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Effect of Ramadan fasting on diabetes mellitus: A population-based study in Qatar

Authors:
  • İstanbul Medipol University Faculty of Medicine and Dentistry and Pharmacy

Abstract

Background: Over one billion Muslims fast worldwide during the month of Ramadan. Fasting during Ramadan is a radical change in lifestyle for the period of a lunar month, and it might affect the biochemical parameters among diabetic patients. Aim: This study aimed to investigate the effect of Ramadan fasting on the blood levels of glucose, glycated hemoglobin (HbA1c), and lipid profile among diabetic patients observing fast during the Ramadan. Patients and methods: An observational study recruiting 1301 Muslim diabetic patients above 18 years age was conducted in diabetic outpatient clinic of Hamad General Hospital, Hamad Medical Corporation, and Primary Health Care Center, Qatar, from July 2012 to September 2013. Data on sociodemographic characteristics (age, sex, nationality, marital status, education level, and occupation) and lifestyle habits (smoking and physical activity), blood pressures, and anthropometric measurements were obtained by a face-to-face interview and measurement using a structured questionnaire. Blood samples were collected for testing glucose, glycosylated hemoglobin (HbA1C), lipid profile, urea, and creatinine (by the licensed research assistants). Results: Slightly less than half of the participants were overweight (BMI: 25-29.9). Significantly higher proportion of female participants were obese as compared with male participants (P<0.001). Among both male participants and female participants, the average level of blood glucose, HbA1c, total cholesterol, low-density and high-density lipoprotein cholesterol, triglycerides, albumin, bilirubin, uric acid, and systolic and diastolic blood pressures were significantly lower during the Ramadan as compared with before Ramadan (P<0.001 each). Conclusion: Results revealed that fasting during Ramadan is significantly associated with decrease in blood lipid profile, blood pressures, glucose, and HbA1C level among diabetic patients. Muslim diabetic patients after the consultation of their primary physician can fast during the month of Ramadan and it might be beneficial for their health.
Effect of Ramadan fasting on diabetes mellitus: a population-
based study in Qatar
Abdulbari Bener
a,b,c
and Mohammad T. Yousafzai
d
a
Department of Medical Statistics and Epidemiology,
Hamad Medical Corporation, Doha,
b
Department
of Public Health, Weill Cornell Medical College,
Ar-Rayyan, Qatar,
c
Department of Public Health and
Primary Care, Faculty of Medical and Human Science,
The University of Manchester, Manchester, UK and
d
Department of Pediatrics and Child Health, Aga Khan
University, Karachi, Pakistan
Correspondence to Abdulbari Bener, Department of
Medical Statistics and Epidemiology, Hamad Medical
Corporation, PO Box 3050, Doha, Qatar
Tel: + 974 4439 3765; + 974 4439 3766;
fax: + 974 439 3769;
e-mails: abener@hmc.org.qa;
abb2007@qatar-med.cornell.edu
Received 6 March 2014
Accepted 14 June 2014
Journal of the Egyptian Public Health
Association 2014, 00:000–000
Background
Over one billion Muslims fast worldwide during the month of Ramadan. Fasting during
Ramadan is a radical change in lifestyle for the period of a lunar month, and it might
affect the biochemical parameters among diabetic patients.
Aim
This study aimed to investigate the effect of Ramadan fasting on the blood levels of
glucose, glycated hemoglobin (HbA1c), and lipid profile among diabetic patients
observing fast during the Ramadan.
Patients and methods
An observational study recruiting 1301 Muslim diabetic patients above 18 years age
was conducted in diabetic outpatient clinic of Hamad General Hospital, Hamad
Medical Corporation, and Primary Health Care Center, Qatar, from July 2012 to
September 2013. Data on sociodemographic characteristics (age, sex, nationality,
marital status, education level, and occupation) and lifestyle habits (smoking and
physical activity), blood pressures, and anthropometric measurements were obtained
by a face-to-face interview and measurement using a structured questionnaire. Blood
samples were collected for testing glucose, glycosylated hemoglobin (HbA1C), lipid
profile, urea, and creatinine (by the licensed research).
Results
Slightly less than half of the participants were overweight (BMI: 25–29.9). Significantly
higher proportion of female participants were obese as compared with male
participants (Po0.001). Among both male participants and female participants, the
average level of blood glucose, HbA1c, total cholesterol, low-density and high-density
lipoprotein cholesterol, triglycerides, albumin, bilirubin, uric acid, and systolic and
diastolic blood pressures were significantly lower during the Ramadan as compared
with before Ramadan (Po0.001 each).
Conclusion
Results revealed that fasting during Ramadan is significantly associated with decrease
in blood lipid profile, blood pressures, glucose, and HbA1C level among diabetic
patients. Muslim diabetic patients after the consultation of their primary physician can
fast during the month of Ramadan and it might be beneficial for their health.
Keywords:
blood glucose, diabetes mellitus, epidemiology, HbA1C, Ramadan fasting
J Egypt Public Health Assoc 00:000–000
&2014 Egyptian Public Health Association
0013-2446
Introduction
One of the five fundamental rituals of Islam, the religion
professed by over one billion people, is fasting during the
month of Ramadan. Muslims neither eat nor drink
anything from dawn until sunset [1,2]. The time of
observance differs each year because it is a lunar calendar.
Fasting period varies with the geographical site and the
season. In summer months and northern latitudes, the
fast can last up to 18 h or more. Muslims observing the
fast must not only abstain from eating and drinking, but
also from taking oral medications, smoking as well as
intravenous fluids and nutrients [1–7].
The prevalence of diabetes mellitus (DM) in several
countries with large Muslim populations appears to be similar
to the rates observed in western countries and is increasing by
10% per year as a result of urbanization and socioeconomic
development [2]. Indeed, fasting is one of the five pillars of
Islam. However, when fasting may significantly affect the
health of the faster or when an individual is sick, Islam
exempts that person from fasting. However, a significant
number of patients persists in fasting against the advice of
their doctors and the permission of religious authorities [2].
DM [1,5] and cardiovascular diseases [3,8–10] are
approaching epidemic proportions worldwide and is
associated with substantial public and personal bur-
den [2]. DM is one of the major causes of mortality and
morbidity in most developed and developing countries
[7–9]. Fasting during Ramadan is essentially a radical
Original article 1
0013-2446 &2014 Egyptian Public Health Association DOI: 10.1097 /01.EPX.0000451852.92252.9b
CE: Diana ED: Maitreyee Op: Mandar EPX: LWW_EPX_892-4
change in lifestyle for the period of 1 lunar month that
may affect diabetic and cardiac patients [2–4,10,11].
During the Ramadan fast, Muslims eat two meals, one
before dawn and the other shortly after sunset. This change
of meal schedule is accompanied with changes in sleep habit
(shortening of time to sleep) and lifestyle habits [11–14].
The drug schedule during the day time is changed because
of fasting, which may have an effect on DM patients. Fasting
is not obligatory for children or menstruating women; sick
and traveling people are excused from fasting [1,2].
