The Physiological and Clinical Impacts of Ramadan Intermittent Fasting:  A Systematic Literature Review (2025 Update)

Rudi Ruhdiat

doi:10.55927/mudima.v6i3.11

Authors

Rudi Ruhdiat FK President University Jababeka Cikarang

DOI:

https://doi.org/10.55927/mudima.v6i3.11

Keywords:

Physiological and Clinical, Ramadan

Abstract

Ramadan Diurnal Intermittent Fasting (RDIF) is a unique model of time-restricted eating practiced by millions globally. This review synthesizes recent evidence on its physiological effects and clinical management

References

GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024 May 18;403(10440):2162-2203. Doi: 10.1016/S0140-6736(24)00933-4. Erratum in: Lancet. 2024 Jul 20;404(10449):244. doi: 10.1016/S0140-6736(24)01458-2. PMID: 38762324; PMCID: PMC11120204.

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants. Lancet. 2024 Nov 23;404(10467):2077-2093. Doi: 10.1016/S0140-6736(24)02317-1. Epub 2024 Nov Erratum in: Lancet. 2025 Apr 5;405(10485):1146. Doi: 10.1016/S0140-6736(25)00620-8. PMID: 39549716; PMCID: PMC7616842.

Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators. Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023. J Am Coll Cardiol. 2025 Dec 2;86(22):2167-2243. doi: 10.1016/j.jacc.2025.08.015. Epub 2025 Sep 24. PMID: 40990886.

GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1923-1994. doi: 10.1016/S0140-6736(18)32225-6. Epub 2018 Nov 8. Erratum in: Lancet. 2019 Jan 12;393(10167):132. Doi: 10.1016/S0140-6736(18)33216-1. Erratum in: Lancet. 2019 Jun 22;393(10190):e44. doi: 10.1016/S0140-6736(19)31429-1. PMID: 30496105; PMCID: PMC6227755.

Lange MG, Coffey AA, Coleman PC, Barber TM, Van Rens T, Oyebode O, Abbott S, Hanson P. Metabolic changes with intermittent fasting. J Hum Nutr Diet. 2024 Feb;37(1):256-269. doi: 10.1111/jhn.13253. Epub 2024 Jan 10. PMID: 37786321; PMCID: PMC10953463.

Maughan RJ, Fallah J, Coyle EF. The effects of fasting on metabolism and performance. Br J Sports Med. 2010 Jun;44(7):490-4. Doi: 10.1136/bjsm.2010.072181. Epub 2010 May 19. PMID: 20484315.

GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025 Oct 18;406(10513):1873-1922. Doi: 10.1016/S0140-6736(25)01637-X. Epub 2025 Oct 12. PMID: 41092926; PMCID: PMC12535840.

Islam MT, Tuday E, Allen S, Kim J, Trott DW, Holland WL, Donato AJ, Lesniewski LA. Senolytic drugs, dasatinib and quercetin, attenuate adipose tissue inflammation, and ameliorate metabolic function in old age. Aging Cell. 2023 Feb;22(2):e13767. doi: 10.1111/acel.13767. Epub 2023 Jan 13. PMID: 36637079; PMCID: PMC9924942.

GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol. 2024 Oct;23(10):973-1003. doi: 10.1016/S1474-4422(24)00369-7. PMID: 39304265; PMCID: PMC12254192.

Herz D, Haupt S, Zimmer RT, Wachsmuth NB, Schierbauer J, Zimmermann P, Voi T, Thurm U, Khoramipour K, Rilstone S, Moser O. Efficacy of Fasting in Type 1 and Type 2 Diabetes Mellitus: A Narrative Review. Nutrients. 2023 Aug 10;15(16):3525. doi: 10.3390/nu15163525. PMID: 37630716; PMCID: PMC10459496.

Marjot T, Tomlinson JW, Hodson L, Ray DW. Timing of energy intake and the therapeutic potential of intermittent fasting and time-restricted eating in NAFLD. Gut. 2023 Aug;72(8):1607-1619. doi: 10.1136/gutjnl-2023-329998. Epub 2023 Jun 7. PMID: 37286229; PMCID: PMC10359613.

GBD 2023 Chronic Kidney Disease Collaborators. Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025 Nov 22;406(10518):2461-2482. Doi: 10.1016/S0140-6736(25)01853-7. Epub 2025 Nov 7. PMID: 41213283.

