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Background Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS. Methods A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus. ResultsThe experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient's situation and surgeon's experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively. Conclusion Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.

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The aim of this study was to investigate the effect of bile acids and lipase supplementation in low energy (LE) diets on growth, fat digestibility, serum lipid profile and meat quality of broilers. Seven hundred one-day-old broiler chicks were divided into 5 dietary treatments with five replicates of 28 birds each. The five treatments were: i) high energy diet (HE; metabolizable energy (ME) = 3,000 and 3,170 kcal/kg for starter and finisher diet), ii) low energy diet (LE; ME = 2,900 and 3,070 kcal/kg for starter and finisher diet), iii) LE diet supplemented with 300 g/ton bile acids (LEB), iv) LE diet supplemented with 180 g/ton lipase (LEL), v) LE diet supplemented both with bile acids (300 g/ton) and lipase (180 g/ton). The experiment lasted 35 days having starter phase from days 1-21 and finisher phase from days 22-35. Dietary inclusion of both bile acids and lipase in LE diet had no effect (p>0.05) on body weight (BW) gain and feed intake. High energy diet reduced feed intake and BW gain during starter and overall period; however, during finisher phase BW gain was similar in all dietary treatments. Dietary energy level had no effect on feed conversion ratio. Fat digestibility (p>0.05) both in the starter and finisher phase was not affected by the dietary treatments. Concentration of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides were not affected by the dietary treatments (p>0.05). Meat quality of breast and thigh muscle was unaffected due to the dietary treatments (p>0.05). It is concluded that the supplementation of bile acids alone or in combination with lipase in low-energy diets did not improve broiler performance, fat digestibility, serum lipid profile and meat quality.