Published online Mar 28, 2026. doi: 10.4329/wjr.v18.i3.117162
Revised: December 9, 2025
Accepted: January 15, 2026
Published online: March 28, 2026
Processing time: 116 Days and 11.9 Hours
Ramadan fasting (RF) is a form of time-restricted feeding, where individuals abstain from eating and drinking from dawn to sunset. RF has been shown to have positive effects on weight loss, as well as vascular and metabolic disorders. We evaluated the effects of RF on the metabolic profiles of a cohort of Muslims in San Antonio. FibroScan (vibration-controlled transient elastography + controlled attenuation parameter) was used to assess liver stiffness and steatosis before and after RF.
To evaluate the effects of RF on metabolic and liver profiles, including body mass index (BMI), metabolic syndrome (MS), and hepatic steatosis, in a cohort of Muslims residing in San Antonio.
A total of 41 subjects residing in San Antonio, TX, who fasted for 14-15 hours daily for 30 consecutive days during Ramadan, were included in this study. Subjects with any alcohol intake, chronic hepatitis (B and C), pregnancy, or use of hepatotoxic/steatotic agents were excluded. All subjects completed two visits (within 1-2 weeks before and after Ramadan). Each visit involved measurements of BMI, blood pressure, metabolic markers (fasting lipid panel and glucose), liver tests [gamma-glutamyl transferase, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, bilirubin (total and indirect), albumin], and FibroScan measurements.
Prior to RF, 29% had MS and 37% had BMI ≥ 30. MS was present in 11% with BMI < 30 and 60% with BMI ≥ 30 (P = 0.01). Hepatic steatosis was more prevalent in the BMI ≥ 30 group (66% vs 30%, P = 0.02) and correlated with BMI (r = 0.54, P = 0.0003). Most participants had mild fibrosis (F0-1 or F2), with advanced fibrosis in 8% (BMI < 30) and 14% (BMI ≥ 30). Liver enzymes were largely normal at baseline. After 30 days of RF, body weight and BMI significantly decreased (P < 0.0001), while MS prevalence remained unchanged. Controlled attenuation parameter scores improved significantly overall (278.6 dB/m to 264.4 dB/m, P < 0.0001) and within both BMI groups, with no major changes in glucose, lipids, or aminotransferases.
In this South Asian Muslim cohort, MS prevalence was high, especially in males with BMI ≥ 30. Higher BMI correlated with steatosis; 30-day RF reduced weight and improved steatosis.
Core Tip: Ramadan fasting is a culturally significant, time-restricted dietary practice whose effects on hepatic steatosis and metabolic health are not well characterized in South Asian populations especially residing in United States. In this prospective observational study of 41 adults in San Antonio, metabolic profiles, body mass index, and liver parameters were measured before and after 30 days of fasting. Hepatic steatosis was quantified by controlled attenuation parameter and fibrosis by elastography. Fasting led to significant reductions in body weight and controlled attenuation parameter-measured steatosis, regardless of baseline body mass index, highlighting the potential radiologic and metabolic benefits of Ramadan fasting.