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Ashkbari A, Nikbakht HA, Amirkhanlou S, Elahi G, Salahi M, Ebrahimi S, Golfiroozi S, Hosseini SA, Ghelichi-Ghojogh M. Impact of Ramadan fasting on lipid profile, uric acid, and HbA1c in CKD: A systematic review and meta-analysis. Prim Care Diabetes 2024; 18:277-283. [PMID: 38616441 DOI: 10.1016/j.pcd.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/16/2024]
Abstract
Studies have shown that fasting during Ramadan has different effects on circulating levels of several biochemical markers. This study aims to conduct a comprehensive evaluation of studies related to the effect of fasting in the holy month of Ramadan on lipid profile, uric acid, and HbA1c in CKD patients. Studies were systematically searched and collected from three databases (PubMed, Scopus, and Web of Science). After screening, the quality and risk of bias assessment of the selected articles were evaluated. Study heterogeneity was assessed using the Cochrane test and I² statistic. In case of any heterogeneity random effects model with the inverse-variance method was applied. All analyses were performed using STATA software version 16. Four observational studies were included in this study. The results of this meta-analysis were that cholesterol (Weighted mean differences (WMD):0.21 with 95% CI:-0.09-0.51 (P-value=:0.18)), LDL (WMD:0.06 with 95% CI -0.24-0.36 (P-value:0.69)), triglyceride (WMD:0.05 with 95% CI:-0.25-0.35 (P-value:0.73)) had not-significant increase. Uric acid (WMD: -0.11 with 95% CI: -0.42-0.21 (P-value:0.51)) and HbA1c (WMD: -0.22 with 95% CI: -0.79-0.36 (P-value: 0.46)) show a non-significant decrease. The results of the analyses did not report significant changes in the lipid profile, uric acid, and HbA1c in CKD patients after Ramadan fasting.
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Affiliation(s)
- Ali Ashkbari
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Saeid Amirkhanlou
- Department of Internal Medicine, Clinical Research Development Unit (CRDU), Shahid Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ghazaleh Elahi
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Marjan Salahi
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sareh Ebrahimi
- Counseling and Reproductive Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Saeed Golfiroozi
- Department of Emergency Medicine, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Seyed Ahmad Hosseini
- Neonatal and Children's Research Center, Department of Biostatistics and Epidemiology, School of Health, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mousa Ghelichi-Ghojogh
- Neonatal and Children's Research Center, Department of Biostatistics and Epidemiology, School of Health, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran.
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2
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Alobaidi S. Ramadan Fasting and Its Impact on Patients With Chronic Kidney Disease: Insights and Guidelines. Cureus 2024; 16:e57522. [PMID: 38706994 PMCID: PMC11066727 DOI: 10.7759/cureus.57522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Fasting during the month of Ramadan is a religious practice observed by millions of Muslims worldwide, including those with chronic kidney disease (CKD). This comprehensive review aims to reflect upon the impacts of Ramadan fasting on CKD patients, excluding those on renal replacement therapy, through an analysis of clinical trials, observational studies, and expert reviews from diverse geographic and methodological backgrounds. It addresses renal function stability, broader health considerations, hydration and electrolyte balance, individual variability in fasting responses, clinical and biochemical effects, nutritional considerations, and metabolic effects. This review reveals that, with appropriate monitoring, dietary management, and individualized care plans, many CKD patients can safely participate in Ramadan fasting without adversely affecting their renal function or overall health. It emphasizes the need for a multidisciplinary approach to patient education, pre-Ramadan assessment, and post-Ramadan follow-up. Furthermore, it highlights the importance of considering individual variability and comorbidities in fasting guidance and underscores the necessity of future research to develop robust, patient-centered fasting guidelines. This review aims to provide healthcare professionals with evidence-based recommendations to support CKD patients wishing to observe Ramadan fasting, ensuring patient safety and optimizing care outcomes.
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Affiliation(s)
- Sami Alobaidi
- Department of Medicine, College of Medicine, University of Jeddah, Jeddah, SAU
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3
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Boobes Y, Afandi B, AlKindi F, Tarakji A, Al Ghamdi SM, Alrukhaimi M, Hassanein M, AlSahow A, Said R, Alsaid J, Alsuwaida AO, Al Obaidli AAK, Alketbi LB, Boubes K, Attallah N, Al Salmi IS, Abdelhamid YM, Bashir NM, Aburahma RMY, Hassan MH, Al-Hakim MR. Consensus recommendations on fasting during Ramadan for patients with kidney disease: review of available evidence and a call for action (RaK Initiative). BMC Nephrol 2024; 25:84. [PMID: 38448807 PMCID: PMC10916266 DOI: 10.1186/s12882-024-03516-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
Ramadan fasting (RF) involves abstaining from food and drink during daylight hours; it is obligatory for all healthy Muslims from the age of puberty. Although sick individuals are exempt from fasting, many will fast anyway. This article explores the impact of RF on individuals with kidney diseases through a comprehensive review of existing literature and consensus recommendations. This study was conducted by a multidisciplinary panel of experts.The recommendations aim to provide a structured approach to assess and manage fasting during Ramadan for patients with kidney diseases, empowering both healthcare providers and patients to make informed decisions while considering their unique circumstances.
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Affiliation(s)
- Yousef Boobes
- Seha Kidney Care, Tawam Hospital, Al Ain, UAE.
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE.
| | - Bachar Afandi
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE
- Endocrine Division, Tawam Hospital, Al Ain, UAE
| | | | - Ahmad Tarakji
- St. George Medical Center & McMaster University-Waterloo Campus, Kitchener, ON, Canada
| | | | | | - Mohamed Hassanein
- Endocrine Section, Dubai Hospital, Dubai Health, Dubai, UAE
- Mohammed Bin Rashid University of Medicine and Health Science, Dubai, UAE
| | - Ali AlSahow
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
| | - Riyad Said
- Department of Nephrology and Medicine, Jordan Hospital and Medical Center Ibn Sina University for Medical Sciences, Amman, Jordan
| | - Jafar Alsaid
- Nephrology department, Ochsner Medical Center, New Orleans, LA, USA
| | | | | | - Latifa B Alketbi
- Ambulatory Healthcare Services - Abu Dhabi Healthcare Services, Abu Dhabi, UAE
| | - Khaled Boubes
- Department of Medicine, Ohio State University, Columbus, OH, USA
| | - Nizar Attallah
- Nephrology Associates of Kentuckiana, University of Kentucky, Louisville, USA
| | - Issa S Al Salmi
- Department of Renal Medicine, The Royal Hospital, Muscat, Oman
| | - Yasser M Abdelhamid
- Nephrology Division, Internal Medicine Department -Faculty of Medicine, Cairo University, Cairo, Egypt
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4
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Bhuiyan MN, Saadiq RA, Mueller MR, Abdalrhim AD, Overgaard J. Patient Care During Ramadan: A Narrative Review. Health Serv Res Manag Epidemiol 2024; 11:23333928241266041. [PMID: 39050928 PMCID: PMC11268016 DOI: 10.1177/23333928241266041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/05/2024] [Accepted: 06/15/2024] [Indexed: 07/27/2024] Open
Abstract
Ramadan is the Islamic holy month when Muslims around the world fast from dawn to sunset. This 30-day pattern of intermittent diurnal fasting can have a significant physiologic impact on the body. Importantly, oral intake is forbidden during this time, and many patients do not wish to take medications. From a clinical perspective, this potentially impacts healthcare delivery and chronic disease states. Despite these important changes, awareness of individual patient practices remains limited among healthcare providers in North America, which may worsen health disparities in Muslim patients. A fundamental understanding of the cultural and physiological implications of fasting during Ramadan can improve cultural competence and patient outcomes. In this paper, we review the physiologic changes during fasting, medical exemptions to fasting, and special considerations for the care of Muslim patients with chronic conditions who may fast during Ramadan.
