Daytime Fasting Research Articles

73 Fasting mediated gut microbiome modulation improves response to immune checkpoint therapy in Renal Cell Cancer

Abstract Background Gut microbiome and microbial metabolome has been shown to be a predictor and modulator of response to immune checkpoint blocker therapy (ICB) in clear cell renal cancer (ccRCC). Based on preliminary data from a prospective clinical study of 100 ccRCC patients, we showed differences in gut microbiome, microbial metabolome and progression free survival. Specifically higher abundance of indole acetic acid, indole acetaldehyde and indole pyruvic acid (IPyA), which represent microbial metabolism of tryptophan were significantly associated with immunotherapy resistance and shorter progression free survival. We hypothesized that time restricted eating would favorably modulate the gut microbiome, microbial metabolome to improve ICB response.We therefore evaluated the efficacy and mechanism of time restricted eating to improve response to immune checkpoint therapy in preclinical kidney cancer models. Methods Specific pathogen free (SPF) BL6 mice were injected subcutaneously with 0.5X106 LVRCC67(Renal adenocarcinoma) cell lines to develop kidney cancer preclinical models followed by randomization into two equal groups when average tumor size reached 100 mm3. Both groups were treated with anti-mouse PD1 twice weekly and daily tyrosine kinase inhibitor (TKI) while group 1 was additionally started on 14 hours of daytime fast(corresponding to period of inactivity), with feeding restricted to ten hours at night, 3 days prior to start of systemic treatment. Tumor volumes were measured twice weekly to evaluate progression free survival (defined as 30% increase in tumor volume), and mice were euthanized at end point, defined as completion of eight doses of antiPD1 treatment. To demonstrate that modulation of gut microbiome is the driving mechanism mediating favorable effect of TRE on ICB response, we conducted fecal microbiota transplant from fasting and non-fasting mice respectively into two groups of germ-free mice. Allowing two weeks for FMT to engraft, mice were injected with RenCa cell lines and subsequently treated with anti-mouse PD1 and TKI, without fasting, once tumors reached an average size of 100 mm 3.Tumors were measured twice weekly to assess PFS, until end point, defined similar to above. Results TRE was associated with significantly longer PFS via modulation of gut microbiome, which is necessary and sufficient to improve ICB response. Tumor growth was significantly slower and PFS significantly longer in SPF TRE mice as compared to non-TRE mice (median PFS 14 days vs 6 days, TRE vs non-TRE, p-0.02). Further GF mice engrafted with fasting microbiome developed significantly smaller tumors, which regressed after treatment, as opposed to those with non-fasting microbiota [(Mean tumor volume-45 mm3 vs 120 mm3, p-0.001 at day15 of injection), median PFS- not reached(NR) vs 7 days, P-0.007)]. Conclusions TRE improves response to ICB in renal cell cancer and can be developed into a cost effective, adjunctive therapy to improve PFS and overall survival of ccRCC patients treated with ICB. Deeper understanding of TRE mediated changes in gut microbiome and microbial metabolome can be leveraged to improve ICB response in patients who are unable to fast.

The Impact of Fasting the Holy Month of Ramadan on Colorectal Cancer Patients and Two Tumor Biomarkers: A Tertiary-Care Hospital Experience.

Fasting during the holy month of Ramadan is a religious ritual practiced bythe majority ofMuslims around the globe. This daytime fasting is short-term or intermittent fasting, which may be associated with valuable health benefits, particularly in cancer patients. A prospective cohort study ofpre- and post-fastingevaluationof 37 colorectal cancer(CRC)patients was conductedat King Abdulaziz Medical City (KAMC) and King Abdullah Specialized Children's Hospital (KASCH)-oncology outpatient clinics. The study aimedto assess the impact of fasting duringthe holy monthofRamadan on the tolerability of chemotherapy side effects and to assess changes in the levels of carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) tumor biomarkers, which are primarily associated with certain types of carcinomas, including CRC. A totalof33patients(89.2%) had fasted at least part of the month of Ramadan.Twenty-seven patients (73%)reported "Serenity" after fasting during Ramadan with improved tolerability of chemotherapy side effects.However,theresults did not reveal any significant difference in the measuredlaboratoryvariables betweenpre-fastingvalues and by the end of the 30 days of Ramadan. Although statistically insignificant, the levels ofCEA andLDH were reduced in46.9%and55.6%of patients, respectively. The mean level of CEA in the fasting group was substantially reduced by more than 40%, attributed to the highly significant decline of CEA levels in three patients(p=0.0283).Moreover, there were no significant differences between pre- and post-fasting blood creatinine levels or estimated glomerular filtration rates, ruling out any possible adverse effects of fasting on renal function. The current study confirms the safety and tolerability of intermittent fasting in CRC patients actively receiving chemotherapy, which is consistent with several reports. Nonetheless, the results did not reveal a significant decrease in CEA and LDH tumor biomarkers.

