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Hillier KAW, Longworth ZL, Vatanparast H. Healthcare professionals knowledge, attitude, practices, and perspectives providing care to Muslims in Western countries who fast during Ramadan: a scoping review. Appl Physiol Nutr Metab 2024; 49:415-427. [PMID: 38128071 DOI: 10.1139/apnm-2023-0462] [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] [Indexed: 12/23/2023]
Abstract
The practice of fasting during the month of Ramadan is an obligation for healthy Muslims and involves abstaining from food and drinks from dawn to dusk for 29-30 consecutive days annually. With changes in dietary and lifestyle patterns, healthcare professionals (HCPs) play a significant role in supporting Muslims health during Ramadan. In this scoping review, we employed a systematic approach to map existing literature on HCPs' knowledge, attitude, practices, and perspectives working with Muslims who fast during Ramadan in Western countries. Our aim was to identify research gaps and opportunities for improving healthcare services for Muslims during Ramadan. Literature searches were generated through multiple scientific literature databases, including Web of Science, Ovid MEDLINE, CINAHL, and Embase and reviewed following The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews guidelines. From the eight sources included in this review, it was found that HCPs' knowledge of Ramadan fasting practices vary, with many lacking adequate knowledge. While HCPs recognize potential health complications, adjustments to medications for fasting patients, especially those with diabetes, are often neglected. Challenges in care included language barriers, limited cultural training, and resource awareness. Strategies identified to address barriers include reducing language barriers, providing resources in relevant languages, and enhancing cultural competence training. Further research is required on HCPs' knowledge providing care to Muslims during Ramadan, cultural competency training impact, and diverse healthcare interventions for fasting Muslims. Addressing these gaps may enhance culturally safe care and improve patient outcomes.
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Affiliation(s)
- Katherine A W Hillier
- University of Saskatchewan, College of Pharmacy and Nutrition, Saskatoon, SK, Canada
| | - Zoe L Longworth
- University of Saskatchewan, College of Pharmacy and Nutrition, Saskatoon, SK, Canada
| | - Hassan Vatanparast
- University of Saskatchewan, College of Pharmacy and Nutrition, Saskatoon, SK, Canada
- University of Saskatchewan, School of Public Health, Saskatoon, SK, Canada
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2
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Cheng W, Meng X, Gao J, Jiang W, Sun X, Li Y, Han T, Zhang D, Wei W. Relationship between circadian eating behavior (daily eating frequency and nighttime fasting duration) and cardiovascular mortality. Int J Behav Nutr Phys Act 2024; 21:22. [PMID: 38409117 PMCID: PMC10895826 DOI: 10.1186/s12966-023-01556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/21/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Knowledge regarding the health impacts of daily eating frequency (DEF) and nighttime fasting duration (NFD) on mortality is very limited. OBJECTIVE This study aimed to examine whether DEF and NFD are associated with CVD and all-cause mortality. METHODS This was a prospective cohort study of a nationally representative sample from the United States, including 30,464 adults who participated in the National Health and Nutrition Examination Survey 2003-2014. Using 24-h dietary recall, DEF was assessed by the number of eating episodes, and NFD was calculated by the first and last eating time across a day. Death information was obtained from the National Death Index up to 2019. Weighted Cox proportional hazards regression models were used to assess survival relationships of DEF and NFD with mortality. RESULTS During 307,686 person-years of follow-up, 4560 deaths occurred, including 1824 CVD cases. After adjustment for confounders, compared to DEF at 4-6 times, participants whose DEF was less than 3 times had greater CVD [hazard-ratio (HR) = 1.33, 95% confidence-interval (CI): 1.06-1.67] and all-cause (HR = 1.16, 95% CI: 1.01-1.33) mortality risks. Furthermore, compared to NFD of 10 to 11 h, participants whose NFD was shorter than 10 h had HRs of 1.30 (95% CI: 1.08-1.55) for CVD mortality and 1.23 (95% CI: 1.08-1.39) for all-cause mortality. NFD longer than 14 h was also related to CVD mortality (HR = 1.37, 95% CI: 1.12-1.67) and all-cause mortality (HR = 1.36, 95% CI: 1.19-1.54). Similar results for the association of NFD and DEF with heart-specific and stroke-specific mortality were observed. CONCLUSION This study found that DEF less than 3 times and NFD shorter than 10 h or longer than 14 h were independently associated with greater cardiovascular and all-cause mortality.