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Affiliation(s)
- M. Nadir Bhuiyan
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rayya A. Saadiq
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael R. Mueller
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ahmed D. Abdalrhim
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joshua Overgaard
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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5
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Shaltout I, Abdelwahab AM, El Meligi A, Hammad H, Abdelghaffar S, Elbahry A, Taha N, Elsaid NH, Gad A, Hammouda L, Abdelmaboud S, Soliman AR. Risk Stratification in People with Diabetes for Fasting During Ramadan: Consensus from Arabic Association for the Study of Diabetes and Metabolism. Curr Diabetes Rev 2024; 20:e201023222409. [PMID: 37867270 PMCID: PMC11041120 DOI: 10.2174/0115733998249793231005105724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/12/2023] [Accepted: 08/23/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Current international guidelines recommend a pre-Ramadan risk assessment for people with diabetes (PwDM) who plan on fasting during the Holy month. However, a comprehensive risk assessment-based recommendation for the management of PwDM intending to fast is still controversial. Therefore, the Arabic Association for the Study of Diabetes and Metabolism (AASD) developed this consensus to provide further insights into risk stratification in PwDM intending to fast during Ramadan. METHODS The present consensus was based on the three-step modified Delphi method. The modified Delphi method is based on a series of voting rounds and in-between meetings of the expert panel to reach agreements on the statements that did not reach the consensus level during voting. The panel group comprised professors and consultants in endocrinology (both adult and pediatric). Other members included experts in the fields of cardiovascular medicine, nephrology, ophthalmology, and vascular surgery, affiliated with academic institutions in Egypt. RESULT In PwDM who intend to fast during Ramadan, risk stratification is crucial to optimize patient outcomes and prevent serious complications. The present consensus provides risk assessment of those living with diabetes according to several factors, including the type of diabetes, presence, and severity of complications, number of fasting hours, and other socioeconomic factors. According to their risk factors, patients were classified into four categories (very high, high, moderate, and low risk). CONCLUSION Future research is warranted due to the controversial literature regarding the impact of fasting on certain comorbidities.
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Affiliation(s)
- Inass Shaltout
- Internal Medicine and Diabetes Department, Cairo University, Cairo, Egypt
| | | | - Amr El Meligi
- Internal Medicine and Diabetes Department, Cairo University, Cairo, Egypt
| | - Hany Hammad
- Internal Medicine and Nephrology Department, Cairo University, Cairo, Egypt
| | - Shereen Abdelghaffar
- Department of Pediatrics, Pediatric Diabetes and Endocrinology Unit, Cairo University, Cairo, Egypt
| | - Atef Elbahry
- Cardiology Unit, Port Fouad Centre, Port Fouad, Egypt
| | - Nasser Taha
- Cardiology Department, Minia University, Minia, Egypt
| | - Nehal Hamdy Elsaid
- Internal Medicine and Diabetes Department, Cairo University, Cairo, Egypt
| | - Amr Gad
- Vascular Surgery Department, Cairo University, Cairo, Egypt
| | - Laila Hammouda
- Ophthalmology Department, Minia University, Minia, Egypt
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6
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AlSahow A. The Impact of Hot Ambient Temperature and Prolonged Fasting Duration during Ramadan on Patients with Chronic Kidney Disease: A Literature Review. Int J Nephrol 2023; 2023:2636507. [PMID: 38106546 PMCID: PMC10725313 DOI: 10.1155/2023/2636507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023] Open
Abstract
The Islamic (lunar) calendar has 11 fewer days each year than the Gregorian (solar) calendar. Consequently, ambient temperatures during the month of Ramadan and the duration of the presunrise-to-sunset fast will change each year. At some point, individuals observing Ramadan will experience prolonged periods of fasting during the hot summer months. In this manuscript, findings published in the English-language medical literature that address the impact of prolonged fasting during the warmer summer months on patients with chronic kidney disease, including dialysis and transplantation patients, are reviewed. This is of particular concern given the accelerated pace of global warming. The limitations of the evidence that is currently available are also discussed, and an approach that might be used to standardize future evaluations of the impact of fasting on kidney health is suggested.
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Affiliation(s)
- Ali AlSahow
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
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7
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Abdallah H, Khalil M, Farella I, JohnBritto JS, Lanza E, Santoro S, Garruti G, Portincasa P, Di Ciaula A, Bonfrate L. Ramadan intermittent fasting reduces visceral fat and improves gastrointestinal motility. Eur J Clin Invest 2023; 53:e14029. [PMID: 37203871 DOI: 10.1111/eci.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Ramadan is a model of intermittent fasting linked with possible beneficial effects. Scarce information, however, is available about the combined effects of Ramadan intermittent fasting (RIF) on anthropometric and metabolic indices, gastrointestinal symptoms, and motility. METHODS In 21 healthy Muslims, we assessed the impact of RIF on caloric intake, physical activity, gastrointestinal symptoms and motility (gastric/gallbladder emptying by ultrasonography, orocaecal transit time by lactulose breath test), anthropometric indices, subcutaneous and visceral fat thickness (ultrasonography), glucose and lipid homeostasis. RESULTS Mean caloric intake decreased from a median of 2069 kcal (range 1677-2641) before Ramadan to 1798 kcal (1289-3126) during Ramadan and increased again to 2000 kcal (1309-3485) after Ramadan. Although physical activity remained stable before, during, and after RIF, body weight, body mass index and waist circumference decreased in all subjects and in both genders, together with a significant decrease in subcutaneous and visceral fat thickness and insulin resistance. The postprandial gastric emptying speed was significantly faster after than before RIF. Fasting gallbladder volume was about 6% smaller after, than before Ramadan, with a stronger and faster postprandial gallbladder contraction. After RIF, lactulose breath test documented increased microbiota carbohydrate fermentation (postprandial H2 peak), and faster orocaecal transit time. RIF also significantly improved gastric fullness, epigastric pain and heartburn. CONCLUSIONS RIF generates, in healthy subjects, multiple systemic beneficial effects in terms of fat burden, metabolic profile, gastrointestinal motility and symptoms. Further comprehensive studies should assess the potential beneficial effects of RIF in diseased people.
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Affiliation(s)
- Hala Abdallah
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Mohamad Khalil
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Ilaria Farella
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Jerlin Stephy JohnBritto
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Elisa Lanza
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Sergio Santoro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Gabriella Garruti
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Piero Portincasa
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Agostino Di Ciaula
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Leonilde Bonfrate
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
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8
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Hassanein M, Yousuf S, Ahmedani MY, Albashier A, Shaltout I, Yong A, Hafidh K, Hussein Z, Kallash MA, Aljohani N, Wong HC, Buyukbese MA, Chowdhury T, Fadhila MERZOUKI, Taher SW, Belkhadir J, Malek R, Abdullah NRA, Shaikh S, Alabbood M. Ramadan fasting in people with diabetes and chronic kidney disease (CKD) during the COVID-19 pandemic: The DaR global survey. Diabetes Metab Syndr 2023; 17:102799. [PMID: 37301008 PMCID: PMC10234835 DOI: 10.1016/j.dsx.2023.102799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND AIMS The DaR Global survey was conducted to observe the impact of the COVID-19 pandemic on the intentions to fast and the outcomes of fasting in people with diabetes and chronic kidney disease (CKD). METHODS Muslim people with diabetes and CKD were surveyed in 13 countries shortly after the end of Ramadan 2020, using a simple Survey Monkey questionnaire. RESULTS This survey recruited 6736 people with diabetes, of which 707 (10.49%) had CKD. There were 118 (16.69%) people with type1 diabetes (T1D), and 589 (83.31%) were with type2 diabetes (T2D). 62 (65.24%) people with T1D and 448 (76.06%) people with T2D had fasted with CKD. Episodes of hypoglycaemia and hyperglycaemia were more frequent among people with T1D compared to T2D, 64.52% and 43.54% vs 25.22% and 22.32% respectively. Visits to the emergency department and hospitalization were more frequent among people with CKD, however no significant difference was found between people with T1D and T2D. CONCLUSION The COVID-19 pandemic had only a minor effect on the intention to fast during Ramadan in people with diabetes and CKD. However, hypoglycaemia and hyperglycaemia were found to be more frequent, as well as emergency visits and hospital admissions among people with diabetic kidney disease. Prospective studies are needed in future to evaluate the risk indicators of hypoglycaemia and hyperglycaemia among fasting people with CKD, especially in the context of different stages of kidney disease.
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Affiliation(s)
- Mohamed Hassanein
- Dubai Hospital, Mohamed Bin Rashed University, United Arab Emirates.
| | - Sanobia Yousuf
- Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
| | | | - Alaa Albashier
- Dubai Hospital, Dubai, University of Sharjah UAE, United Arab Emirates.
| | - Inass Shaltout
- Internal Medicine and Diabetes, Faculty of Medicine, Cairo University, Egypt.
| | - Alice Yong
- Endocrine Centre, RIPAS Hospital, Brunei Darussalam.
| | - Khadija Hafidh
- Diabetes Unit, Department of Medicine, Rashid Hospital, Dubai Academic Health Corporation, Saudi Arabia.
| | - Zanariah Hussein
- Department of Internal Medicine, Hospital Putrajaya, Putrajaya, Malaysia.
| | | | - Naji Aljohani
- Obesity, Endocrine and Metabolic Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Hui Chin Wong
- Division of Endocrinology, Department of Internal Medicine, Hospital Tengku Ampuan Rahimah, Klang, Selangor, Malaysia.
| | | | - Tahseen Chowdhury
- Department of Diabetes and Metabolism, The Royal London Hospital, Whitechapel, London, UK.
| | | | | | - Jamal Belkhadir
- Endocrinologist - Diabetologist, Rabat, Morocco, President of Moroccan League for the Fight Against Diabetes, Chair of IDF Mena Region.
| | | | | | - Shehla Shaikh
- Saifee Hospital, Mumbai, Treasurer Maharashtra ESI Executive Committee Member ESI, India.
| | - Majid Alabbood
- Department of Medicine, Alzahra College of Medicine, University of Basrah, Iraq.
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Trabelsi K, Ammar A, Boujelbane MA, Puce L, Garbarino S, Scoditti E, Boukhris O, Khanfir S, Clark CCT, Glenn JM, Alhaj OA, Jahrami H, Chtourou H, Bragazzi NL. Religious fasting and its impacts on individual, public, and planetary health: Fasting as a "religious health asset" for a healthier, more equitable, and sustainable society. Front Nutr 2022; 9:1036496. [PMID: 36505246 PMCID: PMC9729557 DOI: 10.3389/fnut.2022.1036496] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022] Open
Abstract
Religious fasting is practiced by people of all faiths, including Christianity, Islam, Buddhism, Jainism, as well as Hinduism, Judaism, and Taoism. Individual/clinical, public, global, and planetary health has traditionally been studied as separate entities. Nevertheless, religious fasting, in conjunction with other religious health assets, can provide several opportunities, ranging from the individual to the population, environmental, and planetary levels, by facilitating and supporting societal transformations and changes, such as the adoption of healthier, more equitable, and sustainable lifestyles, therein preserving the Earth's systems and addressing major interconnected, cascading, and compound challenges. In this review, we will summarize the most recent evidence on the effects of religious fasting, particularly Orthodox and Ramadan Islamic fasting, on human and public health. Further, we will explore the potential effects of religious fasting on tackling current environmental issues, with a special focus on nutrition/food restriction and planetary health. Finally, specific recommendations, particularly around dietary intake during the fasting rituals, will be provided to ensure a sustainable healthy planet.
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Affiliation(s)
- Khaled Trabelsi
- Research Laboratory: Education, Motricity, Sport and Health, Sfax, Tunisia
- Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Achraf Ammar
- Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
- UFR SESS-STAPS, Paris-East Créteil University, LIRTES (EA 7313), Créteil, France
| | - Mohamed Ali Boujelbane
- Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Egeria Scoditti
- National Research Council, Institute of Clinical Physiology, Lecce, Italy
| | - Omar Boukhris
- Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
- Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Saber Khanfir
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Cain C. T. Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Jordan M. Glenn
- Department of Health, Exercise Science Research Center Human Performance and Recreation, University of Arkansas, Fayetteville, AR, United States
| | - Omar A. Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Haitham Jahrami
- Department of Psychiatry, Ministry of Health, Manama, Bahrain
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Hamdi Chtourou
- Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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10
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The Association between Acute Myocardial Infarction-Related Outcomes and the Ramadan Period: A Retrospective Population-Based Study. J Clin Med 2022; 11:jcm11175145. [PMID: 36079072 PMCID: PMC9457160 DOI: 10.3390/jcm11175145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 11/24/2022] Open
Abstract
Fasting throughout the Muslim month of Ramadan may impact cardiovascular health. This study examines the association between the Ramadan period and acute myocardial infarction (AMI)-related outcomes among a Muslim population. The data were retrospectively extracted from a tertiary hospital (Beer-Sheva, Israel) database from 2002–2017, evaluating Muslim patients who endured AMI. The study periods for each year were: one month preceding Ramadan (reference period (RP)), the month of Ramadan, and two months thereafter (1840 days in total). A comparison of adjusted incidence rates between the study periods was performed using generalized linear models; one-month post-AMI mortality data were compared using a generalized estimating equation. Out of 5848 AMI hospitalizations, 877 of the patients were Muslims. No difference in AMI incidence between the Ramadan and RP was found (p = 0.893). However, in the one-month post-Ramadan period, AMI incidence demonstrably increased (AdjIRR = 3.068, p = 0.018) compared to the RP. Additionally, the highest risk of mortality was observed among the patients that underwent AMI in the one-month post-Ramadan period (AdjOR = 1.977, p = 0.004) compared to the RP. The subgroup analyses found Ramadan to differentially correlate with AMI mortality with respect to smoking, age, sex, diabetes mellitus, and hypertension, suggesting the Ramadan period is a risk factor for adverse AMI-related outcomes among select Muslim patients.
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11
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Roky R, Aadil N, Krami AM, Benaji B, Errabih I, Abdelrahim DN, Faris ME. Sex as a Biological Factor in the Changes in Disease Patients During Ramadan Intermittent Fasting: A Systematic Review. Front Nutr 2022; 9:908674. [PMID: 35845800 PMCID: PMC9284209 DOI: 10.3389/fnut.2022.908674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background During Ramadan, many patients with diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy choose to fast even against their doctor's advice. The impact of this intermittent fasting on health and disease could be different in men and women. The aim of this study was to determine the effect of sex as a factor in diseases outcomes of patients who opt to fast during Ramadan. Main Body The articles included in this study reported data on six diseases: diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy. A systematic search was performed on PubMed and Scopus for observational and clinical studies mentioning Ramadan, diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy in both men and women. Data was extracted by two independent reviewers using a standardized data-collection form. From 381 original articles, 38 studies were selected, including 25,023 patients of which 44.4% were women. Sex-based differences were reported by 18 studies for several variables such as body mass index, blood glucose, the frequency of hypoglycemia, renal colic, mortality, thrombosis, and gastrointestinal diseases in patients fasting during Ramadan. Most of the differences between men and women were reported both in the baseline period before Ramadan and during Ramadan. Indeed, during the period outside Ramadan, the frequency of renal colic, cardiovascular, gastrointestinal diseases, were higher in men; while body mass index, Thrombosis, and headache were higher in women. In the remaining 21 studies, it was reported that the sex factor was not associated with the effect of Ramadan fasting in the frequency and other outcomes of these diseases. Conclusion Currently, small attention is paid to sex as a determinant factor in patients while fasting during Ramadan. There appeared to be differences in the frequency and incidence of diseases in men and women during Ramadan. Closer attention to sex differences regarding the frequency and the progression of the diseases during fasting may help to improve patient care, especially to benefit those patients willing to fast during Ramadan.
