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Lauche R, Fathi I, Saddat C, Klose P, Al-Abtah J, Büssing A, Rampp T, Dobos G, Cramer H. Effects of Modified Ramadan Fasting on Mental Well-Being and Biomarkers in Healthy Adult Muslims - A Randomised Controlled Trial. Int J Behav Med 2024:10.1007/s12529-024-10296-0. [PMID: 38777939 DOI: 10.1007/s12529-024-10296-0] [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: 05/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Ramadan fasting has seen increased attention in research, often with inconsistent findings. This study aims to investigate whether dietary and lifestyle modifications during Ramadan can improve well-being and health in healthy adult Muslims. METHOD A randomised controlled trial with two parallel groups was conducted in an outpatient clinic of a university hospital in Essen, Germany, in 2016. Healthy adult Muslims (n = 114) aged 18-60 years were randomised to a modified fasting group; i.e., they received educational material prompting dietary and lifestyle modifications pre-Ramadan, and a control group who undertook Ramadan fasting as usual. Primary outcome was quality of life (WHO-5 Well-Being Index). Secondary outcomes included sleep quality, spirituality, and mindfulness (all self-report), body weight, body mass index, body fat, waist circumference, hip circumference, blood pressure, and heart rate, as well as blood serum biomarkers. Safety was examined via adverse events. RESULTS The modified fasting group reported significantly higher quality of life (WHO-5) compared to the control after Ramadan (MD 5.9; 95% CI, 0.02-11.8; p < 0.05). Group differences in favour of the modified fasting were also found for satisfaction with health (MD 5.9, 95% CI 0.19-11.67), ease of life (MD 4.1, 95% CI 0.38-7.80) and mindfulness (MD 7.6, 95% CI 2.68-12.52), reductions in weight (MD, - 0.9 kg; 95% CI - 1.39 to - 0.42), BMI (MD - 0.3 kg/m2, 95% CI - 0.50 to - 0.15), hip circumference (MD - 0.3 kg/m2, 95% CI - 0.50 to - 0.15), and diastolic blood pressure (MD - 2.8 mmHg, 95% CI - 5.15 to - 0.43). About 60% of participants reported adverse events, mostly headaches/migraines, dizziness/fatigue, common cold, and gastrointestinal symptoms, with no group differences. One serious non-related adverse event each occurred in both groups. CONCLUSION Pre-Ramadan dietary and lifestyle advice can lead to short-term improvements in mental and physical well-being of adult Muslims observing Ramadan. As such, this study demonstrates the potential benefits of culturally appropriate health interventions in a religious context. TRIAL REGISTRATION ClinicalTrials.gov (Identifier NCT02775175).
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Affiliation(s)
- Romy Lauche
- National Centre for Naturopathic Medicine, Southern Cross University, Military Rd, Lismore, NSW, 2480, Australia.
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany.
| | - Iman Fathi
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - Chalil Saddat
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - Petra Klose
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - Jallal Al-Abtah
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - Arndt Büssing
- Institute of Integrative Medicine, Faculty of Medicine, University of Witten/Herdecke, Herdecke, Germany
| | - Thomas Rampp
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
- Centre for Complementary and Integrative Medicine, University Hospital Essen, Essen, Germany
| | - Holger Cramer
- National Centre for Naturopathic Medicine, Southern Cross University, Military Rd, Lismore, NSW, 2480, Australia
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Bosch Health Campus, Stuttgart, Germany
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Shamsi N, Naser J, Humaidan H, Al-Saweer A, Jaafar M, Abbas F, Al-Doseri S, Shabeeb N, Al-Shaikh E, Al-Dairi A, Mandoos K. Verification of 2021 IDF-DAR risk assessment tool for fasting Ramadan in patients with diabetes attending primary health care in The Kingdom of Bahrain: The DAR-BAH study. Diabetes Res Clin Pract 2024; 211:111661. [PMID: 38604445 DOI: 10.1016/j.diabres.2024.111661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND There is a high prevalence of diabetes mellitus among Muslim adult patients. Those Muslims are required to fast the holy month of Ramadan. However, the Islam religion exempted some people with medical issues. It was not clear if all the patients with diabetes were considered medically unfit to fast Ramadan. Therefore, IDF-DAR group created a new risk calculator to categorize the patients with diabetes to advise with or against fasting accordingly. OBJECTIVE This study is validating the IDF-DAR tool in assessing the accuracy of IDF-DAR risk calculator tool on adult patients with diabetes visiting primary health care in the Kingdom of Bahrain. The study will facilitate the health care professionals' decision to exempt the patients from fasting. METHODS It is a prospective, randomized study for Ramadan 1444/2023 to assess the new IDF-DAR risk score tool that predicts the complications and the negative outcome of fasting during Ramadan. It included pre- and post-Ramadan questionnaires. 757 patients were selected randomly from the patients list of the central diabetes clinics in primary health care for pre-Ramadan risk assessment scoring. Post-Ramadan a phone a questionnaire was done to evaluate the ability of fasting and the occurrence of adverse events. RESULTS Out of the 757 participants, 611 were included in the study. The mean age of the studied population was 59.8 years and 52.8 % of them were female. 630 (95.3 %) had type 2 diabetes. According to the new IDF-DAR risk calculator, 184 (27.8 %) were categorized as low risk (≤3 score), 252 (38.1 %) as moderate risk (3-6 score), and 225 (34 %) as high risk (>6 score). The percentage of patients completed their 30 days fasting successfully without reporting adverse events in the low, moderate, and high-risk groups were 92.4 %, 89.3 %, 74.7 % respectively. There was significant increased risk in breaking the fast between the low-risk group and high-risk group with a p-value of <0.001. Similarly, there was significant increased risk in breaking the fast between the moderate-risk group and high-risk group with p-value of <0.001. The main reason of breaking the fast was hypoglycemic attacks. The leading factors that play a significant role in increasing the risk of adverse events during fasting Ramadan were type 1 diabetes mellitus, the presence of previous hypoglycemia attacks, the presence of renal impairment, and negative previous Ramadan experience. CONCLUSION The new IDF-DAR risk calculator is a good tool to predict both the ability to fast Ramadan and the probability of experiencing adverse events (mainly hypoglycemia) in people with diabetes mellitus in Kingdom of Bahrain.
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Affiliation(s)
- Najla Shamsi
- Consultant Family Physician, Diabetologist, Clinical Educator in Department of Medicine, RCSI Medical University of Bahrain, The Kingdom of Bahrain.
| | - Jameel Naser
- Consultant Family Physician, Diabetologist, Primary Health Care, The Kingdom of Bahrain
| | - Hanan Humaidan
- Consultant Family Physician, Diabetologist, Primary Health Care, The Kingdom of Bahrain
| | - Abeer Al-Saweer
- Consultant Family Physician, Diabetologist, Primary Health Care, The Kingdom of Bahrain
| | - Masooma Jaafar
- Consultant Family Physician, Diabetologist, Primary Health Care, The Kingdom of Bahrain
| | - Fadheela Abbas
- Consultant Family Physician, Diabetologist, Primary Health Care, The Kingdom of Bahrain
| | - Sumaya Al-Doseri
- Consultant Family Physician, Diabetologist, Primary Health Care, The Kingdom of Bahrain
| | - Najat Shabeeb
- Consultant Family Physician, Diabetologist, Primary Health Care, The Kingdom of Bahrain
| | - Ebtihaj Al-Shaikh
- Consultant Family Physician, Diabetologist, Primary Health Care, The Kingdom of Bahrain
| | - AbdulRasool Al-Dairi
- Consultant Family Physician, Diabetologist, Primary Health Care, The Kingdom of Bahrain
| | - Khawla Mandoos
- Consultant Family Physician, Diabetologist, Primary Health Care, The Kingdom of Bahrain
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Li Z, Huang L, Luo Y, Yu B, Tian G. Effects and possible mechanisms of intermittent fasting on health and disease: a narrative review. Nutr Rev 2023; 81:1626-1635. [PMID: 36940184 DOI: 10.1093/nutrit/nuad026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
The imbalance between energy intake and expenditure in an environment of continuous food availability can lead to metabolic disturbances in the body and increase the risk of obesity and a range of chronic noncommunicable diseases. Intermittent fasting (IF) is one of the most popular nonpharmacological interventions to combat obesity and chronic noncommunicable diseases. The 3 most widely studied IF regimens are alternate-day fasting, time-restricted feeding, and the 5:2 diet. In rodents, IF helps optimize energy metabolism, prevent obesity, promote brain health, improve immune and reproductive function, and delay aging. In humans, IF's benefits are relevant for the aging global population and for increasing human life expectancy. However, the optimal model of IF remains unclear. In this review, the possible mechanisms of IF are summarized and its possible drawbacks are discussed on the basis of the results of existing research, which provide a new idea for nonpharmaceutical dietary intervention of chronic noncommunicable diseases.
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Affiliation(s)
- Zimei Li
- Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, Sichuan, P. R. China
| | - Liansu Huang
- Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, Sichuan, P. R. China
| | - Yuheng Luo
- Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, Sichuan, P. R. China
| | - Bing Yu
- Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, Sichuan, P. R. China
| | - Gang Tian
- Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, Sichuan, P. R. China
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Ali SH, Lin NF, Yi SS. Challenging Dietary Research Measures, Concepts, and Definitions to Promote Greater Inclusivity of Immigrant Experiences: Considerations and Practical Recommendations. J Acad Nutr Diet 2023; 123:1533-1540. [PMID: 37348677 PMCID: PMC10592485 DOI: 10.1016/j.jand.2023.06.280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Shahmir H Ali
- Department of Population Health, New York University Grossman School of Medicine, New York, NY.
| | - Nelson F Lin
- Department of Population Health, New York University Grossman School of Medicine, New York, NY; Brown University, Providence, RI
| | - Stella S Yi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
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Sahin H, Babus SB, Köse A, Erdogan S. The effect of Ramadan on elderly patients presenting to the emergency department. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:76-82. [PMID: 38692594 DOI: 10.25259/nmji_261_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Background Patients visiting the emergency department (ED) may show variations by certain time periods such as Ramadan. We wished to ascertain whether Ramadan affects the ED presentations, clinical conditions and outcomes of patients aged 65 years or older. Methods . Patients aged 65 years or older who presented to ED in Ramadan and in the following month in 2018 were reviewed retrospectively. Results . A total of 1947 patients were enrolled, of whom 958 presented in Ramadan and 989 in the following month. The patients who presented in Ramadan most commonly (23.8%) presented between 8 p.m. and 11.59 p.m.; patients who presented in the following month most commonly (24%) presented between 8 a.m. and 11.59 a.m. (p=0.26). Complaints concerning the central nervous system (CNS) were more common in the month after Ramadan (p<0.0001). Diagnoses related to the cardiovascular system were more commonly made in Ramadan (p=0.037), whereas those related to CNS, otorhinolaryngology and oncology were more commonly made in the following month (p=0.0005, p=0.024 and p=0.003, respectively). No significant difference was found between the two groups with respect to outcomes (p=0.36). Compared to patients who presented in Ramadan, those that presented in the following month had a significantly longer ED stay (p=0.036). Conclusion . Our study detected no significant difference between the two groups with respect to the time of presentation and ED outcomes. Patients who presented in Ramadan had a lower incidence of CNS complaints; a higher incidence of cardiovascular diagnoses; lower incidences of CNS, oncological and otorhinolaryngological diagnoses and a significantly shorter length of ED stay.
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Affiliation(s)
- Hasan Sahin
- Mersin City Education Research Hospital Emergency Service, Turkey
| | - Seyran Bozkurt Babus
- Department of Emergency Medicine, Medical Faculty, Mersin University, Mersin, Turkey
| | - Ataman Köse
- Department of Emergency Medicine, Medical Faculty, Mersin University, Mersin, Turkey
| | - Semra Erdogan
- Biostatistics and Medical Informatics, Medical Faculty, Mersin University, Mersin, Turkey
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Sulaiman SK, Tsiga-Ahmed FI, Faris ME, Musa MS, Akpan UAO, Umar AM, Abubakar SM, Allaham KK, Alyammahi T, Abdbuljalil MA, Javaid SF, Khan MAB. Nigerian Muslim's Perceptions of Changes in Diet, Weight, and Health Status during Ramadan: A Nationwide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14340. [PMID: 36361226 PMCID: PMC9653919 DOI: 10.3390/ijerph192114340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
The Islamic month of Ramadan is marked by fasting, when Muslims refrain from eating and drinking from dawn to sunset, which has an impact on their dietary habits. The study aimed to assess Nigerian Muslims' dietary modifications during Ramadan and their related changes in body weight and health status. A web-based cross-sectional study was conducted among Nigerian adult Muslims. The survey assessed sociodemographic, dietary habits, eating behaviors, food choices, perceived weight changes, and health status. The logistic regression model was used to assess the predictors of weight change and perceived health status. There were 770 participants, 62.9% of whom were women, ranging in age from 18 to 60 years with a mean age of 27.7 ± 6.4 years. Fruits, palm dates, homemade foods, milk products, and vegetables were more frequently consumed. There were fewer energy drinks, pastries, salty snacks, and carbonated or sugared drinks consumed during Ramadan than before. Over half (54.6%, 95% CI: 51.0-58.9%) of the respondents lost weight during Ramadan, 37.0% (95% CI: 17.4-38.6%) maintained their weight and 8.4% (95% CI: 6.6-10.6%) gained weight during the month. Nearly all (97.3%, 95% CI: 95.8-98.3%) reported having good health during Ramadan, and 2.7% (95% CI: 1.7-4.1%) reported having a poorer health state during Ramadan. There was a significant weight loss and healthy dietary change associated with Ramadan fasting in Nigeria. Public health measures must be in place to impart such positive health behaviors so that such healthy habits continue throughout the year.
