Alternate Day Fasting Combined with Exercise for the Treatment of Non-Alcoholic Fatty Liver Disease

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, and exercise alone, on intrahepatic triglyceride content (IHTG). Adults with NAFLD (n = 80) were randomized to 1 of 4 groups for 3 months: combination of ADF (600 kcal “fast day”; 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 was significantly reduced in the combination group (-5.48%; 95% CI, -7.77 to -3.18), compared to 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 ALT significantly decreased, while insulin sensitivity significantly increased, in the combination group compared to the control group. Changes in lean mass, AST, HbA1c, blood pressure, and plasma lipids remained unchanged. Combining intermittent fasting with exercise is effective for reducing hepatic steatosis in patients with NAFLD but may offer no additional benefit versus fasting alone. These results still require confirmation by a larger-scale randomized control trial.