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CompletedNCT03459703Updated Jul 8, 2020

Effect of Time-Restricted Feeding on Fat Loss and Cardiometabolic Risk Factors in Overweight Adults

An interventional study of Early Time-Restricted Feeding and Control Schedule in Obesity, sponsored by University of Alabama at Birmingham. Completed at 1 site in United States. Open to participants aged 25 Years to 75 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2020-07-08.

Sponsored by University of Alabama at Birmingham · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
90
Allocation
Randomized
Ages
25 Years to 75 Years
Sex
All
01

Study summary

Time-restricted feeding (TRF) is a novel type of intermittent fasting that involves eating within a daily period of 10 hours or less, followed by fasting for at least 14 hours daily. Several studies in rodents report that TRF reduces body weight, improves blood sugar control, and reduces the risk of cardiovascular disease-even when food intake is matched to the control group or no weight loss occurs. Preliminary evidence suggests that TRF may also increase weight loss, fat loss, and reduce the risk of diabetes and cardiovascular disease in humans. This study will test whether TRF enhances fat loss and increases weight loss in adults with obesity, relative to conventional dieting alone. In addition, this study will determine whether TRF reduces risk factors for type 2 diabetes and cardiovascular disease and will measure the feasibility and acceptability of TRF.

In conjunction with the parent study described above, four ancillary studies will be conducted:

  1. Effect of weight loss on nitrogen metabolism and bacteria in the mouth. The primary endpoints for this ancillary study are plasma and salivary nitrate and nitrite, and the secondary endpoints are salivary nitrate reductase activity and salivary bacterial abundance.
  2. Effect of weight loss on several biomarkers related to kidney stones. The primary endpoint for this ancillary study is urinary oxalate, and the secondary endpoints are urinary citrate, chloride, sodium, potassium, calcium, phosphorus, uric acid, and creatinine.
  3. Effect of meal timing on blood pressure regulation and kidney function. The primary endpoints of this ancillary study include urinary aldosterone excretion, sodium, potassium, and endothelin, whereas the secondary endpoints include nitric oxide and albumin. Additional exploratory endpoints include renal injury markers (KIM-1, nephrin, and urine albumin-to-creatinine ratio), measures of reactive oxidative stress (e.g., hydrogen peroxide and TBARs), and urinary exosomes. Urine will be analyzed in 12-hour bins to determine how meal timing affects differentially affects these endpoints during the daytime and nighttime. The effects of weight loss on these endpoints may also be considered.
  4. Validation of a meal timing questionnaire to assess the distribution of food intake throughout the day.
02

Conditions studied

  • Obesity

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03

Who can participate

Ages eligible
25 Years to 75 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • Are a new patient at the UAB Weight Loss Medicine Clinic
  • Aged 25-75 years old
  • BMI between 30-60 kg/m2 (inclusive)
  • Weigh less than 450 lbs
  • Wake up regularly between 4-9 am on most days.

Exclusion criteria

Exclusion Criteria:

  • Diagnosed with diabetes, have an HbA1c of ≥6.5%, or are on diabetes medication
  • On weight loss medication
  • Addition of or withdrawal from a chronic medication within the past 10 weeks
  • Clinically significant laboratory abnormality (e.g., abnormal hemoglobin levels)
  • Significant gastrointestinal disease, major gastrointestinal surgery, or gallstones
  • Significant cardiovascular, renal, cardiac, liver, lung, adrenal, or nervous system disease that might compromise the participant's safety or data validity
  • Evidence of cancer (other than non-melanoma skin cancer) within the last 5 years
  • Unstable psychiatric, sleep, or circadian conditions (common conditions such as sleep apnea and depression are acceptable as long as they are stabilized and not rapidly worsening)
  • Lost or gained more than 5 lbs of weight in the past month
  • Currently perform overnight shift work more than once per week on average
  • Regularly eat within a less than 10-hour period each day
  • Regularly eat dinner before 6 pm
  • Traveled more than two time zones away in the two months prior to enrolling in the trial
  • Will travel more than one time zone away during the study
  • Pregnant or breastfeeding
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
90 participants (actual)

Study arms

  • Experimental
    Early Time-Restricted Feeding

    Behavioral: Early Time-Restricted Feeding · Behavioral: Structured Weight Loss Program

  • Active comparator
    Control Schedule

    Behavioral: Control Schedule · Behavioral: Structured Weight Loss Program

Interventions

  • BehavioralEarly Time-Restricted Feeding

    Eat all meals between 7 am - 3 pm for an average of ≥6 days per week.

    Also known as: Early TRF, eTRF

  • BehavioralControl Schedule

    Eat all meals over a 12-hour or longer period for an average of ≥6 days per week.