Wang L, Gao P, Zhang M, Huang Z, Zhang D, Deng Q, Li Y, Zhao Z, Qin X, Jin D, Zhou M, Tang X, Hu Y, Wang L. Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013. JAMA. 2017 Jun 27;317(24):2515-2523. Doi: 10.1001/jama.2017.7596. PMID: 28655017; PMCID: PMC5815077.

Kazeminasab F, Sharafifard F, Bahrami Kerchi A, Bagheri R, Carteri RB, Kirwan R, Santos HO, Dutheil F. Effects of Intermittent Fasting and Calorie Restriction on Exercise Performance: A Systematic Review and Meta-Analysis. Nutrients. 2025 Jun 13;17(12):1992. doi: 10.3390/nu17121992. PMID: 40573103; PMCID: PMC12195750.

Sanvictores T, Casale J, Huecker MR. Physiology, Fasting. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30521298.

Chawla S, Beretoulis S, Deere A, Radenkovic D. The Window Matters: A Systematic Review of Time Restricted Eating Strategies in Relation to Cortisol and Melatonin Secretion. Nutrients. 2021 Jul 23;13(8):2525. Doi: 10.3390/nu13082525. PMID: 34444685; PMCID: PMC8399962.

Ibrahim M, Ba-Essa EM, Ahmed A, Ahmad E, Annabi FA, Chaabane H, Tuccinardi D, Davies MJ, De Domenico F, Eckel RH, Elbarbary N, Houeiss P, Manfrini S, Masood SN, Mobarak O, Shaikh S, Mimouni-Zerguini S, Umpierrez GE. Recommendations for the Management of Diabetes During Ramadan Applying the Principles of the ADA/ EASD Consensus: Update 2025. Diabetes Metab Res Rev. 2025 Jul;41(5):e70057. doi: 10.1002/dmrr.70057. PMID: 40512040.

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016 Apr 9;387(10027):1513-1530. Doi: 10.1016/S0140-6736(16)00618-8. Epub 2016 Apr 6. Erratum in: Lancet. 2017 Feb 4;389(10068):e2. doi: 10.1016/S0140-6736(16)32060-8. PMID: 27061677; PMCID: PMC5081106.

Shaikh S, Latheef A, Razi SM, Khan SA, Sahay R, Kalra S. Diabetes Management During Ramadan. 2022 May 18. In: Feingold KR, Adler RA, Ahmed SF, Anawalt B, Blackman MR, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hamilton E, Hofland J, Jan de Beur S, Kalra S, Kaltsas G, Kapoor N, Kim M, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Muzumdar R, Purnell J, Rey R, Sahay R, Shah AS, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 35816600.

Ibrahim M, Bahijri S, Tuomilehto J. Diabetes and Ramadan. Prim Care Diabetes. 2015 Aug;9(4):241-3. doi: 10.1016/j.pcd.2015.06.005. PMID: 26117424.

Azizi F. Islamic fasting and health. Ann Nutr Metab. 2010;56(4):273-82. Doi: 10.1159/000295848. Epub 2010 Apr 24. PMID: 20424438.

Ahmed UZ, Lykke JA. Ramadan, faste og graviditet [Ramadan, fasting and pregnancy]. Ugeskr Laeger. 2014 Jul 14;176(29):V03140144. Danish. PMID: 25292203.

Jahromi SR, Sahraian MA, Ashtari F, Ayromlou H, Etemadifar M, Ghaffarpour M, Mohammadianinejad E, Nafissi S, Nickseresht A, Shaygannejad V, Togha M, Torabi HR, Ziaie S. Islamic fasting and multiple sclerosis. BMC Neurol. 2014 Mar 22;14:56. doi: 10.1186/1471-2377-14-56. PMID: 24655543; PMCID: PMC3994348.

Haasis E, Bettenburg A, Lorentz A. Effect of Intermittent Fasting on Immune Parameters and Intestinal Inflammation. Nutrients. 2024 Nov 19;16(22):3956. Doi: 10.3390/nu16223956. PMID: 39599741; PMCID: PMC11597193.

