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Boobes Y, Afandi B, AlKindi F, Tarakji A, Al Ghamdi SM, Alrukhaimi M, Hassanein M, AlSahow A, Said R, Alsaid J, Alsuwaida AO, Al Obaidli AAK, Alketbi LB, Boubes K, Attallah N, Al Salmi IS, Abdelhamid YM, Bashir NM, Aburahma RMY, Hassan MH, Al-Hakim MR. Consensus recommendations on fasting during Ramadan for patients with kidney disease: review of available evidence and a call for action (RaK Initiative). BMC Nephrol 2024; 25:84. [PMID: 38448807 PMCID: PMC10916266 DOI: 10.1186/s12882-024-03516-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
Ramadan fasting (RF) involves abstaining from food and drink during daylight hours; it is obligatory for all healthy Muslims from the age of puberty. Although sick individuals are exempt from fasting, many will fast anyway. This article explores the impact of RF on individuals with kidney diseases through a comprehensive review of existing literature and consensus recommendations. This study was conducted by a multidisciplinary panel of experts.The recommendations aim to provide a structured approach to assess and manage fasting during Ramadan for patients with kidney diseases, empowering both healthcare providers and patients to make informed decisions while considering their unique circumstances.
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Affiliation(s)
- Yousef Boobes
- Seha Kidney Care, Tawam Hospital, Al Ain, UAE.
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE.
| | - Bachar Afandi
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE
- Endocrine Division, Tawam Hospital, Al Ain, UAE
| | | | - Ahmad Tarakji
- St. George Medical Center & McMaster University-Waterloo Campus, Kitchener, ON, Canada
| | | | | | - Mohamed Hassanein
- Endocrine Section, Dubai Hospital, Dubai Health, Dubai, UAE
- Mohammed Bin Rashid University of Medicine and Health Science, Dubai, UAE
| | - Ali AlSahow
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
| | - Riyad Said
- Department of Nephrology and Medicine, Jordan Hospital and Medical Center Ibn Sina University for Medical Sciences, Amman, Jordan
| | - Jafar Alsaid
- Nephrology department, Ochsner Medical Center, New Orleans, LA, USA
| | | | | | - Latifa B Alketbi
- Ambulatory Healthcare Services - Abu Dhabi Healthcare Services, Abu Dhabi, UAE
| | - Khaled Boubes
- Department of Medicine, Ohio State University, Columbus, OH, USA
| | - Nizar Attallah
- Nephrology Associates of Kentuckiana, University of Kentucky, Louisville, USA
| | - Issa S Al Salmi
- Department of Renal Medicine, The Royal Hospital, Muscat, Oman
| | - Yasser M Abdelhamid
- Nephrology Division, Internal Medicine Department -Faculty of Medicine, Cairo University, Cairo, Egypt
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Shaltout I, Abdelwahab AM, El Meligi A, Hammad H, Abdelghaffar S, Elbahry A, Taha N, Elsaid NH, Gad A, Hammouda L, Abdelmaboud S, Soliman AR. Risk Stratification in People with Diabetes for Fasting During Ramadan: Consensus from Arabic Association for the Study of Diabetes and Metabolism. Curr Diabetes Rev 2024; 20:e201023222409. [PMID: 37867270 PMCID: PMC11041120 DOI: 10.2174/0115733998249793231005105724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/12/2023] [Accepted: 08/23/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Current international guidelines recommend a pre-Ramadan risk assessment for people with diabetes (PwDM) who plan on fasting during the Holy month. However, a comprehensive risk assessment-based recommendation for the management of PwDM intending to fast is still controversial. Therefore, the Arabic Association for the Study of Diabetes and Metabolism (AASD) developed this consensus to provide further insights into risk stratification in PwDM intending to fast during Ramadan. METHODS The present consensus was based on the three-step modified Delphi method. The modified Delphi method is based on a series of voting rounds and in-between meetings of the expert panel to reach agreements on the statements that did not reach the consensus level during voting. The panel group comprised professors and consultants in endocrinology (both adult and pediatric). Other members included experts in the fields of cardiovascular medicine, nephrology, ophthalmology, and vascular surgery, affiliated with academic institutions in Egypt. RESULT In PwDM who intend to fast during Ramadan, risk stratification is crucial to optimize patient outcomes and prevent serious complications. The present consensus provides risk assessment of those living with diabetes according to several factors, including the type of diabetes, presence, and severity of complications, number of fasting hours, and other socioeconomic factors. According to their risk factors, patients were classified into four categories (very high, high, moderate, and low risk). CONCLUSION Future research is warranted due to the controversial literature regarding the impact of fasting on certain comorbidities.