In Arabian Gulf countries during the month of Ramadan,
Muslim people usually go for very high calorie food; they
neither diet nor exercise, and they sleep and work for less
hours [4,11–14]. Despite the large number of Muslims
worldwide, there is lack of data on DM in Ramadan. The
objective of this study was to investigate the effect of
Ramadan fasting on the blood levels of glucose, glycated
hemoglobin (HbA1c), and lipid profile among diabetic
patients observing fast during Ramadan in Qatar.
Patients and methods
Study patients and setting
This is an observational study that was conducted among
Arab Muslim diabetic patients above 18 years of age,
registered in diabetic clinics of Hamad General Hospital,
Hamad Medical Corporation (HMC), and Primary Health
Care centers in Qatar during the period from July 2012 to
September 2013. Of the total 1645 eligible participants,
1301 (79.15%) agreed and gave their consent to take part
in this study. IRB ethical approval was obtained from
HMC before commencing data collection.
Data collection methods
Questionnaire
Qualified nurses who can speak and write both English and
Arabic were recruited to administer the questionnaires and
perform anthropometric measurements. A standardized
questionnaire-based face-to-face interview was conducted
by the nurses to fill the questionnaires. The questionnaire
was composed of: (a) sociodemographic data such as age,
sex, nationality, marital status, education level, occupation,
height, weight, and parental consanguinity; (b) Anthropo-
metric data such as height and weight; (c) lifestyle habits
such as physical activity and smoking status; (d) Blood
pressure measurements; and (e) Laboratory investigations
during and before Ramadan, such as blood glucose, glycated
hemoglobin (HbA1c), low-density and high-density lipo-
protein (HDL and LDL) cholesterol, cholesterol levels,
triglyceride, urea, creatinine, bilirubin, albumin, etc. Data
related to anthropometry and laboratory were filled based
on actual measurements and laboratory investigations as
described below during Ramadan. Laboratory investigations
before the Ramadan were obtained from the respective
medical records.
Anthropometric measurements
Height was measured in centimeters using a height scale
(SECA
AQ1 , Germany) while the patient was standing bare
feet and with normal straight posture. Weight was
measured in kilograms using a weight scale (SECA).
BMI was calculated as the ratio of weight (kg) to the
square of height (m). A person was considered obese if
the BMI value was at least 30 kg/m
2
and overweight if
BMI was greater than 25 kg/m
2
and less than 30 kg/
m
2
[11,15,16].
Blood pressure measurements
Hypertension was defined according to the WHO, which
is systolic blood pressure at least 130 mmHg or diastolic
blood pressure at least 85 mm Hg or using antihyperten-
sive medication. Two readings of systolic blood pressure
and diastolic blood pressure were taken from the
participant’s left arm while seated and his/her arm at
heart level, using a standard zero mercury sphygmoman-
ometer after at least 10–15 min of rest. Thereafter, the
average of the two readings was obtained [16–18].
Lifestyle habits
Smoking habit was classified in terms of currently being
past or current smoker or nonsmoker. Patients were
classified as physically active, if they reported participat-
ing in walking or cycling for more than 30 min/day.
Laboratory measurements
A blood sample of 10 ml was collected through venipunc-
ture from each participant after fasting for 10 h into
vacutainer tubes containing EDTA. The samples were
kept at room temperature and transported within 2 h to a
central certified laboratory at Hamad General Hospital,
HMC Doha Qatar. Plasma glucose, total cholesterol,
triglyceride, HDL-cholesterol, and LDL-cholesterol were
measured by an autoanalyzer (Hitachi AQ2
747 autoanalyzer,
Japan). Glycosylated hemoglobin (HbA1c) was analyzed
using a high-performance liquid chromatography method.
Other biochemical values such as creatinine, potassium,
bilirubin, and uric acid were collected from their latest
medical records [16].
Definitions
Diabetes mellitus
The presence of DM was determined by the documenta-
tion in the patient’s previous or current medical record of
a documented diagnosis of DM that had been treated
with medications or insulin [19–21].
Ramadan
Time periods corresponding to the month of Ramadan in
the Gregorian calendar have been established, as the
lunar calendar is 11–12 days shorter than the solar
year [1,2]. More than 95% of Qatari and other Arabs
Muslim adults fast without fail during the month of
Ramadan. Data were collected at the beginning of the
month.
Statistical analysis
Data were entered and analyzed using SPSS version 21
(IBM Corp., Armonk, New York, USA). Student’s paired
t-test was used to determine difference between baseline
and 1 month before, regarding biochemistry parameters,
2Journal of the Egyptian Public Health Association
and this was confirmed by the Wilcoxon signed ranked
test, which is a nonparametric test that compares two
paired groups. The w
2
and the Fisher exact tests were
performed to test for differences in proportions of
categorical variables between two or more groups. The
level of Pless than 0.05 was considered as the cutoff
value for significance.
Results
Table 1 shows comparison of sociodemographic and
lifestyle characteristics of the participants in Qatar
(N= 1301). Of 1301 participants, 675(51.9%) were
men. The mean ± SD age of the participants was
45.9 ± 15.3 years. Female participants were significantly
older than male participants (46.8 ± 16.1 vs. 44.7 ± 14.5;
P= 0.031, respectively). Overall, about two-third of the
participants were Qatari nationals, with significantly
higher proportion among female participants as compared
with male participants (females: 79.6% Qatari and 20.4%
non-Qatari, whereas males: 49.6% Qatari and 50.4% non-
Qatari; Po0.001). In addition, about three quarters of
the participants were married with significant difference
across sex (Po0.001). Slightly less than half of the
participants were overweight (BMI: 25–29.9 kg/m
2
),
whereas the proportion of normal weight and obese
participants was equal. Significantly higher proportion of
female participants were obese as compared with male
participants (Po0.001) (Table 1).
Table 2 shows the comparison of mean biochemical
characteristics and blood pressures among the partici-
pants before and during Ramadan. On average, blood
glucose, HbA1c level, total cholesterol, triglycerides,
HDL-C, LDL-C, bilirubin, albumin, uric acid, and
systolic and diastolic blood pressures were significantly
lower during the holy month of Ramadan as compared
with before Ramadan (Po0.001 for each).
Table 3 shows the comparison of biochemical character-
istics and blood pressures among male and female
participants before and during the holy month of
Ramadan fasting. Among both male and female partici-
pants, the mean ± SD blood glucose levels were sig-
nificantly different before and during the fasting of holy
month of Ramadan (8.44 ± 2.09 vs. 7.62 ± 2.10; Po0.001
and 9.08 ± 2.33 vs. 8.27 ± 2.19; Po0.001, respectively).
In addition, mean ± SD HbA1c levels were significantly
lower among both male and female participants during
Ramadan as compared with before Ramadan (8.15 ± 2.02
vs. 8.66 ± 2.04; Po0.001 and 8.37 ± 2.04 vs. 8.88 ± 2.11;
Po0.001, respectively). Both LDL and HDL cholesterol
levels were significantly reduced among both men and
women during Ramadan fasting as compared with before
Ramadan (Po0.001). In addition, total cholesterol and
triglycerides were also significantly reduced among both
men and women during Ramadan fasting (men:
4.87 ± 1.02 vs. 5.64 ± 0.79; Po0.001 and 1.42 ± 0.63 vs.
