Intermittent fasting and liver disease: Insights from the Ramadan model

Intermittent fasting (IF) has gained growing interest for its potential metabolic benefits. However, the unique physiological aspects of Ramadan fasting (RF), a culturally and religiously significant form of dry IF, remain underexplored, particularly regarding liver disease. RF imposes distinct metabolic and circadian challenges through prolonged daily fasting and altered meal timing, placing considerable demands on hepatic adaptability. Given the liver’s essential role in energy balance, metabolism, and inflammation, as well as the high prevalence of liver disease in many Muslim-majority regions, it is crucial to better understand how RF impacts liver health. This review synthesizes current evidence on how RF can impact liver function, including its effects on insulin sensitivity, autophagy, gut microbiota, gene expression, and inflammation-related pathways. We further reviewed the clinical implications of RF across the broad spectrum of liver conditions, from metabolic dysfunction-associated steatotic liver disease (MASLD) to advanced cirrhosis, hepatocellular carcinoma (HCC), and post-transplant states. By addressing this knowledge gap, this review offers an evidence-based foundation for culturally sensitive and risk-stratified fasting recommendations in individuals with liver disease.