Adult-onset loss of the hepatocyte growth hormone receptor (GHR) is associated with increased autophagy in livers of male mice in the context of natural daytime fasting

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

P265. Does Daytime Fasting Affects Mood?

Fasting has been regarded as a promising strategy for treating neuropsychiatric disorders, especially in the presence of comorbid obesity and metabolic syndrome. Fasting in therapeutic protocols usually lasts longer than the usual overnight fasting. However, the effect of daytime fasting on psychiatric symptoms remains to be determined. This study aims to investigate the impact of daytime fasting on mood symptoms.

Withdrawal Symptoms among Cigarette and Waterpipe Smokers: A Study in Natural Setting.

Background:The rates of tobacco use, including cigarette and waterpipe smoking, are surging in the Eastern Mediterranean region. The use of these products causes nicotine dependence that makes even short-term tobacco abstinence difficult due to aversive symptoms. During the daytime fasting of the month of “Ramadan”, people accept significant disruption in regular activities, including tobacco smoking. Thus, daytime during Ramadan (before sunset) is likely associated with abstinence symptoms emerging among tobacco smokers. We assessed this hypothesis by measuring tobacco/nicotine abstinence symptoms and craving among smokers of cigarettes or waterpipes during Ramadan.Methods:A cross-sectional survey-based study was conducted on a convenience sample of adults. Participants were assessed for general information about tobacco smoking, dependence, and nicotine desire or craving, and withdrawal symptoms using the Minnesota Nicotine Withdrawal Scale (MNWS) and the Tiffany-Drobes Questionnaire on Smoking Urges.Results:The study sample included 632 exclusive cigarette smokers and 161 exclusive waterpipe tobacco smokers. After fasting and abstaining from tobacco during the day, approximately 75% of cigarette smokers and 20% of waterpipe smokers reported smoking within the first 30 minutes. In addition, 10% of cigarette smokers and 30% of waterpipe smokers reported smoking within the first 60 minutes. Regarding smoking urge, no significant difference was found between cigarette and waterpipe smokers. For nicotine craving and withdrawal, significant differences between cigarette and waterpipe smokers were found when comparing mean scores for each of the following items: (i) urge to smoke, (ii) craving nicotine, (iii) hunger, (iv) desire for sweets, and (v) depression/feeling blue (P-values < 0.05).Conclusion:This study provided evidence from the month of Ramadan that waterpipe smoking is associated with abstinence-induced smoking urge and withdrawal symptoms that are comparable to cigarette smoking. More interdisciplinary research must be focused on developing interventions to reduce tobacco smoking, including waterpipe.

Effects of Daytime Dry Fasting on Hydration, Glucose Metabolism and Circadian Phase: A Prospective Exploratory Cohort Study in Bahá'í Volunteers

