The role of intermittent fasting diet in NAFLD management: A scoping review of RCT and clinical trial studies in adult patients

Adilah Robbaniyah* -  Dietitian Professional Study Program, Faculty of Health Sciences, Brawijaya University, Malang, Indonesia
Dian Handayani -  Department of Nutrition, Faculty of Health Sciences, Brawijaya University, Malang, Indonesia
DOI : 10.30867/action.v10i4.2514

Non-Alcoholic Fatty Liver Disease (NAFLD) is the accumulation of fat in the liver not caused by alcohol consumption and is now a leading cause of chronic liver disease globally. Intermittent fasting has the potential to improve the metabolic parameters associated with NAFLD; however, more scientific evidence is needed to confirm this. This review aims to examine the role of intermittent fasting in the management of NAFLD based on existing research. The method used was A scoping review was conducted with a literature search through the PubMed and ScienceDirect databases, and article selection was performed using the PRISMA flow. The inclusion criteria were randomized controlled trials (RCTs) or clinical trials published between 2014 and 2024, resulting in seven articles meeting the criteria. The results showed that various IF methods, such as 5:2 fasting, Alternate-Day Fasting and Time-Restricted Eating, can reduce body weight, waist circumference, fat mass, and several biochemical parameters, such as triglycerides, LDL, total cholesterol, ALT, AST, and inflammatory markers. However, its effectiveness on biochemical parameters still requires further study due to the limited number of studies that comprehensively address these parameters. In conclusion, IF is considered safe for patients with NAFLD and may be a strategic approach to improve NAFLD.

Keywords : Intermittent Fasting, NAFLD, Scoping Review, Liver Steatosis, Metabolic syndrome, Diet Intervention

  1. Ahmed, N., Farooq, J., Siddiqi, H. S., Meo, S. A., Kulsoom, B., Laghari, A. H., Jamshed, H., & Pasha, F. (2021). Impact of intermittent fasting on lipid profile: A quasi-randomized clinical trial. Frontiers in Nutrition, 7, 1–8. https://doi.org/10.3389/fnut.2020.596787
  2. Amini-Salehi, E., Letafatkar, N., Norouzi, N., Joukar, F., Habibi, A., Javid, M., Sattari, N., Khorasani, M., Farahmand, A., Tavakoli, S., Masoumzadeh-Kiaee, B., Abbaspour, E., Karimzadhagh, S., Ghadiri, A., Maddineni, G., Khosousi, M. J., Faraji, N., Keivanlou, M. H., Mahapatro, A., … Nayak, S. S. (2024). Global prevalence of nonalcoholic fatty liver disease: An updated meta-analysis on 78 million population over 38 countries. Archives of Medical Research, 55(6). https://doi.org/10.1016/j.arcmed.2024.103043
  3. Ando, Y., & Jou, J. H. (2021). Nonalcoholic fatty liver disease and recent guideline updates. Clinical Liver Disease, 17(1), 23–28. https://doi.org/10.1002/cld.1045
  4. Brocchi, A., Rebelos, E., Dardano, A., Mantuano, M., & Daniele, G. (2022). Effects of intermittent fasting on brain metabolism. Nutrients, 14(6). https://doi.org/10.3390/nu14061275
  5. Cai, H., Qin, Y.-L., Shi, Z.-Y., Chen, J.-H., Zeng, M.-J., Zhou, W., Chen, R.-Q., & Chen, Z.-Y. (2019). Effects of alternate-day fasting on body weight and dyslipidaemia in patients with non-alcoholic fatty liver disease: A randomised controlled trial. BMC Gastroenterology, 19(1), 219. https://doi.org/10.1186/s12876-019-1132-8
