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Change in waist circumference
Time frame: At 0 (baseline), 2, 5, 8, 14, 20 and 26 months.
Measurements will be taken using the same model of standardized soft measuring tape.
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Change in hip circumference
Time frame: At 0 (baseline), 2, 5, 8, 14, 20 and 26 months.
Measurements will be taken using the same model of standardized soft measuring tape.
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Change in body composition
Time frame: At 0 (baseline), 2, 5, 8, 14, 20 and 26 months.
The body composition of patients will be measured using the InBody570 bioelectrical impedance analyzer, assessing key parameters (e.g., body mass index [BMI], fat mass [FM], fat-free mass [FFM], skeletal muscle mass [SMM], visceral fat area [VFA], total body water [TBW], extracellular water [ECW], intracellular water [ICW], basal metabolic rate [BMR], waist-hip ratio [WHR], and phase angle [PhA]).
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Change in blood pressure (systolic pressure and diastolic pressure)
Time frame: At 0 (baseline), 2, 5, 8, 14, 20 and 26 months.
Measurements will be taken using the same brand and model of precision blood pressure monitor.
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Change in heart rate
Time frame: At 0 (baseline), 2, 5, 8, 14, 20 and 26 months.
Measurements will be taken using the same brand and model of precision blood pressure monitor.
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Change in handgrip strength
Time frame: At 0 (baseline), 2, 5, 8, 14, 20 and 26 months.
The handgrip strength of patients will be assessed using handgrip dynamometers of the same brand and model.
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Changes in blood transcriptomics
Time frame: At 0 (baseline), 2, 8 and 14 months.
Transcriptomic sequencing will be performed on blood samples collected from the patients to observe changes in blood transcriptional levels.
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Changes in metabolomics in serum and feces
Time frame: At 0 (baseline), 2, 8 and 14 months.
Metabolomic sequencing will be performed on serum and fecal samples collected from the patients to observe changes in metabolic levels.
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Change in quality of sleep measured by the Pittsburgh Sleep Quality Index (PSQI)
Time frame: At 0 (baseline), 2, 5, 8, 14, 20 and 26 months.
The sleep quality of each patient will be evaluated by the Pittsburgh Sleep Quality Index (PSQI), with scores ranging from 0 to 21, with higher scores indicating poorer sleep quality
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Change in appetite states measured by the Electronic Visual Analogue Scale (eVAS)
Time frame: At 0 (baseline), 2, 5, 8, 14, 20 and 26 months.
Subjective appetite states were assessed using the Electronic Visual Analogue Scale (eVAS), with scores ranging from 0 to 100 for each dimension (hunger, fullness, desire to eat, and estimated food intake). Higher scores indicate stronger sensations.
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The DISC Personality Assessment
Time frame: At 0 (baseline)
The DISC Personality Assessment evaluates four dimensions: Dominance (D), Influence (I), Steadiness (S), and Conscientiousness (C), with higher scores indicating stronger behavioral tendencies in each domain.
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Change in quality of life measured by the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) Questionnaire
Time frame: At 0 (baseline), 2, 8, 14 and 26 months.
Health-related quality of life was assessed using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, with scores ranging from 0 to 100 across five domains (Physical Function, Self-Esteem, Sexual Life, Public Distress, and Work Life). Higher scores indicate better weight-related quality of life.
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Change in fasting blood glucose
Time frame: At 0 (baseline), 2, 8 and 14 months.
Blood samples from the patients will be tested for fasting blood glucose levels.
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Change in fasting insulin
Time frame: At 0 (baseline), 2, 8 and 14 months.
Blood samples from the patients will be tested for fasting insulin levels.
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Change in glycated hemoglobin (HbA1c)
Time frame: At 0 (baseline), 2, 8 and 14 months.
Blood samples from the patients will be tested for glycated hemoglobin (HbA1c) levels.
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Change in serum creatinine level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum creatinine level will be measured from blood samples using an enzymatic method. Results will be reported in micromoles per liter (μmol/L).
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Change in blood urea nitrogen level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Blood urea nitrogen level will be measured from blood samples using the urease method. Results will be reported in millimoles per liter (mmol/L).
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Change in serum uric acid level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum uric acid level will be measured from blood samples using the uricase-ultraviolet method. Results will be reported in micromoles per liter (μmol/L).
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Change in serum Alanine Aminotransferase (ALT) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum alanine aminotransferase (ALT) level will be measured from blood samples using a rate method. Results will be reported in units per liter (U/L).
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Change in serum Aspartate Aminotransferase (AST) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum aspartate aminotransferase (AST) level will be measured from blood samples using a rate method. Results will be reported in units per liter (U/L).
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Change in Aspartate aminotransferase to Alanine aminotransferase ratio (AST/ALT)
Time frame: At 0 (baseline), 2, 8 and 14 months.
