Chrono-medicine considers circadian biology in disease management, including combined lifestyle and medicine interventions. Exercise and nutritional interventions are well-known for their efficacy in managing type 2 diabetes, and metformin remains a widely used pharmacological agent. However, metformin may reduce exercise capacity and interfere with skeletal muscle adaptations, creating barriers to exercise adherence. Research into optimising the timing of exercise has shown promise, particularly for glycaemic management in people with type 2 diabetes. Aligning exercise timing with circadian rhythms and nutritional intake may maximise benefits. Nutritional timing also plays a crucial role in glycaemic control. Recent research suggests that not only what we eat but when we eat significantly impacts glycaemic control, with strategies like time-restricted feeding (TRF) showing promise in reducing caloric intake, improving glycaemic regulation and enhancing overall metabolic health. These findings suggest that meal timing could be an important adjunct to traditional dietary and exercise approaches in managing diabetes and related metabolic disorders. When taking a holistic view of Diabetes management and the diurnal environment, one must also consider the circadian biology of medicines. Metformin has a circadian profile in plasma, and our recent study suggests that morning exercise combined with pre-breakfast metformin intake reduces glycaemia more effectively than post-breakfast intake. In this review, we aim to explore the integration of circadian biology into type 2 diabetes management by examining the timing of exercise, nutrition and medication. In conclusion, chrono-medicine offers a promising, cost-effective strategy for managing type 2 diabetes. Integrating precision timing of exercise, nutrition and medication into treatment plans requires considering the entire diurnal environment, including lifestyle and occupational factors, to develop comprehensive, evidence-based healthcare strategies.

Sleep is vital for the maintenance of physical and mental health, recovery and performance in athletes. Sleep also has a restorative effect on the immune system and the endocrine system. Sleep must be of adequate duration, timing and quality to promote recovery following training and competition. Inadequate sleep adversely impacts carbohydrate metabolism, appetite, energy intake and protein synthesis affecting recovery from the energy demands of daily living and training/competition related fatigue. Sleep’s role in overall health and well-being has been established. Athletes have high sleep needs and are particularly vulnerable to sleep difficulties due to high training and competition demands, as such the implementation of the potential nutritional interventions to improve sleep duration and quality is commonplace. The use of certain nutrition strategies and supplements has an evidence base i.e. carbohydrate, caffeine, creatine, kiwifruit, magnesium, meal make-up and timing, protein and tart cherry. However, further research involving both foods and supplements is necessary to clarify the interactions between nutrition and the circadian system as there is potential to improve sleep and recovery. Additional research is necessary to clarify guidelines and develop products and protocols for foods and supplements to benefit athlete health, performance and/or recovery. The purpose of this review is to highlight the potential interaction between sleep and nutrition for athletes and how these interactions might benefit sleep and/or recovery.

A person’s chronotype reflects individual variability in diurnal rhythms for preferred timing of sleep and daily activities such as exercise and food intake. The aim of this review is to provide an overview of the evidence around the influence of chronotype on eating behaviour and appetite control, as well as our perspectives and suggestions for future research. Increasing evidence demonstrates that late chronotype is associated with adverse health outcomes. A late chronotype may exacerbate the influence of greater evening energy intake on overweight/obesity risk and curtail weight management efforts. Furthermore, late chronotypes tend to have worse diet quality, with greater intake of fast foods, caffeine and alcohol and lower intake of fruits and vegetables. Late chronotype is also associated with eating behaviour traits that increase the susceptibility to overconsumption such as disinhibition, food cravings and binge eating. Whether an individual’s chronotype influences appetite in response to food intake and exercise is an area of recent interest that has largely been overlooked. Preliminary evidence suggests additive rather than interactive effects of chronotype and meal timing on appetite and food reward, but that hunger may decrease to a greater extent in response to morning exercise in early chronotypes and in response to evening exercise in late chronotypes. More studies examining the interplay between an individual’s chronotype, food intake/exercise timing and sleep are required as this could be of importance to inform personalised dietary and exercise prescriptions to promote better appetite control and weight management outcomes.

