By Prof Dr Lee Yeong Yeh
About 1 in 5 Malaysians have fatty liver and about 1 in 2 Malaysians with diabetes mellitus. Fatty liver can be complicated with cirrhosis (or permanent scarring of the liver) and liver cancer. In addition, patients with fatty liver may be more likely to have heart disease due to associated metabolic nature of the disease. More Malaysians are being diagnosed with fatty liver nowadays because of rising obesity and sedentary lifestyle. At the moment, there is no approved pharmacological therapy for fatty liver, and many national guidelines advocate control of risk factors and lifestyle changes including dietary restriction and increase physical activities. Evidence indicates that dietary intervention is effective in improving liver histology, with daily low caloric diet (500 to 1000 kcal) and 7-10 % weight loss as typically recommended targets. However, patients often find it difficult to adhere and maintain with such intense restriction.
Intermittent fasting or IF is very much the latest and the most popular health trend worldwide including Malaysia. IF is low calorie period lasting less than 24 hours followed by a normal feeding period, and IF may achieve a more consistent weight loss probably because of better adherence than intense caloric restriction. In our latest publication in the Scientific Reports, a prestigious Nature publication, we have shown that in comparison to usual habitual diet, 8 weeks of modified alternate-day calorie restriction, a form of IF, was significantly more effective in controlling disease activity of fatty liver including liver inflammation, fats in liver and also fibrosis (transient or early form of liver scarring) with good adherence rate of between 75-83%.
There are many methods of IF, and in our study, during fasting day, participants were asked to restrict 70% of their calorie requirement per day, and on non-fasting day, participants ate ad libitum. During fasting day, calorie-deficient meals were only consumed between 2 and 8 pm, and we had involved a dedicated dietitian to advise the participants on the diet.
How does IF work in fatty liver? One, IF reduces weight and also visceral fat. Second, fasting may result in cell deaths (autophagy) especially damaged cells, and refeeding allows new liver cells to grow (regeneration), and the repeated cycles of autophagy and regeneration will thus restore liver function over time. However the exact molecular mechanisms underlying liver autophagy and regeneration remain relatively unknown.
While IF seems effective in fatty liver, it is important to remember that prolonged IF may lead to nutritional deficiency, and IF alone without exercise, may not be effective in reducing risk of heart attack. Therefore it is prudent to seek medical advice before embarking on IF for clinical indication.
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Prof Dr Lee Yeong Yeh is Professor of Medicine, and Consultant of Gastroenterology, Hepatology and Internal Medicine from Hospital Universiti Sains Malaysia, Kota Bharu. He is widely published with numerous papers in high-impact journals. He was awarded the Outstanding Young Malaysian Award by JCI Malaysia in 2015 and the Top Research Scientist of Malaysia by the Academy of Sciences Malaysia in 2018. He is an honorary member of Young Scientist Network (YSN)-Academy of Sciences Malaysia, and holds other key positions in local and international organizations.