Alternate Day Fasting, Exercise, and NAFLD
Study Details
Study Description
Brief Summary
Approximately 65% of obese individuals have non-alcoholic fatty liver disease (NAFLD), and this condition is strongly related to the development of insulin resistance and diabetes. Innovative lifestyle strategies to treat NAFLD are critically needed. The proposed research will demonstrate that alternate day fasting (ADF) combined with exercise is an effective non-pharmacological therapy to treat NAFLD.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Nonalcoholic fatty liver disease (NAFLD) is characterized by an accumulation of fat in the liver (not resulting from excessive alcohol consumption). Approximately 65% of obese individuals have NAFLD, and this condition is strongly related to the development of insulin resistance and type 2 diabetes. While certain pharmacological agents have been shown to reduce liver fat (i.e. thiazolidinediones), there is mounting concern regarding the safety and weight-gaining effects of these compounds. In light of this, recent research has focused on non-pharmacological lifestyle therapies to reduce hepatic steatosis, such as daily calorie restriction combined with aerobic exercise. Evidence from clinical trials suggest that this combination is an effective lifestyle therapy improve liver fat content and hepatic insulin sensitivity.
More recently, it's been shown that intermittent fasting may produce even greater improvements in hepatic steatosis and hepatic insulin sensitivity, when compared to conventional calorie restriction. For instance, intrahepatic lipid accumulation was lower and insulin sensitivity was higher in mice fasted every other day, when compared to mice who were energy restricted every day. Moreover, data from human trials show that adults with obesity experience greater decreases in insulin and insulin resistance with intermittent fasting versus daily restriction. These findings suggest that intermittent fasting may be a more effective diet therapy to reduce hepatic steatosis and improve insulin sensitivity, when compared to daily calorie restriction. Although these findings are very promising, these data still require confirmation by a randomized controlled clinical trial.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Alternate day fasting These participants will consume 600 kcal on the "fast day" and eat ad libitum at home on alternating "feed days". |
Other: Alternate day fasting
The diet involves consuming 600 kcal on the "fast day" and eat ad libitum at home on alternating "feed days".
|
| Experimental: Exercise These participants will participate in a supervised aerobic exercise program 5 times per week, 40-60 min per session, 60-85% HRmax. |
Other: Exercise
The exercise intervention involves supervised aerobic exercise program 5 times per week, 40-60 min per session, 60-85% HRmax.
|
| Experimental: Combination alternate day fasting plus exercise These participants will consume 600 kcal on the "fast day" and eat ad libitum at home on alternating "feed days". They will also participate in a supervised aerobic exercise program 5 times per week, 40-60 min per session, 60-85% HRmax. |
Other: Alternate day fasting
The diet involves consuming 600 kcal on the "fast day" and eat ad libitum at home on alternating "feed days".
Other: Exercise
The exercise intervention involves supervised aerobic exercise program 5 times per week, 40-60 min per session, 60-85% HRmax.
|
| No Intervention: Control Controls will be instructed to maintain their weight throughout the trial, and not to change eating or physical activity habits. |
Outcome Measures
Primary Outcome Measures
- Change in hepatic steatosis [Change from week 1 to week 12]
Hepatic steatosis will be measured by magnetic resonance imaging (MRI-PDFF)
Secondary Outcome Measures
- Change in body weight [Change from week 1 to week 12]
Measured by digital scale
- Change in lean mass [Change from week 1 to week 12]
Measured by dual-energy x-ray absorptiometry (DXA)
- Change in fat mass [Change from week 1 to week 12]
Measured by dual-energy x-ray absorptiometry (DXA)
- Change in visceral fat mass [Change from week 1 to week 12]
Measured by dual-energy x-ray absorptiometry (DXA)
- Change in Alanine Aminotransferase (ALT) [Change from week 1 to week 12]
Measured by a commercial lab (Medstar, Inc)
- Change in Aspartate Aminotransferase (AST) [Change from week 1 to week 12]
Measured by a commercial lab (Medstar, Inc)
- Change in fasting glucose [Change from week 1 to week 12]
Measured by a commercial lab (Medstar, Inc)
- Change in fasting insulin [Change from week 1 to week 12]
Measured by a commercial lab (Medstar, Inc)
- Change in insulin sensitivity [Change from week 1 to week 12]
Measured by Quantitative insulin sensitivity check index (QUICKI)
- Change in insulin resistance [Change from week 1 to week 12]
Measured by Homeostatic model assessment (HOMA)
- Change in plasma lipid levels [Change from week 1 to week 12]
Measured by a commercial lab (Medstar, Inc)
- Change in HbA1c [Change from week 1 to week 12]
Measured by a commercial lab (Medstar, Inc)
- Change in blood pressure [Change from week 1 to week 12]
Measured by a blood pressure cuff
- Change in heart rate [Change from week 1 to week 12]
Measured by a blood pressure cuff
- Dietary intake [Change from week 1 to week 12]
Measured by a 7-day food record
- Physical activity [Change from week 1 to week 12]
Measured by an activity monitor (Fitbit Alta)
Eligibility Criteria
Criteria
INCLUSION CRITERIA:
-
Age between 18 to 65 years old
-
BMI between 30.0 and 59.9 kg/m2
-
NAFLD (hepatic steatosis ≥ 5% confirmed by MRI-PDFF)
-
Sedentary (<20 min, 2x/week of light activity at 3-4 metabolic equivalents (METs) for 3 mo prior to study)
EXCLUSION CRITERIA:
-
Have chronic liver disease other than NAFLD (hepatitis B or C, primary biliary cirrhosis, sclerosing cholangitis, autoimmune hepatitis, hemochromatosis, Wilson's disease, α1-antitrypsin deficiency)
-
Consume excessive amounts of alcohol women: 70 g of ethanol (5 alcoholic drinks per week) and men 140 g of ethanol (10 drinks per week) in the past 6 months)
-
Have a history of known cardiovascular, pulmonary or renal disease
-
Diagnosed T1DM or T2DM
-
Are not weight stable for 3 months prior to the beginning of study (weight gain or loss > 4 kg)
-
Are claustrophobic or have implanted metallic/electrical devices (e.g. cardiac pacemaker, neuro-stimulator)
-
Are taking drugs that induce steatosis (e.g. corticosteroids, estrogens, methotrexate, Ca channel blockers)
-
Are taking drugs that benefit NAFLD (e.g. betaine, pioglitazone, rosiglitazone, metformin, or gemifibrozil)
-
Are taking drugs that influence study outcomes (weight loss medications)
-
Are perimenopausal or have an irregular menstrual cycle (menses that does not appear every 27-32 days)
-
Are pregnant, or trying to become pregnant
-
Are smokers
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Illinois Chicago | Chicago | Illinois | United States | 60612 |
Sponsors and Collaborators
- University of Illinois at Chicago
Investigators
- Principal Investigator: Krista Varady, PhD, University of Illinois Chicago
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2019-0300