The potential influence of the timing of eating on body weight regulation in humans has attracted substantial research interest. This review aims to critically evaluate the evidence on timed eating for weight loss, considering energetic and behavioural components of the timing of eating in humans. It has been hypothesised that timed eating interventions may alter energy balance in favour of weight loss by enhancing energy expenditure, specifically the thermic effect of food. This energetic effect has been suggested to explain greater weight loss which has been observed with certain timed eating interventions, despite comparable self-reported energy intakes to control diets. However, timed eating interventions have little impact on total daily energy expenditure, and the apparent effect of time of day on the thermic effect of food largely represents an artefact of measurement methods that fail to account for underlying circadian variation in RMR. Differences in weight loss observed in free-living interventions are more likely explainable by real differences in energy intake, notwithstanding similar self-reported energy intakes. In addition, the energetic focus tends to overlook the role of behavioural factors influencing the timing of eating, such as appetite regulation chronotype-environment interactions, which may influence energy intake under free-living conditions. Overall, there is scant evidence that timed eating interventions are superior to general energy restriction for weight loss in humans. However, the role of behavioural factors in influencing energy intake may be relevant for adherence to energy-restricted diets, and this aspect remains understudied in human intervention trials.

Obesity is a chronic, complex and multi-factorial condition with an increasing prevalence worldwide. Irregular eating schedules might be a contributing factor to these numbers through the dysregulation of the circadian system. Time-restricted eating (TRE), an approach that limits eating windows, has been studied as a strategy to treat obesity, aligning eating occasions with metabolic circadian rhythms. This review aims to provide an overview of the impact of TRE protocols on metabolic, inflammatory, oxidative stress and circadian rhythm biomarkers in people with overweight or obesity. Most studies report significant weight loss following TRE protocols. While glucose levels decreased in nearly all TRE interventions, only a few studies demonstrated statistically significant differences when compared to the control groups. The findings for c-reactive protein and TNF-α were inconsistent, with limited significant differences. Changes in lipid profile changes were variable and generally did not reach statistical significance. Both 4-hour and 6-hour TRE interventions significantly reduced 8-isoprostane levels. Additionally, TRE significantly altered clock gene expression, as well as that of genes associated with metabolic regulation in subcutaneous adipose tissue. While the evidence is still inconsistent, limiting eating to a consistent daily window of 8 to 12 h can improve insulin sensitivity, reduce blood glucose, cholesterol and triglyceride levels and promote weight loss. These effects are likely attributable to both direct metabolic impacts and indirect benefits from weight loss and improved dietary habits. However, data on circadian, inflammatory and specific metabolic biomarkers remain scarce and occasionally contradictory, highlighting the need for further research on these interventions.

As obesity rates rise globally, addressing modifiable lifestyle factors, such as sleep, presents an opportunity for public health interventions. This review explores the growing evidence linking sleep duration, quality and timing with weight management and dietary behaviours throughout the life course. Observational studies associate short or irregular sleep with increased obesity risk, poor diet quality and metabolic disturbances. Plausible mechanisms include decreased physical activity, heightened hedonic and/or emotional eating, dysregulated appetite signals and circadian misalignment of metabolism, which contribute to a positive energy balance. Unravelling the bidirectional relationship between sleep and weight is challenging; poor sleep exacerbates weight gain, while obesity-related comorbidities such as obstructive sleep apnoea further impair sleep. Despite promising evidence from sleep-restriction studies showing increased energy intake, long-term randomised controlled trials (RCTs) examining interventions designed to improve sleep with weight management as an outcome are lacking. A handful of short-term interventions suggest benefits in reducing energy intake or improving dietary quality, but their effects on weight loss remain inconclusive. This review calls for robust, well-powered RCTs that integrate sleep, diet and physical activity interventions to evaluate the potential of sleep as a core component of obesity prevention and treatment strategies. Currently, there is insufficient evidence to support sleep-focused interventions as a mandatory element in clinical weight-management programmes.

Presently, about 12% of the population is 65 years or older and by the year 2030 that figure is expected to reach 21%. In order to promote the well-being of the elderly and to reduce the costs associated with health care demands, increased longevity should be accompanied by ageing attenuation. Energy restriction, which limits the amount of energy consumed to 60–70% of the daily intake, and intermittent fasting, which allows the food to be available ad libitum every other day, extend the life span of mammals and prevent or delay the onset of major age-related diseases, such as cancer, diabetes and cataracts. Recently, we have shown that well-being can be achieved by resetting of the circadian clock and induction of robust catabolic circadian rhythms via timed feeding. In addition, the clock mechanism regulates metabolism and major metabolic proteins are key factors in the core clock mechanism. Therefore, it is necessary to increase our understanding of circadian regulation over metabolism and longevity and to design new therapies based on this regulation. This review will explore the present data in the field of circadian rhythms, ageing and metabolism.