Intermittent fasting and the liver: Focus on the Ramadan model

Table 1 Studies focusing on Ramadan fasting and non-alcoholic fatty liver disease

	Aliasghari et al[42], 2017	Ebrahimi et al[53], 2018	Gad et al[56], 2022	Arabi et al[58], 2015	Rahimi et al[59], 2017	Mari et al[63], 2021
Type of study	Prospective observational	Prospective observational	Prospective observational	Prospective observational without a control group	Prospective observational without a control group	Retrospective, case-control study
Number of patients	83	83	40	50	60	155
Anthropometric measures	Improved in fasted NAFLD patients	Improved in fasted NAFLD patients	Improved (no control group)	Non-significant improvement with fasting	Non-significant change	Improved in fasted NAFLD/NASH patients
Hormones and biomarkers evaluated	Plasma insulin, and insulin resistance, reactive protein, and interleukin 6 improved in the fasting group	Vaspin and omentin-1 were reduced in the fasting group	-	-	-	HOMA-IR, CRP improved
Liver biochemical profile		-	Improved	Improved	ALT mean level increased with fasting
Lipid profile		-	Improved	Improved	-
Sugar profile	Improved	-	Improved	FBS increased after Ramadan	-
Imaging profile		-	US calculated liver stiffness and controlled attenuation parameters improved	US used only in the diagnosis of fatty liver	-	-
Others		-	Fibrosis score FIB-4 score improved	Blood pressure significantly improved	-	NFS, BARD scores, and FIB4 scores improved

NAFLD: Non-alcoholic fatty liver disease; FBS: Fasting blood sugar; ALT: Alanine aminotransferase; HOMA-IR: Homeostatic model assessment of β-cell function and insulin resistance; CRP: C-reactive protein; NASH: Steatohepatitis; NFS: Non-alcoholic fatty liver disease fibrosis score; FIB4: Fibrosis-4; BARD scores: The BARD score is composed of only three variables: Aspartate aminotransferase/alanine aminotransferase ratio, presence of diabetes and body mass index; US: Ultrasound.