary of TRE interventions in humans, divided into early (eating window finished before/by 17:00 h), mid (delayed breakfast and end of eating window by 19:00 h), or late (delayed
start of eating window to after 12:00 h), and studies whereby the TRE window was self-selected1

Participants (number, Diet recording methodology and

Study (reference) sex, age, BMI) Design Intervention Major findings related outcomes
“Early” TRE (eating window finishes before/by 17:00 h)
Hutchison et al. 2019 (24) 15, M 1 wk eTRE: 9 h, 08:00–17:00 h ↓ Glucose AUC in eTRE No diet recording or diet analysis; no data
55 y, 34 kg/m2 RXT vs. dTRE: 9 h, and dTRE on timing of when participants ate
(2-wk w/o) 12:00–21:00 h ↓ Fasting glucose by meals
CGM (eTRE)
Jamshed et al. 2019 (21) 11, M + F 4d TRE: 8 h, 08:00–14:00 h ↓ 24-h glucose and Meals provided with matched energy at
and Ravussin et al. 32 y, 30 kg/m2 RXT vs. Control 12 h, glycemic variability via each meal (33% EI), same
2019 (22)2 (3.5–5-wk w/o) 08:00–20:00 h CGM macronutrients (50% CHO, 30% fat, 15%
protein) across day; same as Sutton et
al. (20)
Sutton et al. 2019 (20)2 8, M 5 wk TRE: 8 h, 08:00–14:00 h ↑ Insulin sensitivity Meals provided with matched energy at
56 y, 32 kg/m2 , RXT vs. Control 12 h, ↔ Body weight each meal (33% EI), same
prediabetes (∼7-wk w/o) 08:00–20:00 h macronutrients (50% CHO, 30% fat, 15%
protein) across day; same as
Jamshed/Ravussin et al. (21, 22)
Zeb et al. 2020 (33) 56, M 25 d TRE: 8 h, 07:30–15:30 h ↓ CHO, TGs, AST, ALT, and No diet recording or diet analysis; no data
young (no age) Pre-post albumin on timing of when participants ate
↑ HDL meals
“Mid” TRE (delayed breakfast and early dinner)
Gabel et al. 2018 (32) and 23, M + F 12 wk TRE: 8 h, 10:00–18:00 h ↔ Body weight, fat/lean 7-d food record at baseline and at week
Gabel et al. 2020 (69) 49 y, 34.5 kg/m2 Pre-post vs. historical control mass, fasting glucose 12; decreased energy intake
↓ SBP (∼1420 kJ/d, −20%), NC in
macronutrient intake; self-reported
timing of intake
Martens et al. 2020 (50) 22, M + F 6 wk TRE: 8 h, starting ↔ Vascular endothelial Energy intake (via 24-h diet record ASA24,
67 y, 25 kg/m2 RXT between 10:00 and function, body weight, once per week) was unchanged, diet
(2-wk w/o) 11:00 h fat/lean mass, BP quality (through HEI) unchanged;
↓ Hunger self-reported timing of intake
Parr et al. 2020 (43) 19, M + F 4 wk (+2 wk TRE: 9 h, 10:00–19:00 h ↔ Body weight, fat/lean Food records throughout entire 2-wk
50 y, 34 kg/m2 , type 2 baseline) mass, HbA1c, fasting baseline and 4-wk study; N/C to dietary
diabetes Pre-post glucose intake with TRE (vs. baseline); photos to
capture dietary timing; reduced EI on
adherent TRE days vs. nonadherent
(reduced CHO, alcohol)

(Continued)

Time-restricted eating: integrating what with when 703

 TABLE 1 (Continued)

704
Participants (number, Diet recording methodology and
Study (reference) sex, age, BMI) Design Intervention Major findings related outcomes
Parr et al. 2020 (23)2 11, M 5d TRE: 8 h, 10:00–18:00 h Meals provided; 25:30:45% EI; same

Parr et al.
↔ 24-h glucose
38 y, 32 kg/m2 RXT vs. Control: 15 h, concentrations or AUC macronutrients at each meal (30% CHO,
(2-wk w/o) 07:00 h–22:00 h (CGM), insulin 50% fat, 20% protein); self-reported
↓ Nocturnal glucose timing of intake at structured times
concentrations
Peeke et al. 2021 (19)3 60, M + F 8 wk TRE: 10 h (self-selected ↓ Body weight Controlled meals/energy intake (reduced
44 y, 38 kg/m2 RCT from 07:00–17:00 h to (−10.7 kg) in TRE vs. energy intake by 500–100 kJ/d) via
10:00–20:00 h) CON (−8.9 kg), fasting Jenny Craig Rapid Results Program and
vs. Control 12 h glucose (when FBG purchasing 8 wk of food; no reporting
>5.5 mmol/L) of timing of intake
“Late” TRE (after 12:00 h start)
Cienfuegos et al. 2020 (16) 58, M + F 8 wk TRE: 4 h (from 15:00 h) ↓ Body weight (3.9 and 7-d food record at baseline and week 8;
and Cienfuegos et al. 47 y, 36 kg/m2 RCT and 6 h (from 13:00 h) 3.4%) in TRE groups vs. household measures and self-reported
2021 (70) vs. Control, ad libitum Control (0.1%) times.
↔ Fasting glucose, Decreased EI in both groups
HbA1c (∼−2090 kJ/d) compared with Control
↔ Body weight, pre- vs. (∼−420 kJ/d); N/C to sugar, saturated
postmenopausal fat, cholesterol, fiber, or sodium intakes
women
Isenmann et al. 2021 (63)4 35, M + F 14 wk (+2 wk TRE: 8 h, 12:00–20:00 h) ↓ Body weight (∼5%) in Food records throughout entire 2-wk
27 y, 26 kg/m2 baseline) vs. MBD both TRE and MBD baseline (phase 1) and 8-wk phase 2,
RCT groups encouraged for 6-wk phase 3; N/C to
↓ Body fat dietary intake with TRE or MBD (vs.
↔ Lean mass baseline)
Kotarsky et al. 2021 (60)4 21, M + F 8 wk TRE: 8 h, 12:00–20:00 h) ↓ Body weight in TRE 3-d diet records collected at weeks 1, 4,
44 y, 30 kg/m2 RCT vs. Control, normal diet (3.3%) vs. Control and 7; participants were excluded after
pattern (0.2%) more than 1 noncompliant (to the
timing of eating) day; decreased EI in
both groups (∼1250 kJ/d) due to
decreased CHO intake
Lowe et al. 2020 (34) 105 M + F (online), 12 wk TRE: 8 h, 12:00–20:00 h ↔ Body weight (−0.9 vs. No diet recording or diet analysis; no data
including 46 (in RCT vs. CMT (06:00–10:00 h CMT: −0.6 kg), ↓ on timing of when participants ate
person) breakfast, appendicular lean meals
46 y, 31 kg/m2 11:00–15:00 h lunch, mass index in TRE vs.
17:00–22:00 h dinner) CMT
Moro et al. 2016 (59)4 34, M 8 wk TRE: 8 h, 13:00–20:00 h ↓ Fat mass (−16%) vs. Participants were instructed to consume 3
29 y, 27 kg/m2 RCT vs. Control: 12 h, Control (−2%), fasting meals, based on their baseline (7-d
08:00–20:00 h glucose, fasting recording) dietary intake; TRE was 40%,
insulin, ↔ lean mass 25%, and 35% EI at the 3 meals (13:00,
16:00, and 20:00) vs. Control of 25% at
08:00, 40% at 13:00 and 35% at 20:00;
ND between groups for EI or
macronutrient intake