Background: Religiously motivated Bahá'í fasting (BF) is a form of intermittent dry fasting celebrated by abstaining from food and drinks during daylight hours every year in March for 19 consecutive days.Aim: To test the safety and effects of BF on hydration, metabolism, and the circadian clock.Methods: Thirty-four healthy Bahá'í volunteers (15 women) participated in this prospective, exploratory cohort study. Laboratory examinations were carried out in four study visits: before fasting (V0), in the third week of fasting (V1) as well as 3 weeks (V3) and 3 months (V4) after fasting. Data collection included blood and urine samples, anthropometric measurements and bioelectrical impedance analysis. At V0 and V1, 24- and 12-hour urine and serum osmolality were measured. At V0–V2, alterations in the circadian clock phase were monitored in 16 participants. Our study was augmented by an additional survey with 144 healthy Bahá'í volunteers filling out questionnaires and with subgroups attending metabolic measurements (n = 11) and qualitative interviews (n = 13), the results of which will be published separately.Results: Exploratory data analysis revealed that serum osmolality (n = 34, p < 0.001) and 24-hour urine osmolality (n = 34, p = 0.003) decreased during daytime fasting but remained largely within the physiological range and returned to pre-fasting levels during night hours. BMI (body mass index), total body fat mass, and resting metabolic rate decreased during fasting (n = 34, p < 0.001), while body cell mass and body water appeared unchanged. The circadian phase estimated by transcript biomarkers of blood monocytes advanced by 1.1 h (n = 16, p < 0.005) during fasting and returned to pre-fasting values 3 weeks after fasting. Most observed changes were not detectable anymore 3 months after fasting.Conclusions: Results indicate that BF (Bahá'í fasting) is safe, has no negative effects on hydration, can improve fat metabolism and can cause transient phase shifts of circadian rhythms.Trial Registration:https://www.clinicaltrials.gov/, identifier: NCT03443739.

Should the dose of levothyroxine be changed in hypothyroidism patients fasting during Ramadan?

Background/aimMuslims worship by fasting from predawn (suhoor) until sunset (iftar) for 30 days in the religious month of Ramadan. In addition to prolonged hunger, patients fasting with a diagnosis of hypothyroidism take their doses of levothyroxine (LT4) outside of daytime fasting hours. The purpose of our study is to compare the values of hypothyroid patients which have been obtained through thyroid function tests before and after Ramadan. Materials and methodsNinety-seven patients; ranging from 18 to 65 years old, who were followed with a diagnosis of hypothyroidism, who fasted during Ramadan, and who had no change of their LT4 dose for at least 6 months were included in the study. Results The median serum thyroid-stimulating hormone (TSH) level of patients prior to fasting was 2.19 mIU/L, while median serum TSH after fasting was 2.73 mIU/L. Serum TSH values after Ramadan increased significantly compared to those prior to Ramadan (P = 0.004).Conclusion Our study demonstrates a significant increase in serum TSH levels after Ramadan but no significant change in serum free thyroxine (fT4) levels in hypothyroidism patients who are fasting. It may be appropriate to take precautions by making a small increase in LT4 dose before Ramadan in some hypothyroid patients wishing to fast.

Effect of Jain Fasting on Anthropometric, Clinical and Biochemical Parameters.

Background and Aims:Fasting has a long tradition in most cultures and has many health benefits. Most of the studies are from daytime fasting or intermittent fasting. There is paucity of data from complete fasting (no food and fruits, water only). This prospective study is conducted with aims to study impact of complete fasting on clinical and biochemical parameters.Methods:One hundred ten participants of either gender who voluntarily fasted (3-30 days) were included and underwent clinical and biochemical examination before and after fasting.Results:A total of 110 healthy volunteers (M: 27, F: 83) with mean age 51 ± 16 years (range 18-86) and body mass index 27.1 ± 4.9 kg/m2 (16.1-45.2) were studied. They had undergone fast for varying duration between 3-30 days (short fast: 3-7 days = 72; prolong fast: >7 days = 38). There were significant decrease in weight (66.8 ± 11.0 to 64.7 ± 11.1 kg, P < 0.0001), BMI (27.1 ± 4.9 to 26.2 ± 4.9 kg/m2, P < 0.0001), systolic blood pressure (130 ± 17 to 128 ± 15 mmHg, P = 0.012), serum globulin (3.10 ± 0.42 to 3.01 ± 0.41 mg/dl, P = 0.024), and serum high density lipoprotein (48.3 ± 12.2 to 45.7 ± 12.6 mg/dl, P < 0.0001) post fasting. However, significant increase was observed in pulse rate (81 ± 10 to 83 ± 11 beat/min, P = 0.001), fasting plasma glucose (102.9 ± 35.0 to 132.0 ± 42.0 mg/dl, P < 0.0001), serum triglycerides (137.6 ± 68.3 to 149.0 ± 67.1 mg/dl, P = 0.031), very low density lipoprotein (22.0 ± 10.5 to 24.2 ± 11.1 mg/dl, P = 0.010), and serum cortisol levels (13.5 ± 5.9 to 17.2 ± 6.3 μg/dl, P < 0.0001). These changes were more pronounced with prolong fasting, but were not affected by gender.Conclusions:Fasting results in improvement in anthropometric, physical and biochemical parameters related to physical health. It can be recommended as a mean for improving quality of life.