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Affiliation(s)
- Rachida Roky
- Department of Biology, Laboratory of Physiopathology, Molecular Genetics & Biotechnology, Faculty of Sciences Ain Chock, Health and Biotechnology Research Centre, Hassan II University of Casablanca, Casablanca, Morocco
| | - Nadia Aadil
- Department of Biology, Laboratory of Microbiology, Pharmacology, Toxicology, Biotechnology and Environment Faculty of Sciences Ain Chock, Hassan II University of Casablanca, Casablanca, Morocco
| | - Al Mehdi Krami
- Department of Biology, Laboratory of Physiopathology, Molecular Genetics & Biotechnology, Faculty of Sciences Ain Chock, Health and Biotechnology Research Centre, Hassan II University of Casablanca, Casablanca, Morocco
| | - Brahim Benaji
- Health Technologies Engineering Department, Research Group in Biomedical Engineering and Pharmaceutical Sciences, ENSAM, Mohammed V University, Agdal, Morocco
| | - Ikram Errabih
- Gastroenterology Department, Ibn Sina Hospital, Mohammed V University, Agdal, Morocco
| | - Dana N. Abdelrahim
- Department of Clinical Nutrition and Dietetics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - MoezAlIslam Ezzat Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
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12
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Habas E, Errayes M, Habas E, Farfar KL, Alfitori G, Habas AE, Rayani A, Elzouki ANY. Fasting Ramadan in Chronic Kidney Disease (CKD), Kidney Transplant and Dialysis Patients: Review and Update. Cureus 2022; 14:e25269. [PMID: 35755525 PMCID: PMC9218841 DOI: 10.7759/cureus.25269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic kidney disease (CKD) is a common disease in the Islamic regions. Dehydration occurs after prolonged fasting, particularly in hot and humid climates. In the Arabic months’ calendar, Ramadan is a month of maximum given deeds, where Muslims are required to fast from dawn till sunset. Depending on where you live and when the Ramadan month falls, fasting might last anywhere from 10 to 20 hours or more. In certain circumstances, such as poorly controlled diabetes and advanced CKD patients who are allowed to break their fast, the Ramadan fasting amendment is viable. Some Muslims, however, continue fasting despite these circumstances, placing themselves at risk, which is not allowed in the Islamic religion. There are no medical recommendations that specify who should and should not fast. Nonetheless, the recommendations have been extracted from several published studies. The authors searched EMBASE, PubMed, Google Scholar, and Google for publications, research, and reviews. All authors debate and analyze the related articles. Each author was assigned a part or two of the topics to read, study, and summarize before creating the final draft of their given section. Then this comprehensive review was completed after discussion sessions. In conclusion, by the Islamic religion view, fasting Ramadan is mandatory for every wise adult person. People who have chronic diseases or that may deteriorate by fasting are exempted from fasting. It seems that fasting and the associated disease hours are determinant factors to fasting or not fasting. Up to our knowledge, there are no established guidelines for CKD patients and physicians to follow; however, the International Diabetes Federation and Diabetes and Ramadan (IDF-DAR) Practical Guidelines 2021 have been issued for CKD diabetic patients and fasting.
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13
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Zakhama L, Hammami R, Mzoughi K, Ben Halima M, Antit S, Chaker F, Ben Fatma L, Jammoussi H, Gribaa R, Charfeddine S, Drissa M, Tarmiz A, Taamallah K, Milouchi S, Nouira S, Neffati E, Ouechtati W, Ouali S, Ben Halima A, Turki F, Skhiri H, Amrouch C, Slim I, Zghal K, Koubaa A, Karoui M, Boussarsar M, Besbes MH, Ben Jeddou K, Ouertatani H, Ben Hammouda M, Ben Brahem A, Hammouda C, Bezdah L, Said F, Lakhdhar R. Management of patients with cardiovascular diseases during Ramadan. LA TUNISIE MEDICALE 2022; 100:358-373. [PMID: 36206085 PMCID: PMC9552241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
During the month of Ramadan, over one billion Muslims observe a water and food fast from sunrise to sunset. The practice of this religious duty causes marked changes in eating and sleeping habits. With the increasing incidence of cardiovascular (CV) risk factors, the number of patients with CV pathologies who wish to fast is increasing worldwide, and in Tunisia, which is ranked as a high CV risk country. If fasting has been shown to be beneficial for the improvement of some metabolic parameters, its practice in patients with CV pathology remains debated. The Tunisian Society of Cardiology and Cardiovascular Surgery (STCCCV) in consultation with the National Instance of Evaluation and Accreditation in Health (INEAS) has established this document in the form of a consensus after having analysed the literature with the aim of addressing these questions: -What is the impact of fasting in patients with CV pathologies? -How to stratify the risk of fasting according to CV pathology and comorbidities? -How to plan fasting in patients with CV diseases? -What are the hygienic and dietary measures to be recommended during fasting in patients with CV pathologies? -How to manage medication during the month of Ramadan in patients with CV diseases?
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Affiliation(s)
- Lilia Zakhama
- 1. Service de Cardiologie, Hôpital des Forces de Sécurité Intérieure, La Marsa, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie
| | - Rania Hammami
- 2. Service de Cardiologie, Hôpital Hédi Chaker, Faculté de Médecine de Sfax, Université de Sfax, Tunisie.
| | - Khadija Mzoughi
- 3. Service de Cardiologie, Hôpital Habib Thameur, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Manel Ben Halima
- 4. Service des explorations fonctionnelles et de réanimation cardiaque, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Saoussen Antit
- 1. Service de Cardiologie, Hôpital des Forces de Sécurité Intérieure, La Marsa, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie
| | - Fatma Chaker
- 5. Service d’Endocrinologie, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Lilia Ben Fatma
- 6. Service de Néphrologie, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Henda Jammoussi
- 7. Service de Nutrition A, Institut National de Nutrition de Tunis, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie
| | - Rym Gribaa
- 8. Service de Cardiologie, Hôpital Sahloul, Faculté de Médecine de Sousse, Université de Sousse, Tunisie.
| | - Selma Charfeddine
- 2. Service de Cardiologie, Hôpital Hédi Chaker, Faculté de Médecine de Sfax, Université de Sfax, Tunisie.
| | - Meriem Drissa
- 9. Service de Cardiologie Adulte, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | | | - Karima Taamallah
- 11. Service de Cardiologie Adulte, Hôpital Militaire de Tunis, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Sami Milouchi
- 12. Service de Cardiologie, Hôpital de Mednine, Faculté de Médecine de Sfax, Université de Sfax, Tunisie.
| | - Samir Nouira
- 13. Service des urgences, Hôpital de Fattouma Bourguiba, Faculté de Médecine de Monastir, Université de Monastir, Tunisie
| | - Elyes Neffati
- 8. Service de Cardiologie, Hôpital Sahloul, Faculté de Médecine de Sousse, Université de Sousse, Tunisie.
| | - Wejdène Ouechtati
- 14. Service de Cardiologie, Hôpital Charles Nicolle, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Sana Ouali
- 4. Service des explorations fonctionnelles et de réanimation cardiaque, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Afef Ben Halima
- 15. Service de Cardiologie, Hôpital Abderrahmen Mami de l’Ariana, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Faten Turki
- 2. Service de Cardiologie, Hôpital Hédi Chaker, Faculté de Médecine de Sfax, Université de Sfax, Tunisie.
| | - Habib Skhiri
- 16. Service de Néphrologie, Hôpital de Fattouma Bourguiba, Faculté de Médecine de Monastir, Université de Monastir, Tunisie.
| | - Chiraz Amrouch
- 17. Consultations externes de Nutrition, Institut National de Nutrition de Tunis, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | | | - Khaled Zghal
- 18. Laboratoire de Pharmacologie, Faculté de Médecine de Sfax, Université de Sfax, Tunisie.
| | | | | | | | | | | | | | | | | | | | - Leila Bezdah
- 14. Service de Cardiologie, Hôpital Charles Nicolle, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Fatma Said
- 24. Service de Médecine Interne, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
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14
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AlAbdan NA, Almohammed OA, Altukhaim MS, Farooqui MA, Abdalla MI, Al Otaibi HQ, Alshuraym NR, Alghusun SN, Alotaibi LH, Alsayyari AA. Fasting during Ramadan and acute kidney injury (AKI): a retrospective, propensity matched cohort study. BMC Nephrol 2022; 23:54. [PMID: 35125093 PMCID: PMC8819932 DOI: 10.1186/s12882-022-02674-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/17/2022] [Indexed: 11/27/2022] Open
Abstract
Background During the month of Ramadan, Muslims abstain from daytime consumption of fluids and foods, although some high-risk individuals are exempt. Because fasting's effects on the risk of acute kidney injury (AKI) have not been established, this study assesses the relationship between fasting and risk of AKI and identifies patients at high risk. Methods A single-center, retrospective, propensity-score matched, cohort study was conducted with data collected from adult patients admitted to the emergency room during Ramadan and the following month over two consecutive years (2016 and 2017). AKI was diagnosed based on the 2012 definition from the Kidney Disease: Improving Global Outcomes clinical practice guideline. Multivariable logistic regression analyses were used to examine the correlation and measure the effect of fasting on the incidence of AKI, and assess the effect of different variables on the incidence of AKI between the matching cohorts. Results A total of 1199 patients were included; after matching, each cohort had 499 patients. In the fasting cohort, the incidence of AKI and the risk of developing AKI were significantly lower (adjusted odds ratio (AOR) 0.65;95% confidence interval (CI) 0.44–0.98). The most indicative risk factors for AKI were hypertension (AOR 2.17; 95% CI 1.48–3.18), history of AKI (AOR 5.05; 95% CI 3.46–7.39), and liver cirrhosis (AOR 3.01; 95% CI 1.04–8.70). Patients with these factors or most other comorbidities in the fasting cohort had a lower risk of AKI as compared with their nonfasting counterparts. Conclusion The data show a strong reduction in the risk of developing AKI as a benefit of fasting, particularly in patients with comorbid conditions. Therefore, most patients with comorbid conditions are not harmed from fasting during Ramadan. However, larger prospective studies are needed to investigate the benefit of fasting in reducing the risk of developing AKI.
