• Amir Mari, Tawfik Khoury, Mahamid Baker, Halel Said Ahmad, Fadi Abu Baker, and Mahmud Mahamid.
• Department of Gastroenterology and Hepatology, Nazareth Hospital EMMS, Nazareth, Israel.
• Isr Med Assoc J. 2021 Feb 1; 23 (2): 94-98.

BackgroundNon-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.ObjectivesTo assess the impact of Ramadan fasting on non-alcoholic steatohepatitis (NASH) severity scores.MethodsA retrospective, case control study was conducted in Nazareth Hospital between 2017 and 2019. We included NAFLD patients who had been diagnosed by abdominal ultrasonography. 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.ResultsThe 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).ConclusionsRamadan fasting improved on inflammatory markers, insulin sensitivity, and noninvasive measures for NASH severity assessment.

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