(Continued)
 TABLE 1 (Continued)

Participants (number, Diet recording methodology and

Study (reference) sex, age, BMI) Design Intervention Major findings related outcomes
Schroder et al. 2021 (35) 32, F 3 mo TRE: 8 h, 12:00–20:00 h ↓ Body weight (−3.4 kg) No diet recording or diet analysis; no data
39 y, 33 kg/m2 Non-RCT vs. Control: no change vs. Control (+1.3 kg) on timing of when participants ate
to habitual meals
intake/patterns
Smith et al. 2017 (36) 20, F 4 wk TRE: 8 h, 12:00–20:00 h ↓ Body weight (0.6 kg) Self-reported adherence to the diet
21 y, ∼65 kg Pre-post prescription but no analysis of diet
(no BMI data) energy intake or data on the timing of
when participants ate meals
Stote et al. 2007 (31)2 15, M + F 8 wk TRE: 4 h, 17:00–21:00 h ↓ Body weight (1.4 kg), ↑ Meals provided (∼9890 kJ/d TRE and
45 y, 23 kg/m2 RXT (11-wk w/o) vs. Control (3 meals/d) blood pressure vs. 10,160 kJ/d in Control), same
Control macronutrient intake (50% CHO, 35%
fat, 15% protein)
Tinsley et al. 2017 (61)4 18 M 8 wk TRE: 4 h (between 16:00 ↔ Body weight, fat mass −2720 kJ/d energy reduction each day of
Normal weight RCT and 00:00 h) for 4 TRE (nontraining days)
d/wk
vs. Control
Tinsley et al. 2019 (62)4 40 F 8 wk TRE: 8 h, 12:00–20:00 h ↑ Body weight (both Weighed diet records on selected
22 y, 23 kg/m2 RCT vs. Control (13 h) groups), ↓ fat mass weekday and weekend days during
(∼4%) TRE vs. CON, ↑ pre- and 2 separate weeks during
muscle strength and intervention period; increased EI in all
endurance (both groups (∼84–840 kJ/d)
groups)
Participant choice TRE (no specified “window”)
Anton et al. 2019 (37) 10, M + F 4 wk TRE: 8 h, self-selected ↓ Body fat (−0.6 kg, Food diaries collected for adherence (84%,
77 y, 34 kg/m2 Pre-post −0.7%) in weeks 2–4); no analysis of dietary
intake
Antoni et al. 2018 (17) 13, F 10 wk TRE: 90 min earlier dinner ↔ Body weight (−0.7 vs. Validated food diaries used for the entire
46 y, 29 kg/m2 Pre-post and 90 min later −0.5 kg), ↓ body fat intervention period; diet timing via
breakfast, self-selected percentage self-report in food diaries; decreased EI
by ∼2930 kJ/d
Cai et al. 2019 (41) 271, M + F 12 wk TRE: 8 h, self-selected, vs. ↓ Body weight (−3.6 kg) All groups were prescribed
34 y, 26 kg/m2 NAFLD RCT ADF in TRE (and −4.5 kg in energy-restricted diet intake, with the
vs. Control ADF) vs. Control TRE group being provided 1 meal in the
8-h period; no reporting of baseline
energy intake, self-reported intake
during intervention (weeks 4 and 12),
with eating times
Chow et al. 2020 (18) 20, M + F 12 wk TRE: 8 h, self-selected ↓ Body weight (3.7% Energy intake logged using MCC app to
45 y, 34 kg/m2 Pre-post (achieved 10 h) ∼3.6 kg) in TRE vs. obtain meal timing; number of eating
vs. Control 15 h Control occasions reported, as a surrogate
measure of diet intake; TRE eating
window selected ∼10:40–18:40 h with
55% adherence

(Continued)

Time-restricted eating: integrating what with when 705

 TABLE 1 (Continued)

706
Participants (number, Diet recording methodology and
Study (reference) sex, age, BMI) Design Intervention Major findings related outcomes