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Affiliation(s)
- Sahabi Kabir Sulaiman
- Department of Internal Medicine, Yobe State University Teaching Hospital, Damaturu P.M.B 1047, Nigeria
| | - Fatimah Isma’il Tsiga-Ahmed
- Department of Community Medicine, Bayero University Kano/Aminu Kano Teaching Hospital, Kano P.M.B 3452, Nigeria
| | - MoezAlIslam E. Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 26666, United Arab Emirates
| | - Muhammad Sale Musa
- Department of Internal Medicine, Yobe State University Teaching Hospital, Damaturu P.M.B 1047, Nigeria
| | - Udoyen Abasi-okot Akpan
- Department of Medicine, National Pirogov Memorial Medical University, 21018 Vinnytsia, Ukraine
| | | | - Salisu Maiwada Abubakar
- Department of Biochemistry and Africa Centre of Excellence for Population Health and Policy, Bayero University, Kano P.M.B. 3011, Nigeria
| | - Kholoud K. Allaham
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain P.O. Box 15551, United Arab Emirates
| | - Taif Alyammahi
- Health and Wellness Research Group, Department of Psychiatry and Behavioral Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain P.O. Box 15551, United Arab Emirates
| | - Munther A. Abdbuljalil
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain P.O. Box 15551, United Arab Emirates
| | - Syed Fahad Javaid
- Health and Wellness Research Group, Department of Psychiatry and Behavioral Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain P.O. Box 15551, United Arab Emirates
| | - Moien AB Khan
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain P.O. Box 15551, United Arab Emirates
- Primary Care, NHS North West London, London TW3 3EB, UK
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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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Alotaibi N, Aldriweesh MA, Alhasson MA, Albdah BA, Aldbas AA, Alluhidan WA, Alsaif SA, Almutairi FM, Alskaini MA, Al Khathaami AM. Clinical characteristics and outcomes of ischemic stroke patients during Ramadan vs. non-Ramadan months: Is there a difference? Front Neurol 2022; 13:925764. [PMID: 35937074 PMCID: PMC9353707 DOI: 10.3389/fneur.2022.925764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To study the clinical characteristics and outcomes of patients experiencing an ischemic stroke during Ramadan vs. non-Ramadan months in a tertiary academic center in an Islamic country. Methods We retrospectively reviewed all patients with ischemic stroke (IS) in Ramadan and non-Ramadan months for four consecutive years (February 2016–June 2019). All demographics, vascular risk factors, laboratory results, modified Rankin Scale (mRS) at admission and discharge, National Institute Stroke Scale (NIHSS), and in-hospital complication data were collected for all patients. Results One thousand and 58 patients were included (non-Ramadan, n = 960; during Ramadan, n = 98). The mean age during Ramadan was 59 ± 13 years. Most non-Ramadan IS patients during Ramadan were male (68.5%; 57.1%, respectively). There was no statistical difference in vascular risk factors and medical history between the two groups. However, Ramadan patients had higher median NIHSS scores at discharge (p = 0.0045). In addition, more ICU admissions were noted among Ramadan patients (p = 0.009). In the gender-specific analysis for Ramadan patients, we found a statistically significant difference in smoking and urinary tract infection (p = 0.006, p = 0.005, respectively). Conclusion Based on our results, there was no difference, in general, between patients with IS during Ramadan and non-Ramadan months. However, IS patients had higher NIHSS scores at discharge and more ICU admissions during Ramadan. Last, we suggest future studies with larger sample sizes, longer duration, and including all types of strokes.
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Affiliation(s)
- Naser Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed A. Aldriweesh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Muath A. Alhasson
- Unaizah College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Bayan A. Albdah
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz A. Aldbas
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Waleed A. Alluhidan
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | - Faisal M. Almutairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed A. Alskaini
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali M. Al Khathaami
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
- *Correspondence: Ali M. Al Khathaami ;
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Akbari HA, Yoosefi M, Pourabbas M, Weiss K, Knechtle B, Vancini RL, Trakada G, Ben Saad H, Lavie CJ, Ghram A. Association of Ramadan Participation with Psychological Parameters: A Cross-Sectional Study during the COVID-19 Pandemic in Iran. J Clin Med 2022; 11:jcm11092346. [PMID: 35566470 PMCID: PMC9103718 DOI: 10.3390/jcm11092346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023] Open
Abstract
COVID-19 restrictions are associated with poor physical-activity (PA). Less is known about the relationship between the combination of these restrictions with Ramadan intermittent fasting (RIF), PA, mental health, and sleep-quality. The present study aimed to evaluate whether COVID-19 restrictions and RIF during the fourth wave of the COVID-19 pandemic in Iran are associated with poor PA, anxiety, well-being, and sleep-quality outcomes. A total of 510 individuals participated in an online questionnaire that was disseminated to adults (≥18 years) residing in Iran from 13 May 2021 to 16 May 2021 (~3 days), just after the end of Ramadan 2021. PA behavior (Godin-Shephard Leisure-Time Exercise Questionnaire), anxiety (General Anxiety Disorder-7), well-being (Mental Health Continuum-Short Form), and sleep-quality (Pittsburgh Sleep Quality Index). Of 510 individuals included in the study (331 female (64.9%); mean ± SD, 31 ± 12 years), 172 (33.7%) reported less PA during the Ramadan 2021. PA was associated with better well-being and sleep-quality outcomes. Regardless of PA, participants who fasted for all of Ramadan had less anxiety and better well-being outcomes than those who fasted part of Ramadan or did not fast at all. However, the fasting part of Ramadan decreased the sleep-quality of active participants. The Ramadan 2021 was associated with poor PA, well-being, and sleep-quality of Iranians. However, PA was associated with better well-being and sleep-quality outcomes, and those who fasted all Ramadan had better anxiety and well-being outcomes. Therefore, PA during Ramadan might be an essential and scalable mental health resilience builder during COVID-19 restrictions which should be encouraged.
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Affiliation(s)
- Hesam Addin Akbari
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran 1415563117, Iran; (H.A.A.); (M.Y.); (M.P.)
| | - Mohammad Yoosefi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran 1415563117, Iran; (H.A.A.); (M.Y.); (M.P.)
| | - Maryam Pourabbas
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran 1415563117, Iran; (H.A.A.); (M.Y.); (M.P.)
| | - Katja Weiss
- Medbase St. Gallen Am Vadianplatz, 9100 St. Gallen, Switzerland; (K.W.); (B.K.)
| | - Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, 9100 St. Gallen, Switzerland; (K.W.); (B.K.)
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
| | - Rodrigo Luiz Vancini
- Center for Physical Education and Sports, Federal University of Espírito Santo, Vitória 29075-910, Brazil;
| | - Georgia Trakada
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, 115 28 Athens, Greece;
| | - Helmi Ben Saad
- Research Laboratory “Heart Failure, LR12SP09”, Faculty of Medicine of Sousse, Hospital Farhat HACHED of Sousse, University of Sousse, Sousse 4054, Tunisia;
| | - Carl J. Lavie
- Healthy Living for Pandemic Event Protection (HL—PIVOT) Network, Chicago, IL 60612, USA;
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA
| | - Amine Ghram
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran 1415563117, Iran; (H.A.A.); (M.Y.); (M.P.)
- Healthy Living for Pandemic Event Protection (HL—PIVOT) Network, Chicago, IL 60612, USA;
- Correspondence:
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Besbes A, Khemiss M, Bragazzi N, Ben Saad H. The Impacts of Ramadan Intermittent Fasting on Saliva Flow-Rate and Metabolic Data: A Systematic Review. Front Nutr 2022; 9:873502. [PMID: 35464020 PMCID: PMC9019589 DOI: 10.3389/fnut.2022.873502] [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: 02/10/2022] [Accepted: 03/08/2022] [Indexed: 11/20/2022] Open
Abstract
The aim of this systematic review was to report the impacts of Ramadan intermittent fasting (RIF) on salivary flow-rate (SFR) and metabolic parameters. A thorough literature search was carried out using the databases PubMed and Scopus from their inception up to 15 July 2021. The Boolean connectors used in PubMed were (Saliva [Mesh] AND Fasting [Mesh]). The same keywords were used in Scopus. Inclusion criteria were defined using PICOS. The research included all original studies involving “healthy” adults and published in English. Methodological quality assessment was performed utilizing the Joanna Briggs Institute Critical Appraisal Tool, which allows attributing scores from 1 to 11 to the selected studies. Two authors carried out the literature search, study selection, and data extraction. Differences on issues were resolved by a third author if necessary. The systematic review protocol was registered within the “Open Science Framework” (Doi: 10.17605/OSF.IO/DE7BH). Six articles met the inclusion criteria. All studies were heterogeneous and had a high score of bias and several methodological differences. The following parameters were collected: SFR, melatonin, cortisol, glucose, immunoglobulin A (IgA), uric-acid, alkaline phosphatase (ALP), and aspartate aminotransferase (AST). The SFR decreased by 10% during Ramadan in fasting subjects. The circadian pattern of melatonin remained unchanged during Ramadan, but melatonin levels dropped significantly from baseline. The salivary cortisol levels were unchanged or increased during Ramadan. The salivary glucose levels were decreased. ALP increased significantly, whilst uric-acid and AST decreased significantly. Salivary IgA decreased during the last week of Ramadan. To conclude, there is a trend toward a decrease in SFR and the content of the majority of the biomarkers investigated, with the exception of ALP and uric-acid. These changes cannot be easily attributed to any single factor (hydration status, dietary habits, physical activity, or hygiene habits). Systematic Review Registration: [https://osf.io/de7bh/], identifier [Doi: 10.17605/OSF.IO/DE7B].
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Affiliation(s)
- Amira Besbes
- Laboratory Research of Medical and Molecular Parasitology and Mycology, LR12ES08, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
- Unit of Microbiology, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
| | - Mehdi Khemiss
- Department of Dental Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Nicola Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- Department of Health Sciences, Postgraduate School of Public Health, University of Genoa, Genoa, Italy
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Section of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, United Kingdom
- *Correspondence: Nicola Bragazzi,
| | - Helmi Ben Saad
- Research Laboratory “Heart Failure, LR12SP09”, Faculty of Medicine, Hospital Farhat Hached, University of Sousse, Sousse, Tunisia
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Farooq A, Chamari K, Sayegh S, El Akoum M, Al-Mohannadi AS. Ramadan daily intermittent fasting reduces objectively assessed habitual physical activity among adults. BMC Public Health 2021; 21:1912. [PMID: 34674685 PMCID: PMC8530011 DOI: 10.1186/s12889-021-11961-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Muslims around the world practice intermittent fasting during the month of Ramadan each year. We hypothesized that daily physical activity could be reduced among Muslims due to the inability to refuel and rehydrate in the fasting state. METHODS A cohort study design among adults registered with national physical activity community program. Data from a pedometer-based community program was used to extract 3 months of daily step counts before, during, and after Ramadan for the past years (2013-2019). A survey was conducted among participants to determine fasting practice and other health and environmental factors. RESULTS A total of 209 participants completed the survey and provided valid data on physical activity. During Ramadan, the average steps per day decreased significantly (- 385 ± SE 158) among participants who fasted (n = 151) p = 0.046 and increased (+ 731 ± SE 247) for the non- fasting participants (n = 58) p = 0.010. Fasting participants preferred before sunset (33.8%) or evening (39.7%) for physical activity. Whereas, non-fasting participants preferred early morning (34.5%). CONCLUSION Fasting during Ramadan impacts the daily physical activity behavior among Muslims. Interventions should focus on creating awareness of the importance of maintenance of adequate physical activity for adults fasting during Ramadan.
