Reviewer ’s report  
 
Title: Effects of alternate -day fasting on body weight and dyslipidaemia in patients with non -
alcoholic fa tty liver disease: a randomised controlled trial  
 
Version: 0 Date: 16 Oct 2019  
 
Reviewer: Francesca Ponziani  
 
Reviewer's report:  
 
In this randomized controlled study the Authors have compared the effects of ADF and TRF on 
body weight, body composition, and dyslipidaemia in individuals with NAFLD over a 12 -weeks 
period.  
Decrease in fat mass and tryglicerides was similare between ADF a nd TRF groups but 
cholesterol reduced significantly only in the ADF group. No effect was observed in fat free mass, 
HDL, LDL, fasting insulin, glucose, and systolic or diastolic blood pressure.  
 
Although this study was the first single -centre large -scale r andomised trial to examine the impact 
of ADF on NAFLD patients, actually NAFLD was not the real objective of the study. This is the 
main limitation of this study. It should be worth to provide data on liver function stiffness and so 
on in relation to these  dietary interventions during the follow -up. 
 
Furthermore, as reported int he discussion, the study period of 12 weeks is short and longer trials 
are required to determine the degree of weight loss and its maintenance during ADF diet and, 
more importantly,  its long -term effects on nutritional status.  
 
Tha Authors report that "ADF may also contribute to the prevention of cardiovascular disease by 
reducing dyslipidaemia in these individuals, though further investigation of these effects is 
warranted", i sugge st to delete this sentence.  
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the futu re? 
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
none  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Acc ess Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Effects of alternate -day fasting on body weight and dyslipidaemia in patients with non -
alcoholic fa tty liver disease: a randomised controlled trial  
 
Version: 0 Date: 16 Oct 2019  
 
Reviewer: Francesca Ponziani  
 
Reviewer's report:  
 
In this randomized controlled study the Authors have compared the effects of ADF and TRF on 
body weight, body composition, and dyslipidaemia in individuals with NAFLD over a 12 -weeks 
period.  
Decrease in fat mass and tryglicerides was similare between ADF a nd TRF groups but 
cholesterol reduced significantly only in the ADF group. No effect was observed in fat free mass, 
HDL, LDL, fasting insulin, glucose, and systolic or diastolic blood pressure.  
 
Although this study was the first single -centre large -scale r andomised trial to examine the impact 
of ADF on NAFLD patients, actually NAFLD was not the real objective of the study. This is the 
main limitation of this study. It should be worth to provide data on liver function stiffness and so 
on in relation to these  dietary interventions during the follow -up. 
 
Furthermore, as reported int he discussion, the study period of 12 weeks is short and longer trials 
are required to determine the degree of weight loss and its maintenance during ADF diet and, 
more importantly,  its long -term effects on nutritional status.  
 
Tha Authors report that "ADF may also contribute to the prevention of cardiovascular disease by 
reducing dyslipidaemia in these individuals, though further investigation of these effects is 
warranted", i sugge st to delete this sentence.  
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the futu re? 
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
none  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Acc ess Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Effects of alternate -day fasting on body weight and dyslipidaemia in patients with non -
alcoholic fa tty liver disease: a randomised controlled trial  
 
Version: 0 Date: 16 Oct 2019  
 
Reviewer: Francesca Ponziani  
 
Reviewer's report:  
 
In this randomized controlled study the Authors have compared the effects of ADF and TRF on 
body weight, body composition, and dyslipidaemia in individuals with NAFLD over a 12 -weeks 
period.  
Decrease in fat mass and tryglicerides was similare between ADF a nd TRF groups but 
cholesterol reduced significantly only in the ADF group. No effect was observed in fat free mass, 
HDL, LDL, fasting insulin, glucose, and systolic or diastolic blood pressure.  
 
Although this study was the first single -centre large -scale r andomised trial to examine the impact 
of ADF on NAFLD patients, actually NAFLD was not the real objective of the study. This is the 
main limitation of this study. It should be worth to provide data on liver function stiffness and so 
on in relation to these  dietary interventions during the follow -up. 
 
Furthermore, as reported int he discussion, the study period of 12 weeks is short and longer trials 
are required to determine the degree of weight loss and its maintenance during ADF diet and, 
more importantly,  its long -term effects on nutritional status.  
 
Tha Authors report that "ADF may also contribute to the prevention of cardiovascular disease by 
reducing dyslipidaemia in these individuals, though further investigation of these effects is 
warranted", i sugge st to delete this sentence.  
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the futu re? 
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
none  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Acc ess Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant