Ramadan Fasting as a Therapeutic Strategy for Metabolic Dysfunction-Associated Fatty Liver Disease: Impact on Liver Health, Metabolic Biomarkers, and Gut-Liver Axis Modulation

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a widespread metabolic liver disorder with significant health burdens. This review critically examines the role of Ramadan fasting as a non-pharmacological intervention aimed at improving liver health, modulating metabolic biomarkers, and influencing the gut-liver axis. Through an analysis of current literature, the review delineates the molecular and immune mechanisms underlying MAFLD and evaluates clinical and biochemical outcomes following Ramadan fasting, including improvements in liver enzymes, fibrosis markers, and metabolic parameters. Additionally, it explores shifts in gut microbiota composition, microbial metabolites, immune modulation, and intestinal barrier function associated with fasting. The review highlights key signaling pathways such as AMPK-Nrf2 and nuclear receptor activity and their relevance in reducing inflammation, oxidative stress, and apoptosis. Finally, potential therapeutic implications of integrating Ramadan fasting with probiotic and pharmacological strategies are discussed, emphasizing personalized approaches. The synthesis underscores Ramadan fasting as a promising adjunct therapy for MAFLD, while identifying critical research gaps warranting future clinical trials.