Time-restricted eating may be ‘promising management option’ in patients with NAFLD, NASH
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Key takeaways:
- Irregular meal patterns increased the risk for NAFLD and related metabolic conditions.
- Time-restricted eating can lead to weight loss, improved glycemic control and reprogrammed circadian outputs.
Modifying the timing of daily energy intake may improve metabolic health and restore natural circadian rhythms among patients with nonalcoholic fatty liver disease, according to a review published in Gut.
Citing challenges with drug discovery and a lack of therapeutic agents for NAFLD and nonalcoholic steatohepatitis, Thomas Marjot, MD, of the Oxford Center for Diabetes, Endocrinology and Metabolism, and colleagues wrote: “The mainstay of treatment therefore continues to center on lifestyle intervention and weight loss, which has traditionally been achieved through decreasing total calorie intake and modifications to dietary macronutrient composition.”
They continued, “However, there is also accumulating evidence that the timing of energy intake across the day may play an important role in determining an individual’s risk for NAFLD, including missing breakfast, irregular meal patterns and nighttime eating.”
In a review summarizing observational and epidemiological data, Marjot and colleagues established a link between the timing of food intake and NAFLD and discussed how intermittent fasting (IF) and time-restricted eating (TRE) may benefit patients with NAFLD and NASH.
Highlights include:
- Irregular meal patterns, skipping breakfast and nighttime eating correlated with an increased risk for NAFLD as well as related metabolic conditions. Skipping breakfast also was associated with a higher risk for long-term cardiovascular and cerebrovascular mortality among patients with metabolic dysfunction-associated liver disease.
- Distributing total energy intake throughout the day may improve metabolic health. Data demonstrated a dose-response relationship between higher percentage energy intake at lunch and a lower risk for weight gain.
- Complete fasting during Ramadan was linked to weight loss, reduced insulin resistance and improved liver biochemistry.
- Intermittent fasting led to at least 5% weight loss, reduced hepatic steatosis and improved lipid profiles among patients with NALFD. This type of fasting appeared “superior” to standard diets and weight loss advice.
- TRE induced similar reductions in body weight and intra-hepatic triglycerides compared with continuous energy restriction, although TRE “may be better tolerated” and associated with greater improvements in glycemic control.
- TRE can reprogram and synchronize circadian rhythm and may mitigate adverse metabolic phenotypes associated with circadian misalignment from nightshift working.
“If protocols in humans have drawn on a wealth of preclinical data showing that multiple advantageous metabolic pathways are upregulated in nutrient scarce conditions,” Marjot and colleagues concluded. “Furthermore, TRE may facilitate incremental benefits beyond fasting by resynchronizing circadian rhythms across multiple metabolically active tissues involved in the pathogenesis of NAFLD.”
They continued, “Taken together, there is a strong rationale for further detailed exploration of the liver-specific benefits of TRE and this dietary strategy may emerge as a promising management option for patients with NAFLD and NASH.”
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