Chrononutrition/ Chronotoxicity Intervention in People With Metabolic-associated Steatotic Liver Disease.

NCT ID: NCT06705868

Last Updated: 2025-11-19

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 150 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2026-01-05
• Study Completion Date: 2029-12-15

Brief Summary

The goal of this clinical trial is to study the effect of a time-restricted eating (TRE) dietary pattern combined with a time of consumption restriction about the daily portions of fruits and vegetables in people diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD).

The protocol of the study is an intention to treat protocol. The main research questions are:

1. Does compliance in a TRE dietary scheme (positively) affect changes in body weight and body fat mass in people diagnosed with MASLD?

2. Does an additional time restriction on the consumption of fruits and vegetables within the "light-window" of the day affects the metabolism of food contaminants?

Participants will be asked to:

1. Adhere to a TRE dietary pattern for 3 months. TRE consists of an 8-hour eating vs 16 hours fasting within the day. First meal of the day should not occur at least an hour after wake-up time and last meal of the day should occur not later than 2 hours before bed-time.

2. Adhere to a further time restricted consumption of a "5-a-day" portions of fruits and vegetables between the "light-window hours" between 9am to 4pm.

3. Visit the Nutrition & Dietetics Clinic once every month for anthropometric measurements (on 4 time points).

4. Collect and deliver first morning urine samples (on 7 time points).

5. Collect and deliver saliva samples at baseline and at the end of the trial (Saliva collection should occur every 4-hours for 48-hours including fasting collection at baseline and at the end of three months)

5) Complete a compliance and lifestyle questionnaire questionnaire via telephone interview to the research team every 2 weeks.

6) Share photos to the research team with the use of an application on time of actual fruit and vegetables consumption, 3-4 times per week throughout the study protocol.

Researchers will compare the designed intervention package of this TRE with the Standard of Care (SoC) protocol (based on the international guidelines) that is currently used in daily practice for the management of MASLD.

Detailed Description

This parallel-arm, randomized controlled trial (RCT) will study the effects of an ad libitum TRE dietary pattern (8 hours eating, 16 hours fasting) with an additional restriction regarding the fruit and vegetable consumption on health parameters, pesticide metabolism and concomitant toxicity in MASLD patients compared with the Standard of Care (SoC) approach, that will serve as the control group. Participants will be asked to consume all meals/snacks during the 8 hours daily period that they will select for themselves without any further dietary advice regarding caloric or other macronutrient intake. However, participants will be instructed that their first meal of the day should not start for at least an hour after wake-up hour and will also be asked to have their last meal at least 2 hours earlier than bedtime (actual time of sleep). Additionally, participants will have to consume 5 portions (400g) of fruits and vegetables within time-window for fruit & vegetable consumption earlier in the day; from 9am to 4pm.

Non-caloric beverage consumption (water, black coffee, unsweetened tea, non-sweetened beverages) will be allowed within the restricted hours of the intervention.

Participants allocated in the SoC group (control) will receive oral and written SoC lifestyle advice from a registered dietitian. The SoC advice is based on the EASL/EASD/EASO joint Clinical Practice Guidelines for the management of MASLD. Patients will receive guidance on a) energy restriction, b) weight reduction, c) the macronutrient composition of the diet, d) limitation of alcohol intake (below the risk threshold of 30g/d and 20g/day for men and women, respectively) and e) increase their physical activity levels. Additionally, in this study patients will be asked to consume standard "5-a-day" portions of fruits and vegetables daily, as part of their dietary healthier behaviour.

Conditions

MASLD; MASLD - Metabolic Dysfunction-Associated Steatotic Liver Disease; NAFLD; NAFLD - Non-Alcoholic Fatty Liver Disease; NAFLD (Nonalcoholic Fatty Liver Disease)

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Standard of Care (Group A-Control)

Participants in Group A will follow a Standard of Care Intervention. They will receive guidance on a) energy restriction, b) weight reduction, c) the macronutrient composition of the diet, d) limitation of alcohol intake (below the risk threshold of 30g/d and 20g/day for men and women, respectively) and e) increase their physical activity levels. Additionally, in this study patients will be asked to consume the general recommendation of "5-a-day" as part of their dietary healthier behaviour. Moreover, participants should stay well hydrated and get adequate of sleep (an average of 6 consecutive hours at night). Oral and written guidance for the management of MASLD will be administered. The duration of the intervention is 3 months.

Group Type: OTHER

Lifestyle Management

Intervention Type: OTHER

The SoC intervention refers to an adaptation of a healthier lifestyle in elements that have to do with weight management, adopting healthier dietary habits, alcohol intake reduction, increase physical activity levels, in people diagnosed with MASLD.

