Benefits of alternate day fasting in NAFLD


Dr Veena Aggarwal, Consultant Womens’ Health, CMD and Editor-in-Chief, IJCP Group & Medtalks Trustee, Dr KK’s Heart Care Foundation of India    27 February 2023

Non-alcoholic fatty liver disease (NAFLD) is fast becoming an important public health problem. The rise in the prevalence of NAFLD is largely due to the high prevalence of obesity. Following a regime of alternate day fasting with exercise reduces fat in the liver, according to a recent study published in the journal Cell Metabolism.1


This 3-month study looked at lifestyle interventions in improving liver fat content, specifically intrahepatic triglyceride. For this 80 obese adults with NAFLD were assigned to four groups: combining alternate day fasting with moderate intensity aerobic exercise, alternate day fasting alone, exercise alone or no-intervention (control). The alternate day fasting regimen involved restricting calorie intake to 600 kcal on the day of fast alternating with  “feast day” with unrestricted intake of calories. The moderate intensity exercise involved 5 sessions with each session lasting for an hour.


At the end of the study, a marked reduction in the intrahepatic fat content was seen in the combination group (-5.48%) vs the exercise alone group (-1.30%) vs the control group (-0.17%). However, the difference was non-significant when compared to the alternate day fasting group (-2.25%).


A marked reduction in body weight, fat mass, waist circumference and levels of the hepatic enzyme alanine transaminase (ALT) was seen with both fasting and exercise (combination group), while insulin sensitivity notably increased among the participants in this group indicative of improved glycemic control. Reduction in body weight was also similar between the combination group and the alternate day fasting alone group. No between-group differences were observed for lean mass, aspartate transaminase (AST), HbA1c, BP, serum lipids, liver fibrosis score and hepatokines (fetuin-A, FGF-21, and selenoprotein P.


This study reiterates the benefits of calorie restriction and subsequent weight reduction on fatty liver. Alternate day or intermittent fasting therefore may be a viable nonpharmacological approach to manage patients with NAFLD as evident by this study. The authors also note the need for long-term studies to see if these beneficial effects can be sustained.




  1. Ezpeleta M, et al. Effect of alternate day fasting combined with aerobic exercise on non-alcoholic fatty liver disease: A randomized controlled trial. Cell Metab. 2023 Jan 3;35(1):56-70.e3. doi: 10.1016/j.cmet.2022.12.001.

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