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Affiliation(s)
- Abdualziz Farooq
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, 29222, Doha, Qatar. .,Physical Activity for Health Group, School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK.
| | - Karim Chamari
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, 29222, Doha, Qatar
| | - Suzan Sayegh
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, 29222, Doha, Qatar
| | - Maha El Akoum
- World Innovation Summit for Health (WISH), Qatar Foundation, Doha, Qatar
| | - Abdulla Saeed Al-Mohannadi
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, 29222, Doha, Qatar.,World Innovation Summit for Health (WISH), Qatar Foundation, Doha, Qatar
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12
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Al‐Jafar R, Zografou Themeli M, Zaman S, Akbar S, Lhoste V, Khamliche A, Elliott P, Tsilidis KK, Dehghan A. Effect of Religious Fasting in Ramadan on Blood Pressure: Results From LORANS (London Ramadan Study) and a Meta-Analysis. J Am Heart Assoc 2021; 10:e021560. [PMID: 34619991 PMCID: PMC8751902 DOI: 10.1161/jaha.120.021560] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022]
Abstract
Background Ramadan fasting is practiced by hundreds of millions every year. This ritual practice changes diet and lifestyle dramatically; thus, the effect of Ramadan fasting on blood pressure must be determined. Methods and Results LORANS (London Ramadan Study) is an observational study, systematic review, and meta-analysis. In LORANS, we measured systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 85 participants before and right after Ramadan. In the systematic review, studies were retrieved from PubMed, Embase, and Scopus from inception to March 3, 2020. We meta-analyzed the effect from these studies and unpublished data from LORANS. We included observational studies that measured SBP and/or DBP before Ramadan and during the last 2 weeks of Ramadan or the first 2 weeks of the month after. Data appraisal and extraction were conducted by at least 2 reviewers in parallel. We pooled SBP and DBP using a random-effects model. The systematic review is registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD42019159477). In LORANS, 85 participants were recruited; mean age was 45.6±15.9 years, and 52.9% (n=45) of participants were men. SBP and DBP after Ramadan fasting were lower by 7.29 mm Hg (-4.74 to -9.84) and 3.42 mm Hg (-1.73 to -5.09), even after adjustment for potential confounders. We identified 2778 studies of which 33 with 3213 participants were included. SBP and DBP after/before Ramadan were lower by 3.19 mm Hg (-4.43 to -1.96, I2=48%) and 2.26 mm Hg (-3.19 to -1.34, I2=66%), respectively. In subgroup analyses, lower blood pressures were observed in the groups who are healthy or have hypertension or diabetes but not in patients with chronic kidney disease. Conclusions Our study suggests beneficial effects of Ramadan fasting on blood pressure independent of changes in weight, total body water, and fat mass and supports recommendations for some governmental guidelines that describe Ramadan fasting as a safe religious practice with respect to blood pressure.
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Affiliation(s)
- Rami Al‐Jafar
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | | | - Sadia Zaman
- School of MedicineImperial College LondonLondonUnited Kingdom
| | - Sharmin Akbar
- Department of ChemistryImperial College LondonLondonUnited Kingdom
| | - Victor Lhoste
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | - Ahlam Khamliche
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | - Paul Elliott
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
- Dementia Research Institute at Imperial College LondonLondonUnited Kingdom
- National Institute for Health Research Imperial College Biomedical Research CentreImperial College LondonLondonUnited Kingdom
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | - Abbas Dehghan
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
- Dementia Research Institute at Imperial College LondonLondonUnited Kingdom
- MRC‐PHE Centre for Environment and Health, School of Public HealthImperial College LondonLondonUnited Kingdom
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Ghram A, Ben Saad H, Briki W, Jiménez-Pavón D, Mansoor H, Moalla W, Akbari HA, Ghram A, Al-Mohannadi AS, Arena R, Lavie CJ. Ramadan Intermittent Fasting, Physical Activity, and COVID-19 Pandemic in Patients with Chronic Diseases. Am J Med 2021; 134:1189-1191. [PMID: 34051150 PMCID: PMC8149465 DOI: 10.1016/j.amjmed.2021.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Amine Ghram
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Iran; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill; Department of Cardiac Rehabilitation, Tehran Heart Center, Tehran University of Medical Sciences, Iran.
| | - Helmi Ben Saad
- Faculté de Médecine de Sousse, Hôpital Farhat HACHED de Sousse, Laboratoire de Recherche «Insuffisance Cardiaque» (LR12SP09), Université de Sousse, Sousse, Tunisia
| | - Walid Briki
- Physical Education Department, College of Education, Qatar University, Doha, Qatar
| | - David Jiménez-Pavón
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cádiz, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Hend Mansoor
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Wassim Moalla
- LR19JS01 EM2S: Éducation, Motricité, Sport et Santé, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Hesam Addin Akbari
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Iran
| | - Abdeljelil Ghram
- Laboratory of Epidemiology and Veterinary Microbiology, LR16IP03, Institute Pasteur of Tunis, Tunis El Manar University, Tunis-Belvedere, Tunisia
| | - Abdulla Saeed Al-Mohannadi
- World Innovation Summit for Health (WISH), Qatar Foundation, Doha, Qatar; Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill; Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago
| | - Carl J Lavie
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, La
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The COVID-19 pandemic and physical activity during intermittent fasting, is it safe? A call for action. Biol Sport 2021; 38:729-732. [PMID: 34937984 PMCID: PMC8670795 DOI: 10.5114/biolsport.2021.108300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/09/2021] [Accepted: 08/02/2021] [Indexed: 01/09/2023] Open
Abstract
Intermittent fasting (IF) has recently gained popularity, and has been used for centuries in many religious practices. The Ramadan fasting is a mandatory form of IF practiced by millions of healthy adult Muslims globally for a whole lunar month every year. In Islam, the "Sunna" also encourages Muslims to practice IF all along the year (e.g.; two days a week). The 2019-Coronavirus disease (COVID-19) pandemic in the context of Ramadan has raised the question whether fasting is safe practice during the COVID-19 pandemic health crisis, and what would be the healthy lifestyle behaviors while fasting that would minimize the risk of infection. As COVID-19 lacks a specific therapy, IF and physical activity could help promote human immunity and be part of holistic preventive strategy against COVID-19. In this commentary, the authors focus on this dilemma and provide recommendations to the fasting communities for safely practicing physical activity in time of COVID-19 pandemic.
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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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16
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Impact of Ramadan Intermittent Fasting on the Heart Rate Variability and Cardiovascular Parameters of Patients with Controlled Hypertension. J Nutr Metab 2021; 2021:6610455. [PMID: 33859841 PMCID: PMC8024062 DOI: 10.1155/2021/6610455] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/24/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Conflicting results are reported on the effect of Ramadan fasting on the cardiovascular health of patients with hypertension, a highly prevalent cardiovascular disease risk factor. This research aimed to evaluate the impact of fasting on cardiac health and heart rate variability (as a measure of cardiac stress) of hypertensive patients. Methods Patients with controlled hypertension were followed in a prospective cohort during and after Ramadan. Lipid panel and blood glucose were measured at the end of each phase. Blood pressure and heart rate variability were monitored in the morning, afternoon, and evening of each follow-up day. Results The study included 58 subjects (mean age: 54 ± 11.5 years, 52% male). Fasting did not affect body composition, lipid panel parameters, and blood pressure of hypertensive subjects; males only presented lower body weight and hip circumference during Ramadan. Blood glucose was significantly higher during Ramadan. Fasting significantly increased HRV during the afternoon period. Conclusions Ramadan intermittent fasting reduces cardiac stress among hypertensive patients controlled by and adherent to hypertensive medication, without affecting their hypertensive state.
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Ben Ahmed H, Allouche E, Bouzid K, Zrelli S, Hmaidi W, Molahedh Y, Ouechtati W, Bezdah L. Impact of Ramadan fasting on lipid profile and cardiovascular risk factors in patients with stable coronary artery disease. Ann Cardiol Angeiol (Paris) 2021; 71:36-40. [PMID: 33642044 DOI: 10.1016/j.ancard.2020.11.001] [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] [Received: 07/19/2020] [Accepted: 11/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effects of Ramadan fasting (RF) on cardiometabolic risk factors in patients with stable ischemic heart disease are not well known. AIM The aim of this study was to evaluate the impact of RF on lipid profile and cardiovascular risk factors in patients with a stable coronary heart disease. METHODS A prospective observational study carried out in the Cardiology department of Charles Nicolle Hospital (Tunisia). Eighty-four patients with a stable ischemic heart disease who intended to fast were enrolled during May 2020. Detailed clinical and biochemical assessments were performed before and after the holy month. Parameters of glycemic control, lipid profile, ultrasensitive C-reactive protein concentration (us-CRP) and homocysteine were performed before- and after- Ramadan (BR and AR, respectively). RESULTS Eighty-four patients including 79 males and 5 females, with a mean age of 57±7 years completed the study. Levels of cholesterol, triglycerides, low-density lipoprotein-cholesterol and apoprotein A were significantly improved AR fasting in comparison with their BR values. There was a significant decrease in blood fasting glucose, insulin level, Homeostasis model assessment of insulin resistance index and in us-CRP level. CONCLUSION In patients with stable ischemic heart disease, RF may be accompanied by an improvement of lipid profile and glycemic parameters without increase in coronary events.
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Affiliation(s)
- Habib Ben Ahmed
- Service de Cardiologie, Hôpital Charles Nicolle, Tunis, Tunisie.
| | - Emna Allouche
- Service de Cardiologie, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Kahena Bouzid
- Service de Biochimie clinique, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Sabrine Zrelli
- Service de Biochimie clinique, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Wided Hmaidi
- Service de Biochimie clinique, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Yosra Molahedh
- Service de Biochimie clinique, Hôpital Charles Nicolle, Tunis, Tunisie
| | | | - Leila Bezdah
- Service de Cardiologie, Hôpital Charles Nicolle, Tunis, Tunisie
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18
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Farag HAM, Baqi HR, Qadir SA, El Bilbeisi AH, Hamafarj KK, Taleb M, El Afifi A. Effects of Ramadan fasting on anthropometric measures, blood pressure, and lipid profile among hypertensive patients in the Kurdistan region of Iraq. SAGE Open Med 2020; 8:2050312120965780. [PMID: 33294186 PMCID: PMC7705764 DOI: 10.1177/2050312120965780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/22/2020] [Indexed: 12/17/2022] Open
Abstract
Objective This study was employed to assess the effects of Ramadan fasting on anthropometric measures, blood pressure, and lipid profile among hypertensive patients. Method This cross-sectional study was conducted among a representative sample, which was selected using a census survey of hypertensive patients (both gender, aged 25-50 years, on regular antihypertensive drugs (atenolol: 50 mg orally once a day)), during Ramadan month that was falling in April to May 2020. The patients were receiving care at Halabja hospital in the Kurdistan region of Iraq. All patients were assessed in two phase's baseline (a week before Ramadan) and end stage (a week after Ramadan), using anthropometric indices, physical examination, biochemical tests, and a structured questionnaire. Statistical analysis was performed using SPSS version 21. Results A total of 120 hypertensive patients were included in the study (50% females and 50% males), with a mean age of 37.5 ± 6.6 years. The major finding of our study was the significant decrease in blood pressure (P < 0.001). Furthermore, the body weight, body mass index, and waist circumference of the participants decreased after Ramadan fasting in a significant approach (P < 0.001 for all). However, for the lipid profile components, the total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol change persisted not statistically significant (P > 0.05), while only triglyceride decreased drastically after Ramadan fasting (P < 0.001). Conclusion Ramadan fasting could contribute in the improvement of blood pressure and lowers triglyceride levels, body weight, body mass index, and waist circumference of adult hypertensive patients.
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Affiliation(s)
- Halgord Ali M Farag
- Nursing Department, Technical College of Health, Research Center, Sulaimani Polytechnic University, Sulaimani, Iraq
| | - Hardi Rafat Baqi
- Medical Laboratory Science, Technical College of Applied Sciences, Research Center, Sulaimani Polytechnic University, Sulaimani, Kurdistan, Iraq
| | - Syamand Ahmed Qadir
- Medical Laboratory Science, Technical College of Applied Sciences, Research Center, Sulaimani Polytechnic University, Sulaimani, Kurdistan, Iraq
| | - Abdel Hamid El Bilbeisi
- Department of Clinical Nutrition, Faculty of Pharmacy, Al Azhar University of Gaza, Gaza Strip, Palestine
| | - Kawa Khwarahm Hamafarj
- Nursing Department, Technical College of Health, Research Center, Sulaimani Polytechnic University, Sulaimani, Iraq
| | - Mahmoud Taleb
- Faculty of Pharmacy, Al Azhar University of Gaza, Gaza Strip, Palestine
| | - Amany El Afifi
- Faculty of Pharmacy, Al Azhar University of Gaza, Gaza Strip, Palestine
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19
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Amin OA, Alaarag A. The safety of Ramadan Fasting following Percutaneous Coronary Intervention. BMC Cardiovasc Disord 2020; 20:489. [PMID: 33213367 PMCID: PMC7678075 DOI: 10.1186/s12872-020-01784-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This work aimed to assess the safety of Ramadan Fasting following the Percutaneous Coronary Intervention. METHODS In our two centers' Prospective Cohort Study, We included 303 patients who had successful Percutaneous Coronary Intervention before the first day of Ramadan. We advised the patients that recent Percutaneous Coronary Intervention could be a valid excuse for not fulfilling Ramadan Fasting. However, many patients intended to fast the following Ramadan, and we included them in the fasting Group I. We added the patients who decided not to fast the following Ramadan as a control Group II. We followed all the patients during Ramadan and for 6 months after Ramadan. RESULTS The demographic data of both groups and the complexity of the coronary anatomy showed no statistically significant difference. Group I (n = 153) showed a statistically significant difference in the incidence of Major Adverse Cardiac Events compared to Group II with a P value (0.005). The logistic multivariate regression analysis showed that the duration from index PCI till the start of RF, SYNTAX score > 22, and Complex procedure were independent predictors of Major Adverse Cardiac Events in the fasting Group I with {P = 0.001, OR (2.302), P = 0.026, OR (2.419), and P = 0.032 OR (1.952)}, respectively. Major Adverse Cardiac Events in Group I occurred mainly during Ramadan Fasting, with 19 patients having Major Adverse Cardiac Events during Ramadan and four patients during the remaining of the follow-up period. The Receiver Operating Characteristic curve analysis showed the decline of the incidence of Major Adverse Cardiac Events after 90 days from Percutaneous Coronary Intervention till the start of Ramadan Fasting with Sensitivity and specificity (90% and 65%), respectively. CONCLUSIONS We suggest that low-risk patients with a normal systolic function who underwent Percutaneous Coronary Intervention may safely fast Ramadan. At the same time, Ramadan Fasting during the first 3 months following the Percutaneous Coronary Intervention may not be safe.
