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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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2
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Shahawy S, Raya L, Al Kassab L. Caring for Muslim Patients: A Primer for the Obstetrician Gynecologist. Obstet Gynecol Clin North Am 2024; 51:57-67. [PMID: 38267131 DOI: 10.1016/j.ogc.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Studies show that Muslim American patients experience discrimination and feel uncomfortable seeking appropriate health care for various reasons. Obstetrician-gynecologists should be educated regarding Islamic perspectives on topics such as modesty, sexual health, contraception, abortion, infertility, and fasting during pregnancy. Understanding the barriers Muslim patients face and improving cultural humility will improve the quality of sexual and reproductive care delivered to Muslim patients.
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Affiliation(s)
- Sarrah Shahawy
- Division of Global and Community Health, Department of Obstetrics and Gynecology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA.
| | - Lobna Raya
- Tufts University, 419 Boston Avenue, Medford, MA 02155, USA
| | - Leen Al Kassab
- Department of Obstetrics & Gynecology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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3
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Espinosa A, Rubio-Blancas A, Camacho-Zamora A, Salcedo-Grajales I, Bravo-García AP, Rodríguez-Vega S, Barrera-Flores R, Molina-Segui F, May-Hau A, Ferreyro-Bravo F, Martínez Vázquez SE, Nava-González EJ, Laviada Molina HA. [Intermittent fasting: effects in diverse clinical settings]. NUTR HOSP 2024; 41:230-243. [PMID: 38047415 DOI: 10.20960/nh.04790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Introduction Introduction: intermittent fasting plans propose to limit food intake during specific periods as nutritional therapeutic strategies to treat different metabolic conditions in various clinical entities. However, the heterogeneity between each context of intermittent fasting could generate different results in metabolic parameters. Objective: to evaluate the clinical application of intermittent fasting and to discern whether it offers advantages over other traditional strategies. Methods: structured questions were formulated (PICO), and the methodology followed the guidelines established by the PRISMA 2020 statement. The search was conducted in different databases (PubMed, Cochrane Library and Google Scholar). Results: we found 3,962 articles, of which 56 were finally included; 3,906 articles that did not directly or indirectly answer the structured questions were excluded. Conclusions: compared to conventional diets, the various AI schemes do not generate advantages or disadvantages in terms of weight loss and lipid profile, although in the alternate-day variant there are greater insulin reductions than those observed in the continuous energy restriction. The heterogeneity of the interventions, the populations studied, the comparators, the results, and the type of design make it impossible to extrapolate the effects found in all clinical scenarios and generalize the recommendations.
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Affiliation(s)
- Alan Espinosa
- Departamento de Nutrición. Escuela de Salud Pública. Universidad de Harvard
| | | | | | | | | | | | | | | | - Abraham May-Hau
- Escuela de Ciencias de la Salud. Universidad Marista de Mérida
| | | | - Sophia E Martínez Vázquez
- Departamento de Gastroenterología. Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"
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Alaeddine C, Schreiber J, Amin MEK. Ramadan fasting intentions among pregnant women in Lebanon. J Egypt Public Health Assoc 2024; 99:1. [PMID: 38228944 DOI: 10.1186/s42506-023-00148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/05/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND According to Islam's teachings, women are religiously exempt from fasting during pregnancy if a woman is concerned about her health or that of the fetus. This study assesses the intentions of pregnant women to fast during Ramadan and evaluates the contribution of items derived from the theory of planned behavior (TPB) in predicting these intentions. METHODS A cross-sectional survey was carried out in Arabic on a convenience sample of 181 pregnant women in Lebanon using a mixture of in-person (46), telephone (31), and online recruitment (104) techniques from February to April 2020. An Exploratory Bayes Tree Analysis was done to examine which TPB items appeared to separate the intention to fast in the best possible way. Then, an ordinal regression was completed followed by a latent class analysis to examine specific classes of participants that could be determined based on the regression results. RESULTS Overall, 58% of participants had the intention to fast all days of Ramadan, 22% had the intention to fast some days and 20% did not intend to fast for any duration. A model was run with perceptions of physical ability, Islam guidance, husband's opinion importance, mother's opinion beliefs, and impact on general health as predictors (R2 = 0.74). A four-cluster model was chosen as the most parsimonious one in interpretation, where classes one and two included the groups of women who intended to fast month-long with differences in predictors. Class three represented the group of women who did not have the intention to fast and the final class represented the group of women who had the intention to fast some days of the month. The women's belief in their physical ability to fast and the opinion of the pregnant women's mothers were very important in deciding the participants' intention to fast. CONCLUSIONS Items derived from TPB constructs helped in producing a model predicting women's intention to fast during Ramadan. Educational messages and interventions related to fasting while pregnant may be delivered by individuals with legitimacy among pregnant women such as those viewed by the target population as powerful motherly figures in their communities.
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Affiliation(s)
- Chaza Alaeddine
- Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Jim Schreiber
- School of Nursing, Duquesne University, Pittsburgh, USA
| | - Mohamed E K Amin
- Faculty of Pharmacy, Alamein International University, El Alamein, Egypt.
