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Effects on health of fluid restriction during fasting in Ramadan
Abstract
During the 9th month (Ramadan) of the Islamic calendar (Hijra) many millions of adult Muslims all over the world fast during the daylight hours. Since Hijra is a lunar calendar, Ramadan occurs at different times in the seasonal year over a 33-year cycle. Fasting during Ramadan is partial because the abstention from food, fluid, tobacco and caffeine is from sunrise to sunset. Several categories of people are exempt or can postpone the Ramadan fast. The effect on health and well being of the month-long intermittent fast and fluid restriction has been studied in various potentially vulnerable groups in addition to normal healthy individuals in many countries. The majority of the studies have found significant metabolic changes, but few health problems arising from the fast. A reduction in drug compliance was an inherent negative aspect of the fast. Common findings of the studies reviewed were increased irritability and incidences of headaches with sleep deprivation and lassitude prevalent. A small body mass loss is a frequent, but not universal, outcome of Ramadan. During the daylight hours of Ramadan fasting, practising Muslims are undoubtedly dehydrating, but it is not clear whether they are chronically hypohydrated during the month of Ramadan. No detrimental effects on health have as yet been directly attributed to negative water balance at the levels that may be produced during Ramadan.
... Religious beliefs can also create cultural differences in hydration practices. One prominent practice is Ramadan fasting in Islamic culture, where Muslims abstain from eating and drinking during daylight hours [11]. These cultural differences reveal that individuals might not necessarily adopt recommended hydration practices due to cultural influences. ...
... Ramadan fasting occurs during the month of Ramadan, where Muslims abstain from food and fluid intake, smoking, and sexual interaction from sunrise to sunset [11]. As the Islamic calendar follows a lunar calendar, the time of year of Ramadan differs yearly. ...
... As the Islamic calendar follows a lunar calendar, the time of year of Ramadan differs yearly. The duration also differs between countries, depending on geographical location and season of the year [11]. While all Muslims are encouraged to fast, exceptions are made to several groups of Muslims. ...
It is well-established that appropriate hydration practices are essential in promoting health and optimizing performance and recovery. However, evidence-based hydration guidelines may not be adopted due to cultural differences across countries, such as religious beliefs, traditions, preferences, and beverage availability. Examples of hydration practices influenced by culture include beer consumption after sports in Western countries, consumption of sugarcane juice in India and Ramadan fasting among Muslims. For most cultural hydration practices, there is limited scientific evidence on their effects on rehydration, exercise performance, and recovery. Despite possible benefits of various hydration practices on exercise performance and recovery, they are inconsistent with current evidence-based hydration recommendations. More research on the impacts of cultural hydration differences on physiology, performance, and recovery is warranted to allow evidence-based guidelines and advisories.
Abbreviations: ABV: alcohol by volume, ACSM: American College of Sports Medicine, NATA: National Athletic Trainers’ Association, ROS: reactive oxygen species, TCM: Traditional Chinese Medicine
... This state of daytime hypohydration, manifested in increased urine osmolality, and a rise in serum urea, creatinine, haematocrit and albumin, is followed by rehydration after the sunset hours, and during the eating time window has been shown in a number of studies in different parts of the world. [38][39][40][41] A study using isotope tracer techniques demonstrated no change in overall body water content during RF, although daily water turnover was reduced. 38 The effects of this intermittent hypo-and rehydration on eating and energy balance have not been explored. ...
... [38][39][40][41] A study using isotope tracer techniques demonstrated no change in overall body water content during RF, although daily water turnover was reduced. 38 The effects of this intermittent hypo-and rehydration on eating and energy balance have not been explored. ...
Every year, healthy adult Muslims practice dawn to sunset fasting for a whole lunar month. No food or fluid is allowed for the fasting time window. After sunset, eating is allowed. The dramatic change in the timing of meals is accompanied by changes in sleeping hours and thus alterations in circadian rhythms. Hormonal mechanisms mainly determined by the latter also change. These include shifts in cortisol and melatonin. Food‐dependent hormones such as Ghrelin and leptin also show changes. A well‐established principle of chrononutrition is that the timing of eating may be as or more important than the content of food. Ramadan fasting (RF) is distinct from other forms of intermittent fasting, although there are also some similarities with time restricted eating (TRE). Both have been shown to have health benefits. Here, we examine existing literature to understand and learn from this very commonly practiced form of fasting and its relationships to circadian rhythms and homoeostatic mechanisms.
... Although some minor fluctuations may occur in the amount of body water, it remains relatively constant during a normal life. Abstinence from water and other beverages during the fasting window in Ramadan may result in some degree of hypovolemia and cause subsequent symptoms, such as headache, impaired cognition, and decreased physical performance (13)(14)(15). Besides, the amount of fluid intake in the feasting window may be below the recommended level (16). Very few studies have directly investigated alterations in the content of body water following Ramadan fasting. ...
... A study by Alinezhad-Namaghi et al. showed that TBW had a significant, though small, reduction (0.75%) during Ramadan fasting (18). In the study by Leiper et al., by using a radiotracer technique, it was found that TBW was conserved in Ramadan despite a mild decrease in the daily water turnover (13). These findings may represent a new steady-state balance between fluid intake and water loss, leading to the relative preservation of TBW. ...
Concerning the health outcomes of intermittent fasting in Ramadan, loss of fat-free mass (FFM) and changes in the content of body water are of paramount importance. In this study, we aimed to assess the concomitant alterations in body water compartment and composition following Ramadan fasting in healthy individuals. We conducted an open-label cohort with longitudinal follow-up, involving 73 healthy medical staff who planned to fast for at least 20 consecutive days during Ramadan. The primary outcomes of the cohort were changes in parameters related to body composition and water content, which were measured using bioelectrical impedance analysis by InBody S10 (InBody, Seoul, South Korea). Based on the results, the participants’ weight decreased significantly by approximately 1,030 g after the fasting period ( p < 0.001). There was a significant reduction in the fat mass of an average 828 g ( p < 0.001), which accounted for more than 80% of the weight loss. The decline in FFM was not significant (190 g; p = 0.234). The amount of total body water (TBW) and extracellular water (ECW) did not change, while intracellular water (ICW) decreased significantly by about 160 mL ( p = 0.027). A strong correlation was observed between the reduction of phase angle and the increase in ECW/TBW ratio ( R = −0.71, p < 0.001). Overall, our findings revealed a minimal amount of weight loss after Ramadan fasting, which was mainly due to the loss of fat mass. The parallel decrease in ICW and phase angle indicated impaired cell membrane integrity, with subsequent movement of water from the intracellular to the extracellular compartment.
... We do not include volunteers who have any other disease in the dataset to eliminate the inference of other diseases on the facial landmarks. Research [16,18] shows that people usually have mild dehydration during fasting. Therefore we consider the month of Ramadan for data collection, when practising Muslims fast from sunrise to sunset. ...
... To work around this problem, we leveraged the month of Ramadan, when practising Muslims fast from sunrise to sunset. Research [16,18] shows that people usually have mild dehydration during fasting, which does not result in severe health issues. ...
Dehydration occurs due to fluid loss from the human body, affects regular body functions, and causes health complications. Physical exercises, poor fluid intake, and diseases like fever and diarrhea may result in dehydration. Current clinical and laboratory-based dehydration detection techniques are expensive, time-consuming, and require people to visit medical facilities, which often do not exist in destitute areas. Though recent research has focused on monitoring physiological parameters (e.g., heart rate, stress, and oxygen) and detecting diseases using smartphones, the area of dehydration detection has not been sufficiently addressed. We present a smartphone-based early dehydration detection system using artificial intelligence, which is ubiquitous, quick, and does not require any additional cost or expertise to operate. We develop a siamese network-based deep learning model to detect the changes in the facial landmarks that appear from dehydration and are not detectable with the naked eyes of general people. Our model provides an overall accuracy of 76.1% and is lightweight enough to run on a smartphone processor. By integrating it in the background, we develop a smartphone app, “Dehydration Scan” that simply captures facial images of individuals and detects their hydration status. Knowing early about dehydration allows people to take oral rehydration solutions and avoid severe dehydration.KeywordsDehydration detectionMobile image analysisDeep learning
... A 2020 systematic review reported that TRE did not cause major adverse events or negatively impact eating disorder symptoms among adults with obesity, metabolic syndrome, or diabetes [40]. Within adults with type 2 diabetes [98,121,122] or pre-diabetes [62], TRE with 15-20 h fasting periods does not cause occurrences of hypoglycemia. In addition, one study reported no impact of TRE on psychological well-being (e.g., depression, anxiety, or stress) [121]. ...
... Within adults with type 2 diabetes [98,121,122] or pre-diabetes [62], TRE with 15-20 h fasting periods does not cause occurrences of hypoglycemia. In addition, one study reported no impact of TRE on psychological well-being (e.g., depression, anxiety, or stress) [121]. ...
There is substantial overlap in risk factors for the pathogenesis and progression of breast cancer (BC) and cardiovascular disease (CVD), including obesity, metabolic disturbances, and chronic inflammation. These unifying features remain prevalent after a BC diagnosis and are exacerbated by BC treatment, resulting in elevated CVD risk among survivors. Thus, therapies that target these risk factors or mechanisms are likely to be effective for the prevention or progression of both conditions. In this narrative review, we propose time-restricted eating (TRE) as a simple lifestyle therapy to address many upstream causative factors associated with both BC and CVD. TRE is simple dietary strategy that typically involves the consumption of ad libitum energy intake within 8 h, followed by a 16-h fast. We describe the feasibility and safety of TRE and the available evidence for the impact of TRE on metabolic, cardiovascular, and cancer-specific health benefits. We also highlight potential solutions for overcoming barriers to adoption and adherence and areas requiring future research. In composite, we make the case for the use of TRE as a novel, safe, and feasible intervention for primary and secondary BC prevention, as well as tertiary prevention as it relates to CVD in BC survivors.
... Exercising while fasting during the day can lead to increase water losses in sweat and from the lungs, which can cause headaches, tiredness, and difficulty of concentration. Thus, fasters should recover their hydration status during Ramadan by increased drinking during the night, in order to prevent the individuals from becoming chronically hypohydrated/dehydrated [18]. In addition, fasters should not skip "Suhoor". ...
... In addition, Ramadan IF can in certain extreme cases hamper the athlete's ability to train and compete, and discourage the general community to exercise [17]. Although Ramadan IF can lead to health issues such as fatigue, dizziness, sleep deprivation, irritability, and headaches [18], IF may confer cardiac protection, even after a cardiovascular event and optimize circadian rhythms and ketogenesis [19]. ...
Intermittent fasting (IF) has recently gained popularity, and has been used for centuries in many religious practices. The Ramadan fasting is a mandatory form of IF practiced by millions of healthy adult Muslims globally for a whole lunar month every year. In Islam, the “Sunna” also encourages Muslims to practice IF all along the year (e.g.; two days a week). The 2019-Coronavirus disease (COVID-19) pandemic in the context of Ramadan has raised the question whether fasting is safe practice during the COVID-19 pandemic health crisis, and what would be the healthy lifestyle behaviors while fasting that would minimize the risk of infection. As COVID-19 lacks a specific therapy, IF and physical activity could help promote human immunity and be part of holistic preventive strategy against COVID-19. In this commentary, the authors focus on this dilemma and provide recommendations to the fasting communities for safely practicing physical activity in time of COVID-19 pandemic.
