The impact of Ramadan fasting on the health of cirrhosis patients: A systematic review of available evidences

Ramadan fasting is an annual obligation practiced by millions of Muslims worldwide. This practice is generally safe for healthy individuals, but the metabolic burden of this all-day fasting could cause serious health concerns for those with underlying medical conditions. Cirrhosis is a chronic progressive end-stage liver disease that has profound effect on the body's metabolism. However, the impact of Ramadan Fasting on patient with cirrhosis is still relatively unknown. The aim of this review is to summarize available evidences on the topic of Ramadan Fasting in patients with cirrhosis. Systematic searches were conducted in several databases up to December 2024. Search results were screened using predetermined criteria. Further risk-of-bias assessment was conducted using the ROBINS-I V2 tool. Four studies met the inclusion criteria and underwent a risk-of-bias assessment. Quality of included studies ranges from moderate to serious risk-of bias. Ramadan Fasting was associated with increased severity of Child-Pugh Classification. This increase was most likely caused by the increase in bilirubin level. This increase was especially prominent in decompensated cirrhosis. Included studies reported no significant impact of Ramadan Fasting on serum albumin, PT-INR, or AFP of cirrhosis patients. Studies on the effect of Ramadan Fasting on portal vein parameters and Upper Gastrointestinal Bleeding yielded inconclusive results. Ramadan Fasting might be related with increase in Child-Pugh category of patients, especially in decompensated cirrhosis. Further research is needed to inform the best practice.