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15
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Malik S, Hamer R, Shabir S, Youssouf S, Morsy M, Rashid R, Waqar S, Ghouri N. Effects of fasting on solid organ transplant recipients during Ramadan - a practical guide for healthcare professionals. Clin Med (Lond) 2021; 21:e492-e498. [PMID: 38594852 DOI: 10.7861/clinmed.2021-0250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fasting in the month of Ramadan is an obligatory act for healthy adult Muslims. It requires abstinence from food and drink from dawn to sunset. Although there are exemptions from fasting, many patients are keen to fulfil what they see as a religious obligation, even if this may be against medical advice in some cases. Solid organ transplant (SOT) recipients often ask healthcare professionals for advice on fasting. Studies on the effect of fasting in transplant patients have all been done in the Middle East and North Africa where the average fasting duration is between 12 and 14 hours. In comparison, in temperate regions in the summer, fasting duration can be as long as 20 hours. Fasting when patients have to take immunosuppression 12 hours apart with little time variation poses unique challenges. In this review, current literature is reviewed, and a decision-making tool has been developed to assist clinicians in discussing the risks of fasting in transplant recipients, with consideration also given to circumstances such as the COVID-19 pandemic. Our review highlights that SOT recipients wishing to fast should undergo a thorough risk assessment, ideally 3 months before Ramadan. They may require medication changes and a plan for regular monitoring of graft function and electrolytes in order to fast safely. Recommendations have been based on risk tiers (very high risk, high risk and low/moderate risk) established by the International Diabetes Federation and the Diabetes and Ramadan International Alliance. Patients in the 'very high risk' and 'high risk' categories should be encouraged to explore alternative options to fasting such as winter fasting or Fidyah. Those in the 'low/moderate' category may be able to cautiously fast with guidance from their clinician. Prior to the commencement of Ramadan, all patients must receive up-to-date education on sick-day rules, instructions on when to terminate their fast or abstain from fasting.
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Affiliation(s)
- Shafi Malik
- University Hospitals Coventry and Warwickshire NHS Trust, UK, and honorary clinical lecturer, University of Leicester, Leicester, UK.
| | - Rizwan Hamer
- University Hospitals Coventry and Warwickshire NHS Trust, UK
| | | | | | - Mohamed Morsy
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Nazim Ghouri
- University of Glasgow, Glasgow, UK, and consultant physician in diabetes, endocrinology and general medicine, Queen Elizabeth University Hospital, Glasgow, UK
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16
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Costa NA, Pereira AG, Dorna MDS, Rodrigues HCN, Azevedo PS, Paiva SAR, Polegato BF, Balbi AL, Zornoff LAM, Ponce D, Minicucci MF. Meal timing and frequency implications in the development and prognosis of chronic kidney disease. Nutrition 2021; 91-92:111427. [PMID: 34461602 DOI: 10.1016/j.nut.2021.111427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Patients with chronic kidney disease (CKD) have a higher risk of death than the general population, the main cause being cardiovascular disease (CVD). Nutrition plays a key role in the prevention and treatment of CVD and kidney diseases. Currently, new evidence reinforces the importance of specific foods and general dietary patterns rather than isolated nutrients for cardiovascular risk. In addition, dietary patterns and healthy eating habits seem extremely relevant in decreasing risk factors. Epidemiologic and clinical intervention studies have suggested that late-night dinner and skipping breakfast are associated with an increased risk of obesity, insulin resistance, and CVD. In CKD, despite important changes in nutritional counseling in recent decades, less attention has been paid to meal timing and frequency. Therefore, the purpose of this review is to discuss the evidence of meal timing and frequency in CKD development and prognosis, presented under three main topics: risk of developing CKD, importance of dietary habits, and implications of fasting.
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Affiliation(s)
- Nara Aline Costa
- Faculty of Nutrition, Federal University of Goias, Goiânia, Brazil.
| | - Amanda Gomes Pereira
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Mariana de Souza Dorna
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil
| | | | - Paula Schmidt Azevedo
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Sergio Alberto Rupp Paiva
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Bertha Furlan Polegato
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil
| | - André Luís Balbi
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil
| | | | - Daniela Ponce
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Marcos Ferreira Minicucci
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil
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17
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Karatas A, Canakci E, Arici YK, Kaya M, Sayim B. The effect of Fasting during Ramadan on the Kidney functions of Stage III-IV Chronic Kidney Disease Patients. Pak J Med Sci 2021; 37:972-978. [PMID: 34290768 PMCID: PMC8281173 DOI: 10.12669/pjms.37.4.3661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/18/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Examine the effect of fasting during Ramadan on kidney functions in patients with chronic kidney disease. METHODS The study was conducted on 130 patients with stage III-IV chronic kidney disease (CKD), who were admitted to the Ordu University nephrology polyclinic during the month before Ramadan and one month after Ramadan in 2019. Blood samples were taken in the morning after 12 hours of fasting. RESULTS There was a statistically significant difference between BUN in the fasting group before and after the month of Ramadan. The median BUN before Ramadan was 26.65 mg/dl, the median after Ramadan was 24.05 mg/dl (p=0.004).There was a statistically significant difference between the nonfasting groups before and after Ramadan with respect to creatinine level. Median creatinine before Ramadan was 1.69 mg/dl,and the median after Ramadan was 1.86 mg/dl (p <0.001).There was a statistically significant difference between the fasting groups before and after Ramadan with respect to creatinine levels. Fasting group ,the median before Ramadan was 1.5 mg/dl, and the median after Ramadan was 1.42 mg/dl (p = 0.038).The impact of independent variable of fasting, using linear regression was found to be statistically significant (ppost-<0.001). The eGFR was 14.826 points higher in those who fasted after Ramadan than in those who did not. CONCLUSION Fasting during the month of Ramadan does not deteriorate kidney functions and even leads to a moderate improvement in kidney functions. Taking these results into consideration, fasting may be advised for patients with stage III-IV CKD who want to fast and remain in stable condition.
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Affiliation(s)
- Ahmet Karatas
- Dr. Ahmet Karatas, MD. Nephrologist, Associated Professor, Department of Internal Medicine, Division of Neprology, Education and Research Hospital, Ordu University School of Medicine, Ordu, Turkey
| | - Ebru Canakci
- Dr. Ebru Canakci, MD, Anesthesiologist, Associate Professor, Department of Anesthesiology and Reanimation, Education and Research Hospital, Ordu University School of Medicine, Ordu, Turkey
| | - Yeliz Kasko Arici
- Dr. Yeliz Kasko Arici, PhD. Biostatistics Specialist, Assistant Professor, Department of Biostatistics and Medical Informatics, Ordu University School of Medicine, Ordu, Turkey
| | - Mervegul Kaya
- Mervegul Kaya, MD, Family Medicine Specialist, Attending Physician, Department of Family Medicine, Education and Research Hospital, Ordu University School of Medicine, Ordu, Turkey
| | - Beyza Sayim
- Beyza Sayim, MD, Researcher Fellow Department of Internal Medicine, Education and Research Hospital, Ordu University School of Medicine, Ordu, Turkey
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18
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Tootee A, Larijani B. Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update. J Diabetes Metab Disord 2021; 20:1003-1009. [PMID: 33996651 PMCID: PMC8108432 DOI: 10.1007/s40200-021-00804-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Development of updated guidelines for management of diabetes in Ramadan Fasting is of paramount importance. Nonetheless, evidence-based guidelines in the field of Ramadan Fasting and Diabetes are scarce. Moreover, findings of some recent research such as effects of Ramadan fasting on microbiota, genetics and epigenetics, hormonal changes (such as adiponectin, leptin, testosterone…), and alternations in circadian rhythm should also be reviewed and included on a yearly basis. It is documented that self-monitoring of blood glucose (SMBG) is of vital importance for patients with type 1 diabetes who fast, and advantages of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) techniques should be highlighted. Moreover, the recent findings about applications of advanced insulin delivery technology in patients with diabetes who fast in Ramadan should also considered in the annual updates of the guidelines.