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Affiliation(s)
- Inass Shaltout
- Internal Medicine and Diabetes Department, Cairo University, Cairo, Egypt
| | | | - Amr El Meligi
- Internal Medicine and Diabetes Department, Cairo University, Cairo, Egypt
| | - Hany Hammad
- Internal Medicine and Nephrology Department, Cairo University, Cairo, Egypt
| | - Shereen Abdelghaffar
- Department of Pediatrics, Pediatric Diabetes and Endocrinology Unit, Cairo University, Cairo, Egypt
| | - Atef Elbahry
- Cardiology Unit, Port Fouad Centre, Port Fouad, Egypt
| | - Nasser Taha
- Cardiology Department, Minia University, Minia, Egypt
| | - Nehal Hamdy Elsaid
- Internal Medicine and Diabetes Department, Cairo University, Cairo, Egypt
| | - Amr Gad
- Vascular Surgery Department, Cairo University, Cairo, Egypt
| | - Laila Hammouda
- Ophthalmology Department, Minia University, Minia, Egypt
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Aydin E, Aydin S, Gül M, Yetim M, Demir M, Özkan C, Karakurt M, Burak C, Bayraktar MF, Temizer O, Erbay İ, Muştu M, Karagöz A, Üzoğullari İR, Şen T, Özeke Ö, Topaloğlu S, Aras D, Tanboğa Hİ. Influence of Intermittent Fasting During Ramadan on Circadian Variation of Symptom-Onset and Prehospital Time Delay in Acute ST-Segment Elevation Myocardial Infarction. Angiology 2022; 74:569-578. [PMID: 35975875 DOI: 10.1177/00033197221114087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ramadan interferes with circadian rhythms mainly by disturbing the routine patterns of feeding and smoking. The objective of this study was to investigate the circadian pattern of ST elevation acute myocardial infarction (STEMI) during the month of Ramadan. We studied consecutive STEMI patients 1 month before and after Ramadan (non-Ramadan group-NRG) and during Ramadan (Ramadan group-RG). The RG group was also divided into two groups, based on whether they chose to fast: fasting (FG) and non-fasting group (NFG). The time of STEMI onset was compared. A total of 742 consecutive STEMI patients were classified into 4 groups by 6 h intervals according to time-of-day at symptom onset. No consistent circadian variation in the onset of STEMI was observed both between the RG (P = .938) and NRG (P = .766) or between the FG (P = .232) and NFG (P = .523). When analyzed for subgroups of the study sample, neither smoking nor diabetes showed circadian rhythm. There was a trend towards a delay from symptom onset to hospital presentation, particularly at evening hours in the RG compared with the control group. In conclusion, there was no significant difference in STEMI onset time, but the time from symptom onset to hospital admission was significantly delayed during Ramadan.
