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Effects of Fasting and a Medium Calorie Balanced Diet During the Holy Month Ramadan on Weight, BMI and Some Blood Parameters of Overweight Males
Abstract
Fasting during holy month, Ramadan, is a religious obligation for all adult healthy Muslims. During this month Muslims are allowed to eat and drink between sunset and dawn. However, they are not allowed to eat and drink after dawn. To assess the effects of fasting on weight, BMI (Body Mass Index) and some blood indices, we recruited 28 overweight male volunteers aged 20-26 years. They were on a balanced diet of 2000 calories, containing 70 g protein, 350 g carbohydrate and 35.5 g lipid during Ramadan, while they were on a free diet before Ramadan. Subjects were requested to drink more than 6 glasses (about 1.5 L) of water or fruit juice every night between sunset to dawn during Ramadan. Serum levels of glucose, cholesterol, triglyceride as well as weight and BMI were measured in all subjects one day before and after Ramadan. Fasting resulted in significant (p<0.05) decreases in the mean values of both, weight and the BMI. Similarly, the mean values of glucose and cholesterol were significantly decreased in subjects after Ramadan, although none of these decreases reached to a level with pathological significance. Conversely, no significant changes in serum levels of triglyceride were noted.
... Considering the IF protocols, we categorized them in Alternate-Day Fasting (ADF), Time-Restricted Fasting (TRF) and Religious Fasting (RF) as previously described [2]. The first group-ADF-included the following feeding + fasting protocols: 1 d + 1 d [22,29,33,55,61] [20,24], while the RF included exclusively Ramadan fasting [17,18,21,27,28,31,36,37,39,40,42,44,45,[48][49][50]52,53,57,59,60]. Importantly, ADF protocols also include the modified Alternate-Day Fasting regimens (mADF), since they may or may not include the possibility of consumption of up to 25% of the caloric needs on fasting days (between 300-600 Kcal). ...
... Data presented are related with and religious fasting (RF) and the metabolic conditions: healthy or disease condition, obesity, T2D or MetS. For each study, the square represents the mean difference between baseline and fasting conditions, with the horizontal line intersecting it as the lower and upper limits of the 95% confidence interval [17,18,21,27,28,31,36,37,39,40,42,44,45,[48][49][50]52,53,57,59,60]. Figure 3). With exception between the HDL-c studies, the heterogeneity between the studies compiling the data for LDL-c, total cholesterol and triglycerides was high (Table 4; Figure 6). ...
... Data are presented according to religious fasting (RF) and the metabolic conditions: healthy or disease condition, obesity, T2D or MetS. For each study, the square represents the mean difference between baseline and fasting conditions, with the horizontal line intersecting it as the lower and upper limits of the 95% confidence interval [17,18,21,28,36,37,39,40,45,[48][49][50]57]. Table 5). ...
Intermittent fasting (IF) is an emerging dietetic intervention that has been associated with improved metabolic parameters. Nowadays, the most common IF protocols are Alternate-Day Fasting (ADF) and Time-Restricted Fasting (TRF), but in this review and meta-analysis we have also considered Religious Fasting (RF), which is similar to TRF but against the circadian rhythm. The available studies usually include the analysis of a single specific IF protocol on different metabolic outcomes. Herein, we decided to go further and to conduct a systematic review and meta-analysis on the advantages of different IF protocols for metabolic homeostasis in individuals with different metabolic status, such as with obesity, diabetes mellitus type 2 (T2D) and metabolic syndrome (MetS). Systematic searches (PubMed, Scopus, Trip Database, Web of Knowledge and Embase, published before June 2022) of original articles in peer-review scientific journals focusing on IF and body composition outcomes were performed. Sixty-four reports met the eligibility criteria for the qualitative analysis and forty-seven for the quantitative analysis. Herein, we showed that ADF protocols promoted the major beneficial effects in the improvement of dysregulated metabolic conditions in comparison with TRF and RF protocols. Furthermore, obese and MetS individuals are the most benefited with the introduction of these interventions, through the improvement of adiposity, lipid homeostasis and blood pressure. For T2D individuals, IF impact was more limited, but associated with their major metabolic dysfunctions—insulin homeostasis. Importantly, through the integrated analysis of distinct metabolic-related diseases, we showed that IF seems to differently impact metabolic homeostasis depending on an individual’s basal health status and type of metabolic disease.
