Women's fasting habits and dietary diversity during Ramadan in rural Bangladesh

A systematic review of dietary data collection methodologies for diet diversity indicators

The purpose of the current study was to critically assess the gaps in the existing methodologies of dietary data collection for diet diversity indicators. The study proposed the importance of smartphone application to overcome the drawbacks. The review paper identified and assessed the conventional methodologies used in diet diversity indicators including Minimum Dietary Diversity for Women (MDD-W), Minimum Dietary Diversity of Infant and Young Child Feeding Practices (IYCF-MDD), and Household Dietary Diversity Score (HDDS). The 80 research studies from 38 countries were critically assessed on the basis of their research aim, study design, target audience, dietary data collection methodology, sample size, dietary data type, dietary data collection frequency, and location point of dietary data collection. Results indicated that most studies employed interviewer-administered 24-h recall assessing the dietary diversity. The review paper concluded that smartphone application had potential to overcome the identified limitations of conventional methodologies including recall bias, social-desirability bias, interviewer training, and cost-time constraints.

Caring for Muslim Patients: A Primer for the Obstetrician Gynecologist

Studies show that Muslim American patients experience discrimination and feel uncomfortable seeking appropriate health care for various reasons. Obstetrician-gynecologists should be educated regarding Islamic perspectives on topics such as modesty, sexual health, contraception, abortion, infertility, and fasting during pregnancy. Understanding the barriers Muslim patients face and improving cultural humility will improve the quality of sexual and reproductive care delivered to Muslim patients.

Ramadan fasting intentions among pregnant women in Lebanon

BACKGROUND

According to Islam's teachings, women are religiously exempt from fasting during pregnancy if a woman is concerned about her health or that of the fetus. This study assesses the intentions of pregnant women to fast during Ramadan and evaluates the contribution of items derived from the theory of planned behavior (TPB) in predicting these intentions.

METHODS

A cross-sectional survey was carried out in Arabic on a convenience sample of 181 pregnant women in Lebanon using a mixture of in-person (46), telephone (31), and online recruitment (104) techniques from February to April 2020. An Exploratory Bayes Tree Analysis was done to examine which TPB items appeared to separate the intention to fast in the best possible way. Then, an ordinal regression was completed followed by a latent class analysis to examine specific classes of participants that could be determined based on the regression results.

RESULTS

Overall, 58% of participants had the intention to fast all days of Ramadan, 22% had the intention to fast some days and 20% did not intend to fast for any duration. A model was run with perceptions of physical ability, Islam guidance, husband's opinion importance, mother's opinion beliefs, and impact on general health as predictors (R2 = 0.74). A four-cluster model was chosen as the most parsimonious one in interpretation, where classes one and two included the groups of women who intended to fast month-long with differences in predictors. Class three represented the group of women who did not have the intention to fast and the final class represented the group of women who had the intention to fast some days of the month. The women's belief in their physical ability to fast and the opinion of the pregnant women's mothers were very important in deciding the participants' intention to fast.

CONCLUSIONS

Items derived from TPB constructs helped in producing a model predicting women's intention to fast during Ramadan. Educational messages and interventions related to fasting while pregnant may be delivered by individuals with legitimacy among pregnant women such as those viewed by the target population as powerful motherly figures in their communities.

Effect of Ramadan Fasting on Breast Milk

Introduction: Breast milk is an excellent biofluid that ensures optimal growth, development, and strong immunity of the baby. Breast milk content may alter depending on duration and time of breastfeeding, the infant's age, and maternal health status. There are few studies in the literature investigating the effect of religious fasting on breast milk composition. Method: The study included 21 fasting and 27 nonfasting mothers who exclusively breastfed their babies in 2021 Ramadan month. The energy, carbohydrate, protein, and lipid levels of the collected breast milk samples and the macro- and micronutrient contents of the mothers' diets and the weight gain of the infants during the study were evaluated. Results: The mothers' ages, education levels, and weights at birth and at the time of sampling were similar. There was no significant difference between the energy, carbohydrate, protein, and lipid composition of breast milk in fasting and nonfasting mothers. Although daily energy, protein, carbohydrate, fiber, and vitamin intakes between two groups were similar, mean daily intake of lipid, sodium, chloride, iodine, and omega-3 fatty acids was determined significantly higher in study group. Also, there was no difference in the weight gain of babies during the month of Ramadan. Conclusion: Religious fasting of mothers does not affect the energy and macronutrient content of breast milk. In addition, fasting does not seem to affect the weight of mothers and babies.