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Affiliation(s)
- Weilun Cheng
- Department of General Surgery, the Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China
| | - Xing Meng
- Department of Clinical Nutrition, the First Affiliated Hospital of Harbin Medical University, 199 Dazhi Street, Harbin, 150001, China
| | - Jian Gao
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China
| | - Wenbo Jiang
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, 199 Dazhi Street, Harbin, 150001, China
| | - Xinyi Sun
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China
- Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China
| | - Ying Li
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China
- Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China
| | - Tianshu Han
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China
- Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China
| | - Dandan Zhang
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Harbin Medical University, 199 Dazhi Street, Harbin, 150001, China.
| | - Wei Wei
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China.
- Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China.
- Department of Pharmacology, College of Pharmacy Key Laboratory of Cardiovascular Research, Ministry of Education, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China.
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Paukkonen I, Törrönen EN, Lok J, Schwab U, El-Nezami H. The impact of intermittent fasting on gut microbiota: a systematic review of human studies. Front Nutr 2024; 11:1342787. [PMID: 38410639 PMCID: PMC10894978 DOI: 10.3389/fnut.2024.1342787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/25/2024] [Indexed: 02/28/2024] Open
Abstract
Background Intermittent fasting (IF) has gained popularity in interventions targeting overweight, obesity and metabolic syndrome. IF may affect the gut microbiome composition and therefore have various effects on gut microbiome mediated functions in humans. Research on the effects of IF on human gut microbiome is limited. Therefore, the objective of this systematic review was to determine how different types of IF affect the human gut microbiome. Methods A literature search was conducted for studies investigating the association of different types of IF and gut microbiota richness, alpha and beta diversity, and composition in human subjects. Databases included Cochrane Library (RRID:SCR_013000), PubMed (RRID:SCR_004846), Scopus (RRID:SCR_022559) and Web of Science (RRID:SCR_022706). A total of 1,332 studies were retrieved, of which 940 remained after removing duplicates. Ultimately, a total of 8 studies were included in the review. The included studies were randomized controlled trials, quasi-experimental studies and pilot studies implementing an IF intervention (time-restricted eating, alternate day fasting or 5:2 diet) in healthy subjects or subjects with any disease. Results Most studies found an association between IF and gut microbiota richness, diversity and compositional changes. There was heterogeneity in the results, and bacteria which were found to be statistically significantly affected by IF varied widely depending on the study. Conclusion The findings in this systematic review suggest that IF influences gut microbiota. It seems possible that IF can improve richness and alpha diversity. Due to the substantial heterogeneity of the results, more research is required to validate these findings and clarify whether the compositional changes might be beneficial to human health. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021241619.
