The efficacy of DASH combined with time-restricted feeding (16/8) on metabolic associated fatty liver disease management: a randomized controlled trial.

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• TRF + DASH diet may be able to reduce obesity indices and liver parameters in MAFLD patients

• The low energy density and high dietary fibre content of the DASH diet may help increase satiety and prevent overeating during eating hours.

• Simple lifestyle changes in meal timing and food quality can positively impact liver health in MAFLD patients.

Introduction

Metabolic associated fatty liver disease (MAFLD) is one of the most common chronic liver conditions. This study aimed to evaluate the effects of co-administration of dietary approaches to stop hypertension (DASH) and time-restricted feeding (TRF) on liver biomarkers (primary outcome), glucose homeostasis, lipid profile, inflammation and body composition (secondary outcomes) in patients with MAFLD.

Method

This was a randomised controlled trial. Patients who were diagnosed with MAFLD were stratified into groups by body mass index (BMI) and age. They were then randomly assigned to either the TRF (16/8) combined with the DASH group (n = 27) or the control group (n = 26). The control group was advised to adhere to weight loss diets.

Results

After 12 weeks, the TRF + DASH group showed significantly greater reductions compared to the control group in:

Anthropometrics:

• BMI (P = .030)

• abdominal circumference (P = .005)

• waist–hip ratio (P < .001).

Liver health:

• alanine transaminase (ALT) (−15.23 ± 18.30 vs. −4.73 ± 13.12; P = .039)

• aspartate transaminase (AST) (−7.52 ± 8.31 vs. −3.47 ± 3.11; P = .047)

• gamma-glutamyltransferase (GGT) (−5.71 ± 12.46 vs. −1.03 ± 9.53)

• steatosis score (−68.57 ± 30.94 vs. −30.19 ± 29.49; P < .001)

• fibrosis score (−0.94 kPa; P = .001).

Lipids:

• triglycerides (171.00 ± 89.06 to 138.47 ± 92.06 mg/dL; P = .049).

Adjusted analyses confirmed that between-group differences in AST (P = .003) and fibrosis score (P = .004) remained significant after controlling for BMI and abdominal circumference.

Furthermore, there were no significant between-group changes in fasting blood sugar, HDL-C, total cholesterol, LDL-C, or hs-CRP (P > .05). Insulin and HOMA-IR improved in both groups. Most dietary and nutrient intake measures differed significantly between groups (except Selenium (P = .673) and Vitamin E (P = .545)), with the intervention group showing greater improvements in PUFA-ω6 intake (P = .013).

Conclusion

The authors concluded that the TRF + DASH dietary approach is more effective than a control diet in improving obesity-related measures and liver health in people with MAFLD. The DASH diet may enhance the benefits of TRF by improving satiety, reducing calorie intake, providing key nutrients, and helping to regulate fat storage in the liver.

• Combining TRF (16/8) with a nutrient-dense DASH diet may be a more practical and sustainable dietary approach for improving liver and metabolic health in MAFLD patients.

• Improvements in liver enzymes and fibrosis markers suggest this approach could be used as part of a non-pharmacological management plan for supporting liver health.

• The intervention’s impact on triglycerides highlights its potential role in addressing cardiovascular risk factors commonly associated with MAFLD.

• Nutrient density from the DASH diet (fibre, minerals, healthy fats) appears to support better satiety and adherence, addressing challenges often faced with fasting-based interventions.

• Trials with a longer intervention period are needed to confirm the chronic effects of this type of combined diet and also to evaluate the level of continuous adherence to the TRF + DASH diet in the long term.

• Comparative studies with other intermittent fasting or dietary approaches could identify the most effective protocols.

• Adherence strategies (app-based reminders, meal planning tools) warrant testing for real-world sustainability and effectiveness.