J Relig Health DOI 10.1007/s10943-015-0084-8 ORIGINAL PAPER

Study of Human Biochemical Parameters During and After Ramadan Mubin Mustafa Kiyani1 • Aamir Raoof Memon2 • Mian Imran Amjad1 • Muhammad Rifaqat Ameer3 Muhammad Sadiq4 • Tariq Mahmood5



 Springer Science+Business Media New York 2015

Abstract Ramadan fasting is obligatory for Muslims each year. They abstain from drinking, eating and intimate relationship between dawn and dusk during this month. Dietary restriction during Ramadan has various biochemical and physiological effects. It is shown to decrease the body weight, glucose and lipid profile. This study aims to analyze the changes in body weight, glucose and lipid profile during Ramadan in physiotherapy students in Pakistan. The study was conducted during June–July 2013 (Hijri year 1434). There were 80 students (50 males and 30 females) recruited in the experiment. They all were healthy adults between the age group of 18–24 (mean age 20.5) years. All subjects underwent a general physical examination and interview, and non-healthy subjects were excluded. On statistical analysis, quantitative data were expressed in terms of mean ± SD and a p value of B0.05 was believed statically significant. Paired t test was used to compare the variables. There was a little reduction in body weight (62.7 ± 8.8 vs. 62.3 ± 9.0; p value = 0.009) but a significant decline in glucose level (72.6 ± 12.5 vs. 57.9 ± 10.7; p value = 0.000), low-density lipoprotein level (2.9 ± 0.3 vs. 2.5 ± 0.3; p value = 0.000), total cholesterol (4.6 ± 0.4 vs. 4.2 ± 0.5; p value = 0.000) and triglycerides (1.4 ± 0.5 vs. 1.2 ± 0.5; p value = 0.000) was observed. Moreover, there was some reduction in high-density lipoprotein cholesterol level (1.2 ± 0.3 vs. 1.1 ± 0.3; p value = 0.045). This study shows that Ramadan fasting, a religious obligation for purification of body and soul, resulted in reduced body weight and a positive effect on glucose level and lipid profile.

& Aamir Raoof Memon [email protected] 1

Faculty of Health and Medical Sciences, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan

2

Institute of Physiotherapy and Rehabilitation Sciences, Peoples University of Medical and Health Sciences, Nawabashah, Pakistan

3

Department of Biotechnology, International Islamic University, Islamabad, Pakistan

4

Pakistan Medical College, Peshawar, Pakistan

5

Nano Sciences and Catalysis Division, National Center for Physics, Quaid-i-Azam University, Islamabad, Pakistan

