Effects of Intermittent Fasting on Liver Steatosis and Fibrosis, Serum FGF-21 and Autophagy Markers in Metabolic Dysfunction-Associated Fatty Liver Disease: A Randomized Controlled Trial

Background: This randomized controlled study sought to determine the effect of intermittent fasting on anthropometric measurements, fibroblast growth factor (FGF)-21, and autophagy markers, as well as on hepatic steatosis and fibrosis levels in overweight or obese patients with metabolic dysfunction...

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Main Authors: Tugce Ozlu Karahan, Elvan Yilmaz Akyuz, Demet Yilmaz Karadag, Yusuf Yilmaz, Fatih Eren
Format: Article
Language:English
Published: MDPI AG 2025-04-01
Series:Life
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Online Access:https://www.mdpi.com/2075-1729/15/5/696
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author Tugce Ozlu Karahan
Elvan Yilmaz Akyuz
Demet Yilmaz Karadag
Yusuf Yilmaz
Fatih Eren
author_facet Tugce Ozlu Karahan
Elvan Yilmaz Akyuz
Demet Yilmaz Karadag
Yusuf Yilmaz
Fatih Eren
author_sort Tugce Ozlu Karahan
collection DOAJ
description Background: This randomized controlled study sought to determine the effect of intermittent fasting on anthropometric measurements, fibroblast growth factor (FGF)-21, and autophagy markers, as well as on hepatic steatosis and fibrosis levels in overweight or obese patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Methods: Patients were randomly assigned into two groups: received a dietary treatment involving 22–25 kcal/kg/day of energy for 8 weeks and followed the same dietary intervention and a 16:8 pattern. The extent of hepatic steatosis and fibrosis was determined using transient elastography on a FibroScan<sup>®</sup> device. The controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), determined by transient elastography, reflect hepatic steatosis and fibrosis, respectively. In duplicate, serum levels of FGF-21, Beclin-1, and ATG-5 were determined using enzyme-linked immunosorbent assay. Results: The study included 48 patients with a mean age of 48.2 ± 1.4 years (27 female and 21 male). Improvements in anthropometric measurement and CAP and LSM levels and a decrease in serum FGF-21 levels were found in both groups (<i>p</i> < 0.05). Changes in the CAP and FGF-21 levels were higher in the energy + time-restricted diet group (<i>p</i> < 0.05). Autophagy-related protein (ATG)-5 levels increased only in the energy + time-restricted diet group [(0.74 (0.46–1.29) ng/mL vs. 0.95 (0.73–1.32) ng/mL, <i>p</i> = 0.03]. Conclusions: Intermittent fasting was potentially practical in the management of MAFLD. In particular, changes in FGF-21 and ATG-5 levels indicate the potential of intermittent fasting to regulate metabolic processes and autophagy. However, methodological limitations should be taken into consideration when interpreting the study results.
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spelling doaj-art-d3e366cd4ba340bea842fc27607bc3ee2025-08-20T01:56:28ZengMDPI AGLife2075-17292025-04-0115569610.3390/life15050696Effects of Intermittent Fasting on Liver Steatosis and Fibrosis, Serum FGF-21 and Autophagy Markers in Metabolic Dysfunction-Associated Fatty Liver Disease: A Randomized Controlled TrialTugce Ozlu Karahan0Elvan Yilmaz Akyuz1Demet Yilmaz Karadag2Yusuf Yilmaz3Fatih Eren4Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul 34440, TurkeyDepartment of Nutrition and Dietetics, Hamidiye Faculty of Health Sciences, University of Health Sciences, Istanbul 34668, TurkeyInstitute of Gastroenterology, Marmara University, Istanbul 34854, TurkeyDepartment of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize 53100, TurkeyDepartment of Medical Biology, School of Medicine, Recep Tayyip Erdoğan University, Rize 53100, TurkeyBackground: This randomized controlled study sought to determine the effect of intermittent fasting on anthropometric measurements, fibroblast growth factor (FGF)-21, and autophagy markers, as well as on hepatic steatosis and fibrosis levels in overweight or obese patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Methods: Patients were randomly assigned into two groups: received a dietary treatment involving 22–25 kcal/kg/day of energy for 8 weeks and followed the same dietary intervention and a 16:8 pattern. The extent of hepatic steatosis and fibrosis was determined using transient elastography on a FibroScan<sup>®</sup> device. The controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), determined by transient elastography, reflect hepatic steatosis and fibrosis, respectively. In duplicate, serum levels of FGF-21, Beclin-1, and ATG-5 were determined using enzyme-linked immunosorbent assay. Results: The study included 48 patients with a mean age of 48.2 ± 1.4 years (27 female and 21 male). Improvements in anthropometric measurement and CAP and LSM levels and a decrease in serum FGF-21 levels were found in both groups (<i>p</i> < 0.05). Changes in the CAP and FGF-21 levels were higher in the energy + time-restricted diet group (<i>p</i> < 0.05). Autophagy-related protein (ATG)-5 levels increased only in the energy + time-restricted diet group [(0.74 (0.46–1.29) ng/mL vs. 0.95 (0.73–1.32) ng/mL, <i>p</i> = 0.03]. Conclusions: Intermittent fasting was potentially practical in the management of MAFLD. In particular, changes in FGF-21 and ATG-5 levels indicate the potential of intermittent fasting to regulate metabolic processes and autophagy. However, methodological limitations should be taken into consideration when interpreting the study results.https://www.mdpi.com/2075-1729/15/5/696intermittent fastingfibroblast growth factor 21autophagyfatty livertime-restricted eating
spellingShingle Tugce Ozlu Karahan
Elvan Yilmaz Akyuz
Demet Yilmaz Karadag
Yusuf Yilmaz
Fatih Eren
Effects of Intermittent Fasting on Liver Steatosis and Fibrosis, Serum FGF-21 and Autophagy Markers in Metabolic Dysfunction-Associated Fatty Liver Disease: A Randomized Controlled Trial
Life
intermittent fasting
fibroblast growth factor 21
autophagy
fatty liver
time-restricted eating
title Effects of Intermittent Fasting on Liver Steatosis and Fibrosis, Serum FGF-21 and Autophagy Markers in Metabolic Dysfunction-Associated Fatty Liver Disease: A Randomized Controlled Trial
title_full Effects of Intermittent Fasting on Liver Steatosis and Fibrosis, Serum FGF-21 and Autophagy Markers in Metabolic Dysfunction-Associated Fatty Liver Disease: A Randomized Controlled Trial
title_fullStr Effects of Intermittent Fasting on Liver Steatosis and Fibrosis, Serum FGF-21 and Autophagy Markers in Metabolic Dysfunction-Associated Fatty Liver Disease: A Randomized Controlled Trial
title_full_unstemmed Effects of Intermittent Fasting on Liver Steatosis and Fibrosis, Serum FGF-21 and Autophagy Markers in Metabolic Dysfunction-Associated Fatty Liver Disease: A Randomized Controlled Trial
title_short Effects of Intermittent Fasting on Liver Steatosis and Fibrosis, Serum FGF-21 and Autophagy Markers in Metabolic Dysfunction-Associated Fatty Liver Disease: A Randomized Controlled Trial
title_sort effects of intermittent fasting on liver steatosis and fibrosis serum fgf 21 and autophagy markers in metabolic dysfunction associated fatty liver disease a randomized controlled trial
topic intermittent fasting
fibroblast growth factor 21
autophagy
fatty liver
time-restricted eating
url https://www.mdpi.com/2075-1729/15/5/696
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