  • BehavioralStructured Weight Loss Program

    A structured weight loss program with physical activity recommendations and dietary counseling.

05

What researchers measure

Primary outcomes

  1. Fat loss and lean mass retention

    Percent of weight lost as fat, as measured by dual-energy X-ray absorptiometry (DXA). Lean mass retention will be quantified as 100% minus percent of weight lost as fat (i.e., is measured in the same units).

    Time frame: 14 weeks

  2. Weight loss

    Change in body weight (kg), as measured by scale weight

    Time frame: 14 weeks

  3. Absolute changes in body composition

    Changes in total fat mass, lean mass, bone mass, and regional values (kg), as measured by DXA. (This will be secondary to the assessment of fat loss and lean mass retention as specified above.)

    Time frame: 14 weeks

Secondary outcomes

  1. Fasting glucose

    Fasting glucose (mg/dl)

    Time frame: 14 weeks

  2. Fasting insulin

    Fasting insulin (IU/L)

    Time frame: 14 weeks

  3. HbA1c

    HbA1c (%)

    Time frame: 14 weeks

  4. Lipids

    Total cholesterol (mg/dl), LDL cholesterol (mg/dl), HDL cholesterol (mg/dl), and triglycerides (mg/dl)

    Time frame: 14 weeks

  5. Blood pressure

    Systolic and diastolic blood pressure (mm Hg)

    Time frame: 14 weeks

  6. Heart rate

    Heart rate in beats per minute

    Time frame: 14 weeks

  7. Waist circumference

    Waist circumference (cm)

    Time frame: 14 weeks

Other outcomes

  1. Appetite

    Hunger and fullness as measured by Likert (1-5 scale) and visual analog scales (a 0-100 scale, with 0 meaning "Not at all" and 100 meaning "Extremely")

    Time frame: 14 weeks

  2. Food intake

    Energy intake and food intake in kcal/day, as measured using Remote Food Photography Method (RFPM)

    Time frame: 14 weeks

  3. Macronutrient intake

    % of calories as fat, carbohydrate, and protein, as measured using RFPM

    Time frame: 14 weeks

  4. Meal frequency

    Number of meals and snacks per day, as measured using RFPM

    Time frame: 14 weeks

  5. Meal times

    Clock times of meals and snacks, as measured using RFPM

    Time frame: 14 weeks

  6. Times of eating

    Start and stop times and mid-points of daily eating in clock time, as assessed by the daily adherence survey

    Time frame: 14 weeks

  7. Duration of daily eating

    Average duration of the daily eating period (hours), as measured by the daily adherence survey

    Time frame: 14 weeks

  8. Distribution of food intake across the daytime

    Distribution of calories eaten across the day in % per time period, as measured by a novel questionnaire that is being validated

    Time frame: 14 weeks

  9. Breakfast and nighttime eating habits

    Presence and degree of breakfast and nighttime eating, as measured by a novel questionnaire that is being validated

    Time frame: 14 weeks

  10. Adherence

    Self-reported adherence rate in days per week

    Time frame: 14 weeks

  11. Reasons for non-adherence

    Reasons for non-adherence, as measured by the daily adherence survey

    Time frame: 14 weeks

  12. Retention

    Attrition rate (%)

    Time frame: 14 weeks

  13. Depression

    Depression as measured by the Patient Health Questionnaire-9. (Each question is scored on a 0-3 scale, where 0 means "Not at all" and 3 means "Nearly every day." Answers to each question are tallied to create a single composite score of depression from 0-27, with higher values meaning more depressive symptoms.)

    Time frame: 14 weeks

  14. Mood states

    Mood states as measured by the Profile of Mood States (a 5-point scale with 1 meaning "Not at all" and 5 meaning "Extremely"). This study is particularly interested in the scores for anxiety and related moods.

    Time frame: 14 weeks

  15. Chronotype

    Chronotype/mid-point of sleep (in clock time), as measured by the Munich Chronotype Questionnaire

    Time frame: 14 weeks

  16. Stimulant usage

    Stimulant usage, as measured by the Munich Chronotype Questionnaire (in "servings" per time)

    Time frame: 14 weeks

  17. Sleep duration

    Sleep duration, as measured by the Pittsburgh Sleep Quality Index

    Time frame: 14 weeks

  18. Sleep quality

    Sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PQSI) (This study will use the Global PQSI score, which ranges from 0-21, where higher values correspond to worse sleep quality.)

    Time frame: 14 weeks

  19. Eating Behaviors

    Restrained, emotional, and external eating, as measured by the Dutch Eating Behavior Questionnaire. (Individual questions are scored on a 5-point scale ranging from "Never" to "Very often," and composite scores for restrained, emotional, and external eating are tabulated, with higher numbers reflecting more of each trait.)

