Effects of alternate-day fasting on body weight and dyslipidaemia in patients with non-alcoholic fatty liver disease: a randomised controlled trial

Abstract

Background: Alternate-day fasting (ADF) is a novel diet therapy that may achieve reduction in body weight and improvement of dyslipidaemia, but the impact of this diet on patients with non-alcoholic fatty liver disease (NAFLD) remains unknown. The aim of this study was to evaluate the effects of ADF on the body weight and lipid profile of individuals with NAFLD. Methods: NAFLD patients (n=271) were randomised to the ADF group, time-restricted feeding (TRF) group, or the control group and subjected to the respective diet for 12 weeks. Anthropometric measurements (body weight, fat mass/fat-free mass) were performed, and plasma lipids were analysed enzymatically. Results: Within 4 weeks, the body weight decreased significantly (P<0.001) in the ADF group by 4.56±0.41 kg (6.1 ± 0.5%) and the TRF group by 3.62±0.65 kg (4.83±0.9%) compared to the control group, and it decreased even more after 12 weeks in both groups (ADF: -4.04±0.54 kg, 5.4±0.7%; TRF: -3.25±0.67 kg, 4.3±0.9%). Fat mass was significantly reduced by ADF (-3.49±0.37 kg; 11±1.2%) and TRF (-2.91±0.41 kg; 9.6±1.3%), with ADF leading to a further reduction in fat mass after 12 weeks (-3.48±0.38 kg; 11±1.2%). Total cholesterol was significantly decreased at both time points in the ADF group (-0.91±0.07 mmol/L; 18.5±1.5%) compared to the control and TRF groups. Both ADF (-0.64±0.06 mmol/L; 25±1.9%) and TRF (0.58±0.07 mmol/L; 20±1.7%) achieved a significant reduction in serum triglycerides (P<0.001) after 12 weeks. Changes in fat free mass, HDL, LDL, fasting insulin, glucose, liver stiffness, and systolic or diastolic blood pressure did not differ between the groups. Conclusions: ADF appears to be an effective diet therapy for individuals with NAFLD that can achieve weight loss and improvement of dyslipidaemia within a relatively short period of time (4 to 12 weeks). Potential preventive effects of ADF on cardiovascular disease need to be confirmed by future investigations. Trial registration: ChiCTR1900024411, this trial was retrospectively registered on July 10, 2019

Diet and exercise in NAFLD/NASH: Beyond the obvious

“…Johari et al 69 applied a modified alternate‐day calorie restriction (ie 70% calorie‐restriction on fasting day, ad‐libitum eating on non‐fasting day) to demonstrate an improvement in ALT levels as well as LSM and sonographically assessed steatosis 69 . Another study showed a decrease in BMI and triglyceride levels following 12 weeks of ADF or time‐restricted feeding (energy intake only during an 8h‐window each day) despite no changes in LSM 70 . Finally, Holmer et al 71 compared ICR on two non‐consecutive days/week (ie 5:2 diet, <500/600 kcal/d) vs a LCD/HFD in patients with NAFLD.…”

Dietary Interventions in Liver Diseases: Focus on MAFLD and Cirrhosis

“…In a Malaysian study, 8 weeks of intermittent fasting with alternate-day calorie restriction resulted in the reduction of body weight and liver enzymes as well as liver steatosis and stiffness compared to a habitual diet [46]. A larger Chinese RCT randomized 271 MAFLD patients to undergo intermittent fasting, time-restricted feeding, or no intervention [20]. Both intermittent fasting and BCAAs, branched-chain amino acids; LES, late evening snack; HCC, hepatocellular carcinoma; ONS, oral nutritional supplementation; PNS, parenteral nutritional supplementation time-restricted feeding induced significant weight loss of 5.4% and 4.3%, respectively, while LDL, fasting insulin, and liver stiffness did not differ significantly between groups.…”

Ramzan for Patients with Chronic Liver Disease

“…Another study showed that respiratory quotient (RQ) after an overnight fast is lower in cirrhotic patients as compared to normal person, reflecting catabolism and an accelerated fat oxidation [4]. Another research showed the positive effects of alternate day fasting in patients with Non-alcoholic fatty liver disease (NAFLD) and led to weight loss, improvement in the dyslipidaemia within 12 weeks [5].…”