Effects of Ramadan Fasting on Plasma Free Fatty Acids in Patients with Non-Alcoholic Fatty Liver Disease

Document Type : Research Paper


1 Department of Nutrition, School of Medicine

2 1. Department of Nutrition, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Nutrition, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: Nonalcoholic fatty liver disease (NAFLD) is a global disease which its prevalence is about 10-35%. Several factors are involved in the pathogenesis of the disease. The present study was conducted to evaluate the effect of fasting during Ramadan on plasma free fatty acids in patients with NAFLD. Methods: This cross-sectional study was performed during the month of Ramadan in June-July, 2014 (Islamic year: 1435) with 50 patients who were living in Mashhad, Iran. The participants were recruited from 18-65 years old patients. The inclusion criteria were 1) patients with NAFLD that diagnosed fatty liver by ultrasonography and 2) being at least 10 hours fasting. Levels of plasma free fatty acids (Palmitic, Elaidic and Oleic fatty acid) were analyzed in blood sample of all patients by gas chromatography apparatus equipped with a flame ionization detector (GC-FID). Result: results indicated that there was no significant changes were observed in plasma levels of Palmitic, Elaidic and Oleic fatty acids in overweight patients (BMI 25-30 ), but plasma levels of Elaidic acid significantly increased in obese patients (P


  1. Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc. 1980 Jul;55(7):434-8.
  2. Luyckx FH, Lefebvre PJ, Scheen AJ. Non-alcoholic steatohepatitis: association with obesity and insulin resistance, and influence ofweight loss. Diabetes Metab. 2000 Apr;26(2):98-106. PubMed PMID: 10804323.
  3. Lewis JR, Mohanty SR. Nonalcoholic fatty liver disease: a review and update. Dig Dis Sci. 2010 Mar;55(3):560-78.
  4. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999 Jun;116(6):1413-9.
  5. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999 Jun;116(6):1413-9.
  6. Postic C, Girard J. Contribution of de novo fatty acid synthesis to hepatic steatosis and insulin resistance: lessons from genetically engineered mice. J Clin Invest. 2008 Mar;118(3):829-38.
  7. Zivkovic AM, German JB, Sanyal AJ. Comparative review of diets for the metabolic syndrome: implications for nonalcoholic fatty liver disease. Am J Clin Nutr. 2007 Aug;86(2):285-300.
  8. Petta S, Muratore C, Craxi A. Non-alcoholic fatty liver disease pathogenesis: the present and the future. Dig Liver Dis. 2009 Sep;41(9):615-25.
  9. Dowman JK, Tomlinson JW, Newsome PN. Pathogenesis of non-alcoholic fatty liver disease. QJM. 2010 Feb;103(2):71-83.
  10. Alavian SM, Mohammad-Alizadeh AH, Esna-Ashari F, Ardalan G, Hajarizadeh B. Non-alcoholic fatty liver disease prevalence among school-aged children and adolescents in Iran and its association with biochemical and anthropometric measures. Liver Int. 2009 Feb;29(2):159-63. .
  11. Amirkalali B, Poustchi H, Keyvani H, Khansari MR, Ajdarkosh H, Maadi M, et al. Prevalence of Non-Alcoholic Fatty Liver Disease and Its Predictors in North of Iran. Iranian journal of public health. 2014;43(9):1275-83.
  12. Sass DA, Chang P, Chopra KB. Nonalcoholic fatty liver disease: a clinical review. Dig Dis Sci. 2005 Jan;50(1):171-80
  13. Wilfred de Alwis NM, Day CP. Genes and nonalcoholic fatty liver disease. Curr Diab Rep. 2008 Apr;8(2):156-63.
  14. de Almeida IT, Cortez-Pinto H, Fidalgo G, Rodrigues D, Camilo ME. Plasma total and free fatty acids composition in human non-alcoholic steatohepatitis. Clin Nutr. 2002 Jun;21(3):219-23
  15. Arabi SM, Hejri Zarifi S, Nematy M, Safarian M. The effect of Ramadan fasting on non -alcoholic fatty liver disease (NAFLD) Patients. J Fasting Health. 2015; 3(2): 74-80.
  16. Nematy M, Alinezhad-Namaghi M, Rashed MM, Mozhdehifard M, Sajjadi SS, Akhlaghi S, et al. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study. Nutr J. 2012;11:69.
  17. E.G. Bligh,W.J.Dyer,A Rapid, Method of total lipid extraction and purification, Can. J.Biochem.Physiol.37(1959)911–917.
  18. N. Firl, H.Kienberger, T.Hauser, M.Rychlik, Determination of the fatty acid profile of neutral lipids, free fatty acids and phospholipids in human plasma, Clin. Chem.Lab.Med.51(2013)799–810.
  19. Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. The Journal of clinical investigation. 2005 May
  20. Sprangers F, Romijn JA, Endert E, Ackermans MT, Sauerwein HP. The role of free fatty acids (FFA) in the regulation of intrahepatic fluxes of glucose and glycogen metabolism during short-term starvation in healthy volunteers. Clinical nutrition (Edinburgh, Scotland). 2001;20(2):177-9.
  21. Aoki TT, Muller WA, Brennan MF, Cahill GF, Jr. Metabolic effects of glucose in brief and prolonged fasted man. The American journal of clinical nutrition. 1975;28(5):507-11
  22. Mikiko Yasuhara, Tomoko Ohama, Norio Matsuki, Hiroshi Saito, Junji Shiga, Keizo Inoue, t Kiyoshi Kurokawa, Tamio Teramoto. Induction of fatty liver by fasting in suncus. Journal of Lipid Research Volume 32, 1991 887
  23. Saudek CD, Felig P. The metabolic events of starvation. The American journal of medicine. 1976;60(1):117-26.
  24. Rothman DL, Magnusson I, Katz LD, Shulman RG, Shulman GI. Quantitation of hepatic glycogenolysis and gluconeogenesis in fasting humans with 13C NMR. Science (New York, NY). 1991;254(5031):573-6.
  25. Fan Y, Jimenez Del Val I, Muller C, Lund AM, Sen JW, Rasmussen SK, et al. A multi-pronged investigation into the effect of glucose starvation and culture duration on fed-batch CHO cell culture. Biotechnology and bioengineering. 2015;112(10):2172-84.
  26. Holness MJ, Hegazy S, Sugden MC. Signalling satiety and starvation to beta-Cell insulin secretion. Current diabetes reviews. 2011;7(5):336-45.
  27. Mustonen AM, Karja V, Kilpio M, Tammi R, Tammi M, Rouvinen-Watt K, et al. Manifestations of fasting-induced fatty liver and rapid recovery from steatosis in voles fed lard or flaxseed oil lipids. Nutrients. 2013 Oct;5(10):4211-30
  28. Owen OE, Caprio S, Reichard GA, Jr., Mozzoli MA, Boden G, Owen RS. Ketosis of starvation: a revisit and new perspectives. Clinics in endocrinology and metabolism. 1983;12(2):359-79.
  29. Azizi F. Islamic fasting and health. Annals of nutrition & metabolism. 2010;56(4):273-82.
  30. Unalacak M, KaraIH, Baltaci D, Erdem O, Bucaktepe PG. Effects of Ramadan fasting on biochemical and hematological parameters and cytokines in healthy and obese individuals. Metab Syndr Relat Disord. 2011 Apr;9(2):157-61.
  31. Asemi Z, Samimi M, Taghizadeh M, Esmaillzadeh A. Effects of Ramadan Fasting on Glucose Homeostasis, Lipid Profiles, Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome in Kashan, Iran. Archives of Iranian medicine. 2015;18(12):806-10.