METABOLIC associated fatty liver disease (MAFLD) is a significant global health concern, with a prevalence ranging from 6% to 35%. It is the leading cause of chronic liver disease, characterised by excessive lipid accumulation in hepatocytes without substantial alcohol consumption. Environmental, genetic, sex-related, and hormonal factors contribute to its development. However, cardiovascular diseases remain the primary cause of death in MAFLD patients, and individuals with MAFLD are at increased risk of developing type 2 diabetes mellitus.
Triglyceride accumulation in the liver triggers oxidative stress, protein misfolding, and mitochondrial damage, leading to chronic inflammation. High sensitivity C-reactive protein (hs-CRP) is a key marker of this inflammatory process. Currently, dietary interventions are the most effective strategy for managing MAFLD, as no approved pharmacological treatments exist.
Intermittent fasting (IF) is a dietary pattern involving defined periods of fasting and feeding. One common form, time-restricted feeding (TRF), limits food intake to a set daily window, such as the 16:8 model (16-hour fasting and 8-hour eating window). TRF improves glucose regulation, blood pressure, and inflammation, independent of weight loss. The Dietary Approaches to Stop Hypertension (DASH) diet, rich in fibre, phytoestrogens, and essential minerals while being low in sodium and saturated fats, has demonstrated beneficial effects on weight, liver enzymes, insulin metabolism, and lipid profiles in patients with MAFLD.
Despite the rising prevalence of MAFLD, limited randomised clinical trials have evaluated the combined impact of TRF and the DASH diet on the condition. A study was conducted to assess their combined effects on hepatic parameters, glucose metabolism, lipid profiles, and inflammation in MAFLD patients. The TRF and DASH diet was found to significantly reduce body mass index (BMI), abdominal circumference, ALT, AST, hepatic fibrosis, and steatosis. However, its impact on glycaemic and lipid indices, as well as inflammation, was less pronounced.
Previous research has highlighted the benefits of TRF on liver stiffness, steatosis, visceral fat, and insulin resistance. However, some studies have found no significant improvements in liver stiffness with TRF alone. This suggests that combining TRF with DASH may enhance its efficacy. The high fibre and nutrient density of DASH improve satiety, regulate carbohydrate absorption, and reduce liver fat accumulation. Furthermore, DASH’s lower sodium content may help mitigate liver fibrosis.
While the study had limitations, including a relatively short intervention period and a lack of a TRF-only comparison group, its strengths lie in its randomised controlled trial (RCT) design. The combination of TRF and DASH presents a practical, sustainable dietary strategy for managing MAFLD, with both regimens being adaptable to individual dietary preferences. Future long-term studies are necessary to confirm and expand on these findings.
Katie Wright, EMJ
Reference
Nilghaz M et al. The efficacy of DASH combined with time-restricted feeding (16/8) on metabolic associated fatty liver disease management: a randomized controlled trial. Sci Rep. 2025;15(1):7020.