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Affiliation(s)
- Isa Paukkonen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Elli-Noora Törrönen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Johnson Lok
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Hani El-Nezami
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Molecular and Cell Biology Research Area, School of Biological Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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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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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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Small S, Iglesies-Grau J, Gariepy C, Wilkinson M, Taub P, Kirkham A. Time-Restricted Eating: A Novel Dietary Strategy for Cardiac Rehabilitation. Can J Cardiol 2023; 39:S384-S394. [PMID: 37734709 DOI: 10.1016/j.cjca.2023.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023] Open
Abstract
Cardiac rehabilitation (CR) is a multimodal program considered to be the standard of care for secondary prevention of cardiovascular disease (CVD). The primary goals of CR are managing CVD risk factors and improving quality of life. Exercise is the cornerstone, but nutrition education delivered by registered dietitians (RDs) is a core component of CR. Yet patient constraints to adherence to dietary change and limited availability of RDs represent major barriers to the success of completion of nutrition intervention during CR. Therefore, nutritional strategies that reduce CVD risk factors, barriers to adherence, and have capacity for broad dissemination are warranted within CR programs. In this review, we propose time-restricted eating (TRE) as a nutrition strategy to improve the outcomes of CR by drawing on parallels to CVD in other populations and describe the available preliminary data on the efficacy of TRE for CVD. TRE is a dietary strategy that involves alternating periods of fasting and consumption of calories each day. We outline the feasibility, safety, and beneficial cardiometabolic impact of TRE from TRE research in other populations. We also discuss the potential for synergistic benefits of exercise when combined with TRE. Although there is currently limited research on TRE within CR programs, we highlight CR as a unique clinical setting where TRE could play a role in secondary prevention of CVD. Overall, we outline the potential of TRE as a promising nutrition strategy to enhance the benefits of CR.
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Affiliation(s)
- Stephanie Small
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Josep Iglesies-Grau
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Chantal Gariepy
- Centre EPIC and Research Centre, Montréal Heart Institute, Montréal, Québec, Canada
| | - Michael Wilkinson
- Division of Cardiovascular Medicine, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, California, USA
| | - Pam Taub
- Division of Cardiovascular Medicine, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, California, USA
| | - Amy Kirkham
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
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Wittczak A, Ślot M, Bielecka-Dabrowa A. The Importance of Optimal Hydration in Patients with Heart Failure-Not Always Too Much Fluid. Biomedicines 2023; 11:2684. [PMID: 37893057 PMCID: PMC10604032 DOI: 10.3390/biomedicines11102684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Heart failure (HF) is a leading cause of morbidity and mortality and a major public health problem. Both overhydration and dehydration are non-physiological states of the body that can adversely affect human health. Congestion and residual congestion are common in patients hospitalized for HF and are associated with poor prognosis and high rates of rehospitalization. However, the clinical problem of dehydration is also prevalent in healthcare and community settings and is associated with increased morbidity and mortality. This article provides a comprehensive review of the issue of congestion and dehydration in HF, including HF guidelines, possible causes of dehydration in HF, confirmed and potential new diagnostic methods. In particular, a full database search on the relationship between dehydration and HF was performed and all available evidence in the literature was reviewed. The novel hypothesis of chronic subclinical hypohydration as a modifiable risk factor for HF is also discussed. It is concluded that maintaining euvolemia is the cornerstone of HF management. Physicians have to find a balance between decongestion therapy and the risk of dehydration.
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Affiliation(s)
- Andrzej Wittczak
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
| | - Maciej Ślot
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
- Faculty of Physics and Applied Informatics, University of Lodz, 90-236 Lodz, Poland
| | - Agata Bielecka-Dabrowa
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
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Tang D, Tang Q, Huang W, Zhang Y, Tian Y, Fu X. Fasting: From Physiology to Pathology. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2204487. [PMID: 36737846 PMCID: PMC10037992 DOI: 10.1002/advs.202204487] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/06/2023] [Indexed: 06/18/2023]
Abstract
Overnutrition is a risk factor for various human diseases, including neurodegenerative diseases, metabolic disorders, and cancers. Therefore, targeting overnutrition represents a simple but attractive strategy for the treatment of these increasing public health threats. Fasting as a dietary intervention for combating overnutrition has been extensively studied. Fasting has been practiced for millennia, but only recently have its roles in the molecular clock, gut microbiome, and tissue homeostasis and function emerged. Fasting can slow aging in most species and protect against various human diseases, including neurodegenerative diseases, metabolic disorders, and cancers. These centuried and unfading adventures and explorations suggest that fasting has the potential to delay aging and help prevent and treat diseases while minimizing side effects caused by chronic dietary interventions. In this review, recent animal and human studies concerning the role and underlying mechanism of fasting in physiology and pathology are summarized, the therapeutic potential of fasting is highlighted, and the combination of pharmacological intervention and fasting is discussed as a new treatment regimen for human diseases.