Dietary Behaviour and Sociocultural Determinants of Dietary Diversity among Rural Women of Reproductive Age: A Case of Amhara Region, Ethiopia

Women of reproductive age have specific nutritional requirements due to pregnancy and lactation. Little is known about the sociocultural determinants of dietary diversity among women of reproductive age. This study assesses trends of dietary behaviour and associated determinants of dietary diversity of women of reproductive age. A community-based cross-sectional study was conducted in the Amhara region of Ethiopia in 2019. Using multistage systematic random sampling, the dietary diversity of n = 421 women of reproductive age was assessed by a qualitative 24 h dietary recall. Descriptive analysis revealed characteristics of dietary behaviour and a chi-square test enabled the identification of associated determinants of women's dietary diversity. Only about a quarter (26.8%) of the women consumed five or more food groups per day and met the minimum dietary diversity score (MDD-W). Drawing on the socioecological framework, at an intrapersonal/individual level, women's education, age, perception of nutritious diet, and frequency of consumption of animal-sourced foods, vegetables, and fruit were significantly associated with MDD-W. At an interpersonal/household level, the husbands' education, women's decision-making regarding food purchase/consumption, the family's actual eating occasion, and women's engagement in domestic and farming tasks were significantly associated with MDD-W. At a community level, access to clean water and especially cultural beliefs were significant determinants of MDD-W. Amharic proverbs and sayings prioritise men and pose severe restrictions on women regarding food allocation. The majority (76.7%) of women of reproductive age practise frequent religious fasting, relating to the institutional/national level. This undermines efforts to support healthy dietary behaviour of women of reproductive age. Indepth studies on religious and cultural practices are needed, to assess not only their negative effects on the dietary diversity of women of reproductive age but also on women's lives.

Effect of Ramadan Fasting in Turkey Upon Fetal Well-being and Perinatal Outcomes During the Last-Trimester of Pregnancy

Ramadan, a one-month period in which eating and drinking are prohibited from sunrise to sunset, is considered sacred by Muslims. According to Islamic rules, fasting is obligatory for adults and healthy people, but patients and travelers are exempted from this rule. It is not clear whether pregnant women can fast during Ramadan. This cross-sectional case-control study included low-risk pregnant women at 32-37 weeks of gestation in Turkey. We examined healthy women in the last period of their pregnancy and found similar perinatal outcomes between the fasting and nonfasting participants. In the evaluation of fetal well-being, a decrease in the number of accelerations in the non-stress test (NST) and the need to repeat the test were found to be statistically significantly higher in fasting pregnant women. We consider that this may prolong the evaluation period and increase unnecessary hospitalizations due to nonreactive NST results. More randomized controlled trials are needed to conclude that fasting during pregnancy is safe.

Chrononutrition during Pregnancy and Its Association with Maternal and Offspring Outcomes: A Systematic Review and Meta-Analysis of Ramadan and Non-Ramadan Studies

Much evidence suggests that food intakes and eating patterns are major determinants of the phase of peripheral circadian clocks, and desynchronization between them is thought to contribute to the development of metabolic disorders. However, much remains to be understood about how different dimensions of chrononutrition during pregnancy affect pregnant women's and their offspring's health outcomes. Therefore, we systematically reviewed and integrated all emerging evidence on chrononutrition during pregnancy (including meal skipping, meal frequency, night eating, and (Ramadan) fasting) and their relationships with maternal and offspring outcomes. The results suggest that meal skipping and night eating during pregnancy were generally associated with adverse pregnancy and birth outcomes, whereas no strong conclusion could be reached for meal frequency. In our meta-analysis, Ramadan fasting did not seem to be related with birth weight or gestational age at birth, but evidence for other mother-offspring outcomes was inconsistent. To further elucidate the effect of chrononutrition factors on maternal and offspring health outcomes, larger and well-conducted prospective cohort and interventional studies are needed. In addition, information on covariates such as physical activity, sleep, diet quality and quantity, fasting days, fasting period per day, and trimester exposure should also be collected and considered during analysis.