... Previous studies in untrained subjects indicated that frequency and quantity of food and fluid intake, nocturnal sleep duration and daily physical activity are reduced during the month of Ramadan (Leiper et al., 2003;Husain et al., 1987;Margolis and Reed 2004;Roky et al., 2004;Waterhouse, 2010;Afifi, 1997). Furthermore, dehydration, variation in hormone levels, impairment in muscular performances, increase in lipid oxidation and decrease in resting metabolic rate and VO2 max are some of the other changes observed during Ramadan fasting (Leiper et al., 2003;Roky et al., 2004;Bogdan et al., 2001;Bigard et al., 1998;Ramadan et al., 1999;Sweileh et al., 1992). ...
... Previous studies in untrained subjects indicated that frequency and quantity of food and fluid intake, nocturnal sleep duration and daily physical activity are reduced during the month of Ramadan (Leiper et al., 2003;Husain et al., 1987;Margolis and Reed 2004;Roky et al., 2004;Waterhouse, 2010;Afifi, 1997). Furthermore, dehydration, variation in hormone levels, impairment in muscular performances, increase in lipid oxidation and decrease in resting metabolic rate and VO2 max are some of the other changes observed during Ramadan fasting (Leiper et al., 2003;Roky et al., 2004;Bogdan et al., 2001;Bigard et al., 1998;Ramadan et al., 1999;Sweileh et al., 1992). ...
... The alteration in body mass is mostly comparatively minor. Also, in the first two weeks of fasting, the weight of the body seems to be greater [32]. Many factors have been suggested to describe Ramadan fasting encouraged body mass loss. ...
Ramadan fasting is a religious practice observed by millions of Muslims
worldwide. Firstly, the experimental studies were searched on different
websites like PubMed, Science direct, and google scholar to find out the
latest research regarding Ramadan fasting. Studies have shown that
Ramadan fasting influences body weight, blood glucose, insulin, lipid levels,
and blood pressure. However, the effects of fasting on mental health and
specific health conditions such as cardiovascular diseases, cancer or
metabolic disorders vary depending on individual factors. Because, fasting
duration, the presence of chronic diseases, and obesity are all factors that can
alter the outcomes. Until now, Multiple studies on Ramadan fasting's impact
on health have been conducted but certain limitations make the results
inconclusive. We hope to gain a better understanding of the potential
benefits and risks associated with this religious practice. Ultimately, this
knowledge can be used to inform healthcare professionals and individuals
who are participating in Ramadan fasting. Further research is necessary to
explore underlying mechanisms and optimize fasting protocols for chronic
disease patients. Overall, this review emphasizes the need for further
research on the effects of Ramadan fasting on human health and its potential
as a tool for improving health outcomes in diverse populations.
... Fasting status has a major impact on workers' health and is associated with health concerns. Fasting can impact on: dehydration and loss body-weight (Toda and Morimoto 2004); blood pressure and the body mass index (Dewanti et al. 2006); metabolic status (Leiper et al. 2003); core body temperature (Roky et al. 2004); and glucose levels (Chamsi-Pasha and Ahmed 2004). However, few studies have addressed the impact of fasting on workers in the construction industry, and none of them considered this factor for measuring workers' physiological status. ...
Purpose
Construction worker health and safety is a primary concern for construction companies and researchers. Arabian Gulf region, like Saudi Arabia, has been experiencing extremely hot and humid (EHH) weather, which directly affects construction workers’ health and safety. This study aims to address the problem of EHH weather conditions and their impacts on construction workers’ physiological status.
Methods
This study assesses the impacts of EHH weather on construction workers’ physiological status through the measurement of workers’ physical body parameters (age, height, and weight); type of activities; and assigned tasks. Thirty-five multinational workers participated in the measurements, which were conducted in real construction site conditions A quantitative analysis was then applied to quantify the physiological impacts of the weather conditions. Several hypotheses were tested to identify the significant impacts of individual and working aspects on the workers’ physiological responses.
Results and conclusion
The results provide empirical evidence that the recorded Heart Rate (HR) exceeded the acceptable physiological zones for construction workers exposed to extremely hot and humid weather conditions. Physical body parameters, work activities, and worker status significantly influence construction workers’ physiological responses. This study recommends adopting a continuous monitoring approach as an early warning system under extremely hot and humid weather conditions.
... The relative weight loss during Ramadan was explained, in part, by a mild dehydration due to fluid restriction during fasting. This was confirmed by the findings that weight loss during Ramadan is frequently gained four weeks post-Ramadan (Leiper et al., 2003). On the other hand, weight gain among males was associated with the daily consumption of sweets (29.8%) and soft drinks (21.4%). ...
Context
Ramadan fasting (RF) is associated with various physiological and metabolic changes among fasting Muslims. However, it remains unclear whether these effects are attributable to changes in meal timing or changes in dietary energy and macronutrient intakes. Furthermore, the literature on the associations between RF, meal timing, and energy and macronutrient intakes is inconclusive.
Objectives
This systematic review aimed to estimate the effect sizes of RF on energy and macronutrient intakes (carbohydrates, protein, fats, dietary fiber, and water) and determine the effect of different moderators on the examined outcomes.
Data Sources
The Cochrane, CINAHL, EMBASE, EBSCOhost, Google Scholar, PubMed/MEDLINE, ProQuest Medical, Scopus, ScienceDirect, and Web of Science databases were searched from inception to January 31, 2022.
Data Extraction
The studies that assessed energy, carbohydrate, protein, fat, fiber, and water intakes pre- and post-fasting were extracted.
Data Analysis
Of the 4776 identified studies, 85 relevant studies (n = 4594 participants aged 9–85 y) were selected. The effect sizes for the studied variables were as follows: energy (number of studies [K] = 80, n = 3343 participants; mean difference [MD]: −142.45; 95% confidence interval [CI]: −215.19, −69.71), carbohydrates (K = 75, n = 3111; MD: −23.90; 95% CI: −36.42, −11.38), protein (K = 74, n = 3108; MD: −4.21; 95% CI: −7.34, −1.07), fats (K = 73, n = 3058; MD: −2.03; 95% CI: −5.73, 1.67), fiber (K = 16, n = 1198; MD: 0.47; 95% CI: −1.44, 2.39), and water (K = 17, n = 772; MD: −350.80; 95% CI: −618.09, 83.50). Subgroup analyses showed age significantly moderated the 6 dietary outcomes, and physical activity significantly moderated water intake. There were significant reductions in energy, carbohydrate, and protein intakes during RF.
Conclusions
The change in meal timing rather than quantitative dietary intake may explain various physiological and health effects associated with RF.
Background: In Ramadan, most of the dosing schedules for the patients are changed, and to ensure patient compliance to medications and to healthy life among patients, appropriate guidelines and educations are needed. This can be achieved by pharmacy personnel in all clinical settings who are recognized as biopharmaceutical experts and integral educators of medications. Aims: This study aimed to identify the perspective knowledge of pharmacy personnel about effect of medication route and medical procedure on nullifying fasting in Ramadan and to determine the predictors of this knowledge. Methods: A cross-sectional study was conducted in Jordan during March-April 2022. An internet-based self-administrated questionnaire on knowledge, and views was distributed using social media groups to the pharmacy personnel among different geographical areas in Jordan. A descriptive and univariate analysis were performed. Binary logistic regression was conducted to determine the predictors of knowledge including all variables with p
Purpose
During Ramadan, millions of Muslims fast from sunrise to sunset. Fasting influences the hormonal system, sympathetic activity, blood circulation, and metabolic pathways. Because of these changes, we employed optical coherence tomography angiography (OCTA) to investigate the effects of fasting on the macula and optic nerve.
Methods
In this prospective before-and-after study, both eyes of 45 participants were examined. Vascular characteristics of the macula and optic nerve head were evaluated in the morning and evening, once before Ramadan and once on the 20th day of Ramadan.
Results
Compared to the non-fasting condition, fasting significantly reduced inner parafoveal retinal thickness in both eyes and total foveal retinal thickness in the left eye in the morning and evening. Fasting in the morning also considerably reduced inner foveal retinal thickness in both eyes and total parafoveal retinal thickness in the right eye. Fasting significantly reduced central choroidal flow (1 mm) in both eyes in the evening (all p-values are < 0.05). In the morning, there were significant increases in the foveal avascular zone (FAZ) area (p-value = 0.006) and deep parafoveal vascular density in the left eye (p-value = 0.001).
Conclusion
Fasting alters both the macular characteristics and the optic nerve head, as seen in OCTA, although it did not affect participants’ vision. However, further research is needed before reaching a broad conclusion.
According to diverse indices of political performance, the Middle East is the world's least free region. Some believe that it is Islam that hinders liberalization. Others retort that Islam cannot be a factor because the region is no longer governed under Islamic law. This book by Timur Kuran, author of the influential Long Divergence, explores the lasting political effects of the Middle East's lengthy exposure to Islamic law. It identifies several channels through which Islamic institutions, both defunct and still active, have limited the expansion of basic freedoms under political regimes of all stripes: secular dictatorships, electoral democracies, monarchies legitimated through Islam, and theocracies. Kuran suggests that Islam's rich history carries within it the seeds of liberalization on many fronts; and that the Middle East has already established certain prerequisites for a liberal order. But there is no quick fix for the region's prevailing record of human freedoms.
Background:
Accommodating and addressing the beliefs and attitudes of Muslim patients, means designing culturally competent mental health services. Practicing Muslims around the world often use the Qur'an when seeking guidance for health.
Aims:
The aim of this study was to identify interventions using the Qur'an as a promoting factor for mental health.
Methods:
The paucity of academic literature in the area meant a systematic scoping review of the evidence was appropriate. Conducting the search for peer-reviewed evidence used six databases, searching for grey literature used Google Scholar, for evidence published up to 29th December 2022. Analysis used the Patterns, Advances, Gaps, Evidence for practice and Research recommendations (PAGER) framework for scoping reviews to report the findings clearly and accessibly.
Results:
Out of 1590 articles from databases and 35 from other sources (n = 1625), 79 full-text articles meeting the inclusion criteria were retrieved. Further assessment for eligibility, excluded 35 articles; leaving 44 studies in the final analysis. Interventions identified Salah and supplicant praying, recitation, reading, memorizing and listening to the Qur'an to reduce anxiety, depression and stress and increase quality of life and coping. There was a paucity of evidence from Western countries utilising the Qur'an to support mental health and wellbeing, suggesting a lack of cultural accommodation. Interventions tended to be mostly biomedical and excluded exploration of psychosocial factors such as the effect of social support.
Conclusions:
Future research could utilise the Qur'an for Muslim patients, integrating it into routine health care interventions and delivery platforms and more closely relating to Islamic lifestyles. This aims to promote mental health and wellbeing, working towards the WHO 2013-2030 MHAP building mental health and psychosocial support capacity and the United Nations Sustainable Development Goal 3, good health and wellbeing, by 2030.
In the aftermath of the devastating earthquake in Turkey in the aftermath of the COVID-19 pandemic, which has affected all lives globally, online education continued in 2023. This situation has shown that online education is an indispensable alternative at a local or national level for various reasons in the coming years. Past research has demonstrated the potential of online education to bring about changes in students' daily routines. Just like online education, fasting during Ramadan, one of the Muslim societies' religious practices, affects individuals' daily lives in various ways. By conducting a comprehensive analysis of university students' sleep habits during Ramadan and considering the role of online education, this study aims to provide valuable insights into the factors contributing to these changes and provide evidence-based recommendations for maintaining optimal sleep quality. Seventy-four university students from two universities in Turkey were evaluated using the Pittsburgh Sleep Quality Index (PSQI) before and after Ramadan. The results indicated a significant deterioration in subjective sleep quality, sleep latency, sleep disturbances, daytime dysfunction, and overall sleep quality (global PSQI score) during Ramadan. However, no significant changes were observed in sleep duration, habitual sleep efficiency, and sleep medication usage. The findings underline the need for tailored strategies to support university students' sleep hygiene during Ramadan, particularly in the context of online learning.