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Affiliation(s)
- Dongmei Tang
- Division of Endocrinology and Metabolism, National Clinical Research Center for Geriatrics, State Key Laboratory of Biotherapy, West China HospitalSichuan University and Collaborative Innovation Center of BiotherapyChengduSichuan610041China
| | - Qiuyan Tang
- Neurology Department of Integrated Traditional Chinese and Western Medicine, School of Clinical MedicineChengdu University of Traditional Chinese MedicineChengduSichuan610075China
| | - Wei Huang
- West China Centre of Excellence for PancreatitisInstitute of Integrated Traditional Chinese and Western MedicineWest China‐Liverpool Biomedical Research CentreWest China HospitalSichuan UniversityChengduSichuan610041China
| | - Yuwei Zhang
- Division of Endocrinology and MetabolismWest China HospitalSichuan UniversityChengduSichuan610041China
| | - Yan Tian
- Division of Endocrinology and Metabolism, National Clinical Research Center for Geriatrics, State Key Laboratory of Biotherapy and Cancer Center, West China HospitalSichuan University and Collaborative Innovation Center of BiotherapyChengduSichuan610041China
| | - Xianghui Fu
- Division of Endocrinology and Metabolism, National Clinical Research Center for Geriatrics, State Key Laboratory of Biotherapy and Cancer Center, West China HospitalSichuan University and Collaborative Innovation Center of BiotherapyChengduSichuan610041China
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Agarwala A, Satish P, Al Rifai M, Mehta A, Cainzos-Achirica M, Shah NS, Kanaya AM, Sharma GV, Dixon DL, Blumenthal RS, Natarajan P, Nasir K, Virani SS, Patel J. Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S. JACC. ADVANCES 2023; 2:100258. [PMID: 38089916 PMCID: PMC10715803 DOI: 10.1016/j.jacadv.2023.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/20/2023]
Abstract
South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population.
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Affiliation(s)
- Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas, USA
| | - Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Anurag Mehta
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
- Institut Hospital del Mar d’Investigacions Mediques (IMIM), Barcelona, Spain
- Hospital del Mar, Parc Salut Mar, Barcelona, Spain
| | - Nilay S. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alka M. Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Garima V. Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Dave L. Dixon
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Cardiovascular Research Center Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Salim S. Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
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Wang W, Liu Y, Li Y, Luo B, Lin Z, Chen K, Liu Y. Dietary patterns and cardiometabolic health: Clinical evidence and mechanism. MedComm (Beijing) 2023; 4:e212. [PMID: 36776765 PMCID: PMC9899878 DOI: 10.1002/mco2.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 02/08/2023] Open
Abstract
For centuries, the search for nutritional interventions to underpin cardiovascular treatment and prevention guidelines has contributed to the rapid development of the field of dietary patterns and cardiometabolic disease (CMD). Numerous studies have demonstrated that healthy dietary patterns with emphasis on food-based recommendations are the gold standard for extending lifespan and reducing the risks of CMD and mortality. Healthy dietary patterns include various permutations of energy restriction, macronutrients, and food intake patterns such as calorie restriction, intermittent fasting, Mediterranean diet, plant-based diets, etc. Early implementation of healthy dietary patterns in patients with CMD is encouraged, but an understanding of the mechanisms by which these patterns trigger cardiometabolic benefits remains incomplete. Hence, this review examined several dietary patterns that may improve cardiometabolic health, including restrictive dietary patterns, regional dietary patterns, and diets based on controlled macronutrients and food groups, summarizing cutting-edge evidence and potential mechanisms for CMD prevention and treatment. Particularly, considering individual differences in responses to dietary composition and nutritional changes in organ tissue diversity, we highlighted the critical role of individual gut microbiota in the crosstalk between diet and CMD and recommend a more precise and dynamic nutritional strategy for CMD by developing dietary patterns based on individual gut microbiota profiles.
