Time-restrictive eating no more effective than daily calorie restriction in NAFLD
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Key takeaways:
- Time-restricted eating and daily calorie restriction produced comparable effects on liver stiffness and NAFLD resolution.
- Data support the importance of calorie intake restriction for NAFLD management.
Compared with daily calorie restriction, time-restricted eating did not achieve additional benefits for reducing intrahepatic triglyceride content or body fat among patients with nonalcoholic fatty liver disease and obesity.
“Dietary calorie restriction (DCR) has been proven to be effective in reducing weight and intrahepatic lipid levels among patients with NAFLD. Nevertheless, long-term adherence to lifestyle modification is difficult. Time-restricted eating (TRE) is one of the most popular intermittent fasting regimens,” Xueyun Wei, MD, of the department of endocrinology and metabolism at Southern Medical University in China, and colleagues wrote in JAMA Network Open. “To date, the efficacy of TRE on NAFLD is uncertain. Furthermore, to our knowledge, no studies compared the effects of TRE and DCR on intrahepatic lipid levels in patients with NAFLD.”
In a randomized, parallel-group, observer-blinded clinical trial, 88 patients with NAFLD and obesity (mean age, 32 years; 56% men; mean BMI, 32.3) were assigned to 8-hour TRE (n = 45) or DCR (n = 43) to compare the effects of these regimens on intrahepatic triglyceride (IHTG) content and metabolic risk factors.
Patients assigned to the TRE group ingested meals only between 8 a.m. and 4 p.m. while patients in the DCR group adhered to their habitual meal timing. Researchers instructed patients to maintain a diet of 1,500 to 1,800 calories for men and 1,200 to 1,500 calories for women for 12 months. Of enrolled participants, 92% completed the 6-month intervention and 84% completed the entire 12-month intervention.
Researchers reported an 8.3% (95% CI, –10 to –6.6) reduction in IHGT content among patients in the TRE group and an 8.1% (95% CI, –9.8 to –6.4) reduction among patients in the DCR group at 6 months, and 6.9% (95% CI, –8.8 to –5.1) and 7.9% (95% CI, –9.7 to –6.2) reductions, respectively, at 12 months. The net change in IHGT content was not “significantly different” between groups at either time point.
Liver stiffness also was reduced by –2.1 kPa (95% CI, –2.7 to –1.6) in the TRE group vs. –1.7 kPa (95% CI, –2.3 to –1.2) in the DCR group at 12 months, as was body weight (–8.4 kg [95% CI, –10.3 to –6.4] vs. –7.8 kg [95% CI, –9.7 to –5.9]). NAFLD resolution, defined as IHTG content less than 5%, was reported in 33% and 49% of patients, respectively, at 12 months.
Researchers additionally noted body weight and metabolic risk factors were “significantly and comparably reduced” among patients in both groups.
“In this randomized clinical trial of adults with obesity and NAFLD, a TRE regimen did not achieve additional benefits for reducing IHTG content, weight, body fat and metabolic risk factors compared with DCR, whereas TRE might be more effective in improving insulin sensitivity than DCR,” Wei and colleagues concluded. “In addition, both diets produced a comparable effect on liver stiffness and resolution of NAFLD. These data support the importance of caloric intake restriction when adhering to a regimen of TRE for the management of NAFLD.”
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