| Sumario: | Background: Metabolic disease is accelerating across Low- and Middle-Income Countries (LMICs), where calorie-focused dietary prescriptions frequently fail due to cost and complexity. Time-Restricted Eating (TRE) is a distinct approach. It restructures when food is eaten rather than what or how much, limiting daily intake to a 6 to 10 hour window as a cost-free chronomedicine strategy. Its mechanisms and long-term glycemic effects in diverse LMIC populations remain incompletely synthesised. Objectives: To systematically review TRE's clinical efficacy on glycemic control, insulin sensitivity, and anthropometric outcomes across LMIC cohorts, and to evaluate molecular evidence for AMPK/mTOR pathway activation. Data Sources and Methods: A PRISMA 2020-compliant systematic review was conducted using PubMed, Scopus, and Web of Science. Eligible studies included randomised controlled trials and quasi-experimental designs involving adults in LMICs with metabolic conditions. TRE windows of 6 to 10 hours were required. Risk of bias was assessed using RoB 2.0 and ROBINS-I. The review was prospectively registered with PROSPERO (CRD420261352841). Results: Twenty-six unique cohorts (28 reports) across India, China, Indonesia, Iran, Tunisia, and Brazil were included. TRE was associated with reductions in insulin resistance, fasting blood sugar, and body weight across most included studies. A persistent HbA1c reduction of -0.78% at 18 months in one longitudinal cohort suggested that glycemic benefits may compound with sustained adherence. Contradictions emerged between centres regarding TRE's superiority over caloric restriction. Conclusion: TRE may represent a feasible, low-cost dietary strategy for metabolic health management in resource-limited settings, though further evidence from larger and longer trials is needed. Plain language summary: Millions of people in developing countries live with Type 2 Diabetes, yet expensive dietary programmes are often unaffordable. Time-Restricted Eating simply limits the hours during which food is consumed each day. This review examined 26 studies from India, China, Indonesia, Iran, Tunisia, and Brazil. Restricting eating to 6 to 10 hours daily was associated with improvements in blood sugar, reduced insulin resistance, and supported weight loss without requiring changes to food quality or supplements. Blood sugar improvements remained evident 18 months later. One small study found early signs of cellular energy changes within 20 days of starting TRE. Growing evidence suggests that the timing of meals may be as important as the content of meals in managing metabolic disease.
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