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Affiliation(s)
- Ali Tootee
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Institute, Beneath Dr. Shariati Hospital, 3rd floor, Gomnam highway, Tehran, 1411713137 Iran
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19
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Tootee A, Larijan B. Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update. J Diabetes Metab Disord 2021; 20:1085-1091. [PMID: 33968836 PMCID: PMC8088403 DOI: 10.1007/s40200-021-00806-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
Development of updated guidelines for management of diabetes in Ramadan Fasting is of paramount importance. Nonetheless, evidence-based guidelines in the field of Ramadan Fasting and Diabetes are scarce. Moreover, findings of some recent research such as effects of Ramadan fasting on microbiota, genetics and epigenetics, hormonal changes (such as adiponectin, leptin, testosterone…), and alternations in circadian rhythm should also be reviewed and included on a yearly basis. It is documented that self-monitoring of blood glucose (SMBG) is of vital importance for patients with type 1 diabetes who fast, and advantages of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) techniques should be highlighted. Moreover, the recent findings about applications of advanced insulin delivery technology in patients with diabetes who fast in Ramadan should also considered in the annual updates of the guidelines.
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Affiliation(s)
- Ali Tootee
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijan
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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20
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Alper AT, Akboğa MK, Özcan KS, Tengiz İ, Türk UÖ, Yıldız M, Yılmaz MB, Kayıkçıoğlu M, Gazi E, Yıldırır A. Recommendations for Ramadan fasting to patients with cardiovascular diseases; Turkish Society of Cardiology consensus report. Anatol J Cardiol 2021; 25:284-293. [PMID: 33960303 DOI: 10.5152/anatoljcardiol.2021.206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ahmet Taha Alper
- Department of Cardiology, University of Health and Sciences, Siyami Ersek Training and Research Hospital; İstanbul-Turkey
| | - Mehmet Kadri Akboğa
- Department of Cardiology, Faculty of Medicine, Gazi University; Ankara-Turkey
| | - Kazım Serhan Özcan
- Department of Cardiology, University of Health and Sciences, Siyami Ersek Training and Research Hospital; İstanbul-Turkey
| | - İstemihan Tengiz
- Department of Cardiology, Medical Park İzmir Hospital; İzmir-Turkey
| | - Uğur Önsel Türk
- Department of Cardiology, Medical Park İzmir Hospital; İzmir-Turkey
| | - Mustafa Yıldız
- Department of Cardiology, Institute of Cardiology, İstanbul University-Cerrahpaşa; İstanbul-Turkey
| | - Mehmet Birhan Yılmaz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Faculty of Medicine, Ege University; İzmir-Turkey
| | - Emine Gazi
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University; Çanakkale-Turkey
| | - Aylin Yıldırır
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey
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21
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Malik S, Bhanji A, Abuleiss H, Hamer R, Shah SH, Rashad R, Junglee N, Waqar S, Ghouri N. Effects of fasting on patients with chronic kidney disease during Ramadan and practical guidance for healthcare professionals. Clin Kidney J 2021; 14:1524-1534. [PMID: 34079617 PMCID: PMC7929006 DOI: 10.1093/ckj/sfab032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 12/30/2022] Open
Abstract
There are an estimated 1.8 billion Muslims worldwide, with the majority of them choosing to fast during the month of Ramadan. Fasting, which requires abstinence from food and drink from dawn to sunset can be up to 20 h per day during the summer months in temperate regions. Fasting can be especially challenging in patients on haemodialysis and peritoneal dialysis. Moreover, there is concern that those with chronic kidney disease (CKD) can experience electrolyte imbalance and worsening of renal function. In this article, current literature is reviewed and a decision-making management tool has been developed to assist clinicians in discussing the risks of fasting in patients with CKD, with consideration also given to circumstances such as the coronavirus disease 2019 pandemic. Our review highlights that patients with CKD wishing to fast should undergo a thorough risk assessment ideally within a month before Ramadan, as they may require medication changes and a plan for regular monitoring of renal function and electrolytes in order to fast safely. Recommendations have been based on risk tiers (very high risk, high risk and low-moderate risk) established by the International Diabetes Federation and the Diabetes and Ramadan International Alliance. Patients in the very high risk and high risk categories should be encouraged to explore alternative options to fasting, while those in the low-moderate category may be able to fast safely with guidance from their clinician. Prior to the commencement of Ramadan, all patients must receive up-to-date education on sick-day rules and instructions on when to terminate their fast or abstain from fasting.
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Affiliation(s)
- Shafi Malik
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK.,University of Leicester, Leicester, UK
| | - Amir Bhanji
- Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Rizwan Hamer
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | - Naushad Junglee
- University Hospital Llandough, Cardiff and Vale, University Health Board, Cardiff, Wales
| | - Salman Waqar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nazim Ghouri
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, Scotland.,Department of Diabetes and Endocrinology, Queen, Elizabeth University Hospital, Glasgow, Scotland
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Effects of Time-Restricted Feeding during Ramadan on Dietary Intake, Body Composition and Metabolic Outcomes. Nutrients 2020; 12:nu12082478. [PMID: 32824528 PMCID: PMC7468808 DOI: 10.3390/nu12082478] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 12/24/2022] Open
Abstract
Ramadan fasting is a form of time-restricted feeding which combines a fast and feast period daily for a duration of one month every year. During Ramadan, Muslims abstain from food and drink consumption from dawn till sunset and this change in the meal schedule and frequency results in significant changes to the composition of the diet, such as energy and nutrient intake. These changes in dietary habits and their corresponding effects on cardiometabolic disease risk are compiled in this review. Ramadan fasting shows limited benefits to body composition via reductions in body mass in both healthy and obese individuals, although the results are often found to be transient and heterogeneous. There is, however, a more consistent improvement in blood lipid profile during Ramadan fasting, which often lasts beyond the Ramadan period. The results for glucose homeostasis, on the contrary, are more conflicting and inconclusive. The heterogeneity in the findings from the various studies can be generally attributed to cultural variations in dietary habits, differences in the duration of fasting due to seasonal/climatic differences at various geographical locations, age, gender and socioeconomic status, as well as other health and lifestyle factors of the various study populations.
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The effect of Ramadan fasting on kidney function in patients with chronic kidney disease. Int Urol Nephrol 2020; 52:1337-1343. [PMID: 32458211 DOI: 10.1007/s11255-020-02506-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/11/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Because of the increase in globalization, clinicians all over the world are confronted the questions about safety of Ramadan fasting. However, there is no clear information about whether there is an obstacle for fasting patients with chronic disease. Hence, in the present study, we aimed to investigate the effects of Ramadan fasting on kidney and the factors affecting this relationship in patients with chronic kidney disease. METHODS This study involving 117 patients [36 females, 81 males; mean age, 60 (46.0-70.0) years] with stage 2-3 chronic kidney and fasting. Patients were evaluated every 10 days for acute kidney injury (AKI) in Ramadan month. And, patients with acute kidney injury and patients without AKI were grouped. RESULTS When the patients were evaluated for AKI, we observed that in 27 patients had acute kidney injury. While patients without AKI fasted for more days (p < 0.001), urea levels and frequency of hypertension were higher in the group with AKI (p = 0.019; p = 0.025 respectively). We also performed univariate and multiple binary logistic regression analysis to identify the risk factors of AKI. Hypertension and number of fasting day were found to be predictive of AKI (p = 0.02; p < 0.001 respectively). CONCLUSIONS We found a significant relationship between hypertension, the number of fasting days and acute kidney injury. Patients with chronic kidney damage and hypertension should be evaluated more carefully, informed about the importance of hydration after fasting and should be followed frequently for AKI.