  6. Deng, Q., Lv, R., Zou, H., & Zou, T. (2024). Beneficial effects of intermittent fasting on nonalcoholic fatty liver disease: A narrative review. Egyptian Liver Journal, 14(1). https://doi.org/10.1186/s43066-024-00368-x
  7. Dong, X., Li, J.-M., Lu, X.-L., Lin, X.-Y., Hong, M.-Z., Weng, S., & Pan, J.-S. (2024). Global burden of adult non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) has been steadily increasing over the past decades and is expected to persist in the future. Translational Gastroenterology and Hepatology, 9, 0–0. https://doi.org/10.21037/tgh-23-118
  8. Ezpeleta, M., Gabel, K., Cienfuegos, S., Kalam, F., Lin, S., Pavlou, V., Song, Z., Haus, J. M., Koppe, S., Alexandria, S. J., Tussing-Humphreys, L., & Varady, K. A. (2023). Effect of alternate-day fasting combined with aerobic exercise on non-alcoholic fatty liver disease: A randomized controlled trial. Cell Metabolism, 35(1), 56–70.e3. https://doi.org/10.1016/j.cmet.2022.12.001
  9. Fanti, M., Mishra, A., Longo, V. D., & Brandhorst, S. (2021). Time-restricted eating, intermittent fasting, and fasting-mimicking diets in weight loss. Current Obesity Reports, 10(2), 70–80. https://doi.org/10.1007/s13679-021-00424-2
  10. Farzanegi, P., Dana, A., Ebrahimpoor, Z., Asadi, M., & Azarbayjani, M. A. (2019). Mechanisms of beneficial effects of exercise training on non-alcoholic fatty liver disease (NAFLD): Roles of oxidative stress and inflammation. European Journal of Sport Science, 19(7), 994–1003. https://doi.org/10.1080/17461391.2019.1571114
  11. Golabi, P., Locklear, C. T., Austin, P., Afdhal, S., Byrns, M., Gerber, L., & Younossi, Z. M. (2016). Effectiveness of exercise in hepatic fat mobilization in nonalcoholic fatty liver disease: Systematic review. World Journal of Gastroenterology, 22(27), 6318–6327. https://doi.org/10.3748/wjg.v22.i27.6318
  12. Goss, A. M., Goree, L. L., Ellis, A. C., Chandler-Laney, P. C., Casazza, K., Lockhart, M. E., & Gower, B. A. (2013). Effects of diet macronutrient composition on body composition and fat distribution during weight maintenance and weight loss. Obesity, 21(6), 1139–1142. https://doi.org/10.1002/oby.20191
  13. He, Z., Xu, H., Li, C., Yang, H., & Mao, Y. (2023). Intermittent fasting and immunomodulatory effects: A systematic review. Frontiers in Nutrition, 10, 1–12. https://doi.org/10.3389/fnut.2023.1048230
  14. Holmer, M., Lindqvist, C., Petersson, S., Moshtaghi-Svensson, J., Tillander, V., Brismar, T. B., Hagström, H., & Stål, P. (2021). Treatment of NAFLD with intermittent calorie restriction or low-carb high-fat diet: A randomised controlled trial. JHEP Reports, 3(3), 100256. https://doi.org/10.1016/j.jhepr.2021.100256
  15. Johari, M. I., Yusoff, K., Haron, J., Nadarajan, C., Ibrahim, K. N., Wong, M. S., Hafidz, M. I. A., Chua, B. E., Hamid, N., Arifin, W. N., Ma, Z. F., & Lee, Y. Y. (2019). A randomised controlled trial on the effectiveness and adherence of modified alternate-day calorie restriction in improving activity of non-alcoholic fatty liver disease. Scientific Reports, 9(1), 1–9. https://doi.org/10.1038/s41598-019-47763-8
  16. Kalas, M. A., Chavez, L., Leon, M., Taweesedt, P. T., & Surani, S. (2021). Abnormal liver enzymes: A review for clinicians. World Journal of Hepatology, 13(11), 1688–1698. https://doi.org/10.4254/wjh.v13.i11.1688