Parr et al.
Gill and Panda, 2015 (14) 8, M + F 16 wk TRE: 10 h, self-selected ↓ Body weight (−3.3 kg) Custom mobile app (MCC) to take photos
27 y, 33 kg/m2 Pre-post of food for entire period; annotated and
analyzed using FDDNS or CalorieKing. EI
decreased by 20.26% (−4.92 to 35.6%
95% CI)
Kesztyüs et al. 2019 (38) 40, M + F 12 wk TRE: 8 h, self-selected ↓ Body weight (−1.7 kg), Self-reported intake of main diet
49 y, 31 kg/m2 Pre-post ↓ waist circumference components rated on 6-point Likert
↓ HbA1c scale (never–several times a day) at
baseline and postintervention; no diet
intake reporting or analysis;
self-reported timing of eating (time of
first and last meal) using a diary
Kesztyüs et al. 2021 (39) 63, M + F 12 wk TRE: 8–9 h, self-selected ↓ Body weight (−1.3 kg), Self-reported adherence (∼72%) via time
48 y, 26 kg/m2 Pre-post ↓ waist circumference of first and last meal; no diet intake
(−1.7 cm), ↑ HRQoL reporting or analysis
LeCheminant et al. 2013 (15) 27, M 2 wk TRE: 06:00–19:00 h ↓ Body weight (−0.4 kg) 3-d diet recall (2 weekdays, 1 weekend)
21 y, 24 kg/m2 RXT vs. ad libitum vs. ad libitum during each week using 24-h multi-pass
(1-wk w/o) (+0.6 kg) recall
Reduced EI in TRE vs. ad libitum, no
differences in macronutrient intake;
self-reported timing of intake
McAllister et al. 2020 (71) 22, M 4 wk TRE: 8 h, self-selected ↔ Body weight Self-reported time of first and last meal,
22 y, 28 kg/m2 RCT vs. either ad libitum or ↓ Body fat, ↓ BP diet intake logged using MyFitnessPal;
prescribed trend (P = 0.054) for higher diet intake
isoenergetic in the ad libitum TRE group compared
with isoenergetic
Phillips et al. 2021 (49) 213 M + F 1-mo observation TRE: 12 h, self-selected ↓ Body weight (TRE: Diet intake logged using MCC app (for
(observation), 40 y, 6-mo vs. SDA (10-min 1.6% vs. SDA: 1.1%) timing), text coded for dietary quality
25 kg/m2 RCT nutrition counseling) analysis using NOVA (unprocessed to
54, M + F (RCT) processed) categories; no analysis of
43 y, ∼28 kg/m2 energy intake
Pureza et al. 2020 (72) 58, F 3 wk TRE: 12 h, self-selected ↓ Body weight (−1 kg to No measurement of diet timing but
31 y, 33 kg/m2 Pre-post vs. unrestricted (Control) 2 kg in both groups), energy reduction (prescribed) was
↓ body fat in TRE similar in both groups (−2680 kJ/d)
Wilkinson et al. 2020 (40) 19, M + F 12 wk TRE: 10 h, self-selected ↓ Body weight [−3 kg Diet intake logged using MCC app (for
59 y, 33 kg/m2 Pre-post (−3%)], fat mass, BP timing), estimated ∼9% (840 kJ/d)
MetS ↔ Fasting glucose, energy reduction but no analysis of
insulin, HbA1c macronutrient intake
1
Arrows indicate significant reductions (↓) or no significant changes (↔). ADF, alternate-day fasting; ALT, alanine transaminase; ASA24, Automated Self-Administered 24-hour dietary assessment tool; AST, aspartate aminotransferase; BP, blood
pressure; CGM, continuous glucose monitor; CHO, carbohydrate; CMT, consistent meal timing; dTRE, delayed time-restricted eating; EI, energy intake; eTRE, early time-restricted eating; FBG, fasting blood glucose; FDDNS, Food and Nutrient
Database for Dietary Studies; HbA1c, glycated hemoglobin; HEI, Healthy Eating Index; HRQoL, health-related quality of life; MBD, macronutrient-based diet; MCC, MyCircadianClock; MetS, metabolic syndrome; NAFLD, nonalcoholic fatty liver
disease; N/C, no change; ND, no difference; RCT, randomized controlled trial; RXT, randomized crossover trial; SBP, systolic blood pressure; SDA, standard dietary advice; TG, triglyceride; TRE, time-restricted eating; w/o, washout.
2
Provided meals (isoenergetic).
3
Prescribed diet (hypoenergetic).
4
Exercise protocol with TRE/Control.
TRE protocols that did not induce a reduction in body Without the information of what food has been consumed,
weight and/or changes in body composition, and neglected to the TRE advice provided to individuals is limited to simply
conduct any analysis of dietary intake, failed to change their the eating window. Although this may help keep the message
dietary intake (quality or quantity) (33, 34, 36). However, the simple, in practice, individuals will naturally ask what foods
interventions that have provided meals matched for EI, and they can consume within a specified time. It would be ideal
in which only the timing of eating is altered, demonstrate that to elucidate the best TRE eating window along with the ideal
a reduced EI may not be necessary for improvements to a meal timing and macronutrient composition for optimal
selected metabolic health outcome (20–23). Whether stan- results (i.e., combining the what with the when).
dard dietary advice regarding food quality induces additive The quality of ingested nutrients plays a crucial role
and superior health outcomes to appropriately timed TRE when determining any effects of dietary intervention on
has yet to be investigated (i.e., improving both what and when metabolic health outcomes. For example, carbohydrate-rich
individuals consume food). To reach consensus between TRE foods that have a widely different glycemic index induce
