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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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Ong AKW, Yee AL, Fong AJH, Arasoo VJT, Ramadas A. Effects of Ramadan fasting on fetal health: A systematic review. Aust N Z J Obstet Gynaecol 2023; 63:625-637. [PMID: 37283305 DOI: 10.1111/ajo.13706] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Ramadan fasting (RF) is mandatory for all healthy Muslims in the ninth month of the Islamic calendar. Although pregnant women are exempt from fasting, many make the decision to practise it. Concerns that fasting during pregnancy harms the fetus remain, as there are no firm recommendations regarding its safety. OBJECTIVES To provide a systematic review on the effects of RF on fetal health. SEARCH STRATEGY We conducted a literature search for peer-reviewed articles through Ovid MEDLINE, PubMed, SCOPUS, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) until 31 December 2021. SELECTION CRITERIA All case-control and observational cohort studies that reported on fetal outcomes of pregnant women who underwent RF for at least one day during pregnancy are included. DATA COLLECTION AND ANALYSIS Two researchers independently reviewed the eligibility of all studies. A third researcher resolved any conflict between researchers. Findings are extracted from eligible papers and presented as narratives. MAIN RESULTS Fourteen articles are included based on eligibility criteria, with a total sample size of 2889. Studies demonstrate negative associations between RF and neonatal weight, amniotic fluid index, preterm birth and growth parameters mainly during the second and third trimesters. However, the evidence is not strongly supported. CONCLUSION There is limited data to elucidate the relationship between RF and fetal health, hence the need for more studies to provide a better understanding.
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Affiliation(s)
- Andrew Khai Weyn Ong
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Anne Li Yee
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Adrian Jing Hong Fong
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | | | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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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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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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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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