Ramadan exposure and birth outcomes: a population-based study from the Netherlands.

Ramadan, the Islamic month of daytime fasting, is observed by many pregnant Muslims. Although pregnant women are exempt, many prefer to fast. Previous research has shown long-term adverse effects on various health outcomes among the offspring, but evidence on effects on perinatal outcomes is mixed. This study investigates effects of Ramadan during pregnancy among Muslims in the Netherlands. Data from the Perinatal Registry of the Netherlands (Perined) on all births between 2000 and 2010 to mothers recorded as Mediterranean (i.e. of Turkish/Moroccan descent, a proxy for Muslim) (n = 139,322) or as ethnically Dutch (n = 1,481,435) were used. Ramadan exposure was defined using an intention-to-treat approach as the occurrence of a Ramadan during gestation. Muslims with versus without a Ramadan occurring during gestation were compared using difference-in-differences analyses. In these multiple linear/logistic regressions, non-Muslims were additionally included in order to take out potentially remaining confounding through seasonal effects. The occurrence of a Ramadan during pregnancy among Muslims was not associated with altered birth weight, gestational length, newborn's sex, perinatal mortality, low Apgar, or mild congenital anomalies. Odds for severe congenital anomalies were higher among the exposed (odds ratio: 1.17; 95% confidence interval: 1.00, 1.37), but this association became non-significant when adjusting for multiple testing. Despite earlier research showing long-term adverse health effects of prenatal exposure to Ramadan, there seems to be little or no relation between exposure to Ramadan during pregnancy and birth outcomes.

Association of Ramadan daytime fasting with ocular surface inflammation and dry eye

PurposeDespite the widespread practice of fasting, there are no studies looking at ocular surface inflammation, specifically matrix metalloproteinase 9 (MMP-9) testing, during fasting. In this prospective study, we wanted to evaluate the effect of Ramadan fasting on the level of tear film MMP-9 as well as other standard indicators of dry eye disease.MethodsForty healthy patients without history of ocular disease were tested before and toward the end of Ramadan. Each patient was assessed at each timepoint for tear film MMP-9 positivity as measured by a commercially available test (InflammaDry; Quidel Corp., San Diego, CA, USA) which detects MMP-9 levels of more than 40 ng/ml. Ocular surface disease index (OSDI) scores, tear breakup time (TBUT), Schirmer I test (S1T) and corneal fluorescein staining (CFS) were also evaluated at each timepoint.ResultsInflammaDry was positive in 10 patients (25%) prior to Ramadan and 21 patients (52.5%) during Ramadan fasting, and this change was statistically significant (p = 0.02). Mean TBUT decreased from 7 s prior to Ramadan to 5.3 s during Ramadan fasting, and this change was statistically significant (p = 0.01). OSDI, CFS and S1T did not show any statistically significant changes (p > 0.05 for all).ConclusionRamadan fasting has a significant impact on TBUT and ocular surface inflammation detected by Inflamma Dry testing. Patients who suffer from dry eye disease and those who develop symptoms during Ramadan are advised to consult with a physician before or during Ramadan fasting.

Ramadan and Culturally Competent Care: Strengthening Tuberculosis Protections for Recently Resettled Muslim Refugees.

To improve latent tuberculosis infection treatment completion rates, Tarrant County Public Health began providing after-dusk home delivery of a 12-dose latent tuberculosis infection regimen of weekly rifapentine plus isoniazid administered via directly observed preventive therapy during Ramadan, a month of prayer and daytime fasting observed by Muslims. In unadjusted difference-in-difference logistic regression analyses (n = 148), Muslim patients had lower treatment completion rates than non-Muslim patients during Ramadan prior to program implementation (68.8% vs 95.4%), whereas rates were comparable postimplementation (95.7% vs 96.4%; difference-in-difference P = .011). Similar results were found after adjusting for age and gender (pre: 71.4% vs 94.8%; post: 95.5% vs 96.3%; P = .032). These findings provide evidence of the need for and effectiveness of programmatic innovations tailored to the varying cultural norms of the widely diverse populations served by public health authorities and suggest that culturally competent clinical care may advance population health goals.