... In addition to its use in clinical practice, IF is also used in certain religious practices, notably a month-long period of Ramadan [18]. With fasting from "dawn to dusk," it can last 11-18 hours/day, depending on the geographic location and season of the year during which the Muslims abstain from ingesting food and liquids, making their intake exclusively nocturnal. ...
... Whereas the Ramadan fast is a form of IF practiced by millions of adult Muslims globally for a whole month [19], its common consequences are reduction in body weight, relative fat mass (FM) and resting basal metabolic rate (BMR) [18,20]. Moreover, the IF, related caloric restriction decreases total cholesterol, low-density lipoprotein (LDL) and fasting plasma glucose (FPG) levels [20]. ...
The Fasting, since prehistory , has been a part of human custom across the globe for health, ritualistic, mental and spiritual rejuvenation. Many of the notable physicians of ancient times recommended it as an integral component of curative and preventive strategies. Recent work on the usefulness of fasting has revealed that it is, undoubtedly, the most effective biological method of treatment. In addition to its significant role in the management of certain chronic diseases, it can arguably be suggested as a complementary therapy to immunization, to boost up immunity. Intermittent fasting (IF), the history of which is traced to Gautama Buddha, is an umbrella term for various eating patterns or cycles that switches between fasting and eating on a regular schedule. In addition to its use in clinical practice, IF is also used in certain religious practices with significant beneficial effects on health, notably a month-long period of Ramadan: fasting from "dawn to dusk". The resultant "metabolic switching " protects bodily organs against chronic diseases like type 2 diabetes, heart disease, age-related neurodegenerative disorders, even inflammatory bowel disease and many cancers. The fasting, an ancient ritual of worship, disciplines the body and soul and has existed in various forms in almost all the religions. The practice is mentioned in the Bible, the Qur'an, the Mahabharata, and the Upanishads. It is much more than usually thought abstinence from food and drinks. The fasting, created by divine wisdom, is an effective tool in setting boundaries for self-restraint. It aims at compliance with the divine command while keeping away from His prohibitions, developing self-discipline, forbearance, and righteousness. It should not be practiced just "going hungry" or a "dieting program". It needs to be accompanied by repentance, supplicant prayers and developing sense of empathy for those underprivileged .
... According to these results, the overall weight of subjects experienced a gradual decline toward the end of Ramadan. However, WHR and body fat percentage decreased only slightly, and these changes were not statistically significant, which seems to be in accordance with others studies (26)(27). Evidently, there is controversy in the results obtained by Saada Reduced body weight during Ramadan can be a direct result of decreased body water supplies that are associated with glycogen and decreased body tissues, along with certain degrees of hypohydration and volume concentration of the extracellular (28). ...
... and colleagues (2010) andChennaoui et al. (2009) (13,23).Ziaee, et al. (2006) In a study conducted on 81 male and female subjects, concluded that at the end of Ramadan, weight and body mass index (BMI) in both male and female subjects dropped(26).Salehi and colleagues (2007), noted an ample reduction in weight, BMI, blood glucose and cholesterol levels after a period of fasting in Ramadan(27).Chennaoui et al (2009) examined the effects of Ramadan fasting on physical performance and metabolic, hormonal, and inflammatory parameters in middledistance runners, concluding that weight and body fat percentage barely changed during Ramadan(13).Saada et al (2010) exhibited no changes in weight and BMI. However, the levels of glucose, HDL-C, urea, creatinine and protein had increased remarkably. ...
Introduction: Hunger and reduction in regular energy intake can lead to a number of problems based on their intensity. For instance, low energy level can cause blood cell production to decline or it may pose a higher risk of anemia. It can also weaken the immune system and platelet aggregation or negatively affect clot formation. This study aimed to have a closer look at fasting and regular physical activity and their impacts on body composition and blood hematological-biochemical parameters among professional wrestlers. Method: In this semi-experimental study, 9 subjects were selected by convenience sampling. The selected training program included participation in this exerciseprogram, 90 min per session, 6 times per week for a period of one month. Blood samples were obtained four times: before the start of Ramadan, 2 weeks after the start, during the last week and 2 weeks after the end of Ramadan. To make intra-group comparison, repeated measure analysis of variance was used. For all statistical comparisons, the level of significance was considered at PResults: Body weight and red blood cell count (RBC) dropped significantly at the end of Ramadan (Respectively P= 0.001 and P=0.034). However, the number of white blood cells (WBC) and circulating platelets (PLT) significantly increased during fasting (Respectively P= 0.048 and P=0.042). As a matter of fact, PLT and WBC were the only factors which dramatically increased during fasting. Intra-group variations of tetracycline (TC), low-density lipoprotein (LDL), LDL: high-density lipoprotein (HDL), triglyceride (TG): HDL and TC: HDL reduced at the end of Ramadan. However, HDL levels drastically increased during fasting (P≤0.05). Conclusion: Based on the results of the research, despite being a regular activity and fasting has beneficial effects on lipid profile in athletes, however, they can with tangible changes in hematological factors may lead to weaken the immune system of athletes.
