The Effect of Fasting during Ramadan on The Immune System and Inflammation: a Systematic Review

Eka Febriyanti

Abstract


Chronic low-grade inflammation is a major contributor to the development of non-communicable diseases, including obesity, diabetes, cardiovascular disease, and autoimmune disorders. Identifying non-pharmacological interventions capable of modulating immune function and reducing inflammatory burden is therefore an urgent global health priority. Ramadan fasting, a unique form of intermittent fasting practiced annually by millions of individuals worldwide, offers a natural model to investigate the physiological effects of time-restricted feeding on immune and inflammatory responses. This systematic review aims to evaluate current evidence on the impact of Ramadan fasting on immune system activity and inflammatory biomarkers in humans. A structured search was conducted in PubMed and ScienceDirect for studies published between 2015–2025. Five eligible studies were included, consisting of randomized controlled trials, interventional studies, and pre–post designs. Results demonstrate consistent reductions in pro-inflammatory cytokines such as IL-6 and TNF-α, increases in adiponectin, enhancement of autophagy pathways, and improved immune cell regulation. Benefits were more pronounced among individuals with obesity or metabolic risk. Although heterogeneity in study design limits quantitative comparison, evidence suggests that Ramadan fasting has clinically relevant immunomodulatory and anti-inflammatory effects. Larger standardized studies are needed to clarify mechanisms and long-term outcomes.


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References


Ahmed, S., Khokhar, N., & Shubrook, J. H. (2022). Fasting during Ramadan : A Comprehensive Review for Primary Care Providers. Diabetology, 3(2), 276–291.

Ashique, S., Debnath, B., Mojgani, N., Tariq, M., Haider, T., Shorog, E., Yasmin, S., Islam, A., Sharma, H., Hussain, S., Madan, A., Malik, T., & Yousuf, M. (2025). Current Research in Biotechnology Gut microbiota modulation and health benefits of various fasting regimens. Current Research in Biotechnology, 10(June), 100311. https://doi.org/10.1016/j.crbiot.2025.100311

Bragazzi, N. L. (2017). Ramadan Fasting Exerts Immunomodulatory Effects : Insights from a Systematic Review. Frontiers in Immunology, 8(1144). https://doi.org/10.3389/fimmu.2017.01144

Cifuentes, M., Verdejo, H. E., Castro, P. F., Corvalan, A. H., Ferreccio, C., Quest, A. F. G., Kogan, M. J., & Lavandero, S. (2025). Low-Grade Chronic Inflammation: a Shared Mechanism for Chronic Diseases. Physiology, 40(1), 4–25. https://doi.org/10.1152/physiol.00021.2024

Elhag, M. R. A., Abu-median, A., Da, M., Haris, P. I., Ibrahim, M., Husam, D., & Faris, M. E. (2025). Transforming gut health through Ramadan intermittent fasting : A review on metabolic and microbiomic insights. Clinical Nutrition ESPEN, 69, 115–130. https://doi.org/10.1016/j.clnesp.2025.06.051

Erlangga, Z., Khosandam, S., Hamdan, I., Melk, A., Gutenbrunner, C., & Nugraha, B. (2023). Human Nutrition & Metabolism The effect of prolonged intermittent fasting on autophagy , inflammasome and senescence genes expressions : An exploratory study in healthy young males. Human Nutrition & Metabolism, 32(January), 200189. https://doi.org/10.1016/j.hnm.2023.200189

Faris, M. A.-I., Jahrami, H., BaHammam, A., Kalaji, Z., Madkour, M., & Hassanein, M. (2020). A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on glucometabolic markers in healthy subjects. Diabetes Research and Clinical Practice, 165, 108226. https://doi.org/https://doi.org/10.1016/j.diabres.2020.108226

Faris, “Mo’ez Al-Islam” E, Kacimi, S., Al-Kurd, R. A., Fararjeh, M. A., Bustanji, Y. K., Mohammad, M. K., & Salem, M. L. (2012). Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects. Nutrition Research, 32(12), 947–955. https://doi.org/https://doi.org/10.1016/j.nutres.2012.06.021

Feizollahzadeh, S., Rasuli, J., Kheirouri, S., & Alizadeh, M. (2014). Augmented Plasma Adiponectin after Prolonged Fasting During Ramadan in Men. Health Promot Perspect, 4(1), 77–81. https://doi.org/10.5681/hpp.2014.010

Feyzi, P. (2023). The Effect of Ramadan Fasting on the Immune System Function. Journal of North Khorasan University of Medical Sciences, 14(4), 126–130. https://doi.org/10.32592/nkums.14.4.126

