Intermittent fasting improves hepatic end points in nonalcoholic fatty liver disease: A systematic review and meta-analysis

Abstract

Background and Aims: Despite NAFLD being the most prevalent liver disease globally, currently there are no FDA-approved treatments, and weight loss through caloric restriction and enhanced physical activity is the recommended treatment strategy. Intermittent fasting (IF) has been proposed as an alternative strategy with additional cardiometabolic benefits. In this systematic review and meta-analysis, we evaluated the anthropometric, biochemical, and hepatic impacts of IF in patients with NAFLD. Methods: MEDLINE, EMBASE, Cochrane Central, and conference abstracts were searched for IF interventions in adults with NAFLD until April 2, 2023. Meta-analysis with a random effects model was used to compare pre-intervention and post-intervention changes in anthropometric, biochemical, and hepatic end points in the IF intervention group with the control group. Publication bias was assessed using Egger’s test. Results: Fourteen studies were included in the systematic review and ten in the meta-analysis (n = 840 participants, 44.64% male). Studies varied in modalities for NAFLD diagnosis, duration of IF (4–52 weeks), and type of IF (5:2 diet, modern alternate-day fasting, time-restricted eating, or religious fasting). Body weight, body mass index, and waist to hip ratio all significantly improved following fasting intervention (p< 0.05). Adults with NAFLD showed an improvement in serum alanine transaminase, aspartate aminotransferase, hepatic steatosis (controlled attenuation parameter measured by vibration-controlled transient elastography), and hepatic stiffness (measured by vibration-controlled transient elastography) after fasting intervention (p < 0.05). Conclusions: There is limited, but moderate- to high-quality evidence to suggest that IF can improve hepatic end points and promote weight loss in adults with NAFLD. Larger randomized controlled studies with extended duration are needed to further validate our findings.

Metabolic-Dysfunction-Associated Steatotic Liver Disease—Its Pathophysiology, Association with Atherosclerosis and Cardiovascular Disease, and Treatments

“…In the meta-analysis, there were significant differences in body weight, BMI and ALT and aspartate aminotransferase (AST) levels between the control and intermittent fasting groups [65]. In another meta-analysis, body weight, BMI and waistto-hip ratio were significantly improved following the intermittent fasting intervention (p < 0.05) [66]. Adults with MASLD showed an improvement in serum ALT and AST levels, hepatic steatosis and hepatic stiffness measured by vibration-controlled transient elastography after an intermittent fasting intervention (p < 0.05) [66].…”

Practical Lifestyle Management of Nonalcoholic Fatty Liver Disease for Busy Clinicians

“…To date, all trials have been relatively short, not all have been RCTs, and there are few long-term follow-up data ( 38 ). In an 8-week RCT, alternate-day calorie restriction (fasting day: 30% of calorie requirement, nonfasting day ad libitum) compared with no intervention resulted in a greater reduction of steatosis and fibrosis, as measured by ultrasound and elastography ( 39 ).…”

MASLD treatment—a shift in the paradigm is imminent

“…Focusing on an eating window rather than caloric intake, has the advantage of potentially higher adherence compared to calorie-restricted diets, since simply skipping a meal can promote by itself a restriction in caloric intake and weight loss ( 32 ). Intermittent fasting also seems to improve metabolic dysfunction with better glucose and blood pressure control ( 33 ), liver steatosis, and liver fibrosis assessed by NIT ( 34 ). However, the level of evidence resumes small studies with weak endpoints, and it is not more effective than other diets with calorie restriction regarding weight loss or metabolic dysfunction ( 35 ).…”