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Affiliation(s)
- Osama A Amin
- Department of Cardiology, Beni Suef University, Beni Suef, Egypt.
| | - Ahmed Alaarag
- Department of Cardiology, Tanta University, Tanta, Egypt
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20
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Sarro AA, Payedimarri AB, Concina DD, Farsoni MF, Piu NN, Rinaldi C, Panella MP. The efficacy of fasting regimens on health outcomes: a systematic overview. Minerva Gastroenterol (Torino) 2020; 67:289-298. [PMID: 32914941 DOI: 10.23736/s2724-5985.20.02757-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Fasting can be defined as abstinence or reduction from food, drink, or both, for a defined period. There are many different types of fasting regimens, such as Ramadan fasting, intermittent fasting, Christian Orthodox fasting. The aim of this overview is to provide an exhaustive summary on the beneficial effects and harms associated with fasting regimens and discuss mechanisms by which this non-pharmacological approach might lead to improve human health. EVIDENCE ACQUISITION A systematic search was performed on MEDLINE (PubMed), Embase, Cochrane Library and CINHAL. We included systematic reviews (SRs) that report on impact of different types of fasting regimens on health. Selection of SRs, data extraction and quality assessment were undertaken in duplicate. EVIDENCE SYNTHESIS A total of 21 SRs were included. Cumulatively, 97 health outcomes were identified. Of them, cardiovascular risk factors were the most frequently analyzed. Ramadan fasting is associated with significant improvements in body weight and visceral lean mass, high-density lipoprotein cholesterol (HDL-c), and with reductions in low-density lipoprotein cholesterol (LDL-c) and total cholesterol (T-chol), especially in cardiac patients. Similarly, reviews on Intermittent and Orthodox fasting proved benefits of those on weight, BMI, lipidic and glucose profile, inflammatory markers. CONCLUSIONS Fasting regimens showed potential beneficial effects on several health indicators in adult populations. Nevertheless, evidence on some specific health dimensions (cognitive function, well-being, quality of life) is limited. Thus, in the future, further RCTs or cohort studies with good methodological quality and larger sample sizes are warranted to better understand the underlying biological mechanism and the benefits on multidimensional aspects of health.
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Affiliation(s)
- Andrea A Sarro
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy -
| | - Anil B Payedimarri
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Diego D Concina
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Marco F Farsoni
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Nicola N Piu
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Carmela Rinaldi
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy.,Maggiore della Carità University Hospital, Novara, Italy
| | - Massimiliano P Panella
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy
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Ahmed SH, Chowdhury TA, Hussain S, Syed A, Karamat A, Helmy A, Waqar S, Ali S, Dabhad A, Seal ST, Hodgkinson A, Azmi S, Ghouri N. Ramadan and Diabetes: A Narrative Review and Practice Update. Diabetes Ther 2020; 11:1-44. [PMID: 32922560 PMCID: PMC7480213 DOI: 10.1007/s13300-020-00886-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
Fasting in the Islamic month of Ramadan is obligatory for all sane, healthy adult Muslims. The length of the day varies significantly in temperate regions-typically lasting ≥ 18 h during peak summer in the UK. The synodic nature of the Islamic calendar means that Ramadan migrates across all four seasons over an approximately 33-year cycle. Despite valid exemptions, there is an intense desire to fast during this month, even among those who are considered to be at high risk, including many individuals with diabetes mellitus. In this review we explore the current scientific and clinical evidence on fasting in patients with diabetes mellitus, focussing on type 2 diabetes mellitus and type 1 diabetes mellitus, with brief reviews on pregnancy, pancreatic diabetes, bariatric surgery, the elderly population and current practice guidelines. We also make recommendations on the management of diabetes patients during the month of Ramadan. Many patients admit to a do-it-yourself approach to diabetes mellitus management during Ramadan, largely due to an under-appreciation of the risks and implications of the rigors of fasting on their health. Part of the issue may also lie with a healthcare professional's perceived inability to grasp the religious sensitivities of Muslims in relation to disease management. Thus, the pre-Ramadan assessment is crucial to ensure a safe Ramadan experience. Diabetes patients can be risk-stratified from low, medium to high or very high risk during the pre-Ramadan assessment and counselled accordingly. Those who are assessed to be at high to very high risk are advised not to fast. The current COVID-19 pandemic upgrades those in the high-risk category to very high risk; hence a significant number of diabetes patients may fall under the penumbra of the 'not to fast' advisory. We recognize that fasting is a personal choice and if a person chooses to fast despite advice to the contrary, he/she should be adequately supported and monitored closely during Ramadan and for a brief period thereafter. Current advancements in insulin delivery and glucose monitoring technologies are useful adjuncts to strategies for supporting type 1 diabetes patients considered to be high risk as well as 'high-risk' type 2 patients manage their diabetes during Ramadan. Although there is a lack of formal trial data, there is sufficient evidence across the different classes of therapeutic hypoglycaemic agents in terms of safety and efficacy to enable informed decision-making and provide a breadth of therapeutic options for the patient and the healthcare professional, even if the professional advice is to abstain. Thus, Ramadan provides an excellent opportunity for patient engagement to discuss important aspects of management, to improve control in the short term during Ramadan and to help the observants understand that the metabolic gains achieved during Ramadan are also sustainable in the other months of the year by maintaining a dietary and behavioural discipline. The application of this understanding can potentially prevent long-term complications. ELECTRONIC SUPPLEMENTARY MATERIAL The online version of this article (10.1007/s13300-020-00886-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Syed H. Ahmed
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, UK
- Institute of Diabetes, Endocrinology and Obesity, King’s Health Partners, London, UK
| | - Ateeq Syed
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ali Karamat
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ahmed Helmy
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Salman Waqar
- Nuffield Department of Primary Care Health Sciences, University Oxford, Oxford, UK
| | - Samina Ali
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Susan T. Seal
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Anna Hodgkinson
- Department of Diabetes and Endocrinology, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- NHS South East London Clinical Commissioning Group, London, UK
| | - Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nazim Ghouri
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow, UK
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Iqbal MD, Askari S, Ahmedani MY. The frequency of major complications among fasting people with diabetes according to risk categories of IDF-DAR guidelines 2016. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Dong TA, Sandesara PB, Dhindsa DS, Mehta A, Arneson LC, Dollar AL, Taub PR, Sperling LS. Intermittent Fasting: A Heart Healthy Dietary Pattern? Am J Med 2020; 133:901-907. [PMID: 32330491 PMCID: PMC7415631 DOI: 10.1016/j.amjmed.2020.03.030] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/26/2022]
Abstract
Dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet, have been shown to improve cardiac health. Intermittent fasting is another type of popular dietary pattern that is based on timed periods of fasting. Two different regimens are alternative day fasting and time-restricted eating. Although there are no large, randomized control trials examining the relationship between intermittent fasting and cardiovascular outcomes, current human studies that suggest this diet could reduce the risk for cardiovascular disease with improvement in weight control, hypertension, dyslipidemia, and diabetes. Intermittent fasting may exert its effects through multiple pathways, including reducing oxidative stress, optimization of circadian rhythms, and ketogenesis. This review evaluates current literature regarding the potential cardiovascular benefits of intermittent fasting and proposes directions for future research.
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Affiliation(s)
- Tiffany A Dong
- Department of Medicine; Emory Clinical Cardiovascular Research Institute
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University, Emory School of Medicine, Atlanta, Ga
| | - Devinder S Dhindsa
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University, Emory School of Medicine, Atlanta, Ga
| | - Anurag Mehta
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University, Emory School of Medicine, Atlanta, Ga
| | - Laura C Arneson
- Department of Medicine at Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Allen L Dollar
- Division of Cardiology, Emory University, Emory School of Medicine, Atlanta, Ga
| | - Pam R Taub
- Division of Cardiovascular Medicine, UC San Diego School of Medicine, La Jolla, Calif
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University, Emory School of Medicine, Atlanta, Ga.
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Faris MAI, Jahrami H, BaHammam A, Kalaji Z, Madkour M, Hassanein M. A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on glucometabolic markers in healthy subjects. Diabetes Res Clin Pract 2020; 165:108226. [PMID: 32446800 DOI: 10.1016/j.diabres.2020.108226] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/30/2020] [Accepted: 05/16/2020] [Indexed: 12/13/2022]
Abstract
AIM Studies on the effect of Ramadan diurnal intermittent fasting (RDIF) on glucometabolic markers have yielded conflicting results. We conducted ameta-analysis to estimate the effect size for changes in glucometabolic markers in healthy, non-athletic Muslims during Ramadan, and to assess the effect of variable covariates using meta-regression. METHODS CINAHL, Cochrane, EBSCOhost, EMBASE, Google Scholar, ProQuest Medical, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science databases were searched from date of inceptionto January 2020. The glucometabolic markers analyzed were: fasting glucose (FG), insulin, insulin resistance (HOMA-IR), leptin, and adiponectin. RESULTS We identified seventy-two studies (3134 participants in total) that were conducted in 22 countries between 1982 and 2020. RDIF-induced effect sizes for the glucometabolic markers were: FG (no. of studies K = 61, number of subjects N = 2743, Hedges'g = -0.102, 95% CI: -0.194, -0.01); serum insulin (K = 16, N = 648, Hedges'g = 0.030 95% CI: -0.165, 0.226); HOMA-IR (K = 10, N = 349, Hedges'g = -0.012, 95% CI: -0.274, 0.250); leptin (K = 13, N = 442, Hedges'g = -0.010, 95% CI: -0.243, 0.223); and adiponectin (K = 11, N = 511, Hedges'g = 0.034, 95% CI: -0.227, 0.296). CONCLUSION RDIF imposes no adverse metabolic impacts, and might help in improving some glucometabolic markers in healthy subjects.
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Affiliation(s)
- Mo'ez Al-Islam Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates.
| | - Haitham Jahrami
- Rehabilitation Services, Periphery Hospitals, Ministry of Health, Manama, Bahrain; College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ahmed BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia; The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Zaina Kalaji
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Mohammed Madkour
- Department of Medical Laboratory Sciences, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamed Hassanein
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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Pellegrini M, Cioffi I, Evangelista A, Ponzo V, Goitre I, Ciccone G, Ghigo E, Bo S. Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis. Rev Endocr Metab Disord 2020; 21:17-33. [PMID: 31808043 DOI: 10.1007/s11154-019-09524-w] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Restriction in meal timing has emerged as a promising dietary approach for the management of obesity and dysmetabolic diseases. The present systematic review and meta-analysis summarized the most recent evidence on the effect of time-restricted feeding (TRF) on weight-loss and cardiometabolic variables in comparison with unrestricted-time regimens. Studies involving TRF regimen were systematically searched up to January 2019. Effect size was expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). A total of 11 studies, 5 randomized controlled trials and 6 observational, were included. All selected studies had a control group without time restriction; hours of fasting ranged from 12-h until 20-h and study duration from 4 to 8-weeks. Most studies involved the Ramadan fasting. TRF determined a greater weight-loss than control regimens (11 studies, n = 485 subjects) (WMD: -1.07 kg, 95%CI: -1.74 to -0.40; p = 0.002; I2 = 56.2%), unrelated to study design. The subgroup analysis showed an inverse association between TRF and fat free mass in observational studies (WMD: -1.33 kg, 95%CI: -2.55 to -0.11; p = 0.03; I2 = 0%). An overall significant reduction in fasting glucose concentrations was observed with TRF regimens (7 studies, n = 363 subjects) (WMD: -1.71 mg/dL, 95%CI: -3.20 to -0.21; p = 0.03; I2 = 0%), above all in trials (WMD:-2.45 mg/dL, 95%CI: -4.72 to -0.17; p = 0.03; I2 = 0%). No between-group differences in the other variables were found. TRF regimens achieved a superior effect in promoting weight-loss and reducing fasting glucose compared to approaches with unrestricted time in meal consumption. However, long-term and well-designed trials are needed to draw definitive conclusions.
