Effect of alternate day fasting combined with aerobic exercise on non-alcoholic fatty liver disease: A randomized controlled trial

Ezpeleta, Mark; Gabel, Kelsey; Cienfuegos, Sofia; Kalam, Faiza; Lin, Shuhao; Pavlou, Vasiliki; Song, Zhenyuan; Haus, Jacob M.; Koppe, Sean; Alexandria, Shaina J.; Tussing‐Humphreys, Lisa; Varady, Krista A

doi:10.1016/j.cmet.2022.12.001

Cited by 75 publications

(82 citation statements)

References 102 publications

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“…As previously reported [ 10 ], 132 individuals were assessed for eligibility, and 52 of these individuals did not meet one or more of the inclusion criteria. A total of 80 participants were randomized into the combination group (n = 20), ADF group (n = 20), exercise group (n = 20), or the control group (n = 20).…”

Section: Resultsmentioning

confidence: 99%

“…This is a secondary analysis of a 3-month randomized, controlled, parallel-arm study. The trial examined the effects of ADF combined with exercise, to each intervention alone, on intrahepatic triglyceride content and metabolic disease risk factors in patients with NAFLD [ 10 ]. Participants were randomized to 1 of 4 intervention groups: ADF plus exercise, ADF alone, exercise alone, or a no-intervention control group.…”

Section: Methodsmentioning

confidence: 99%

“…As described previously [ 10 ], subjects in the combination group and ADF group were asked to eat 600 kcal as a dinner (between 5 and 8 pm) on fast days and eat food ad libitum on alternating feast days. The feast and fast days began at 12 am each day.…”

Section: Methodsmentioning

confidence: 99%

“…Intrahepatic triglyceride content was measured by MRI-PDFF [ 10 ]. These scans were carried out at the UIC Center for Magnetic Resonance Research.…”

Section: Methodsmentioning

confidence: 99%

“…Evidence from two studies show that alternate-day fasting (ADF; 600 kcal “fast day” alternated with an ad libitum intake “feast day”) is effective for reducing liver steatosis score, circulating levels of alanine transaminase (ALT), and body weight in patients with NAFLD [ 8 , 9 ]. In addition, we recently performed a randomized controlled trial showing that ADF combined with aerobic exercise decreased body weight by 5%, intrahepatic triglyceride content by 5%, and ALT concentrations in adults with NAFLD [ 10 ]. While these studies are valuable to the field, they are limited in that none of them examined the underlying role of sleep in mediating these effects.…”

Section: Introductionmentioning

confidence: 99%

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Alternate-Day Fasting Combined with Exercise: Effect on Sleep in Adults with Obesity and NAFLD

et al. 2023

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Objective: This study investigated how alternate-day fasting (ADF) combined with aerobic exercise impacts body weight and sleep in adults with non-alcoholic fatty liver disease (NAFLD). Methods: Adults with obesity and NAFLD (n = 80) were randomized into one of four groups for 3 months: combination of ADF (600 kcal “fast day,” alternated with an ad libitum intake “feast day”) and moderate-intensity aerobic exercise (five sessions per week, 60 min/session); ADF alone; exercise alone; or a no-intervention control group. Results: By month 3, body weight and intrahepatic triglyceride content decreased (p < 0.001, group × time interaction) in the combination group versus the exercise group and control group, but not versus the ADF group. Sleep quality, measured by the Pittsburgh Sleep Quality Inventory (PSQI), did not change in the combination group (baseline: 6.0 ± 0.7; month 3: 5.6 ± 0.7), ADF group (baseline: 8.9 ± 1.0; month 3: 7.5 ± 0.8), or exercise group (baseline: 6.4 ± 0.6; month 3: 6.7 ± 0.6), versus controls (baseline: 5.5 ± 0.7; month 3: 4.6 ± 0.5). Wake time, bedtime, sleep duration, and insomnia severity did not change (no group x time interaction) over the course of the study in any group. Risk for obstructive sleep apnea was present in 30% of combination subjects, 75% of ADF subjects, 40% of exercise subjects, and 75% of controls, and did not change in the intervention groups, versus controls, by month 3. No associations were observed between changes in body weight, intrahepatic triglyceride content, and any sleep outcome. Conclusions: The weight loss induced by ADF combined with exercise does not improve sleep quality, duration, insomnia severity, or risk of obstructive sleep apnea in individuals with NAFLD.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Intrahepatic triglyceride content was measured by MRI-PDFF [ 10 ]. These scans were carried out at the UIC Center for Magnetic Resonance Research.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Alternate-Day Fasting Combined with Exercise: Effect on Sleep in Adults with Obesity and NAFLD

