首都医科大学附属北京友谊医院 普外科中心减重与代谢外科，北京 100050
Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
背景与目的 减重与代谢手术是治疗中重度肥胖症和病理性肥胖症最有效的治疗手段，但减重手术有着严格的手术适应证，部分未达手术指征的患者也需要一种可行且有效的减重方式。超级肥胖患者直接进行减重手术的风险显著增高，此类患者同样需要一种易接受且效果确切的减重方式进行术前预减重以降低手术风险。限时饮食干预（TRE）是一种基于昼夜节律的减重和治疗代谢疾病的新兴策略，有希望成为减重手术的有力补充，但目前缺乏TRE对体质量、身体成分以及机体代谢影响的全面评估。因此，本研究通过Meta分析系统评价TRE对体质量、身体成分和机体代谢参数的影响，为临床决策提供依据。方法 检索PubMed、Web of Science、EMBASE、CNKI、万方数据库中有关TRE对体质量、身体成分以及机体代谢的影响的随机对照研究，检索时间为自建库起至2022年4月1日。由2名研究者独立筛选文献、提取资料并对纳入文献进行质量评价，采用Stata 17.0软件进行Meta分析。结果 共纳入14篇文献，共587例受试者。Meta分析的结果显示，与不限制热量的正常饮食的个体比较，采用TRE后的个体的体质量（WMD=-2.40，95% CI=-3.52~-1.29，P<0.001）及脂肪重量（WMD=-1.48，95% CI=-2.26~-0.69，P<0.001）明显减轻，甘油三酯水平下降（WMD=-8.42，95% CI=-13.69~-3.15，P=0.002），而非脂肪重量、空腹血糖、收缩压、舒张压、总胆固醇、高密度脂蛋白及低密度脂蛋白等指标差异无统计学意义（均P>0.05）。结论 TRE是一种有效的减重治疗方法，可明显降低体质量，并以降低脂肪质量为主，对非脂肪质量无明显影响，同时有助于甘油三酯水平的改善，可作为减重手术的有力补充。受所纳入的研究数量与质量限制，上述结论仍需更多高质量研究予以验证。
Background and Aims Bariatric and metabolic surgery is the most effective treatment modality for moderate to severe obesity and pathological obesity, but there are strict surgical indications for bariatric surgery, and a feasible and effective approach for weight loss is also needed for some patients who do not meet the surgical criteria. The risk of bariatric surgery is significantly increased for super-obese patients. Such patients also need an acceptable and efficacious approach to lose weight before surgery to reduce the risk of surgery. Time-restricted eating (TRE) is a new strategy for weight loss and treatment of metabolic diseases based on circadian rhythm, which is expected to be a powerful supplement to bariatric surgery. However, there is no comprehensive assessment of the impact of TRE on weight, body composition, and metabolism. Therefore, this study was conducted to evaluate the effects of TRE on weight, body composition, and body metabolic parameters through systematic review and Meta-analysis to provide evidence-based medical information for clinical decision-making.Methods The randomized controlled studies regarding the effects of TRE on body weight, body composition, and body metabolism were searched in the PubMed, Web of Science, EMBASE, CNKI, and Wanfang databases. The retrieval time was from the inception of the database to April 1, 2022. After the literature screening, data extraction, and assessment of the bias risk of the included studies by two independent researchers, Meta-analysis was performed using Stata 17.0 software.Results A total of 14 studies with 587 subjects were included. The results of the Meta-analysis showed that in the individuals after TRE intervention versus those with a calorically unrestricted normal diet, the weight (WMD=-2.40, 95% CI=-3.52--1.29, P<0.001) and fat mass (WMD=-1.48, 95% CI=-2.26--0.69, P<0.001) were significantly reduced, and the concentration of triglyceride (WMD=-8.42 mg/dL, 95% CI=-13.69--3.15, P=0.002) was decreased; however, there were no significant differences in fat-free mass, fasting glucose, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein, and low-density lipoprotein (all P>0.05).Conclusion TRE is an effective weight-loss treatment, which yields significant weight loss with a main effect on fat mass reduction and no significant influence on fat-free mass, and meanwhile is helpful for improving the triglyceride levels. It may be used as a powerful supplement to bariatric surgery. However, the above conclusion still needs to be verified by more high-quality studies due to the limitations in the number and quality of the included studies.