  17. Kechagias, S., Nasr, P., Blomdahl, J., & Ekstedt, M. (2020). Established and emerging factors affecting the progression of nonalcoholic fatty liver disease. Metabolism: Clinical and Experimental, 111, 154183. https://doi.org/10.1016/j.metabol.2020.154183
  18. Kord-Varkaneh, H., Salehi-Sahlabadi, A., Tinsley, G. M., Santos, H. O., & Hekmatdoost, A. (2023). Effects of time-restricted feeding (16/8) combined with a low-sugar diet on the management of non-alcoholic fatty liver disease: A randomized controlled trial. Nutrition, 105, 111847. https://doi.org/10.1016/j.nut.2022.111847
  19. Kord-Varkaneh, H., Salehi-Sahlabadi, A., Găman, M.-A., Rajabnia, M., Sedanur Macit-Çelebi, M., Santos, H. O., & Hekmatdoost, A. (2022). Effects of the 5:2 intermittent fasting diet on non-alcoholic fatty liver disease: A randomized controlled trial. Frontiers in Nutrition, 9, 948655. https://doi.org/10.3389/fnut.2022.948655
  20. Koutoukidis, D. A., Koshiaris, C., Henry, J. A., Noreik, M., Morris, E., Manoharan, I., Tudor, K., Bodenham, E., Dunnigan, A., Jebb, S. A., & Aveyard, P. (2021). The effect of the magnitude of weight loss on non-alcoholic fatty liver disease: A systematic review and meta-analysis. Metabolism: Clinical and Experimental, 115, 154455. https://doi.org/10.1016/j.metabol.2020.154455
  21. Lavallee, C. M., Bruno, A., Ma, C., & Raman, M. (2022). The role of intermittent fasting in the management of nonalcoholic fatty liver disease: A narrative review. Nutrients, 14(21). https://doi.org/10.3390/nu14214655
  22. Li, J., Zou, B., Yeo, Y. H., Feng, Y., Xie, X., Lee, D. H., Fujii, H., Wu, Y., Kam, L. Y., Ji, F., Li, X., Chien, N., Wei, M., Ogawa, E., Zhao, C., Wu, X., Stave, C. D., Henry, L., Barnett, S., … Nguyen, M. H. (2019). Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019: A systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology, 4(5), 389–398. https://doi.org/10.1016/S2468-1253(19)30039-1
  23. Lindqvist, C., Holmer, M., Hagström, H., Petersson, S., Tillander, V., Brismar, T. B., & Stål, P. (2023). Macronutrient composition and its effect on body composition changes during weight loss therapy in patients with non-alcoholic fatty liver disease: Secondary analysis of a randomized controlled trial. Nutrition, 110, 111982. https://doi.org/10.1016/j.nut.2023.111982
  24. Lundsgaard, A. M., Holm, J. B., Sjøberg, K. A., Bojsen-Møller, K. N., Myrmel, L. S., Fjære, E., Jensen, B. A. H., Nicolaisen, T. S., Hingst, J. R., Hansen, S. L., Doll, S., Geyer, P. E., Deshmukh, A. S., Holst, J. J., Madsen, L., Kristiansen, K., Wojtaszewski, J. F. P., Richter, E. A., & Kiens, B. (2019). Mechanisms preserving insulin action during high dietary fat intake. Cell Metabolism, 29(1), 50–63.e4. https://doi.org/10.1016/j.cmet.2018.08.022
  25. Malinowski, B., Zalewska, K., Węsierska, A., Sokołowska, M. M., Socha, M., Liczner, G., Pawlak-Osińska, K., & Wiciński, M. (2019). Intermittent fasting in cardiovascular disorders: An overview. Nutrients, 11(3), 1–18. https://doi.org/10.3390/nu11030673
  26. Mantovani, A., & Dalbeni, A. (2021). Treatments for NAFLD: State of art. International Journal of Molecular Sciences, 22(5), 1–27. https://doi.org/10.3390/ijms22052350
  27. Naous, E., Achkar, A., & Mitri, J. (2023). Intermittent fasting and its effects on weight, glycemia, lipids, and blood pressure: A narrative review. Nutrients, 15(15), 1–18.
