The Impacts of Ramadan Intermittent Fasting on Oxidant/Antioxidant Stress Biomarkers of Stable Chronic Obstructive Pulmonary Disease Male Patients

Abstract

No prior study has evaluated the impacts of Ramadan intermittent fasting (RIF) on oxidant/antioxidant stress (OS/AOS) biomarkers in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the impacts of RIF on some OS/AOS biomarkers measured in male patients with stable COPD. Fifteen COPD patients (mean age: 71 ± 6 years) fasting Ramadan in 2017 volunteered to take part in the study. Three sessions (before Ramadan [BR], end Ramadan [ER], after Ramadan [AR]) were selected. Blood samples of OS (homocysteine [μmol/L], thiobarbituric acid reactive substances [TBARS, μmol/L]) and AOS (catalase [U/ml], ceruloplasmin [g/L], superoxide dismutase [SOD, ng/ml], zinc [µmol/L], albumin [g/L]) biomarkers were consistently taken 4.5 to 2.5 hr before the iftar . Findings were analyzed by applying Friedman or Kruskal–Wallis ANOVA. Comparisons of the number of patients with high OS [high homocysteine and/or TBARS] and low AOS (low catalase and/or ceruloplasmin and/or SOD and/or zinc and/or albumin) blood values between the three sessions were performed using the Cochran test. The median ± interquartile of homocysteine (BR: 21.48 [18.98–24.49], ER: 23.15 [21.77–26.45], AR: 24.87 [21.91–37.12]), ceruloplasmin (BR: 0.27 [0.24–0.30], ER: 0.28 [0.26–0.33], AR: 0.28 [0.25–0.32]), SOD (BR: 288.00 [112.00–400.00], ER: 182.00 [152.00–386.00], AR: 234.00 [190.00–420.00]) and the mean ± SD of TBARS (BR: 5.66 ± 1.26, ER: 4.59 ± 0.78, AR: 5.29 ± 1.69), catalase (BR: 120.97 ± 54.62, ER: 106.73 ± 50.92, AR: 137.39 ± 40.88), zinc (BR: 11.85 ± 2.01, ER: 12.47 ± 2.34, AR: 12.21 ± 2.58) and albumin (BR: 39.78 ± 3.19, ER: 40.74 ± 2.26, AR: 40.56 ± 2.38) were not significantly affected by RIF. The number of patients with high OS (BR [ n = 13], ER [ n = 15], AR [ n = 14]) or low AOS (BR [ n = 12], ER [ n = 13], AR [ n = 13]) statuses were not significantly influenced by RIF. In conclusion, RIF did not induce any significant statistical or clinical changes in OS/AOS biomarkers or statuses in COPD patients.

Influence of Long-Term Fasting on Blood Redox Status in Humans

“…The association between obesity and increased lipid peroxidation has been documented earlier [ 53 ]. This was also observed in the context of Ramadan intermittent fasting [ 54 ]. We found a positive correlation between TBARS and glucose levels, and a negative correlation between GSH and glucose.…”

“…However, our study shows that this is not the case for a period of 10 days fast, as presently studied, since its effects on redox biomarkers are the same regardless of the GSH baseline values. Other studies that analyzed antioxidant enzymes such as catalase and were performed on animals have observed an increase after prolonged fasting [ 54 ].…”

Rheumatology patients' attitude regarding Ramadan and fasting

“…Ramadan, the 9th month of the Islamic calendar, is a sacred month for Muslims 1 . Throughout Ramadan, Muslims should avoid all kinds of food, drinks, drugs, smoking and sexual intercourse between dawn and sunset 1,2 . Two main courses are eaten during Ramadan; 1 just before dawn ( Suhur ) and the other right after sunset ( İftar ).…”

“…However, Ramadan fasting also includes changes in the sleep cycle, physical activities and lifestyle (such as meal hours, amount and quality of food, nocturnal food consumption and eating frequency). Such changes may affect patients negatively unless properly addressed 2 …”

“…While all Muslim adults are expected to fast according to Islam, pregnant and breastfeeding women, travelers, old, weak and ill people are exempt from such religious duty. However, most of the individuals with chronic diseases that are suitable for exemption prefer to fast since they want to share that special time of the year with their families and peers 2,6,7 . Even though fasting is safe for healthy individuals, those with chronic diseases must consult healthcare professionals for fasting during Ramadan and strictly follow scientific advice 4‐6 …”