interventions, traditional dietary records for a minimum of different glucose/insulin responses (46). Thus, the quality of
3 d (2 weekdays and 1 weekend day), undertaken at least the ingested food is also important from a metabolic health
3 times (baseline, midpoint, and end of intervention) for perspective (47, 48), with dietary guidelines recommending
the determination of energy and macronutrients should be changes to both the quality (i.e., increased grains vs. refined
a minimum requirement, and provide valuable information foods; whole foods vs. processed foods) and the quantity
regarding the most effective protocol of TRE. While frequent (i.e., reduced portion sizes) of food. Only 2 of the 25 TRE
(i.e., daily), comprehensive, and extended dietary analysis studies reviewed (Table 1) have utilized a measure of dietary
(i.e., macronutrients, micronutrients, dietary patterns, core quality to assess TRE and compared this with either a 10-min
food-group analysis, level of processed food, and timing of all nutrition-counseling session (standard dietary advice) (49)
meals/snacks) throughout a TRE intervention would provide or no advice (50). Using the qualitative NOVA classification
valuable information, it is important to be mindful of the (51) from free-text annotations of food photos collected
dietary analysis skills of research teams, the time burden throughout a 6-mo intervention, Phillips and colleagues
to participants of daily records, along with the impact that (49) reported that participants receiving standard dietary
dietary recording has on dietary intake (42). advice significantly increased their intake of unprocessed or
The other, less studied, yet important dietary component minimally processed foods by 7% and compensated by a
is the change in macronutrient and energy distribution across reduced intake of processed food, with no changes to fluids
meals, as well as the number of meals and snacks consumed consumed. Martens and colleagues (50) used the Healthy
during a day. Typically, in Western cultures/societies, break- Eating Index (52) to obtain an outcome of dietary quality
fast is the most carbohydrate-centric meal, yet contributes from weeks 3–5 of a 6-wk intervention compared with 6 wk
the least to total daily EI. In the evening, dinner is generally of no advice (following normal diet). Importantly, for the
higher in protein compared with other meals, as well as being comparisons in both studies, the TRE condition did not
the largest meal with regard to total EI. Due to lack of detailed improve or change dietary quality, which was described as
dietary data reported in previous TRE interventions, it is “adhering to the protocol” (49) or not adversely affecting
currently unknown if TRE protocols change the distribution dietary intake (50). Detailed dietary analysis that has been
or intake of macronutrients at meals across the day. performed in several studies has indicated that time-of-day
In addition to failing to report EI, most studies of TRE foods, such as late evening snacks and alcohol consumption,
that have manipulated the size of meals throughout the day are reduced with TRE (14, 43). If TRE can induce such
do not specify what proportions of macronutrient have been changes to dietary intake and quality without structured
provided/consumed at each meal. The TRE studies that have advice, then more rigorous dietary analysis is crucial in future
utilized meal photo timing have provided a comprehensive TRE interventions.
analysis of the number of eating occasions (as a surrogate
measure of total EI) and reported a reduction (14, 18) or
similar number (43), in response to the reduced eating TRE: not just another weight-loss intervention
window. Evidence from studies by Jakubowicz and colleagues The primary outcomes of TRE interventions to date have
(44, 45) has shown that larger morning meals (high in been weight loss, glycemic control, and selected biomarkers
carbohydrate) with small evening meals (high in protein) are of cardiometabolic health, with the majority of studies
effective for reducing body weight and improving glycemic reporting positive effects on these and several other measures
control. However, in these studies, it is difficult to determine (6, 8, 9, 53, 54). However, it is not currently known whether
whether it is the EI or the macronutrient distribution that it is the modest energy restriction induced by TRE protocols
led to changes in several physiological outcomes. Neglecting or the alignment of meal timing with circadian oscillations
to consider what is being consumed and how frequently that induce many of the health benefits of TRE. Not only
in a TRE intervention, while focusing solely on when does circadian phase influence the metabolic response to
food is consumed, is overlooking a crucial component in food intake but food intake itself is under control by
understanding the full benefit of TRE. This is particularly the endogenous circadian system (i.e., independent of the
important when translating TRE research into practice. sleep/wake and fasting/feeding cycle) (55).