1.67 ± 0.81; Po0.001, women: 4.94 ± 1.12 vs. 5.67 ±
0.83; Po0.001 and 1.39 ± 0.61 vs. 1.63 ± 0.80; Po0.001,
respectively).
Figure 1 shows comparison of average HbA1c level before
and during the holy month of Ramadan fasting across
different age groups. There was a significant decrease in
HbA1c level during Ramadan as compared with before
Ramadan in each age group among both men and women.
Discussion
The present study included representative Muslim
diabetic population in the State of Qatar where more
than 95% of the Muslims fast regularly during the holy
month of Ramadan. The current study found positive
impact of Ramadan fasting on blood glucose level,
HbA1C, and lipid profile. It revealed significant reduc-
tion in blood sugar (Po0.001). This was confirmed by
HbA1C that showed significant improvement
(Po0.001), which is consistent with the previous
reports [1,4–7,13,14]. Moreover, the study did not find
any negative effects of Ramadan fasting during the holy
month of Ramadan on the status of DM concerning lipid
profile – LDL, HDL, cholesterol, and triglyceride. This is
consistent with that reported in other stu-
dies [1,4–7,14,19–24].
In fact, although blood sugar levels in diabetes can be
achieved through manipulation of diet, exercise, and
medication [1,14], a change in any one of these three
things can skew blood sugar levels and create complica-
tions associated with hyperglycemia or hypoglycemia.
Fasting during the month of Ramadan is a religious
activity that devout Muslims practice whether they are
diabetic or not. As such fasting involves abstinence from
food and water for 12 h or more during the day from dawn
to dusk, it is evident that advice regarding exercise and
medication will have to be modified appropriately during
this period [1–4]. There is ample evidence that it is safe
for well-controlled diabetics to fast during the month of
Ramadan [1,2,19,20].
Sahin et al. [6] examined 122 patients in Istanbul with type 2
diabetes before and after Ramadan; 88 of 122 patients fasted
during Ramadan. The frequencies of both severe hypergly-
cemia and hypoglycemia were higher in the fasting group,
but the difference was not significant. Weight, BMI, waist
circumference, blood pressure, fasting blood glucose
(143.38 ± 52.04 vs. 139.31 ± 43.47 mg/dl), postprandial
glucose (213.40 ± 98.56 vs. 215.66 + 109.31 mg/dl), fructo-
samine (314.18 ± 75.40 vs. 314.49 ± 68.36 mmol/l), HbA1c
(6.33 ± 0.98 vs. 6.22 ± 0.92%), and fasting insulin
(12.61 ± 8.94 vs. 10.51 ± 6.26 mU/ml) were unchanged in
patients who fasted during Ramadan. Microalbuminuria
significantly decreased during Ramadan (132.85 ± 197.11 vs.
45.03 ± 73.11 mg/dl). They concluded that fasting during
Ramadan did not worsen the glycemic control of patients
with type 2 diabetes.
More recent studies did not find any negative effects of
extended fasting on glucose regulation of patients with
diabetes who are using certain medications. No serious
adverse event was observed, and they have failed to
demonstrate benefits of increasing the number of meals
Ramadan fasting and diabetes mellitus Bener and Yousafzai 3
in patients with diabetes [5,13,14]. This is confirmative
with the current reported study.
Meanwhile, Ramadan fasting for pregnant women with
diabetes remains controversial and underreported. A
retrospective study carried out by Ismail et al. [13] in a
tertiary hospital in Malaysia over a period of 3 years
including pregnant diabetic women, who were on short-
acting, intermediate-acting, or a combination of them,
and opted to carry out Ramadan fasting, investigated the
glycemic control in pregnant diabetic women on insulin
who fasted during Ramadan. Glycemic control was
assessed before, in the middle of, and after Ramadan
fasting. There was no difference between glycemic
Table 1. Comparison of sociodemographic and lifestyle characteristics of the participants in Qatar (N= 1301)
n(%)
Total Male (n= 675) Female (n= 626) Pvalue
Age (mean ± SD) (years) 45.9 ± 15.3 44.9 ± 14.5 46.8 ± 16.1 0.031
Age (years)
o30 247 (19) 117 (17.3) 130 (20.8) o0.001
30–39 169 (13) 110 (16.3) 59 (9.4)
40–49 266 (20.4) 148 (21.9) 118 (18.8)
50–59 408 (31.4) 232 (34.4) 176 (28.1)
Z60 (mean ± SD) 211 (16.2) 68 (10.1) 143 (22.8)
Nationality
Qatari 833 (64) 335 (49.6) 498 (79.6) o0.001
Non-Qatari 468 (36) 340 (50.4) 128 (20.4)
Marital status
Single 220 (16.9) 120 (17.8) 100 (16) o0.001
Married 980 (75.3) 523 (77.5) 457 (73)
Divorced 38 (2.9) 16 (2.4) 22 (3.5)
Widow 63 (4.8) 16 (2.4) 47 (7.5)
BMI (kg/m
2
)
o25 354 (27.2) 213 (31.6) 141 (22.5) o0.001
25–29.9 590 (45.3) 304 (45) 286 (45.7)
Z30 357 (27.4) 158 (23.4) 199 (31.8)
Level of education
Illiterate 229 (17.6) 120 (17.8) 109 (17.4) 0.206
Elementary 278 (21.4) 154 (22.8) 124 (19.8)
Intermediate 271 (20.8) 146 (21.6) 125 (20)
Secondary 340 (26.1) 158 (23.4) 182 (29.1)
University 183 (14.1) 97 (14.4) 86 (13.7)
Household income (QR)
o5000 97 (7.5) 51 (7.6) 46 (7.3) 0.641
5000–10 000 417 (32.1) 208 (30.8) 209 (33.4)
10 000–15 000 464 (35.7) 251 (37.2) 213 (34)
Z15 000 323 (24.8) 165 (24.4) 158 (25.2)
Consanguinity
Yes 509 (39.1) 273 (40.4) 236 (37.7) 0.311
No 792 (60.9) 402 (59.6) 390 (62.3)
Smoking status
Never 1097 (84.3) 523 (77.5) 574 (91.7) o0.001
Current smoker 142 (10.9) 111 (16.4) 31 (5)
Past smoker 62 (4.8) 41 (6.1) 21 (3.4)
Physical activity
Yes 388 (29.8) 208 (30.8) 180 (28.8) 0.417
No 913 (70.2) 467 (69.2) 446 (71.2)
Table 2. The comparison of biochemical characteristics and blood pressures among participants before and during Ramadan in both
sexes (N= 1301)
Blood investigations During Ramadan (mean ± SD) Before Ramadan (mean ± SD) Change (paired t-value) (95% CI) Pvalue
Blood glucose 7.93 ± 2.17 8.75 ± 2.24 – 0.81 (– 0.85 to – 0.77) o0.001
HbA1C 8.25 ± 2.02 8.77 ± 2.07 – 0.51 (– 0.56 to – 0.47) o0.001
Urea 4.22 ± 1.62 4.26 ± 1.69 – 0.04 (– 0.11 to 0.02) 0.219
Creatinine 63.54 ± 16.70 64.14 ± 14.96 – 0.60 (–1.26 to 0.07) 0.077
Bilirubin 6.22 ± 2.24 6.79 ± 2.11 – 0.57 (– 0.61 to – 0.53) o0.001
Albumin 40.76 ± 4.19 41.60 ± 4.04 – 0.85 (– 1.02 to – 0.67) o0.001
Cholesterol 4.90 ± 1.07 5.65 ± 0.80 – 0.75 (– 0.82 to – 0.69) o0.001
Triglycerides 1.41 ± 0.62 1.65 ± 0.81 – 0.24 (– 0.27 to – 0.22) o0.001
HDL-C 1.34 ± 0.35 1.42 ± 0.29 – 0.07 (– 0.09 to – 0.06) o0.001
LDL-C 2.63 ± 0.76 2.78 ± 0.99 – 0.15 (– 0.20 to – 0.09) o0.001
Uric acid 284.36 ± 95.42 296.17 ± 95.31 – 11.81 (– 13.50 to – 10.12) o0.001
Blood pressure
Systolic 125.77 ± 14.17 130.63 ± 14.29 –4.86 (– 4.93 to – 4.79) o0.001
Diastolic 77.57 ± 8.92 81.42 ± 9.25 – 3.84 (– 3.91 to – 3.76) o0.001
Two-sided Pvalues based on paired t-test.
HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol.
4Journal of the Egyptian Public Health Association
control of type 2 DM and gestational DM women before
fasting. In the middle of Ramadan, serum fructosamine
decreased in both groups. However, only serum HbA1c
was reduced in gestational DM after Ramadan. They
concluded that the pregnant diabetic women on insulin
were able to fast during Ramadan and that their glycemic
control was improved during fasting period.
Carbohydrate and lipid metabolism is influenced by
fasting, resulting in changes in blood chemistry. There is
no caloric intake during fasting, and the continual use of
glucose in the body for various vital functions [23] leads
to lowering of blood glucose level. The depletion of
glycogen stores after prolonged fasting further decreases
its level. Our study participants demonstrated lower
levels of blood glucose during the month of Ramadan,
which were consistent with the observations reported by
earlier workers [6,13,23–25]. The variation in lipid levels
observed by different workers may be attributed to the
difference in dietary habits and duration of fasting in
different seasons and countries. It is also obvious from the
present study that the benefits of Ramadan dietary habits
in terms of reduction in cholesterol, TGs, and LDL levels
and rise in HDL levels are transient and may be helpful
only if the diet pattern is framed according to the routine
followed in Ramadan on regular basis [23].
Ensuring good control of plasma glucose during the
fasting month of Ramadan is a challenge for both
Table 3. The comparison of biochemical characteristics and blood pressures among participants before and during Ramadan
according to sex (N= 1301)
Blood investigations During Ramadan (mean ± SD) Before Ramadan (mean ± SD) Change (paired t-value) (95% CI) Pvalue
Blood glucose
Male 7.62 ± 2.10 8.44 ± 2.09 – 0.82 (– 0.88 to – 0.76) o0.001
Female 8.27 ± 2.19 9.08 ± 2.33 – 0.80 (– 0.87 to – 0.74) o0.001
HbA1C
Male 8.15 ± 2.02 8.66 ± 2.04 – 0.51 (– 0.57 to – 0.46) o0.001
Female 8.37 ± 2.04 8.88 ± 2.11 – 0.51 (– 0.59 to – 0.44) o0.001
Urea
Male 4.25 ± 1.65 4.23 ± 1.72 0.02 (– 0.07 to 0.11) 0.679
Female 4.18 ± 1.60 4.29 ± 1.67 – 0.11 (– 0.20 to – 0.02) 0.022
Creatinine
Male 66.46 ± 18.12 66.95 ± 15.43 – 0.50 (– 1.56 to 0.57) 0.362
Female 60.40 ± 14.41 61.11 ± 13.83 – 0.71 (– 1.48 to 0.06) 0.070
Bilirubin
Male 6.38 ± 2.29 6.98 ± 2.16 – 0.60 (– 0.66 to – 0.55) o0.001
Female 6.05 ± 2.17 6.58 ± 2.04 – 0.53 (– 0.59 to – 0.47) o0.001
Albumin
Male 40.96 ± 4.41 41.86 ±4.13 – 0.89 (– 1.13 to – 0.65) o0.001
Female 40.53 ± 3.93 41.32 ± 3.93 – 0.79 (– 1.04 to – 0.55) o0.001
Cholesterol
Male 4.87 ± 1.02 5.64 ± 0.79 – 0.77 (– 0.85 to – 0.68) o0.001
Female 4.94 ± 1.12 5.67 ± 0.83 – 0.73 (– 0.83 to – 0.64) o0.001
Triglycerides
Male 1.42 ± 0.63 1.67 ± 0.81 – 0.25 (– 0.28 to – 0.22) o0.001
Female 1.39 ± 0.61 1.63 ± 0.80 – 0.23 (– 0.27 to – 0.20) o0.001
HDL-C
Male 1.32 ± 0.32 1.40 ± 0.27 – 0.07 (– 0.10 to – 0.05) o0.001
Female 1.37 ± 0.37 1.44 ± 0.32 – 0.07 (– 0.10 to – 0.05) o0.001
LDL-C
Male 2.63 ± 0.79 2.78 ± 1.14 – 0.15 (– 0.24 to – 0.06) 0.001
Female 2.62 ± 0.72 2.77 ± 0.80 – 0.15 (– 0.21 to – 0.08) o0.001
Uric acid
Male 289.13 ± 95.09 300.43 ± 96.85 – 11.29 (– 13.63 to – 8.96) o0.001
Female 279.15 ± 95.59 291.52 ± 93.45 – 12.37 (–14.83 to – 9.91) o0.001
Blood pressure
Systolic
Male 125.34 ± 13.42 130.14 ± 13.55 – 4.80 (– 4.91 to – 4.69) o0.001
Female 126.23 ± 14.95 131.16 ± 15.03 – 4.93 (– 5.01 to – 4.84) o0.001
Diastolic
Male 76.89 ± 8.77 80.65 ± 9.23 – 3.76 (– 3.89 to – 3.64) o0.001
Female 78.33 ± 9.04 82.24 ± 9.20 – 3.92 (– 3.98 to – 3.85) o0.001
Two-sided Pvalues based on paired t-test.
HDL-C, high-density lipoprotein cholesterol.
Figure 1.
7.0
7.5
8.0
8.5
9.0
9.5
<30 30-39 40-49 50-59 =>60
Age groups (Years)
Mean HbA1c(%)
Female
7.0
7.5
8.0
8.5
9.0
9.5 Before Ramadan
During Ramadan
Male
Comparison of mean HbA1c across different age groups before and
during the holy month of Ramadan fasting.
Ramadan fasting and diabetes mellitus Bener and Yousafzai 5
physicians and patients [1]. Along with these changes in
medication, it is important that doctors educate their
patients about how their plasma glucose depends on the
relationship between food intake and glucose-lowering
medication. Patients should also be told of the need to
monitor their plasma glucose on a regular basis through-
out the fasting month [14].
