Effects of Ramadan fasting on body weight and metabolic profile

Effects of Ramadan fasting on body ……. Zanco J. Med. Sci., Vol. 18, No. (3), 2014 http://dx.doi.org/10.15218/zjms.2014.0039 Effects of Ramadan fasting on body weight and metabolic profile Received: 28/8/2013 Halgurd F. Ahmed * Accepted: 29/1/2014 Saleem S. Qader ** Bashdar M. Hussen ** Namir G. Al-Tawil *** Abstract Background and objective: Fasting during the Ramadan month is a religious duty and it is obligatory for all healthy adult Muslims. The aim of this study was to investigate the effects of fasting during Ramadan in different times and place on body weight, blood sugar, serum lipids and blood pressure. Methods: Fifty three healthy adult fasting volunteers were included in the study. Peripheral venous blood samples were taken three days before Ramadan, at the end of the first week, and at the end of the fourth week of fasting. The last blood sample was taken one week after the end of Ramadan. Serum total cholesterol, HDL and LDL, triglycerides and glucose were measured. Vital signs and body mass index were taken by one of the researchers. Results: Thirty three (62.3%) volunteers were males, 93.4% were below 40 years of age. Weight changed significantly during Ramadan. Mean systolic blood pressure decreased by 11 mmHg while diastolic blood pressure decreased by 9 mmHg (P <0.001). Fasting blood sugar decreased by 14.96 mg/dl (P <0.001). Plasma lipids; cholesterol decreased by 19.3 mg/dl (P <0.027), LDL by 23 mg/dl (P <0.001), triglyceride by 44 mg/dl (P <0.003) but the HDL increased by 5.4 mg/dl (P <0.002) during Ramadan fasting. Before Ramadan, 19% of participants had abnormal serum cholesterol and 37% had abnormal LDL level, while after Ramadan all had normal lipid levels (P <0.001). The proportion of participants with abnormal HDL decreased from 94% before Ramadan to 50% after Ramadan (P <0.001). Conclusion: Ramadan affects the body physiology and lowers the weight, serum lipids, blood pressure and blood glucose levels. Keywords: Ramadan, fasting, lipid profile. Introduction calendar and because of the difference with Gregorian calendar, Ramadan month occurs 10.25 days earlier every year and may occur in any of the four seasons. The length of fasting hours is also variable ranging from 11 to 18 hours per day in tropical countries for 29- 30 days.1 Ramadan 2011 occurred during July 10th, to August 20th, 2011. The duration of fasting was about 18 hours and the temperature was around 45 degree centigrade during the day time in Iraq. Long-term fasting in animals has a negative effect on the body, while short-term fasting during Ramadan regularly has many advantages and Fasting during the day time in Ramadan month (29-30days) is a religious duty and it is obligatory for all healthy adult Muslims. Hundreds of millions of Muslims fast during Ramadan worldwide. Children, menstruating women, travelers and sick people during Ramadan are excused from fasting during this month. Those who fast have two good-sized meals during Ramadan, one immediately after sunset (Iftar) and the other one just before dawn (Suhur). They are allowed to eat, and drink between sunset and dawn but not after dawn. Since Ramadan month is according to the lunar *Kurdistan Board for Medical Specialties, Erbil, Iraq. **Medical Research Centre, Hawler Medical University, Erbil, Iraq. *** Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq. 816 Effects of Ramadan fasting on body ……. Zanco J. Med. Sci., Vol. 18, No. (3), 2014 http://dx.doi.org/10.15218/zjms.2014.0039 2 Physical Examination: Vital signs were taken by one of the researchers (specialist physician). Blood pressure was measured by mercury sphygmomanometer first before Ramadan and second at 22nd of Ramadan. The pulse rate and respiratory rate were taken once, at the same time of taking blood sample. Body mass index was measured according to the height and weight: (weight divided by the squared height in meter), so any BMI more than 30 regarded as obese: as it´s a disease in which excess body fat has accumulated to such an extent that health may be negatively affected. Ethical considerations: Approval was obtained from the ethics committee of the Medical Research Centre, Hawler Medical University. Participants were fully informed about the methods and objectives of the study. Statistical Analysis: Statistical Packages for the Social Sciences (Version 19) was used for analysis of the data. Student's t test for two independent samples was used to compare between means. Paired t test was used to compare between readings before Ramadan, during and after Ramadan. Chi square test of association (or McNemar test) was used to compare between proportions. A P value of ≤ 0.05 was considered as statistically significant. positive effects on the body. The following parameters go down during fasting: serum lipids,3 blood sugar,4 blood pressure (BP) 5 and body weight.6 This study sought to investigate the effects of Ramadan fasting during summer time on the body physiology particularly in terms of body weight, blood sugar, serum lipids and BP. To our knowledge, this is the first study conducted in our region on this issue. Methods Setting: This study was performed during Ramadan of July 10th, to August 20th, 2011 (1432 Hijre) in Erbil, Kurdistan Region, Iraq. Subjects: Fifty three fasting healthy adult volunteers (33 males and 20 females) from three different locations in Erbil City. Their mean age was (33±8years). The participants did not change their life style during the study period. They were fast nearly 16 hours. Exclusion Criteria: Participants with any acute or chronic diseases or those who are on regular medication during the study were excluded from the study. Pregnant ladies were also excluded from the study. Blood Collection: Venous blood samples were withdrawn from cubital vein of the participants three days before Ramadan, at the end of the first week, and at the end of fourth weeks of Ramadan month. The last blood sample was taken one week after the end of Ramadan. Blood Analysis: Blood samples were centrifuged directly after collection and the serum either immediately analyzed or stored at ≤ -20°C in the Medical Research Centre, Hawler Medical University. Serum total cholesterol (TC) normally (<200mg/dl), high density lipoprotein cholesterol (HDL-C) male normally >40mg/dl, female>50mg/dl, low-density lipoprotein cholesterol (LDL-C) normally<130mg/dl, triglycerides (TG)male normally<164mg/dl, female<132mg/dl, were measured using the commercially available kits (Enzymatic colorimetric method used according to Trinder method). 817 Effects of Ramadan fasting on body ……. Zanco J. Med. Sci., Vol. 18, No. (3), 2014 http://dx.doi.org/10.15218/zjms.2014.0039 Results Fifty three volunteers were recruited in this study. Most of them (94.3%) were below 40 years. Their age was between 20-39 years and the mean (±SD) age was 33±8 years. 83% were married and 28.3% underwent previous surgery. Around 70% had their own car and 18.9% had history of obesity (Table1). Ten (18.8%) participants were at primary education or illiterate, 9.4% of them at the secondary school level and 71.7% were graduates of institutes or higher levels (Table 2). Nine (17%) participants were unemployed (free work or trading) while the rest (83%) had governmental work (sedentary) (Table 3). The participants eat sweets on daily bases especially during Ramadan e.g. dates (100%), juice (81%), sweet (55%) while other items are less frequently consumed e.g. sugar containing cola (15%) and cakes (6%). Other items consumed by study participants included rice (100%) chicken meat (92%) and red meat (60%) (Table 4). Table 1: Distribution of samples by some demographic data. Table 3: Distribution occupation. Demographic data No. Occupation No. Percentage Male sex 33 Percentage n = 53 62.3 Nurse 14 26.4 Age less than 40 years 50 94.3 Teacher 8 15.1 History of operation (any) 15 28.3 Employed 17 32.1 Marriage 44 83 Physician 5 9.4 Car ownership 37 69.8 Freeworker 9 17 History of obesity 10 18.9 Total 53 100 Table 2: Distribution educational level. of samples by Education No. Percentage Illiterate 5 Primary of samples by Table 4: Food preferences of the studied samples. Type of food No. Percentage n = 53 9.4 Juice 43 