Introduction
Non-alcoholic fatty liver disease (NAFLD) includes a wide spectrum of liver disease, ranging from simple steatosis to steatohepatitis, advanced fibrosis and liver cirrhosis, with histological features of alcohol induced liver disease. Despite the high morbidity and mortality burden of NAFLD, no definite treatment is established yet. Lifestyle modifications are one of the most valued measures for NAFLD amelioration. A lot of dietary regimens have been recommended with pro-ved weight loss, inflammation reduction, along with improved cardiovascular and metabolic markers. Many regimens have been suggested for NAFLD patients: caloric restriction, low carbohydrate high fat diet, or intermittent fasting diets (IF). Notably, in IF people are allowed to eat for a restricted time and abstain food and caloric fluids for another time. Remarkably, IF is capable of reversal of insulin resistance, leading to marvelous achievements in most resistant cases. Accordingly, IF is one of the most promising regimens suggested for improving the unhealthy NAFLD parameters. Being an Islamic pillar, Ramadan fasting (RF) might also be considered as a form of dry intermittent fasting. Despite the reported deleterious impacts of fasting on liver cirrhosis, fruitfully IF had been suggested to improve NAFLD patients.
Therefore, this study was designed to assess short term effects (one month) of intermittent fasting on various biochemical, anthropometric, and radiological measurements of NAFLD patients.
Aims & Methods
Despite the ample flow of non-alcoholic fatty liver disease (NAFLD) drugs in the pipeline, lifestyle modifications are still the optimal solution of NAFLD. The aim of the study was to assess short term effects of Ramadan fasting (RF) as a sort of intermittent fasting (IF) on biochemical, radiological, and anthropometric parameters of NAFLD patients.
Ninety-eight NAFLD patients were recruited and voluntarily subjected to 16 hours daily fasting for an average of 22-29 days, without special dietary recommendations. Anthropometric, laboratory and radiological parameters were measured before, at 30 days, and one month after fasting (fasting and non-fasting phases).
Results
Patients were mostly rural (76%), hypertensive (34.7%), diabetic (43.9%), and female (76.8%), with overt criteria of metabolic syndrome (67.3%). Liver transaminases (ALT and AST) were ameliorated significantly after fasting (p ≤ 0.01), which continued in the following month (p ≤ 0.01) especially in those with elevated ALT before fasting (46%). Eleven patients (24.4%) experienced ALT normalization after one month of fasting, which was further increased to 15 (33.3%) one month later. Lipid profiles (cholesterol, triglycerides, HDL, LDL, cholesterol/HDL risk ratio) were significantly corrected following IF (p ≤ 0.01) and continuing in the next phase (p ≤ 0.010). Body mass index (BMI) lessened following the fasting (p ≤ 0.01), while no remarkable changes were noted regarding waist, hip, and triceps skin fold thickness (p ≤ 0.01). Glycemic indices (HbA1c, postprandial, HOMA-IR) and fibrosis markers (FIB-4 and APRI) were significantly ameliorated (p ≤ 0.01), while reduction in inflammatory markers was not long lasting (p ≤ 0.01).
Conclusion
Intermittent fasting led to momentous improvements in ultrasonographic, biochemical, and anthropometric parameters of NAFLD especially in early phases and prediabetics.
References
Badran H, Elsabaawy M, Sakr A, Eltahawy M, Elsayed M, Elsabaawy DM, Abdelkreem M. Impact of intermittent fasting on laboratory, radiological, and anthropometric parameters in NAFLD patients. Clin Exp Hepatol. 2022 Jun;8(2):118-124. doi: 10.5114/ceh.2022.115056. Epub 2022 May 30. PMID: 36092752; PMCID: PMC9442655.
Pubmed:
https://pubmed.ncbi.nlm.nih.gov/36092752/
Disclosure
No conflict of interest.