Conclusion
This study revealed that fasting during Ramadan is
significantly associated with decrease in blood lipid
profile, blood pressures, glucose, and HbA1C level among
diabetic men and women. Muslim diabetic patients after
the consultation of their physicians can fast during the
month of Ramadan, and it might be beneficial
AQ3 for their
health.
Acknowledgements
This work was generously supported and funded by the Qatar
Foundation Grant No. UREP 13-136-3-025. The authors thank the
Hamad Medical Corporation for their support and ethical approval
(HMC RP # Research proposal #13234/13).
Conflicts of interest
None declared
AQ4 .
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6Journal of the Egyptian Public Health Association
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... Fasting is obligatory for all adult Muslim men and women from dawn to dusk in the month of Ramadan except for those who are sick [1,2]. Ramadan falls on the ninth lunar month of the Islamic Hijra calendar and is considered to be the holiest month of the Islamic religion [3][4][5]. There are about 2.18 billion Muslims in the world, comprising 28% of the world's population of 7.412 billion [5]. ...
... Hypertension [5,6], diabetes [3,5,7] and cardiovascular diseases [8][9][10] and stroke [11] are approaching epidemic proportions worldwide. Hypertension is one of the leading global causes of mortality and morbidity [5,6,[12][13][14]. ...
... Plasma glucose, total cholesterol, triglyceride, and low-and high-density lipoprotein cholesterol (HDL and LDL) were measured by an auto-analyzer (ROCHE COBAS 6000). Glycosylated hemoglobin (HbA1c) was analyzed using an HPLC method [3,5,17]. ...
Article
Full-text available
Aim: The aim of this study was to determine the effect of Ramadan fasting on blood pressure (BP), fatigue, sleeping and physical activity among hypertensive patients. Subjects and methods: A cross-sectional study was conducted from April 2019 to July 2019. Of the total 1500 hypertensive patients approached, 1118 (74.5%) gave their consent. Data analysis included sociodemographics, lifestyle habits, anthropometric measurements and clinical biochemistry parameters at baseline, and after 3 months. Results: Out of 1118 subjects, 593(47.6%) were male and 653(52.4%) were female. There were statistically significant differences between males and females regarding age groups in years, educational level, occupational status, income, smoking habits, physical exercise, sports activities and fatigue. There were statistically significant differences for the biochemistry parameters regarding vitamin D, blood glucose, HbA1c level, creatinine, bilirubin, albumin, total cholesterol, triglycerides, HDL-C, LDL-C, uric acid and SBP for both males and females after the holy month of Ramadan as compared to before Ramadan. Also, BMI was significantly lower during the after month of Ramadan as compared to before Ramadan (P < 0.001). Multiple linear regression analysis results revealed that less hours of sleeping (P < 0.001), SBP (mmHg) (P < 0.001), DBP (mmHg) (P < 0.001), family size (P = 0.002), obesity BMI (kg/m) (P = 0.013), fatigue (P = 0.022) and smoking cigarette (P = 0.029) were identified as statistically significant predictors of hypertensive patients with Ramadan fasting as contributing at higher risk factors. Conclusion: This study confirmed that fasting during Ramadan has no effect on the BP, blood glucose, HbA1C level, sleep quality, fatigue and BMI among hypertensive patients.
... Although several studies have shown reductions in systolic (SBP) and diastolic blood pressure (DBP), [4][5][6][7][8] others have reported an increase 9,10 or no changes in blood pressure. [11][12][13][14][15] The available studies are limited in number and sample size and suffer from suboptimal sampling methods. ...
... [11][12][13][14][15] The available studies are limited in number and sample size and suffer from suboptimal sampling methods. For instance, many of the previous studies recruited samples such as students, 9 workers, 6 and patients with chronic disease who have regular visits to clinics, 4 which may not represent the whole community. Therefore, we conducted the LORANS (London Ramadan Study) in which we collected data from participants in London to assess the effect of Ramadan fasting on blood pressure using a comprehensive data analysis. ...
Article
Full-text available
Background Ramadan fasting is practiced by hundreds of millions every year. This ritual practice changes diet and lifestyle dramatically; thus, the effect of Ramadan fasting on blood pressure must be determined. Methods and Results LORANS (London Ramadan Study) is an observational study, systematic review, and meta‐analysis. In LORANS, we measured systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 85 participants before and right after Ramadan. In the systematic review, studies were retrieved from PubMed, Embase, and Scopus from inception to March 3, 2020. We meta‐analyzed the effect from these studies and unpublished data from LORANS. We included observational studies that measured SBP and/or DBP before Ramadan and during the last 2 weeks of Ramadan or the first 2 weeks of the month after. Data appraisal and extraction were conducted by at least 2 reviewers in parallel. We pooled SBP and DBP using a random‐effects model. The systematic review is registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD42019159477). In LORANS, 85 participants were recruited; mean age was 45.6±15.9 years, and 52.9% ( n =45) of participants were men. SBP and DBP after Ramadan fasting were lower by 7.29 mm Hg (−4.74 to −9.84) and 3.42 mm Hg (−1.73 to −5.09), even after adjustment for potential confounders. We identified 2778 studies of which 33 with 3213 participants were included. SBP and DBP after/before Ramadan were lower by 3.19 mm Hg (−4.43 to −1.96, I ² =48%) and 2.26 mm Hg (−3.19 to −1.34, I ² =66%), respectively. In subgroup analyses, lower blood pressures were observed in the groups who are healthy or have hypertension or diabetes but not in patients with chronic kidney disease. Conclusions Our study suggests beneficial effects of Ramadan fasting on blood pressure independent of changes in weight, total body water, and fat mass and supports recommendations for some governmental guidelines that describe Ramadan fasting as a safe religious practice with respect to blood pressure.
... Intermittent fasting during Ramadan has been reported to have a positive impact. For example, it has been found to be significant at improving fasting blood glucose [62-67, 275, 278] and reducing the HbA1c levels of individuals with diabetes [64,66,68,69,279,280], creating a positive impact on health outcomes [61]. Furthermore, it has been previously concluded that most individuals with T2DM can safely practise fasting during the month of Ramadan if their condition is well controlled beforehand [4]. ...
... The observed sharp drop in the mean of HbA1c during the month of Ramadan could be due to the fasting during Ramadan, which is strikingly consistent with numerous studies that have shown that Ramadan fasting has a definite reduction in HbA1c values of individuals with diabetes [64,66,68,69,279,280]. However, Ramadan can be associated with some alterations in the lifestyle such as dietary intake, sleeping and physical activity. ...
