Time-Restricted Feeding, Low-Sugar Diet Help Manage Nonalcoholic Fatty Liver Disease

Combined use of time-restricted feeding and a low-sugar diet decreases body fat and improves liver, lipid, and inflammatory markers in NAFLD.

Combined treatment with time-restricted feeding and a low-sugar diet for patients with nonalcoholic fatty liver disease (NAFLD) improves cardiometabolic and inflammatory biomarkers and reduces adiposity, according to study findings in Nutrition.

While previous research has investigated TRF and a low-sugar diet separately, data on a combination of both treatments for managing NAFLD has been lacking.

Researchers conducted a 12-week randomized controlled trial to observe the combined effects of TRF treatment (16 hours fasting and 8 hours eating daily) and a low-sugar diet on cardiometabolic and inflammatory markers as well as body composition in patients with NAFLD.

 Patients were aged 18 to 50 years, had a body mass index (BMI) of 27 to 40 kg/m2, grade 2 NAFLD, an absence of recent participation in a weight loss diet, and were not receiving treatment with any medications for at least a week prior to study enrollment.

TRF along with low-sugar diet could be viewed as a promising non-pharmacological treatment for NAFLD.

Of 106 patients identified, 52 were included in the study. Participants were stratified by BMI and age and then randomly assigned to a combined TRF and low-sugar diet group (treatment; n=27) or a control group (n=25).

The low-sugar diet followed guidelines set by the World Health Organization, which limits the addition of monosaccharides and disaccharides to food and drinks, including sugars that are found in natural sources. Traditional diets were evaluated by a dietitian.  

For both groups, the daily recommended macronutrient intake was 55% from carbohydrates, 30% calories from fats, 15% from protein with 9 servings and fruits and vegetables.

By the end of the trial, 4 participants from the treatment group and 3 participants from the control group withdrew. The average age of patients in both groups was 42.8±7.9 years and average BMI was 29.9±2.9 kg/m2.

A per protocol analysis was conducted, and researchers saw significant differences in body weight, with an average weight reduction of 3.21 kg in the treatment group (P <.001) compared with a decrease of 1.02 kg in the control group (P =.064). Significant BMI decreases were recorded, with an average decrease of 1.11 (P <.0001) in the treatment group and a reduction in 0.34 in the control group (P =.063).

Participants in the treatment group experienced a decrease of 2.47 kg (P =.001) in average body fat, and the control group experienced an average increase of 1.72 kg (P =.041).

Between-group differences were significant in the same categories of body weight (P =.029), BMI (P =.013), and fat mass (P =.025).

Overall fibrosis scores were reduced in the treatment group (6.33±1.01 kPa; P =.024) compared with the control group (5.15±1.15 kPa; P =.009). Similar trends were observed for steatosis scores or controlled attenuation parameter, with the treatment group experiencing reductions of 322.9±34.9 dB/m (P <.001) compared with the control group (decrease of 270.9±36.16 dB/m [P <.001]).

The treatment group showed significant reductions in triglycerides with 201.5±35.34 mg/dL (P <.001) compared with a reduction of 133.27±48.67 mg/dL (P <.001) in the control group. Decreases in total cholesterol (P =.001 in both groups) and LDL-C were also observed (treatment group, P =.017; control group, P =.014).

Inflammatory biomarkers also showed significant between-group differences in hs-CRP and CK-18 (P <.001 for both markers).

Study limitations include a small sample size, a relatively short study period, and the inability to measure the effects of TRF and the low-sugar diet separately.

“Combining TRF with a low-sugar diet is a novel dietary strategy in NAFLD research, and our study sheds light on a possible combination of nutritional strategies that have been considered for this population,” the study authors noted. “While various low-carbohydrate strategies have emerged to promote health improvement and metabolic modulation, the low-sugar diet employed in the present study is not as restrictive of carbohydrate intake as many of these programs.”


Varkaneh HK, Salehisahlabadi A, Tinsley GM, Santos HO, Hekmatdoost A. Effects of time-restricted feeding (16/8) combined with a low-sugar diet on the management of nonalcoholic fatty liver disease: a randomized controlled trial. Nutrition. Published online September 13, 2022. doi:10.1016/j.nut.2022.111847