Early, midday, and late time-restricted eating impact on anthropometry and cardiometabolic health: a network meta-analysis of RCTs

ObjectiveThis network meta-analysis (NMA) evaluates the physiological effects of early time-restricted eating (eTRE), midday TRE (mTRE), and late TRE (lTRE), with and without exercise (EX), calorie restriction (CR), and control on anthropometric and metabolic indices in adults with cardiometabolic risk factors.MethodsA comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and Embase up to April 24, 2025. A Bayesian NMA was performed. Treatment effects were expressed as mean differences (MD) with 95% credible intervals (CrI). Intervention rankings were assessed using the surface under the cumulative ranking curve (SUCRA). Certainty of evidence was evaluated using the GRADE approach.ResultsThirty-nine randomized controlled trials including 3,236 participants were analyzed. Most interventions, except mTRE + EX, reduced anthropometric measures compared with control. eTRE reduced fasting blood glucose (MD −3.64 mg/dL, 95% CrI −5.93 to −1.36) and HOMA-IR (MD −0.42, 95% CrI −0.83 to −0.03), compared with control group. eTRE + EX reduced HOMA-IR (MD −1.33, 95% CrI −2.58 to −0.08). Across outcomes, eTRE + EX and eTRE consistently ranked highest according to SUCRA. Certainty of evidence ranged from very low to moderate for most anthropometric and metabolic outcomes.ConclusionAlthough clear differences between TRE patterns and CR were limited, consistent SUCRA rankings favored eTRE, particularly when combined with exercise, which may suggest a potential role of meal timing in metabolic regulation. However, these rankings should be interpreted cautiously, as they were based on a limited number of trials, and the certainty of evidence ranged from very low to moderate for most outcomes.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251018349.