Letter: Clarifying the Synergistic Mechanisms of Mediterranean Diet and Time-Restricted Feeding in MASLD Management—Authors' Reply

We sincerely thank Drs. Zhu and Zhou [1] for their thoughtful comments on our recent randomised study examining the effects of a 12-week Mediterranean-type time-restricted feeding (TRF) protocol in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) [2].

Our study is distinguished by the use of a hypocaloric Mediterranean diet as the control group, which has emerged as the gold standard for MASLD dietary management. This aligns with current recommendations emphasising lifestyle changes and a target weight loss of over 5% of initial body weight as primary treatment goals [3, 4]. Previous studies have shown that ad libitum TRF can lead to modest weight loss (1%–4%), while greater, clinically significant reductions typically require caloric restriction [5]. Therefore, combining TRF with a structured hypocaloric approach offers a promising avenue, as demonstrated by improvements in key metabolic parameters in our trial and others [2, 6].

We appreciate the pertinent questions raised regarding the underlying mechanisms and impact in specific sub-groups of such dietary interventions [1]. As pointed out in our original article [2], further research is needed to explore these complex interactions. Although a single clinical trial cannot address all knowledge gaps, we believe that our study lays the groundwork for future investigations in this scientific area. Ongoing planned analyses from our clinical trial may give insight into the field of circadian rhythms.

The authors' declarations of personal and financial interests are unchanged from those in the original article [2].

Sofia Tsitsou: writing – original draft, investigation, methodology, data curation. Magdalini Adamantou: writing – original draft, data curation, investigation. Triada Bali: investigation, data curation. Aristi Saridaki: data curation, investigation. Kalliopi-Anna Poulia: methodology. Dimitrios S. Karagiannakis: methodology. Emilia Papakonstantinou: writing – review and editing, methodology. Evangelos Cholongitas: conceptualization, investigation, methodology, writing – review and editing, project administration, supervision, visualization, writing – original draft.

This article is linked to Tsitsou et al. paper. To view this article, visit, https://doi.org/10.1111/apt.70044 and https://doi.org/10.1111/apt.70154.