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Alsulami SS, Ghamri KA. Effect of Ramadan Fasting on Blood Glucose Level in Pregnant Women with Gestational and Type 2 Diabetes. Diabetes Metab Syndr Obes 2023; 16:3105-3113. [PMID: 37822801 PMCID: PMC10563769 DOI: 10.2147/dmso.s429249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
Background Pregnant women with diabetes are strongly advised against Ramadan fasting and have religious exemption, but a large proportion still choose to fast. Unfortunately, there is little information about glycemic control in these patients. This study aims to determine the fasting and postprandial blood glucose levels and to predict the risk factors for hypoglycemia in pregnant women with type 2 diabetes mellitus (DM) and gestational DM (GDM) who fast during Ramadan. Methods A prospective cohort research was conducted at a single tertiary hospital between 2021 and 2023 on 70 pregnant women with GDM (n = 53) and type 2 DM (n = 17) in their second and third trimester. Their fasting and postprandial blood glucose levels during Ramadan were compared to those of the previous month, and hypoglycemia was defined as blood glucose levels less than 60 mg/dl. Binary regression was used to predict the risk variables for hypoglycemia. Results The GDM and type 2 DM groups were similar in terms of age, parity, number of fasting days, and number of daily fasting hours. Only 26.9% of the women who were permitted to fast were given special instructions for Ramadan fasting. Dietary intervention was more common in the GDM group, whereas insulin and metformin treatment were more common in the type 2 DM group. The fasting glucose level decreased significantly after Ramadan fasting in both groups, from 92.5 (17.4) mg/dl to 90 (17.13) mg/dl (p = 0.033). However, there were a significantly higher number of hypoglycemia events in the type 2 DM group. Further, type 2 DM was identified as a risk factor for hypoglycemia (OR = 6.23; 95% CI = 1.04-37.54; P = 0.046. Conclusion The present findings indicate that Ramadan fasting may improve fasting glucose control. In addition, type 2 DM was identified as a risk factor for hypoglycemia.
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Affiliation(s)
- Salhah S Alsulami
- Department of Medicine, Faculty of Medicine Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kholoud A Ghamri
- Internal Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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6
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Denizli R, Sakcak B, Farisoğulları N, Erdinç AS, Kara Ö, Tanacan A, Şahın D. Effect of Ramadan Fasting in Turkey Upon Fetal Well-being and Perinatal Outcomes During the Last-Trimester of Pregnancy. JOURNAL OF RELIGION AND HEALTH 2023; 62:879-887. [PMID: 36689062 DOI: 10.1007/s10943-023-01744-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Ramadan, a one-month period in which eating and drinking are prohibited from sunrise to sunset, is considered sacred by Muslims. According to Islamic rules, fasting is obligatory for adults and healthy people, but patients and travelers are exempted from this rule. It is not clear whether pregnant women can fast during Ramadan. This cross-sectional case-control study included low-risk pregnant women at 32-37 weeks of gestation in Turkey. We examined healthy women in the last period of their pregnancy and found similar perinatal outcomes between the fasting and nonfasting participants. In the evaluation of fetal well-being, a decrease in the number of accelerations in the non-stress test (NST) and the need to repeat the test were found to be statistically significantly higher in fasting pregnant women. We consider that this may prolong the evaluation period and increase unnecessary hospitalizations due to nonreactive NST results. More randomized controlled trials are needed to conclude that fasting during pregnancy is safe.
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Affiliation(s)
- Ramazan Denizli
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, 06800, Turkey.
| | - Bedri Sakcak
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, 06800, Turkey
| | - Nihat Farisoğulları
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, 06800, Turkey
| | - Ayşe Seval Erdinç
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, 06800, Turkey
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Özgür Kara
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, 06800, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, 06800, Turkey
| | - Dilek Şahın
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, 06800, Turkey
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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7
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Chen YE, Loy SL, Chen LW. Chrononutrition during Pregnancy and Its Association with Maternal and Offspring Outcomes: A Systematic Review and Meta-Analysis of Ramadan and Non-Ramadan Studies. Nutrients 2023; 15:nu15030756. [PMID: 36771469 PMCID: PMC9921927 DOI: 10.3390/nu15030756] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Much evidence suggests that food intakes and eating patterns are major determinants of the phase of peripheral circadian clocks, and desynchronization between them is thought to contribute to the development of metabolic disorders. However, much remains to be understood about how different dimensions of chrononutrition during pregnancy affect pregnant women's and their offspring's health outcomes. Therefore, we systematically reviewed and integrated all emerging evidence on chrononutrition during pregnancy (including meal skipping, meal frequency, night eating, and (Ramadan) fasting) and their relationships with maternal and offspring outcomes. The results suggest that meal skipping and night eating during pregnancy were generally associated with adverse pregnancy and birth outcomes, whereas no strong conclusion could be reached for meal frequency. In our meta-analysis, Ramadan fasting did not seem to be related with birth weight or gestational age at birth, but evidence for other mother-offspring outcomes was inconsistent. To further elucidate the effect of chrononutrition factors on maternal and offspring health outcomes, larger and well-conducted prospective cohort and interventional studies are needed. In addition, information on covariates such as physical activity, sleep, diet quality and quantity, fasting days, fasting period per day, and trimester exposure should also be collected and considered during analysis.
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Affiliation(s)
- Yu-En Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17 Xu-Zhou Road, Taipei 10055, Taiwan
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Ling-Wei Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17 Xu-Zhou Road, Taipei 10055, Taiwan
- Master of Public Health Program, College of Public Health, National Taiwan University, No. 17 Xu-Zhou Road, Taipei 10055, Taiwan
- Correspondence:
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8
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Wang Z, Chaudhry M, Mistry R, Needham BL, Baylin A, Mancuso P, Singh K, Khandelwal S. A mixed-methods study on the dietary practices of early postpartum women during the summer rainy season in Belgaum, Karnataka, India. Ecol Food Nutr 2022; 61:728-752. [PMID: 36268551 DOI: 10.1080/03670244.2022.2136171] [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: 11/03/2022]
Abstract
The current mixed-method study uses Food Frequency Questionnaires and 24-hour dietary recalls (n = 41) to assess the food/nutrient intake; and qualitative interviews to identify local perceptions of food among 41 early postpartum women in Belgaum, India. The results show that total energy, protein, and most micronutrient intake were significantly lower than the Recommended Dietary Allowance of India (p < .05 individually); ninety percent of mothers restricted the consumption of some specific fruits, vegetables, and other foods during postpartum due to their perceptions of foods, folk medicines, and health beliefs. Culturally sensitive programs relevant to postpartum diet practices for women should be implemented.