The holy month of Ramadan brings many changes to the lifestyle of Muslims. The effect of these changes on patients with end-stage renal disease (ESRD) is not well studied. The purpose of this study was to investigate the effect of Ramadan on the clinical and metabolic profile of non-fasting patients with ESRD who were maintained on hemodialysis (HD) in the eastern region of Saudi Arabia. A single-center prospective longitudinal study of patients with ESRD who were maintained on HD at a major community hospital in Eastern Saudi Arabia. The patients adopted the lifestyle and dietary changes typically associated with Ramadan in Eastern Saudi Arabia. Measurements included body weight, blood pressure, interdialytic weight gain, serum potassium, serum phosphorus, and serum albumin at the beginning and the end of Ramadan. The development of fluid overload and hyperkalemia was monitored. Seventy patients with ESRD who were maintained on HD were screened and 18 patients were identified to meet the inclusion criteria. There were no differences in patients' weight, interdialytic weight gain, or blood pressure at the beginning and end of Ramadan. Laboratory parameters, including serum potassium, serum phosphorus, and serum albumin, showed no significant changes either; and there were no emergency encounters for fluid overload or hyperkalemia. Lifestyle and dietary changes during the fasting month of Ramadan did not result in significant clinical or laboratory differences among non-fasting HD patients in Eastern Saudi Arabia.
Background:
Ramadan fasting (RF) is mandatory for all healthy Muslims in the ninth month of the Islamic calendar. Although pregnant women are exempt from fasting, many make the decision to practise it. Concerns that fasting during pregnancy harms the fetus remain, as there are no firm recommendations regarding its safety.
Objectives:
To provide a systematic review on the effects of RF on fetal health.
Search strategy:
We conducted a literature search for peer-reviewed articles through Ovid MEDLINE, PubMed, SCOPUS, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) until 31 December 2021.
Selection criteria:
All case-control and observational cohort studies that reported on fetal outcomes of pregnant women who underwent RF for at least one day during pregnancy are included.
Data collection and analysis:
Two researchers independently reviewed the eligibility of all studies. A third researcher resolved any conflict between researchers. Findings are extracted from eligible papers and presented as narratives.
Main results:
Fourteen articles are included based on eligibility criteria, with a total sample size of 2889. Studies demonstrate negative associations between RF and neonatal weight, amniotic fluid index, preterm birth and growth parameters mainly during the second and third trimesters. However, the evidence is not strongly supported.
Conclusion:
There is limited data to elucidate the relationship between RF and fetal health, hence the need for more studies to provide a better understanding.
Background and aim: Ramadan is a holy month for Muslims. Muslims fast off any food, solid or liquid, including medication and smoke. RF can cause many physiological changes in people with diabetes. Therefore, they should have special care and management plan during Ramadan Methods I searched the following data for the recent publication and clinical recommendation for the physiological and management plans for diabetic patients during RF. Examples: Journal of the Royal Society of Medicine, Diabetes research and clinical practice, The Journal of Clinical Endocrinology and Metabolism, International Journal of Sport Studies for Health, etc. Results IDF and other guidelines are now acceptable for properly managing diabetic patients during RF. Conclusion diabetic patients must be prepared well before RF and given a proper management plan and advice to minimize the risk of complications during fasting. The management plan should be fully integrated with essential educational advice, nutritional consultation, physical activity, and medication dosing personalizing.
Introduction: Islamic fasting is widely advocated for its health benefits around the world. According to the Holy Quran, it is prescribed by The Almighty Allah (God) for the Muslim to fast in the holy month of Ramadan of the Islamic Calendar every year. Aim: This study aimed to assess the hydration status of the students who were performing their fasting during the holy month of Ramadan. Methods: Thirty male and female students at the International Islamic University Malaysia (IIUM) Kuantan Campus volunteered to participate in this study. All study participants were of healthy and normal body mass index (BMI) according to the WHO classification. Their hydration status was assessed using a bioelectrical impedance (BIA) instrument. This was done before, during, and after fasting, on specific adjusted time post meal. The collected data were compiled and statistically analysed. Results: The results indicated that the total body water (TBW) was increased without affecting the balance of intracellular water (ICW) and extracellular water (ECW) of the fasting study participants. Conclusion: This study indicates that Islamic fasting does not cause a reduction in TBW in fasting individuals. The TBW is maintained due to the burning of body fat.
We estimate the impact of the Ramadan fasting ritual on criminal sentencing decisions in Pakistan and India from half a century of daily data. We use random case assignment and exogenous variation in fasting intensity during Ramadan due to the rotating Islamic calendar and the geographical latitude of the district courts to document the large effects of Ramadan fasting on decision-making. Our sample comprises roughly a half million cases and 10,000 judges from Pakistan and India. Ritual intensity increases Muslim judges’ acquittal rates, lowers their appeal and reversal rates, and does not come at the cost of increased recidivism or heightened outgroup bias. Overall, our results indicate that the Ramadan fasting ritual followed by a billion Muslims worldwide induces more lenient decisions.
Fasting during the Islamic Ramadan month is one of the five obligatory pillars for each adult, healthy, and sane Muslim. People with severe illnesses, including type 1 and type 2 diabetes mellitus are exempt from fasting. However, many Muslims often insist on Ramadan participating despite any medical advises. It’s known that Muslims are the second largest religious group in Russia; thus, its crucial to have as much modern recommendation for management patients with type 1 and type 2 diabetes mellitus as possible. The aim of this narrative review is to evaluate physiological and pathophysiological metabolism changing during holy Ramadan month, to clarify the management of patients with type 1 and type 2 diabetes mellitus during Ramadan, to determine the frequency of glucose measuring during the day, and to understand when its time to interrupt the fasting. Moreover, we discuss specific recommendations in glucose-lowering therapy changing, nutrition, physical activities and education.
Religious fasting is practiced by people of all faiths, including Christianity, Islam, Buddhism, Jainism, as well as Hinduism, Judaism, and Taoism. Individual/clinical, public, global, and planetary health has traditionally been studied as separate entities. Nevertheless, religious fasting, in conjunction with other religious health assets, can provide several opportunities, ranging from the individual to the population, environmental, and planetary levels, by facilitating and supporting societal transformations and changes, such as the adoption of healthier, more equitable, and sustainable lifestyles, therein preserving the Earth's systems and addressing major interconnected, cascading, and compound challenges. In this review, we will summarize the most recent evidence on the effects of religious fasting, particularly Orthodox and Ramadan Islamic fasting, on human and public health. Further, we will explore the potential effects of religious fasting on tackling current environmental issues, with a special focus on nutrition/food restriction and planetary health. Finally, specific recommendations, particularly around dietary intake during the fasting rituals, will be provided to ensure a sustainable healthy planet.
We investigate how the intensity of Ramadan affects educational outcomes by exploiting spatio-temporal variation in annual fasting hours. Longer fasting hours are related to increases in student performance in a panel of TIMSS test scores (1995–2019) across Muslim countries but not other countries. Results are confirmed in a panel of PISA test scores (2003–2018) allowing within country-wave comparisons of Muslim to non-Muslim students across Europe. We provide evidence that a demanding Ramadan affects PISA test scores of Muslim students only in cohorts with a large share of co-religionists. This finding is consistent with the hypothesis that shared experiences during more intensive Ramadans facilitate the formation of social capital and a social identity conducive to learning outcomes.
During Ramadan fasting, people are likely to consume water and beverages lower than recommended intake due to the limited time. However, it is necessary to achieve the recommended daily water intake to maintain the hydration status, as well as productivity during fasting. Unfortunately, there is a lack of data on drinking patterns during Ramadan. This study aims to investigate water and beverage intake and drinking patterns to help achieve water requirements during Ramadan among Indonesian adults. This is a cross-sectional study conducted during the Ramadan period from April to May 2021 (Ramadan 1442 Hijri). We used a self-administered questionnaire on drinking habits during Ramadan and utilized a 7-day fluid record (Liq.In 7) to assess water and beverage intake among participants who were managed through online procedure. There were 380 participants from five universities across Indonesia who completed the questionnaire accordingly and then analyzed it. The result shows that total water and beverage intake during Ramadan among participants was below the recommendation [1,670 (1,326–2,034) ml/day]. Among the type of beverages, water is the highest level of consumption [1,262 (983–1,666) ml/day] then followed by sugar-sweetened beverages [200 (91–350) ml/day]. We found a significant difference in water and beverages consumption between time of iftar [474 (375–590) ml/day], nighttime [574 (414–810) ml/day], and suhoor [560 (423–711) ml/day]. From this study, we found that during Ramadan the most common drinking pattern is 2-4-2, but a drinking pattern of 4-2-2 glasses (sequence of four glasses at iftar, two glasses at nighttime, two glasses at suhoor) had a significantly higher chance to adhere with the recommendation of fluid intake compared to other patterns. Therefore, based on this research on water and beverage intake, it is necessary and important to make improvements among Indonesian adults during Ramadan, and the drinking pattern of 4-2-2 glasses may help to achieve the recommended daily water consumption.
Background and aims
There is a large body of research focused on various aspects related to Ramadan intermittent fasting (RIF) and human health and disease. This study aimed to quantify the bibliometric data of RIF medical research over the past seven decades and explore these variables qualitatively via text mining analysis.
Methods
We used the Scopus search engine to identify published articles related to RIF from inception to December 31, 2021. All types of research articles were included. Scientometric and bibliometric measures were determined using Excel, Biblioshiny, and VOSviewer. This study proposed a bibliometric and text mining method to qualitatively and quantitatively recognize the RIF research trend.
Results
The Scopus search returned 1916 relevant articles. Most citations pertained to publications from the last two decades, and most publications were original research articles. These publications had received around 27,000 citations, and the 20 most prolific publishing journals had an average h-index of 112.25. More than one-third of all medical publications were in open-access journals. There was a 13-fold increase in medical research on RIF over the past few decades. We identified the 10 most prolific publishing countries, institutes, journals, and authors. We also identified five scientific hotspots of RIF scientific literature, which were: diabetes, metabolic health, public health, physiology, and maternity.
Conclusion
This is the first comprehensive bibliometric analysis of medical research related to RIF. The research gaps identified will shape future research directions and foster collaborative research activities toward enhanced medical nutrition research revolving around RIF.
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.
Recently we reported that in healthy volunteer Ramadan-associated intermittent fasting (RAIF) remodels the gut microbiome and resulted in an increase in small chain fatty acid producing bacteria concomitant with improved metabolic parameters. As interpretation of these results is hampered by the possible psychological effects associated with the study, we now aim to investigate RAIF in experimental animals. To this end, 6-week male BALB/c mice were subjected to RAIF (30 days of a 16-h daily fasting; n = 8) or provided with feed ad libitum ( n = 6). Fecal samples were collected before and the end of fasting and bacterial 16S rRNA sequencing was performed. We found that RAIF remodeled the composition of gut microbiota in BALB/c mice ( p < 0.01) and especially provoked upregulation of butyrate acid-producing Lachnospireceae and Ruminococcaceae ( p < 0.01), resembling the effects seen in human volunteers. Hence we conclude that the effects of RAIF on gut microbiome relate to the timing of food intake and are not likely related to psychological factors possibly at play during Ramadan.
Purpose
In this study, we aimed to investigate the effect of Ramadan fasting (RF) on nasal mucociliary clearance (MCC) and peak nasal inspiratory flow (PNIF).
