{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:03:09Z","timestamp":1790362989861,"version":"4.1.0"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T00:00:00Z","timestamp":1678752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01DK119783"],"award-info":[{"award-number":["R01DK119783"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Objective: This study investigated how alternate-day fasting (ADF) combined with aerobic exercise impacts body weight and sleep in adults with non-alcoholic fatty liver disease (NAFLD). Methods: Adults with obesity and NAFLD (n = 80) were randomized into one of four groups for 3 months: combination of ADF (600 kcal \u201cfast day,\u201d alternated with an ad libitum intake \u201cfeast day\u201d) and moderate-intensity aerobic exercise (five sessions per week, 60 min\/session); ADF alone; exercise alone; or a no-intervention control group. Results: By month 3, body weight and intrahepatic triglyceride content decreased (p &lt; 0.001, group \u00d7 time interaction) in the combination group versus the exercise group and control group, but not versus the ADF group. Sleep quality, measured by the Pittsburgh Sleep Quality Inventory (PSQI), did not change in the combination group (baseline: 6.0 \u00b1 0.7; month 3: 5.6 \u00b1 0.7), ADF group (baseline: 8.9 \u00b1 1.0; month 3: 7.5 \u00b1 0.8), or exercise group (baseline: 6.4 \u00b1 0.6; month 3: 6.7 \u00b1 0.6), versus controls (baseline: 5.5 \u00b1 0.7; month 3: 4.6 \u00b1 0.5). Wake time, bedtime, sleep duration, and insomnia severity did not change (no group x time interaction) over the course of the study in any group. Risk for obstructive sleep apnea was present in 30% of combination subjects, 75% of ADF subjects, 40% of exercise subjects, and 75% of controls, and did not change in the intervention groups, versus controls, by month 3. No associations were observed between changes in body weight, intrahepatic triglyceride content, and any sleep outcome. Conclusions: The weight loss induced by ADF combined with exercise does not improve sleep quality, duration, insomnia severity, or risk of obstructive sleep apnea in individuals with NAFLD.<\/jats:p>","DOI":"10.3390\/nu15061398","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T07:24:03Z","timestamp":1678778643000},"page":"1398","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Alternate-Day Fasting Combined with Exercise: Effect on Sleep in Adults with Obesity and NAFLD"],"prefix":"10.3390","volume":"15","author":[{"given":"Mark","family":"Ezpeleta","sequence":"first","affiliation":[{"name":"Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, Room 532, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4613-8892","authenticated-orcid":false,"given":"Kelsey","family":"Gabel","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, Room 532, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2225-527X","authenticated-orcid":false,"given":"Sofia","family":"Cienfuegos","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, Room 532, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4326-4009","authenticated-orcid":false,"given":"Faiza","family":"Kalam","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, Room 532, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7982-746X","authenticated-orcid":false,"given":"Shuhao","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, Room 532, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki","family":"Pavlou","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, Room 532, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista A.","family":"Varady","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, Room 532, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"993","DOI":"10.2174\/1381612826666200303114934","article-title":"Epidemiology of Non-alcoholic Fatty Liver Disease in North America","volume":"26","author":"Arshad","year":"2020","journal-title":"Curr. Pharm. Des."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"93","DOI":"10.2147\/NSS.S31063","article-title":"Sleep duration, cardiovascular disease, and proinflammatory biomarkers","volume":"5","author":"Grandner","year":"2013","journal-title":"Nat. Sci. Sleep"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e00417","DOI":"10.14309\/ctg.0000000000000417","article-title":"Sleep Duration, Sleep Quality, and the Development of Nonalcoholic Fatty Liver Disease: A Cohort Study","volume":"12","author":"Um","year":"2021","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Um, Y.J., Chang, Y., Jung, H.S., Cho, I.Y., Shin, J.H., Shin, H., Wild, S.H., Byrne, C.D., and Ryu, S. (2022). Decrease in Sleep Duration and Poor Sleep Quality over Time Is Associated with an Increased Risk of Incident Non-Alcoholic Fatty Liver Disease. J. Pers. Med., 12.","DOI":"10.3390\/jpm12010092"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1016\/j.metabol.2016.05.004","article-title":"Nonalcoholic fatty liver disease and obstructive sleep apnea","volume":"65","author":"Clement","year":"2016","journal-title":"Metabolism"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1007\/s11325-013-0806-7","article-title":"The impact of diet and lifestyle management strategies for obstructive sleep apnoea in adults: A systematic review and meta-analysis of randomised controlled trials","volume":"17","author":"Thomasouli","year":"2013","journal-title":"Sleep