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Affiliation(s)
- Marianna Pellegrini
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy
| | - Iolanda Cioffi
- Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, CPO, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Valentina Ponzo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy
| | - Ilaria Goitre
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, CPO, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Ezio Ghigo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy
| | - Simona Bo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy.
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26
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Almulhem M, Susarla R, Alabdulaali L, Khunti K, Karamat MA, Rasiah T, Tahrani AA, Hanif W, Nirantharakumar K. The effect of Ramadan fasting on cardiovascular events and risk factors in patients with type 2 diabetes: A systematic review. Diabetes Res Clin Pract 2020; 159:107918. [PMID: 31711857 DOI: 10.1016/j.diabres.2019.107918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/02/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
Abstract
Ramadan is the fasting month in Islam. Muslims around the world observe Ramadan every year, including people with diabetes. Data on the association of fasting in people with diabetes are sparse. The purpose of this study is to assess the association of fasting on cardiovascular risk factors and events in people with diabetes. A comprehensive search was conducted in the following database: Embase, Medline, Cochrane library and CINAHL. The following key terms were used: Ramadan, Ramazan, Ramadhan, Muslim, Islam and fasting. Studies were eligible if they included people with Type 2 diabetes who fasted during Ramadan and reporting results on cardiovascular risk factors or events. Overall 22 studies met inclusion criteria for the review; five studies reported cardiovascular outcomes and 17 reported changes in risk factors. There is insufficient evidence to link Ramadan fasting with increased or reduced incidence of cardiovascular events in people with diabetes, though there were some indication stroke risk may be increased. Findings were inconsistent in term of risk factors as some favoured Ramadan and others did not..
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Affiliation(s)
- Munerah Almulhem
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Radhika Susarla
- Institute of Translational Medicine, University of Birmingham, UK
| | - Luluh Alabdulaali
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | | | - Thayakaran Rasiah
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Abd A Tahrani
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, UK.
| | - Wasim Hanif
- Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, UK.
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27
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Ebrahimi S, Gargari BP, Aliasghari F, Asjodi F, Izadi A. Ramadan fasting improves liver function and total cholesterol in patients with nonalcoholic fatty liver disease. INT J VITAM NUTR RES 2020; 90:95-102. [DOI: 10.1024/0300-9831/a000442] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract. Background: Nonalcoholic fatty liver disease (NAFLD) is a serious global health problem, thus the prevention and management of the disease is necessary. This study aimed to determine the effects of Ramadan Fasting (RF) on liver function, Visceral Adiposity Index (VAI) and Atherogenic Index of Plasma (AIP) in these patients. Methods: Eighty-three NAFLD patients (57 males and 26 females) were enrolled in the study, 42 patients who practiced RF, between Jun 18 through July 17, 2015 and 41 patients in non-fasting groups. Anthropometric parameters and Ultrasound grading were measured before and after Ramadan. The biochemical parameters including lipid profiles (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides), liver enzymes (Aspartate aminotransferase, SGOT and Alanine aminotransferase, SGPT) were evaluated before and after Ramadan. AIP and VAI were calculated based on formula. Results: The mean decreases in anthropometric indices were significantly different between groups. Similarly, the mean decrease in the total cholesterol values in the fasting group was remarkably greater than in the control group (p = 0.02). The values of AIP and VAI decreased at the end of the study in both group and the mean of changes showed no differences between groups (p = 0.79 and p = 0.65 for AIP and VAI, respectively). The changes in the concentrations of liver enzymes, as well as the severity of hepatic steatosis, showed remarkable differences between groups (p = 0.03, p = 0.05, and p = 0.02 for SGOT and SGPT, and Liver steatosis, respectively). Conclusion: RF improved liver steatosis in NAFLD patients and might be useful in the management of NAFLD.
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Affiliation(s)
- Sara Ebrahimi
- Master of Nutrition, Jahrom University of Medical Sciences, Motahari Hospital, Jahrom, Iran
| | - Bahram Pourghassem Gargari
- Department of Biochemistry and Diet Therapy, Nutrition Research Center, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fereshteh Aliasghari
- Department of Biochemistry and Diet Therapy, Nutrition Research Center, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Iran
| | - Foad Asjodi
- Board member of Sport Nutrition in IFMARC (Iran Football Medical Assessment and Research Center), Tehran, Iran
| | - Azimeh Izadi
- Department of Biochemistry and Diet Therapy, Nutrition Research Center, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Iran
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28
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Faris MAIE, Jahrami HA, Alhayki FA, Alkhawaja NA, Ali AM, Aljeeb SH, Abdulghani IH, BaHammam AS. Effect of diurnal fasting on sleep during Ramadan: a systematic review and meta-analysis. Sleep Breath 2019; 24:771-782. [PMID: 31832984 DOI: 10.1007/s11325-019-01986-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The current meta-analysis aimed to obtain a more stable estimate of the effect size of Ramadan diurnal intermittent fasting (RDF) on sleep duration and daytime sleepiness. METHODS Databases (Scopus, ScienceDirect, ProQuest Medical, PubMed/MEDLINE, Web of Science, EBSCOhost, Cochrane, CINAHL, and Google Scholar) were searched from database inception to the end of June 2019. The sleep quality measures analyzed were excessive daytime sleepiness (EDS) measured by the Epworth sleepiness scale (ESS) and total sleep time (TST). Subgroup analyses for age, sex, and levels of physical activity were conducted. RESULTS We identified 24 studies (involving 646 participants, median age 23.7 years, 73% men) conducted in 12 countries from 2001 to 2019. The results revealed that TST decreased from 7.2 h per night [95% confidence interval (CI) 6.7-7.8] before Ramadan to 6.4 h (95% CI 5.3-7.5) during Ramadan, while the ESS score increased slightly from 6.1 (95% CI 4.5-7.7) before Ramadan to 7.0 (95% CI 5.2-8.8) during Ramadan. Effect sizes on sleep quality measures during RDF demonstrated a moderate reduction in TST (number of studies, K = 22; number of subjects, N = 571, Hedges' g value of -0.43, 95% CI - 0.64 to -0.22, Q = 90, τ2 = 0.15, I2 = 78%, P < 0.001), while ESS score showed negligible effect on EDS (K = 9, N = 362, Hedges' g value of -0.06, 95% CI -0.43 to 0.28, Q = 21, τ2 = 0.13, I2 = 76%, P value = 0.001). CONCLUSION During the month of Ramadan, there is approximately a 1 hour reduction in TST and nearly a 1 point increase in the ESS score.
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Affiliation(s)
- Mo'ez Al-Islam E 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
| | - Haitham A Jahrami
- Ministry of Health, Manama, Bahrain.,College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Fatema A Alhayki
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Noor A Alkhawaja
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ameera M Ali
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Shaima H Aljeeb
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Israa H Abdulghani
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ahmed S BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Box 225503, Riyadh, 11324, Saudi Arabia. .,The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.
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Karaküçük Y, Beyoglu A, Çömez A. Quantitative assessment of the effect of fasting on macular microcirculation: an optical coherence tomography angiography study. Br J Ophthalmol 2019; 104:1098-1102. [DOI: 10.1136/bjophthalmol-2019-314962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/11/2019] [Accepted: 10/17/2019] [Indexed: 11/04/2022]
Abstract
AimTo analyse the effect of fasting on the retinal vascular plexus and choriocapillaris structures in healthy subjects via Optical Coherence Tomography Angiography (OCTA).MethodsIn this prospective study, OCTA scans of 98 eyes in 49 healthy subjects were compared in fasting and non-fasting period. All cases had a full ophthalmological examination, with OCTA parameters measured, including superficial flow area (SCP) (mm2), deep flow area (DCP) (mm2), choriocapillaris flow area (CC) (mm2), superficial and deep vascular density (SVD and DVD, respectively) (%), superficial foveal avascular zone area (FAZs) (mm2), deep foveal avascular zone area (FAZd) (mm2), subfoveal choroidal thickness (SFCT) (µm) and central macular thickness (CMT) (µm).ResultsThe mean SCP, DCP and CC flow area values were induced to be significantly lower in a fasting than a non-fasting period (p<0.001, p<0.001, p=0.049, respectively). The mean VD in a fasting period was statistically significantly lower than in a non-fasting period at the SCP level (p=0.009). No statistically significant difference was found between the two periods in respect to DVD, FAZd and CMT (p=0.068, p=0.653 and p=0.531, respectively); however, FAZs were significantly lower in a non-fasting than fasting period (p=0.038). The SFCT was determined to be statistically significant and thicker during a fasting period (p<0.001).ConclusionThe current study documented several physiological changes in a fasting period, such as changes in SCP, DCP, CC flow, SVD and DVD, via OCTA.
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Impact of Ramadan diurnal intermittent fasting on the metabolic syndrome components in healthy, non-athletic Muslim people aged over 15 years: a systematic review and meta-analysis. Br J Nutr 2019; 123:1-22. [PMID: 31581955 DOI: 10.1017/s000711451900254x] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Studies on the impact of Ramadan diurnal intermittent fasting (RDIF) on the metabolic syndrome (MetS) components among healthy Muslims observing Ramadan month have yielded contradictory results. This comprehensive meta-analysis aimed to obtain a more stable estimate of the effect size of fasting during Ramadan on the MetS components, examine variability among studies, assess the generalisability of reported results and perform subgroup analyses for associated factors. We searched the CINAHL, Cochrane, EBSCOhost, Google Scholar, ProQuest Medical, PubMed/MEDLINE, ScienceDirect, Scopus and Web of Science databases for relevant studies published from 1950 to March 2019. The MetS components analysed were: waist circumference (WC), systolic blood pressure (SBP), fasting plasma/serum glucose (FG), TAG, and HDL-cholesterol. We identified eighty-five studies (4326 participants in total) that were conducted in twenty-three countries between 1982 and 2019. RDIF-induced effect sizes for the MetS components were: small reductions in WC (no. of studies K = 24, N 1557, Hedges' g = -0·312, 95 % CI -0·387, -0·236), SBP (K = 22, N 1172, Hedges' g = -0·239, 95 % CI -0·372, -0·106), FG (K = 51, N 2318, Hedges' g = -0·101, 95 % CI -0·260, 0·004) and TAG (K = 63, N 2862, Hedges' g = -0·088, 95 % CI -0·171, -0·004) and a small increase in HDL-cholesterol (K = 57, N 2771, Hedges' g = 0·150, 95 % CI 0·064, 0·236). We concluded that among healthy people, RDIF shows small improvement in the five MetS components: WC, SBP, TAG, FG and HDL.
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Mirmiran P, Bahadoran Z, Gaeini Z, Moslehi N, Azizi F. Effects of Ramadan intermittent fasting on lipid and lipoprotein parameters: An updated meta-analysis. Nutr Metab Cardiovasc Dis 2019; 29:906-915. [PMID: 31377182 DOI: 10.1016/j.numecd.2019.05.056] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
AIMS This systematic review and meta-analysis aimed to clarify several aspects of intermittent fasting during the month of Ramadan on lipid and lipoprotein levels in apparently healthy subjects. DATA SYNTHESIS We searched PubMed, Scopus, and Embase databases and the reference lists of previous reviews, up to Feb 2019 for studies that investigated the effects of Ramadan fasting on fasting levels of triglycerides (TG), total cholesterol (TC), HDL-C, LDL-C, and VLDL-C among healthy subjects including pregnant women and athletic subjects. Studies were selected for quality assessment, meta-analyses, subgroup analyses, and meta-regressions; data of 33 eligible studies, conducted between 1978 and 2019, were included in the analysis. RESULTS Intermittent fasting showed no significant effect on circulating TG (WMD = -0.38 mg/dl, 95% CI = -5.33, 4.57), TC (WMD = -1.58 mg/dl, 95% CI = -6.04, 2.88), and LDL-C levels (WMD = 1.85 mg/dl, 95% CI = 0.77, 2.92). Overall, HDL-C (WMD = -2.97 mg/dl; 95% CI = -6.43, 0.48 mg/dl) and VLDL-C (WMD = -1.41 mg/dl; 95% CI = -2.73, -0.10 mg/dl) significantly decreased after Ramadan fasting. A significant increase in LDL-C levels was observed in athletic subjects (WMD = 2.97 mg/dl; 95% CI = 0.80, 5.13) and apparently healthy subjects (WMD = 1.81 mg/dl; 95% CI = 0.55, 3.07). Change in TG levels was associated with age (β = -0.94, P = 0.043), its baseline values (β = -0.44, P = 0.001), and weight change during the fasting period (β = -0.57, P = 0.032). CONCLUSION Ramadan fasting may be accompanied by a moderate improvement of lipid and lipoprotein parameters, especially HDL-C levels; fasting appears to be more beneficial for men and athletic subjects.