Methods
Sixty-two (41 male and 21 female) healthy subjects who stated that they would fast continuously during the month of Ramadan were included in this prospective study. Day 0 (baseline), 1st day (after one day of RF), and 29th (after 29 days of RF) nasal mucociliary clearance time (MCT) with saccharine test and PNIF values were determined. Subject weights (SW) were measured on Day 0 and Day 29. The obtained data were analyzed statistically.
Results
The mean of SW on day 0 was 78.53 ± 10.95 kg, and the mean of SW on Day 29 was 78.69 ± 10.87 kg. There was no significant difference in terms of SW (p = 0.251, p > 0.05). A significant difference was found between the MCT and PNIF values measured on different study days (p < 0.05). The MCT values for Day 29 were significantly higher than the values for other days (p < 0.05). There was no significant difference between the MCT values on the first day and the baseline (p = 0.891, p > 0.05). The PNIF values for Day 29 were significantly higher than the values for other days (p < 0.05). The PNIF values on the first day were significantly higher than the baseline (p = 0.008, p < 0.05).
Conclusion
The present study showed that RF leads to MCT prolongation and PNIF increase. Ramadan fasting causes deterioration in nasal airway defense and improvement in nasal respiration.
COVID-19 restrictions are associated with poor physical-activity (PA). Less is known about the relationship between the combination of these restrictions with Ramadan intermittent fasting (RIF), PA, mental health, and sleep-quality. The present study aimed to evaluate whether COVID-19 restrictions and RIF during the fourth wave of the COVID-19 pandemic in Iran are associated with poor PA, anxiety, well-being, and sleep-quality outcomes. A total of 510 individuals participated in an online questionnaire that was disseminated to adults (≥18 years) residing in Iran from 13 May 2021 to 16 May 2021 (~3 days), just after the end of Ramadan 2021. PA behavior (Godin-Shephard Leisure-Time Exercise Questionnaire), anxiety (General Anxiety Disorder-7), well-being (Mental Health Continuum-Short Form), and sleep-quality (Pittsburgh Sleep Quality Index). Of 510 individuals included in the study (331 female (64.9%); mean ± SD, 31 ± 12 years), 172 (33.7%) reported less PA during the Ramadan 2021. PA was associated with better well-being and sleep-quality outcomes. Regardless of PA, participants who fasted for all of Ramadan had less anxiety and better well-being outcomes than those who fasted part of Ramadan or did not fast at all. However, the fasting part of Ramadan decreased the sleep-quality of active participants. The Ramadan 2021 was associated with poor PA, well-being, and sleep-quality of Iranians. However, PA was associated with better well-being and sleep-quality outcomes, and those who fasted all Ramadan had better anxiety and well-being outcomes. Therefore, PA during Ramadan might be an essential and scalable mental health resilience builder during COVID-19 restrictions which should be encouraged.
Fasting also known as abstinence, means different things to different group. To some, it's ordinarily abstinence from eating and drinking. Others sees it as, abstinence from eating, drinking, and all sexually related activities. Irrespective of one's perspective, fasting in Islām is considered as an act of worship which goes beyond eating and drinking. It also, involves, abstinence from sexually related activities, intoxicant and all unethical behaviour from sunrise to sunset. This is why it's referred to in the Qur'ān as Ṣiyām (pl.) and not ṣawm. It's an established principle in Islām that must be carried out for either 29 or 30 days annually in the 9 th month (Ramaḍān) of Islāmic lunar calendar. The paper is library based, descriptive and historical in methodology. It x-rays various definitions of fasting, appraises the universality of fasting. It will also examine various types and kinds of fasting in Islām and x-rays why fasting in some days are considered as forbidden. The objectives of fasting as well as its significance to the heath of man shall also be discussed. It also recommends commitment of Muslims as well as non-Muslims to inculcate the habit of fasting at least once in a week or month due to the enormous spiritual and health benefits in fasting.
The aim of this systematic review was to report the impacts of Ramadan intermittent fasting (RIF) on salivary flow-rate (SFR) and metabolic parameters. A thorough literature search was carried out using the databases PubMed and Scopus from their inception up to 15 July 2021. The Boolean connectors used in PubMed were (Saliva [Mesh] AND Fasting [Mesh]). The same keywords were used in Scopus. Inclusion criteria were defined using PICOS. The research included all original studies involving "healthy" adults and published in English. Methodological quality assessment was performed utilizing the Joanna Briggs Institute Critical Appraisal Tool, which allows attributing scores from 1 to 11 to the selected studies. Two authors carried out the literature search, study selection, and data extraction. Differences on issues were resolved by a third author if necessary. The systematic review protocol was registered within the "Open Science Framework" (Doi: 10.17605/OSF.IO/DE7BH). Six articles met the inclusion criteria. All studies were heterogeneous and had a high score of bias and several methodological differences. The following parameters were collected: SFR, melatonin, cortisol, glucose, immunoglobulin A (IgA), uric-acid, alkaline phosphatase (ALP), and aspartate aminotransferase (AST). The SFR decreased by 10% during Ramadan in fasting subjects. The circadian pattern of melatonin remained unchanged during Ramadan, but melatonin levels dropped significantly from baseline. The salivary cortisol levels were unchanged or increased during Ramadan. The salivary glucose levels were decreased. ALP increased significantly, whilst uric-acid and AST decreased significantly. Salivary IgA decreased during the last week of Ramadan. To conclude, there is a trend toward a decrease in SFR and the content of the majority of the biomarkers investigated, with the exception of ALP and uric-acid. These changes cannot be easily attributed to any single factor (hydration status, dietary habits, physical activity, or hygiene habits). Systematic Review Registration: [https://osf.io/de7bh/], identifier [Doi: 10.17605/OSF.IO/DE7B].
Background
Ramadan fasting (RF) is associated with major changes in meal times. This can affect thyroxine absorption and thyroid function (TF) in patients with hypothyroidism. We aimed to examine the short- and long-term impact of RF on TF in patients with primary hypothyroidism on levothyroxine.
Methods
TF tests in patients with primary hypothyroidism attending an endocrine center in the United Arab Emirates were retrospectively analyzed. The impact of RF on TF, namely serum thyrotropin (TSH) TSH, free thyroxine (fT4) and free triiodothyronine (fT3), was investigated in 481 patients within 3 months before Ramadan (BR), 1–2 weeks (PR1), and 3–6 months (PR2) post-Ramadan. Controlled TF was defined as TSH between 0.45 and 4.5 μIU/mL. Inadequate control was defined as TSH >4.5 μIU/mL. Loss of control was defined as having controlled TF at BR and inadequate control at PR1. Multivariable regression analyses were used to assess the association of baseline TSH, baseline levothyroxine dose, and medication use with loss of thyroid control in Ramadan.
Results
TSH increased significantly from a median of 2.0 (0.8–3.7) μIU/mL at BR to 2.9 (1.4–5.6) μIU/mL at PR1 (p < 0.001). This was accompanied by a fall in fT4 and fT3 at PR1 (p < 0.001). 25.5% of patients with previously controlled TF at BR had deterioration in TF at PR1. Sixty-one percent of patients with previously uncontrolled TF at BR remained uncontrolled at PR1. Baseline TSH was significantly associated with loss of thyroid control in Ramadan with an odds ratio (95% confidence interval) of 1.5 (1.17–1.92) (p < 0.001), whereas other variables, including medications known to affect levothyroxine absorption were not associated with loss of control. TSH, fT4, and fT3 levels returned to normal at PR2.
Conclusions
RF can negatively affect TF of patients on levothyroxine replacement. Although this effect is modest and transitory in most patients, a significant minority exhibit more pronounced, and clinically relevant changes. The latter includes those with higher TSH BR, and a smaller group whose thyroid disease appears to be particularly affected by the mealtime and lifestyle changes of Ramadan.
Managing chronic conditions during the Islamic month of Ramadan can be challenging, especially as many patients may prioritise fasting over health concerns. For example, one epidemiological study of 13 countries with large Muslim populations in Asia, northern Africa, and the Middle East showed increased hypoglycaemic episodes in people with diabetes (types 1 and 2).1 Also challenging is when Ramadan occurs close to the summer solstice in regions at extremes of latitude (when daylight hours are longer), in both hemispheres.
Pre-Ramadan consultations with patients wishing to fast who have existing conditions—ideally held one to four months before the start of Ramadan—are advocated by the British Islamic Medical Association, the International Diabetes Federation, and the Diabetes and Ramadan Alliance, among others.
Healthcare professional opinion is pivotal—with it, Islamic authorities (such as imams and scholars) can offer further advice or assurance to patients about religious exemption from fasting.
What will this article cover?
This article describes which patients might benefit from pre-Ramadan consultations, what to ask and review during consultations, and suggestions for risk stratification and joint decision making. It is aimed at healthcare professionals including GPs, specialist doctors, specialist nurses, midwives, and pharmacists.
Background: Fasting places prohibitions on eating and drinking for a certain period. Although many dental treatments have been said to be safe and can be performed while fasting, others may break the fast. The study aims to evaluate the perception of dental patients regarding the effect of such treatments and hygiene measures during fasting. Methodology: A cross-sectional survey was carried out in two dental teaching hospitals of Lahore, Pakistan. A self-administered structured questionnaire was developed to assess the knowledge and perception of patients regarding dental treatments and hygiene practices while fasting. The chi-squared test was used to observe differences between knowledge amongst gender, occupation and education status. Moreover, multinomial regression analysis was performed to assess the relationship between these variables. Results: Among 374 responses, about 76.2% of respondents believed that undergoing extraction broke fast. Scaling thought to nullify the fast by 45.5%. 52.9% perceived root canal treatment (RCT) to break the fast, along with 67.6%, who believed anesthesia administration broke fast. Brushing was reported to break the fast by 57.5%, with mouthwash invalidating fast by 63.4%. Conclusion: Most respondents thought most oral hygiene measures broke the fast, whereas responses were split regarding procedures where few were perceived to break the fast, and the rest did not.
Dawn to sunset fasting, a type of intermittent fasting commonly practiced in the month of Ramadan, requires fasting from dawn to sunset without food or liquid intake. Dawn and dusk are two transition time zones of the day that play a critical role in the human circadian rhythm. Practicing dawn to sunset fasting requires the alignment of mealtimes and wake-sleep times with the human biological dawn and dusk.
Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) impairs immune cell responses at multiple levels and leads to severe Coronavirus Disease 2019 (COVID-19). It generates high levels of pro-inflammatory cytokines and chemokines, also known as a cytokine storm, leads to mitochondrial dysfunction and generation of excessive amounts of mitochondrial reactive oxygen species, downregulates autophagy to escape detection for unchecked replication, and alters gut microbiome composition. Severe cases of COVID-19 have been associated with several comorbidities that impair immune responses (e.g., obesity, diabetes, malignancy) and blood laboratory abnormalities (e.g., elevated procalcitonin, C-reactive protein, interleukin-6 (IL-6), leukocytosis, lymphopenia).
Several studies of dawn to sunset fasting showed anti-inflammatory effect by suppressing several pro-inflammatory cytokines, reducing oxidative stress, inducing a proteome response associated with increased autophagy, remodeling the gut microbiome, and improving the components of metabolic syndrome (e.g., obesity, blood glucose levels, blood pressure, lipids).
In conclusion, dawn to sunset fasting has the potential to optimize the immune system function against SARS‐CoV‐2 during the COVID-19 pandemic as it suppresses chronic inflammation and oxidative stress, improves metabolic profile, and remodels the gut microbiome. This review presents scientific literature related to the effects of dawn to sunset fasting on the immune system. Studies are needed to assess and confirm the potential benefits of dawn to sunset fasting against SARS-CoV-2.
