The DAR 2020 Global survey: Ramadan fasting during COVID 19 pandemic and the impact of older age on fasting among adults with Type 2 diabetes

Hassanein, Mohamed; Hussein, Zanariah; Shaltout, Inass; Seman, Wan Juani Wan; Tong, Chin Voon; Noor, Nurain Mohd; Büyükbeşe, Mehmet Akif; Tony, Lobna El; Shaker, Gamal Mohamed; Alamoudi, Reem; Hafidh, Khadija; Fariduddin, M; Batais, Mohammed Ali; Shaikh, Shehla; Malek, Pr Rachid; Alabbood, Majid; Sahay, Rakesh; Alshenqete, Abdulwadod M.; Ahmedani, Muhammad Yakoob

doi:10.1016/j.diabres.2021.108674

Cited by 25 publications

(33 citation statements)

References 13 publications

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“…However, studies during Ramadan in the Middle East, including those on patients with diabetes for instance ( 21 , 22 ) and our own experience in Emirati individuals with T1DM and T2DM in a prospective study has shown that at least 80% of these choose to fast most of Ramadan (unpublished data). Hence, extrapolating from Diabetes and Research alliance ( 16 ) surveys conducted in high-risk patients, it will be safe to assume that patients with thyroid disorders are even more likely to fast during Ramadan.…”

Section: Discussionmentioning

confidence: 94%

Ramadan Fasting and Changes in Thyroid Function in Hypothyroidism: Identifying Patients at Risk

Alkaf

Siddiqui

Ali

et al. 2022

Thyroid

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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.

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Section: Discussionmentioning

confidence: 94%

Ramadan Fasting and Changes in Thyroid Function in Hypothyroidism: Identifying Patients at Risk

Alkaf

Siddiqui

Ali

et al. 2022

Thyroid

View full text Add to dashboard Cite

show abstract

“…It is thus rational that those with a higher baseline fCal will be the most prone to clinical deterioration when an inciting factor (fasting) is present. Older patients are more prone to negative effects of fasting such as dehydration and hypoglycaemia, the symptoms of which might raise the “physician global assessment” part of the partial Mayo score [ 54 ]. Elderly patients also more commonly have comorbidities and have polypharmacy problems that are compounded during the month of Ramadan.…”

Section: Discussionmentioning

confidence: 99%

Effect of Ramadan intermittent fasting on inflammatory markers, disease severity, depression, and quality of life in patients with inflammatory bowel diseases: A prospective cohort study

et al. 2022

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Background Intermittent fasting (IF) during the month of Ramadan is part of the religious rituals of Muslims. The effect of intermittent fasting on disease activity in inflammatory bowel diseases (IBD) is still unknown. This is the first study to assess the effect of IF during Ramadan on inflammatory markers in patients diagnosed with IBD. The effects on clinical disease activity, quality of life, and levels of depression were also assessed. Methods Patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) who intended to observe Ramadan fasting were recruited. The following were assessed immediately before and at the end of Ramadan: Serum CRP and stool calprotectin, partial Mayo score, Harvey Bradshaw index (HBI), Simple IBD questionnaire (SIBDQ), and Hamilton depression scale questionnaire. Results 80 patients diagnosed with IBD were recruited (60 UC, 20 CD). Serum CRP and stool calprotectin did not show a significant change before vs after fasting (median CRP 0.53 vs 0.50, P value = 0.27, Calprotectin 163 vs 218 respectively, P value = 0.62). The partial Mayo score showed a significant rise after fasting (median 1 before vs 1 after fasting, mean: 1.79 vs 2.33 respectively, P value = 0.02). Harvey-Bradshaw index did not show a significant change after fasting (median 4 vs 5, P value = 0.4). Multiple linear regression revealed that older age and a higher baseline calprotectin were associated with a higher change in Mayo score after fasting (P value = 0.02 and P value = 0.01, respectively). No significant change was detected in SIBDQ or Hamilton depression scale scores. Conclusions In patients diagnosed with UC, IF during Ramadan was associated with worsening of clinical parameters, the effect was more pronounced in older patients and those with higher baseline calprotectin levels. However, IF during Ramadan was not associated with an adverse effect on objective inflammatory markers (CRP and calprotectin).