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Affiliation(s)
- Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Gaeini
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Moslehi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Beltaief K, Bouida W, Trabelsi I, Baccouche H, Sassi M, Dridi Z, Chakroun T, Hellara I, Boukef R, Hassine M, Addad F, Razgallah R, Khochtali I, Nouira S. Metabolic effects of Ramadan fasting in patients at high risk of cardiovascular diseases. Int J Gen Med 2019; 12:247-254. [PMID: 31410047 PMCID: PMC6643153 DOI: 10.2147/ijgm.s172341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 02/14/2019] [Indexed: 01/08/2023] Open
Abstract
Background and aim The effects of Ramadan fasting on health are a little controversial. The present study is aimed at evaluating the metabolic effects on a group of 517 patients with ≥2 cardiovascular risk factors over a period running from 2012 to 2014. Methods Each patient was assessed at three visits: before, during, and after Ramadan. Demographical, clinical and biological tests were performed at each visit. Results Metabolically, we noted a significant and discrete rise in blood glucose level (+1.2 mmol/L), triglycerides (+0.3 mmol/L), cholesterol (+0.12 mmol/L) and creatinine (+3 µmol/L) during Ramadan. These disturbances decreased significantly after Ramadan. The same variations were observed among diabetics (n=323). However, there was a significant decrease in HbA1c after Ramadan (9.0% vs 7.6%, p<0.001). Our findings also revealed there was no significant correlation between variations of metabolic parameters and dietary intake. No acute metabolic incidents were reported during the study period. Conclusion The current study showed that Ramadan is responsible for a transient but well tolerated disturbance of metabolic parameters followed by a significant post-Ramadan improvement. These changes did not seem to be directly related to dietary intake.
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Affiliation(s)
- K Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - W Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - I Trabelsi
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - H Baccouche
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - M Sassi
- Biological Laboratory, Maternity and Neonatal Medicine Center, Monastir, Tunisia
| | - Z Dridi
- Cardiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - T Chakroun
- Regional Blood Transfusion Center, Farhat Hached University Hospital, Sousse, Tunisia
| | - I Hellara
- Hematology Department, Fattouma Bourguiba University Hospital, Monasitr, Tunisia
| | - R Boukef
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - M Hassine
- Hematology Department, Fattouma Bourguiba University Hospital, Monasitr, Tunisia
| | - F Addad
- Cardiology Department, Abderrahman Mami University Hospital, Ariana 1080, Tunisia
| | | | - I Khochtali
- Endocrinology and Internal Medicine Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - S Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
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Faris MAIE, Madkour MI, Obaideen AK, Dalah EZ, Hasan HA, Radwan H, Jahrami HA, Hamdy O, Mohammad MG. Effect of Ramadan diurnal fasting on visceral adiposity and serum adipokines in overweight and obese individuals. Diabetes Res Clin Pract 2019; 153:166-175. [PMID: 31150725 DOI: 10.1016/j.diabres.2019.05.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/07/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023]
Abstract
AIM Excessive visceral adiposity is a major risk factor for developing insulin resistance and systemic low-grade inflammation. Ramadan diurnal fasting (RDF) is a religious ritual practiced by more than one billion Muslim throughout the world. It has been considered as one of the most common types of complementary and integrative health practices. The aim of this study is to examine the impact of RDF on visceral adiposity, circulating adipokines and glucoregulatory markers in patients with overweight or obesity. METHODS Overweight and obese subjects (n = 61; 23 men and 38 women) were included in the study. Body weight, visceral fat tissue area (measured by 3D-MRI), glucoregulatory factors, serum adipokines concentrations, dietary intake, and physical activity were assessed one week before and at the end of the lunar month of Ramadan. RESULTS From baseline, body weight and visceral fat tissue area serum total cholesterol, triglycerides, HDL-cholesterol, and systolic blood pressure significantly decreased (P < 0.05 for each) at the end of Ramadan. The serum levels of adiponectin, IL-6, TNF-α, and IGF-1 significantly decreased (P < 0.05 for each), but serum visfatin, leptin, apelin, IL-10, and IL-10/IL-6 ratio significantly increased (P < 0.05 for each) at the end of Ramadan. Changes in visceral adiposity significantly correlated with changes in plasma glucose (r = 0.4, P < 0.5) and resistin (r = 0.44, P < 0.001) at the end of Ramadan. CONCLUSION RDF lowers visceral adiposity, body weight and variably affects adipokines without adversely affecting markers of glucose homeostasis in individuals with overweight or obesity.
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Affiliation(s)
- Mo'ez Al-Islam E Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, P.O. Box: 27272, Sharjah, United Arab Emirates.
| | - Mohamed I Madkour
- Department of Medical Laboratory Sciences, College of Health Sciences/Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, P.O. Box: 27272, Sharjah, United Arab Emirates.
| | - Abdulmunhem K Obaideen
- Department of Medical Diagnostic Imaging, University Hospital Sharjah (UHS), P.O. Box: 72772, Sharjah, United Arab Emirates.
| | - Entesar Z Dalah
- Department of Medical Diagnostic Imaging, College of Health Sciences/Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, P.O. Box: 27272, Sharjah, United Arab Emirates.
| | - Hayder A Hasan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, P.O. Box: 27272, Sharjah, United Arab Emirates.
| | - Hadia Radwan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, P.O. Box: 27272, Sharjah, United Arab Emirates.
| | - Haitham A Jahrami
- Rehabilitation Services, Periphery Hospitals, Ministry of Health, P.O. Box: 12, Manama, Bahrain.
| | - Osama Hamdy
- Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Mohammad G Mohammad
- Department of Medical Laboratory Sciences, College of Health Sciences/Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, P.O. Box: 27272, Sharjah, United Arab Emirates.
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Dabbous Z, Bashir M, Elzouki AN, Ahmed MS, Farouk S, Hassanien M, Malik RA, Abou Samra AB, Elhadd T. Differential effects of gender and patient background diversity on the changes in metabolic and biophysical profiles in people with type-2 diabetes from different ethnicities who fast during Ramadan (H1439); a prospective study from Qatar. Diabetes Res Clin Pract 2019; 152:171-176. [PMID: 30930290 DOI: 10.1016/j.diabres.2019.03.032] [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: 11/06/2018] [Revised: 03/03/2019] [Accepted: 03/25/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The 'PROspective Study of dose adjustment of multiple anti-diabetic therapy for Type-2 diabetic patients FASTing the Month of Ramadan aimed to assess the biophysical and metabolic effects of fasting during Ramadan, including HbA1c, weight, blood pressure and lipid profile. STUDY DESIGN METHODS We performed a prospective study of people with Type-2 diabetes who were on ≥3 drugs for lowering glucose before and after Ramadan of H1438 (May-June 2017) in Hamad Medical Corporation, Qatar. We enrolled 228 participants, of whom 181 completed the study and were included in the analysis. RESULTS There were 115 (63.5%) men and 66 (36.5%) women, mean age 53.6 ± 9.7 years and mean diabetes duration of 10 ± 6 years. Both HBA1c [7.8% (62 mmol/mol) vs. 7.6% (60 mmol/mol); p = 0.004]; and diastolic BP (75.7 ± 8.55 vs. 68.8 ± 23.1 mmHg, P = 0.001) improved significantly after Ramadan while there was an increase in total cholesterol (3.94 ± 0.89 mmol/l vs 4.11 ± 1.02 mmol/l; p = 0.008) and triglycerides (1.55 ± 0.72 mmol/l vs 1.71 ± 0.9 mmol/l; p = 0.012). Subgroup analysis showed that patients on sulphonylurea, South Asians and males had a significant reduction in both HBA1c and weight. CONCLUSION Patients with Type 2 diabetes who fast during Ramadan show an improvement in glycaemic control and diastolic blood pressure, but a worsening of total cholesterol and triglycerides, particularly those of South Asian origin and men.
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Affiliation(s)
- Zeinab Dabbous
- Department of Medicine & Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Mohammed Bashir
- Department of Medicine & Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Abdel-Naser Elzouki
- Department of Medicine & Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mustafa Sid Ahmed
- Department of Medicine & Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Seleena Farouk
- Department of Medicine & Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Abdul Badie Abou Samra
- Department of Medicine & Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Tarik Elhadd
- Department of Medicine & Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
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Hassanein M, Rashid F, Elsayed M, Basheir A, Al Saeed M, Abdelgadir E, AbuelKheir S, Khalifa A, Al Sayyah F, Bachet F, Jacob S, Alawadi F. Assessment of risk of fasting during Ramadan under optimal diabetes care, in high-risk patients with diabetes and coronary heart disease through the use of FreeStyle Libre flash continuous glucose monitor (FSL-CGMS). Diabetes Res Clin Pract 2019; 150:308-314. [PMID: 30771364 DOI: 10.1016/j.diabres.2019.01.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/18/2019] [Accepted: 01/27/2019] [Indexed: 11/21/2022]
Abstract
AIM Most of Muslims patients with diabetes and Coronary Heart Disease (CHD) elect to fast in Ramadan, but the actual risk in this subset of patients with diabetes is largely unknown. We aimed to understand the safety of fasting in CHD patients with diabetes insisting on fasting Ramadan under optimal care. We also monitored the change in biophysical and biochemical parameters of these patients before and after Ramadan. We conducted this prospective study in a tertiary care hospital in Dubai during Ramadan 2016, (June 6th till July 5th). PATIENTS AND METHODS 21 Patients with T2DM with stable known CHD during the three months prior to study and insisted on fasting despite advice against it were recruited for the study. All patients received continuous glucose monitoring with free style libre monitoring device (FSL-CGM) during and outside Ramadan period. We recorded DM or CVD-related emergency visit or hospitalisation, change in BMI, systolic and diastolic BP, lipids profile, e-GFR, HBA1c, and frequency of hypoglycemia during Ramadan fasting and not -fasting period. RESULTS This is first study using CGM in CHD patients with diabetes who observe fast in Ramadan. Patients had a significantly higher incidence (3.2 ± 2.8 vs 1.1 ± 1.6 episodes, p = 0.033) and prolonged duration of hypoglycemia (117.8 ± 87.2, 49.1 ± 59.1 min p 0.022) during fasting compared to non-fasting respectively. No significant alteration was seen in BMI, SBP and DBP, lipid profile and renal function. There is a significant improvement in HBA1c during Ramadan. CONCLUSION We could not associate any adverse cardiovascular effects with fasting Ramadan in patients with stable CHD under optimal diabetes care. FSL-CGMS data showed higher frequency of hypoglycemia during Ramadan fasting. Studies with larger sample size are needed for further validation of these findings.
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Affiliation(s)
| | - Fauzia Rashid
- Endocrine Department, Dubai Hospital, United Arab Emirates.
| | | | | | | | | | | | - Azza Khalifa
- Endocrine Department, Dubai Hospital, United Arab Emirates
| | | | - Fawzi Bachet
- Endocrine Department, Dubai Hospital, United Arab Emirates
| | - Susan Jacob
- Endocrine Department, Dubai Hospital, United Arab Emirates
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Effect of Ramadan Fasting on Weight and Body Composition in Healthy Non-Athlete Adults: A Systematic Review and Meta-Analysis. Nutrients 2019; 11:nu11020478. [PMID: 30813495 PMCID: PMC6412279 DOI: 10.3390/nu11020478] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 02/03/2023] Open
Abstract
Background: Ramadan involves one month of fasting from sunrise to sunset. In this meta-analysis, we aimed to determine the effect of Ramadan fasting on weight and body composition. Methods: In May 2018, we searched six databases for publications that measured weight and body composition before and after Ramadan, and that did not attempt to influence physical activity or diet. Results: Data were collected from 70 publications (90 comparison groups, 2947 participants). There was a significant positive correlation between starting body mass index and weight lost during the fasting period. Consistently, there was a significant reduction in fat percentage between pre-Ramadan and post-Ramadan in people with overweight or obesity (−1.46 (95% confidence interval: −2.57 to −0.35) %, p = 0.010), but not in those of normal weight (−0.41 (−1.45 to 0.63) %, p = 0.436). Loss of fat-free mass was also significant between pre-Ramadan and post-Ramadan, but was about 30% less than loss of absolute fat mass. At 2–5 weeks after the end of Ramadan, there was a return towards, or to, pre-Ramadan measurements in weight and body composition. Conclusions: Even with no advice on lifestyle changes, there are consistent—albeit transient—reductions in weight and fat mass with the Ramadan fast, especially in people with overweight or obesity.
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Buddhist Activities related to Sedentary behavior and Hypertension in Tibetan monks. J Hum Hypertens 2018; 33:756-762. [PMID: 30420645 DOI: 10.1038/s41371-018-0136-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/05/2018] [Accepted: 10/25/2018] [Indexed: 02/06/2023]
Abstract
Previous studies suggest sedentary behavior (SB) is a risk factor for hypertension. However, buddhist activities related to SB in Tibetan monks is quite different from common SB. Meditation, chanting, and buddhist teaching are the main features during sitting. There is no study to examine the association between buddhist activities related to sitting and hypertension. There were 594 Tibetan monks included for analysis. Buddhist activities related to SB involve hours of meditation, chanting, and buddhist teaching for a typical weekday and weekend day. After controlling potential risk factors, compared with Tibetan monks who has the sedentary time < 8 h/d, those with 10 h/d ≤ sedentary time < 11 h/d was associated with about 80% decrease in the risk of hypertension (OR = 0.22;95% CI = 0.07-0.71), and about 90% decrease (OR = 0.11; 95% CI = 0.03-0.40) in those with sedentary time ≥ 11 h/d. In hypertension subgroup, buddhist activities related to SB is associated with a decrease in BP during linear regression analysis (standard β = -0.355; P = 0.004 for SBP; standard β = -0.345; P = 0.013 for DBP). We conclude that sitting might not simply represent the extremely low energy expenditure of the physical activity continuum. Psychosocial activities may play an important role in SB.
