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

Hua Cai, Yue-Lan Qin, Ze-Ya Shi, Jin-Hui Chen, Min-Jie Zeng, Wei Zhou, Ru-Qun Chen, Zhi-Yuan Chen, Hua Cai, Yue-Lan Qin, Ze-Ya Shi, Jin-Hui Chen, Min-Jie Zeng, Wei Zhou, Ru-Qun Chen, Zhi-Yuan Chen

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.

Keywords: Alternate-day fasting; Dyslipidaemia; Non-alcoholic fatty liver disease; Weight loss.

Conflict of interest statement

Authors declare no conflicts of interest for this article.

Figures

Fig. 1
Fig. 1
Flow chart of the study protocol. ADF: alternate-day fasting; TRF: time-restricted feeding
Fig. 2
Fig. 2
Changes in body weight and body composition at week 4 and week 12. Values are reported as mean ± standard deviation. ADF: alternate-day fasting; TRF: time-restricted feeding. Significant decreases in body weight and fat mass were observed in the ADF and TRF groups compared to the control group. : P < 0.001; : P < 0.05
Fig. 3
Fig. 3
Changes in dyslipidaemia at week 4 and week 12. Values are reported as mean ± SEM (standard error of the mean) ADF achieved a significant decrease in total cholesterol compared to both the control and TRF groups. Triglycerides were significantly decreased in both the ADF and TRF groups compared to the control group. : P < 0.001; : P < 0.05.

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