Time-restricted eating: integrating what with when 707

FIGURE 3 Representative schematic of glucose concentrations changing over a 24-h period comparing the effects of 3 meals during a
control day (meals over >12 h; dashed line) with a time-restricted eating pattern (meals within 8 h; solid line). CON, control; TRE,
time-restricted eating. Adapted from reference 23 with permission.

In energy-restricted diets that induce weight loss, there is or mid-TRE (Table 1). As highlighted by Zhao et al. (66),
a concomitant reduction in lean mass, typically accounting the distribution of carbohydrate intake across the eating
for at least 25% of the total weight lost (56). The loss of window is vital when attempting to modify glycemic control,
lean tissue during energy restriction can be mitigated by a factor that should be considered in future studies, and
exercise in the face of adequate protein intake (57), but high- emphasizes the need for rigorous dietary assessment in
protein, energy-restricted diets are not effective in isolation TRE interventions. The range of improvements in glycemic
(58). In the few TRE studies that have measured body control across the limited TRE literature to date provides
composition, the magnitude of change in lean mass has scope for specific TRE interventions with such markers as
been small (∼1.0 kg) (34) or negligible (32, 43, 50), usually primary outcome variables, especially in populations such
reflecting a modest loss in body weight, or possibly typical as individuals with T2D (43), where glucose management
measurement error. Several investigations have combined is important to minimize diabetes-associated complications
TRE with exercise training to maximize improvements in and improve health and quality of life.
body composition (reduced fat mass and maintained or
increased lean mass) (59–63). Whether a restricted eating Adherence to TRE
window is optimal to promote adequate rates of protein A major benefit of TRE protocols compared with other
synthesis to maintain protein balance in the absence of an dietary interventions is the ability for individuals to adhere
exercise stimulus is an important question that warrants to such practices without overt changes on the quality or
further research (64). Indeed, whether TRE confers additive quantity of dietary intake. This removes some of the stigma
benefits to disordered metabolism above and beyond those and psychological barriers often associated with dietary
induced by exercise training remains to be determined modification. It has been suggested that, over the long
experimentally (65). term, TRE may be easier to tolerate and implement than
Dietary interventions are often implemented with the aim other dietary approaches (67) as the focus is on when
of improving glycemic control. In addition to weight loss, rather than on what to eat. While not all aspects of TRE
TRE interventions improve fasting glucose concentrations may encourage adherence [reviewed previously (67)], TRE
(19, 19, 24, 59), 24-h glucose profiles (determined by con- may offer an option of an alternative dietary strategy to
tinuous glucose monitoring) (21, 40), glycated hemoglobin improve metabolic health. Adherence to TRE in free-living
(HbA1c) (38), reduce glucose AUC in response to an oral- environments has varied from 5 d (43) to 6 d/wk (16, 32)
glucose-tolerance test (24, 50), reduce nocturnal glucose con- over 4- to 10-wk intervention periods, 55% over 12 wk (18),
centrations (23) (Figure 3), and enhance insulin sensitivity ∼62% over 10 wk (17), and up to ∼84% over 6 wk (50) or
(16, 20). Typically, but not always, changes in glucose pa- 12 wk (34). In a subanalysis, Martens et al. (50) measured
rameters have been evident in cohorts with elevated glucose improved adherence (from 84% to 95% over 6 wk) when
concentrations (>5.6 mmol/L) at baseline (i.e., impaired the eating window was extended from 8 h to 8.5 h/d (50).
fasting glucose, T2D, metabolic syndrome) compared with In a supported 8-wk intervention, immediately followed by
a lack of change observed in those studies in which these 6 wk of free-living TRE (12:00–20:00 h) in habitual (3–
parameters were in the normal range before the intervention 4 sessions/wk) exercisers, Isenmann et al. (63) reported
(16, 32, 34, 40). Furthermore, most of the improvements a drop in adherence from 98% (supported) to 71% (self-
in glycemic control measures come from studies of early- implemented). Participants in that study (63) rated the ease

708 Parr et al.

of TRE implementation as similar to that for a group that these 2 variables and their potential impact on reducing
followed a traditional macronutrient-based diet. While no the burden of chronic metabolic diseases at the population
explanation for these observations was provided, participants level.
in other studies have indicated that if the evening mealtime
could be delayed slightly, it would improve their adherence
(17, 43). Acknowledgments
Adherence to TRE in studies discussed and summarized We acknowledge the funding bodies for the grants, and the
in Table 1 is typically from self-report. Studies incorporating wider research team for the continual sharing of ideas and
objective time-stamped photos are still limited as they rely on progression of this work. The authors’ responsibilities were
participants to accurately capture their meal timing. In sup- as follows—EBP and BLD: conceptualized the article; EBP:
port of the self-reported adherence are qualitative responses drafted the manuscript and Table 1; EBP, BLD, and JAH:
from participants that mid-TRE as a dietary intervention is edited and revised all sections of the manuscript and had