  28. Pierantonelli, I., & Svegliati-Baroni, G. (2019). Nonalcoholic fatty liver disease: Basic pathogenetic mechanisms in the progression from NAFLD to NASH. Transplantation, 103(1), e1–e13. https://doi.org/10.1097/TP.0000000000002480
  29. Pouwels, S., Sakran, N., Graham, Y., Leal, A., Pintar, T., Yang, W., Kassir, R., Singhal, R., Mahawar, K., & Ramnarain, D. (2022). Non-alcoholic fatty liver disease (NAFLD): A review of pathophysiology, clinical management and effects of weight loss. BMC Endocrine Disorders, 22(1), 1–9. https://doi.org/10.1186/s12902-022-00980-1
  30. Santos, H. O., & Macedo, R. C. O. (2018). Impact of intermittent fasting on the lipid profile: Assessment associated with diet and weight loss. Clinical Nutrition ESPEN, 24, 14–21. https://doi.org/10.1016/j.clnesp.2018.01.002
  31. Softic, S., Cohen, D. E., & Kahn, C. R. (2016). Role of dietary fructose and hepatic de novo lipogenesis in fatty liver disease. Digestive Diseases and Sciences, 61(5), 1282–1293. https://doi.org/10.1007/s10620-016-4054-0
  32. Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., Yki-Järvinen, H., Gastaldelli, A., Vettor, R., Frühbeck, G., & Dicker, D. (2024). EASL–EASD–EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of Hepatology, 81(3), 492–542. https://doi.org/10.1016/j.jhep.2024.04.031
  33. Teng, M. L. P., Ng, C. H., Huang, D. Q., Chan, K. E., Tan, D. J. H., Lim, W. H., Yang, J. D., Tan, E., & Muthiah, M. D. (2023). Global incidence and prevalence of nonalcoholic fatty liver disease. Clinical and Molecular Hepatology, 29(Suppl 1), 32–42. https://doi.org/10.3350/cmh.2022.0365
  34. Vos, M. B., & Lavine, J. E. (2013). Dietary fructose in nonalcoholic fatty liver disease. Hepatology, 57(6), 2525–2531. https://doi.org/10.1002/hep.26299
  35. Wei, S., Wang, L., Evans, P. C., & Xu, S. (2024). NAFLD and NASH: Etiology, targets and emerging therapies. Drug Discovery Today, 29(3), 103910. https://doi.org/10.1016/j.drudis.2024.103910
  36. Wei, X., Lin, B., Huang, Y., Yang, S., Huang, C., Shi, L., Liu, D., Zhang, P., Lin, J., Xu, B., Guo, D., Li, C., He, H., Liu, S., Xue, Y., Xu, Y., & Zhang, H. (2023). Effects of time-restricted eating on nonalcoholic fatty liver disease: The TREATY-FLD randomized clinical trial. JAMA Network Open, 6(3), e233513. https://doi.org/10.1001/jamanetworkopen.2023.3513
  37. Welton, S., Minty, R., Willms, H., Poirier, D., Madden, S., & Kelly, L. (2020). Systematic review: Intermittent fasting and weight loss. Canadian Family Physician, 66, 117–125.
  38. Zhang, Q., Zhang, C., Wang, H., Ma, Z., Liu, D., Guan, X., Liu, Y., Fu, Y., Cui, M., & Dong, J. (2022). Intermittent fasting versus continuous calorie restriction: Which is better for weight loss? Nutrients, 14(9), 1–19. https://doi.org/10.3390/nu14091781
  39. Zhu, Y., Huang, Y., Santos, H. O., de Oliveira, C. V. C., Zhou, H., & Tang, N. (2021). Effects of purslane supplementation on C-reactive protein levels and biomarkers of oxidative stress as marks for metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Phytotherapy Research, 35(10), 5477–5486. https://doi.org/10.1002/ptr.7182

Open Access Copyright (c) 2025 Adilah Robbaniyah, Dian Handayani
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