Time Restricted Eating and Liver Health Findings

TIME-RESTRICTED EATING (TRE) may improve hepatic fat fraction in overweight or obese adults, but a 12-week multicentre randomised trial found that the timing of the eight-hour eating window did not provide greater improvements in liver health of faecal microbiota than Mediterranean diet-based usual care alone. The findings suggest that weight loss, rather than the timing of food intake, is more closely associated with reductions in liver fat.

Time Restricted Eating and Liver Outcomes

Researchers investigated whether early, late, or self-selected TRE offered additional benefits when combined with a Mediterranean diet-based education programme.

The study included 197 adults, half of whom were women, who were randomly assigned to usual care, early, late or self-selected TRE for 12 weeks.

Hepatic fat fraction was assessed using MRI, while liver health was evaluated using elastography based parameters, liver enzymes, and circulating biomarkers. Faecal microbiota composition was analysed using 16S ribosomal RNA gene sequencing.

Within each of the three TRE groups, hepatic fat fraction decreased significantly across the intervention period, with all comparisons reaching statistical significance: P≤0.02. However, no significant differences were observed when comparing any of the TRE groups with usual care. Mean differences were: early TRE (-0.4%; p=0.95); late TRE (-1.5%; p=0.15); self-selected TRE (-0.7%; p=0.77). No significant differences were identified between the three TRE approaches: all p≥0.41.

Weight Loss Drives Hepatic Fat Reduction

The data indicated that participants with MASLD at baseline experienced greater reductions in hepatic fat fraction than those without the condition (mean difference: -2.7%; p<0.001). Similarly, participants achieving at least 5% weight loss demonstrated larger reductions than those who did not (mean difference: -2.6%; p<0.001).

Although liver outcomes were comparable between groups, a substantially greater proportion of participants assigned to time restricted eating achieved at least 5% weight loss compared with those receiving usual care (41-44% versus 16%; p=0.001).

Clinical Implications for Practice

No intergroup differences were observed in liver health markers or faecal microbiota composition, suggesting that altering the timing of the eating window did not provide measurable advantages beyond those associated with weight loss. The investigators noted that the study was not powered for secondary outcomes.

The findings support prioritising practical dietary strategies that help patients achieve clinically meaningful weight loss rather than focusing on a specific eating schedule. This approach may be particularly relevant for patients with metabolic dysfunction associated steatotic liver disease, who appeared to derive the greatest reductions in hepatic fat fraction during the study.

Reference

Dote-Montero M et al. Time-restricted eating, liver health, and fecal microbiota in adults with overweight or obesity: a randomized controlled trial. JHEP Rep. 2026;DOI:10.1016/j.jhepr.2026.101956

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