GBD 2021 US Burden of Disease and Forecasting Collaborators. Burden of disease scenarios by state in the USA, 2022-50: a forecasting analysis for the Global Burden of Disease Study 2021. Lancet. 2024 Dec 7;404(10469):2341-2370. doi: 10.1016/S0140-6736(24)02246-3. Erratum in: Lancet. 2025 May 3;405(10489):1579. doi: 10.1016/S0140-6736(25)00828-1. PMID: 39645377; PMCID: PMC11715278.

Omar SI, El-Mulla KF, Eldabah N, El-Busaidy A. The effects of Ramadan fasting on acne vulgaris: clinical, immunological, and oxidative status considerations. Arch Dermatol Res. 2024 Dec 12;317(1):97. Doi: 10.1007/s00403-024-03561-5. PMID: 39666154.

Sheikh A, Wallia S. Ramadan fasting and diabetes. BMJ. 2007 Sep 22;335(7620):613-4. doi: 10.1136/bmj.39323.573148.BE. PMID: 17884907; PMCID: PMC1989019.

Dastghaib S, Siri M, Rahmani-Kukia N, Heydari ST, Pasalar M, Zamani M, Mokaram P, Bagheri-Lankarani K. Effect of 30-day Ramadan fasting on autophagy pathway and metabolic health outcome in healthy individuals. Mol Biol Res Commun. 2025;14(2):115-127. doi: 10.22099/mbrc.2024.50105.1978. PMID: 40028479;PMCID: PMC11865935

Şat S, Aydınkoç-Tuzcu K, Berger F, Barakat A, Schindler K, Fasching P. Diabetes and Migration. Exp Clin Endocrinol Diabetes. 2021 Aug;129(S 01):S106-S118. doi: 10.1055/a-1284-6778. Epub 2021 Apr 14. PMID: 33853175.

Mousavi SN, Rayyani E, Heshmati J, Tavasolian R, Rahimlou M. Effects of Ramadan and Non-ramadan Intermittent Fasting on Gut Microbiome. Front Nutr. 2022 Mar 22;9:860575. doi: 10.3389/fnut.2022.860575. PMID: 35392284; PMCID: PMC8980861.

Ahmed MH, Husain NE, Elmadhoun WM, Noor SK, Khalil AA, Almobarak AO. Diabetes and Ramadan: A concise and practical update. J Family Med Prim Care. 2017 Jan-Mar;6(1):11-18. doi: 10.4103/2249-4863.214964. PMID: 29026740; PMCID: PMC5629872.

Motaib I, Rhmari Tlemçani FZ, Khalis M, Laidi S, Elamari S, Chadli A. Ramadan and Diabetes: What About Non-Fasting Patients with Diabetes? Diabetes Metab Syndr Obes. 2022 Jun 28;15:1975-1983. doi: 10.2147/DMSO.S354627. PMID: 35789894; PMCID: PMC9250316.

Ahmed SH, Chowdhury TA, Hussain S, Syed A, Karamat A, Helmy A, Waqar S, Ali S, Dabhad A, Seal ST, Hodgkinson A, Azmi S, Ghouri N. Ramadan and Diabetes: A Narrative Review and Practice Update. Diabetes Ther. 2020 Nov;11(11):2477-2520. doi: 10.1007/s13300-020-00886-y. Epub 2020 Sep 9. PMID: 32909192; PMCID: PMC7480213.

Ahmed SH, Chowdhury TA, Hussain S, Syed A, Karamat A, Helmy A, Waqar S, Ali S, Dabhad A, Seal ST, Hodgkinson A, Azmi S, Ghouri N. Ramadan and Diabetes: A Narrative Review and Practice Update. Diabetes Ther. 2020 Sep 9:1-44. Doi: 10.1007/s13300-020-00886-y. Epub ahead of print. PMID: 32922560.

Bandarian F, Namazi N, Atlasi R, Nasli-Esfahani E, Larijani B. Research gapsin Ramadan fasting studies in health and disease. Diabetes Metab Syndr. 2021 May-Jun;15(3):831-835. doi: 10.1016/j.dsx.2021.04.009. Epub 2021 Apr 15. PMID: 33866118.

Adawi M. The Effects of the Ramadan Fasting on Metabolic and Immunological Disorders. Isr Med Assoc J. 2021 Apr;23(4):251-252. PMID: 33899359.