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Affiliation(s)
- Ertan Aydin
- Cardiology, Prof. Dr A. İlhan Özdemir Training and Research Hospital, Giresun University, Giresun, Turkey
| | | | - Murat Gül
- Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
| | - Mucahit Yetim
- Cardiology, Erol Olçok Training and Research Hospital, Hitit University, Çorum, Turkey
| | - Mevlüt Demir
- Cardiology, Evliya Celebi Training and Research Hospital, Kütahya Health Sciences University, Kutahya, Turkey
| | - Can Özkan
- Cardiology, Muş State Hospital, Muş, Turkey
| | - Mustafa Karakurt
- Cardiology, Kırıkkale Yuksek Ihtisas Hospital, Kırıkkale, Turkey
| | - Cengiz Burak
- Cardiology, Faculty of Medicine, 485644Kafkas University, Kars, Turkey
| | | | | | - İlke Erbay
- Cardiology, Muş State Hospital, Muş, Turkey
| | - Mehmet Muştu
- Cardiology, Faculty of Medicine, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Ahmet Karagöz
- Cardiology, Prof. Dr A. İlhan Özdemir Training and Research Hospital, Giresun University, Giresun, Turkey
| | | | - Taner Şen
- Cardiology, Evliya Celebi Training and Research Hospital, Kütahya Health Sciences University, Kutahya, Turkey
| | - Özcan Özeke
- Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Serkan Topaloğlu
- Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Dursun Aras
- Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Zakhama L, Hammami R, Mzoughi K, Ben Halima M, Antit S, Chaker F, Ben Fatma L, Jammoussi H, Gribaa R, Charfeddine S, Drissa M, Tarmiz A, Taamallah K, Milouchi S, Nouira S, Neffati E, Ouechtati W, Ouali S, Ben Halima A, Turki F, Skhiri H, Amrouch C, Slim I, Zghal K, Koubaa A, Karoui M, Boussarsar M, Besbes MH, Ben Jeddou K, Ouertatani H, Ben Hammouda M, Ben Brahem A, Hammouda C, Bezdah L, Said F, Lakhdhar R. Management of patients with cardiovascular diseases during Ramadan. LA TUNISIE MEDICALE 2022; 100:358-373. [PMID: 36206085 PMCID: PMC9552241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
During the month of Ramadan, over one billion Muslims observe a water and food fast from sunrise to sunset. The practice of this religious duty causes marked changes in eating and sleeping habits. With the increasing incidence of cardiovascular (CV) risk factors, the number of patients with CV pathologies who wish to fast is increasing worldwide, and in Tunisia, which is ranked as a high CV risk country. If fasting has been shown to be beneficial for the improvement of some metabolic parameters, its practice in patients with CV pathology remains debated. The Tunisian Society of Cardiology and Cardiovascular Surgery (STCCCV) in consultation with the National Instance of Evaluation and Accreditation in Health (INEAS) has established this document in the form of a consensus after having analysed the literature with the aim of addressing these questions: -What is the impact of fasting in patients with CV pathologies? -How to stratify the risk of fasting according to CV pathology and comorbidities? -How to plan fasting in patients with CV diseases? -What are the hygienic and dietary measures to be recommended during fasting in patients with CV pathologies? -How to manage medication during the month of Ramadan in patients with CV diseases?
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Affiliation(s)
- Lilia Zakhama
- 1. Service de Cardiologie, Hôpital des Forces de Sécurité Intérieure, La Marsa, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie
| | - Rania Hammami
- 2. Service de Cardiologie, Hôpital Hédi Chaker, Faculté de Médecine de Sfax, Université de Sfax, Tunisie.
| | - Khadija Mzoughi
- 3. Service de Cardiologie, Hôpital Habib Thameur, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Manel Ben Halima
- 4. Service des explorations fonctionnelles et de réanimation cardiaque, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Saoussen Antit
- 1. Service de Cardiologie, Hôpital des Forces de Sécurité Intérieure, La Marsa, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie
| | - Fatma Chaker
- 5. Service d’Endocrinologie, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Lilia Ben Fatma
- 6. Service de Néphrologie, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Henda Jammoussi
- 7. Service de Nutrition A, Institut National de Nutrition de Tunis, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie
| | - Rym Gribaa
- 8. Service de Cardiologie, Hôpital Sahloul, Faculté de Médecine de Sousse, Université de Sousse, Tunisie.
| | - Selma Charfeddine
- 2. Service de Cardiologie, Hôpital Hédi Chaker, Faculté de Médecine de Sfax, Université de Sfax, Tunisie.
| | - Meriem Drissa
- 9. Service de Cardiologie Adulte, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | | | - Karima Taamallah
- 11. Service de Cardiologie Adulte, Hôpital Militaire de Tunis, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Sami Milouchi
- 12. Service de Cardiologie, Hôpital de Mednine, Faculté de Médecine de Sfax, Université de Sfax, Tunisie.