    Time frame: 14 weeks

  20. Loneliness

    Loneliness, as measured by the UCLA Loneliness Scale (a 3-point scale with 1 meaning "hardly ever" and 3 meaning "often")

    Time frame: 14 weeks

  21. Intervention satisfaction

    Intervention satisfaction and barriers and facilitators of adherence, as measured by qualitative exit interview

    Time frame: 14 weeks

  22. Social life and daily habits

    Social life and daily habits, as measured by the frequency of occurrence of social activities (5- and 8-point rating scales)

    Time frame: 14 weeks

  23. Physical activity

    Physical activity status, as measured by the Baecke Physical Activity questionnaire

    Time frame: 14 weeks

  24. Plasma and salivary nitrate and nitrite

    Plasma and salivary nitrate and nitrite (nM)

    Time frame: 14 weeks

  25. Salivary nitrate reductase activity

    Salivary nitrate reductase activity (nmol / min / colony forming unit) in tongue swab samples

    Time frame: 14 weeks

  26. Salivary bacterial abundance

    Salivary bacterial abundance (colony forming units) in tongue swab samples

    Time frame: 14 weeks

  27. 24-hour urinary oxalate, citrate, sodium, calcium, chloride, potassium, and creatinine

    24-hour urinary oxalate, citrate, sodium, calcium, chloride, potassium, and creatinine, as measured in mg/day

    Time frame: 14 weeks

  28. 24-hour urinary phosphorus and uric acid

    24-hour urinary phosphorus and uric acid, as measured in g/day

    Time frame: 14 weeks

  29. 24-hour urinary aldosterone excretion

    24-hour urinary aldosterone excretion (µg/12 hr)

    Time frame: 14 weeks

  30. 12-hour urinary sodium and potassium

    12-hour urinary sodium and potassium (mmol/12 hr)

    Time frame: 14 weeks

  31. 12-hour urinary endothelin

    12-hour urinary endothelin (ng/12 hr)

    Time frame: 14 weeks

  32. 12-hour urinary nitric oxide

    12-hour urinary nitric oxide (mmol/12 hr)

    Time frame: 14 weeks

  33. 12-hour urinary albumin

    12-hour urinary albumin (mg/12 hr)

    Time frame: 14 weeks

  34. 12-hour urinary KIM-1

    12-hour urinary KIM-1 (pg/g creatinine or pg/12 hr)

    Time frame: 14 weeks

  35. 12-hour urinary nephrin

    12-hour urinary nephrin (ng/g creatinine or ng/12 hr)

    Time frame: 14 weeks

  36. 12-hour albumin-to-creatinine ratio

    12-hour albumin-to-creatinine ratio

    Time frame: 14 weeks

  37. 12-hour urinary reactive oxidative stress

    12-hour urinary hydrogen peroxide and TBARs (µmol/g creatinine or µmol/12 hr)

    Time frame: 14 weeks

  38. Urinary exosomes

    Urinary exosomes (particles/ml)

    Time frame: 14 weeks

06

Study locations

1 site
  • UAB Weight Loss Medicine Clinic
    Birmingham, Alabama 35205, United States
07

References and documents

Publications

  • Jamshed H, Steger FL, Bryan DR, Richman JS, Warriner AH, Hanick CJ, Martin CK, Salvy SJ, Peterson CM. Effectiveness of Early Time-Restricted Eating for Weight Loss, Fat Loss, and Cardiometabolic Health in Adults With Obesity: A Randomized Clinical Trial. JAMA Intern Med. 2022 Sep 1;182(9):953-962. doi: 10.1001/jamainternmed.2022.3050. PubMed 35939311 ↗
  • Allaf M, Elghazaly H, Mohamed OG, Fareen MFK, Zaman S, Salmasi AM, Tsilidis K, Dehghan A. Intermittent fasting for the prevention of cardiovascular disease. Cochrane Database Syst Rev. 2021 Jan 29;1(1):CD013496. doi: 10.1002/14651858.CD013496.pub2. PubMed 33512717 ↗
08

Registry details

Key details

Study ID
NCT03459703
Lead sponsor
University of Alabama at Birmingham
Responsible party
Courtney M Peterson (Assistant Professor, University of Alabama at Birmingham) — Principal investigator
First posted
Mar 9, 2018
Start date
Jul 12, 2018
Primary completion
Apr 30, 2020
Completion
Apr 30, 2020
Last update
Jul 8, 2020

Study contacts

Courtney M Peterson, Ph.D.
principal investigator · University of Alabama at Birmingham

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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