In utero Ramadan exposure and child nutrition

In this study, we empirically analyse whether in utero exposure to the Ramadan fasting period is negatively associated with child nutrition. The data for the analyses come from a retrospective assessment of 759,799 children from 103 Demographic and Health Surveys (DHS) across 56 countries during 2003-2020. Considering the month-long Ramadan exposure as a natural experiment, we implement an intent-to-treat framework, comparing stunting and underweight among children aged 0-5 years who were exposed to Ramadan fasting at any time in utero with those who were not exposed. Our findings do not show significant evidence to conclude that in utero exposure to the Ramadan fasting period is negatively associated with child nutrition. On the contrary, except for stunting in Muslim children who had in utero exposure to Ramadan fasting during the first months of pregnancy, we find no significant association between in utero exposure to Ramadan fasting and child stunting and underweight. Our main results are robust to multiple robustness checks.

Ramadan Fasting in Health and Disease in 2021: A Narrative Review

Introduction: The literature on the health aspects of Ramadan fasting (RF) is widely spread in many journals.

Materials and Methods: This is a narrative review of data obtained from the PubMed database (National Library of Medicine, Bethesda, Maryland, United States). We used the search term “Ramadan fasting,” and relevant records were examined. The publications are narrated thematically.

Results: The publications spanned fundamental, clinical, professional, cultural, and advocacy facets. The publications crossed conventional disciplinary lines and geographical locations and appeared in journals with different access systems. The contents are presented under the themes that emerged depending on the retrieved literature. This year basic coverage included changes in physiology and nutrition during Ramadan. However, the clinical issues included a wide range of topics. These included the impact of RF on nonalcoholic fatty liver disease and adjustments needed in endocrine replacement therapy for hypothyroidism and adrenal insufficiency. Coverage also included chronic kidney disease. The impact on maternal health, fetal well-being, and long-term effects of RF exposures were addressed in several studies. Studies in cardiovascular medicine focused on blood pressure and cardiovascular risk factors. Sports medicine and athletes' well-being received somewhat prominent coverage. The impact on renal function, particularly in patients with chronic kidney disease, was investigated by a few authors. Several groups addressed the eyes' structure and function, neurological conditions, especially headache disorders, and hematological and oncological conditions. Finally, the impact of RF on several aspects of mental health and well-being was addressed by various groups.

Conclusions: Health aspects of RF received a sustained academic interest with a broad spectrum in 2021. This narration provides an overview of the year's scholarly health-related literature on various aspects of health and disease. It should help researchers and clinicians catch up quickly with the health concerns during Ramadan.

Considering intermittent fasting among Saudis: insights into practices

BACKGROUND

There is a dearth of studies on intermittent fasting in Saudi Arabia outside of Ramadan. The aim of this research was to study and describe the practice of intermittent fasting outside of Ramadan among Saudi people.

METHODS

A web-based survey that focused on intermittent fasting practices-specifically the use of intermittent fasting applications, goal setting, and the effects of fasting on an individual's state of health-was administered, collected, and analyzed.

RESULTS

The study revealed that 58% (298/514) of the respondents practiced intermittent fasting for a duration of less than 3 months. The most-practiced pattern of intermittent fasting was a 16/8 fasting pattern (43.8%, 225/514). About 88.3% (454/514) of those who followed intermittent fasting drank fluids while fasting. Additionally, the amount of weight loss after intermittent fasting was less than 2.2 kg for 35% (180/514) of the participants. The primary goal of intermittent fasting for 44.9% (231/514) of the respondents was to lose weight. The majority of the participants (84.6%, 435/514) did not use any fasting applications.

CONCLUSION

The results of the current research on intermittent fasting outside of Ramadan are preliminary and inconclusive. The findings of the present study advance the idea that for some Saudis, the practice of intermittent fasting does not necessarily begin and end with Ramadan; this finding may present a strategic opportunity for Saudi health professionals who are focused on the obesity epidemic and other public health issues in Saudi Arabia. This study sought to help start a discussion on this topic and fill the knowledge gap.