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Affiliation(s)
- Zeyuan Wang
- Nutritional Science, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Monica Chaudhry
- Department of Public Health Nutrition, Public Health Foundation of India (PHFI), Delhi, India
| | - Ritesh Mistry
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Belinda L Needham
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Ana Baylin
- Nutritional Science, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Peter Mancuso
- Nutritional Science, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kalpana Singh
- Department of Public Health Nutrition, Public Health Foundation of India (PHFI), Delhi, India
| | - Shweta Khandelwal
- Department of Public Health Nutrition, Public Health Foundation of India (PHFI), Delhi, India
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9
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Uludağ E, Göral Türkcü S. Ramadan Fasting as a Religious Obligation: A Qualitative Study on Opinions and Experiences of Muslim Pregnant Women about Fasting in Turkey. JOURNAL OF RELIGION AND HEALTH 2022; 61:2960-2974. [PMID: 35612646 DOI: 10.1007/s10943-022-01588-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to examine opinions and experiences of Muslim pregnant women about Ramadan fasting in Turkey. The study had a descriptive, phenomenological design and included 17 Muslim pregnant women living in Turkey. Content analysis and word cloud analysis were performed. The content analysis revealed two themes. The most frequent words in the word cloud analysis were fasting, pregnancy, Ramadan, fast, religious duty, health, observing a missed fast, relief, concern, baby, thirsty and hungry. The findings of the study showed that religious beliefs, experiences, family and society pressured the pregnant women to keep Ramadan fasts. However, due to feeling worried about their own physical and psychological health and their infants, some of the women did not go on a fast. It can be recommended that pregnant women wanting to keep their fasts should be offered information about possible risks of fasting.
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Affiliation(s)
- Elif Uludağ
- Faculty of Health Science, Pamukkale University, Denizli, Turkey.
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10
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Caron JP, Kreher MA, Mickle AM, Wu S, Przkora R, Estores IM, Sibille KT. Intermittent Fasting: Potential Utility in the Treatment of Chronic Pain across the Clinical Spectrum. Nutrients 2022; 14:nu14122536. [PMID: 35745266 PMCID: PMC9228511 DOI: 10.3390/nu14122536] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
Dietary behavior can have a consequential and wide-ranging influence on human health. Intermittent fasting, which involves intermittent restriction in energy intake, has been shown to have beneficial cellular, physiological, and system-wide effects in animal and human studies. Despite the potential utility in preventing, slowing, and reversing disease processes, the clinical application of intermittent fasting remains limited. The health benefits associated with the simple implementation of a 12 to 16 h fast suggest a promising role in the treatment of chronic pain. A literature review was completed to characterize the physiologic benefits of intermittent fasting and to relate the evidence to the mechanisms underlying chronic pain. Research on different fasting regimens is outlined and an overview of research demonstrating the benefits of intermittent fasting across diverse health conditions is provided. Data on the physiologic effects of intermittent fasting are summarized. The physiology of different pain states is reviewed and the possible implications for intermittent fasting in the treatment of chronic pain through non-invasive management, prehabilitation, and rehabilitation following injury and invasive procedures are presented. Evidence indicates the potential utility of intermittent fasting in the comprehensive management of chronic pain and warrants further investigation.
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Affiliation(s)
- Jesse P. Caron
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
| | - Margaret Ann Kreher
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
| | - Angela M. Mickle
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
| | - Stanley Wu
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
| | - Rene Przkora
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
- Department of Anesthesiology, Division of Pain Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Irene M. Estores
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
| | - Kimberly T. Sibille
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
- Department of Anesthesiology, Division of Pain Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
- Correspondence:
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11
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Prates KV, Pavanello A, Gongora AB, Moreira VM, de Moraes AMP, Rigo KP, Vieira E, Mathias PCDF. Time-restricted feeding during embryonic development leads to metabolic dysfunction in adult rat offspring. Nutrition 2022; 103-104:111776. [DOI: 10.1016/j.nut.2022.111776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022]
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12
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Ekhzaimy A, Alkatari S, AlMaatouq M, Alotaibi D, Aljasser S, Aseeri A, Jammah A, Mujammami M, Fouda M, Alfadda AA, Sulaimani R. Fructosamine as an Index of Short-Term Glycemic Control in Pregnant Women with Diabetes: Before, During and After Ramadan. Int J Womens Health 2022; 14:435-444. [PMID: 35386939 PMCID: PMC8978904 DOI: 10.2147/ijwh.s351654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Impact of ramadan fasting on healthy and women with diabetes is already known. However, there is a scarcity of data on impact of fasting on pregnant women with diabetes. Moreover, religious and medical recommendations advise pregnant women against fasting as it is unsafe. Despite being exempted, many pregnant Muslim women with diabetes still choose to fast during ramadan. This study investigated different glycemic marker as an indicator for diabetes control in fasting pregnant women. Patients and Methods This is a prospective observational study. A total of 89 pregnant diabetes women were recruited. Blood glucose was self-monitored in all the pregnant women using glucose monitoring device at home. We measure the fructosamine, HbA1c levels before, during and after ramadan. Results Pregnant women with type 1 diabetes were 14 (25%), type 2 diabetes were 21 (37.5%), and gestational diabetes were 21 (37.5%). The mean fructosamine level decreased during and after ramadan in gestation diabetes pregnant women compared to type 2 diabetes and type 1 diabetes pregnant women subjects (p = 0.009). Conclusion The present study indicates that pregnant women with diabetes were able to fast during ramadan and there fructosamine level reduced during fasting. Utilization of fructosamine for short-term monitoring of glycemic control in addition to home glucose monitoring in pregnant women with diabetes will provide a good index of glycemic control. Recommendation Religious and medical recommendations advise pregnant women against fasting as it is unsafe, and they are under high risk. However, if they insist to do fast, they must do under strict medical supervision and fructosamine can be used as a glycemic control marker.
