4. Discussion
NAFLD, obesity, visceral/abdominal, liver steatosis, fatty liver, caloric reduction, fibrosis, weight gain, weight loss
OBESITY, LIVER STEATOSIS, INFLAMMATION, FATTY LIVER, FIBROSIS, HEPATIC STEATOSIS, INSULIN SENSITIVITY
NAFLD is highly prevalent and is associated with adverse long-term health outcomes. Hence, effective, easily administered therapies are needed. Although many lifestyle modifications involve the goal of losing weight through CR and exercise, there has been an increasing interest in TRF with and without CR as a treatment for obesity [IF is a more attractive lifestyle modification because it is simpler to restrict the time at which one eats rather than what is being eaten. The main strength of our study is that it accurately presents results for individuals with NAFLD typically seen in the outpatient setting. In addition, TRF advice is easy to follow, and the effects are easily measurable via point-of-care assessments, TE, and anthropometry, and these assessments can be conducted at little expense, with immediate benefits in terms of helping to guide decision making.NAFLD treatment success is determined by a reduction in hepatic steatosis, inflammation, and fibrosis. We used the CAP function of FibroScanHepatic fibrosis is the main predictor of NAFLD progression [We considered caloric reduction as an explanation for the significant changes seen in the TRF groups; however, there was no change in total energy consumption from baseline or through the study in either the TRF or SC participants. On average, each group consumed 7500 kJ/day. The fact that the caloric intakes of the groups did not change, only the time during which calories were consumed can account for the changes associated with fasting, which may explain why the TRF individuals lost significant visceral/abdominal fat. A randomized trial by Koopman et al. showed that despite having the same high caloric intakes, individuals who ate more often rather than consuming three large meals without snacking had more liver steatosis and abdominal fat independent of weight gain [There was no change in fasting insulin, glucose, cholesterol TNF-α, or ALT over the 12-week study period in either the TRF or SC groups, likely due to the normal baseline biochemical markers in most participants. However, significant increases in adiponectin and significant decreases in leptin were observed. In the liver, adiponectin increases insulin sensitivity and has anti-fibrotic and anti-inflammatory effects [An association between weight loss and BP reduction has been well established through CR with or without exercise [Throughout the study, neither caloric intake nor activity levels significantly changed in either group despite the dietary and exercise advice given to the SC group. Most TRF participants (88%) adhered to the 8 h TRF. The 12% lack of compliance (52/422 days) was mainly due to adding milk to morning coffee. Both diets were well accepted, with no change in hunger scores, happiness, or diet satisfaction.Our study had a number of limitations. NAFLD was diagnosed via ultrasound, the most commonly used diagnostic tool for the detection of hepatic steatosis, with a reported sensitivity of 60–94% and a specificity of 66–95% [At the time of this study, the standard-of-care dietary advice for fatty liver was general advice on reducing calories and fats. The guidelines published in 2021 are more detailed and recommend (but do not exclusively prescribe) the Mediterranean diet. Future studies should compare advice on the Mediterranean diet and TRF.