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Keywords

Body weight  Biochemical  Fasting  Glucose level  Lipid level  Ramadan

Introduction Ramadan is the ninth month of lunar (Islamic) calendar (AlMaatouq 2012; Shehab et al. 2012; Trabelsi et al. 2011), in which Muslims abstain from drinking, eating, smoking, medications and intimate relationship between dawn and dusk by observing fasting (Al Hourani et al. 2009; Fararjeh et al. 2012; Gu¨venc¸ 2011; Qureshi 2002; Sadiya et al. 2011; Shehab et al. 2012; Trabelsi et al. 2013; Trepanowski and Bloomer 2010). It is a religious obligation and one of the five pillars of Islam (Gu¨venc¸ 2011). Ramadan occurs 11 days earlier than the Gregorian (solar) calendar (Al Hourani et al. 2009; Gu¨venc¸ 2011; Kamal et al. 2012; Trabelsi et al. 2013; Trepanowski and Bloomer 2010) because it lasts between 29 and 30 days based on the sighting of moon (Qureshi 2002; Sadiya et al. 2011; Stannard 2011), which of course is related to the difference between the two calendars. Moreover, it follows the 33-year cycle (Gu¨venc¸ 2011; Trepanowski and Bloomer 2010), and every 9 years there is a seasonal shift in Ramadan (Alzoghaibi et al. 2014). Due to this, Ramadan can occur in any of the season. There is a great variation in the duration of fasting hours during Ramadan depending on various geographical regions. Generally, it lasts between 11 and 18 h (Al Hourani et al. 2009; Kamal et al. 2012; Stannard 2011; Trabelsi et al. 2013) with an average of 12 h per day (Fararjeh et al. 2012; Shehab et al. 2012; Trepanowski and Bloomer 2010). In winter, the duration of fasting is about 10 h which turns in summer to 18 h (Khafaji et al. 2012; Lamri-Senhadji et al. 2009; Trabelsi et al. 2013). There are about 1.7 billion Muslims who observe fasting across the world (AlMaatouq 2012; Khafaji et al. 2012; Salahuddin et al. 2014). Of these 1.7 billion Muslims, approximately 60 % dwell in Asia-Pacific and around 20 % in North Africa and Middle East and Muslims contribute to the population of almost every nation (Khafaji et al. 2012). The purpose of fasting in Islam is not to put the followers to hardships rather it teaches them self-restraint, feeling the pain of poor and body purification (Al Hourani et al. 2009; Shehab et al. 2012). Islam has a space of leniency during Ramadan fasting for menstruating, pregnant, debilitated, breastfeeding, traveling and sick (Stannard 2011; Trepanowski and Bloomer 2010). Ramadan fasting is obligatory for those who have achieved puberty and age generally accepted for girls is 9–12 years and for boys 13–15 years at which they can start fasting (AlMaatouq 2012; Trepanowski and Bloomer 2010). Fasting in biochemical terms is considered to be a mere calorie restriction for 12–14 h (Rohin et al. 2013; Sadiya et al. 2011), whereas from an Islamic perspective, it is not only abstaining calories but also drinking water is prohibited in fasting. Considering this, it is important to mention that Islamic fasting is not like the experimental fasting but it is a unique model of intermittent or alternate day fasting because fluid and food intake becomes permissible only at night time and rest of the day is spent on two meal times: one before sunrise and later just after the sunset (Al Suwaidi et al. 2004; Alzoghaibi et al. 2014; Azizi 2001; Fararjeh et al. 2012; Khafaji et al. 2012; Nigam 2011). There is alteration in eating habits and energy intake, frequency, composition and quantity of food intake, sleep cycle and physical activity during Ramadan leading to biochemical and physiological changes in body (Alzoghaibi et al. 2014; Fararjeh et al. 2012; Hosseini et al. 2013; Nematy et al. 2012; Shehab et al. 2012). Foods with more levels of carbohydrates and lipids are consumed during Ramadan (Alzoghaibi et al. 2014;

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Nematy et al. 2012; Schweizer et al. 2014). Lipid profile is impacted by increased consumption of refined sugar, changes in dietary habits, decreased physical activity and different dietary fats (Nematy et al. 2012; Salahuddin et al. 2014; Shehab et al. 2012). However, health-related impact of fasting varies with different populations. Due to some confounding factors such as smoking status, medication, diet, and cultural habits, there is variability in the results of different studies (Al Suwaidi et al. 2004). Bouguerra et al. observed that there is a moderate effect of Ramadan fasting on glycemic and lipid control (Bogdan et al. 2001). Dietary restrictions are documented to affect the body weight, glucose, cholesterol level and various cardiovascular and hematological parameters (Fararjeh et al. 2012; Hosseini et al. 2013; Kamal et al. 2012; Nematy et al. 2012; Trepanowski and Bloomer 2010). The weight reduction in Ramadan is attributed to decreased caloric intake and increased dehydration in prevailing literature (Gu¨venc¸ 2011; Shehab et al. 2012). Ramadan fasting is associated with improvement in biochemical risk markers including decrease in plasma LDL-C and TG level, as well as improved insulin sensitivity, HDL-C, adiponectin and leptin. It is also associated with decrease in plasma homocysteine, fibrinogen, C-reactive protein (CRP), D-dimer level and IL-6 (Ahmed and Abdu 2011; Benli Aksungar et al. 2005; Lamri-Senhadji et al. 2009). Salehi and Neghab (2007) showed a significant decline in body mass index, glucose, body weight and serum cholesterol after Ramadan fasting (Hosseini et al. 2013). Effect of Ramadan fasting dietary intake, body mass index, lipid profile and blood pressures during Ramadan fasting in adult population has been documented in a systematic review by Imtiaz et al. (Salahuddin et al. 2014; Salim et al. 2013). There are various benefits of calorie restriction as occurs in Ramadan fasting. It delays the onset of atherosclerosis, neurodegenerative diseases, autoimmune diseases, cardiomyopathies, respiratory diseases, diabetes, cancer, and renal diseases (Trepanowski and Bloomer 2010). It has positive changes on cardiovascular health also, which include decrease in blood pressure (BP) and resting heart rate (HR), improved left ventricular function, increased HR variability and flow-mediated vasodilation (Mattson and Wan 2005; Trepanowski and Bloomer 2010). In terms of glucoregulatory health, caloric restriction decreases the levels of insulin and fasting glucose, increases insulin sensitivity, lowers the incidence of diabetes and decreases body fat percentage (Fontana and Klein 2007; Trepanowski and Bloomer 2010).