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Affiliation(s)
- Aishah Ekhzaimy
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Shadin Alkatari
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed AlMaatouq
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Daad Alotaibi
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sarah Aljasser
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Amal Aseeri
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Anwar Jammah
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Muhammad Mujammami
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.,University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mona Fouda
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Assim A Alfadda
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Obesity Research Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Riad Sulaimani
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
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13
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Kumar S, Diamond T. Ramadan Fasting and Maternal and Fetal Outcomes in Pregnant Women with Diabetes Mellitus: Literature Review. Front Endocrinol (Lausanne) 2022; 13:900153. [PMID: 35813638 PMCID: PMC9263982 DOI: 10.3389/fendo.2022.900153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
There is an emerging Muslim and diabetic population in the United States and other Western countries and majority of pregnant women and patients with diabetes mellitus choose to fast during Ramadan. Fasting during Ramadan in pregnant women with diabetes may represent a 'perfect storm' of metabolic disturbances including hyperglycemia, hypoglycemia and ketosis. Recent continuous and flash glucose monitoring data suggests increased glycemic variability (fasting hypo- and post-Iftar hyperglycemia) in non-pregnant patients with diabetes during Ramadan. Only five small-scale studies, predominantly focused on women with gestational diabetes mellitus in Muslim-majority nations have explored maternal glycemic outcomes during Ramadan which is associated with lower mean blood glucose levels and higher frequency of fasting hypoglycemia. Data is limited however on important clinical outcomes such as symptomatic and serious hypoglycemia requiring hospitalization. Results have been conflicting regarding maternal Ramadan fasting and association with fetal outcomes in women without diabetes. Only one recently published study reported on perinatal outcomes in pregnant women with gestational diabetes which found no effect of Ramadan exposure on mean birthweight or macrosomia frequency but lower neonatal hypoglycemia prevalence, however a significant limitation was lack of documentation of maternal fasting status. At this stage, due to paucity of data, the current medical recommendation is against Ramadan fasting for pregnant Muslim women with diabetes. Large-scale population-based studies are warranted regarding maternal and fetal outcomes in pregnant fasting women with diabetes and such studies should characterize maternal fasting status and have meaningful and consistent clinical outcomes. High-quality data derived from these studies can assist clinicians in providing more evidence-based advice to safely navigate both mother and fetus through a potentially challenging pregnancy.
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14
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Flanagan EW, Kebbe M, Sparks JR, Redman LM. Assessment of Eating Behaviors and Perceptions of Time-Restricted Eating During Pregnancy. J Nutr 2021; 152:475-483. [PMID: 35051269 PMCID: PMC8826837 DOI: 10.1093/jn/nxab397] [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: 08/02/2021] [Revised: 09/20/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The maternal metabolic milieu is challenged during pregnancy and may result in unwarranted metabolic complications. A time-restricted eating (TRE) pattern may optimize the metabolic response to pregnancy by improving glucose metabolism and reducing circulating glucose concentrations, as it does in nonpregnant individuals. OBJECTIVES The objectives of this study were to 1) assess eating timing in pregnant women; 2) understand the perceptions of adopting a TRE pattern; 3) determine the barriers and support mechanisms for incorporating a TRE pattern; and 4) identify those most willing to adopt a TRE pattern during pregnancy. METHODS This was a cross-sectional quantitative and quasi-qualitative online survey study for women who were pregnant at the time of study completion or had given birth in the prior 2 years. Group analyses were performed based off willingness to try a TRE pattern using chi-squared analyses, independent samples t-tests, or an analysis of variance. Three separate reviewers reviewed qualitative responses. RESULTS A total of 431 women (BMI, 27.5 ± 0.3 kg/m2) completed the study. Of the participating women, 23.7% reported willingness to try a TRE pattern during pregnancy. Top barriers to adopting a TRE pattern during pregnancy were concerns for 1) safety; 2) nausea; and 3) hunger. The highest ranked support mechanisms were: 1) the ability to choose the eating window; 2) more frequent prenatal visits to ensure the health of the baby; and 3) receiving feedback from a dietician/nutritionist. Women who did not identify as White/Caucasian expressed a higher willingness to try a TRE pattern during pregnancy (P = 0.01). Women who were nulliparous expressed a higher willingness to try a TRE pattern (P = 0.05). DISCUSSION TRE, an alternative dietary strategy shown to optimize metabolic control, may be effective to prevent and manage pregnancy-related metabolic impairments. To create an effective TRE intervention during pregnancy, the input of pregnant mothers is necessary to increase adherence and acceptability.
