Can patients with chronic liver diseases withstand Ramadan fasting?

Ramadan is a sacred month for Muslims all around the world. During this lunar-based month, healthy adult Muslims are obligated to abstain from eating, drinking, smoking, or using oral medications from predawn to sunset. Followers will typically eat just after sunset and again before dawn (1). The Islamic lunar Hijri calendar is 11 days shorter than the Gregorian solar calendar, and therefore, the month of Ramadan can occur in any season of the year. The hours spent on fasting can vary from 12 to 18 h, depending on the seasonal and regional features, and this ultimately will affect the ability of individuals and patients to fast. In the North Pole, the day time is very long and may reach up to 22 hours; toward the equator the temperature and humidity are high. These entire environmental factors directly decrease the ability of patients to complete one month of continuous fasting. The studies focusing the impact of fasting during Ramadan on different liver diseases are scarce (2,3) and that is why no structured guidelines for fasting and liver diseases(4) have been set up.