Method The study was conducted during June–July 2013 (Hijri year 1434). There were 80 students (50 males and 30 females) recruited in the experiment. They all were healthy adults between the age group of 18–24 (mean age 20.5) years from Riphah International University, Islamabad. All subjects underwent a general physical examination, and a questionnaire was used to collect the data pertaining to demographics and medical history or current use of medications and non-healthy subjects were excluded. A written consent was taken from the participants. Ethical review committee of Riphah International University, Islamabad approved the study protocol. The blood sample was collected before (first day) and after (last day) Ramadan; 5 mL of blood was taken in EDTA tube and samples were centrifuged at 3000 rps for 10 min at 4 C. The blood samples, stored at -20 C, were then analyzed for total cholesterol,

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plasma triglycerides, low- and high-density lipoprotein cholesterol (LDL-C and HDL-C) enzymatically by Hitachi 917 (Roche, Mannheim, Germany). The fasting blood sugar (FBS-glucose) was analyzed using glucose assay kit (ab65333). Weight of the students was taken through electronic scale, and three consecutive findings were taken so as to avoid an error. Statistical analysis was done by using SPSS-20, and quantitative data were expressed in terms of mean ± SD; a p value of B0.05 was believed statically significant. Paired t test was used to compare the variables before and after Ramadan.

Results There were 80 participants enrolled in the study (62.5 % males and 37.5 % females). The age group was 18–24 years (mean age 20.5). There was a little reduction in body weight (Pre = 62.7 ± 8.8 and Post = 62.3 ± 9.0 with p value = 0.009). Blood glucose level showed an evident decline after Ramadan fasting (Pre = 72.6 ± 12.5 and Post = 57.9 ± 10.7) with a p value of 0.000 (see Table 1). Similarly, the atherogenic markers showed a significant decrease after Ramadan. Total cholesterol (TC) level was significantly reduced after Ramadan (Pre = 4.6 ± 0.4 and Post = 4.2 ± 0.5), and there was a decline in Triglycerides (TAG or TG) level (Pre = 1.4 ± 0.5 and Post = 1.2 ± 0.5) and LDL level (Pre = 2.9 ± 0.3 and Post = 2.5 ± 0.3) as well, all yielding a p value of 0.000, respectively. There was decrease in cardioprotective HDL level after Ramadan (Pre = 1.2 ± 0.3 and Post = 1.1 ± 0.3) with a p value of 0.045 (see Table 2).

Discussion We found a significant reduction in body weight after Ramadan (Pre = 62.7 ± 8.8 and Post = 62.3 ± 9.0) similar to the findings of previous studies (Khaled et al. 2006; Ziaee et al. 2006). This weight loss due to Ramadan fasting in this study may be attributed to metabolic alterations due to restricted calories intake, mild dehydration during the fasting resulting from restraining from fluid consumption and changes in circadian rhythm of eating. However, in some there was no any alteration in body weight following Ramadan (Ramadan 2002; Yarahmadi et al. 2003), and one study found increased body weight after fasting (Bouguerra et al. 2006). This may be due to more sedentary population in those studies and the presence of some confounding variables like smoking, medications or disease. In addition, the essence of fasting is not as of dieting but adopting healthy lifestyle behaviors.

Table 1 Body weight and blood glucose level before and after Ramadan Parameters

Pre-Ramadan (mean ± SD)

Post-Ramadan (mean ± SD)

Ranges (minimum–maximum)

p value

Weight (kg)

62.7 ± 8.8

62.3 ± 9.0

Pre-Ramadan: 47–80 Post-Ramadan: 46–79

0.009*

Blood glucose (mg/dL)

72.6 ± 12.5

57.9 ± 10.7

Pre-Ramadan: 49–115 Post-Ramadan: 43–88

0.000*

* p value of B0.05

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J Relig Health Table 2 Lipid profile before and after Ramadan Parameters

Pre-Ramadan (mean ± SD)

Post-Ramadan (mean ± SD)

Ranges (minimum–maximum)

p value

Total cholesterol (mmol/L)

4.6 ± 0.4

4.2 ± 0.5

Pre-Ramadan: 4.0–5.8 Post-Ramadan: 3.2–5.3

0.000*

TGs (mmol/L)

1.4 ± 0.5

1.2 ± 0.5

Pre-Ramadan: 0.5–2.3 Post-Ramadan: 0.4–2.1

0.000*

HDL (mmol/L)