... Além de ser usado para fins clínicos, o JI também está também implicado em muitas práticas religiosas. Um exemplo notável é o JI-Ramadão -a forma de JI universalmente mais estudada (49). Este tipo de JI resulta em reduções significativas ao nível do peso corporal, MG, IMC, taxa metabólica de repouso e secreção de hormonas anabólicas (e.g. ...
... adrenalina e glucagon) (43,70). Os efeitos do JI-Ramadão ao nível da composição corporal são secundários a aumentos na capacidade de mobilização de ácidos gordos saturados para processos metabólicos (44), diminuição inevitável na frequência das refeições (de 3-4/dia para 2/dia) e desidratação coerciva (49,54,56,71). No entanto, a perda ponderal é mais pronunciada em indivíduos que apresentam valores de IMC mais elevados (17,46). ...
The scientific community currently expresses a high level of interest in intermittent fasting - periods of voluntary abstinence from energy intake, ranging from several hours to days. Intermittent fasting is clinically relevant and may represent an effective non- pharmacological strategy to improve physical performance and body composition. It has been studied mainly in athletes during the religious period of Ramadan and in people predisposed to decrease body fat without loss of fat-free mass parallel. The purpose of this review is to provide an overview of the impact of intermittent fasting during Ramadan vs. non-Ramadan intermittent fasting in terms of physical performance and body composition. The literature shows some inconsistencies in terms of the interaction between intermittent fasting and physical performance. However, non-Ramadan intermittent fasting is found to be effective in improving maximal aerobic power. Nevertheless, this intervention reduces performance during the repeated sprints over the first few days of intervention. On the other hand, intermittent fasting during Ramadan being the maximum aerobic power and this is more expressive during the second half of this religious period. However, both interventions are manifestly innocuous in terms of muscle strength and anaerobic capacity. With regard to body composition, there is greater consensus. According to available data, both interventions encourage beneficial adaptations at this level. Still, fat loss is more pronounced with intermittent non-Ramadan fasting.
... [15,20] Studies discussed fasting among Type 2 diabetic patients during Ramadan showed discrepancy in BG level changes. [3,4,29,30] These differences could be attributed to the changes in the pattern and duration of fasting in the religion. Other factors, such as amount or type of the food and decreased physical activities during fast, also could modulate metabolic effects of religious fasting. ...
Context: Religious fasting has a variable metabolic impact health. Studies on Orthodox Christian fasting in diabetic patients are very scarce, and studies on health effects of Christian fasting in Egypt are lacking. Objective: The objective of the study is to evaluate the effect of fasting among Egyptian Coptic Orthodox Christians with and without Type 2 diabetes mellitus (DM). Settings and Design: A prospective study was conducted in Sohag San George Church and involved 49 Egyptian Coptic Orthodox Christians with Type 2 DM and 48 non-diabetic persons during the period of Great Lent 2013. Subjects and Methods: Both diabetic and non-diabetic groups were subjected to clinical evaluation, anthropometric measurements and laboratory investigations before and after fasting. Statistical Analysis Used: Statistical analysis was conducted using SPSS (11.0) for Windows and P < 0.05 considered as statistically significant. Results: Among the diabetic group, there was a significant reduction in systolic and diastolic blood pressure after fasting with P = 0.0001 and 0.047, respectively. Body mass index (BMI) and waist circumference were reduced significantly after fasting with P = 0.0005 and 0.001, respectively. Significant reduction in glycosylated haemoglobin after fasting was also detected. No significant change lipid profile was detected. Among non-diabetic group, significant decrease in BMI, waist circumference and high-density lipoprotein level was detected after fasting. There were no significant changes in blood pressure, triglycerides, cholesterol and low-density lipoprotein levels. Conclusion: Fasting among Egyptian Coptic Orthodox Christians has positive impacts on health among patients with Type 2 DM. It also showed some beneficial effects among fasting non-diabetic individuals.