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Abazid RM, Khalaf HH, Sakr HI, Altorbak NA, Alenzi HS, Awad ZM, Smettei OA, Elsanan MA, Widyan AM, Azazy AS, Chamsi-Pasha HW. Effects of Ramadan fasting on the symptoms of chronic heart failure. Saudi Med J 2018; 39:395-400. [PMID: 29619492 PMCID: PMC5938654 DOI: 10.15537/smj.2018.4.22011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: To investigate the effect of Ramadan fasting on the symptoms of chronic heart failure with a reduced ejection fraction (HFrEF). Globally, more than one billion Muslims fast during Ramadan. Data regarding the effect of fasting in heart failure patients with a reduced ejection fraction are limited. Methods: We prospectively studied 249 outpatients with HFrEF who undertook Ramadan fasting at tertiary care cardiac center in Saudi Arabia in 2017. We obtained information regarding the clinical assessment, diagnosis, emergency department visits, and hospitalization during and in the month preceding Ramadan. Results: We enrolled 249 patients, 227 (91%) undertook the fast for the entire month. During Ramadan, 209 (92%) patients remained hemodynamically stable, whereas 18 (8%) developed instability. The mean New York Heart Association (NYHA) functional class was significantly lower in the stable than in the unstable group (1.46±0.7 vs. 3.22±0.55, p<0.0001), although no intergroup differences were observed before Ramadan. Patients from the unstable vs. the stable group showed significantly less adherence to medications (67% vs. 94%, p<0.0001) and to diet (39% vs. 79%, p<0.0001), and a lower likelihood of demonstrating ischemic cardiomyopathy as an underlying etiology of HFrEF (33% vs. 57%, p=0.046). Dependent t-test analysis including all patients showed that the NYHA classification before Ramadan was significantly higher than during Ramadan (2.19±0.9 vs. 1.6±0.8, t-value 8.5, p<0.0001). Conclusion: In most patients with chronic HFrEF, Ramadan fasting is considered safe. Non-adherence to medication and diet are significantly associated with decompensated heart failure during Ramadan.
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Affiliation(s)
- Rami M Abazid
- Department of Cardiology, Prince Sultan Cardiac Center, Qassim, Buraydah, Kingdom of Saudi Arabia. E-mail.
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Venegas-Borsellino C, Sonikpreet, Martindale RG. From Religion to Secularism: the Benefits of Fasting. Curr Nutr Rep 2018; 7:10.1007/s13668-018-0233-2. [PMID: 29987704 DOI: 10.1007/s13668-018-0233-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Since the early development of human societies, religious beliefs, and practices has been integral to their identity, culture, and social structure, traditions are influenced by the area, era, and culture wherein they developed. Some religions offer advice on behavioral and diet modifications as strategies to fortify the body, purify the spirit, and elevate consciousness. This review is an attempt to compare different practices, describe the health benefits and risks of fasting, and reconcile these age-old recommendations with practical modern life. RECENT FINDINGS Research to clarify and quantify the impact of these dietary modifications is challenging due to the variability in recommendations among various religions and in day-to-day practices. Most religions share common goals of well-being, body-mind integration, and spiritual attainment. Historically, the transformational power of fasting periods has been appreciated, but there is still much to discover about the underlying beneficial physiologic mechanisms of fasting in preventing and treating metabolic diseases.
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Affiliation(s)
- Carla Venegas-Borsellino
- Departments of Critical Care Medicine and Neurocritical Care at Mayo Clinic, Jacksonville, USA.
- Departments of Critical Care and Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Sonikpreet
- Departments of Hemato-Oncology at Mayo Clinic, Jacksonville, USA
| | - Robert G Martindale
- Departments of General Surgery at Oregon Health & Science University, Portland, USA
- Hospital Nutrition Services at Oregon Health & Science University, Portland, USA
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Salam AM, Sulaiman K, Alsheikh-Ali AA, Singh R, Asaad N, Al-Qahtani A, Salim I, AlHabib KF, Al-Zakwani I, Al-Jarallah M, AlMahmeed W, Bulbanat B, Ridha M, Bazargani N, Amin H, Al-Motarreb A, Al Faleh H, Albackr H, Panduranga P, Shehab A, Al Suwaidi J. Acute heart failure presentations and outcomes during the fasting month of Ramadan: an observational report from seven Middle Eastern countries. Curr Med Res Opin 2018; 34:237-245. [PMID: 28871820 DOI: 10.1080/03007995.2017.1376629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Fasting during the month of Ramadan is practiced by over 1.5 billion Muslims worldwide. It remains unclear, however, how this change in lifestyle affects heart failure, a condition that has reached epidemic dimensions. This study examined the effects of fasting in patients with acute heart failure (AHF) using data from a large multi-center heart failure registry. METHODS AND RESULTS Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multi-center study of consecutive patients hospitalized with AHF during February-November 2012. The study included 4,157 patients, of which 306 (7.4%) were hospitalized with AHF in the fasting month of Ramadan, while 3,851 patients (92.6%) were hospitalized in other days. Clinical characteristics, precipitating factors, management, and outcome were compared among the two groups. Patients admitted during Ramadan had significantly lower prevalence of symptoms and signs of volume overload compared to patients hospitalized in other months. Atrial arrhythmias were significantly less frequent and cholesterol levels were significantly lower in Ramadan. Hospitalization in Ramadan was not independently associated with increased immediate or 1-year mortality. CONCLUSIONS The current study represents the largest evaluation of the effects of fasting on AHF. It reports an improved volume status in fasting patients. There were also favorable effects on atrial arrhythmia and total cholesterol and no effects on immediate or long-term outcomes.
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Affiliation(s)
- Amar M Salam
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | | | - Alawi A Alsheikh-Ali
- c College of Medicine , Mohammed Bin Rashid University of Medicine and Health Sciences , Dubai , United Arab Emirates
- d Institute of Cardiac Sciences , Sheikh Khalifa Medical City , Abu Dhabi , United Arab Emirates
| | - Rajvir Singh
- e Biostatistics Section, Cardiovascular Research , Heart Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Nidal Asaad
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | - Awad Al-Qahtani
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | - Imtiaz Salim
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | - Khalid F AlHabib
- f Department of Cardiac Sciences , King Fahad Cardiac Center, King Saud University , Riyadh , Saudi Arabia
| | - Ibrahim Al-Zakwani
- g College of Medicine & Health Sciences, Department of Pharmacology & Clinical Pharmacy , Sultan Qaboos University, and Gulf Health Research , Oman
| | | | | | - Bassam Bulbanat
- h Department of Cardiology , Sabah Al-Ahmed Cardiac Center , Kuwait
| | | | - Nooshin Bazargani
- k Department of Cardiology , Dubai hospital , Dubai , United Arab Emirates
| | - Haitham Amin
- l Department of Cardiology , Mohammed Bin Khalifa Cardiac Center , Manamah , Bahrain
| | - Ahmed Al-Motarreb
- m Department of Cardiology, Faculty of Medicine , Sana'a University , Sana'a , Yemen
| | - Husam Al Faleh
- n Department of Cardiology and Cardiovascular Surgery , Security Forces Hospital , Riyadh , Saudi Arabia
| | - Hanan Albackr
- f Department of Cardiac Sciences , King Fahad Cardiac Center, King Saud University , Riyadh , Saudi Arabia
| | | | - Abdulla Shehab
- o Internal Medicine Department , College of Medicine and Health Sciences (CMHS), UAE University , United Arab Emirates
| | - Jassim Al Suwaidi
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
- p Qatar Cardiovascular Research Center , Doha , Qatar
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Investigating physiological glucose excursions before, during, and after Ramadan in adults without diabetes mellitus. Physiol Behav 2017; 179:110-115. [DOI: 10.1016/j.physbeh.2017.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/04/2017] [Accepted: 05/31/2017] [Indexed: 11/22/2022]
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Fasting and ambulatory blood pressure monitoring. Blood Press Monit 2017; 22:258. [PMID: 28574855 DOI: 10.1097/mbp.0000000000000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effect of fasting on 24-h blood pressure values of individuals with no previous history of hypertension. Blood Press Monit 2017; 22:247-252. [PMID: 28225380 DOI: 10.1097/mbp.0000000000000244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to analyze the difference in 24-h blood pressure values during Ramadan of fasting and nonfasting individuals with no previous history of hypertension. PATIENTS AND METHODS This study was planned as a multicenter research study in the cities of Izmit, Zonguldak, Sivas, and Adana. The percentage changes in the blood pressure of the patients were calculated from their blood pressure measurements at 0 h while they were resting. A Food Frequency Questionnaire was filled out by all participants. RESULTS Forty patients were included in the fasting group and 55 patients were included in the nonfasting group in the study. There was a difference between the two groups in percent changes of systolic measurements performed at the 4th (5% difference and P=0.020), 13th (6% difference and P=0.015), 14th (10% difference and P=0.017), 18th (9% difference and P=0.027), 19th (9% difference and P=0.020), and 20th (6% difference and P=0.014) hours with respect to the baseline measurement at the 0 h. There was a difference between the fasting and nonfasting groups in the Fasting Food Questionnaire results. Meat consumption was significantly higher in the fasting group. CONCLUSION A systolic blood pressure increase in fasting patients was observed in measurements at 18:00, 19:00, and 20:00 h. We believe that an increase of more than 10% in blood pressure at the time of iftar is an important result of our study in terms of the meal preferences of the individuals under risk.
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Kiyani MM, Memon AR, Amjad MI, Ameer MR, Sadiq M, Mahmood T. Study of Human Biochemical Parameters During and After Ramadan. JOURNAL OF RELIGION AND HEALTH 2017; 56:55-62. [PMID: 26149778 DOI: 10.1007/s10943-015-0084-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Ramadan fasting is obligatory for Muslims each year. They abstain from drinking, eating and intimate relationship between dawn and dusk during this month. Dietary restriction during Ramadan has various biochemical and physiological effects. It is shown to decrease the body weight, glucose and lipid profile. This study aims to analyze the changes in body weight, glucose and lipid profile during Ramadan in physiotherapy students in Pakistan. The study was conducted during June-July 2013 (Hijri year 1434). There were 80 students (50 males and 30 females) recruited in the experiment. They all were healthy adults between the age group of 18-24 (mean age 20.5) years. All subjects underwent a general physical examination and interview, and non-healthy subjects were excluded. On statistical analysis, quantitative data were expressed in terms of mean ± SD and a p value of ≤0.05 was believed statically significant. Paired t test was used to compare the variables. There was a little reduction in body weight (62.7 ± 8.8 vs. 62.3 ± 9.0; p value = 0.009) but a significant decline in glucose level (72.6 ± 12.5 vs. 57.9 ± 10.7; p value = 0.000), low-density lipoprotein level (2.9 ± 0.3 vs. 2.5 ± 0.3; p value = 0.000), total cholesterol (4.6 ± 0.4 vs. 4.2 ± 0.5; p value = 0.000) and triglycerides (1.4 ± 0.5 vs. 1.2 ± 0.5; p value = 0.000) was observed. Moreover, there was some reduction in high-density lipoprotein cholesterol level (1.2 ± 0.3 vs. 1.1 ± 0.3; p value = 0.045). This study shows that Ramadan fasting, a religious obligation for purification of body and soul, resulted in reduced body weight and a positive effect on glucose level and lipid profile.
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Affiliation(s)
- Mubin Mustafa Kiyani
- Faculty of Health and Medical Sciences, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan
| | - Aamir Raoof Memon
- Institute of Physiotherapy and Rehabilitation Sciences, Peoples University of Medical and Health Sciences, Nawabashah, Pakistan.
| | - Mian Imran Amjad
- Faculty of Health and Medical Sciences, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan
| | | | | | - Tariq Mahmood
- Nano Sciences and Catalysis Division, National Center for Physics, Quaid-i-Azam University, Islamabad, Pakistan
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Ahmed MH, Husain NE, Elmadhoun WM, Noor SK, Khalil AA, Almobarak AO. Diabetes and Ramadan: A concise and practical update. J Family Med Prim Care 2017; 6:11-18. [PMID: 29026740 PMCID: PMC5629872 DOI: 10.4103/2249-4863.214964] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the fact that the month of Ramadan includes 29–30 days and the duration of fasting for each day can last for between 12 and 16 h, it was estimated that a large number of individuals with diabetes do fast during Ramadan. In light of recent advancement of new pharmacological agents, drugs such as vildagliptin, sitagliptin, and liraglutide were found to be safe to use during this month of fasting. These therapeutic agents can also be used in combination with metformin. The use of sulfonylureas, in most of the recent guidelines about diabetes and Ramadan, seems not to gain much support due to the risk of hypoglycemia. In this review, we also addressed the use of insulin injection, insulin pump, and education before, during, and after Ramadan. Further research is needed to determine (i) the therapeutic benefit of new antidiabetic agents and (ii) the benefit of new technologies for the treatment of diabetes.
