Q&A: Time-restricted eating can have a 'meaningful impact' on metabolic syndrome
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Key takeaways:
- Time-restricted eating can reduce type 2 diabetes risk and improve overall health in those with metabolic syndrome.
- PCPs should advise patients to rest their metabolism, an expert said.
Time-restricted eating can improve the health of individuals with metabolic syndrome, who are on the precipice of type 2 diabetes, heart disease and other health complications, according to an expert.
Pam R. Taub, MD, FACC, FASPC, a cardiologist, professor of medicine and director of the Step Family Foundation Cardiovascular Rehabilitation and Wellness Center at UC San Diego Health System, and colleagues conducted a randomized controlled trial among 122 participants to evaluate the effects that time-restricted eating (TRE) as a lifestyle intervention might have on adults with metabolic syndrome.
The researchers, who published their findings in the Annals of Internal Medicine, found that the intervention effectively improved cardiometabolic health in this population.
Healio spoke with Taub to learn more about the study and what PCPs need to know about TRE.
Healio: Why did you decide to study TRE in this population? Will you describe the importance of your research?
Taub: Metabolic syndrome, especially when paired with prediabetes, represents a critical tipping point in which the risk for developing type 2 diabetes and heart disease greatly increases. Clinically, these patients are often neglected because they have mild abnormalities when viewed in isolation — for example, mild elevation in blood pressure, weight, triglycerides or blood sugar. But when these abnormalities are viewed holistically is when the true risk of CVD and diabetes is fully appreciated. Also, most of our health care resources go to patients with established disease, and we need to be focusing more on upstream prevention.
Our research demonstrates that a lifestyle intervention like TRE at this important time point for patients with metabolic syndrome/prediabetes can have a meaningful impact on the trajectory of their overall health and reduce the risk for future type 2 diabetes.
Healio: Will you briefly describe your results and their clinical implications?
Taub: We conducted a randomized clinical trial in 122 adults with metabolic syndrome. Participants were randomly assigned to a 3-month intervention of personalized 8 to 10 hours of TRE or standard of care (SOC). In the TRE group, participants limited their eating window to 8 to10 hours a day. We saw a statistically significant reduction in HbA1c, direct LDL, weight and body fat in the TRE group compared with the SOC group. We did not see any significant change in total lean mass/skeletal muscle mass or total bone mineral content, which indicates that TRE is a safe lifestyle strategy and does not cause sarcopenia.
We are seeing multiple cardiometabolic benefits with TRE that go beyond just weight loss. The HbA1C reduction of 0.1% in the TRE group is similar to what was seen in the landmark Diabetes Prevention Study, in which a similar reduction in prediabetes led to a 58% decrease in the future development of diabetes. This reduction of 0.1% in A1c in the TRE group with a no-cost lifestyle intervention is not trivial.
In this randomized controlled study of TRE, we saw significant reductions in HbA1c — the study’s primary endpoint. This concomitantly occurred with other improvements in cardiometabolic parameters, such as reduction in direct LDL, decrease in fat percentage and improvement in glycemic variability, in participants treated with standard medical therapy that included statins and antihypertensives for components of the metabolic syndrome. The combination of these improvements in multiple cardiometabolic health parameters is clinically relevant for decreasing cardiovascular risk over time.
Healio: Are there any factors that primary care providers should consider when recommending this approach to patients?
Taub: PCPs should take into account concomitant medications that patients take because there may be a need to alter these therapies based on the results achieved with TRE. For example, many patients who do TRE have improvement in blood pressure, and their antihypertensives and diuretics may need to be adjusted.
Healio: Is there anyone who should avoid TRE?
Taub: Individuals who have poorly controlled diabetes and who take insulin or sulfonylureas should avoid TRE.
Healio: What is the take-home message for PCPs here?
Taub: The average American consumes food all day — [with an] eating window of 14 hours — and should give the body a metabolic rest, just like our brain needs adequate sleep to function properly. Similarly, constantly eating food is not good for the cells and metabolic systems of our body. Giving it a period of rest from eating allows cells to engage in important processes of cellular rejuvenation, repair and autophagy, which then makes our cellular metabolism more efficient.
At the minimum, we should have our patients avoid eating after dinner and encourage them to skip the late-night snacks.