The impact of ramadan fasting on fatty liver disease severity: A retrospective case control study from Israel

Background: Non-alcoholic fatty liver disease (NAFLD) is emerging as an important public health condition. The effect of Ramadan fasting on several metabolic conditions has been previously assessed. Objectives: To assess the impact of Ramadan fasting on non-alcoholic steatohepatitis (NASH) severity scores. Methods: A retrospective, case control study was conducted in Nazareth Hospital between 2017 and 2019. We included NAFLD patients who had been diagnosed by abdominal ultrasonogra-phy. The study population was divided in two matched groups: NASH subjects who fasted all of Ramadan and NAFLD/NASH subjects who did not fast (control). Metabolic/NASH severity scores, homeostatic model assessment of β-cell function and insulin resistance (HOMA-IR), NAFLD Fibrosis Score (NFS), BARD scores, and fibrosis-4 (FIB4) scores were assessed in both groups before and after the Ramadan month. Results: The study included 155 NASH subjects, 74 who fasted and 81 who did not. Among the fasting group, body mass index decreased from 36.7 ± 7.1 to 34.5 ± 6.8 after fasting (P < 0.003), NFS declined from 0.45 ± 0.25 to 0.23 ± 0.21 (P< 0.005), BARD scores declined from 2.3 ± 0.98 to 1.6 ± 1.01 (P< 0.005), and FIB4 scores declined from 1.93 ± 0.76 to 1.34 ± 0.871 (P< 0.005). C-reactive protein decreased from 14.2 ± 7.1 to 7.18 ± 6.45 (P< 0.005). Moreover, HOMA-IR improved from 2.92 ±1.22 to 2.15 ± 1.13 (P< 0.005). Conclusions: Ramadan fasting improved on inflammatory markers, insulin sensitivity, and noninvasive measures for NASH severity assessment.