1.2 ± 0.3

1.1 ± 0.3

Pre-Ramadan: 0.7–1.8 Post-Ramadan: 0.6–1.8

0.045*

LDL (mmol/L)

2.9 ± 0.3

2.5 ± 0.3

Pre-Ramadan: 2.2–3.5 Post-Ramadan: 2.0–3.2

0.000*

TG triglyceride, LDL low-density lipoprotein, HDL high-density lipoprotein * p value of B0.05

There was a significant reduction in glucose level after Ramadan (Pre = 72.6 ± 12.5 and Post = 57.9 ± 10.7) which was consistent with the findings of previous studies (Adlouni et al. 1997; Fararjeh et al. 2012; Hajek et al. 2011; Khatib and Shafagoj 2004; Mansi 2007; Nematy et al. 2012; Rahman et al. 2003; Rohin et al. 2013; Salahuddin et al. 2014; Ziaee et al. 2006). This may be because of decreased food and caloric intake during this month and partly due to more active lifestyle of the participants of the study, whereas there are some studies that found no changes in glucose level after Ramadan (Benli Aksungar et al. 2005; Haouari et al. 2008; Ibrahim et al. 2008; Lamri-Senhadji et al. 2009; Leiper and Molla 2003). These controversial findings are due to difference in number of fasting days and their duration based on geographical variation, varying among caloric intake in different populations, genetic tendency, effect of seasonal changes on fasting individuals and their difference between their daily activities. The atherogenic cholesterol showed a great reduction after the fasting. The value for total cholesterol levels significantly reduced after Ramadan (Pre = 4.6 ± 0.4 and Post = 4.2 ± 0.5) as found in previous studies (Ibrahim et al. 2008; Lamri-Senhadji et al. 2009; Mansi 2007; Nematy et al. 2012). There was a decline in TAG level (Pre = 1.4 ± 0.5 and Post = 1.2 ± 0.5) and LDL level (Pre = 2.9 ± 0.3 and Post = 2.5 ± 0.3) as well, all yielding a p value of 0.000; same results were documented before (Adlouni et al. 1997; Fakhrzadeh et al. 2003; Ziaee et al. 2006). On the contrary, there are still some studies that show an increase or no change in the levels of LDL, TC and TAG after Ramadan (Adlouni et al. 1997; Beltaifa et al. 2001; Benli Aksungar et al. 2005; Fakhrzadeh et al. 2003; Khatib and Shafagoj 2004; Sarraf-Zadegan et al. 2000). The reduction in levels of LDL, TC and TAG could partly be explained by changes in fat intake during Ramadan. Dietary habits of Pakistani people are very different from Gulf and African countries. During this month, fasting individuals here mostly consume juices and liquids and foods rich in carbohydrates yet comparatively less than the other countries and less fat diet is used. However, we did not collect information on actual food items consumed during Ramadan. The antiatherogenic cholesterol HDL is expected to increase after Ramadan as validated by prevailing literature (Adlouni et al. 1997; Benli Aksungar et al. 2005; Fakhrzadeh et al. 2003; Ibrahim et al. 2008; Lamri-Senhadji et al. 2009; Mansi 2007; Nematy et al. 2012; Qujeq et al. 2002; Ziaee et al. 2006); our findings were opposite to what had been expected since there was a significant decrease rather than an increase in HDL level after Ramadan (Pre = 1.2 ± 0.3 and Post = 1.1 ± 0.3) with a p value of 0.45. However, there are some

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studies with similar findings (Al-Hourani and Atoum 2007; Beltaifa et al. 2001; Bouguerra et al. 2006; Khaled et al. 2006; Khatib and Shafagoj 2004; Sarraf-Zadegan et al. 2000). There is no definitive reason for these variant results, but this difference between the findings could be attributed to geographical, cultural, genetic, lifestyle, and dietary variation in different samples.

Conclusion This study shows that Ramadan fasting, a religious obligation for purification of body and soul, resulted in reduced body weight and a positive effect on glucose level and lipid profile. Although there was a little variation in the findings than what was expected which could be attributed to geographical, cultural, genetic, lifestyle, and dietary variation in different samples. This month is observed by the followers once a year and shows a strong health benefit. We recommend 2 days a month fasting so as to keep a balance between the biochemical markers of the body.

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Study of Human Biochemical Parameters During and After Ramadan.

Ramadan fasting is obligatory for Muslims each year. They abstain from drinking, eating and intimate relationship between dawn and dusk during this mo...
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