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

• Published in: Cell metabolism Vol. 35; no. 1; pp. 56 - 70.e3
• Main Authors: 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.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 03.01.2023
• Subjects: Adult; aerobic exercise; Aged; alternate day fasting; Body Weight; Exercise; Fasting; Female; Humans; insulin resistance; intermittent fasting; Liver; Male; Middle Aged; non-alcoholic fatty liver disease; Non-alcoholic Fatty Liver Disease - therapy; obesity; Triglycerides; weight loss; Young Adult; aerobic exercise; alternate day fasting; intermittent fasting; non-alcoholic fatty liver disease; weight loss; insulin resistance; obesity
• ISSN: 1550-4131; 1932-7420
• DOI: 10.1016/j.cmet.2022.12.001

Innovative non-pharmacological lifestyle strategies to treat non-alcoholic fatty liver disease (NAFLD) are critically needed. This study compared the effects of alternate day fasting (ADF) combined with exercise to fasting alone, or exercise alone, on intrahepatic triglyceride (IHTG) content. Adults with obesity and NAFLD (n = 80, 81% female, age: 23–65 years) were randomized to 1 of 4 groups for 3 months: combination of ADF (600 kcal/2,500 kJ “fast day” alternated with an ad libitum intake “feast day”) and moderate-intensity aerobic exercise (5 session per week, 60 min/session); ADF alone; exercise alone; or a no-intervention control group. By month 3, IHTG content was significantly reduced in the combination group (−5.48%; 95% CI, −7.77% to −3.18%), compared with the exercise group (−1.30%; 95% CI, −3.80% to 1.20%; p = 0.02) and the control group (−0.17%; 95% CI, −2.17% to 1.83%; p < 0.01) but was not significantly different versus the ADF group (−2.25%; 95% CI, −4.46% to −0.04%; p = 0.05). Body weight, fat mass, waist circumference, and alanine transaminase (ALT) levels significantly decreased, while insulin sensitivity significantly increased in the combination group compared with the control group. Lean mass, aspartate transaminase (AST), HbA1c, blood pressure, plasma lipids, liver fibrosis score, and hepatokines (fetuin-A, FGF-21, and selenoprotein P) did not differ between groups. Combining intermittent fasting with exercise is effective for reducing hepatic steatosis in patients with NAFLD but may offer no additional benefit versus fasting alone. [Display omitted] •Adults with NAFLD followed an intermittent fasting plus exercise protocol for 3 months•Hepatic steatosis was significantly reduced by 5.5% versus controls•Body weight, fat mass, and waist circumference also decreased versus controls•By month 3, ALT was reduced, while insulin sensitivity increased, versus controls Ezpeleta et al. examined the effect of alternate day fasting combined with aerobic exercise on hepatic steatosis in adults with non-alcoholic fatty liver disease (NAFLD). After 3 months, the combination therapy produced significant decreases in hepatic steatosis, body weight, fat mass, waist circumference, and ALT levels and increases in insulin sensitivity.