achievable on most days of the week (17, 23, 43), with early- primary responsibility for the final content; and all authors:
TRE deemed subjectively feasible based on positive health read and approved the final manuscript.
outcomes (20). Although the implementation of these early-
TRE protocols is challenging with regard to the impact on References
social and family life, to date, early-TRE interventions have 1. Asher G, Sassone-Corsi P. Time for food: the intimate interplay between
not been investigated in free-living conditions. In several nutrition, metabolism, and the circadian clock. Cell 2015;161(1):84–92.
studies, investigators have chosen TRE eating windows based 2. Di Francesco A, Di Germanio C, Bernier M, de Cabo R. A time to fast.
Science 2018;362(6416):770–5.
on participants’ personal preferences (i.e., 12:00–20:00 h) due 3. Hawley JA, Sassone-Corsi P, Zierath JR. Chrono-nutrition for the
to both social considerations and the importance of evening prevention and treatment of obesity and type 2 diabetes: from mice to
meals with family or friends (34–36, 59, 60). Taken together, men. Diabetologia 2020;63(11):2253–9.
there is an underlying narrative of what can be achieved in 4. Mattson MP, Allison DB, Fontana L, Harvie M, Longo VD, Malaisse WJ,
the real world versus what is most efficacious with regard to Mosley M, Notterpek L, Ravussin E, Scheer F, et al. Meal frequency and
timing in health and disease. Proc Natl Acad Sci 2014;111(47):16647–
optimal meal timing to align with circadian rhythms. There is 53.
also unlikely to be a single eating window that will be equally 5. de Cabo R, Mattson MP. Effects of intermittent fasting on health, aging,
beneficial for every individual, as circadian preferences vary and disease. N Engl J Med 2019;381(26):2541–51.
between “larks” (morning chronotypes) and “owls” (night 6. Gabel K, Cienfuegos S, Kalam F, Ezpeleta M, Varady KA. Time-
chronotypes) (68), leading to difficulties in making generic restricted eating to improve cardiovascular health. Curr Atheroscler Rep
2021;23(5):22.
recommendations. 7. Chaix A, Manoogian ENC, Melkani GC, Panda S. Time-restricted
eating to prevent and manage chronic metabolic diseases. Annu Rev
Conclusions and Future Directions Nutr 2019;39(1):291–315.
TRE has become a popular dietary strategy to improve 8. Regmi P, Heilbronn LK. Time-restricted eating: benefits, mechanisms,
and challenges in translation. Iscience 2020;23(6):101161.
measures of metabolic health, possibly due to a lack of focus
9. Waldman HS, Renteria LI, McAllister MJ. Time-restricted feeding for
on weight loss per se. Indeed, we believe that TRE protocols the prevention of cardiometabolic diseases in high-stress occupations:
can be adapted to tackle a variety of pre-existing metabolic a mechanistic review. Nutr Rev 2020;78(6):459–64.
conditions dependent on the goals or desired health out- 10. Lee MB, Hill CM, Bitto A, Kaeberlein M. Antiaging diets: separating
comes of the individual. Further research expanding the fact from fiction. Science 2021;374(6570):eabe7365.
11. Clayton DJ, Mode WJA, Slater T. Optimising intermittent fasting:
use of TRE interventions in different clinical populations
evaluating the behavioural and metabolic effects of extended morning
under free-living conditions is essential to evaluate long-term and evening fasting. Nutr Bull 2020;45(4):444–55.
adherence and feasibility before recommending additions to 12. Van Cauter E, Blackman JD, Roland D, Spire JP, Refetoff S, Polonsky
national and international diet guidelines. In this regard, KS. Modulation of glucose regulation and insulin secretion by circadian
we acknowledge that TRE is not the only option or dietary rhythmicity and sleep. J Clin Invest 1991;88(3):934–42.
13. Van Cauter E, Shapiro ET, Tillil H, Polonsky KS. Circadian modulation
strategy in a health professional’s toolbox to be used to
of glucose and insulin responses to meals: relationship to cortisol
improve or manage the diverse range of chronic metabolic rhythm. Am J Physiol 1992;262:E467–75.
conditions seen in society. However, we hope this Perspective 14. Gill S, Panda S. A smartphone app reveals erratic diurnal eating patterns
article has highlighted the necessity for future studies of TRE in humans that can be modulated for health benefits. Cell Metab
to increase the rigor of dietary data collected, assessed, and 2015;22(5):789–98.
15. LeCheminant JD, Christenson E, Bailey BW, Tucker LA. Restricting
reported to ensure there is a consistent and standardized
night-time eating reduces daily energy intake in healthy young men: a
approach across TRE interventions. Almost the entire body short-term cross-over study. Br J Nutr 2013;110(11):2108–13.
of dietary literature to date, along with the profession of 16. Cienfuegos S, Gabel K, Kalam F, Ezpeleta M, Wiseman E, Pavlou V, Lin
nutrition science, has focused on what we eat; new knowledge S, Oliveira ML, Varady KA. Effects of 4- and 6-h time-restricted feeding
from TRE interventions is shifting that narrative so that now on weight and cardiometabolic health: a randomized controlled trial in
adults with obesity. Cell Metab 2020;32(3):366–78.
it is vital that we also consider that the timing of meals plays
17. Antoni R, Robertson TM, Robertson MD, Johnston JD. A pilot
an important role in determining metabolic health outcomes. feasibility study exploring the effects of a moderate time-restricted
Without consideration of both what and when is eaten, we feeding intervention on energy intake, adiposity and metabolic
cannot begin to understand the potential synergies between physiology in free-living human subjects. J Nutr Sci 2018;7:E22.

