Ramadan intermittent fasting (RIF) offers several health benefits, particularly for individuals in good health and those diagnosed with metabolic dysfunction–associated fatty liver disease (MAFLD). By realigning circadian rhythms in tissues involved in metabolic processes linked to MAFLD, RIF could reduce the likelihood of developing MAFLD in healthy individuals and help manage the progression of the condition to metabolic dysfunction–associated steatohepatitis (MASH) in those already affected. Positive outcomes include enhanced body composition, better blood pressure control, improved lipid levels, normalized liver enzyme activity, and reduced liver fat accumulation. However, individuals with advanced cirrhosis, particularly those classified as Child–Pugh B or C, may experience worsening symptoms such as fluid retention (ascites), elevated bilirubin leading to jaundice, cognitive impairment (encephalopathy), and even life-threatening outcomes. Therefore, fasting is strongly discouraged for this high-risk group. Patients with cirrhosis face heightened risks of gastrointestinal (GI) bleeding, both from enlarged veins (varices) and ulcers, exacerbated by fasting-induced stress on the portal system. Emerging research explores intermittent fasting (IF), including RIF, for its possible protective effects against certain cancers, such as liver cancer (hepatocellular carcinoma). Individuals who have undergone liver transplantation require close monitoring during RIF due to risks like dehydration, inconsistent use of immunosuppressive medications, and missed medical appointments. Regular checks of liver function, electrolyte balance, and drug levels (e.g., tacrolimus and cyclosporine) are essential. Fasting should be halted if health declines. Individuals with Gilbert syndrome may initially experience an increase in bilirubin levels during fasting, but these typically stabilize without any serious consequences. To summarize, while RIF could improve metabolic markers and reduce steatosis in MAFLD, clinical deterioration and bleeding risks were observed in cirrhotic patients. Gilbert syndrome patients generally tolerate RIF safely, but close monitoring for transplant recipients is recommended.