Abstract / Summary
Abstract Background Time-restricted feeding (TRF) may provide metabolic benefits for women with polycystic ovary syndrome (PCOS), but longitudinal adherence patterns and their associations with clinical outcomes remain unclear. We characterized TRF adherence over time and examined its relationships with body weight and metabolic and reproductive outcomes. Methods: Thirty-six PCOS patients with hyperinsulinemic-euglycemic clamp-confirmed IR underwent a 20-week 8-h TRF (30 completed). Anthropometric, metabolic, reproductive endocrine, and mental health outcomes were assessed before and after the intervention, TRF adherence was recorded weekly. Segmented regression assessed temporal adherence patterns, and linear mixed-effects models evaluated associations between adherence and weight trajectories. Participants subsequently entered a 1-year unsupervised follow-up. Results TRF significantly reduced body weight (-8.42%) and improved insulin sensitivity (elevated GDR, decreased HOMA-IR). Menstrual regularity improved in 83.3%, optimized reproductive hormones (increased SHBG; decreased TT, FAI, LH, LH/FSH and AMH). Improvements were also observed in CRP, hepatic metabolic burden (ALT, AST, GGT, TC, TG, LDL-C) and potentially anxiety, depression, and sleep quality. Mean adherence was 5.45 ± 0.74 days/week. A change point occurred at week 11; adherence was stable beforehand (slope, -0.019 days/week; P =0.265) but declined thereafter (-0.137 days/week; P <0.001). Greater weekly adherence was associated with more favorable weight trajectories (week-by-adherence β =-0.0368 kg/week per additional adherent day; 95% CI -0.0503 to -0.0234; P <0.001), with consistent sensitivity analyses. Associations between mean adherence and changes in several metabolic or reproductive outcomes were not evident. During follow-up, 11 participants continued TRF, and three with pregnancy intentions conceived spontaneously and delivered at term. No significant adverse events occurred. Conclusions TRF improved weight, insulin sensitivity, metabolic parameters, and reproductive endocrine profiles in PCOS with IR. Adherence varied over time, and greater weekly adherence was associated with favorable weight trajectories. Long-term TRF management should emphasize adherence monitoring and support. Larger controlled studies should confirm long-term metabolic and reproductive benefits. Trial registration Chinese Clinical Trial Registry, ChiCTR2300077501, registered November 10, 2023, https://www.chictr.org.cn/bin/project/edit?pid=196341