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Affiliation(s)
| | - Maryam Kebbe
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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15
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Bernier J, Bilodeau-Bertrand M, Djeha A, Auger N. Ramadan exposure during early pregnancy and risk of stillbirth in Arab women living in Canada. Paediatr Perinat Epidemiol 2021; 35:689-693. [PMID: 34080705 DOI: 10.1111/ppe.12761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Data on fasting during Ramadan and the risk of preterm birth and child mortality are conflicting, but the association with stillbirth is unknown. OBJECTIVE We studied the relationship between Ramadan and the risk of stillbirth for Arab women in Quebec, Canada. METHODS We conducted a retrospective cohort study using birth certificates for Arab women in Quebec, Canada, between 1981 and 2017. The exposure was Ramadan in the first and second trimester (1-27 weeks of gestation), and the outcome was early (<28 weeks) or late (≥28 weeks) stillbirth. We used log-binomial regression models to estimate risk ratios (RR) and 95% confidence intervals (CI) for the association between Ramadan and risk of stillbirth. We adjusted models for maternal characteristics and assessed associations by cause of death. RESULTS The study included 78,349 live births and 274 stillbirths. There were 3.5 stillbirths per 1,000 pregnancies for women exposed to Ramadan between weeks 1-27 of gestation (95% CI 3.0, 4.0), and 3.4 per 1,000 for unexposed women (95% CI 2.8, 4.1). Compared with no exposure, Ramadan between weeks 1-27 was not associated with the risk of early (RR 1.32, 95% CI 0.76, 2.28) or late stillbirth (RR 0.93, 95% CI 0.70, 1.23) in adjusted models. RRs for early stillbirth were 1.40 for Ramadan between weeks 15-21 (95% CI 0.70, 2.80) and 1.38 for Ramadan between weeks 22-27 (95% CI 0.67, 2.84). Relative to no exposure, Ramadan between weeks 15-21 was associated with early stillbirth due to congenital anomaly (RR 3.96; 95% CI 1.35, 11.57) in unadjusted models. There was no association with other causes of stillbirth. CONCLUSIONS There is no evidence that Ramadan is associated with the risk of early or late stillbirth overall. Further research is needed to confirm an association with stillbirth due to congenital anomalies.
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Affiliation(s)
- Julie Bernier
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | | | - Améyo Djeha
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Nathalie Auger
- Institut national de santé publique du Québec, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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16
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Ramadan Fasting during Pregnancy and Health Outcomes in Offspring: A Systematic Review. Nutrients 2021; 13:nu13103450. [PMID: 34684451 PMCID: PMC8540108 DOI: 10.3390/nu13103450] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022] Open
Abstract
Ramadan is one of the five pillars of Islam, during which fasting is obligatory for all healthy individuals. Although pregnant women are exempt from this Islamic law, the majority nevertheless choose to fast. This review aims to identify the effects of Ramadan fasting on the offspring of Muslim mothers, particularly on fetal growth, birth indices, cognitive effects and long-term effects. A systematic literature search was conducted until March 2020 in Web of Science, Pubmed, Cochrane Library, Embase and Google Scholar. Studies were evaluated based on a pre-defined quality score ranging from 0 (low quality) to 10 (high quality), and 43 articles were included. The study quality ranged from 2 to 9 with a mean quality score of 5.4. Only 3 studies had a high quality score (>7), of which one found a lower birth weight among fasting women. Few medium quality studies found a significant negative effect on fetal growth or birth indices. The quality of articles that investigated cognitive and long-term effects was poor. The association between Ramadan fasting and health outcomes of offspring is not supported by strong evidence. To further elucidate the effects of Ramadan fasting, larger prospective and retrospective studies with novel designs are needed.
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17
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Meal Timing and Glycemic Control during Pregnancy-Is There a Link? Nutrients 2021; 13:nu13103379. [PMID: 34684381 PMCID: PMC8540614 DOI: 10.3390/nu13103379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 02/06/2023] Open
Abstract
Hyperglycemia during pregnancy and gestational diabetes mellitus (GDM) constitute an important public health problem due to their prevalence and long-term health consequences both for the mother and offspring. Results from studies in rodents and some clinical investigations suggest that meal time manipulation may be a potential lifestyle approach against conditions involving perturbations in glucose homeostasis (e.g., hyperglycemia, insulin resistance, diabetes, etc.). The purpose of this review is to summarize and critically evaluate the current literature on the role of meal timing and daily nutrient distribution on glycemic control during pregnancy. Only a small number of mostly observational studies have assessed the role of meal timing in glucose homeostasis during pregnancy. Food consumption earlier in the day and short-term fasting with adequate nutrient intake may improve glycemic control during the second and third trimester of gestation. Considering that the field of chrononutrition is still in its infancy and many questions remain unanswered, future prospective and carefully designed studies are needed to better understand the role of meal timing in metabolic homeostasis and maternal and fetal health outcomes during pregnancy.
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18
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Hossain N, Samuel M, Mughal S, Shafique K. Ramadan Fasting: Perception and maternal outcomes during Pregnancy. Pak J Med Sci 2021; 37:1262-1267. [PMID: 34475896 PMCID: PMC8377932 DOI: 10.12669/pjms.37.5.4109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives: To see perception and knowledge of women about Ramadan fasting and maternal effects of fasting. Methods: The study design was prospective, case-controlled. This study was conducted at Holy Family Hospital from 1st May 2020 to July 2020. Pregnant women with spontaneous conception and singleton pregnancies, who fasted for seven or more days, were cases, and those who did not fast were taken as controls. Questionnaire was filled regarding perception of women about maternal fasting. Primary maternal outcomes included preterm delivery, pregnancy induced hypertension, and gestational diabetes mellitus. The analysis was conducted using Statistical Package for Social Sciences version 16.0. Results: A total of 215 women were included in the study, 123 women fasted, and 92 women did not fast. Only 2.8% of women knew that fasting is forbidden in pregnancy. Sixty five percent of women reported weakness as the main reason for not fasting. The rate of gestational diabetes, pregnancy induced hypertension and preterm delivery was higher among women who fasted (17% vs 14%, 7% vs 2%, 9% vs 9%) respectively, compared to non-fasting women, but were not found statistically significant. There was no difference in anthropometric measurements of newborn, among both groups. Conclusion: Ramadan fasting does not affect maternal outcomes during pregnancy.