... Moreover, a study conducted in Shiraz, Iran, showed a significant reduction in weight and BMI among overweight males. This was explained by the possible effect of drinking large quantities of fluids, which may have suppressed appetite and restricted food consumption (36). In another study, drinking excessive amounts of water induced an increase in thermogenesis through an increase in sympathetic nervous system activity and energy expenditure and was thus considered a possible reason for weight loss (37). ...
Introduction: Many changes occur in Muslims’ lives during Ramadan that affect body weight, diet and calorie intake. This study investigated the impacts of fasting during Ramadan on the daily habits, diet, and weight of people with diabetes in Saudi Arabia. Methods: A cohort study analyzed 104 Saudi individuals with diabetes (42 and 62 patients with type I and type II diabetes, respectively) aged ≥ 20 years who fasted a minimum of 15 days during Ramadan. The patients were seen twice per study period (before and during Ramadan). The patients’ demographic data was obtained, their average daily food intake was assessed, and anthropometric parameters were measured. Results: During Ramadan, 52% of patients with type I DM and 66% of patients with type II DM did not perform any physical activity compared to 37% and 42%, respectively, pre-Ramadan. A high percentage of patients slept during the daytime. A paired-sample T test analysis showed that during Ramadan, the calorie intake and carbohydrate intake increased significantly in patients with type II diabetes (p = 0.03). Protein intake remained unchanged, whereas fat consumption increased in patients with both types of diabetes (p = 0.03 and 0.04, respectively). In addition, there was a decrease in anthropometric parameters (statistically significant in patients with type II diabetes, p < 0.05). Conclusion: Ramadan fasting changed the dietary and daily habits of patients with diabetes in Saudi Arabia and had beneficial effects on weight, mainly in patients with type II DM.
... Moreover, a study conducted in Shiraz, Iran, showed a significant reduction in weight and BMI among overweight males. This was explained by the possible effect of drinking large quantities of fluids, which may have suppressed appetite and restricted food consumption (36). In another study, drinking excessive amounts of water induced an increase in thermogenesis through an increase in sympathetic nervous system activity and energy expenditure and was thus considered a possible reason for weight loss (37). ...
Introduction: Many changes occur in Muslims' lives during Ramadan that affect body weight, diet and calorie intake. This study investigated the impacts of fasting during Ramadan on the daily habits, diet, and weight of people with diabetes in Saudi Arabia. Methods: A cohort study analyzed 104 Saudi individuals with diabetes (42 and 62 patients with type I and type II diabetes, respectively) aged ≥ 20 years who fasted a minimum of 15 days during Ramadan. The patients were seen twice per study period (before and during Ramadan). The patients' demographic data was obtained , their average daily food intake was assessed, and anthropometric parameters were measured. Results: During Ramadan, 52% of patients with type I DM and 66% of patients with type II DM did not perform any physical activity compared to 37% and 42%, respectively, pre-Ramadan. A high percentage of patients slept during the daytime. A paired-sample T test analysis showed that during Ramadan, the calorie intake and carbohydrate intake increased significantly in patients with type II diabetes (p = 0.03). Protein intake remained unchanged, whereas fat consumption increased in patients with both types of diabetes (p = 0.03 and 0.04, respectively). In addition, there was a decrease in anthropometric parameters (statistically significant in patients with type II diabetes, p < 0.05). Conclusion: Rama-dan fasting changed the dietary and daily habits of patients with diabetes in Saudi Arabia and had beneficial effects on weight, mainly in patients with type II DM.
https://iksadyayinevi.com/wp-content/uploads/2022/12/TEMEL-TIP-BILIMLERINDE-MULTIDISIPLINER-BAKIS-1.pdf
Aims
The primary goal of this meta-analysis was to examine the changes in various components of metabolic syndrome (MetS) in healthy adults who observed Ramadan fasting (RF) before Ramadan (T1) and at the end of RF (T2). A secondary goal was to assess the impact of RF on MetS severity in various ethnic and sex groups using the MetS z-score.
