Intermittent fasting as a promising method of treatment of metabolically associated steatotic liver disease. Review

Abstract

Metabolic‑associated steatotic liver disease (MASLD) is one of the most common diseases of the century. According to a recent meta‑analysis, its prevalence in the Western world is estimated at approximately 25% of the entire adult population. Currently, there is no single pharmacological treatment of MASLD approved by international guidelines. Therefore, changes in the lifestyle, diet and eating behavior remain the cornerstone of the treatment of MASLD. Recently, a lot of attention in the treatment of obesity and MASLD is paid to the so‑called intermittent fasting (IF) — a food regimen, the essence of which is to divide the day into periods of eating (food window) and complete refusal of food. Because chronic dysregulation of circadian rhythms may increase the risk of metabolic disease, time‑restricted diets, or dietary interventions, including IF, may maintain circadian rhythms and ameliorate metabolic disease. Acting on the main metabolic pathways, IF in patients with MASLD is able to restore metabolic flexibility, which is understood as the ability of the body to coordinate the sensation, exchange, storage and utilization of nutrients, as well as to choose adequate metabolic pathways to maintain energy homeostasis in accordance with the availability and demand for energy substrates. Several possible mechanisms of the influence of intermittent fasting on the pathogenesis of MASLD are known, in particular, energy switching to ATP generation processes, such as β‑oxidation; reduction of inflammation and oxidative stress; improvement of autophagy, sensitivity to insulin and composition of gut microbiota. Randomized controlled clinical trials demonstrated that depending on the type and duration of the diets, IF can lead to significant weight loss compared to hypocaloric or other diets, it affects almost all of the major metabolic drivers of MASLD, thus slowing the progression of liver disease and serving as an additional tool in the treatment of this pathology. Thus, intermittent fasting can become a promising, effective, and cheap treatment method with low side effects for a wide range of patients.