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Affiliation(s)
- Wenting Wang
- National Clinical Research Centre for Chinese Medicine Cardiology Xiyuan Hospital China Academy of Chinese Medical Sciences Beijing China
| | - Yanfei Liu
- National Clinical Research Centre for Chinese Medicine Cardiology Xiyuan Hospital China Academy of Chinese Medical Sciences Beijing China
| | - Yiwen Li
- National Clinical Research Centre for Chinese Medicine Cardiology Xiyuan Hospital China Academy of Chinese Medical Sciences Beijing China
| | - Binyu Luo
- National Clinical Research Centre for Chinese Medicine Cardiology Xiyuan Hospital China Academy of Chinese Medical Sciences Beijing China
| | - Zhixiu Lin
- Faculty of Medicine The Chinese University of Hong Kong Hong Kong
| | - Keji Chen
- National Clinical Research Centre for Chinese Medicine Cardiology Xiyuan Hospital China Academy of Chinese Medical Sciences Beijing China
| | - Yue Liu
- National Clinical Research Centre for Chinese Medicine Cardiology Xiyuan Hospital China Academy of Chinese Medical Sciences Beijing China
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Muacevic A, Adler JR, Chreih T. Pre-Ramadan Consultation: Does a Physician's Religious Belief and Specialty Matter? Cureus 2023; 15:e33209. [PMID: 36733579 PMCID: PMC9887660 DOI: 10.7759/cureus.33209] [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: 01/01/2023] [Indexed: 01/02/2023] Open
Abstract
Background A pre-Ramadan consultation is a practical approach to optimize the care of patients with chronic conditions before the month-long fast. The present study aims to assess healthcare professionals' knowledge, attitude, and practice (KAP) toward pre-Ramadan counseling in Arab countries and assess the effects of physicians' specialty and religious beliefs on their KAP. Method An online cross-sectional survey was conducted to assess physicians' KAP toward pre-Ramadan consultation and management of patients with pre-existing health issues before Ramadan. Each participant got three scores: (1) knowledge score, (2) attitude score, and (3) practice score. A one-way ANOVA and post hoc tests were performed to detect the differences in physicians' KAP toward pre-Ramadan consultation with their specialties and religious backgrounds. Result Most of the participants did not use pre-Ramadan consultation timely (Only two of the 200 subjects did). The mean values of the physicians' scores were as follows: the knowledge score was 7.8 out of 17, the attitude score was 2.28 out of 4, and the practice score was 4.33 out of 11. However, post hoc tests showed that family physicians were more knowledgeable regarding pre-Ramadan consultation than other specialties. Moreover, Muslim participants achieved better attitude and practice scores than non-Muslim participants. Conclusion Most of the participants did not offer pre-Ramadan consultation timely. The attitudes and practices toward pre-Ramadan consultation were statistically different between Muslim and non-Muslim doctors. The findings of this study suggest that improving physicians' pre-Ramadan consultation knowledge is imperative to optimize the care of patients before Ramadan. Moreover, improving the attitude and practice of non-Muslim physicians is required to enrich the patient-centered approach. This study was limitedby the absence of earlier literature discussing pre-Ramadan consultation, so further work is needed to cover the literature gap.
