Augmented Plasma Adiponectin after Prolonged Fasting During Ramadan in Men

Health Promotion Perspectives, 2014, 4(1), 77-81 doi: 10.5681/hpp.2014.010 http://journals.tbzmed.ac.ir/HPP Augmented Plasma Adiponectin after Prolonged Fasting During Ramadan in Men Sadegh Feizollahzadeh1, Javad Rasuli2, *Sorayya Kheirouri3, Mohammad Alizadeh4 1Department of Clinical Diagnostic Laboratories, Shahid Madani Hospital, Urmia University of Medical Sciences, Khoy, Iran 2Department of Public Health, Urmia University of Medical Sciences, Urmia, Iran 3Department of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran 4Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ARTICLE INFO Article type: Original Article Article history: Received: Sep 28 2013 Accepted: Jan 07 2014 e-published: July 12 2014 Keywords: Ramadan fasting, Adiponectin, TNF-α, Insulin sensitivity *Corresponding Author: Sorayya Kheirouri Tel: +98 411 3362117; e-mail: ABSTRACT Background: Intermittent fasting during Ramadan entails major changes in metabolism and energy expenditure. This study sought to determine effect of the Ramadan fasting on serum levels of adiponectin and tumor necrosis factor-α (TNF-α) as two inter-related peptides involved in cells sensitivity to insulin and glucose metabolism. Methods: Total of seventy healthy men, with age range equal or greater than 30, with at least three type2 diabetes mellitus (DM) risk factors were selected. Serum lipid profile, anthropometric indices and plasma glucose levels were determined using conventional methods. Also, serum adiponectin and TNF- α concentrations were assessed using Enzyme-linked Immunosorbent Assay. Data were analyzed by paired t-test. Results: Ramadan fasting resulted in a significant increase of serum adiponectin (P< 0.000), fasting glucose (P< 0.000) and triglycride (P< 0.001). Body mass index was lowered during the fasting (P< 0.000). Finally, no remarkable decrease was found in serum TNF-α levels (P= 0.100). Conclusion: Ramadan fasting resulted in augmented adiponectin levels which may help in improving metabolic stress induced by insulin resistance in men with predisposing factors of type2 DM. Citation: Feizollahzadeh S, Kheirouri S, Rasuli J, Alizadeh M. Augmented Plasma Adiponectin after Prolonged Fasting During Ramadan in Men. Health Promot Perspect 2014; 4(1):77-81. Introduction Intentional abstention from foods is a frequent practice among followers of many religions including Muslims. These behavioral changes provide a great forum for researchers who interested in life style modification strategies to look for its effects on individuals’ health status. The month of Ramadan, as a specific model of intermittent fasting, is associated with very profound alteration in life style of the observers includ77 ing dietary patterns and physical activity. The fasting is known to affect many aspects of metabolism such as body composition and glucose and lipid profile. Adipokines play as key coordinators in many aspects of body metabolisms including energy expenditure pathways. Adipocytes are the most frequent source of production for these active polypeptides.1 Adiponectin, a 30-KD protein, is one of the most abundant Health Promotion Perspectives, Vol. 4, No. 1, 2014; P: 77-81 adipokines that is involved in modulation of both glucose and fatty acid metabolism. It has a specific conformational structure consisting four domains; an N-terminal signal sequence, a specific variable region, a collagen-like domain and a carboxy-terminal globular domain. Interestingly, the latest domain, has partial structure similar to tumornecrosis factor-α (TNF-α).2,3 However, they down regulate each others' secretion implying their important role on pathogenesis of diabetes mellitus (DM), obesity and also chronic inflammatory diseases.4-6 A high plasma level of adiponectin is associated with augmented insulin sensitivity in peripheral tissues. Adiponectin may be involved in activation of AMP activated protein kinase which in turn down regulates lipogenesis. Moreover, adiponectin suppresses expression of enzymes responsible for gluconeogenesis in mRNA level and subsequently liver and muscular glucose load.3 Besides, it is efficiently able to impede damage of β-cells in endocrine pancreas which is usually induced by either autoimmune components or lipid peroxidation.7 On the contrary, TNF-α produced by macrophages, mononuclear lymphocytes and adipose tissue posses a potent pro-inflammatory effect.8 Thus, it is thought to play a major role in the etiology of insulin resistance through inhibition of insulin signaling pathways followed by termination of insulin responsiveness.9 Adiponectin levels could be increased through both pharmaceutical and lifestyle modifications.10 In addition, the most successful therapeutic managements of type 2 DM patients are strongly correlated with significant elevation of adiponectin via control of sensitivity to insulin.11 Collectively, up-regulation of plasma adiponectin levels plays a major role in reduction of insulin resistance and metabolic syndrome.12,13 It seems that TNF-α and adiponectin antagonize each other, regulating expression of the other and acting in an antagonist manner in modulating many aspects of insulin action.3, 14 Fasting during Ramadan, ninth lunar month is the religious duty of all healthy adult Muslims. During this month, Muslims abstain eating and drinking from dawn to sunset. This mode of fasting is a unique model of intermittent daily fasting for one month and is distinct from experimental fasting. This alteration in daily eating patterns and meal frequency influences many metabolic and physiologic aspects of human body.15 Most importantly, the Ramadan intermittent fasting entails major changes in sleep pattern, physical activity and eating habits which may cause changes in cytokines balance. The aim of current study was to elucidate alterations of adiponectin and TNF-α among men observing Ramadan fasting with three risk factors of type 2 DM. Materials and Methods This study was performed during Ramadan of 2012 (July-August). Ethical approval of this study was gained from the Research Ethics Committee. Females were excluded from the study, because they are not allowed to observe fasting during menstruation. Men who were suffering from obesity, defined as body mass index (BMI) greater than 30, DM, cardiovascular diseases, liver diseases including hyperbilirubinemia, high levels of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase, acute or chronic inflammatory disease or any other known disease were excluded from the study. Healthy men who had at least three risk factors of type 2 DM; overweight (25<BMI<30), age ≥ 30 years and a sedentary lifestyle were included in the study. Participants with physical activity of less than 20 minute a day and with frequencies of less than three times a week were considered to be sedentary. The obese men were also excluded because it could affect adiponectin production.4 A (...truncated)