Effect of Ramadan fasting on metabolic markers, body composition, and dietary intake in Emiratis of Ajman (UAE) with metabolic syndrome

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Dovepress open access to scientific and medical research O r i g i n al R e s e a r c h Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy downloaded from https://www.dovepress.com/ by 213.32.48.132 on 12-Jul-2018 For personal use only. Open Access Full Text Article Effect of Ramadan fasting on metabolic markers, body composition, and dietary intake in Emiratis of Ajman (UAE) with metabolic syndrome This article was published in the following Dove Press journal: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 14 December 2011 Number of times this article has been viewed Amena Sadiya 1 Solafa Ahmed 1 Hisham Hussain Siddieg 1 Irish Joy Babas 1 Martin Carlsson 1,2 1 Rashid Centre for Diabetes and Research, Ministry of Health, Ajman, UAE; 2Kalmar County Hospital, Sweden Introduction Correspondence: Amena Sadiya Rashid Centre for Diabetes and Research, Ministry of Health, Ajman, UAE. Tel +971 6 7147345 Email submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/DMSO.S24221 Powered by TCPDF (www.tcpdf.org) Background/aim: The aim of the study was to evaluate the effect of Ramadan fasting on metabolic markers, body composition and dietary intake in native Emiratis of Ajman, UAE with the metabolic syndrome (MS). Design: 19 patients (14 Female, 5 Male) aged 37.1 ± 12.5 years, were encouraged healthy lifestyle changes during fasting and data was collected 1 week before and in the fourth week of Ramadan. Results: No patients experienced complications or increased symptoms of hypoglycemia during Ramadan. Total energy consumption remained similar. Meal frequency decreased (3.2 ± 0.5 vs 2.1 ± 0.4 meals/day). Protein intake decreased 12% (P = 0.04) but fat intake increased 23% (P = 0.03). Body weight (103.9 ± 29.8 vs 102.1 ± 29.0 kg, P = 0.001) and waist circumference (123 ± 14 vs 119 ± 17 cm, P = 0.001) decreased. Forty percent of patients increased their physical activity due to increased praying hours. Fasting P-glucose (6.3 ± 1.7 vs 6.8 ± 2.0 mmol/L, P = 0.024) and B-HbA1c concentrations 6.3 ± 0.9 vs 6.5% ± 0.9%, P = 0.003) increased but P-insulin concentration, HOMA-IR index and lipid concentrations remained unchanged. Conclusion: The present study investigated the effect of Ramadan fasting on dietary intake, metabolic parameters and body composition showing that the energy consumption per day did not decrease, although the fat intake increased. However, the patients lost weight and reduced their waist circumference. Ramadan fasting has also elicited small but significant increases in Glucose and HbA1c after 4 weeks. Keywords: metabolic syndrome, Ramadan, fasting, body composition, type 2 diabetes, obesity, Ajman Ramadan is the holiest month in the Islamic calendar. Since it is a lunar-based month its duration varies between 29 and 30 days. Muslims fast everyday from dawn to sunset and refrain from drinking and eating for this period; however, there are no restrictions on food or fluid intake between sunset and dawn. The period of fast may vary depending on the geographical location of the country and the season of the year.1 The Ramadan model of fasting is abundantly available but not extensively studied and the physiological changes induced by Ramadan fasting are not well known. Although there have been reports on the metabolic changes during and after Ramadan in healthy subjects2,3 and in patients with diabetes4,5 the results have been conflicting.6,7 The variability in the results is probably attributed to several confounding variables like ethnicity, hours of fasting, climatic conditions, cultural influences, physical Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2011:4 409–416 409 © 2011 Sadiya et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. Dovepress Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy downloaded from https://www.dovepress.com/ by 213.32.48.132 on 12-Jul-2018 For personal use only. Sadiya et al Powered by TCPDF (www.tcpdf.org) c omposition and dietary intake in the subjects with MS in Ajman, UAE. activity and most commonly the dietary patterns.6 Muslims with diabetes and other chronic diseases are exempted from fasting, when fasting may lead to harmful consequences. However, many patients insist on participating in Ramadan fasting. Because of the conflicting results regarding the effects of Ramadan fasting, physicians working in Muslim communities often face a difficult task when advising patients with diabetes or Metabolic Syndrome (MS) whether it is safe to fast, as well as recommending the proper dietary and drug regimens. Food consumption patterns and dietary habits in the Arabian Gulf have changed in the recent past, due to increasing wealth and westernization.8 Obesity and type 2 diabetes mellitus (DM) have recently reached epidemic proportions in the region. The prevalence of the MS in the United Arab Emirates (UAE) is now reported to be one of the highest in the world reaching approximately 40% using the National Cholesterol Education Program (NCEP) definition or the International Diabetes Federation (IDF) definition.9 The high prevalence is possibly caused by genetic factors in combination with rapid socioeconomic developments. Many Emiratis have in the past 20–30 years adapted a sedentary lifestyle with a minimum of physical activity and an over consumption of energy-dense food.10 Presence of MS serves well as a simple clinical tool for identifying highrisk subjects predisposed to cardiovascular disease.11 The dominant underlying risk factors for this syndrome appear to be abdominal obesity and insulin resistance. Prevention or reduction of obesity, particularly abdominal obesity, is a main therapeutic goal in patients with MS.12 Weight reduction can be optimally achieved with a multimodality approach by adapting to healthy lifestyle through diet modification, physical activity and possible pharmacological therapy. 13 A moderate weight loss of about 5% has shown to improve glycemic and blood pressure control, improve insulin action, decrease fasting plasma glucose concentrations, as well as improve lipid concentrations.14 Based on the Ministry of Economy census in 2005, 76% of the total population is Muslim in the UAE,15 and most of the adult population adheres to the Ramadan fasting. To the best of our knowledge, we are not aware of any previous published reports on the effect of Ramadan fasting on the subjects with the MS in this region. Therefore, the present pilot study was undertaken at Rashid Centre for Diabetes and Research (RCDR), Ajman, UAE to evaluate the effect of Ramadan fasting on the metabolic markers, body The subjects were randomly selected based on the inclusionexclusion criteria. Twenty-three subjects were recruited, four withdrew and 19 subje (...truncated)