Abstract
OBJECTIVE: Previous studies examining the impact of Ramadan fasting on patients with metabolic dysfunction-associated fatty liver disease (MAFLD) have yielded mixed results. Therefore, assessing the health benefits of such fasting in patients with MAFLD through a systematic review and meta-analysis (SR/MA) is important. METHODS: A systematic search was conducted on MEDLINE, Scopus, Web of Science, Google Scholar, and ClinicalTrials.gov from their inception to March 5, 2025, to identify relevant studies involving adults with MAFLD fasting during Ramadan. The primary outcome was liver-related parameters, while additional outcomes included changes in anthropometric and metabolic parameters during the peri-Ramadan period. Statistical analysis was performed using R software, and the results were presented as mean differences (MD) with 95% confidence intervals (CI). RESULTS: Eight studies (10 reports), mostly with serious risk of bias, involving 603 subjects revealed that Ramadan fasting was associated with reductions in alanine transaminase (ALT [MD -4.11 U/L]), aspartate transaminase (AST [MD -4.24 U/L]), FIB4 index (MD -0.09), and nonalcoholic fatty liver disease fibrosis score (MD -0.22) from baseline in fasting individuals. However, the changes in ALT and AST were similar in studies comparing fasting and non-fasting groups. Fasting individuals experienced significantly greater weight loss (MD -1.44 kg), as well as reductions in body mass index (MD -0.66 kg/m(2)) and waist circumference (MD -0.91 cm), compared to those who did not fast. Individuals who fasted experienced a glycemic benefit characterized by a reduction in glycated hemoglobin (MD -0.4%). However, changes in mean body fat percentage and HOMA-IR were similar in both the fasting and non-fasting groups. Individuals who fasted experienced reductions in both systolic and diastolic blood pressure, along with improved lipid parameters. CONCLUSION: This SR/MA of small existing data suggests that fasting during Ramadan improves certain MAFLD-related outcomes. Larger, multinational studies with wider global representation are needed to improve clinical practice decisions.