et al. 2023

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Aerobic Exercise and Weight Loss in Adults

Jayedi,

Soltani,

Emadi

et al. 2024

JAMA Netw Open

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ImportanceCurrent guidance on the duration of aerobic exercise recommended in existing guidelines comes primarily from individual trials. Meta-analyses are lacking to examine the dose-response association of aerobic exercise with adiposity measures.ObjectiveTo clarify the dose-response association of aerobic exercise with adiposity measures.Data SourcesPubMed, Scopus, the Cochrane Central Register of Controlled Trials, and gray literature sources (ProQuest and ClinicalTrials.gov) from inception to April 30, 2024.Study SelectionRandomized clinical trials with intervention durations of at least 8 weeks evaluating the effects of supervised aerobic training on adults with overweight or obesity.Data Extraction and SynthesisThe PRISMA guidelines were followed to report the results of the meta-analysis. Data extraction was conducted by 2 teams of 2 reviewers each, working independently and in duplicate. Random-effects meta-analyses were performed to estimate mean differences and 95% CIs for each 30-minute per week aerobic exercise and to clarify the shape of the curvilinear associations.Main Outcomes and MeasuresMeasures of body weight, waist circumference, body fat, adverse events, medication use reduction, and health-related quality of life score. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool, with a range from very low to high certainty.ResultsIn total, 116 randomized clinical trials involving 6880 participants (4199 [61%] female; mean [SD] age, 46 [13] years) with overweight or obesity were included. Each 30 minutes per week of aerobic exercise was associated with reduced body weight by 0.52 kg (95% CI, −0.61 to −0.44 kg; n = 109 trials, GRADE = moderate), waist circumference by 0.56 cm (95% CI, −0.67 to −0.45 cm; n = 62 trials, GRADE = high), body fat percentage by 0.37% (95% CI, −0.43% to −0.31%; n = 65 trials, GRADE = moderate), as well as the areas of visceral (mean difference, −1.60 cm2 [95% CI, −2.12 to −1.07 cm2]; n = 26 trials, GRADE = high) and subcutaneous (mean difference, −1.37 cm2 [95% CI, −1.82 to −0.92 cm2]; n = 27 trials, GRADE = moderate) adipose tissues. Aerobic exercise was associated with modestly increased physical (standardized mean difference, 1.69 SD [95% CI, 1.18-2.20 SD]) and mental (standardized mean difference, 0.74 SD [95% CI, 0.29-1.19 SD]) aspects of quality of life (1 trial with 80 participants, GRADE = low). It was associated with modestly increased mild to moderate adverse events, which were mostly musculoskeletal symptoms (risk difference, 2 more events per 100 participants [95% CI, 1 to 2 more]; GRADE = low). Dose-response meta-analyses indicated that body weight, waist circumference, and body fat measures decreased linearly or monotonically in association with increasing duration of aerobic exercise to 300 minutes per week, with aerobic exercise lasting 150 minutes per week at moderate to vigorous intensities resulting in clinically important reductions in waist circumference and body fat.Conclusions and RelevanceIn this meta-analysis of randomized clinical trials, engaging in 30 minutes of aerobic exercise per week was associated with modest reductions in body weight, waist circumference, and body fat measures among adults with overweight or obesity. However, aerobic training exceeding 150 minutes per week at moderate intensity or greater may be needed to achieve clinically important reductions.

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