Article - The effects of intermittent fasting on antioxidant and inflammatory markers and liver enzymes in postmenopausal, overweight and obese women with rheumatoid arthritis: a randomized controlled trial.

Plain Language Summary

Rheumatoid arthritis (RA) is a chronic inflammatory condition that affects postmenopausal women. This randomised controlled trial aimed to determine how intermittent fasting (IF), which involves cycling between periods of eating and fasting, impacts antioxidant levels, inflammation, and liver health in 44 overweight and obese women with RA over eight weeks.

The results showed that IF may lead to improvements in certain antioxidant and inflammatory markers, as well as liver health, suggesting potential benefits for this specific group of women.

It was concluded that IF may be an effective dietary pattern to manage RA by addressing symptoms and overall health. This study could be used by healthcare professionals to understand the potential benefits of intermittent fasting in a 16:8 pattern on inflammation and liver health in postmenopausal women with rheumatoid arthritis.

Expert Review

Reviewer: Karin Elgar

14th Nov 2025

Conflict of interest

None

Take home message

• Intermittent fasting may be of benefit for postmenopausal overweight or obese women with RA with regards to a decrease in inflammatory markers and liver enzymes.

Evidence category

A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)

Summary review

Introduction

• The aim of this study was to evaluate the effects of intermittent fasting (IF) on inflammatory and antioxidant markers as well as liver enzymes in postmenopausal women with overweight/obesity and rheumatoid arthritis (RA).

Methods

• 8-week parallel randomised controlled trial of 44 postmenopausal women with RA and a body mass index of 25-35 kg/m².

• The intervention groups followed a 16:8 IF eating pattern (16 hours fasting, 8 hours eating window) with a 300 kcal per day caloric deficit. The control group followed a traditional eating pattern with three main meals and two snacks with standard healthy eating recommendations.

• Outcome measures included antioxidant and inflammatory markers (malondialdehyde (MDA), nitric oxide (NO), total antioxidant capacity (TAC), total oxidant status (TOS), catalase, myeloperoxidase, platelet/lymphocyte ratio and neutrophil to lymphocyte ratio), liver enzymes and creatinine.

Results

• Three participants in each group dropped out of the trial, three in the intervention and two in the control group due to not adhering to the fasting/diet protocol, and one due to requiring surgery.

• Based on dietary food records, there were no significant differences in the intake of energy, macro- or micronutrients between the two groups over the study period (all p-values >0.05).

• After adjusting for baseline values, there were significantly greater reductions for MDA (p<0.001), NO (p=0.05) and neutrophil to lymphocyte ratio (p=0.018) in the IF group compared to controls and a significantly greater increase for catalase (p=0.016). A trend (p=0.06) for an increased TOS was also observed in the IF group. There were no significant differences between groups for myeloperoxidase, platelet/lymphocyte ratio or TAC.

• There were significantly greater reductions in AST and ALT (p<0.001 after adjustment) in the IF group, but no significant difference between groups for creatinine (p=0.39).

Conclusion

• The authors concluded that IF offers a benefit for this population in terms of both RA and associated metabolic complications.

Clinical practice applications

• Intermittent fasting/time restricted eating with a 300 kcal per day caloric deficit could be a valuable adjunct to the clinical management of postmenopausal women with RA and overweight/obesity

Considerations for future research

• Longer-term studies would be of value to determine the long-term efficacy and safety of, as well as compliance with, IF.

Studies with larger sample sizes to increase statistical power would be of value.

• Such studies should also assess other outcomes such as disease severity scores and anthropometric parameters to determine clinical benefits.

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Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disorder affecting postmenopausal women. This study investigated the effects of intermittent fasting (IF) on antioxidant and inflammatory markers and liver enzymes in postmenopausal, overweight and obese women with RA. This 8-week randomized controlled trial included 44 postmenopausal women with RA divided into an intervention group following a 16:8 IF diet and a control group maintaining their usual diet and received recommendations for healthy eating. Inflammatory indices, oxidative stress markers, and liver enzymes were measured at baseline and post intervention. The IF group showed significant decreases in serum malondialdehyde (MDA) levels (P = 0.02) and neutrophil-to-lymphocyte ratio (P = 0.018) and increased catalase levels (P = 0.004) compared to the control group. Liver enzymes aspartate transaminase (AST) and alanine transaminase (ALT) also decreased significantly in the IF group (P = 0.02 and P = 0.03, respectively). No significant differences were observed in the other measured parameters between groups. In conclusion, the 16:8 IF diet demonstrated beneficial effects on some oxidative stress markers, inflammatory indices, and liver enzymes in postmenopausal, overweight, and obese women with RA. These findings suggest that IF may be an effective non-pharmacological intervention for managing RA in this population, potentially addressing both primary disease symptoms and associated metabolic complications. Further research is needed to elucidate the long-term effects and mechanisms of IF in the management of RA.