Time-restricted eating (Group B-Intervention)

Participants will have to adhere to an ad libitum TRE dietary pattern (8 hours eating, 16 hours fasting) with an additional dietary restriction regarding the "5-a-day" fruit and vegetable in which they will need to be consumed between 9am-4pm. Some more restrictions regarding first and last meal will be asked. Participants will be instructed that their first meal of the day should not start for at least an hour after wake-up hour and will also be asked to have their last meal at least 2 hours earlier than bedtime (actual time of sleep). The duration of the intervention is 3 months.

Group Type: EXPERIMENTAL

Diet-Time-restricted eating (TRE)

Intervention Type: OTHER

Ad libitum time-restricted scheme with a further time-restriction on fruit and vegetable consumption in participants with MASLD

Interventions

Diet-Time-restricted eating (TRE)

Ad libitum time-restricted scheme with a further time-restriction on fruit and vegetable consumption in participants with MASLD

Intervention Type: OTHER

Lifestyle Management

The SoC intervention refers to an adaptation of a healthier lifestyle in elements that have to do with weight management, adopting healthier dietary habits, alcohol intake reduction, increase physical activity levels, in people diagnosed with MASLD.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. Body mass index 25 (±0,5)-45(±0,5) kg/m2

2. Clinical diagnosis of MASLD, not excluding undiagnosed NASH or with NASH stage F0-F1

3. Self-reported habitual eating period more than or equal to 14 h per day, BUT NOT LESS.

4. Cyprus inhabitants of for at least 1 year

5. Registered to the National Health System of the Republic of Cyprus (Gesy

Exclusion Criteria

1. Night Shift worker

2. Fasting >12-h/day more than once a week or > once a week no food intake after 18:00

3. Co-existing causes of chronic liver disease according to standard diagnostic testing including, but not restricted to:

1. Positive hepatitis B surface antigen

2. Positive hepatitis C virus RNA

3. Suspicion of drug-induced liver disease

4. Alcoholic liver disease

5. Autoimmune hepatitis

6. Wilson's disease

7. Hemochromatosis

8. Primary biliary cholangitis or primary sclerosing cholangitis

9. Known or suspected hepatocellular carcinoma

4. Medications which cause liver disease or secondary hepatic steatosis (Tamoxifen, systemic corticosteroids, methotrexate, tetracycline, estrogens, valproic acid, and statin (registration is possible if statin is delivered in a consistent dosage within 12 weeks)

5. Current or recent history (<5 years) of significant alcohol intake (>30g of alcohol/ day or >210g/week for men, >20g of alcohol/day or >140g/week for women)

6. Doctor diagnosed diabetes mellitus on insulin or sulfonylureas

7. Severe medical comorbidities [ischemic heart disease, 3rd degree atrioventricular block, chronic obstructive pulmonary disease, severe hypertension (blood pressure >200/120 mmHg)]

8. Unstable weight (>5% change in the last 2 months) or participation in a weight-loss program within the past 12 weeks

9. Sleep disorder (with a medical diagnosis) or individuals self-reporting sleep difficulties and poor sleep [average sleep less than 6 consecutive hours or patients who systematically experience sleep interruption for more than 2 times each night (waking up for toilet use is not to be considered sleep interruption)]

10. Individuals with food allergies (or hypersensitivity to the fruits and vegetables that will be selected for the study)

11. Systematic organic products consumers (defined as a self-reported usual consumption of more than 80% of their weekly fruits & vegetables being organic)

12. Pregnant or trying to become pregnant or lactating women

13. People not in position to communicate in Greek or English language

14. Having metallic parts in the body.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 70 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Cyprus State Heath Organization Services

UNKNOWN

Sponsor Role: collaborator

Cyprus University of Technology

OTHER

Sponsor Role: lead

Responsible Party

Konstantinos Makris

Professor of Environmental Health

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Limassol General Hospital

Limassol, , Cyprus

Countries

Cyprus

Central Contacts

Konstantinos C. Makris, Professor

Role: CONTACT

konstantinos.makris@cut.ac.cy

0035725002398

Elina I Ioannou

Role: CONTACT

elii.ioannou@edu.cut.ac.cy

Facility Contacts

Elina Ioannou, Dietitian-Public Health Nutritionist

Role: primary

elii.ioannou@edu.cut.ac.cy

+35799688943 ext. +35725801124

Other Identifiers

CHRONOMASLD

Identifier Type: -

Identifier Source: org_study_id