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Arabi Z, Ghalib B, Asmari I, Gafar M, Alam S, Abdulgadir M, AlShareef A, Rashidi A, Alruwaymi M, Altheaby A. Instructions for kidney recipients and donors (In English for medical providers and in Arabic for patients and donors). Avicenna J Med 2020; 10:41-53. [PMID: 32110549 PMCID: PMC7014992 DOI: 10.4103/ajm.ajm_120_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Medical providers are often asked by their kidney recipients and donors about what to do or to avoid. Common questions include medications, diet, isolation, return to work or school, pregnancy, fasting Ramadan, or hajj and Omrah. However, there is only scant information about these in English language and none in Arabic. Here, we present evidence-based education materials for medical providers (in English language) and for patients and donors (in Arabic language). These educational materials are prepared to be easy to print or adopt by patients, providers, and centers.
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Affiliation(s)
- Ziad Arabi
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Basmeh Ghalib
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim Asmari
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Gafar
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Syed Alam
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohamad Abdulgadir
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ala AlShareef
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Awatif Rashidi
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alruwaymi
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman Altheaby
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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25
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Bello AK, Kurzawa J, Osman MA, Olah ME, Lloyd A, Wiebe N, Habib S, Qarni U, Shojai S, Pauly RP. Impact of Ramadan fasting on kidney function and related outcomes in patients with chronic kidney disease: a systematic review protocol. BMJ Open 2019; 9:e022710. [PMID: 31446401 PMCID: PMC6720242 DOI: 10.1136/bmjopen-2018-022710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 12/11/2018] [Accepted: 12/19/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Fasting during the month of Ramadan is a significant Islamic religious practice that involves abstinence from food, drink and medication from dawn to dusk. As just under a quarter of the world's population identifies as Muslim, the effect of fasting on chronic conditions, such as chronic kidney disease (CKD) is a topic of broad relevance. To date, the information in this area has been mixed, with many limitations of previous studies. This study aims to synthesise the evidence of the effect of Ramadan fasting on changes on kidney function, risk factors, episodes of acute kidney injury and impact on the quality of life in patients with CKD or kidney transplant. METHODS AND ANALYSIS A systematic review of the literature will be conducted, using electronic databases such as MEDLINE, Embase, Global Health, CINAHL and Scopus. Original research and grey literature on the effect of Ramadan fasting in adult patients with CKD or renal transplantation will be included. Two reviewers will independently screen articles for inclusion in the review and independently assess the methodology of included studies using a customised checklist. Mean difference or risk ratio will be reported for continuous or dichotomous outcomes and results will be pooled using a random-effects model where heterogeneity is reasonable. If possible, subgroups (CKD status, setting, season and risk of bias) will be analysed for effect modification with fasting and the outcomes of interest. Risk of bias will be assessed using the Downs and Black checklist. ETHICS AND DISSEMINATION The results will be disseminated using a multifaceted approach to engage all stakeholders (patients, practitioners and community leaders). Research ethics board approval is not required as this is a systematic review of previously published research. PROSPERO REGISTRATION NUMBER CRD42018088973.
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Affiliation(s)
- Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Julia Kurzawa
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A Osman
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle E Olah
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Anita Lloyd
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Syed Habib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Uwais Qarni
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert P Pauly
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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26
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Abushady MM, Samy M, Bekhet M, Abdullah A. Effect of Ramadan fasting on renal function in patients with type 2 diabetes. Diabetes Res Clin Pract 2019; 153:176-183. [PMID: 31195024 DOI: 10.1016/j.diabres.2019.05.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/30/2019] [Indexed: 11/21/2022]
Abstract
AIM To evaluate the effect of Ramadan fasting on kidney functions in patients with type 2 DM. METHODS We recruited 90 subjects with type 2 DM intending to fast Ramadan; classified into 30 with albuminuria and renal impairment (group I), 30 with albuminuria and normal kidney functions (group II) and 30 without albuminuria and normal kidney functions (group III). Two weeks before and after Ramadan, fasting plasma glucose, 2 h plasma glucose, hemoglobin A1c, fructosamine, serum creatinine, BUN, eGFR and albumin/ creatinine ratio were measured. RESULTS On comparing data before and after Ramadan, significant reduction in HbA1c was found in all groups. As regards kidney function parameters, no significant difference was found in group I but a significant decline in these parameters was found in groups II and III; serum creatinine, eGFR, urinary albumin/ creatinine ratio (p <0.001). Only Group I showed significant hypoglycemic events and need for dose reduction. CONCLUSION Ramadan fasting improved glycemic control in patients with type 2 DM with no decline in kidney functions in renally impaired group, only a decline in albuminuric and healthy groups within the normal range. Patients should be adviced regarding adequate hydration and dietary modification during Pre-Ramadan health care education.
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Affiliation(s)
- M M Abushady
- Internal Medicine & Endocrinology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - M Samy
- Internal Medicine & Endocrinology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M Bekhet
- Internal Medicine & Endocrinology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A Abdullah
- Internal Medicine Department in Specialized Damietta Hospital, Damietta, Egypt
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27
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Dogan I, Eser B, Kayadibi H. The effect of Ramadan fasting on renal functions in patients with chronic kidney disease. TURKISH JOURNAL OF BIOCHEMISTRY 2019. [DOI: 10.1515/tjb-2018-0373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Abstract
Objective
We aimed to investigate the effects of Ramadan fasting on renal functions in patients with stage 3 and 4 chronic kidney disease.
Materials and methods
The study was conducted in Ramadan month which was between June and July. Patients were evaluated before Ramadan, the week immediately following the end of the Ramadan, and 3 and 6 months after Ramadan.
Results
Twenty-four fasting (mean age of 68 ± 13 years) and 55 non-fasting individuals (mean age of 69 ± 9 years) were included in this study. There was no statistically significant difference for creatinine levels in the first week after Ramadan in both groups compared to levels before Ramadan (p = 0.070, p = 0.470, respectively). The groups were compared according to the criteria of deterioration in renal function (reduction of 25% in GFR and 30% increase in serum creatinine levels). There were no statistically significant differences between the two groups according to these two criteria (p = 0.452, p = 0.660, respectively). In univariate and multivariate logistic regression analysis, the presence of diabetes mellitus and proteinuria were found to be independent risk determinants of renal dysfunction.
Conclusion
Patients with diabetes mellitus and prominent proteinuria may constitute critical patient groups for renal function deterioration during Ramadan fasting.
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Affiliation(s)
- Ibrahim Dogan
- Hitit University , Faculty of Medicine, Department of Nephrology , Corum, TR 19100 , Turkey
| | - Baris Eser
- Hitit University , Faculty of Medicine, Department of Nephrology , Corum, TR 19100 , Turkey
| | - Huseyin Kayadibi
- Hitit University , Department of Medical Biochemistry , Corum , TR 19100 , Turkey
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28
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Chowdhury A, Khan H, Lasker SS, Chowdhury TA. Fasting outcomes in people with diabetes and chronic kidney disease in East London during Ramadan 2018: The East London diabetes in Ramadan survey. Diabetes Res Clin Pract 2019; 152:166-170. [PMID: 31150726 DOI: 10.1016/j.diabres.2019.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/09/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Fasting in summer months for Muslim people with diabetes during Ramadan is challenging, particularly in temperate climates, where duration of fasting is prolonged. Risk of fasting may be greater in people with diabetes and chronic kidney disease (CKD). We aimed to prospectively monitor the outcomes of patients with diabetes and CKD stage 3 during Ramadan 2018 in East London. METHODS Patients with type 2 diabetes (T2D) and CKD stage 3 attending community diabetes clinics were approached prior to Ramadan 2018 to discuss fasting. Patients were risk categorised according to Diabetes and Ramadan Alliance guidelines. If they chose to fast, Ramadan education was given, and biomedical assessments were undertaken within one week prior to and one week after fasting. Outcomes between patients fasting and non-fasting groups were compared. RESULTS Fasting (n = 68) and non-fasting groups (n = 71) were similar apart from slightly higher insulin use in the non-fasting group. Median days fasted was 21 (range 12-29). There were no significant changes in weight, blood pressure, creatinine, glycated haemoglobin, cholesterol and urinary PCR pre- and post-Ramadan, and no significant differences between the fasting and non-fasting groups. There was no difference in adverse events (acute kidney injury, hypoglycaemia or cardiovascular events) between the fasting and non-fasting groups. CONCLUSIONS No significant differences were seen in clinical or biochemical parameters, or adverse events between fasting and non-fasting patients. Patients with T2D and stable CKD stage 3 may be able to fast safely during Ramadan.