Breath"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Cai, H., Qin, Y.L., Shi, Z.Y., Chen, J.H., Zeng, M.J., Zhou, W., Chen, R.Q., and Chen, Z.Y. (2019). Effects of alternate-day fasting on body weight and dyslipidaemia in patients with non-alcoholic fatty liver disease: A randomised controlled trial. BMC Gastroenterol., 19.","DOI":"10.1186\/s12876-019-1132-8"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"11232","DOI":"10.1038\/s41598-019-47763-8","article-title":"A Randomised Controlled Trial on the Effectiveness and Adherence of Modified Alternate-day Calorie Restriction in Improving Activity of Non-Alcoholic Fatty Liver Disease","volume":"9","author":"Johari","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.cmet.2022.12.001","article-title":"Effect of alternate day fasting combined with aerobic exercise on non-alcoholic fatty liver disease: A randomized controlled trial","volume":"35","author":"Ezpeleta","year":"2023","journal-title":"Cell Metab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/hep.21669","article-title":"FIB-4: An inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest","volume":"46","author":"Mallet","year":"2007","journal-title":"Hepatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1389-9457(00)00065-4","article-title":"Validation of the Insomnia Severity Index as an outcome measure for insomnia research","volume":"2","author":"Bastien","year":"2001","journal-title":"Sleep Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1097\/ALN.0b013e31816d91b5","article-title":"Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients","volume":"108","author":"Chung","year":"2008","journal-title":"Anesthesiology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1002\/oby.20996","article-title":"Effects of a 2-year behavioral weight loss intervention on sleep and mood in obese individuals treated in primary care practice","volume":"23","author":"Alfaris","year":"2015","journal-title":"Obesity (Silver Spring)"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1001\/jamainternmed.2016.1189","article-title":"Effect of Calorie Restriction on Mood, Quality of Life, Sleep, and Sexual Function in Healthy Nonobese Adults: The CALERIE 2 Randomized Clinical Trial","volume":"176","author":"Martin","year":"2016","journal-title":"JAMA Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kalam, F., Gabel, K., Cienfuegos, S., Ezpeleta, M., Wiseman, E., and Varady, K.A. (2021). Alternate Day Fasting Combined with a Low Carbohydrate Diet: Effect on Sleep Quality, Duration, Insomnia Severity and Risk of Obstructive Sleep Apnea in Adults with Obesity. Nutrients, 13.","DOI":"10.3390\/nu13010211"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1139\/apnm-2019-0032","article-title":"Effect of 8-h time-restricted feeding on sleep quality and duration in adults with obesity","volume":"44","author":"Gabel","year":"2019","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/02601060211002347","article-title":"The effect of 4-h versus 6-h time restricted feeding on sleep quality, duration, insomnia severity and obstructive sleep apnea in adults with obesity","volume":"28","author":"Cienfuegos","year":"2022","journal-title":"Nutr. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.cmet.2019.11.004","article-title":"Ten-Hour Time-Restricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patients with Metabolic Syndrome","volume":"31","author":"Wilkinson","year":"2020","journal-title":"Cell Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e5172","DOI":"10.7717\/peerj.5172","article-title":"Exercise can improve sleep quality: A systematic review and meta-analysis","volume":"6","author":"Banno","year":"2018","journal-title":"PeerJ"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"664499","DOI":"10.3389\/fpsyt.2021.664499","article-title":"Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"12","author":"Xie","year":"2021","journal-title":"Front. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"191","DOI":"10.2147\/NSS.S285854","article-title":"The Coronavirus Pandemic: A Possible Model of the Direct and Indirect Impact of the Pandemic on Sleep Quality in Italians","volume":"13","author":"Casagrande","year":"2021","journal-title":"Nat. Sci. Sleep"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.sleh.2014.12.010","article-title":"National Sleep Foundation\u2019s sleep time duration recommendations: Methodology and results summary","volume":"1","author":"Hirshkowitz","year":"2015","journal-title":"Sleep Health"},{"key":"ref_25","first-page":"1364387","article-title":"Interrelationship between Sleep and Exercise: A Systematic Review","volume":"2017","author":"Dolezal","year":"2017","journal-title":"Adv. Prev. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3015","DOI":"10.1001\/jama.284.23.3015","article-title":"Longitudinal study of moderate weight change and sleep-disordered breathing","volume":"284","author":"Peppard","year":"2000","journal-title":"JAMA"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/6\/1398\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:54:51Z","timestamp":1760122491000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/6\/1398"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,14]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["nu15061398"],"URL":"https:\/\/doi.org\/10.3390\/nu15061398","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,14]]}}}