81 5 9.4 Cake 3 6 Sweet 3 6 Secondary 5 9.4 Another sweet (cake) 29 55 Institute 15 28.3 Dates 53 100 Rice 53 100 College 18 34 Chicken meat 49 92 Postgraduate 5 9.4 Every day eating meat 22 41.5 Total 53 100 Red meat 32 60 Cola (normal) 8 15 818 Effects of Ramadan fasting on body ……. Zanco J. Med. Sci., Vol. 18, No. (3), 2014 http://dx.doi.org/10.15218/zjms.2014.0039 by 14.96 mg/dl (P <0.001). Plasma lipids have decreased significantly during Ramadan; cholesterol decreased by 19.3 mg/dl (P <0.027), LDL by 23 mg/dl (P <0.001), triglyceride by 44 mg/dl (P <0.003) but the HDL increased by 5.4 mg/dl (P <0.002) during Ramadan fasting (Table 6). The weight of the participants changed significantly during Ramadan as it decreased at all readings (Table 5). Blood pressure of the participants significantly reduced during fasting; systolic BP decreased by 11 mmHg while diastolic BP decreased by 9 mmHg (P <0.001). Fasting blood sugar decreased Table 5: Weight changes during Ramadan fasting. Weight Mean difference ± SD 95% CI p value weight1- weight2 1.50 ± 1.61 1.06 - 1.95 <0.001 weight1- weight3 1.75 ± 2.03 1.19– 2.31 <0.001 weight1- weight4 0.68 ± 2 0.11 - 1.24 <0.019 Weight 1, before Ramadan; weight 2, at the end of first week of Ramadan fasting; weight 3, at 22 nd day of fasting, and weight 4, one week after Ramadan fasting. Table 6: Effect of fasting on some parameters. Physiological parameters Mean difference ±SD p value SBP(mmHg) before -SBP during 11.03 12.26 < 0.001 DBP before- DBP during Ramadan 9.15 10.03 < 0.001 cholesterol1- cholesterol2 (mg/dl) 12.43 39.72 <0.027 cholesterol1 - cholesterol3 19.32 43.93 <0.002 cholesterol1 - cholesterol4 12.75 38.33 <0.019 LDL1 - LDL2(mg/dl) 19.52 31.46 < 0.001 LDL1 - LDL3 23.66 38.19 < 0.001 LDL1 - LDL4 34.68 41.3 < 0.001 HDL1 - HDL2(mg/dl) -6.02 10.13 < 0.001 HDL1 - HDL3 -5.46 12.14 <0.002 HDL1 - HDL4 -11.96 11.56 < 0.001 TG1 - TG2(mg/dl) 44.11 101.21 <0.003 TG1 - TG3 25.7 128.08 <0.150 TG1 - TG4 -2.08 81.2 <0.853 Glucose before Ramadan: glucose during Ramadan (mg/dl) 14.96 29.15 <0.001 Reading 1: the samples have been taken 1 week before Ramadan, Reading 2; the samples have been taken at the end of the first week of Ramadan, Reading 3; the samples have been taken at 22nd days of Ramadan and reading 4; that the samples have been taken 1 week after Ramadan. 819 Effects of Ramadan fasting on body ……. Zanco J. Med. Sci., Vol. 18, No. (3), 2014 http://dx.doi.org/10.15218/zjms.2014.0039 Table 7: Comparison between the proportions of individuals with abnormal serum lipids, before Ramadan with those during and after Ramadan. Test Before Ramadan* 6th day of fasting p value 22nd day of fasting p value 6days after Ramadan Cholesterol 19% 7% ˂0.001 3% <0.002 0 Triglyceride 49% 24% <0.07 41% <0.523 47% LDL 37% 13% <0.01 7% ˂0.001 0 HDL 94% 73% <0.007 73% <0.007 50% p value <1.0 ˂0.001 *All readings during and after Ramadan were compared with proportions before Ramadan , which is in agreement with Mansi et al7 and Ziaee et al,8 although Temizhan et al showed no change in the body weight during Ramadan fasting,9 possibly because of his small sample size. Blood pressure of the participants significantly reduced during fasting period; systolic BP decreased by 11 mmHg while diastolic blood pressure by 9 mmHg, which is in agreement with another study.7 Fasting blood sugar decreased by 14.96 mg/dl, which is in accordance with Mansi et al who reported 9 mg/dl reduction in sugar7 but contrary to Adlouni et al who observed no change in blood sugar,10 in which may be because of variability of time of taking blood sample. Plasma lipids have decreased significantly during Ramadan; cholesterol decreased by 19.3 mg/dl although less decrease was detected by Mansi7or no effect on cholesterol found by Ziaee et al.8 LDL decreased by 23 mg/dl and such decrease was similar to another study.7 Triglyceride decreased by 44 mg/dl although Mansi found 9mg/dl reduction in triglyceride7 but Ziaee et al found no effect on triglyceride.8 Triglyceride decreased during Ramadan but increased soon after Ramadan. HDL increased by 5.4 mg/dl during Ramadan fasting which is in contrary to