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Affiliation(s)
- Aisha Chowdhury
- Department of Diabetes and Metabolism, Royal London Hospital, London E1 1BB, UK
| | - Halima Khan
- Department of Diabetes and Metabolism, Royal London Hospital, London E1 1BB, UK
| | | | - Tahseen A Chowdhury
- Department of Diabetes and Metabolism, Royal London Hospital, London E1 1BB, UK.
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29
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Ahmad S, Chowdhury TA. Fasting during Ramadan in people with chronic kidney disease: a review of the literature. Ther Adv Endocrinol Metab 2019; 10:2042018819889019. [PMID: 31798822 PMCID: PMC6859673 DOI: 10.1177/2042018819889019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/27/2019] [Indexed: 12/18/2022] Open
Abstract
Chronic kidney disease (CKD) is common among Muslim patients, and many such patients are keen to fast during the month of Ramadan. Fasting for prolonged periods may be deleterious for patients with CKD, but the changing season of fasting means that the duration of fast is very variable between geographical locations. There is, furthermore, a paucity of evidence to guide patients and clinicians in management of fasting in people with CKD. In this article, we aim to review the available evidence for patients with CKD and fasting, including haemodialysis and renal transplantation. We suggest that all patients with CKD should be deemed high risk or very high risk for fasting. We conclude, however, that patients with stable mild/moderate CKD (stage 1-3) may be able to fast providing they are carefully monitored and counselled. We also suggest that patients with stable renal transplants may also be able to fast, providing they are monitored carefully by their transplant team. Patients on haemodialysis or peritoneal dialysis should not be encouraged to fast, but if they do so, they will need careful weekly monitoring. There is an urgent need for high-quality data for patients with CKD who plan to fast over Ramadan, to enable more guidance to be developed for this vulnerable group of patients.
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Affiliation(s)
- Shahzaib Ahmad
- Specialist Trainee in Anaesthetics and Intensive Care, Department of Anaesthetics and Intensive Care, St Helier Hospital, London, UK
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30
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Zimhony N, Abu-Salameh I, Sagy I, Dizitzer Y, Oxman L, Yitshak-Sade M, Novack V, Horev A, Ifergane G. Increase in Ischemic Stroke Incident Hospitalizations Among Bedouin Arabs During Ramadan Month. J Am Heart Assoc 2018; 7:JAHA.117.008018. [PMID: 29728012 PMCID: PMC6015316 DOI: 10.1161/jaha.117.008018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Previous studies have not shown any significant effect on stroke incidence during Ramadan. We aimed to investigate the association between ischemic stroke incident hospitalizations and Ramadan, accounting for seasonality and temperature. Methods and Results This retrospective cohort study included all patients admitted with acute ischemic stroke to Soroka University Medical Center from June 2012 to June 2016. We obtained daily mean temperatures and relative humidity rates from 2 monitoring stations in South Israel. We analyzed the association between stroke incidence and Ramadan month, adjusting for weekly temperature and seasonality using Poisson regression models. We compared the first versus the last Ramadan fortnight. We performed an effect specificity analysis by assessing stroke incidence in the non‐Bedouin population. We identified 4727 cases of ischemic stroke, 564 cases of which were Bedouin Arabs. Fifty‐one cases occurred during Ramadan. Ramadan was significantly associated with an increased risk for ischemic stroke (RR 1.48; 95% confidence interval, 1.04–2.09), mainly during the first fortnight (RR 1.73, 95% confidence interval, 1.13–2.66) when compared with non‐Ramadan periods. Mean weekly temperatures and the summer season were not associated with stroke incidence among Bedouin Arabs (RR 0.98; 95% confidence interval, 0.82–1.18 and RR 0.77; confidence interval 0.56–1.06 accordingly). Such association was not observed in the non‐Bedouin population. Conclusion The Ramadan month, particularly in its first 2 weeks, is an independent and ethnicity specific risk factor for ischemic stroke hospitalizations among the Bedouin Arab fasting population.
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Affiliation(s)
- Noa Zimhony
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Ibrahim Abu-Salameh
- Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Iftach Sagy
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Yotam Dizitzer
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Liat Oxman
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Maayan Yitshak-Sade
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Anat Horev
- Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Ifergane
- Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel .,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Bakhit AA, Kurdi AM, Wadera JJ, Alsuwaida AO. Effects of Ramadan fasting on moderate to severe chronic kidney disease. A prospective observational study. Saudi Med J 2017; 38:48-52. [PMID: 28042630 PMCID: PMC5278065 DOI: 10.15537/smj.2017.1.17566] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: To examin the effect of Ramadan fasting on worsening of renal function (WRF). Method: This was a single-arm prospective observational study including 65 patients with stage 3 or higher chronic kidney disease (CKD). By definition, WRF was considered to have occurred when serum creatinine levels increased by 0.3 mg/dL (26.5 µmol/l) from baseline during or within 3 months after Ramadan. The study was conducted in the Nephrology Clinic of King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia during the month of Ramadan 1436 AH (Hijiri), which corresponded to June 18-July 17, 2015. Results: This study included 65 adults with a mean age of 53 years. Overall, 33% of patients developed WRF. In the multivariate analysis, more advanced CKD stage, higher baseline systolic blood pressure and younger age were independently associated with WRF. Underlying cause of CKD, use of diuretics, use of renin angiotensin blockers, gender, and smoking status were not associated with WRF. Conclusion: In patients with stage 3 or higher CKD, Ramadan fasting during the summer months was associated with worsening of renal function. Clinicians need to warn CKD patients against Ramadan fasting.
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Affiliation(s)
- Amaar A Bakhit
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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32
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Osman NA, Hassanein SM, Leil MM, NasrAllah MM. Complementary and Alternative Medicine Use Among Patients With Chronic Kidney Disease and Kidney Transplant Recipients. J Ren Nutr 2015; 25:466-71. [DOI: 10.1053/j.jrn.2015.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 12/17/2022] Open
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Effects of Intermittent Fasting, Caloric Restriction, and Ramadan Intermittent Fasting on Cognitive Performance at Rest and During Exercise in Adults. Sports Med 2015; 46:35-47. [DOI: 10.1007/s40279-015-0408-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
BACKGROUND During Ramadan, Muslims fast throughout daylight hours. There is a direct link between fasting and increasing incidence of infections. Antibiotic usage for treatment of infections should be based on accurate diagnosis, with the correct dose and dosing regimen for the shortest period to avoid bacterial resistance. This study aimed to evaluate the practices of physicians in prescribing suitable antibiotics for fasting patients and the compliance of the patients in using such antibiotics at regular intervals. MATERIALS AND METHODS An observational study was carried out during the middle 10 days of Ramadan 2014 in two pharmacies at Baghdad. A total of 34 prescriptions (Rx) for adults who suffered from infections were examined. For each included Rx, the researchers documented the age and sex of the patient, the diagnosis of the case, and the name of the given antibiotic(s) with dose and frequency of usage. A direct interview with the patient was also done, at which each patient was asked about fasting and if he/she would like to continue fasting during the remaining period of Ramadan. The patient was also asked if the physician asked him/her about fasting before writing the Rx. RESULTS More than two-thirds of participating patients were fasting during Ramadan. Antibiotics were prescribed at a higher percentage by dentists and surgeons, for which a single antibiotic with a twice-daily regimen was the most commonly prescribed by physicians for patients during the Ramadan month. CONCLUSION Physicians fail to take patient fasting status into consideration when prescribing antibiotics for their fasting patients. Antibiotics with a twice-daily regimen are not suitable and best to be avoided for fasting patients in Iraq during Ramadan - especially if it occurs during summer months - to avoid treatment failure and provoking bacterial resistance.
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Affiliation(s)
- Ehab Mudher Mikhael
- Clinical Pharmacy Department, College of Pharmacy, Baghdad University, Baghdad, Iraq
- Correspondence: Ehab Mudher Mikhael, Clinical Pharmacy Department, College of Pharmacy, Baghdad University, Bab Almuatham, Baghdad, Iraq, Tel +964 770 621 6933, Email
| | - Ali Lateef Jasim
- Clinical Pharmacy Department, College of Pharmacy, Baghdad University, Baghdad, Iraq
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