Time-restricted eating: integrating what with when 709

18. Chow LS, Manoogian ENC, Alvear A, Fleischer JG, Thor H, Dietsche 37. Anton SD, Lee SA, Donahoo WT, McLaren C, Manini T, Leeuwenburgh
K, Wang Q, Hodges JS, Esch N, Malaeb S, et al. Time-restricted eating C, Pahor M. The effects of time restricted feeding on overweight, older
effects on body composition and metabolic measures in humans who adults: a pilot study. Nutrients 2019;11(7):1500.
are overweight: a feasibility study. Obesity 2020;28(5):860–9. 38. Kesztyüs D, Cermak P, Gulich M, Kesztyüs T. Adherence to time-
19. Peeke PM, Greenway FL, Billes SK, Zhang D, Fujioka K. Effect of time restricted feeding and impact on abdominal obesity in primary care
restricted eating on body weight and fasting glucose in participants with patients: results of a pilot study in a pre–post design. Nutrients
obesity: results of a randomized, controlled, virtual clinical trial. Nutr 2019;11(12):2854.
Diabetes 2021;11(1):6. 39. Kesztyüs D, Vorwieger E, Schönsteiner D, Gulich M, Kesztyüs T.
20. Sutton EF, Beyl R, Early KS, Cefalu WT, Ravussin E, Peterson CM. Early Applicability of time-restricted eating for the prevention of lifestyle-
time-restricted feeding improves insulin sensitivity, blood pressure, and dependent diseases in a working population: results of a pilot study in a
oxidative stress even without weight loss in men with prediabetes. Cell pre-post design. Ger Med Sci 2021; 19:Doc04.; 10.3205/000291.
Metab 2018;27(6):1212–21.e3. 40. Wilkinson MJ, Manoogian ENC, Zadourian A, Lo H, Fakhouri S,
21. Jamshed H, Beyl RA, Della Manna DL, Yang ES, Ravussin E, Peterson Shoghi A, Wang X, Fleischer JG, Navlakha S, Panda S, et al. Ten-hour
CM. Early time-restricted feeding improves 24-hour glucose levels and time-restricted eating reduces weight, blood pressure, and atherogenic
affects markers of the circadian clock, aging, and autophagy in humans. lipids in patients with metabolic syndrome. Cell Metab 2020;31(1):92–
Nutrients 2019;11(6):1234. 104.e5.
22. Ravussin E, Beyl RA, Poggiogalle E, Hsia DS, Peterson CM. Early time- 41. Cai H, Qin Y-L, Shi Z-Y, Chen J-H, Zeng M-J, Zhou W, Chen
restricted feeding reduces appetite and increases fat oxidation but does R-Q, Chen Z-Y. Effects of alternate-day fasting on body weight
not affect energy expenditure in humans. Obesity 2019;27(8):1244–54. and dyslipidaemia in patients with non-alcoholic fatty liver disease:
23. Parr EB, Devlin BL, Radford BE, Hawley JA. A delayed morning and a randomised controlled trial. BMC Gastroenterol 2019;19(1):
earlier evening time-restricted feeding protocol for improving glycemic 219.
control and dietary adherence in men with overweight/obesity: a 42. Dao MC, Subar AF, Warthon-Medina M, Cade JE, Burrows T, Golley
randomized controlled trial. Nutrients 2020;12(2):505. RK, Forouhi NG, Pearce M, Holmes BA. Dietary assessment toolkits: an
24. Hutchison AT, Regmi P, Manoogian ENC, Fleischer JG, Wittert GA, overview. Public Health Nutr 2019;22(3):404–18.
Panda S, Heilbronn LK. Time-restricted feeding improves glucose 43. Parr EB, Devlin BL, Lim KHC, Moresi LNZ, Geils C, Brennan L,
tolerance in men at risk for type 2 diabetes: a randomized crossover trial. Hawley JA. Time-restricted eating as a nutrition strategy for individuals
Obesity (Silver Spring) 2019;27:724–32. with type 2 diabetes: a feasibility study. Nutrients 2020;12(11):
25. Hatori M, Vollmers C, Zarrinpar A, DiTacchio L, Bushong EA, 3228.
Gill S, Leblanc M, Chaix A, Joens M, Fitzpatrick JAJ, et al. 44. Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric intake at
Time-restricted feeding without reducing caloric intake prevents breakfast vs. dinner differentially influences weight loss of overweight
metabolic diseases in mice fed a high-fat diet. Cell Metab 2012;15(6): and obese women. Obesity 2013;21(12):2504–12.
848–60. 45. Jakubowicz D, Wainstein J, Ahrén B, Bar-Dayan Y, Landau Z,
26. Chaix A, Zarrinpar A, Miu P, Panda S. Time-restricted feeding is a Rabinovitz HR, Froy O. High-energy breakfast with low-energy dinner
preventative and therapeutic intervention against diverse nutritional decreases overall daily hyperglycaemia in type 2 diabetic patients: a
challenges. Cell Metab 2014;20(6):991–1005. randomised clinical trial. Diabetologia 2015;58(5):912–9.
27. Zarrinpar A, Chaix A, Panda S. Daily eating patterns and their 46. Radulian G, Rusu E, Dragomir A, Posea M. Metabolic effects of low
impact on health and disease. Trends Endocrinol Metab 2016;27(2): glycaemic index diets. Nutr J 2009;8(1):5.
69–83. 47. Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY,
28. Chaix A, Zarrinpar A. The effects of time-restricted feeding on lipid Chung ST, Costa E, Courville A, Darcey V, et al. Ultra-processed diets
metabolism and adiposity. Adipocyte 2015;4(4):319–24. cause excess calorie intake and weight gain: an inpatient randomized
29. Panda S. Circadian physiology of metabolism. Science controlled trial of ad libitum food intake. Cell Metab 2019;30(1):67–77,
2016;354(6315):1008–15. e3.
30. Cienfuegos S, McStay M, Gabel K, Varady KA. Time restricted eating 48. Wirt A, Collins CE. Diet quality—what is it and does it matter? Public
for the prevention of type 2 diabetes. J Physiol 2021;10.1113/JP281101 Health Nutr 2009;12(12):2473–92.
Published online: 21 August 2021. 49. Phillips N, Mareschal J, Schwab N, Manoogian E, Borloz S, Ostinelli
31. Stote KS, Baer DJ, Spears K, Paul DR, Harris GK, Rumpler WV, Strycula G, Gauthier-Jaques A, Umwali S, Gonzalez Rodriguez E, Aeberli D,
P, Najjar SS, Ferrucci L, Ingram DK, et al. A controlled trial of reduced et al. The effects of time-restricted eating versus standard dietary advice
meal frequency without caloric restriction in healthy, normal-weight, on weight, metabolic health and the consumption of processed food:
middle-aged adults. Am J Clin Nutr 2007;85(4):981–8. a pragmatic randomised controlled trial in community-based adults.
32. Gabel K, Hoddy KK, Haggerty N, Song J, Kroeger CM, Trepanowski JF, Nutrients 2021;13(3):1042.
Panda S, Varady KA. Effects of 8-hour time restricted feeding on body 50. Martens CR, Rossman MJ, Mazzo MR, Jankowski LR, Nagy EE,
weight and metabolic disease risk factors in obese adults: a pilot study. Denman BA, Richey JJ, Johnson SA, Ziemba BP, Wang Y, et al. Short-
Nutr Healthy Aging 2018;4(4):345–53. term time-restricted feeding is safe and feasible in non-obese healthy
33. Zeb F, Wu X, Chen L, Fatima S, Haq I, Chen A, Majeed F, Feng Q, midlife and older adults. GeroScience 2020;42(2):667–86.
Li M. Effect of time-restricted feeding on metabolic risk and circadian 51. Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC,
rhythm associated with gut microbiome in healthy males. Br J Nutr Jaime PC. The UN Decade of Nutrition, the NOVA food classification
2020;123(11):1216–26. and the trouble with ultra-processing. Public Health Nutr 2018;21(1):
34. Lowe DA, Wu N, Rohdin-Bibby L, Moore AH, Kelly N, Liu YE, Philip E, 5–17.
Vittinghoff E, Heymsfield SB, Olgin JE, et al. Effects of time-restricted 52. Krebs-Smith SM, Pannucci TE, Subar AF, Kirkpatrick SI, Lerman JL,
eating on weight loss and other metabolic parameters in women and Tooze JA, Wilson MM, Reedy J. Update of the Healthy Eating Index:
men with overweight and obesity: the TREAT randomized clinical trial. HEI-2015. J Acad Nutr Diet 2018;118(9):1591–602.
JAMA Intern Med 2020;180(11):1491. 53. Moon S, Kang J, Kim SH, Chung HS, Kim YJ, Yu JM, Cho ST, Oh C-M,
35. Schroder JD, Falqueto H, Mânica A, Zanini D, de Oliveira T, de Sá CA, Kim T. Beneficial effects of time-restricted eating on metabolic diseases:
Cardoso AM, Manfredi LH. Effects of time-restricted feeding in weight a systemic review and meta-analysis. Nutrients 2020;12(5):1267.
loss, metabolic syndrome and cardiovascular risk in obese women. J 54. Pellegrini M, Cioffi I, Evangelista A, Ponzo V, Goitre I, Ciccone G,
Transl Med 2021;19(1):3. Ghigo E, Bo S. Effects of time-restricted feeding on body weight and
36. Smith ST, LeSarge JC, Lemon PWR. Time-restricted eating in women— metabolism. a systematic review and meta-analysis. Rev Endocr Metab
a pilot study. WURJ Health Nat Sciences 2017;8:1–6. Disord 2020;21(1):17–33.