Data synthesis
Using PRISMA2020, seven databases were searched for relevant studies published between January 1950 and March 2022. Data extraction involved high-density lipoprotein cholesterol (HDL), triglycerides (TG), fasting blood glucose (FBG), waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) for T1 and T2, respectively. The MetS z-score was computed according to international diabetes federation criteria. At T1, the pooled estimates of HDL, TG, FBG, WC, SBP, DBP and MAP were 1.20 [1.13; 1.27] mmol/L, 1.32 [1.23; 1.42] mmol/L, 4.98 [4.82; 5.15] mmol/L, 87.21 [84.21; 90.21] Cm, 114.22 [101.45; 126.99] mmHg, 76.80 [70.12; 83.47] mmHg, 89.27 [80.56; 97.98] mmHg, respectively. At T2, the pooled estimates of HDL, TG, FBG, WC, SBP, DBP and MAP were 1.24 [1.18; 1.31] mmol/L, 1.24 [1.14; 1.34] mmol/L, 4.77 [4.55; 4.99] mmol/L, 85.73 [82.83; 88.64] Cm, 109.48 [97.20; 121.75] mmHg, 74.43 [68.01; 80.85] mmHg, 86.11 [77.74; 94.48] mmHg, respectively. The Mets z-score showed improvement at T2 for all ethnic groups and both sexes by -0.22 [-0.24; -0.01].
Conclusions
The current meta-analysis suggests that the RF positively impact the MetS components and the overall MetS z-score.
Registration
PROSPERO registration number: ID CRD42022329297.
Open Science Framework Identifier
DOI 10.17605/OSF.IO/U9H7T.
Aims
This study aimed to evaluate the effects of Ramadan diurnal intermittent fasting (RDIF; 29–30 days) on cardiometabolic risk factors (CMRF) in healthy adults, and examine the effect of various cofactors on the outcomes using sub-group meta-regression.
Data synthesis
We conducted a systematic review and meta-analysis to measure the effect sizes of changes in CMRF in healthy adult Muslims observing RDIF. Ten scientific databases (EBSCOhost, CINAHL, Cochrane, EMBASE, PubMed/MEDLINE, Scopus, Google Scholar, ProQuest Medical, ScienceDirect, and Web of Science) were searched from the date of inception (1950) to the end of November 2020. The CMRF searched and analyzed were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), diastolic blood pressure (DBP), and heart rate (HR). We identified 91 studies (4431 adults aged 18–85 years) conducted between 1982 and 2020 in 23 countries distributed over four continents. RDIF-induced effect sizes for CMRF were: TC (no. of studies K=77, number of subjects N=3705, Hedge’s g=−0.092, 95% confidence interval (CI): −0.168, 0.016); TG (K=74, N=3591, Hedge’s g=−0.127, 95% CI: −0.203, 0.051); HDL-C (K=68, N=3528, Hedge’s g=0.141, 95% CI: 0.053, 0.228); LDL-C (K=65, N=3354, Hedge’s g= −0.118, 95% CI: −0.201, 0.035); VLDL-C (K=13, N=648, Hedge’s g=−0.252, 95% CI: −0.431, 0.073), DBP (K=32, N=1716, Hedge’s g=−0.255, 95% CI: −0.363, 0.147), and HR (K=12, N=674, Hedge’s g=−0.082, 95% CI: −0.300, 0.136). Meta-regression revealed that the age of the fasting people was the significant moderator for changes in both HDL-C (P=0.02) and VLDL-C (P=0.01), while male sex was the only significant moderator for changes in LDL-C (P=0.055). The fasting time duration was the only significant moderator for HDL-C (P=0.001) at the end of Ramadan.
Conclusions
RDIF positively impacts CMRF, which may confer short-term transient protection against cardiovascular disease among healthy people.
The objective of this article is to review important changes which may occur during Islamic fasting in diabetic patients and the safety of fasting during the Islamic month of Ramadan for diabetics. Despite diverse findings regarding the physiological impact of Ramadan on diabetics, researchers have not yet found, in the diabetics who fast, any pathological changes in body weight, blood glucose, HbA1c, C-peptide, insulin, fructosamine, cholesterol, or triglycerides. In the guidelines section of the article, we recommend that diabetic patients continue their regular daily activity and diet regimen. It is also critical that diabetics adjust their drug regimen, particularly those diagnosed as type 1 diabetes mellitus. These three important factors, i.e. drug regimen adjustment, diet control, and daily activity constitute the "Ramadan 3D Triangle". With 3D attention, proper education, and diabetes management, we conclude that most type 2 and some type 1 diabetic patients who insist on fasting can carefully observe Ramadan.