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Background: Diabetes is a metabolic disease that results when either the cells resist insulin or when there is a relative deficiency of insulin production. Kingdom of Saudi Arabia is one of the top ten countries with the highest prevalence of diabetes. Recently, there is a great interest in developing non-pharmacological strategies for preventing, managing, or reversing T2DM. Intermittent fasting is one such strategy that has been shown to be beneficial for individuals with diabetes and in some cases reversal of T2DM has been demonstrated. The month of Ramadan involves a type of religious intermittent fasting, practiced by the majority of Saudi adults, which may offer an excellent opportunity for protecting and improving public health. Aims: This study aimed to investigate the impact of Ramadan on changes in physical, clinical, and biochemical parameters of individuals with T2DM who chose to fast in Ramadan. The role of changes in lifestyle such as physical activity, diet, sleeping patterns, and sun exposure were analysed. The impact of the month of Ramadan on HbA1c levels, an important marker for T2DM, in a Saudi population as a function of monthly ambient temperature was also investigated. Methods: This study investigated Saudi nationals attending hospitals in Riyadh. Ethical approvals were obtained from De Montfort University and relevant Saudi organizations. The methodology of the study is described below in three parts. In study one, a total of 168,614 patients’ records that included age, gender, and HbA1c data for six years were obtained from their medical records. These data were correlated with the ambient monthly temperature, extracted from the General Authority of Meteorology and Environmental Protection in Saudi Arabia. Study two was a prospective, observational, non-interventional study that was conducted on 82 Saudi adults with T2DM in three different phases (pre-, during, and post-Ramadan). In each phase, physical, clinical, and laboratory measurements were obtained from each participant, along with self-administered questionnaires that addressed the demographic variables, dietary patterns, physical activity, sleeping patterns, and sun exposure of the individual. In study three, 36 individuals, randomly selected from the prospective, observational, non-interventional study, were each given a Fitbit Flex 2TM accelerometer along with a questionnaire to assess their physical activity and sleep patterns during two different time points (during, and post-Ramadan). All the obtained data were analysed using univariate and multivariate statistical approaches. Results: For study one, there was a statistically significant positive correlation between ambient temperature and HbA1c levels, where for each 1°C increase in average weekly temperature HbA1c increased by 0.007%. However, this relationship was disrupted by the month of Ramadan, even though this month coincided with a high-temperature period, where the mean of HbA1c declined to the lowest level when compared to the other months. Despite the mean weight, BMI, and waist circumference of the 82 participants were non-significantly higher during Ramadan, study two demonstrated significant reductions in the mean FBG and HbA1c during Ramadan phase (P < 0.05), and improvements in the lipid profile and some other biochemical and clinical measurements compared to pre- and post-Ramadan phases. There were some significant changes in the dietary and sleeping patterns between phases. However, only changes in the frequency of eating rice, fruits, and vegetables had significant medium effect size in the reduction of HbA1c during Ramadan (P = 0.021 and P = 0.043; respectively). Although there were no significant changes in physical activity between the different periods, those with higher physical activity had significantly lower HbA1c levels. In study three, both instruments (Fitbit and questionnaire) revealed a high prevalence of low physical activity among the participants with non-significant changes between phases, and shorter sleeping duration at night-time. The average daily total sleeping hours and average daily night-time sleeping hours significantly increased in the post-Ramadan phase compared to the during Ramadan phase. Conclusion: Overall, the month of Ramadan has a positive impact on the biochemical and clinical parameters related to T2DM. This includes the protective effect against the negative impact of rising ambient temperature on HbA1c levels. Furthermore, dietary changes during Ramadan, especially the reduction in the consumption of rice and increased intake of fruits and vegetables leads to significant reductions in HbA1c. Considering the beneficial changes reported in the current study, it can be concluded that Ramadan fasting has the potential to be used by public health professionals for preventing, managing, or reversing T2DM. However, to obtain the maximal benefits of Ramadan fasting, individuals with T2DM can be advised to follow a healthy diet and achieve the recommended levels of sleep and physical activity. This will help them to better control their diabetes and may even reverse the disease.
... Regarding impact of Ramadan fasting on glycemic control in patients with diabetes, earlier large-scale observational studies showed either no difference or reduction in HbA1c and mean BGLs (17,(50)(51)(52)(53)(54)(55). Limitations included retrospective study design, reliance on patient self-reporting, and comparing pre-and post-Ramadan rather than observing changes during Ramadan. ...
Article
Full-text available
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.
... Fasting during Ramadan is significantly associated with decrease in blood lipid profile, blood pressures, glucose, and HbA1C level among diabetic patients [64][65][66][67][68][69][70]. The total energy intake decreases during Ramadan, whereas the dietary fat consumption increases because of an augmentation of fatty food that does not occur during other periods [71]. ...
Article
Full-text available
With the increasing burden of non-communicable diseases in low-income and middle-income countries (LMICs), biological risk factors, such as hyperglycemia, are a major public health concern in Bangladesh. Optimization of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost. Diabetes had 2 times more days of inpatient treatment, 1.3 times more outpatient visits, and nearly 10 times more medications than non- diabetes patients, as reported by British Medical Journal. And surprisingly, 80% of people with this so called “Rich Man's Disease” live in low- and middle-income countries. According to a recent study of American Medical Association, China and India collectively are home of nearly 110 million diabetic patients. The prevalence of diabetes in this region is projected to increase by 71% by 2035. Bangladesh was ranked as the 8th highest diabetic populous country in the time period of 2010-2011. In Bangladesh, the estimated prevalence of diabetes among adults was 9.7% in 2011 and the number is projected to be 13.7 million by 2045. The cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalization costs. According to Bangladesh Bureau of Statistics, in 2017 the annual average cost per T2DM was $864.7, which is 52% of per capita GDP of Bangladesh and 9.8 times higher than the general health care cost. Medicine is the highest source of direct cost (around 85%) for patients without hospitalization. The private and public financing of diabetes treatment will be severely constrained in near future, representing a health threat for the Bangladeshi population.
... [14] The reduced physical activity during the fasting month of Ramadan also contributes to the incidence of hyperglycemia. [15] However, in this study, it cannot be known about the measurable changes in the physical activity of the subjects, as well as changes in dietary patterns during Ramadan compared to pre-Ramadan so that the correlation between the two with the incidence of hypoglycemia and hyperglycemia cannot be concluded. ...
Article
Ramadan fasting for Diabetes Mellitus (DM) patients can lead to acute complications such as hypoglycemia, hyperglycemia, diabetic ketoacidosis (DKA) and thrombosis. Risk stratification predicts fasting safety of DM patients. Dose and timing of antihyperglycemia drugs adjusted during Ramadan fasting. Aim: To know the correlation between the risk stratification of Ramadan fasting and type of antihyperglycemia drugs with the incidence of acute complications in DM patients undergoing Ramadan fasting. Methods: DM patients in Endocrinology Clinic, dr. Saiful Anwar, General Hospital Malang who intend to fast during Ramadan classified in IDF-DAR risk stratification, conduct blood glucose monitoring and filled out a daily logbook during fasting. Results: Thirty-seven subjects were included in the study, only 1 patient with type-1 DM. Average fasting time is 18 days. Acute complications found higher in very high-risk group (5/6) compared to mild/moderate (2/13) and high-risk group (7/18) (p=0.009). Acute complications found higher in group with OAD and insulin combination regiment (2/4) compared to OAD (9/24) or insulin group (3/9) (p= 0. 731). One subject in very high-risk group suffered from acute coronary syndrome. Relationship between risk stratification and the incidence of hypoglycemia (p=0.040) and hyperglycemia (p=0.031) was significant. Relative risk in the very high-risk group was 2.538 compared to mild/moderate risk RR (95% CI)= 0.77 (0.62-0.96). Conclusions: There is a correlations between risk stratification and acute complications in DM patients undergoing Ramadan fasting. No relationship between type of antihyperglycemia drugs with acute complications of Ramadan fasting.