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Affiliation(s)
- Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Nazik Elmalaika Husain
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Wadie M Elmadhoun
- Department of Pathology, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Sufian K Noor
- Department of Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | | | - Ahmed O Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
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Chihaoui M, Chaker F, Yazidi M, Grira W, Ben Amor Z, Rejeb O, Slimane H. Ramadan fasting in patients with adrenal insufficiency. Endocrine 2017; 55:289-295. [PMID: 27878773 DOI: 10.1007/s12020-016-1186-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
AIM The risks of fasting during Ramadan in patients with adrenal insufficiency are unknown. The aims of this study were to evaluate these risks in such patients, to determine the risk factors and finally to set some recommendations. METHODS It is a cross-sectional study about 180 patients with known and treated adrenal insufficiency. The patients responded to a 14-item questionnaire concerning their knowledge about the disease and fasting during the last month of Ramadan. RESULTS There were 132 women and 48 men. The mean age was 47.6 ± 15.0 years (14-79). One hundred and thirty eight patients (76.7 %) were advised by their physician not to fast. Ninety-one patients (50.5 %) tried to fast. Complications occurred in 61 cases (67.0 %): asthenia in 88.5 % of cases, intense thirst in 32.8 %, symptoms of dehydration in 49.2 % and symptoms of hypoglycaemia in 18 %. One patient was hospitalized. Fifty-five patients (60.4 %) were able to fast for the whole month. Age, gender, duration of the disease, its primary origin, associated hypothyroidism, diabetes mellitus, hypertension or diabetes insipidus and daily dose of hydrocortisone did not significantly differ between fasters and non-fasters, full-month-fasters and partial-month-fasters, and fasters with complications and fasters without complications. The frequency of adequate knowledge about the disease was significantly higher in full-month-fasters vs. partial-month-fasters, and in fasters without complications vs. those with complications. CONCLUSION In patients with adrenal insufficiency, fasting can cause complications especially if the level of knowledge about the disease is low.
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Affiliation(s)
- Mélika Chihaoui
- Department of Endocrinology, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia.
| | - Fatma Chaker
- Department of Endocrinology, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia
| | - Meriem Yazidi
- Department of Endocrinology, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia
| | - Wafa Grira
- Department of Endocrinology, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia
| | - Zohra Ben Amor
- Department of Endocrinology, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia
| | - Ons Rejeb
- Department of Endocrinology, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia
| | - Hedia Slimane
- Department of Endocrinology, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia
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Moro T, Tinsley G, Bianco A, Marcolin G, Pacelli QF, Battaglia G, Palma A, Gentil P, Neri M, Paoli A. Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males. J Transl Med 2016; 14:290. [PMID: 27737674 PMCID: PMC5064803 DOI: 10.1186/s12967-016-1044-0] [Citation(s) in RCA: 389] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 10/03/2016] [Indexed: 01/10/2023] Open
Abstract
Background Intermittent fasting (IF) is an increasingly popular dietary approach used for weight loss and overall health. While there is an increasing body of evidence demonstrating beneficial effects of IF on blood lipids and other health outcomes in the overweight and obese, limited data are available about the effect of IF in athletes. Thus, the present study sought to investigate the effects of a modified IF protocol (i.e. time-restricted feeding) during resistance training in healthy resistance-trained males. Methods Thirty-four resistance-trained males were randomly assigned to time-restricted feeding (TRF) or normal diet group (ND). TRF subjects consumed 100 % of their energy needs in an 8-h period of time each day, with their caloric intake divided into three meals consumed at 1 p.m., 4 p.m., and 8 p.m. The remaining 16 h per 24-h period made up the fasting period. Subjects in the ND group consumed 100 % of their energy needs divided into three meals consumed at 8 a.m., 1 p.m., and 8 p.m. Groups were matched for kilocalories consumed and macronutrient distribution (TRF 2826 ± 412.3 kcal/day, carbohydrates 53.2 ± 1.4 %, fat 24.7 ± 3.1 %, protein 22.1 ± 2.6 %, ND 3007 ± 444.7 kcal/day, carbohydrates 54.7 ± 2.2 %, fat 23.9 ± 3.5 %, protein 21.4 ± 1.8). Subjects were tested before and after 8 weeks of the assigned diet and standardized resistance training program. Fat mass and fat-free mass were assessed by dual-energy x-ray absorptiometry and muscle area of the thigh and arm were measured using an anthropometric system. Total and free testosterone, insulin-like growth factor 1, blood glucose, insulin, adiponectin, leptin, triiodothyronine, thyroid stimulating hormone, interleukin-6, interleukin-1β, tumor necrosis factor α, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were measured. Bench press and leg press maximal strength, resting energy expenditure, and respiratory ratio were also tested. Results After 8 weeks, the 2 Way ANOVA (Time * Diet interaction) showed a decrease in fat mass in TRF compared to ND (p = 0.0448), while fat-free mass, muscle area of the arm and thigh, and maximal strength were maintained in both groups. Testosterone and insulin-like growth factor 1 decreased significantly in TRF, with no changes in ND (p = 0.0476; p = 0.0397). Adiponectin increased (p = 0.0000) in TRF while total leptin decreased (p = 0.0001), although not when adjusted for fat mass. Triiodothyronine decreased in TRF, but no significant changes were detected in thyroid-stimulating hormone, total cholesterol, high-density lipoprotein, low-density lipoprotein, or triglycerides. Resting energy expenditure was unchanged, but a significant decrease in respiratory ratio was observed in the TRF group. Conclusions Our results suggest that an intermittent fasting program in which all calories are consumed in an 8-h window each day, in conjunction with resistance training, could improve some health-related biomarkers, decrease fat mass, and maintain muscle mass in resistance-trained males.
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Affiliation(s)
- Tatiana Moro
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Grant Tinsley
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Giuseppe Marcolin
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | | | - Giuseppe Battaglia
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Antonio Palma
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Paulo Gentil
- College of Physical Education and Dance, Federal University of Goias, Goiania, Brazil
| | - Marco Neri
- Italian Fitness Federation, Ravenna, Italy
| | - Antonio Paoli
- Department of Biomedical Sciences, University of Padova, Padua, Italy.
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48
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Ali S, Davies MJ, Brady EM, Gray LJ, Khunti K, Beshyah SA, Hanif W. Guidelines for managing diabetes in Ramadan. Diabet Med 2016; 33:1315-29. [PMID: 26802436 DOI: 10.1111/dme.13080] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/03/2015] [Accepted: 01/19/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Globally there are approximately 90 million Muslims with diabetes of which approximately 400 000 reside within the UK. The holy month of Ramadan is a fundamental practice of this religion of which fasting from sun-rise to sun-set is an integral part. This poses many potential risks for those with diabetes who wish to observe Ramadan. METHODS The evidence base for best clinical management of Type 1 and Type 2 diabetes during Ramadan was reviewed. We reviewed current and previous recommendations for safe fasting during Ramadan. RESULTS The risks associated with fasting in those with diabetes and preparing your patient for Ramadan are discussed. We have reviewed the evidence around diet-controlled diabetes and therapies including; metformin, acarbose, metglitinides, sulfonylureas, thiazolidinidiones, dipeptidyl peptidase-4 inhibitor (DPP-4), sodium glucose co-transporter -2 (SGLT-2) inhibitors, glucagon-like peptide -1 (GLP-1) receptor agonists and insulin. CONCLUSION Up to date guidelines for the management of treatment regimes are set-out for those with Type 1 and Type 2 diabetes who wish to fast during Ramadan.
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Affiliation(s)
- S Ali
- Department of Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester
| | - E M Brady
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester
| | - L J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester
| | - S A Beshyah
- Center for Diabetes and Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - W Hanif
- Department of Diabetes & Endocrinology, University Hospital Birmingham, NHS Trust, Birmingham, UK.
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49
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Tinsley GM, Forsse JS, Butler NK, Paoli A, Bane AA, La Bounty PM, Morgan GB, Grandjean PW. Time-restricted feeding in young men performing resistance training: A randomized controlled trial. Eur J Sport Sci 2016; 17:200-207. [PMID: 27550719 DOI: 10.1080/17461391.2016.1223173] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A randomized controlled trial was conducted to examine eight weeks of resistance training (RT) with and without time-restricted feeding (TRF) in order to assess nutrient intake and changes in body composition and muscular strength in young recreationally active males. The TRF programme consisted of consuming all calories within a four-hour period of time for four days per week, but included no limitations on quantities or types of foods consumed. The RT programme was performed three days per week and consisted of alternating upper and lower body workouts. For each exercise, four sets leading to muscular failure between 8 and 12 repetitions were employed. Research visits were conducted at baseline, four, and eight weeks after study commencement. Measurements of total body composition by dual-energy X-ray absorptiometry and muscle cross-sectional area by ultrasound were obtained. Upper and lower body strength and endurance were assessed, and four-day dietary records were collected. TRF reduced energy intake by ∼650 kcal per day of TRF, but did not affect total body composition within the duration of the study. Cross-sectional area of the biceps brachii and rectus femoris increased in both groups. Effect size data indicate a gain in lean soft tissue in the group that performed RT without TRF (+2.3 kg, d = 0.25). Upper and lower body strength and lower body muscular endurance increased in both groups, but effect sizes demonstrate greater improvements in the TRF group. Overall, TRF reduced energy intake and did not adversely affect lean mass retention or muscular improvements with short-term RT in young males.
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Affiliation(s)
- Grant M Tinsley
- a Department of Kinesiology and Sport Management , Texas Tech University , Lubbock , TX , USA
| | - Jeffrey S Forsse
- b Department of Health, Human Performance, and Recreation , Baylor University , Waco , TX , USA
| | - Natalie K Butler
- b Department of Health, Human Performance, and Recreation , Baylor University , Waco , TX , USA
| | - Antonio Paoli
- c Department of Biomedical Sciences , University of Padova , Padova , Italy
| | - Annie A Bane
- b Department of Health, Human Performance, and Recreation , Baylor University , Waco , TX , USA
| | - Paul M La Bounty
- d Exercise and Sport Science Department , University of Mary Hardin-Baylor , Belton , TX , USA
| | - Grant B Morgan
- e Department of Educational Psychology , Baylor University , Waco , TX , USA
| | - Peter W Grandjean
- b Department of Health, Human Performance, and Recreation , Baylor University , Waco , TX , USA
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50
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Turin TC, Ahmed S, Shommu NS, Afzal AR, Al Mamun M, Qasqas M, Rumana N, Vaska M, Berka N. Ramadan fasting is not usually associated with the risk of cardiovascular events: A systematic review and meta-analysis. J Family Community Med 2016; 23:73-81. [PMID: 27186152 PMCID: PMC4859102 DOI: 10.4103/2230-8229.181006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Over one billion Muslims worldwide fast during the month of Ramadan. Ramadan fasting brings about some changes in the daily lives of practicing Muslims, especially in their diet and sleep patterns, which are associated with the risk of cardiovascular diseases. Over the years, many original studies have made the effort to identify the possible impact of the Ramadan fast on cardiovascular diseases. This systematic review and meta-analysis is an attempt to present the summary of key findings from those articles and an appraisal of selected literature. A systematic search using keywords of “;Ramadan fasting” and “;cardiovascular diseases” was conducted in primary research article and gray-literature repositories, in combination with hand searching and snow balling. Fifteen studies were finally selected for data extraction on the outcomes of stroke, myocardial infarction, and congestive heart failure. The analysis revealed that the incidence of cardiovascular events during the Ramadan fast was similar to the nonfasting period. Ramadan fast is not associated with any change in incidence of acute cardiovascular disease.
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Affiliation(s)
- Tanvir C Turin
- Department of Family Medicine, Foothills Medical Center, Calgary, Alberta, Canada; Department of Community Health Sciences, Foothills Medical Center, Calgary, Alberta, Canada
| | - Salim Ahmed
- Department of Family Medicine, Foothills Medical Center, Calgary, Alberta, Canada
| | - Nusrat S Shommu
- Department of Family Medicine, Foothills Medical Center, Calgary, Alberta, Canada
| | - Arfan R Afzal
- Department of Family Medicine, Foothills Medical Center, Calgary, Alberta, Canada
| | - Mohammad Al Mamun
- Department of Public Health, General Directorate of Health Affairs in Tabuk Region, Ministry of Health, Kingdom of Saudi Arabia
| | - Mahdi Qasqas
- Department of Faculty of Social Work, Foothills Medical Center, Calgary, Alberta, Canada
| | - Nahid Rumana
- Department of Sleep Center, Foothills Medical Center, Calgary, Alberta, Canada
| | - Marcus Vaska
- Knowledge Resource Service, Alberta Health Services, Calgary, Alberta, Canada
| | - Noureddine Berka
- Calgary Laboratory Services, University of Calgary, Calgary, Alberta, Canada
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