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“…Ten patients (four fasters and six non-fasters) were admitted with symptoms related to COVID-19 (nine of whom were confirmed COVID-19 positive), however, none required intensive care. In the study of the DAR 2020 global survey on Ramadan fasting during the COVID-19 pandemic aiming to describe the characteristics and care of participants with T2DM showed that in 5,865 participants (recruited from 20 predominantly Muslim cities) concern over the COVID-19 pandemic affected the decision to fast by 7.6% from ≥65 years old vs. 5.4% from <65 years old, while 94.8% fasted ≥15 days and 12.6% had to break the fast due to diabetes-related illness ( 64 ). As reported by Chowdhury et al ( 65 ), if a diabetic develops symptoms of COVID-19 during fasting, he/she must be told to break the fast immediately, to hydrate, to regularly monitor capillary blood glucose, because according to the study of Li et al ( 66 ), there is evidence that ketosis and ketoacidosis were more common in people with diabetes and COVID-19.…”

Section: Covid-19 Pandemic Diabetes and Ramadan Fastingmentioning

confidence: 99%

Ramadan Fasting and NCDs-Example of the Diabetes

et al. 2022

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Although Ramadan lasts only for 1 month each year, it can be accompanied by significant changes in: both energy and nutritional intake; in the diet composition; in the working hours; and the usual way of life. The majority of practitioners consume two meals, one after sunset (Iftar) and one before dawn (Sohor). During this month, it is also an opportunity to share a meal with family and friends, a period of highly intensified socialization. In parallel with the nutritional changes brought about by this unique pattern of fasting in Ramadan, other metabolic and physiological changes may occur, such as fluctuations in body weight and/or disturbance in the quantity and quality of the sleep-wake circadian rhythm. In the verses of the Qur'an, the exemption from fasting in certain situations such as illness is clearly stated. Despite this religious tolerance, many faithful who are eligible for the exemption observe the fast of Ramadan either for the spiritual aspect it provides by performing it, by religious guilt or to mark a normalization in the Muslim community for fear of the gaze of others. The world is experiencing an increase in the emergence of non-communicable diseases (NCDs); leading cause of the global mortality. Environmental and behavioral risk factors related to lifestyle, such as smoking, excessive alcohol consumption, unhealthy diet, and sedentarity have a causal association with NCDs. Other factors, such as genetic and physiological factors may also be associated (overweight, high blood pressure, dyslipidemia). Diabetes is one of the highest prevalent NCDs in the world and it continues increasing year by year. This chronic disease can lead to significant potential complications (degenerative, dermatological, and acute) to the patient's health. This requires an individual and appropriate care, both dietetic and therapeutic and over the long term will at best make it possible to sensitize the diabetic patient to the adverse effects related to his disease and thus improve its quality of life. Performing the Fast of Ramadan for a diabetic is a common situation. Diabetes is the only chronic disease widely studied in relation to Ramadan fasting. In the literature, many studies have investigated the effects of Ramadan intermittent fasting on diabetic patients. This article aims to provide a general overview and highlight if there are many effect of Ramadan fasting on diabetes, as an example of a NCDs.

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The DAR 2020 Global survey: Ramadan fasting during COVID 19 pandemic and the impact of older age on fasting among adults with Type 2 diabetes

Cited by 25 publications

References 13 publications

Ramadan Fasting and Changes in Thyroid Function in Hypothyroidism: Identifying Patients at Risk

Ramadan Fasting and Changes in Thyroid Function in Hypothyroidism: Identifying Patients at Risk

Effect of Ramadan intermittent fasting on inflammatory markers, disease severity, depression, and quality of life in patients with inflammatory bowel diseases: A prospective cohort study

Ramadan Fasting and NCDs-Example of the Diabetes

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