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Affiliation(s)
- Nazli Hossain
- Nazli Hossain, FCPS, MBE. Department of Obstetrics & Gynecology Unit II, Dow Medical College & Ruth Pfau KM Civil Hospital, Karachi, Pakistan
| | - Mahwish Samuel
- Mahwish Samuel, MBBS. Resident Trainee, Holy Family Hospital, Karachi, Pakistan
| | - Saba Mughal
- Saba Mughal, M.Phil. School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Kashif Shafique
- Kashif Shafique, MBBS, MPH, PhD. School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
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19
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Beshyah SA, Ali KF, Hajjaji IM, Hafidh K, Raza SA, Ghour N, Khochtali I. Knowledge gaps and perceptions of future research directions on management of diabetes during Ramadan fasting: An online survey of physicians. Diabetes Res Clin Pract 2021; 177:108923. [PMID: 34146601 DOI: 10.1016/j.diabres.2021.108923] [Citation(s) in RCA: 4] [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: 11/10/2020] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Current knowledge and research on diabetes and Ramadan form the basis for evidence-based clinical practice. In this context, we aimed to explore physicians' perceptions of current knowledge gaps about research fasting (RF), barriers to, and foreseeable directions for advancement of the field. METHODS We conducted an online survey of a convenience sample of 260 physicians from 27 countries. The survey questionnaire addressed three main domains: perceived current knowledge gaps and unmet needs in research about RF and diabetes, barriers to the conduct of research, and future directions for furthering the evidence in this field. RESULTS Majority of respondents (65.7%) were senior physicians in adult endocrinology/diabetes (45.9%) working at tertiary centers (65.2%). The majority (67.3%) reported seeing an average of 20+ patients with diabetes weekly and felt "very or fairly confident" in managing diabetes during RF (67.7%). The knowledge gaps identified were the management of high-risk patients with diabetes (54.1%), such as renal impairment (59.8%), and pregnancy (61.5%). The main barriers to research were lack of adequate funding to academic centers (75.7%) and lack of interest of institutions in the subject (64.6%). Future efforts should be directed at the conduct of large epidemiological studies (49.5%) or double-blinded, placebo-controlled clinical trials (48.6%) to address the former gaps. Research findings should be widely disseminated via hands-on workshops (recommended by 70.3% of respondents) or international conferences (61.2%). CONCLUSIONS There is a wide agreement regarding the knowledge gaps in the management of diabetes during RF. Future efforts should focus on addressing these critical deficiencies.
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Affiliation(s)
- Salem A Beshyah
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates.
| | - Khawla F Ali
- Department of Medicine, Royal College of Surgeons in Ireland Medical University of Bahrain, Adliya, Bahrain.
| | - Issam M Hajjaji
- Department of Medicine, Faculty of Medicine, University of Tripoli, Tripoli, Libya; National Centre for Diabetes, Tripoli, Libya
| | - Khadija Hafidh
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates; Department of Diabetes and Endocrinology, Rashid Hospital, DHA, Dubai, United Arab Emirates
| | - Syed Abbas Raza
- Department of Endocrinology, Shaukat Khanum Hospital, and Research Center, Lahore, Pakistan
| | - Nazim Ghour
- Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom; Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, United Kingdom; University of Glasgow, Glasgow, Scotland, United Kingdom.
| | - Ines Khochtali
- Endocrinology and Internal Medicine Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
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20
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Alshamrani A, Aldahmash W, Falodah F, Arafah M, Harrath AH, Alwasel S. Long-Term but Not Short-Term Maternal Fasting Reduces Nephron Number and Alters the Glomerular Filtration Barrier in Rat Offspring. Life (Basel) 2021; 11:life11040318. [PMID: 33917410 PMCID: PMC8067523 DOI: 10.3390/life11040318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 01/04/2023] Open
Abstract
The present study examined the effects of maternal Ramadan-type fasting during selected days in the first, second, or third trimester, or during the entire pregnancy, on the kidney structure of male rat offspring. Pregnant rats were provided with food ad libitum during pregnancy (control group, C), or they were exposed to 16 h of fasting/day for three consecutive days in the middle of the first (FT1), second (FT2), or third trimester (FT3), or during whole pregnancy (FWP). Our results showed that dams in the FWP group demonstrated lower food intake and body weight during gestation. Litter size was unaltered by fasting in all groups; however, litter weight was significantly reduced only in the FWP group. Nephron number was decreased in the FWP group, but it remained unchanged in the other fasting groups. The ultrastructure of the glomerular filtration barrier indicated that the kidneys of offspring of the FWP group demonstrated wider diameters of fenestrations and filtration slits and smaller diameters of basement membranes. This was reflected by a significant increase in proteinuria in FWP only. These results suggest that, unlike with short-term fasting, which seems to be safe, maternal long-term fasting induces structural changes that were non-reversible, and that may contribute to impaired renal function, leading to chronic diseases in later life.
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Affiliation(s)
- Abdullah Alshamrani
- Zoology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (A.A.); (W.A.); (F.F.); (A.H.H.)
| | - Waleed Aldahmash
- Zoology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (A.A.); (W.A.); (F.F.); (A.H.H.)
| | - Fawaz Falodah
- Zoology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (A.A.); (W.A.); (F.F.); (A.H.H.)
| | - Maria Arafah
- Department of Pathology, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Abdel Halim Harrath
- Zoology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (A.A.); (W.A.); (F.F.); (A.H.H.)
| | - Saleh Alwasel
- Zoology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (A.A.); (W.A.); (F.F.); (A.H.H.)
