Effect of Different Types of Intermittent Fasting on Biochemical and Anthropometric Parameters among Patients with Metabolic-Associated Fatty Liver Disease (MAFLD)—A Systematic Review

Abstract

Metabolic-associated fatty liver disease (MAFLD), previously called non-alcoholic fatty liver disease (NAFLD), is the most common chronic liver disease worldwide. It is characterised by excessive fat accumulation in hepatocytes. Currently, no pharmacological therapy is effective for this disease, so non-pharmacological alternatives such as diet, supplementation or physical activity are being sought. For this reason, we reviewed the available databases to analyse the studies conducted to date using different modifications of intermittent fasting among patients with MAFLD. Eight studies using this dietary strategy were included in this review. The results obtained in the different trials are varied and do not allow a clear determination of the effect of the different types of intermittent fasting on anthropometric and biochemical parameters among patients with MAFLD. However, this type of diet seems to show some therapeutic potential, but further studies are needed.

Dietary and nutrition considerations in caring for patients with nonalcoholic fatty liver disease: Updates for the practicing clinician

“…A recent systematic review analyzed eight of these trials, including five during the 4-week religious fast of Ramadan: one followed a time-restricted feeding protocol for 12 weeks, one followed a 5:2 model for 12 weeks, and two used an alternate day fast for 8 and 12 weeks, respectively. 36 Some of the shorter trials noted small improvements in BMI, waist circumference, and aminotransferase levels, though many of these were not statistically significant. There was greater improvement in anthropometric and laboratory values in the trials that followed patients for longer periods of time (ie, 12 weeks), 36 however it is difficult to draw definitive conclusions as these studies were small and assessment of liver steatosis and/or fibrosis was not performed.…”

“…Some of the shorter trials noted small improvements in BMI, waist circumference, and aminotransferase levels, though many of these were not statistically significant. There was greater improvement in anthropometric and laboratory values in the trials that followed patients for longer periods of time (ie, 12 weeks), 36 however it is difficult to draw definitive conclusions as these studies were small and assessment of liver steatosis and/or fibrosis was not performed.…”

“…Both time‐restricted feeding and other approaches to intermittent fasting, such as alternate day fasting or 5:2 models in which patients limit caloric intake to 20%–25% of their calculated daily energy needs 2 days a week, have been assessed in small clinical trials with inconclusive results. A recent systematic review analyzed eight of these trials, including five during the 4‐week religious fast of Ramadan: one followed a time‐restricted feeding protocol for 12 weeks, one followed a 5:2 model for 12 weeks, and two used an alternate day fast for 8 and 12 weeks, respectively 36 . Some of the shorter trials noted small improvements in BMI, waist circumference, and aminotransferase levels, though many of these were not statistically significant.…”

Management of metabolic-associated fatty liver disease: The diabetology perspective

“…Aim of all forms of nutritional interventions for MAFLD is to reduce the proportion of macronutrient content of the diet to achieve total energy deficit by restricting intake of simple carbohydrates, saturated fat, and added sugars, along with adoption of healthier eating options like a Mediterranean diet. Recent research data also suggests that intermittent fasting and time-restricted eating behavior are associated with improvement of MAFLD[ 25 , 26 ].…”

Effect of 12-week intermittent calorie restriction on liver fat content in comparison with standard-of-care in patients with nonalcoholic fatty liver disease: a study protocol for a randomized controlled trial (FLICR)

“…Although recent studies have evaluated the association between speci c nutrients or dietary habits including low carbohydrate/high fat diet or intermittent fasting, and the development or progression of NAFLD, these studies have been conducted on only a small number of patients, and few have shown signi cant improvement in hepatic in ammation or brosis [8][9][10][11][12]. Intermittent calorie restriction (ICR), comprising phases of extreme energy restriction and regular energy intake, is a novel dietary approach for NAFLD treatment [13].…”