Abstract
Currently, there is no effective therapy for non-alcoholic fatty liver disease (NAFLD), and although calorie restriction is recommended in guidelines, but adherence is an issue. The current study aimed to determine the effectiveness of eight weeks intermittent fasting (IF) strategy in the control of NAFLD activity and the adherence rate of such strategy. This was a randomized controlled trial with modified alternate-day calorie restriction (MACR), a form of IF, as the active intervention and usual habitual diet as control. The outcome measures included changes in body mass index (BMI), blood lipids (cholesterol, LDL, HDL and triglyceride), fasting blood sugar (FBS), liver enzymes (ALT and AST), and ultrasound measurements of liver steatosis and 2-dimensional shear wave elastography (SWE). Per-protocol (PP) analysis was performed with comparison within (post vs. pre-intervention) and between (MACR vs. control) groups and P < 0.05 as significant. Of 115 individuals with NAFLD, 43 satisfied the study entry criteria, and 33 were randomised to MACR and 10 to control group, and after 8 weeks, 30 from MACR and 9 from control group completed PP. Significant reduction in weight and BMI (P = 0.001 and 0.02 respectively) was observed in MACR vs. control. Likewise, ALT was reduced with MACR but not control (P = 0.02). No reductions in lipid parameters and FBS were found in between-group analyses (all P > 0.22). Both liver steatosis and fibrosis (SWE) scores were significantly reduced in MACR vs. controls (both P < 0.01). Adherence level for MACR remained between 75-83% throughout the study. As a conclusion, eight weeks of IF (MACR) strategy appears more effective than usual habitual diet in the control of NAFLD activity and with good adherence rate.
Highlights
There is no effective therapy for non-alcoholic fatty liver disease (NAFLD), and calorie restriction is recommended in guidelines, but adherence is an issue
Lifestyle-induced weight loss through dietary restriction and exercises are commonly recommended as initial management of NAFLD4,5
Our employed intermittent fasting (IF) (i.e. Modified alternate-day calorie restriction (MACR)) strategy was a form of calorie-restricted regime rather than a strictly time-restricted feeding
Summary
There is no effective therapy for non-alcoholic fatty liver disease (NAFLD), and calorie restriction is recommended in guidelines, but adherence is an issue. The current study aimed to determine the effectiveness of eight weeks intermittent fasting (IF) strategy in the control of NAFLD activity and the adherence rate of such strategy. This was a randomized controlled trial with modified alternate-day calorie restriction (MACR), a form of IF, as the active intervention and usual habitual diet as control. Eight weeks of IF (MACR) strategy appears more effective than usual habitual diet in the control of NAFLD activity and with good adherence rate. A hypocaloric diet (500–1000 kcal) with 7–10% weight loss target is a recommended strategy in NAFLD4,5 Such strategy may be achieved effectively through daily fasting, an extreme form of dietary restriction. Periodic fasting (PF) cycles that last 2 or more days separated by a week of normal diet or time-restricted diet which restricts normal calories to only certain hours in a day[13]
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