Health outcomes of in utero Ramadan exposure have been reported in a systematic literature review; however, the available literature on long-term effects were not fully covered. Our study aims to specifically review the long-term outcomes of in utero Ramadan exposure. We searched for original research articles analyzing any long-term outcome of in utero Ramadan exposure, excluding maternal and perinatal outcomes. Sixteen studies from 8304 non-duplicate search results were included. Most studies suggest negative consequences from in utero Ramadan exposure on health, as well as on economic outcomes later in adulthood. Higher under-five mortality rate, higher mortality under three months, and under one year, shorter stature, lower body mass index, increased incidence of vision, hearing and learning disabilities, lower mathematics, writing and reading scores,
as well as a lower probability to own a home were associated with Ramadan exposure during conception or the first trimester of pregnancy. Furthermore, age and sex seem to play a pivotal role on the association. Existing studies suggest that in utero Ramadan exposure may adversely impact long-term health and economic well-being. However, evidence is limited. Meanwhile, increasing awareness of the potential risks of Ramadan fasting during pregnancy should be raised among pregnant women and clinicians and other antenatal care workers should promote better maternal healthcare.
Religious fasting (RF) is practiced annually by millions of Christian and Muslim followers worldwide. Scarce data exist on the impact of RF on the metabolic and hematological profile of individuals with or without dyslipidemia.
The present study included: (i) 60 Greek Orthodox participants, 30 with dyslipidemia and 30 without dyslipidemia, who abstained from meat, fish and dairy products for seven consecutive weeks, and (ii) 15 young, non-dyslipidemic Muslim participants abstaining totally from food and liquid from dawn till sunset during 30 days. Biochemical (iron, ferritin, vitamin B12, calcium, low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), triglyceride and fasting glucose) and hematological (hemoglobin, hematocrit) serum blood test results of study participants were measured pre- and post- RF (at weeks 0 and 7 for Orthodox participants and at weeks 0 and 4 for Muslim participants).
In dyslipidemic and non-dyslipidemic Orthodox participants, a significant reduction of fasting glucose, HDL, LDL and TC levels was found post-RF. Hemoglobin, hematocrit, iron and ferritin levels were significantly increased, while post-RF vitamin B12 and calcium levels were substantially decreased. Subanalysis between dyslipidemic and non-dyslipidemic Orthodox participants revealed a greater decrease of cholesterol levels in the former. In Muslim participants, triglyceride, LDL and total cholesterol levels were increased post-RF (all p values < 0.05).
Our study adds to the existing literature evidence about the significant impact of RF on metabolic and hematological profiles of Orthodox and Muslim followers. The prevention of calcium and B12 deficiency during Orthodox RF by supplement consumption as well as the protection from dehydration and dysregulation of lipid metabolism during Ramadan RF should concern both clinicians and dietician nutritionists. Nevertheless, studies with larger sample size and/or long-term follow-up are warranted before reaching definite conclusions about the effects of RF on human health.
Résumé
Introduction
Plusieurs patients musulmans atteints d’un cancer tiennent à respecter le jeûne du mois de Ramadan, et ceci même en cours de traitement. Le but de cette étude observationnelle est d’étudier la pratique du jeûne chez des patients recevant une radiothérapie externe.
Méthodes
Notre étude a été menée durant le mois hégirien de Ramadan 1441 (2018) au sein du service de radiothérapie du CHU Ibn Rochd de Casablanca. Nous avons inclus tous les malades qui recevaient un traitement par radiothérapie externe durant cette période. Nous avons ainsi collecté les caractéristiques des patients, de la maladie ainsi que les modalités du traitement. Après une entrevue, munis d’un questionnaire préétabli, nous avons pu établir l’observance du jeûne.
Résultats
Nous avons colligé 209 patients. Les localisations les plus fréquemment représentées étaient les cancers mammaires suivis des cancers gynécologiques dans respectivement 35,4 % et 18,7 % des cas. Tous nos patients jeûnaient avant le diagnostic du cancer, cependant, seulement 39,2 % jeûnaient au cours du traitement par radiothérapie externe, et à peine 40 % des patients ont discuté la possibilité du jeûne avec leurs oncologues. En analyse multivariée, le stade de la maladie était le seul facteur lié au statut du jeûne de nos patients.
Discussion
Même sous traitement, un bon nombre de nos patients jeûnaient durant le mois de Ramadan. D’autres études sont nécessaires afin d’évaluer la tolérance du jeûne sur les patients afin de pouvoir mieux répondre à la question « puis-je jeûner? ».
Hydration is an important aspect of human health, as water is a critical nutrient used in many physiological processes. However, there is currently no clinical gold standard for non-invasively assessing hydration status. Recent work has suggested that permittivity in the microwave frequency range provides a physiologically meaningful metric for hydration monitoring. Using a simple time of flight technique for estimating permittivity, this study investigates microwave-based hydration assessment using a population of volunteers fasting during Ramadan. Volunteers are measured throughout the day while fasting during Ramadan and while not fasting after Ramadan. Comparing the estimated changes in permittivity to changes in weight and the time s fails to establish a clear relationship between permittivity and hydration. Assessing the subtle changes in hydration found in a population of sedentary, healthy adults proves difficult and more work is required to determine approaches suitable for tracking subtle changes in hydration over time with microwave-based hydration assessment techniques.
Aim:
To observe the effect of Ramadan fasting on renal function of people with diabetes.
Methods:
This prospective, observational, and longitudinal study was conducted at Baqai Institute of Diabetology and Endocrinology, between April-July 2019. People with type2 diabetes mellitus were recruited using convenient sampling. Demographic data along with renal function were recorded before Ramadan. Kidney functions were assessed in those who came for follow up at 6weeks, 3months, and a year after Ramadan.
Results:
A total of seventy people with diabetes participated in this study with the mean age of 53.11±8.70 years. A significant decline in eGFR was noted around six weeks post Ramadan with a significant improvement of eGFR at 3months follow-up. The normalization of kidney functions among the study participants was observed even after one year of Ramadan.
Conclusion:
In this study post Ramadan assessment of creatinine clearance showed a significant fall among fasting people with diabetes though remained with in normal limits. Significant improvement and reversal of kidney functions was noted in those who followed within three months' time.
Background
The rates of tobacco use, including cigarette and waterpipe smoking, are surging in the Eastern Mediterranean region. The use of these products causes nicotine dependence that makes even short-term tobacco abstinence difficult due to aversive symptoms. During the daytime fasting of the month of “Ramadan”, people accept significant disruption in regular activities, including tobacco smoking. Thus, daytime during Ramadan (before sunset) is likely associated with abstinence symptoms emerging among tobacco smokers. We assessed this hypothesis by measuring tobacco/nicotine abstinence symptoms and craving among smokers of cigarettes or waterpipes during Ramadan.
Methods
A cross-sectional survey-based study was conducted on a convenience sample of adults. Participants were assessed for general information about tobacco smoking, dependence, and nicotine desire or craving, and withdrawal symptoms using the Minnesota Nicotine Withdrawal Scale (MNWS) and the Tiffany-Drobes Questionnaire on Smoking Urges.
Results
The study sample included 632 exclusive cigarette smokers and 161 exclusive waterpipe tobacco smokers. After fasting and abstaining from tobacco during the day, approximately 75% of cigarette smokers and 20% of waterpipe smokers reported smoking within the first 30 minutes. In addition, 10% of cigarette smokers and 30% of waterpipe smokers reported smoking within the first 60 minutes. Regarding smoking urge, no significant difference was found between cigarette and waterpipe smokers. For nicotine craving and withdrawal, significant differences between cigarette and waterpipe smokers were found when comparing mean scores for each of the following items: (i) urge to smoke, (ii) craving nicotine, (iii) hunger, (iv) desire for sweets, and (v) depression/feeling blue (P-values < 0.05).
Conclusion
This study provided evidence from the month of Ramadan that waterpipe smoking is associated with abstinence-induced smoking urge and withdrawal symptoms that are comparable to cigarette smoking. More interdisciplinary research must be focused on developing interventions to reduce tobacco smoking, including waterpipe.
This study aimed to investigate the effects of blood glucose control and the kidneys' functions, depending on fasting, in the streptozotocin-induced diabetes model in rats via TNF-α, NLRP-3, TGF-β1 and VCAM-1 mRNA expression in the present study. 32 Wistar albino rats were allocated randomly into four main groups; H (Healthy, n = 6), HF (Healthy fasting, n = 6), D (Diabetes, n = 10), DF (Diabetes and fasting, n = 10). Blood glucose and HbA1c levels significantly increased in the D group compared to the healthy ones (p < 0.05). However, the fasting period significantly improved blood glucose and HbA1c levels 14 days after STZ induced diabetes in rats compared to the D group. Similar findings we obtained for serum (BUN-creatinine) and urine samples (creatinine and urea levels). STZ induced high glucose levels significantly up-regulated TNF-α, NLRP-3, TGF-β1 and VCAM-1 mRNA expression and fasting significantly decreased these parameters when compared to diabetic rats. Histopathological staining also demonstrated the protective effects of fasting on diabetic kidney tissue. In conclusion, intermittent fasting regulated blood glucose level as well as decreasing harmful effects of diabetes on kidney tissue. The fasting period significantly decreased the hyperglycemia-related inflammatory cytokine damage on kidneys and also reduced apoptosis in favor of living organisms.
Wellbeing has been operationalized in a variety of ways, most of which fit within either a hedonic and/or eudemonic framework. The hedonic worldview equates wellbeing with subjective happiness, pleasure and momentary experiences of positive over negative affect, whereas a eudemonic worldview understands psychological wellbeing as capturing aspects of self-actualization, living well, and reaching one’s potential by developing inner capacities that serve to make an individual more fully functioning. “Chaironic” happiness, a relatively recent addition to the discussion, takes a different approach by considering the influence of spiritual and transcendental elements in wellbeing. For practicing Muslims, the goal of life is not the attainment of complete happiness, but rather a complete submission and orientation towards God. In this chapter, we discuss these conceptualizations as well as the ways in which Muslim health and wellbeing may be attained through the Five Pillars of Islam.
Background: The purpose of this research was to investigate the diurnal effect of Ramadan fasting on the amplitude of accommodation and anterior segment parameters in visually healthy participants.Materials and Methods: The study included 68 healthy individuals, aged 26–42 years. The subjective accommodation amplitude was measured using the "minus lens" technique. Corneal refraction (K1, K2, and Kmax), central corneal thickness, corneal volume, anterior chamber volume, and anterior chamber depth parameters were evaluated using the Scheimpflug camera system. Participants were evaluated twice, at 08:00 and 16:00, while fasting during Ramadan. Data were analyzed by paired sample t-test.Results: The mean age of the participants, of which 28 were women and 40 were men, was 34.38±4.93 (range: 26–42). Comparison of measurements taken at 08:00 and 16:00 during fasting showed that at 16:00, the K1 values (08:00: 42.81±1.51 diopter and 16:00: 42.85±1.50 diopter, P = 0.016) and Kmax values (08:00: 44.29 ± 1.73 diopter and 16:00: 44.38±1.78 diopter, P = 0.020) were significantly steeper. When data collected at 08.00 and 16.00 were compared, there were no significant differences in diurnal changes: amplitude of accommodation (08:00: 7.39±1.40 diopter and 16:00: 7.37±1.40 diopter, P = 0.783), central corneal thickness (08:00: 535.60 ± 30.43 µm and 16:00: 535.25±30.66 µm, P = 0.694), corneal volume (08:00: 59.72±3.85 mm3 and 16:00: 59.60±3.98 mm3, P= 0.344), anterior chamber volume (08.00: 170.91±30.77 mm3 and 16.00: 171.22±32.61 mm3, P = 0.808) and anterior chamber depth (08:00: 2.91 ± 0.28 mm and 16:00: 2.92 ± 0.29 mm, P = 0.053).Conclusions: The results showed that dehydration due to fasting affects some anterior segment parameters, such as corneal refraction; however, it does not affect the diurnal changes of amplitude of accommodation, corneal pachymetry, or anterior chamber anatomy.
