RAMADAN intermittent fasting may improve liver health and cardiometabolic parameters in adults with metabolic dysfunction-associated steatotic liver disease (MASLD), according to new research.
The prospective, multicentre study found that Ramadan diurnal intermittent fasting was associated with significant reductions in liver fat, liver enzymes, waist circumference, and several lipid measures. Notably, these improvements occurred despite participants reporting lower levels of physical activity during Ramadan.
Researchers recruited 80 adults aged 18–65 years with MASLD and elevated alanine aminotransferase (ALT) levels from eight tertiary centres in Saudi Arabia and Egypt.
Participants underwent assessments within 7 days before Ramadan and again during the final week of Ramadan. These included measurements of body composition, liver biochemistry, lipid and glycaemic profiles, dietary intake, and physical activity.
Liver steatosis and stiffness were assessed using vibration-controlled transient elastography, including controlled attenuation parameter (CAP). The analysis included participants who completed at least 21 consecutive days of Ramadan fasting.
Participants had a median age of 46.1 years, 61.2% were male, and the median BMI was 31.9 kg/m².
Following Ramadan fasting, ALT levels decreased significantly from 95.3 U/L to 70.0 U/L, while aspartate aminotransferase (AST) fell from 55.5 U/L to 46.3 U/L.
Overall, 70% of participants achieved an ALT reduction of at least 20%, while ALT levels normalised in 17.5%.
Liver fat also improved. CAP decreased from 317.0 dB/m before Ramadan to 280.5 dB/m during the final week of fasting. Reductions in ALT, AST, and CAP remained significant after multivariable adjustment.
However, no significant change was observed in liver stiffness measurements over the relatively short study period.
Participants also experienced a modest reduction in body weight, from 90.0 kg to 89.5 kg, alongside a larger reduction in waist circumference, from 103.1 cm to 97.0 cm.
Total cholesterol, triglycerides, and low-density lipoprotein cholesterol also decreased significantly.
Interestingly, physical activity declined significantly during Ramadan, while exploratory analyses found no consistent relationship between behavioural changes and improvements in liver measures.
The researchers suggest that this could indicate that the metabolic effects of Ramadan fasting are not explained solely by increased physical activity or reduced calorie consumption. However, the observational design means the study cannot establish that fasting itself caused the improvements.
The authors conclude that Ramadan fasting represents a culturally embedded form of time-restricted eating that warrants further investigation as a potential lifestyle approach for MASLD. Controlled studies are now needed to establish causality and clarify the mechanisms underlying the observed hepatic benefits.
Reference
Alswat K et al. Hepatic and metabolic changes during Ramadan diurnal intermittent fasting in adults with MASLD and elevated ALT: a prospective multicenter study. BMC Gastroenterology. 2026.
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