The AST/ALT ratio (De Ritis ratio) will be calculated from the measured values of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Results will be reported as a ratio.
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Change in serum Gamma-Glutamyl Transferase (GGT) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum gamma-glutamyl transferase (GGT) level will be measured from blood samples using a rate method. Results will be reported in units per liter (U/L).
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Change in serum Total Protein (TP) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum total protein (TP) level will be measured from blood samples using the biuret method. Results will be reported in grams per liter (g/L).
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Change in serum Albumin (ALB) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum albumin (ALB) level will be measured from blood samples using the bromocresol green (BCG) method. Results will be reported in grams per liter (g/L).
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Change in serum Globulin (GLOB) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum globulin (GLOB) level will be calculated by subtracting the measured serum albumin value from the measured serum total protein value. Results will be reported in grams per liter (g/L).
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Change in Albumin to Globulin ratio (A/G)
Time frame: At 0 (baseline), 2, 8 and 14 months.
The Albumin to Globulin ratio (A/G) will be calculated from the measured values of serum albumin and calculated globulin. Results will be reported as a ratio.
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Change in depression symptoms as measured by the Self-Rating Depression Scale (SDS)
Time frame: At 0 (baseline), 2, 8, 14 and 26 months.
Depression symptoms will be assessed using the Self-Rating Depression Scale (SDS). The SDS total score ranges from 20 to 80, with higher scores indicating more severe depressive symptoms (worse outcome).
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Change in anxiety symptoms as measured by the Self-Rating Anxiety Scale (SAS)
Time frame: At 0 (baseline), 2, 8, 14 and 26 months.
Anxiety symptoms will be assessed using the Self-Rating Anxiety Scale (SAS). The SAS total score ranges from 20 to 80, with higher scores indicating more severe anxiety symptoms (worse outcome).
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Change in serum Total Cholesterol (TC) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Total Cholesterol (TC) will be measured from blood samples using the cholesterol oxidase method. Results will be reported in millimoles per liter (mmol/L).
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Change in serum Triglycerides (TG) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Triglycerides (TG) will be measured from blood samples using an enzymatic method. Results will be reported in millimoles per liter (mmol/L).
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Change in serum High-Density Lipoprotein Cholesterol (HDL-C) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of High-Density Lipoprotein Cholesterol (HDL-C) will be measured from blood samples using an enzymatic method. Results will be reported in millimoles per liter (mmol/L).
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Change in serum Low-Density Lipoprotein Cholesterol (LDL-C) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Low-Density Lipoprotein Cholesterol (LDL-C) will be measured from blood samples using an enzymatic method. Results will be reported in millimoles per liter (mmol/L).
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Change in serum Interleukin-1 beta (IL-1β) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Interleukin-1 beta (IL-1β) will be measured from blood samples using a standardized multiplex immunoassay. Results will be reported in picograms per milliliter (pg/mL).
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Change in serum Interleukin-6 (IL-6) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Interleukin-6 (IL-6) will be measured from blood samples using a standardized multiplex immunoassay. Results will be reported in picograms per milliliter (pg/mL).
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Change in serum Interleukin-8 (IL-8) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Interleukin-8 (IL-8) will be measured from blood samples using a standardized multiplex immunoassay. Results will be reported in picograms per milliliter (pg/mL).
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Change in serum Interleukin-10 (IL-10) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Interleukin-10 (IL-10) will be measured from blood samples using a standardized multiplex immunoassay. Results will be reported in picograms per milliliter (pg/mL).
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Change in serum Tumor Necrosis Factor-alpha (TNF-α) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Tumor Necrosis Factor-alpha (TNF-α) will be measured from blood samples using a standardized multiplex immunoassay. Results will be reported in picograms per milliliter (pg/mL).
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Change in serum Transforming Growth Factor-beta (TGF-β) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Transforming Growth Factor-beta (TGF-β) will be measured from blood samples using a standardized multiplex immunoassay. Results will be reported in picograms per milliliter (pg/mL).
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Change in serum Monocyte Chemoattractant Protein-1 (MCP-1/CCL2) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Monocyte Chemoattractant Protein-1 (MCP-1/CCL2) will be measured from blood samples using a standardized multiplex immunoassay. Results will be reported in picograms per milliliter (pg/mL).
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Change in serum Leptin level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Leptin will be measured from blood samples using a standardized immunoassay. Results will be reported in nanograms per milliliter (ng/mL).
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Change in serum Adiponectin level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Adiponectin will be measured from blood samples using a standardized immunoassay. Results will be reported in micrograms per milliliter (μg/mL).
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Change in serum C-reactive Protein (CRP) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of C-reactive Protein (CRP) will be measured from blood samples using an immunoturbidimetric assay. Results will be reported in milligrams per liter (mg/L).
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Change in serum Tumor Necrosis Factor-alpha-induced protein 3 (TNFAIP3/A20) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Tumor Necrosis Factor-alpha-induced protein 3 (TNFAIP3/A20) will be measured from blood samples using a standardized enzyme-linked immunosorbent assay (ELISA). Results will be reported in nanograms per milliliter (ng/mL).
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Change in plasma Lipopolysaccharide (LPS) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Plasma concentration of Lipopolysaccharide (LPS) will be measured from blood samples using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Results will be reported in endotoxin units per milliliter (EU/mL).
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Change in serum Lipopolysaccharide-Binding Protein (LBP) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Lipopolysaccharide-Binding Protein (LBP) will be measured from blood samples using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Results will be reported in micrograms per milliliter (μg/mL).
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Change in serum Resolvin D1 (RvD1) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Resolvin D1 (RvD1) will be measured from blood samples using liquid chromatography with tandem mass spectrometry (LC-MS/MS). Results will be reported in picograms per milliliter (pg/mL).
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Change in serum Resolvin E1 (RvE1) level
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum concentration of Resolvin E1 (RvE1) will be measured from blood samples using liquid chromatography with tandem mass spectrometry (LC-MS/MS). Results will be reported in picograms per milliliter (pg/mL).
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Daily Energy and Macronutrient Intake
Time frame: At 0 (baseline), 2, 5, 8 14, 20, and 26 months.
Total energy intake and macronutrient distribution (percentage of energy from carbohydrates, fat, and protein) will be assessed at each time point using three non-consecutive 24-hour dietary recalls. Results will be reported in kilocalories (kcal) for energy and percentage points (%) for macronutrient distribution.
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Within-individual variability in daily interstitial glucose (SD)
Time frame: At months 2, 8, and 14. Each assessment will be conducted using continuous glucose monitoring (CGM) over a consecutive 14-day period.
Variability in daily interstitial glucose will be assessed using the standard deviation (SD) of mean daily glucose values across the continuous glucose monitoring (CGM) period. This metric quantifies day-to-day fluctuation in glucose concentration. Results will be reported in milligrams per deciliter (mg/dL).
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Within-individual variability in daily interstitial glucose (CV)
Time frame: At months 2, 8, and 14. Each assessment will be conducted using continuous glucose monitoring (CGM) over a consecutive 14-day period.
Variability in daily interstitial glucose will be assessed using the coefficient of variation (CV), calculated as the standard deviation divided by the mean glucose level across the CGM period. This metric quantifies relative variability in glucose concentration. Results will be reported as a percentage (%).
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Mean amplitude of glycemic excursions (MAGE)
Time frame: At months 2, 8, and 14. Each assessment will be conducted using continuous glucose monitoring (CGM) over a consecutive 14-day period.
Variability in daily interstitial glucose will be assessed using mean amplitude of glycemic excursions (MAGE), which represents the average magnitude of significant glucose fluctuations across the CGM period. This metric quantifies short-term glycemic variability. Results will be reported in milligrams per deciliter (mg/dL).
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Percentage of monitoring time with interstitial glucose 70-140 mg/dL (TIR)
Time frame: At months 2, 8, and 14. Each assessment will be conducted using continuous glucose monitoring (CGM) over a consecutive 14-day period.
Glycemic control will be assessed as the percentage of total monitoring time spent in the target glucose range of 70-140 mg/dL during CGM. This metric quantifies the proportion of time glucose values remain within the predefined range. Results will be reported as a percentage (%).
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Change in postprandial glucose excursion
Time frame: At 2, 8, and 14 months.
The magnitude of postprandial glucose excursion will be assessed using continuous glucose monitoring (CGM), calculated as the difference between the peak interstitial glucose concentration and the pre-prandial level following main meals. Glucose data will be time-synchronized with self-reported dietary intake logs. Results will be reported in millimoles per liter (mmol/L).
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Change in postprandial time above range (pTAR)
Time frame: At 2, 8, and 14 months.
The percentage of time that interstitial glucose concentrations exceed 10.0 mmol/L during the 3-hour postprandial period will be assessed using continuous glucose monitoring (CGM). Glucose data will be time-synchronized with self-reported dietary intake logs. Results will be reported as a percentage of the postprandial monitoring period (%).
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Change in thyroid-stimulating hormone (TSH)
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum TSH levels will be measured from blood samples. Results will be reported in milli-international units per liter (mIU/L).
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Change in free thyroxine (FT4)
Time frame: At 0 (baseline), 2, 8 and 14 months.
Serum FT4 levels will be measured from blood samples. Results will be reported in picomoles per liter (pmol/L).
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DNA Methylation Patterns
Time frame: At 0 (baseline), 2, 8, and 14 months.
Genome-wide DNA methylation profiles will be assessed using peripheral blood samples collected at specified time points. Changes in DNA methylation will be explored as potential mechanistic biomarkers mediating the effects of time-restricted eating on metabolic health and weight regulation.