Objective: The purpose of the study was to evaluate the effect of Ramadan fasting on lipid profile and blood sugar. Setting: Adan Hospital ñ Kuwait Subjects and Methods: The study was performed on 60 healthy adult volunteers and was carried out in the month of Ramadan (October ñ November 2003). Each volunteer had observed fasting for an average 12 hours a day. Blood samples were obtained from them on the 1st and 4th week of Ramadan and were analyzed for total cholesterol (TC), low ñ density lipoprotein cholesterol (LDLc), very lowñ density lipoprotein cholesterol (VLDLc), high ñ density lipoprotein cholesterol (HDLc), Triglyceride (TG) and blood sugar. Results: The LDLc was significantly reduced at the end of fasting (P< 0.005). A reduction in the average TC value was observed at the end of fasting but the difference was not statistically significant (P
The effects of Ramadan fasting on thyroid function tests in healthy male subjects were investigated. Plasma thyroxine (T4), Triiodothyronine (T3), thyroid stimulating hormone (TSH) and free T4 levels were determined in 28 healthy male subjects before and at the end of the 30 day Ramadan fast. The effect of short term food deprivation between dawn and sunset was also investigated. There were no significant differences between the morning and evening (after 14 hour fast) values in the thyroid function tests; the respective values (means ± SD) for a.m. and p.m. Plasma T4, T3, free T4 and TSH being 7.1±1.34 μg% and 7.2±1.33 μg%; 1.1±0.17 ng% and 1.1±0.11; 1.1±0.15 ng/dL and 1.1±0.20 ng/dL; 1.9±0.81 mu/ml and 1.4±0.51 mu/ml respectively; P>0.1 for all comparisons. In addition, there was no significant change in the results of the thyroid function tests done before and at the end of Ramadan. The values respectively for plasma T4, T3, free T4 and TSH before and after Ramadan were 7.0±1.08 μg% and 7.1±1.34 μg%; 1.1±0.17 ng/ml and 1.1±17 ng/ml; 1.1±0.21 ng/dL and 1.1±0.15 ng/dL; 1.7±0.62 mu/ml and 1.4±0.81 mu/ml; P>0.1 for all comparisons. It is concluded that Ramadan fasting by healthy adult males did not alter the standard indices of thyroid function.
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A study comprising 41 males, 5 females of the age ranging from 28 to 56 years was conducted during Ramadan of 1989 to compare T3, T4 and TSH levels in fasting with the levels of non-fasting conditions. Each individual gave 6 blood samples: One sample was taken 20 days before the onset of Ramadan, 3 samples at different fasting days and last two samples were drawn 23 days and five months after the end of Ramadan, respectively. The results showed a significant gradual rise in TSH throughout the fasting month, although the mean levels remained within normal limits. Pre- Ramadan levels were re-attained well after the end of Ramadan. There was no significant change in T3 and T4 levels.
EDITOR,—Britain is failing to meet targets that have been set for reducing obesity.1 One of the aims of the Health of the Nation strategy is to reduce the percentages of men and women who are obese to 6% and 8%, respectively, by 2005,2 but the Health Survey for England 1994 shows that the prevalence of obesity had increased to 13.2% among men and 16.0% among women by 1994.3 This increase is probably partly due to a reduction in physical activity; the importance of the composition of the diet is not …
Compared with non-vegetarians, Western vegetarians have a lower mean BMI (by about 1 kg/m2), a lower mean plasma total cholesterol concentration (by about 0.5 mmol/l), and a lower mortality from IHD (by about 25%). They may also have a lower risk for some other diseases such as constipation, diverticular disease, gallstones and appendicitis. No differences in mortality from common cancers have been established. There is no evidence of adverse effects on mortality. Much more information is needed, particularly on other causes of death, other morbidity including osteoporosis, and long-term health in vegans. The evidence available suggests that widespread adoption of a vegetarian diet could prevent approximately 40,000 deaths from IHD in Britain each year.
The relationship between obesity, impaired respiratory function and weight loss is established.
Some aspects need further elucidation: the different impact of the pathological modifications of body compartments (total and regional fat mass and lean body mass) on respiratory function, the choice of a restricted diet, the relationship between the modifications of body compartments and the variations in respiratory parameters after weight loss.
The restricted diet was elaborated according to the traditional Mediterranean diet. In a series of 16 obese patients, respiratory function was assessed by spirometry; body composition was assessed by dual-energy X-ray absorptiometry, allowing the direct estimation of total and segmental body fat and lean body mass.
Weight loss was sustained mainly by fat mass decrease, mostly upper body fat. Total and truncal lean body mass were not affected. Lung volumes and function were improved. A correlation was observed between lean body mass and respiratory parameters, and was unmodified after weight loss.
Mediterranean-style restricted diet was well accepted and enabled a selective decrease in fat mass, with a good improvement in lung function. Truncal fat (as well as abdominal fat) was decreased, while truncal lean body mass (i.e. respiratory muscles) were not affected, as expected in obese subjects with respiration problems.