He, Z., Xu, H., Li, C., Yang, H., & Mao, Y. (2023). Intermittent fasting and immunomodulatory effects : A systematic review. Frontiers in Nutrition, 10(February), 1048230. https://doi.org/10.3389/fnut.2023.1048230

Horne, B. D., Anderson, J. L., May, H. T., Le, V. T., Bair, T. L., Bennett, S. T., Knowlton, K. U., & Muhlestein, J. B. (2023). International Journal of Cardiology Cardiovascular Risk and Prevention Intermittent fasting and changes in clinical risk scores : Secondary analysis of a randomized controlled trial. International Journal of Cardiology Cardiovascular Risk and Prevention, 19(April), 200209. https://doi.org/10.1016/j.ijcrp.2023.200209

Khalil, M., Abdallah, H., Jaber, N., Garruti, G., & Di, A. (2024). European Journal of Internal Medicine Distinct biophysiological effects of Ramadan fasting and traditional intermittent fasting on markers of body fat storage . A real-life study. European Journal of Internal Medicine, 129(August), 111–120. https://doi.org/10.1016/j.ejim.2024.08.014

Ma, R. (2024). A detective story of intermittent fasting effect on immunity. Immunology, 173(2), 227–247. https://doi.org/10.1111/imm.13829

Madkour, M. I., Islam, T., Tippetts, T. S., Chowdhury, K. H., Lesniewski, L. A., Summers, S. A., Zeb, F., Abdelrahim, D. N., Alkurd, R., Khraiwesh, H. M., Abushihab, K. H., Albakri, A., Obaideen, K., & Faris, M. E. (2023). Ramadan intermittent fasting is associated with ameliorated inflammatory markers and improved plasma sphingolipids / ceramides in subjects with obesity : lipidomics analysis. Scientific Reports, 1–12. https://doi.org/10.1038/s41598-023-43862-9

Marko, D. M., Conn, M. O., & Schertzer, J. D. (2024). Endocrinology & Metabolism Intermittent fasting in fl uences immunity and metabolism. Trends in Endocrinology & Metabolism, 35(9), 821–833. https://doi.org/10.1016/j.tem.2024.04.014

Mindikoglu, A. L., Abdulsada, M. M., Jain, A., Min, J., Jalal, P. K., Devaraj, S., Mezzari, M. P., Petrosino, J. F., & Opekun, A. R. (2020). Intermittent fasting from dawn to sunset for 30 consecutive days is associated with anticancer proteomic signature and upregulates key regulatory proteins of glucose and lipid metabolism , circadian clock , DNA repair , cytoskeleton remodeling , immune system and cognitive function in healthy subjects. Journal of Proteomics, 217(September 2019), 103645. https://doi.org/10.1016/j.jprot.2020.103645

Moghadam, M. T., Taati, B., Mojtaba, S., & Ardakani, P. (2021). Ramadan Fasting During the COVID-19 Pandemic ; Observance of Health , Nutrition and Exercise Criteria for Improving the Immune System. Frontiers in Nutrition, 7(January), 570235. https://doi.org/10.3389/fnut.2020.570235

Mohammed, K. I. A., & Mahmood, M. M. (2010). Effect of Ramadan fasting on the levels of IL-1a, IL-2, IL-6 and IL-8 cytokines.

Mushtaq, R., Akram, A., Mushtaq, R., Khwaja, S., & Ahmed, S. (2019). The role of inflammatory markers following Ramadan Fasting. Pak J Med Sci, 35(1), 77–81.

Ramos-Lopez, O., Milagro, F. I., Riezu-Boj, J. I., & Martinez, J. A. (2021). Epigenetic signatures underlying inflammation: an interplay of nutrition, physical activity, metabolic diseases, and environmental factors for personalized nutrition. Inflammation Research, 70(1), 29–49. https://doi.org/10.1007/s00011-020-01425-y

Reias, M., & States, U. (2021). THE IMPACT OF INTERMITTENT FASTING DURING RAMADAN ON IMMUNITY. AL-MAQASID: The International Journal of Maqasid Studies and Advanced Islamic Research, 2(1), 66–68.

Zouhal, H., Bagheri, R., Ashtary-Larky, D., Wong, A., Triki, R., Hackney, A. C., Laher, I., & Abderrahman, A. Ben. (2020). Effects of Ramadan intermittent fasting on inflammatory and biochemical biomarkers in males with obesity. Physiology & Behavior, 225, 113090. https://doi.org/https://doi.org/10.1016/j.physbeh.2020.113090




DOI: https://doi.org/10.3059/insis.v0i0.28670

DOI (PDF): https://doi.org/10.3059/insis.v0i0.28670.g15043

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