- Correspondence:
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21
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Hassanein M, Abuelkheir S, Alsayyah F, Twair M, Abdelgadir E, Basheir A, Rashid F, Al Saeed M, Eltayb F, Abdellatif M, Khalifa A, Alawadi F. Evaluation of optimum diabetes care on glycemic control of patients with gestational diabetes during Ramadan fasting. Diabetes Res Clin Pract 2021; 173:108669. [PMID: 33460717 DOI: 10.1016/j.diabres.2021.108669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022]
Abstract
AIMS There is limited evidence that evaluates the impact of fasting during Ramadan in pregnant women. We explored the safety of fasting in Gestational Diabetes Mellitus (GDM) in Ramadan, while understating the glycemic variability. METHODS 25 patients with GDM who choose to fast, were enrolled and provided optimum care that included Ramadan focused education and FreeStyle LibreFlashContinuous Glucose Monitoring(FSL-CGM) was utilized for 2-4 weeks assessment period of non-Ramadan days plus 2-3 weeks during Ramadan and medication adjustment. RESULTS The average glucose improved significantly, while time in target and percent above target numerically improved during Ramadan compared to pre-Ramadan. There was significant increment on the number of hypoglycemic events in Ramadan. The average lowest blood glucose reading reduced significantly by 14 mg/dL with average duration of hypoglycemic events increased significantly by 38.5 min. CONCLUSION Our study reinforces the importance of structured education before Ramadan to deliver optimal care for the management of diabetes. Strikingly FSL-CGM demonstrated that hypoglycemia is significantly increased during Ramadan Fasting. There was effective reflection of hyperglycemic spikes, immediately post Iftar. The results corroborated with the earlier studies for higher frequency of hypoglycemia during Ramadan fasting, under similar standards of care in high-risk patients with diabetes.
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Affiliation(s)
- Mohamed Hassanein
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates.
| | - Sona Abuelkheir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fatima Alsayyah
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Manal Twair
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Elamin Abdelgadir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Alaaeldin Basheir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fauzia Rashid
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Maryam Al Saeed
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fawzi Eltayb
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Mohammed Abdellatif
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Azza Khalifa
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
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22
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Seiermann AU, Al-Mufti H, Waid JL, Wendt AS, Sobhan S, Gabrysch S. Women's fasting habits and dietary diversity during Ramadan in rural Bangladesh. MATERNAL AND CHILD NUTRITION 2021; 17:e13135. [PMID: 33522117 PMCID: PMC8189200 DOI: 10.1111/mcn.13135] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 01/01/2023]
Abstract
Little is known about fasting practices and dietary changes during Ramadan in low‐ and lower‐middle‐income countries. Although pregnant women are exempt from fasting, they may still fast. This is of interest as dietary habits during pregnancy may affect the development of the unborn child. In a community‐based sample of young women in rural Sylhet division, Bangladesh, we described fasting practices and beliefs (n = 852). We also examined reported food group consumption and minimally adequate dietary diversity for women (MDD‐W) by Ramadan occurrence (n = 1,895) and by fasting adherence (n = 558) using logistic regression with Hindu women as a seasonal control. During Ramadan in 2018, 78% of pregnant Muslim women fasted every day. Over 80% of Muslim women believe that they should fast during pregnancy and over 50% expect positive health effects on the mother and the unborn child. We found strong evidence that Muslim women have more diverse diets during Ramadan, with higher odds of MDD‐W (OR [95% CI]: 5.0 [3.6, 6.9]) and increased consumption of pulses, dairy, fruit, and large fish. Dietary diversity increased to a lesser extent on non‐fasting days during Ramadan. Ramadan appears to improve dietary quality in both fasting and non‐fasting Muslim women in a rural population in Bangladesh. These results help to interpret findings from studies on Ramadan during pregnancy on later‐life outcomes and thus contribute to a better understanding of intrauterine influences of maternal nutrition on healthy child development.
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Affiliation(s)
- Andrea U Seiermann
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hudaalrahman Al-Mufti
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Nineveh Directorate of Health, Ministry of Health, Nineveh, Iraq
| | - Jillian L Waid
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Amanda S Wendt
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Shafinaz Sobhan
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Gabrysch
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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23
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Al-Rifai RH, Abdo NM, Paulo MS, Saha S, Ahmed LA. Prevalence of Gestational Diabetes Mellitus in the Middle East and North Africa, 2000-2019: A Systematic Review, Meta-Analysis, and Meta-Regression. Front Endocrinol (Lausanne) 2021; 12:668447. [PMID: 34512543 PMCID: PMC8427302 DOI: 10.3389/fendo.2021.668447] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED Women in the Middle East and North Africa (MENA) region are burdened with several risk factors related to gestational diabetes mellitus (GDM) including overweight and high parity. We systematically reviewed the literature and quantified the weighted prevalence of GDM in MENA at the regional, subregional, and national levels. Studies published from 2000 to 2019 reporting the prevalence of GDM in the MENA region were retrieved and were assessed for their eligibility. Overall and subgroup pooled prevalence of GDM was quantified by random-effects meta-analysis. Sources of heterogeneity were investigated by meta-regression. The risk of bias (RoB) was assessed by the National Heart, Lung, and Blood Institute's tool. One hundred and two research articles with 279,202 tested pregnant women for GDM from 16 MENA countries were included. Most of the research reports sourced from Iran (36.3%) and Saudi Arabia (21.6%), with an overall low RoB. In the 16 countries, the pooled prevalence of GDM was 13.0% (95% confidence interval [CI], 11.5-14.6%, I2 , 99.3%). Nationally, GDM was highest in Qatar (20.7%, 95% CI, 15.2-26.7% I2 , 99.0%), whereas subregionally, GDM was highest in Gulf Cooperation Council (GCC) countries (14.7%, 95% CI, 13.0-16.5%, I2 , 99.0%). The prevalence of GDM was high in pregnant women aged ≥30 years (21.9%, 95% CI, 18.5-25.5%, I2 , 97.1%), in their third trimester (20.0%, 95% CI, 13.1-27.9%, I2 , 98.8%), and who were obese (17.2%, 95% CI, 12.8-22.0%, I2 , 93.8%). The prevalence of GDM was 10.6% (95% CI, 8.1-13.4%, I2 , 98.9%) in studies conducted before 2009, whereas it was 14.0% (95% CI, 12.1-16.0%, I2 , 99.3%) in studies conducted in or after 2010. Pregnant women in the MENA region are burdened with a substantial prevalence of GDM, particularly in GCC and North African countries. Findings have implications for maternal health in the MENA region and call for advocacy to unify GDM diagnostic criteria. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018100629.