Temizhan et al9 but in agreement with Mansiwho found 12.73mg/dl increase in HDL.7 Results showed that 19% of the samples had abnormal serum cholesterol and 37% had abnormal LDL level before Ramadan. All participants had normal Results showed that 19% of the participants had abnormal serum cholesterol and 37% had abnormal LDL level before Ramadan. After Ramadan all participants had normal lipid levels (P <0.001).The proportion of participants with abnormal HDL decreased from 94% before Ramadan to 50% after Ramadan (P <0.001). Triglyceride level decreased during Ramadan but increased soon after Ramadan (P <0.007) (Table 7). Discussion Short term fasting during Ramadan affects the body physiology, especially the metabolic state. People fasts during Ramadan for about 16 hours per day during the summer time, so they suffer from both hunger and thirst. Although 70% of the participants own a car but only 18.9 % were obese before Ramadan. Using cars for daily activity encourage sedentary life and the people will not perform any physical activities during their fasting. Sweets and fatty meals are commonly and frequently used in our community. Most of our people eat these types of food on daily bases, especially during Ramadan fasting e.g. dates (100%), chicken meat (92%), juice (81%), red meat (60%) and sweet 55%. Other sorts of sweets are less frequently drunk or eaten e.g. cola is only drunk by15% and cakes are only eaten by 6% of the sample. Weight changed significantly during Ramadan. It decreased at all readings during and after Ramadan 820 Effects of Ramadan fasting on body ……. Zanco J. Med. Sci., Vol. 18, No. (3), 2014 http://dx.doi.org/10.15218/zjms.2014.0039 fasting Singapore Med J 2006; 47(5):409. 9. Temizhan A, Donderici O, Ouz D, Demirbas B. Is there any effect of Ramadan fasting on acute coronary heart disease events? Int J Cardiol 1999; 70:149-53. 10. Adlouni A, Ghalim N, Benslimane A, Lecert JM, Saile R. Fasting during Ramadan induces a marked increase in high-density lipoprotein cholesterol and decrease in low-density lipoprotein cholesterol. Ann Nutr Metab1997; 41:242-9. lipid levels after Ramadan, a part of triglyceride. The proportion of participants with abnormal HDL decreased from 94% before Ramadan to 50% after Ramadan. These changes might suggest that fasting has significant effects on the lipid profile and can normalize the abnormal lipid profiles, which has been reported for the first time in Erbil city. Conclusion Ramadan affects the body physiology. It decreases the body weight and lowers the serum lipids, BP and blood glucose levels. Conflicts of interest The authors report no conflicts of interest. ACKNOWLEDGMENTS Thanks to Hawler Medical University. Thanks to the participants in the study. Thanks to the Medical Research Center staff. Thanks to Dr. Naznaz Perot for her cooperation and collection of samples. References 1. Azizi F. Research in Islamic fasting and health. Ann Saudi Med 2002; 122:186-91. 2. Akanji AO, Mojiminiyi OA, Abdella N. Beneficial changes in serum apo A-1 and its ratio to apo B and HDL in stable hyper-lipidaemic subjects after Ramadan fasting in Kuwait. Euro J Clin Nutr 2000; 54:508-13. 3. Yucel A, Degirmanci B, Acar M, Albayrak R, Haktanir A. The effect of fasting month of Ramadan of the abdominal fat distribution. Tohoku J Exp Med 2004; 204(3):179-87. 4. Hind AE, Awad MA. Effect of Ramadan Fasting on blood levels of glucose, triglyceride and cholesterol. S J public health 2006; 1(3):167-75. 5. Nagra SA, Shaista N, Nomani MZA, Amanat A. The effect of Ramadan fasting on serum protein concentrations. Can J App Sci 2011; 1(2):29-42. 6. Sarraf-Zadegan N, Atashi M, Naderi GA, Baghai AM, Asgary S, Fatehifar M. The effect of fasting in Ramadan on values and interrelations between biochemical, coagulation and hematological factors. Ann Saudi Med 2000; 20:5-6. 7. Mansi K. Study the effect of Ramadan fasting on the serum glucose and lipid profile among healthy Jordanian students. A J App Sci 2007; 4 (8):565-9. 8. Ziaee V, Razaei M, Ahmadinejad Z, Shaikh H, Yousefi R, YarmohammadiL, et al. The changes of metabolic profile and weight during Ramadan 821