| | - Samir Nouira
- 13. Service des urgences, Hôpital de Fattouma Bourguiba, Faculté de Médecine de Monastir, Université de Monastir, Tunisie
| | - Elyes Neffati
- 8. Service de Cardiologie, Hôpital Sahloul, Faculté de Médecine de Sousse, Université de Sousse, Tunisie.
| | - Wejdène Ouechtati
- 14. Service de Cardiologie, Hôpital Charles Nicolle, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Sana Ouali
- 4. Service des explorations fonctionnelles et de réanimation cardiaque, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Afef Ben Halima
- 15. Service de Cardiologie, Hôpital Abderrahmen Mami de l’Ariana, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Faten Turki
- 2. Service de Cardiologie, Hôpital Hédi Chaker, Faculté de Médecine de Sfax, Université de Sfax, Tunisie.
| | - Habib Skhiri
- 16. Service de Néphrologie, Hôpital de Fattouma Bourguiba, Faculté de Médecine de Monastir, Université de Monastir, Tunisie.
| | - Chiraz Amrouch
- 17. Consultations externes de Nutrition, Institut National de Nutrition de Tunis, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | | | - Khaled Zghal
- 18. Laboratoire de Pharmacologie, Faculté de Médecine de Sfax, Université de Sfax, Tunisie.
| | | | | | | | | | | | | | | | | | | | - Leila Bezdah
- 14. Service de Cardiologie, Hôpital Charles Nicolle, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
| | - Fatma Said
- 24. Service de Médecine Interne, Hôpital de la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunisie.
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Akhtar AM, Ghouri N, Chahal CAA, Patel R, Ricci F, Sattar N, Waqar S, Khanji MY. Ramadan fasting: recommendations for patients with cardiovascular disease. Heart 2022; 108:258-265. [PMID: 33990414 PMCID: PMC8819657 DOI: 10.1136/heartjnl-2021-319273] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 12/28/2022] Open
Abstract
Ramadan fasting is observed by most of the 1.8 billion Muslims around the world. It lasts for 1 month per the lunar calendar year and is the abstention from any food and drink from dawn to sunset. While recommendations on 'safe' fasting exist for patients with some chronic conditions, such as diabetes mellitus, guidance for patients with cardiovascular disease is lacking. We reviewed the literature to help healthcare professionals educate, discuss and manage patients with cardiovascular conditions, who are considering fasting. Studies on the safety of Ramadan fasting in patients with cardiac disease are sparse, observational, of small sample size and have short follow-up. Using expert consensus and a recognised framework, we risk stratified patients into 'low or moderate risk', for example, stable angina or non-severe heart failure; 'high risk', for example, poorly controlled arrhythmias or recent myocardial infarction; and 'very high risk', for example, advanced heart failure. The 'low-moderate risk' group may fast, provided their medications and clinical conditions allow. The 'high' or 'very high risk' groups should not fast and may consider safe alternatives such as non-consecutive fasts or fasting shorter days, for example, during winter. All patients who are fasting should be educated before Ramadan on their risk and management (including the risk of dehydration, fluid overload and terminating the fast if they become unwell) and reviewed after Ramadan to reassess their risk status and condition. Further studies to clarify the benefits and risks of fasting on the cardiovascular system in patients with different cardiovascular conditions should help refine these recommendations.
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Affiliation(s)
- Abid Mohammed Akhtar
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, 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
| | - C Anwar A Chahal
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine, Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Riyaz Patel
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, University of Gabriele d'Annunzio Chieti and Pescara, Chieti Scalo, Abruzzo, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Casa di Cura Villa Serena, Pescara, Italy
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Salman Waqar
- Nuffield Department of Primary care Health Sciences, University of Oxford, Oxford, UK
| | - Mohammed Yunus Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London, UK
- Department of Cardiovascular Disease Prevention and Proactive Care, UCLPartners, London, UK
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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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7
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Hafidh K, Ali K, Beshyah S. Ramadan fasting in health and disease (2020): A narrative review. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2021. [DOI: 10.4103/ijmbs.ijmbs_35_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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