... It is common knowledge that fasting has myriad health benefits. Fasting during Ramadan is significantly associated with decrease in blood lipid profile, blood pressures, glucose, and HbA1C level among diabetic patients [71][72][73][74][75][76][77] . The total energy intake decreases during Ramadan, whereas the dietary fat consumption increases because of an augmentation of fatty food that does not occur during other periods [78] . ...
... Meskipun demikian, penurunan ini tidak bermakna secara statistik (p = 0,082). Sebagian penelitian menunjukkan bahwa tidak ada perbedaan nilai HbA1c pasien DM yang signifikan antara sebelum dan setelah puasa Ramadan [7,8,22], sedangkan sebagian yang lain menyatakan sebaliknya [23][24][25]. Perbedaan hasil penelitian ini dapat terjadi karena kadar glukosa darah pada pasien DM yang berpuasa dipengaruhi oleh banyak hal seperti perubahan waktu makan, tipe makanan, perubahan aktivitas fisik dan perubahan pada regimen obat [7][8][9]23]. Nilai HbA1c merupakan refleksi dari rata-rata kadar glukosa darah selama 120 hari masa hidup sel darah merah. ...
Article
Full-text available
Penelitian ini bertujuan untuk mengevaluasi pengaruh penyesuaian obat diabetes pada saat puasa Ramadan berdasarkan rekomendasi dari International Diabetes Federation-Diabetes and Ramadan International Alliance (IDF-DAR) terhadap nilai HbA1c pasien diabetes melitus (DM) tipe-2. Penelitian dilakukan di salah satu rumah sakit di Jakarta, Indonesia dengan menggunakan desain studi cross-sectional yang melibatkan 80 orang pasien DM tipe-2 rawat jalan yang menjalankan puasa Ramadan tahun 2016. Sebanyak 60% pasien menggunakan obat antidiabetes oral (OAD) dengan kombinasi obat terbanyak biguanida + sulfonilurea (27,5%). Penyesuaian obat dilakukan di mana sebanyak 56,2% adalah sesuai dengan rekomendasi IDF-DAR. Hasil penelitian menunjukkan bahwa rata-rata nilai HbA1c mengalami penurunan tidak bermakna (p = 0,082) dari 8,75 ± 1,90 menjadi 8,63 ± 1,82 setelah penyesuaian obat. Terdapat perbedaan bermakna pada nilai HbA1c pasien yang menggunakan obat antara yang sesuai dengan yang tidak sesuai rekomendasi IDF-DAR (p = 0,030). Ketidaksesuaian penggunaan obat berdasarkan IDF-DAR menyebabkan nilai HbA1c tidak terkontrol 3,222 kali lebih besar dibandingkan kesesuaian penggunaan obat berdasarkan IDF-DAR. Variabel yang memberikan pengaruh paling besar terhadap nilai HbA1c adalah jenis obat (p = 0,006). Penyesuaian yang tidak tepat pada insulin dan kombinasi insulin-OAD dapat menyebabkan nilai HbA1c yang tidak terkontrol 5 kali lebih besar dibandingkan OAD.
Article
Purpose: The aim of this study was to assess the impact of Ramadan intermittent fasting on metabolic and inflammatory profiles in type 2 diabetic patients (T2D). Methods: It was a prospective study including 55 T2D patients treated with oral hypoglycemic drugs, who intended to observe Ramadan fasting in 2019. All participants underwent a questionnaire, a physical examination, laboratory investigations, and a cardiovascular risk assessment using the Framingham score before Ramadan (T0), immediately after Ramadan (T1), and two months after Ramadan (T2). Results: The mean age of participants was 54.5 ± 10.1 years. The number of fasted days was 29.3 ± 2.3 days. The mean total daily calorie intake decreased significantly by 19% during Ramadan (p < 10-3). A significant decrease in weight (79.8 ± 12.9 vs 78.4 ± 13.3 kg, p = 0.003), body mass index (29.8 ± 5.4 vs 29.2 ± 5.4 kg/m2, p = 0.004), waist circumference (98.2 ± 9.6 vs 96.3 ± 10.2 cm, p = 0.015), fat body mass (24.3 ± 9.4 vs 23.5 ± 9.7 kg, p = 0.043) was observed at T1. The weight loss was significantly correlated with the number of fasting days (r = 0.348, p = 0.009) and was maintained at T2. Serum fructosamine increased at T1 (303.6 ± 46 vs 333.49 ± 59.49 µmol/L, p < 10-3) and returned to its baseline levels at T2. A significant decrease in insulin (9.7 ± 5.5 vs 7.98 ± 5.05 mIU/L, p = 0.043), fibrinogen (3.7 ± 0.8 vs 3.4 ± 0.6 g/L, p = 0.003), and hs-CRP (4.8 ± 5.7 vs 3.7 ± 4.5 mg/L, p = 0.058) levels was observed at T1. Homocysteine level was significantly higher after Ramadan (12.2 ± 6.2 vs 13.5 ± 6.4 µmol/L, p = 0.001). However, no significant changes were found in blood pressure, fasting blood glucose, HOMA-IR, uric acid, lipids, and white blood cells count. The mean Framingham score decreased insignificantly after Ramadan. Conclusions: Ramadan fasting in T2D patients seems to have a favorable impact on anthropometric parameters and inflammatory profile. However, it may cause a transient worsening of glycemic control.
Article
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The aim of this study was to investigate the association of the Pro12Ala polymorphism of the human peroxisome proliferator-activated receptor gamma 2 (PPARγ2) gene with hypertension and obesity in a highly consanguineous aboriginal Qatari population. A cross-sectional survey conducted from January 2011-December 2012. Primary health care clinics. A random sample of 1,528 Qatari male and female population older than 20 years of age. Data on age, sex, income, level of education, occupation status, body mass index, and blood pressure and lipid profile were obtained. The Pro12Ala in the PPARγ2 gene was detected on the LightCycler® using two specific probes: (Sensor [G] 5'-CTC CTA TTG ACG CAG AAA GCG-FL and PPAR Anchor 5' LC Red 640- TCC TTC ACT GAT ACA CTG TCT GCA AAC ATA TC-PH). Univariate and multivariate logistic regression were performed. Out of a total 1,528 participants, 220 were diagnosed with essential hypertension, and 420 were obese. Participants with consanguinity were significantly higher among hypertensive than normotensive (41.9% versus 30.8%; P=0.001). Altogether, more than three-fourths (89%) of the participants had a wild genotype (Pro12Pro), 9.8% were heterozygous with Pro12Ala, and only 1.2% was homozygous with the Ala12Ala genotype. The frequency of the Pro allele was 94.5% in normotensive versus 90.5% in hypertensive, while the distribution of the Ala allele was 5.5% in normotensive versus 9.5% in the hypertensive group (P=0.001). The odds of hypertension were 1.7 times higher among the participants with the Ala allele as compared to those with the Pro, while adjusting for other potential confounders (adjusted odds ratio 1.69; 95% confidence interval 1.12-2.55; P=0.012). There was no association between the PPARγ2Ala allele and obesity (P=0.740). The current study revealed an association between the PPARγ2Ala allele and hypertension in Qatar's population. On the other hand, this study found no association between the Ala allele and obesity.
