Background Although Ramadan fasting has a beneficial effect on health, the role of Ramadan fasting on patients with non-alcoholic fatty liver disease (NAFLD), as quantified by the controlled attenuation parameter (CAP), is not determined yet. So, this study aimed to determine the effect of Ramadan fasting on patients with NAFLD by assessing the controlled attenuation parameter (CAP) and biochemical parameters of the fatty liver. Patients and methods A prospective observational study was conducted on 40 NAFLD patients, who were diagnosed by ultrasonography and quantified with controlled attenuation parameter (CAP) in transient elastography (FibroScan) and fasted the month of Ramadan. Transient elastography for CAP and liver stiffness measurement (LSM) were performed. Fibrosis 4 score (FIB4) and NAFLD fibrosis score (NFS) were also calculated. Results There is a statistically significant change in body mass index, fasting blood glucose, HbA1c, triglycerides, LDL cholesterol, HDL cholesterol, total cholesterol, serum albumin, total protein, AST, ALT, and alkaline phosphatase after Ramadan fasting. There were significant clinical improvements after Ramadan fasting in FIB-4 (1.31 ± 0.26 and 1.24 ± 0.25 respectively, p < 0.001), CAP (318.52 ± 34.59 and 294.0 ± 20.34, respectively, p < 0. 001), and LSM (6.95 ± 1.62 and 6.59 ± 1.49, respectively, p < 0. 001). Conclusion Our study demonstrates that Ramadan fasting could improve liver steatosis in patients with NAFLD proved with a significant reduction in the CAP and LSM.