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Affiliation(s)
- Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- *Correspondence: Rami H. Al-Rifai,
| | - Noor Motea Abdo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marília Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sumanta Saha
- Department of Community Medicine, R. G. Kar Medical College, Kolkata, India
| | - Luai A. Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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24
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de Diego-Cordero R, Rivilla-Garcia E, Diaz-Jimenez D, Lucchetti G, Badanta B. The role of cultural beliefs on eating patterns and food practices among pregnant women: a systematic review. Nutr Rev 2020; 79:945-963. [PMID: 33119079 DOI: 10.1093/nutrit/nuaa119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
CONTEXT Despite the importance of cultural beliefs in clinical practice, few systematic reviews have investigated how these beliefs influence food practices in pregnant women. OBJECTIVE To explore the role of cultural beliefs in eating patterns and food practices among pregnant women, highlighting food recommendations, food taboos and restrictions, and their association with health. DATA SOURCES A systematic review was conducted using the following electronic databases: PubMed, Scopus, CINAHL, PsycINFO, and Web of Science from May 2014 to May 2019. DATA EXTRACTION Articles were included if the studies included pregnant women, analyzed how cultural beliefs may influence eating patterns, were peer-reviewed articles with original data, published in the last 5 years, and in English or Spanish language. Quality assessment was also performed. DATA ANALYSIS A total of 544 articles were identified in the search and 24 were included in the final analysis (17 using qualitative design, 6 using quantitative design, and 1 with a mixed-design). These studies were predominantly from the African continent (n = 15). Our findings showed that culture is a key factor related to "taboos" and food restrictions, which are transmitted by the family or members of community, having a strong religious or spiritual influence. All these restrictions are related to the fear of unfavorable pregnancy outcomes such as the risk of abortion, dystocia, and congenital macrosomia, or are used to avoid child problems such as cutaneous and respiratory disorders. CONCLUSIONS Findings from this study indicate cultural beliefs are strongly associated with food patterns and eating habits in pregnant women. Administrators and health professionals should be aware of these beliefs to minimize problems in the perinatal period.
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Affiliation(s)
| | | | - Desireé Diaz-Jimenez
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, Seville, Spain
| | - Giancarlo Lucchetti
- Department of Medicine, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Bárbara Badanta
- Department of Nursing , Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, Seville, Spain
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Parveen R, Khakwani M, Latif M, Tareen AU. Maternal and Perinatal outcome after Ramadan Fasting. Pak J Med Sci 2020; 36:894-898. [PMID: 32704259 PMCID: PMC7372656 DOI: 10.12669/pjms.36.5.2612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To determine maternal and perinatal outcome after Ramadan fasting during pregnancy Methods: This cross sectional study was conducted at The Department of Obstetrics and Gynaecology, Nishtar Hospital, Multan from May to October 2019. A total of 226 women attending labour room, aged 18–35 years, having gestational amenorrhoea 15 – 40 weeks of gestation were included. Women who fasted for more than 15 days were compared with those who did not fast or fasted for less than 15 days in the month of Ramadan. Demographical profile along with maternal and perinatal outcomes were compared between the study groups considering p value less than 0.05 as significant. Results: Out of 226 women, 58 (25.7%) fulfilled the criteria to be included in the fasting group while remaining 168 (74.3%) were slotted in the non-fasting group. There was no difference (p value > 0.05) in between the both group with respect to demographical characteristics except significantly less women were employed in the fasting group (p value=0.0246). No statistical difference was found in terms of maternal or perinatal outcomes between both the study groups. Conclusion: Fasting women were not found to have poor maternal and fetal outcomes when compared to non-fasting women.
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Affiliation(s)
- Rashida Parveen
- Rashida Parveen, Department of Obstetrics and Gyne, Unit-II, Nishtar Medical University & Hospital, Multan, Pakistan
| | - Mehnaz Khakwani
- Mehnaz Khakwani, Department of Obstetrics and Gyne, Unit-II, Nishtar Medical University & Hospital, Multan, Pakistan
| | - Munazza Latif
- Munazza Latif, Department of Obstetrics and Gyne, Unit-II, Nishtar Medical University & Hospital, Multan, Pakistan
| | - Ayesha Uzaima Tareen
- Ayesha Uzaima Tareen, Department of Obstetrics and Gyne, Unit-II, Nishtar Medical University & Hospital, Multan, Pakistan
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26
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Safari K, Piro TJ, Ahmad HM. Correction to: Perspectives and pregnancy outcomes of maternal Ramadan fasting in the second trimester of pregnancy. BMC Pregnancy Childbirth 2019; 19:481. [PMID: 31815611 PMCID: PMC6900852 DOI: 10.1186/s12884-019-2647-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Kolsoom Safari
- Department of Midwifery, College of Nursing, Hawler Medical University, Erbil, Iraq.
| | - Tiran Jamil Piro
- Department of Midwifery, College of Nursing, Hawler Medical University, Erbil, Iraq
| | - Hamdia Mirkhan Ahmad
- Department of Basic Science, College of Basic Science, Hawler Medical University, Erbil, Iraq
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