Intermittent fasting- the future treatment in nash patients?

Non-alcoholic steatohepatitis (NASH) is one of the leading causes of chronic liver disease with the potential of evolving towards end-stage liver disease and hepatocellular carcinoma (HCC), even in the absence of cirrhosis. Apart from becoming an increasingly prevalent indication for liver transplantation in cirrhotic and HCC patients, its burden on the healthcare system is also exerted by the increased number of non-cirrhotic NASH patients. Intermittent fasting (IF) has recently gained more interest in the scientific community as a possible treatment approach for different components of the metabolic syndrome. Basic science and clinical studies have shown that apart from inducing body weight loss, improving cardio-metabolic parameters, namely blood pressure, cholesterol and triglyceride levels, insulin and glucose metabolism, IF can reduce inflammatory markers, endoplasmic reticulum (ER) stress, oxidative stress, autophagy, and endothelial dysfunction, as well as modulate gut microbiota. This review aims to further explore the main NASH pathogenetic metabolic drivers on which IF can act upon and improve the prognosis of the disease, and summarize the current clinical evidence.