1. Time Restricted Eating for Non-Alcoholic Fatty Liver Disease & Obesity
Enzo M. Di Battista PhD, MNutr, RD.
Clinical Research Dietitian: Aneurin Bevan University Health Board
Post-Doc Research Fellow (RCBC Wales): University of South Wales

2. Overview Describe NAFLD and the relationship with obesity
Define Time Restricted Eating (TREating)
Review the potential benefits of TREating on NAFLD & obesity
Consider what research design can identify such potential benefits

3. Overview Describe NAFLD and the relationship with obesity
Define Time Restricted Eating (TREating)
Review the potential benefits of TREating on NAFLD & obesity
Consider what research design can identify such potential benefits

4. Overview Describe NAFLD and the relationship with obesity
Define Time Restricted Eating (TREating)
Review the potential benefits of TREating on NAFLD & obesity
Consider what research design can identify such potential benefits

5. Overview Describe NAFLD and the relationship with obesity
Define Time Restricted Eating (TREating)
Review the potential benefits of TREating on NAFLD & obesity
Consider what research design can identify such potential benefits

6. Non-Alcoholic Fatty Liver Disease
“NAFLD is defined as hepatic fat infiltration >5% of hepatocytes on liver biopsy with no evidence of viral, autoimmune, alcohol or drug-induced liver disease”

12. Non-Alcoholic Fatty Liver Disease Prevalence

13. NAFLD in general population
Overweight and Obesity in general population
NAFLD in severe obese population (i.e. BMI ≥40kg m/2)

14. NAFLD in general population
Overweight and Obesity in general population
NAFLD in severe obese population (i.e. BMI ≥40kg m/2)

15. NAFLD in general population
Overweight and Obesity in general population
NAFLD in severe obese population (i.e. BMI ≥40kg m/2)

16. NAFLD in general population
Overweight and Obesity in general population
NAFLD in severe obese population (i.e. BMI ≥40kg m/2)

17. Obesity increases risk of NAFLD by 3.5 fold
(Li et al, 2016)

18. Main treatment for NAFLD is weight loss
(if overweight / obesity present)

21. Dietary approaches to obesity & NAFLD
Daily caloric restriction ( calories)
Meal Replacements
Very low calorie diets (approx. 800 calories / day)
Macronutrient specific (e.g. Mediterranean diet, high protein, low carb, high fat, low fat/high fibre)
Fasting approaches (e.g. 5:2, alternate day, time restricted)

22. Dietary approaches to obesity & NAFLD
Daily caloric restriction ( calories)
Meal Replacements
Very low calorie diets (approx. 800 calories / day)
Macronutrient specific (e.g. Mediterranean diet, high protein, low carb, high fat, low fat/high fibre)
Fasting approaches (e.g. 5:2, alternate day, time restricted)

23. Dietary approaches to obesity & NAFLD
Daily caloric restriction ( calories)
Meal Replacements
Very low calorie diets (approx. 800 calories / day)
Macronutrient specific (e.g. Mediterranean diet, high protein, low carb, high fat, low fat/high fibre)
Fasting approaches (e.g. 5:2, alternate day, time restricted)

24. Dietary approaches to obesity & NAFLD
Daily caloric restriction ( calories)
Meal Replacements
Very low calorie diets (approx. 800 calories / day)
Macronutrient specific (e.g. Mediterranean diet, high protein, low carb, high fat, low fat/high fibre)
Fasting approaches (e.g. 5:2, alternate day, time restricted)

25. Dietary approaches to obesity & NAFLD
Daily caloric restriction ( calories)
Meal Replacements
Very low calorie diets (approx. 800 calories / day)
Macronutrient specific (e.g. Mediterranean diet, high protein, low carb, high fat, low fat/high fibre)
Fasting approaches (e.g. 5:2, alternate day, time restricted)

26. Dietary approaches to obesity & NAFLD
Daily caloric restriction ( calories)
Meal Replacements
Very low calorie diets (approx. 800 calories / day)
Macronutrient specific (e.g. Mediterranean diet, high protein, low carb, high fat, low fat/high fibre)
Fasting approaches (e.g. 5:2, alternate day, time restricted)

28. Time Restricted Eating: TREating defined
“Consuming meals and calorific drinks within a 10 hour timeframe each day, extending night time fasting to 14 hours”

29. Time Restricted Eating: TREating defined
“Consuming meals and calorific drinks within a 10 hour timeframe each day, extending night time fasting to 14 hours”
First meal: 12pm
Second meal: 4pm
Final meal: 9pm

30. Time Restricted Eating: TREating defined
“Consuming meals and calorific drinks within a 10 hour timeframe each day, extending night time fasting to 14 hours”
First meal: 8am
Second meal: 12pm
Final meal: 5pm

31. Time Restricted Eating: Why TREating?

32. With general caloric restriction, approximately one-fourth to one-third of the weight loss is known to be of lean tissue.

34. TREating can turn the ‘metabolic switch’

35. Shift from utilization of glucose from glycogenolysis to fatty acids and fatty acid-derived ketones.
The metabolic switch typically occurs when glycogen stores in hepatocytes are depleted and accelerated adipose tissue lipolysis produces increased fatty acids and glycerol
The metabolic switch:12 and 36 hours after cessation of food consumption, depending on the liver glycogen content at the beginning of the fast, and on the amount of the individual’s energy expenditure/exercise during the fast.

36. Shift from utilization of glucose from glycogenolysis to fatty acids and fatty acid-derived ketones.
The metabolic switch typically occurs when glycogen stores in hepatocytes are depleted and accelerated adipose tissue lipolysis produces increased fatty acids and glycerol
The metabolic switch:12 and 36 hours after cessation of food consumption, depending on the liver glycogen content at the beginning of the fast, and on the amount of the individual’s energy expenditure/exercise during the fast.

37. Shift from utilization of glucose from glycogenolysis to fatty acids and fatty acid-derived ketones.
The metabolic switch typically occurs when glycogen stores in hepatocytes are depleted and accelerated adipose tissue lipolysis produces increased fatty acids and glycerol
The metabolic switch:12 and 36 hours after cessation of food consumption, depending on the liver glycogen content at the beginning of the fast, and on the amount of the individual’s energy expenditure/exercise during the fast.

39. TREating benefits?

40. The TREating Liver Feasibility Study

54. In Summary…
NAFLD is prevalent in society and has 90% prevalence in severe obesity cases
TREating is a novel concept with limited research that might have particular potential in weight management and improved insulin sensitivity / lean muscle mass retention to control or reverse NAFLD
Acceptability of TREating needs to be studied in populations with obesity and NAFLD

55. Questions…