Abstract
Background In view of the association of Ramadan intermittent fasting with profound changes in lifestyle both in nondiabetic and diabetic patients, the aim of this study was to investigate the effect of Ramadan fasting on adiponectin, leptin and leptin to adiponectin ratio (LAR), growth hormone (GH), human-sensitive C-reactive protein (hs-CRP), and diabetic and metabolic syndrome factors in patients with Type 2 Diabetes Mellitus (Type 2 DM), their first-degree relatives (FDRs), and healthy controls. Methods This cohort study involved 98 Yemeni male subjects aged 30-70 years old: 30 Type 2 DM, 37 FDRs of Type 2 diabetic patients, and 31 healthy control subjects. Subjects' body mass index (BMI), waist circumference (WC), and blood pressure (BP) were measured, and venous blood samples were collected twice: the first samples were collected a couple of days prior to Ramadan fasting (baseline) and the second samples after 3 weeks of fasting. Results Ramadan fasting did not affect BMI, WC, and BP in Type 2 DM and their FDRs with respect to the baseline levels prior to Ramadan, whereas triglyceride and cholesterol were borderline significantly decreased in Type 2 DM with no effect in FDRs. Fasting blood glucose was not affected in Type 2 DM but was significantly increased in FDRs and control groups, whereas glycated haemoglobin (HbA1c) was slightly decreased in Type 2 DM, FDRs, and healthy controls. C-peptide, insulin, and insulin resistance (HOMA-IR) were significantly increased in Type 2 DM and FDRs, with no effect in the control group, whereas β-cell function (HOMA-β) was significantly decreased in FDRs and controls with no change in Type 2 DM. Ramadan fasting significantly decreased GH in both FDRs and control groups, and significantly increased hs-CRP in the control with no effect in Type 2 DM and FDRs. Adiponectin was significantly decreased, and leptin and LAR were significantly increased in Type 2 DM, FDRs, and control groups. Conclusion Ramadan intermittent fasting decreased adiponectin and increased leptin, LAR, insulin, and insulin resistance in both Type 2 DM and FDRs as well as decreased GH in both FDRs and healthy controls and increased hs-CRP in healthy controls. Moreover, Ramadan intermittent fasting neither worsens a patient's glycemic parameters nor improves it, with the exception of a slight improvement in HbA1c in Type 2 DM, FDRs, and healthy controls.
Highlights
Ramadan is the holiest month in the Islamic calendar, in which Muslims fast during this month by refraining from all intakes of food, water, beverages, oral medicine, and smoking from sunrise till sunset [1]
In view of the association of Ramadan intermittent fasting with profound changes in lifestyle, such as altered sleeping durations and times and changes in physical activities as well as feeding patterns and restriction of food intake to night-time only, together with the existing controversial data in the literature on the effect of Ramadan fasting on metabolic and hormonal factors, this study is aimed at investigating the effect of Ramadan fasting on adipocytokines (adiponectin, leptin, and leptin/adiponectin ratio (LAR)), growth hormone (GH), human-sensitive C-reactive protein, diabetic parameters, and metabolic syndrome factors in Type 2 DM and their first-degree relatives (FDRs) and healthy controls
HbA1c, and C-peptide were nonsignificantly higher in FDRs, whereas insulin was borderline significantly (p = 0:054) higher by 31.8% and both HOMA-IR and HOMA-β were nonsignificantly higher by 30.3% and 16.6% than that of the control group
Summary
Ramadan is the holiest month in the Islamic calendar, in which Muslims fast during this month by refraining from all intakes of food, water, beverages, oral medicine, and smoking from sunrise till sunset [1]. During Ramadan, food and liquid are usually consumed in two meals, in the morning before sunrise and in the evening after sunset, shifting the pattern of energy intake from daytime to the hours of darkness [3, 4]. These changes in the timing of food intake as well as in the composition of diet can alter energy metabolism, and may affect important enzymatic, hormonal, and metabolic responses and different aspects of human health [4,5,6,7,8,9]. Ramadan intermittent fasting decreased adiponectin and increased leptin, LAR, insulin, and insulin resistance in both Type 2 DM and FDRs as well as decreased GH in both FDRs and healthy controls and increased hs-CRP in healthy controls. Ramadan intermittent fasting neither worsens a patient’s glycemic parameters nor improves it, with the exception of a slight improvement in HbA1c in Type 2 DM, FDRs, and healthy controls
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