Effect of Intermittent Fasting (18/6) on Energy Expenditure, Nutritional Status, and Body Composition in Healthy Adults

Objective

This study was aimed at evaluating the effect of intermittent fasting of Ramadan on resting energy expenditure (REE), body composition, and nutritional status.

Methods

The study was conducted on a total of 27 adults (16 females, 11 males) who were fasting (18 h) in the Ramadan month (May 6–June 3) of 2019. REE was measured using the indirect calorimeter. Dietary energy and nutrient intakes were evaluated by 3-day food records in baseline and post-Ramadan. Body composition and some metabolic parameters were analyzed simultaneously with REE measurements. All measurements were performed two times at baseline, and post-Ramadan.

Results

Body weight (−2.9% vs. −1.4%), body mass index (BMI) (−3.1% vs. −2.1%), fat-free mass (−2.7% vs. −1.4%), and hydration status were decreased in both males and females after the Ramadan fasting (p < 0.05). REEs (kcal/d) of the participants were 1708.1 ± 262.50 kcal/d and 1596.5 ± 302.27 kcal/d at baseline and post-Ramadan, respectively (6.5%) (p < 0.05). This decrease in REE (kcal/d) in females was greater than that in males (−8.1% vs. −4.6%). However, no statistically significant difference was found in sleep duration (h), physical activity levels, dietary energy and nutrient intakes, and blood pressures (mm Hg) of both genders compared to baseline (p > 0.05).

Conclusion

Intermittent circadian fasting may lead to a decreased energy expenditure and a change in fat-free mass in healthy individuals, and this effect is interpreted as gender-dependent.

Long-Term Outcomes of in Utero Ramadan Exposure: A Systematic Literature Review

Health outcomes of in utero Ramadan exposure have been reported in a systematic literature review; however, the available literature on long-term effects were not fully covered. Our study aims to specifically review the long-term outcomes of in utero Ramadan exposure. We searched for original research articles analyzing any long-term outcome of in utero Ramadan exposure, excluding maternal and perinatal outcomes. Sixteen studies from 8304 non-duplicate search results were included. Most studies suggest negative consequences from in utero Ramadan exposure on health, as well as on economic outcomes later in adulthood. Higher under-five mortality rate, higher mortality under three months, and under one year, shorter stature, lower body mass index, increased incidence of vision, hearing and learning disabilities, lower mathematics, writing and reading scores, as well as a lower probability to own a home were associated with Ramadan exposure during conception or the first trimester of pregnancy. Furthermore, age and sex seem to play a pivotal role on the association. Existing studies suggest that in utero Ramadan exposure may adversely impact long-term health and economic well-being. However, evidence is limited. Meanwhile, increasing awareness of the potential risks of Ramadan fasting during pregnancy should be raised among pregnant women and clinicians and other antenatal care workers should promote better maternal healthcare.

Women's fasting habits and dietary diversity during Ramadan in rural Bangladesh

Little is known about fasting practices and dietary changes during Ramadan in low‐ and lower‐middle‐income countries. Although pregnant women are exempt from fasting, they may still fast. This is of interest as dietary habits during pregnancy may affect the development of the unborn child. In a community‐based sample of young women in rural Sylhet division, Bangladesh, we described fasting practices and beliefs (n = 852). We also examined reported food group consumption and minimally adequate dietary diversity for women (MDD‐W) by Ramadan occurrence (n = 1,895) and by fasting adherence (n = 558) using logistic regression with Hindu women as a seasonal control.

During Ramadan in 2018, 78% of pregnant Muslim women fasted every day. Over 80% of Muslim women believe that they should fast during pregnancy and over 50% expect positive health effects on the mother and the unborn child. We found strong evidence that Muslim women have more diverse diets during Ramadan, with higher odds of MDD‐W (OR [95% CI]: 5.0 [3.6, 6.9]) and increased consumption of pulses, dairy, fruit, and large fish. Dietary diversity increased to a lesser extent on non‐fasting days during Ramadan. Ramadan appears to improve dietary quality in both fasting and non‐fasting Muslim women in a rural population in Bangladesh. These results help to interpret findings from studies on Ramadan during pregnancy on later‐life outcomes and thus contribute to a better understanding of intrauterine influences of maternal nutrition on healthy child development.