710 Parr et al.

55. Scheer F, Morris CJ, Shea SA. The internal circadian clock increases physically active individuals—a 14-week randomised controlled trial.
hunger and appetite in the evening independent of food intake and other Nutrients 2021;13(9):3122.
behaviors: body clock controls hunger. Obesity 2013;21(3):421–3. 64. Lees MJ, Hodson N, Moore DR. A muscle-centric view of time-
56. Parr EB, Coffey VG, Hawley JA. ‘Sarcobesity’: a metabolic conundrum. restricted feeding for older adults. Curr Opin Clin Nutr Metab Care
Maturitas 2013;74(2):109–13. 2021;24(6):521–7.
57. Parr EB, Coffey VG, Cato LE, Phillips SM, Burke LM, Hawley JA. 65. Parr EB, Heilbronn LK, Hawley JA. A time to eat and a time to exercise.
A randomised trial of high dairy protein, variable carbohydrate diets Exerc Sport Sci Rev 2020;48(1):4–10.
and exercise on body composition in adults with obesity. Obesity 66. Zhao L, Hutchison AT, Heilbronn LK. Carbohydrate intake and
2016;24(5):1035–45. circadian synchronicity in the regulation of glucose homeostasis. Curr
58. Englert I, Bosy-Westphal A, Bischoff SC, Kohlenberg-Müller K. Impact Opin Clin Nutr Metab Care 2021;24:342–8.
of protein intake during weight loss on preservation of fat-free 67. O’Connor SG, Boyd P, Bailey CP, Shams-White MM, Agurs-Collins
mass, resting energy expenditure, and physical function in overweight T, Hall K, Reedy J, Sauter ER, Czajkowski SM. Perspective: time-
postmenopausal women: a randomized controlled trial. Obesity Facts restricted eating compared with caloric restriction: potential facilitators
2021;14(3):259–70. and barriers of long-term weight loss maintenance. Adv Nutr
59. Moro T, Tinsley G, Bianco A, Marcolin G, Pacelli QF, Battaglia 2021;12(2):325–33.
G, Palma A, Gentil P, Neri M, Paoli A. Effects of eight weeks 68. Roenneberg T, Kuehnle T, Juda M, Kantermann T, Allebrandt K,
of time-restricted feeding (16/8) on basal metabolism, maximal Gordijn M, Merrow M. Epidemiology of the human circadian clock.
strength, body composition, inflammation, and cardiovascular Sleep Med Rev 2007;11(6):429–38.
risk factors in resistance-trained males. J Transl Med 2016;14(1): 69. Gabel K, Marcell J, Cares K, Kalam F, Cienfuegos S, Ezpeleta M,
290. Varady KA. Effect of time restricted feeding on the gut microbiome
60. Kotarsky CJ, Johnson NR, Mahoney SJ, Mitchell SL, Schimek RL, in adults with obesity: a pilot study. Nutr Health 2020;26(2):
Stastny SN, Hackney KJ. Time-restricted eating and concurrent exercise 79–85.
training reduces fat mass and increases lean mass in overweight and 70. Cienfuegos S, Gabel K, Kalam F, Ezpeleta M, Lin S, Varady KA. Changes
obese adults. Physiol Rep 2021;9. 10 e14868. in body weight and metabolic risk during time restricted feeding
61. Tinsley GM, Forsse JS, Butler NK, Paoli A, Bane AA, La Bounty PM, in premenopausal versus postmenopausal women. Exp Gerontol
Morgan GB, Grandjean PW. Time-restricted feeding in young men 2021;154:111545.
performing resistance training: a randomized controlled trial. Eur J 71. McAllister MJ, Pigg BL, Renteria LI, Waldman HS. Time-restricted
Sport Sci 2017;17(2):200–7. feeding improves markers of cardiometabolic health in physically active
62. Tinsley GM, Moore ML, Graybeal AJ, Paoli A, Kim Y, Gonzales JU, college-age men: a 4-week randomized pre-post pilot study. Nutr Res
Harry JR, VanDusseldorp TA, Kennedy DN, Cruz MR. Time-restricted 2020;75:32–43.
feeding plus resistance training in active females: a randomized trial. 72. Pureza I, Melo ISV, Macena ML, Praxedes DRS, Vasconcelos LGL, Silva-
Am J Clin Nutr 2019;110(3):628–40. Júnior AE, Florêncio T, Bueno NB. Acute effects of time-restricted
63. Isenmann E, Dissemond J, Geisler S. The effects of a macronutrient- feeding in low-income women with obesity placed on hypoenergetic
based diet and time-restricted feeding (16:8) on body composition in diets: randomized trial. Nutrition 2020;77:110796.

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