1. Fluid intake, urine output and evaporative water loss were measured and fluid balance calculated in sixteen subjects for 1 d before Ramadan, during weeks 1–5 of fasting and on the 10th day after the end of Ramadan.
2. Plasma osmolality at 06.00 hours, the beginning of the fast, at 18.00 hours, before breaking the fast and at 19.00 hours, 1 h after breaking the fast, and urine osmolality during the day and night were measured before, during and after Ramadan.
3. All subjects developed an initial negative fluid balance which was maximum at the beginning of week 3 of fasting and that deficit was compensated for during the later weeks.
4. Compensation was brought about by an increase in urine concentration, a decrease in urine volume by day, and salt retention.
5. No significant changes were observed in plasma osmolality during the days of fasting and the ‘setting’ of plasma osmolality during Ramadan also was not changed.
6. It was concluded that healthy young adults maintain good control of fluid and electroytes during Ramadan.
Road traffic injuries are the second major cause of death in the United Arab Emirates (UAE).
A retrospective study for a 1 year period of all road traffic accidents and injuries was conducted in Jimi Hospital for the period 1 January to 31 December, 1990. A total of 1197 injuries were encountered at the Hospital Emergency Department. The majority of victims were males and under the age of 35 years. During the Ramadan (fasting month), the number of persons who were injured by traffic accidents was slightly higher than during other months. Excessive speed was closely related to traffic accidents and injuries. Most of the accidents and inj uries occurred from 8.00 am to 2.00 pm. Head injury was the most frequently noted type of injury (40.5%), followed by limbs injury (22.1 %) and chest, abdomen and pelvic injuries (14.7%). These findings suggest that there is a need to take a comprehensive approach on both excessive speed and driving habits.
Twenty two Muslim diabetic patients on oral hypoglycaemic agents were studied during the fasting month of Ramadan to determine the effect of fasting on their diabetic control. All the patients completed their fast during the month. Their mean (+/- standard deviation) blood glucose, serum fructosamine and body weight before the fasting month were 10.7 +/- 4.6 mmol/l, 6.64 +/- 3.64 mmol/l and 60.5 +/- 12.6 kg and by the end of the fasting month were 10.9 +/- 4.4 mmol/1,4.34 +/- 1.08 mmol/l and 59.8 +/- 12.3 kg respectively. There was no significant difference between the blood glucose levels but there were significant reductions in the mean body weight and fructosamine values (p = 0.01 and p = 0.03 respectively). The mean decrease in body weight and fructosamine were 0.7 +/- 1.3 kg and 2.29 +/- 3.09 mmol/l respectively. There were also statistically significant differences between the mean daily calorie content before the fasting and during the fasting month (1480 +/- 326 vs 1193 +/- 378 Cal/day - p less than 0.005) and between the mean daily carbohydrate content (389 +/- 298 vs 187 +/- 46 gm/day - p less than 0.005). In conclusion, fasting was safe for diabetic patients on oral hypoglycaemic agents and it was associated with weight reduction and improvement in the overall diabetic control. This was most likely due to decrease in food intake.
The birth weights of 13,351 babies born at full term from 1964-84 to Asian Moslem mothers in Birmingham were analysed to see if the effect of the Ramadan fast on maternal biochemical profiles was of any clinical relevance. These were compared with two age matched control groups comprising white and non-Moslem Asian babies. Ramadan had no effect on mean birth weight at whatever stage of pregnancy it occurred. There was an increase in the prevalence of low birth weights (4.5% to 8%) among babies who were born at full term when Ramadan had occurred during the second trimester, but this was not significant. We conclude that the Ramadan fast has no effect on the birth weights of babies born at full term.
Urine analysis was conducted on male Muslims before, during and after Ramadan. Various changes in urine volume, osmolality, total solute, sodium, potassium, titratable acidity and urea in response to altered feeding and activity regimens were found. There were no detectable levels of ketones, protein, glucose, urobilinogen and haemoglobin. It was concluded that the body adapted to fasting during Ramadan and that there were no adverse effects on renal function.
1. Metabolic changes associated with Ramadan fasting were studied in eleven Asian pregnant mothers. This was compared with a group of control mothers undergoing a normal physiological fast.
2. At the end of the Ramadan fast day there was a significant fall in glucose, insulin, lactate and carnitine, and a rise in triglyceride, non-esterified fatty acid and 3-hydroxybutyrate. When compared with the control group, none of the Ramadan mothers had a completely normal set of biochemical values at the end of the fast day.
3. Pregnancy outcome in the two groups was comparable.
4. We are wary of the metabolic departures from normal observed in the Ramadan fasting mothers. If asked we advise mothers to take up the dispensation from fasting during pregnancy which is allowed.
1. Anthropometric variables, resting heart rate and respiratory gas exchange were measured in twelve male and nine female Asiatic adult Moslems during the month of Ramadan, the week before and the month after Ramadan.
2. Energy intakes were estimated from dietary recall during fasting and non-fasting conditions.
3. Both male and female subjects experienced a decrease in body mass with the reduction in energy intake during fasting. Males experienced a greater reduction than females in resting heart rate; females lost more body weight and subcutaneous fat than males.
4. Urine output and fluid intake were measured in twelve male subjects for 1 d during each week of fasting and 1 d during the pre-fasting control period. Among the subjects examined, the Ramadan regimen did not result in changes in the pattern of fluid exchange.
Fasting serum cholesterol, triglycerides, thyroxine, triiodothyronine, uric acid, gastrin, and insulin were measured in a group of 24 Muslims at the beginning and end of Ramadan--the Muslim month of fasting. There was a significant increase in the levels of total serum cholesterol, thyroxine, and uric acid and a significant fall in body weight. There was no significant change in the levels of total serum triglycerides, triiodothyronine, gastrin, insulin (fasting), or in the rise in gastrin or insulin 1/2 h after food. These changes, although unlikely to affect normal people, may be significant in patients. Physicians working in Muslim countries should be aware that Ramadan may affect some laboratory findings.
Possible effects of Ramadan fasting on anthropometric and metabolic variables were investigated in healthy Tunisian Moslem women. Total daily energy intake remained unchanged whereas the qualitative components of nutrients were markedly affected. Neither body weight nor body composition were influenced by Ramadan fasting. Results also indicate the concomitant decrease of plasma insulin concentrations with respiratory and energy expenditure during Ramadan. The circadian evolution of nutrient oxidation rates was modified. Fat oxidation was increased and carbohydrate oxidation was decreased during the light span of the nycthemeron. Qualitative and quantitative circadian changes in feeding associated with Ramadan might be counterbalanced by specific metabolic changes in order to preserve normal body weight and composition.
We evaluated the effect of the Ramadan fasting on plasma lipids and lipoproteins in normal individuals. Twenty-four healthy subjects were studied before the end of the Ramadan month (Ram) and for 1 mo thereafter. Plasma total cholesterol (TC), triglycerides, low-density-lipoprotein cholesterol (LDL-C), and very-low-density-lipoprotein cholesterol (VLDL-C) did not change. High-density-lipoprotein cholesterol (HDL-C) was 30% higher (P < 0.005) at the end of Ram; apolipoprotein A-I also increased (P < 0.0001). Both the ratios of TC to HDL-C and LDL-C to HDL-C (P < 0.001) decreased at Ram. There was a striking nonpharmacologic improvement in plasma HDL-C and ratios of TC to HDL-C and LDL-C to HDL-C, which were most probably induced by eating one large evening meal a day. Further studies to determine the mechanism of this observation are underway.
Ethnic background is a factor always to be considered in dealing with food habits. Here is a clear explanation of partial fasting as practiced by Muslims—three million of whom live in the United States and Canada
This study was conducted in five provinces and food consumption, physical activity types and duration for 3 consecutive days were recorded in the questionnaire together with some general characteristics of 750 (320 males, 430 females) adults who were on fast during Ramadan at time of interview. One hundred and eighty-seven subjects had some type of health problems, among whom 60.4% were using drugs, and 31.6% were on diets; however, during Ramadan 9.7 and 18.8% of the subjects dropped taking drugs and did not regularly keep on diets, respectively. During the fasting time, from dawn to sunset, 34.3% of the subjects developed some behavioural disturbances, such as feeling tired and being unwilling to work. Although the meal consumed at dawn consisted of foods that were usually eaten at breakfast, the meal consumed at sunset consisted of a great variety of foods. Calcium intake was the most insufficiently consumed nutrient. It was observed that the daily energy intakes were less than the expenditures both in males and females. Further research should be done on the effects of fasting in health and disease.
During Ramadan, the 9th month of the Islamic lunar calendar, all capable Muslims are required to abstain from eating and drinking from dawn until sunset daily. In order to investigate the effects of this practice on meal frequency, 7 male Muslim volunteers were asked to keep daily food records during Ramadan, and for an additional wk, starting 11 wk thereafter. Oral glucose tolerance tests (40 g/m2 of body surface) were performed at the end of Ramadan, and 12 wk later. The following changes occurred during Ramadan, as shown by comparison with the data obtained 12 wk later: meal frequency and daily energy intake were decreased, most of a day's energy supply being consumed within 3 hr of sunset; increased ability to dispose of glucose and enhanced insulin secretion in response to glucose challenge. The fasting levels of free glycerol in plasma were elevated, but those of glucose, insulin, glyceride, glycerol, free fatty acids and cholesterol remained unaltered. The results suggest that interplay of energy intake and eating frequency may influence the outcome of infrequent eating.
This book, a paperback version of the 1998 hardcover edition, is an
account for the general reader of the history and underlying basis of
each of the most important calendars of the world, from antiquity to
modern times. There are descriptions of prehistoric calendars, of those
devised by the Egyptians, the Mayans, the Aztecs, and other
civilizations, of the short-lived French Republican calendar.
The dietary pattern of thirteen non-insulin-dependent diabetics during the Ramadan fast and the effect of Ramadan fasting on the metabolic control of these diabetics was studied. The dosage of oral hypoglycaemic drugs and insulin (in insulin-requring patients) was left unaltered during the fasting period. Patients ingested significantly less calories (p<0.05), more carbohydrates (p<0.05) and less fats (p<0.05) during the fasting as compared to pre-fasting period. The metabolic control, as judged by blood glucose values and glycosylated haemoglobin, remained unchanged at the end of the fasting period. This study demonstrates the safety of Ramadan fasting at 7pm, 10pm and 4am in non-insulin-dependent diabetics.
1. The changes in serum levels of uric acid and lipids during 1 month of starvation-refeeding were measured in sixteen male volunteers.
2. Uric acid levels increased linearly with the duration of the experiment. The increase was positively correlated with the increase in serum triglycerides but not with cholesterol or phospholipids.
3. Triglycerides increased at a faster rate than uric acid implying that the increase in uric acid was secondary to that of the lipid.
4. It was concluded that the purine and lipid synthetic pathways are linked through a common small-molecular-weight effector rather than through the sharing of a common enzyme.