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Naz H, Haider R, Rashid H, Ul Haq Z, Malik J, Zaidi SMJ, Ishaq U, Trevisan R. Islamic fasting: cardiovascular disease perspective. Expert Rev Cardiovasc Ther 2022; 20:795-805. [PMID: 36260858 DOI: 10.1080/14779072.2022.2138344] [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] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Ramadan is a month of obligatory fasting observed by the majority of 2 billion Muslims living around the globe. The guidelines for 'risk-free' fasting exist for chronic diseases, including diabetes mellitus, but recommendations for cardiovascular disease (CVD) patients are deficient due to the paucity of literature. AREAS COVERED Databases were screened to find relevant studies for an evidence-based consensus regarding the risk stratification and management of CVD. Using practical guidelines of the European Society of Cardiology (ESC), we categorized patients into low-, moderate-, and high-risk categories and proposed a pre-Ramadan checklist for the assessment of cardiac patients before fasting. Regular moderate-intensity exercise is recommended for most cardiac patients, which has been demonstrated to provide an anti-inflammatory and antioxidant effect that improves immune function. EXPERT OPINION In Ramadan, many physiological changes occur during fasting, which brings about a balanced metabolic homeostasis of the body. In addition, Ramadan fasting is a nonpharmacologic means of decreasing CV risk factors. As Islam exempts Muslims from fasting if they are unwell; therefore, patients with the acute coronary syndrome (ACS), advanced heart failure (HF), recent percutaneous coronary intervention (PCI), or cardiac surgery should avoid fasting.
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Affiliation(s)
- Hifza Naz
- Medical Student, School of Medicine and Surgery, University of Milan Bicocca, Bergamo, Italy
| | - Rakhshan Haider
- Department of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Haroon Rashid
- Department of Intensive care, Wythenshawe Hospital, Manchester, UK
| | | | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | | | - Uzma Ishaq
- Department of Hematology, Healthways Laboratories, Rawalpindi, Pakistan
| | - Roberto Trevisan
- Department of Endocrinology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
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Alam S, Hussain S, Abbas J, Raza MH, Rasool WA, K. Alsubai A, Al-Mousawi R, Aldhaheri KSO, Malik J, Almas T. Clinical outcomes of fasting in patients with chronic heart failure with preserved ejection fraction: A prospective analysis. Ann Med Surg (Lond) 2022; 81:104373. [PMID: 36039141 PMCID: PMC9418796 DOI: 10.1016/j.amsu.2022.104373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
Fasting is a part of many world religions and in Islam fasting is obligatory for every adult Muslim during the month of Ramadan. Islam has exempted sick people from fasting; however, many people still partake in this activity. We investigated how Islamic fasting affects patients with heart failure with preserved ejection fraction (HFpEF). We enrolled 938 patients (fasting n = 456; non-fasting = 482) in this prospective observational study. The fasting group showed a decrease in NYHA functional class III (23.36% vs. 17.77%; p-value < 0.05) and IV (3.76% vs. 2.19%; p-value < 0.05), and an increase in class I(35.57% vs. 43.64%; p-value < 0.05). symptoms. This is an important area for physicians to advise patients with HFpEF to fast in the month of Ramadan as it can have a favorable effect on their symptoms and quality of life.
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Rahman S. Ramadan Fasting and its Health Benefits: What’s New? Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Fasting is one of the five pillars of Islam. Fasting entails more than abstaining from food and drink, fasting improves impulse control and aids in the development of good behavior. The holy month of Ramadan falls on the 9th month of the lunar calendar. Ramadan is a month-long fasting period that takes place between dawn and sunset. Some people with diabetes and those who are sick or have certain medical conditions may be exempt. The majority of people with diabetes, on the other hand, choose to fast; even against medical advice. Many studies have been conducted to determine the health benefits of fasting. Apart from the benefits to the body’s organs, Ramadan fasting is also beneficial for the growth of the gut microbiota and gene expression and is believed to impact the body’s autophagy process. Furthermore, Ramadan fasting has an impact on mental health; TC and LDL were lower, while HDL and TG were higher, lowers inflammation, and oxidative stress markers.
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Maslov PZ, Sabharwal B, Ahmadi A, Baliga R, Narula J. Religious Fasting and the Vascular Health. Indian Heart J 2022; 74:270-274. [PMID: 35917971 PMCID: PMC9453020 DOI: 10.1016/j.ihj.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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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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Hassan-Beck R, Hafidh K, Badi A, Doukman K, Karmo M, Mir R, Beshyah SA. Ramadan Fasting in Health and Disease in 2021: A Narrative Review. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2022. [DOI: 10.1055/s-0042-1757473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
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.
