Effect of Ramadan Fast on Liver Function Tests

Dear Editor, The Ramadan fast as a religious duty is practiced by millions of healthy adults. This type of intermittent fasting has different physiological effects on the body. Given the immense number of Muslims fasting every year, this study was designed to assess the effect of the Ramadan fast on liver function tests. Liver function tests have scarcely been mentioned by studies and the results have been diverse. Some studies have demonstrated no change in aspartate transaminase (AST) and alanine transaminase (ALT), but a rise in bilirubin levels. 1 Conversely, others have reported a decrease in AST and ALT and no change in bilirubin levels. 2 Therefore, the present study aimed to assess liver function tests during the Ramadan fast to provide physicians with a broader view on the impact of the Ramadan fast on the liver. The target population was seminary students in the Iranian city of Shahrekord. This research was carried out in the month of Ramadan in 2006 (from September to November). Healthy adults within the age range of 15 to 50 years with no history of liver diseases and no current use of any medication affecting the liver were included in the current study. The exclusion criteria consisted of any history of hepatic disease, lack of involvement in any session of blood sampling, and use of medications with hepatic side effects. Fifty-seven adult healthy participants, 35 males and 22 females, at an age range of 15–24 years were included in the study. Fasting serum levels of liver function tests, including ALT, AST, alkaline phosphatase (ALP), albumin, and total and direct bilirubin, were measured 4 times: before, during (the second and last weeks), and a month after the holy month of Ramadan. The data were analyzed using a repeated measured ANOVA model, and comparison between stages was performed using the paired t-test by SPSS software version 16. Mean AST increased gradually in the second and fourth stages (P=0.032 and P=0.001, respectively) compared to baseline levels, and total serum bilirubin also increased (P=0.059), except for the second week (P=0.07). Mean ALT decreased significantly (P<0.05) only in the second week. ALP assessment showed no significant change during the whole study (P=0.342). Serum albumin only increased significantly 1 month after Ramadan (P<0.05). Elfert et al. 3 compared liver function test serum values before and after Ramadan in 216 cirrhotic patients and reported a rise in serum bilirubin 1 month after …