Article
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For Ramadan fasting, observing Muslims do not eat or drink between sunrise and sunset during Ramadan, Islam's holy month of the year according to the lunar calendar. In 2011, fasting patients with diabetes fasted for an average of 16.5 hours per day, having 2 meals between sunset and sunrise for a month. We aimed to evaluate the impact of extended fasting on glucose regulation and observe possible complications of extended fasting in type 2 diabetes mellitus patients. We conducted a randomized, retrospective, observational study. Patients who presented at the Diabetes Clinic during the 15 days before and after Ramadan in August 2011 Istanbul, whose hemoglobin A1c, fasting plasma glucose, postprandial plasma glucose, weight and height value examinations and follow-up were completed were included in the study. Seventy-six diabetes patients who fasted during Ramadan (fasting group) and 71 patients with diabetes who did not fast (non-fasting group) were included in the study. These two groups with similar demographic characteristics were compared before and after Ramadan. HbA1c, fasting and postprandial plasma glucose, body mass index, weight and adverse events were evaluated. No statistically significant difference was observed among the fasting and the non-fasting groups. There was no difference between the pre and post-Ramadan values of the fasting group. We could not find any negative effects of extended fasting on glucose regulation of patients with diabetes who are using certain medications. No serious adverse event was observed. We failed to demonstrate benefits of increasing the number of meals in patients with diabetes.
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Background: Millions of Muslims fast from dawn until dusk during the annual Islamic holy month of Ramadan. Most of the studies evaluating biochemical changes in diabetic patients during Ramadan showed little changes in the glycemic control. In this study, our aim was to assess the impact of fasting during Ramadan on glycemic control in patients with type 2 diabetes. Methods and design: We examined 122 patients with type 2 diabetes (82 female, 40 male, age 56.93±9.57 years) before and after the Ramadan. 66.4% of the patients were treated with oral antidiabetic (OAD) alone, 6.5% with a combination of insulin plus OAD and 19.7% with insulin alone. 88 of 122 patients fasted during Ramadan (26.98±5.93 days). Weight, body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose (FPG), postprandial glucose (PPG), fructosamine, HbA1c, fasting insulin and lipid parameters were measured. Results: The frequencies of both severe hyperglycemia and hypoglycemia were higher in the fasting group, but the difference was not significant (p=0.18). Weight, BMI, waist circumference, blood pressure, FPG (143.38±52.04 vs. 139.31±43.47 mg/dl) PPG (213.40±98.56 vs. 215.66+109.31 mg/dl) , fructosamine (314.18±75.40 vs. 314.49±68.36 µmol/l), HbA1c (6.33±0.98 vs. 6.22±0.92%) and fasting insulin (12.61±8.94 vs. 10.51±6.26 µU/ml) were unchanged in patients who fasted during Ramadan. Microalbuminuria significantly decreased during Ramadan (132.85±197.11 vs. 45.03±73.11 mg/dl). Conclusions: In this study, we concluded that fasting during Ramadan did not worsen the glycemic control of patients with type 2 diabetes.
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To determine possible effects of fasting on breast milk composition for Muslim mothers during the holy month of Ramadan in the United Arab Emirates (UAE).A prospective descriptive study.Muwajihi Primary Health Care (PHC) Clinic, Al-Ain Medical District.26 healthy nursing mothers were recruited. Their mean age was 27 ± 5 years.Each mother was seen twice by a physician in the morning at the PHC clinic firstly between the second and fourth weeks of Ramadan and secondly two weeks after the end of Ramadan. Before attending the clinic, the mothers had allowed their babies to suckle. At the first visit, the mother was personally interviewed by the doctor and a sample of breast milk was taken for analysis. A second sample was similarly taken at the second visit after Ramadan. For each sample, total fat, protein, lactose, total solids, non-fat solids, triglycerides and cholesterol were measured.No significant differences were seen in the content of major nutrients of milk taken during and after Ramadan. There was a slight increase and a slight decrease respectively in the concentrations of triglycerides and cholesterol after the end of Ramadan, although these changes were also not significant.The present study showed that no major changes occur in the composition of human breast milk as a consequence of reverting to a normal alimentary pattern at the end of Ramadan.
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Purpose – The aim of the study is to investigate whether fasting and lifestyle habits in Ramadan have any effect on headaches. Design/methodology/approach – This cross‐sectional study was carried out in the state of Qatar for a period from 13 October to 13 November 2004. A total of 1,200 fasting Muslims aged between 18 to 65 years were approached and 898 subjects participated. The International Headache Society [IHS] questionnaire and another questionnaire were used to collect the data. Findings – Of the total 898 subjects, 54.2 per cent were males and 45.8 per cent females. The prevalence of the headache during the month of Ramadan was 76.6 per cent and after Ramadan was 73.7 per cent. Originality/value – The study did not find any negative effects of fasting during Ramadan on headache frequencies.
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Background: Ramadan fasting for pregnant women with diabetes remains controversial and underreported. The objective of this study was to determine the glycemic control in pregnant diabetic women on insulin who fasted during Ramadan. Methods: This was a retrospective study carried out over a period of three years including pregnant diabetic women, who were on short-acting, intermediate-acting, or a combination of them, and opted to carry out Ramadan fasting. Glycemic control was assessed before, middle and after Ramadan fasting. Results: Thirty seven women opted to fast with 24 (64.9%) of them had type 2 diabetes mellitus and 83.8% of them required combined insulin (short- acting, intermediate-acting) therapy. The age of the participants was 32.13±4.68 years, and the age of their pregnancies was 25.60±7.12 weeks when the study was performed. The median number of days fasted was 25 days, and most of the women were able to fast for more than 15 days. There was no difference between glycemic control of type 2 diabetes mellitus and gestational diabetes mellitus women prior to fasting. In the middle of Ramadan, serum fructosamine decreased in both groups. However, only serum HbA1c reduced in gestational diabetes mellitus after Ramadan. Conclusion: the findings indicate that pregnant diabetic women on insulin were able to fast during Ramadan and that their glycemic control was improved during fasting period. They may also suggest that instead of absolute ban on fasting for pregnant diabetic women more practical approach and close consultation with health care providers might be more helpful.
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A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (greater than or equal to25 kg/m(2)). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22 kg/m(2) to 25 kg/m(2) in different Asian populations; for high risk it varies from 26 kg/m(2) to 31 kg/m(2). No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action, points (23.0, 27.5, 32.5, and 37.5 kg/m(2)) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.
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Target blood sugar levels in diabetes are achieved through manipulation of diet, exercise and medication. A change in any one of these three things can skew blood sugar levels and create complications associated with hyperglycemia or hypoglycemia. Fasting during the month of Ramadan is a religious activity that devout Muslims practice whether they are diabetic or not. Since such fasting involves abstinence from food and water for twelve hours or more during the day from dawn to dusk, it is evident that advice regarding exercise and medication will have to be modified during this period.
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A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (⩾25 kg/m2). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22kg/m2 to 25kg/m2 in different Asian populations; for high risk it varies from 26kg/m2 to 31kg/m2. No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23·0, 27·5, 32·5, and 37·5 kg/m2) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.