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Affiliation(s)
- Reem Hassan-Beck
- Clinical Trial Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Khadija Hafidh
- Department of Diabetes and Endocrinology, Rashid Hospital, Dubai, United Arab Emirates
- Department of Medicine, Dubai Medical College for Girls, Dubai, United Arab Emirates
| | - Amal Badi
- Department of Obstetrics and Gynecology, Koster Clinic, Dubai, United Arab Emirates
| | - Khaled Doukman
- Department of Medicine, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Abu Dhabi Sports Council, Abu Dhabi, United Arab Emirates
| | - Mazn Karmo
- Department of Medicine, Yas Clinic Khalifa City, Abu Dhabi, United Arab Emirates
| | - Ruqqia Mir
- Department of Medicine, Yas Clinic Khalifa City, Abu Dhabi, United Arab Emirates
- Department of Neurology, Abu Dhabi Stemm Cell Center, Abu Dhabi, United Arab Emirates
| | - Salem A. Beshyah
- Department of Medicine, Dubai Medical College for Girls, Dubai, United Arab Emirates
- Department of Medicine, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Medicine, Yas Clinic Khalifa City, Abu Dhabi, United Arab Emirates
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18
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To TP, Taylor SE, Abdullah A, Abdullah N, Huang K, Khan N, Shirzad S, Elmi H, Zayegh I. Qualitative exploration of Australian Muslim patients' perceptions and experiences surrounding medication management during Ramadan. AUST HEALTH REV 2022; 46:346-354. [PMID: 35546250 DOI: 10.1071/ah21392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/19/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveTo explore Australian Muslim patients' perceptions and experiences surrounding medication management practices during Ramadan.MethodsThis was a qualitative exploration of the views and experiences of Muslim patients who were hospitalised during or shortly prior to Ramadan 2021. Data comprised comments obtained from a cross-sectional telephone or face-to-face questionnaire about medications and Ramadan fasting at a tertiary-referral hospital in Melbourne, Australia. A purposeful criterion sampling approach was employed for participant recruitment. Data were analysed using thematic analysis. Data were coded inductively and subthemes and themes were developed via an iterative process.ResultsComments were provided by 88 patients born in a wide range of countries and with a variety of medical and surgical co-morbidities. Themes identified included interpretation of Ramadan fasting, altering medications to facilitate fasting, perceptions about healthcare professionals and health knowledge. Many patients altered their medications to facilitate Ramadan fasting and there was considerable variability in interpretation of what breaks the fast. Patients' perceptions and previous experiences with healthcare professionals determined whether they sought advice about managing their medications during Ramadan or dismissed advice and/or self-managed their medications, sometimes inappropriately.ConclusionsThis exploration of Australian Muslim patients found diverse views and experiences around medication practices during Ramadan - past relationships with healthcare professionals influenced this practice. As there are ramifications for physical, spiritual and family wellbeing, it is imperative that healthcare professionals partner with their Muslim patients to optimise their medication management and health outcomes for Ramadan.