The western region of Saudi Arabia is an area with a high prevalence of urolithiasis. This study was designed to find the effect of climatic changes on the occurrence of urinary stone colic as well as the effect of Ramadan fasting and pilgrimage festival. The emergency room (E.R.) records at King Abdulaziz University Hospital in Jeddah were studied for 3 consecutive years. Males diagnosed as urinary colic during this period were recorded on monthly basis with correction for 30 days a month. Data were recorded before, during and after the fasting month as well as before and after the pilgrimage festival. The results showed a steady increase in urinary stone colic in the hot season with a maximum rate in the months of June, July and August. The mean number of males with stone colic in these months was 45.33, 44.19 and 45.16 respectively. The lowest number was in March (28.06) with a rate of 4.11 per 1000 patients. A strong correlation was found between urinary stone colic and both temperature and atmospheric pressure with a P value of < 0.0001. No significant correlation was observed with relative humidity and similarly no significant change in relation to Ramadan fasting or the pilgrimage festival. These results suggest that there is a clear stone season in this area corresponding to the hot summer months. No significant increase in urinary stone colic was observed in relationship to the fasting month of Ramadan or the pilgrimage festival.
Orthodox Moslems subject themselves to complete fluid and food deprivation during daylight hours of the Lenten month Ramadan. The effects of the Islamic Lenten month on body weight, state of health, hematologic and clinically relevant chemical parameters were studied in 12 subjects carrying on limited physical activity during that period. The main symptoms observed were signs of dehydration (increased hematocrit, total serum-protein [particularly albumin], creatinine and urea) as well as a modified electrolyte balance. Considering that signs of dehydration already appear when restricted physical activity is pursued, heavy work - especially when associated with massive sweating - can definitely not be recommended during daytime fluid deprivation.
1. The changes in serum levels of uric acid and lipids during 1 month of starvation-refeeding were measured in sixteen male volunteers. 2. Uric acid levels increased linearly with the duration of the experiment. The increase was positively correlated with the increase in serum triglycerides but not with cholesterol or phospholipids. 3. Triglycerides increased at a faster rate than uric acid implying that the increase in uric acid was secondary to that of the lipid. 4. It was concluded that the purine and lipid synthetic pathways are linked through a common small-molecular-weight effector rather than through the sharing of a common enzyme.
During a 72 hour fast in pregnant women, significant decrements in the maternal plasma glucose concentrations, accompanied by a significant increase in the plasma placental lactogen (hPL) concentration, occur. At the same time, utilization of glucogenic amino acids, principally alanine, takes place. The mean postprandial glucose concentration in pregnancy is significantly lower than that of comparable nonpregnant women (70.5 +/- 1.7 versus 79.5 +/- 1.3 mg. per 100 ml., p less than 0.001). There appears to be a significant sparing effect on the maternal plasma glucose concentration during acute fasting which may be mediated through hPL. Concentrations of amniotic fluid and fetal plasma glucose from women undergoing fasting decrease in a manner parallel to that of the mother. Fasting provokes a mean rise in plasma hPL of 33.2 per cent over basal levels. This rise is still evident 72 hours after refeeding, after which it gradually returns to pretest concentrations. The infusion of alanine or arginine to pregnant women at the end of the fast produced increments in the peripheral maternal glucose concentration. The response was much greater with alanine than with arginine, demonstrating the increased gluconeogenic potential of this amino acid. The increment in human growth hormone (hGH) following alanine infusion was significantly greater than that observed after arginine administration. Hypoaminoacidemia was present in nonpregnant and pregnant women in response to fasting, but the decline was greater in pregnancy. Acute fasting in the first half of gestation appears to produce significant alterations in carbohydrate metabolism evidenced by profound hypoglycemia, hypoinsulinemia, and hypoaminoacidemia. This maternal deficit can be reflected in fetal substrate concentrations. The effect of these changes on fetal growth and development is speculative at this time.
Muslims abstain from food and drink from dawn to sunset during Ramadam, the ninth month of the Islamic calendar. The purpose of this study was to examine the changes that occurred in body composition and both resting and exercise metabolism during a 4 week Ramadan fast. Subjects consumed an average of 1220 kcal each day during Ramadan and lost a significant 1.92 kg body weight. The subjects also lost 2.8% fat. Fat-free mass did not change. Serum sodium, chloride, and protein increased during the first week of Ramadan and returned to the pre-fasting levels during the last week. This indicates a state of dehydratation existed during the first week of Ramadan. Consistent with this is first week 1.13 kg body weight loss with no change in percent fat. First week Ramadan tests showed a significant decrease in VO2max with a return to the pre-test levels in the last week. The lower resting afternoon VO2 suggests that during Ramadan the body's metabolism slows down during the day in order to conserve its energy stores, however, exercise economy as measured by submaximal VO2 in mk/kg/min is not affected.
The phenomenon of involuntary dehydration, the delay in full restoration of a body water deficit by drinking, has been described extensively but relatively little is known about its physiological mechanism. It occurs primarily in humans when they are exposed to various stresses including exercise, environmental heat and cold, altitude, water immersion, dehydration, and perhaps microgravity, singly and in various combinations. The level of involuntary dehydration is approximately proportional to the degree of total stress imposed on the body. Involuntary dehydration appears to be controlled by more than one factor including social customs that influence what is consumed, the capacity and rate of fluid absorption from the gastrointestinal system, the level of cellular hydration involving the osmotic-vasopressin interaction with sensitive cells or structures in the central nervous system, and, to a lesser extent, hypovolemic-angiotensin II stimuli. Since humans drink when there is no apparent physiological stimulus, the psychological component should always be considered when investigating the total mechanisms for drinking.
During the period between Rajab 1405 and Jamad Thani 1407 (March 1985-January 1987) a total of 5280 babies were delivered at King Khalid Hospital, Al-Kharj, Saudi-Arabia. Out of these children, 345 i.e. 6.53% weighed less than 2500g. Seventy-three, i.e. 21% of the low birthweight (LBW) babies were born during the festival months of Ramadan and Hajj. When compared with the non-festival months, the number was statistically significant p less than 0.01; and Odds Ratio of 1.42. The perinatal mortality rate for the LBW infants was 176.8 per thousand compared with 25.82 for all deliveries during the same period of time. As in a previous report adolescent primiparae made a large contribution to the total number of LBW deliveries. Therefore there is a need for more vigilance in the care of pregnant patients and, more provisions for the care of LBW infants during the festival months.
The effect of fasting during the holy month of Ramadan on the metabolic control of 39 patients with overweight and non-insulin-dependent diabetes (NIDD) was studied. There were 29 females and 10 males with a mean age of 51.5 +/- 1.65 years and body mass index of 31.5 +/- 0.98 kg/m2. All were treated with diet and oral hypoglycaemic agents (OHA). There was no change in body weight, fasting plasma glucose, glycosylated haemoglobin (HbA1), C-peptide and insulin blood levels at the end of fasting. Total blood cholesterol concentration rose significantly (p 0.05) but not triglycerides at the end of Ramadan. There were no acute metabolic complications (e.g. hypoglycaemia) in the present study. We conclude that fasting during Ramadan is generally safe in NIDD. However, patients should be advised to make use of this opportunity to combine the spiritual benefit with improvement in the metabolic control of the diabetes mainly through weight reduction.
The effect of alteration of eating pattern during Ramadan on body mass index (BMI), serum fructosamine: total protein ratio (F/TP), and glucose level in 18 healthy male Asiatic Moslems were studied. The results showed a significant decrease (p less than 0.025) in F/TP at the second week of Ramadan in 11 subjects who experienced continuous decrease in BMI throughout Ramadan. The remaining 7 subjects showed no significant changes in BMI and F/TP. No evidence of hypoglycaemia was observed in the subjects during the study. Serum fructosamine: total protein ratio in subjects with altered eating pattern preferably should be interpreted along with the change in body mass index.
Two experiments are reported which investigated the effects of fasting on visual flicker fusion (VFF). In Exp. 1 the VFF of 40 undergraduate students, 20 men and 20 women, whose mean age was 22.5 yr., was measured in nonfasting conditions 1 to 2 weeks before and in fasting conditions during the Muslim fasting month of Ramadan. In Exp. 2 the VFF of a comparable group of 15 men and 15 women, whose mean age was 23.2 yr., was measured in a different month in both fasting and nonfasting conditions. Subjects were assigned randomly to these two conditions. Analysis shows that fasting reduced VFF significantly in both experiments. This finding indicates that fasting is likely to reduce perceptual sensitivity. The results were explained in terms of fatigue and physical exhaustion effects produced by fasting.
The doubly-labelled water (2H218O) method was used to measure total energy expenditure (TEE) in ten non-pregnant, non-lactating (NPNL), six pregnant (P) and fourteen lactating (L) women in a rural Gambian community. Measurements were made on free-living subjects at a period of peak energetic stress when high agricultural work loads coincided with a hungary season to induce moderately severe negative energy balance. TEE averaged 10.42 (SD 2.08) MJ/d, equivalent to 1.95 (SD 0.38) times resting metabolic rate (RMR). The energy cost of physical activity plus thermogenesis, derived as TEE-RMR, averaged 4.94 (SD 1.96) MJ/d. Expressed per kg body-weight (103 kJ/kg per d) this component of expenditure was 2.5 times greater than comparative values from inactive, affluent women studied previously (39 kJ/kg per d). Estimated energy intake (EI) in a subset of the women (n 13) was only 4.80 (SD 1.58) MJ/d, yielding an apparent deficit of 6.08 MJ/d between EI and TEE. Weight changes suggested that endogenous fat oxidation accounted for only about 0.85 MJ/d, leaving an unexplained difference of over 5 MJ/d. Critical analysis of possible errors suggests that the new doubly-labelled water method has provided the most reliable estimates and that the estimates of EI were substantially in error. This finding has important consequences for other food intake studies.
An investigation was conducted to study the changes in body weight and blood lipids during Ramadan fasting in men on hypocaloric diets. Sixteen healthy male college students were fed a high-carbohydrate diet for the first 2 wk (means 1696 kcal/d), followed by another 2 wk of high-fat diet (means 1834 kcal/d). Fasting blood samples were taken on days 0 (base line), 14, and 28 and were analyzed for triglycerides (TGs) and cholesterol. By the end of Ramadan, body weight, blood TGs, and high-density lipoprotein cholesterol (HDL-chol) had decreased significantly (p less than 0.05), low-density lipoprotein cholesterol (LDL-chol) had increased, and total cholesterol had not changed compared with base-line values. The variance in blood lipid levels was explained by weight change through linear and curvilinear regression models. The findings contribute to a better understanding of the contrasting results reported by various investigators and they may be useful in regulating blood lipid levels through Ramadan fasting.
The characteristics of fluid intake in humans were investigated using a diary self-report method. Thirty-six adult humans were paid to record in a diary, for 7 consecutive days, everything that they either ate or drank, the time that they ingested it, and how thirsty and hungry they were on seven point scales. The diary entries were encoded and entered into a computer. Draughts were identified according to five different bout definitions and three different definitions of fluid amount; total fluid ingested in both solids and liquids, excess fluid ingested above digestive requirements, and total fluid ingested in "drinks." The fluid and caloric compositions of the bouts, the estimated stomach contents at the beginning and end of the bouts, and prebout and postbout intervals were calculated. These variables were then interrcorrelated with univariate and multivariate techniques. Self-rated thirst and hunger were found to be equivalent in magnitude at the beginning of the draughts but self-rated hunger was more closely associated with the prebout interval and stomach contents of food and water than was self-rated thirst. Subjective thirst was found to be negatively related to the amount in the stomach regardless of composition. The amount of fluid ingested, regardless of its definition, was found to be primarily related to the amount of food ingested in the bout, not to the estimated prebout stomach contents or the prebout interval, and only slightly with self-rated thirst. "Drinks" which occurred independent of eating were relatively rare but were strongly correlated with the degree of subjective thirst. The amount of time that would elapse before the subsequent draught, the postbout interval, was related to the amount of food ingested in the bout and not to the amount of liquid ingested regardless of definition. It was concluded that the spontaneous intake of fluid by humans, under ad lib conditions, occurs in excess of requirements, is principly determined in amount and timing by eating, and water balance is left to regulation by the kidneys.
