The Study
Effect of alternate day fasting combined with aerobic exercise on non-alcoholic fatty liver disease: A randomized controlled trial
This study is like a fair race between four groups: one did fasting + exercise, one did only fasting, one did only exercise, and one did nothing. It shows that doing both fasting and exercise helped more than doing nothing or just exercise — but we can't say for sure if it's better than just fasting. It's like saying two snacks together helped more than one snack, but we don't know if two snacks are better than two different snacks.
Analysis score
Maximum 90 for a randomized controlled trial.
Where the score came from
Scientists tested if skipping calories every other day plus walking or biking five times a week helps shrink fat in the liver better than just doing one or the other.
Where does this study sit?
Reviews of RCTs (Meta-analyses)
Max 100Randomized Trials
Max 90Reviews of Cohort Studies
Max 85Cohort Studies
Max 72Reviews of Case-Control Studies
Max 63Case-Control Studies
Max 58Cross-Sectional & Case Series
Max 50Expert Opinion
Max 568 / 100
Quality score
Participants are randomly assigned to treatment or control groups, minimizing bias. The gold standard for testing whether an intervention causes an effect.
Key takeaways
Summary
Based on the study abstract and findings.
- 1A 5.5% drop in liver fat is meaningful — it’s similar to what’s needed to improve liver health, and fasting alone worked almost as well as doing both.
- 2After 3 months: Fasting + exercise cut liver fat by 5.5%; fasting alone cut it by 2.3%; exercise alone cut it by 1.3%; no change in the group that did nothing.
- 3Weight dropped 4.6% with both, 5.1% with fasting alone, and 2.1% with exercise alone.
Score breakdown, methodology, conflicts of interest, evidence analysis & raw study data
Publication
Journal
Cell metabolism
Year
2022
Authors
M. Ezpeleta, K. Gabel, S. Cienfuegos, F. Kalam, Shuhao Lin, V. Pavlou, Zhenyuan Song, J. Haus, Sean Koppe, S. Alexandria, L. Tussing-Humphreys, K. Varady
Related Content
Claims (7)
When no food is consumed during fasting, insulin levels drop, leading to the breakdown of fat stores and increased burning of fat in the liver.
Reducing dietary carbohydrates lowers insulin levels, which allows fat breakdown to increase and enhances the liver's ability to use fat for energy.
In adults with obesity and mild non-alcoholic fatty liver disease, three months of alternate-day fasting reduces liver fat by 2.25%, a change that is not significantly different from the 5.48% reduction seen when fasting is combined with aerobic exercise.
In adults with obesity and mild fatty liver disease, combining alternate-day fasting with aerobic exercise leads to a 4.58% loss in body weight and 3.24 kg loss in fat mass after three months. This is more than exercise alone or no intervention, but not more than fasting alone.
In adults with obesity and mild fatty liver disease, three months of alternate-day fasting and aerobic exercise does not lower liver enzymes, blood pressure, blood fats, or liver scarring, even though liver fat and insulin sensitivity improve.
In adults with obesity and mild fatty liver disease, combining alternate-day fasting with aerobic exercise for three months increases insulin sensitivity by 4% and lowers insulin resistance by 2.55 HOMA-IR units compared to no change, but the improvement is not greater than either intervention alone.
Not medical advice. For informational purposes only. Always consult a qualified healthcare professional before making health decisions.