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Affiliation(s)
- The-Phung To
- Pharmacy Department, Austin Health, Melbourne, Vic., Australia
| | - Simone E Taylor
- Pharmacy Department, Austin Health, Melbourne, Vic., Australia
| | - Ayat Abdullah
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Nur Abdullah
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Kerry Huang
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Naemah Khan
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Sakinah Shirzad
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Huda Elmi
- Pharmacy Department, Austin Health, Melbourne, Vic., Australia
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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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Mahmood A, Dar S, Dabhad A, Aksi B, Chowdhury TA. Advising patients with existing conditions about fasting during Ramadan. BMJ 2022; 376:e063613. [PMID: 35101897 DOI: 10.1136/bmj-2020-063613] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ammad Mahmood
- Institute of Neurosciences and Psychology, University of Glasgow, Imaging Centre of Excellence, Queen Elizabeth University Hospital, Glasgow
| | - Sahira Dar
- NHS Greater Glasgow and Clyde Primary Care Division, Glasgow
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Otto CM. Heartbeat: bleeding risk in atrial fibrillation patients on non-vitamin K oral anticoagulant medications. Heart 2022; 108:243-245. [DOI: 10.1136/heartjnl-2022-320820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Visioli F, Mucignat-Caretta C, Anile F, Panaite SA. Traditional and Medical Applications of Fasting. Nutrients 2022; 14:nu14030433. [PMID: 35276792 PMCID: PMC8838777 DOI: 10.3390/nu14030433] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 02/07/2023] Open
Abstract
Fasting has been practiced for millennia, for religious, ethical, or health reasons. It is also commonplace among different species, from humans, to animals, to lower eukaryotes. Research on fasting is gaining traction based on recent studies that show its role in many adaptive cellular responses such as the reduction of oxidative damage and inflammation, increase of energy metabolism, and in boosting cellular protection. In this expert review, we recount the historical evolution of fasting and we critically analyze its current medical applications, including benefits and caveats. Based on the available data, we conclude that the manipulation of dietary intake, in the form of calorie restriction, intermittent fasting, dietary restriction with the exclusion of some nutrients, prolonged fasting, and so forth, is anthropologically engraved in human culture possibly because of its positive health effects. Indeed, many studies show that fasting ameliorates many biochemical parameters related to cardiovascular and cancer risk, and neurodegeneration. Mechanistic studies are plentiful, but largely limited to cell cultures or laboratory animals. Understandably, there are no controlled trials of any form of fasting that gauge the effects on [any cause] mortality. Physicians should be aware that misinformation is pervasive and that their patients often adopt dietary regimens that are far from being clinically validated. Moreover, doctors are often unaware of their patients’ religious or traditional fasting and of its potential health effects. Based on current evidence, no long-term fasting should be undertaken without medical supervision until future research will hopefully help shed further light on fasting and its effects on human health.
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Affiliation(s)
- Francesco Visioli
- Department of Molecular Medicine, University of Padova, Viale G. Colombo, 335121 Padova, Italy; (C.M.-C.); (F.A.)
- IMDEA-Food, 28049 Madrid, Spain
- Correspondence: ; Tel.: +390498276107
| | - Carla Mucignat-Caretta
- Department of Molecular Medicine, University of Padova, Viale G. Colombo, 335121 Padova, Italy; (C.M.-C.); (F.A.)
| | - Francesca Anile
- Department of Molecular Medicine, University of Padova, Viale G. Colombo, 335121 Padova, Italy; (C.M.-C.); (F.A.)
| | - Stefan-Alexandru Panaite
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, School of Hygiene and Preventive Medicine, University of Padova, 35121 Padova, Italy;
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Hammami R, Bahloul A, Charfeddine S, Gargouri R, Ellouze T, Abid L, Triki F, Kammoun S, Mrad IB, Amor HIH. [Maladies cardiaques et Ramadan : revue de la littérature]. Ann Cardiol Angeiol (Paris) 2022; 71:166-172. [PMID: 35039144 DOI: 10.1016/j.ancard.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 09/07/2021] [Indexed: 12/23/2022]
Abstract
We review the literature on the safety of fasting in cardiac patients. We examined the changes of blood pressure among hypertensive patients and the incidence of cardiac events during Ramadan in patients with coronary disease and heart failure. We also assess the modifications of INR levels in cardiac patients who take oral anticoagulant. We found that Ramadan fasting is safe in stable cardiac patients, even under several drugs. Fasting does not affect blood pressure. There is no difference in regards to cardiac event incidence between Ramadan and the non-fasting-months. The level of INR is slightly higher when fasting, it is thus recommended to monitor patients with high bleeding risk during Ramadan.
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Affiliation(s)
- Rania Hammami
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Amine Bahloul
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Selma Charfeddine
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Rania Gargouri
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Tarek Ellouze
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Leila Abid
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Faten Triki
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Samir Kammoun
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
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