A study was carried out to compare the nutritional intake and meal pattern during and after Ramadan. It was found that in a sample group of 15 young Saudis there was a significant increase in caloric, fat, carbohydrate and protein intake. Although there was a significant reduction in meal frequency and the number of meals taken outside the family, a significant increase in body weight was noted during Ramadan.
The effects of fasting on the drug regimens of 81 Asian Moslem patients during the religious month of Ramadan have been examined.
Twenty-two male and 15 female patients were found to change their drug dosage pattern while fasting: 35 missed doses; 8 took their tablets at different times and 4 patients took all their medication as one single daily dose after breaking fast in the evening.
The consequences of these changes are discussed and ways in which the problems which arise may be overcome are examined.
In studies in a rural West African village it was observed that all lactating women and 90 per cent of pregnant women fasted throughout the period of Ramadan. The metabolic consequences of this fasting were studied by measuring serum glucose, free fatty acid, triglyceride, beta-hydroxybutyrate, alanine, insulin, glucagon and T3 levels at 0700 h and 1900 h in 22 pregnant, 10 lactating and 10 non-pregnant, non-lactating women. Results were also compared with overnight-fasted values obtained outside Ramadan. Values for the lactating women were not significantly different from the non-pregnant, non-lactating controls despite the additional metabolic stress of lactation. Ramadan-fasted (1900 h) glucose values from women in late pregnancy (3.01 +/- 0.11 mmol/l) were significantly lower than all other groups (P less than 0.01) and were 15 per cent (P less than 0.01) lower than overnight-fasted values from similar subjects. Ramadan-fasted free fatty acid and beta-hydroxybutyrate levels were significantly higher (P less than 0.05) and alanine values were significantly lower (P less than 0.05) in late than in early pregnancy. It is concluded that the phenomenon of 'accelerated starvation' occurs when women in late pregnancy fast during Ramadan. The possible consequences of this failure to maintain glucose homoeostasis are discussed with reference to the poor outcome of the actual pregnancies studied.
1. The effects of dehydration on mechanisms of water balance and milk synthesis were investigated in ten lactating Gambian women who were fasting during Ramadan. Ten non-pregnant, non-lactating women acted as controls. Fasting consisted of total water abstention from 05.00 hours to 19.30 hours and was accompanied by high insensible water losses.
2. Lactating women lost 7.6% of their total body water between 07.00 hours and 19.00 hours. Control subjects lost significantly less.
3. Plasma indices of dehydration (osmolality, sodium, uric acid) showed a greater rise in the lactating women than in the control subjects over the period of fasting. However, the 19.00 hours values remained in the normal range obtained on non-Ramadan days.
4. During Ramadan the lactating women restricted their urinary output to a lesser degree than the controls, and for much of the day their urine was also less concentrated. The lactating women appeared to have adapted by superhydrating themselves overnight. This resulted in very low urine concentrations (osmolality, sodium, urea, creatinine) in morning samples. Urine concentrations approached, but did not exceed, non-Ramadan levels by late afternoon.
5. The daily water turnover of 6.4 litres in the lactating women was 2 litres greater than in the controls. This difference was much greater than that required for milk synthesis (500 ml) and may represent a further protective mechanism.
6. Fasting caused changes in milk osmolality, lactose, sodium and potassium concentrations indicative of a marked disturbance of milk synthesis. The results suggested that the normally tight junctions between the mammary secretory cells had become permeable to small ions and formed a paracellular pathway.
Fasting is frequently mentioned by patients and in textbooks as a trigger for headache. In this study, we attempted to define the role of fasting as a possible precipitator of headache. Headache history was documented in 370 hospital employees (60% female) before and immediately after a 25-hour fast for the 1993 Day of Atonement (Yom Kippur). The population included 211 who fasted; 39% of fasters developed headache, compared with only 7% of nonfasters (p < 0.000001). Headache was usually of a nonpulsating quality, mild to moderate in intensity, and bilateral and frontal in location. Subjects with a history of headache were more likely to develop fasting-induced headache than were those without such history (66% versus 29%, p < 0.000002). The number of headache sufferers increased in direct relation to the duration of the fast. Caffeine and nicotine withdrawal and oversleeping did not appear to have an influence on headache development. We conclude that fasting is a strong headache precipitator, especially among chronic headache sufferers. It is usually nonpulsating and nonlateralized.
Fasting during the month of Ramadan provides researchers with a good opportunity to study experimental hunger.
The case histories of patients brought to Ankara Numune Hospital and hospitalized there because of peptic ulcer complaints during the period 1987-92 were retrospectively studied.
The ratio of peptic ulcer complications was in all the years of the study higher during Ramadan than during the periods before Ramadan (0.05 > p > 0.01) and after Ramadan (0.1 > p > 0.05). Female patients tended to develop more haemorrhage and perforations during Ramadan. In the peptic ulcer perforation group the average age of women was significantly higher during Ramadan, whereas it was significantly lower in men.
A type of partial hunger during Ramadan increased peptic ulcer complications.
To compare the efficacy of two glibenclamide regimens in patients with non-insulin dependent diabetes who were fasting during Ramadan and regular glibenclamide treatment in the non-fasting group.
Non-randomised control group of patients who did not fast during Ramadan and two groups of patients who fasted randomised equally to one of two regimens: to take their usual morning dose of glibenclamide in the evening and their usual evening dose before dawn; or to follow this pattern but to reduce the total dose by a quarter.
Two university hospitals, one private hospital, and two private clinics in Casablanca and Rabat, Morocco.
591 diabetic patients (198 men, 391 women, two unspecified) with similar duration of diabetes and length and amount of glibenclamide treatment, of whom 542 completed the study.
Serum fructosamine and total glycated haemoglobin concentrations and number of hypoglycaemic events.
At the end of Ramadan there were no significant differences between the groups in fructosamine concentration (400 mumol/l in controls and 381 mumol/l and 376 mumol/l in the fasting groups); percentage of glycated haemoglobin (14.7%, 14.0%, and 13.6%); or number of hypoglycaemic events during Ramadan (11, 14, and 10).
Glibenclamide is effective and safe for patients with non-insulin dependent diabetes who fast during Ramadan. The easiest regimen is to take the normal morning dose (together with any midday dose) at sunset and any evening dose before dawn.
To assess the effect of exercise on water turnover in endurance trained middle aged men.
Water turnover was assessed using 2H2O as a tracer for water in six exercising and six sedentary middle aged men over seven consecutive days. The exercising subjects ran on average 14.8 km per day, while the sedentary group did not take part in any regular physical activity.
The average median (range) rate of water turnover (ml.d-1) was higher in the exercising group [4673 (4320 to 9606)] than in the sedentary group [3256 (2055 to 4185); P = 0.001]. Although there was a tendency for non-renal water losses (ml.d-1) to be greater in the exercising group [1746 (1241 to 5196)] than in the sedentary group [1223 (1021 to 1950); P = 0.08], the major difference in water loss between the groups was the greater urine output (ml.d-1) in those who exercised [3021 (2484 to 4225)] compared to those who were sedentary [(1883 (925 to 2266); P = 0.001].
The results suggest that fluid intake in middle aged men who exercise regularly must be greater than that of sedentary individuals of the same age group, and that the difference in volume is in excess of that required to replace exercise induced sweat and respiratory water losses.
We demonstrated for the first time in a Moroccan population that fasting during Ramadan, the ninth lunar month of the Muslims' year, affected lipid and lipoprotein metabolism in a group of 32 healthy adult male volunteers. This investigation was conducted to study the changes in serum total cholesterol, triglycerides, cholesterol in high-density lipoprotein (HDL) and low-density lipoprotein (LDL), glucose, and body weight during Ramadan. The results showed a significant decrease (7.9%, p < 0.001) in serum total cholesterol concentration during Ramadan as compared with the prefasting period. Also, we obtained a significant decrease of serum triglyceride concentration (30%, p < 0.001) during Ramadan fasting as compared to the period before Ramadan. The reduction of both serum triglycerides and total cholesterol was maintained 1 month after Ramadan. By the end of Ramadan, serum HDL cholesterol had markedly increased (14.3%, p < 0.001) and remained elevated 1 month after Ramadan in contrast to LDL cholesterol which showed a significant decrease (11.7%, p < 0.0001) also maintained 1 month after Ramadan. Mean body weight declined by 2.6% (p < 0.01) on day 29 of Ramadan, whereas during Ramadan, the diet pattern used by our subjects showed an increase of total energy intake due to carbohydrates (+ 1.4% of total energy), proteins (+ 0.4% of total energy) but not fat (-0.7% of total energy) compared to a usual diet used throughout the rest of the year. Moreover, the fat diet is high in monounsaturated (p < 0.05) and polyunsaturated fatty acid in contrast to saturated fatty acid which significantly (p < 0.05) decreased during Ramadan. These findings suggest that feeding behavior that occurs during Ramadan beneficially affects plasma lipids and lipoproteins.
A cross-sectional study was carried out to explore the effect of the Ramadan fast on daily practices (life events, diet and smoking), health and performance of 265 university students. Analysis showed that more people got involved in stress reducing (watching TV, listening to the radio and visiting) and spiritual activities (prayers and reading Koran) during this month. They drank less caffeine-containing beverages and smoked less.
Food intake appeared to improve during Ramadan with higher proportions eating foods from all food groups. The amount of foods did not differ significantly except in the case of foods from the cereal, meat and vegetable groups. Even though less, cereal consumption was still in the adequate range.
Change in weight was variable. Weight loss was significantly more among the sick. A large proportion of the latter improved during the month especially those with irritable bowel syndrome and constipation. Reduced activity, study desire and concentration ability were reported by more than 50% of subjects.
During Ramadan, physiological changes are expected to result from both long-term dietary restriction and partial sleep loss.
We speculated that Ramadan fasting has deleterious effects on muscle performances and on orthostatic tolerance.
There were 11 senior fighter pilots tested on three occasions during the first week of Ramadan (Beg-R), during the fourth week (End-R) and during a control period, 2 mo after Ramadan (C). Each test session consisted of an assessment of the strength and endurance performances of the knee extensors and elbow flexors and of an analysis of the HR and BP responses to the orthostatic stress imposed by a 80 degrees head-up tilt.
Body weight decreased by 2.7% at End-R in comparison with C period (p < 0.01). Maximum isometric strength (MVC) of elbow flexor muscles decreased immediately (by 10-12%; p < 0.05). Muscular endurance at both 35 and 70% MVC were lower at End-R in comparison with C period (-28%, -22%, respectively; p < 0.05). The head-up tilt test at End-R was accompanied by a higher increase in heart response than during orthostasis during C and Beg-R periods, and by a decrease in pulse pressures (p < 0.001). These alterations in responses to the head-up tilt were associated with a fall by about 7% in plasma volume.
These data demonstrate that Ramadan fasting leads to an impairment in muscular performances and to a decrease in orthostatic tolerance. Further studies are needed to verify the impact of these changes on +Gz tolerance.