Fluid deficits during prolonged overnight fasting in young healthy adults.

Overnight fasting is often prolonged before scheduled surgery, and the extent of perioperative fluid replacement may influence outcome. In clinical practice, basic requirements are estimated at 1.2-2.0mL·kg-1 ·h-1 , but there is little contemporary clinical data on what deficits result from complete fasting. This prospective preclinical study was designed to determine total fluid loss during overnight fasting, prolonged during daytime. Twenty (10 female) healthy adult volunteers, aged 24 (range 21-46) years, fasted from 22:00 until 16:00, and had their body weight and urine output measured at predefined time intervals. The median (interquartile range) fluid deficits were 0.82 (0.73-1.00) kg, corresponding to 1.26 (1.11-1.41) g·kg-1 ·h-1 for the initial overnight fasting period, 0.59 (0.40-0.70) kg and 0.99 (0.83-1.31) g·kg-1 ·h-1 for the consecutive daytime period, and 1.47 (1.27-1.64) kg and 1.19 (1.05-1.28) g·kg-1 ·h-1 for the total period of fasting. Urine output accounted for 52% of total weight loss and was 36% of the baseline hourly level during the last four-hour period of fasting. Ten hours of overnight fasting in young adults induces fluid deficits at the lower limit of estimated intervals referred to in clinical practice, and hourly weight loss gradually decreases further during prolonged daytime fasting. These findings indicate that current routine procedures do slightly overestimate fluid deficits resulting from prolonged fasting in perioperative clinical practice.

Efek Pemuasaan pada Masa Dara terhadap Pola Produksi Telur dan Distribusi Waktu Oviposisi pada Burung Puyuh

The research is aimed to investigate the effect of fasting at grower period (3 to 6 week of age) on pattern of egg production and distribution of oviposition time in Japanese quail. Three hundreds and forty female of Japanese quails at 3 week of age were used in this research. The treatments were (1) without fasting or control, (2) skip-a-day fasting, (3) nighttime fasting: 18.00 p.m to 06.00 a.m.; and (4) daytime fasting: 06.00 a.m to 18.00 p.m. Data collected were age of the onset of laying (sexual maturity) until 12 weeks of age. The results showed that (1) the peak of egg production of control group was faster (10 weeks of age) and higher (89,3%) than the quails of groups fasting at grower period, but the peak of egg production was maintained longger than control group; (2) there was a fact that the egg production compensation was happened in fasting groups at grower period; (2) in quails group of daytime fasting at was grower period the distribution of oviposition time was relative smoother between periode observed: 12.00 – 18.00 p.m., 18.00 – 24.00 p.m. and 00.00 – 06.00 a.m., than other treatments. Key words: japanese quail, fasting, egg production, oviposition time

Glucose homeostasis during ramadan fasting: First case series illustrated by flash glucose monitoring and ambulatory glucose profiling

Background: The impact of fasting during the month of Ramadan, practiced by adult Muslims, on glucose homeostasis has attracted much attention recently with view to understanding the metabolic price of fasting and to help plan rational management. The flash glucose monitoring (FGM) expressed as ambulatory glucose profiles (AGP) provides a minimally invasive yet comprehensive insight into blood glucose (BG) changes in relationship to various physiological and behavioral factors. Objectives: To investigate the BG homeostasis during Ramadan fasting in a group of individuals with different states of glucose tolerance. Methods: Eight individuals who were fasting during Ramadan were studied by FGM using the Abbott's FreeStyle® Libre™ system. They included individuals with normal glucose tolerance during pregnancy (1), prediabetes (2), postbariatric hypoglycemia (1) and type 2 diabetes mellitus (4). Results: In the normal pregnancy AGP's fluctuated minimally around meals with some asymptomatic low BG readings on prolonged fasting. In those with prediabetes, most of the daytime BG were within normal but there was a minimal post-prandial rises and some asymptomatic lower readings on prolonged fasting too. In the case of the patient with history of post-bariatric hypoglycemia, daytime fasting periods had perfectly stable normal BG. However, marked early postprandial hyperglycemia occurred in the evening followed by a short-lived symptomatic hypoglycemia. In the 4 patients with diabetes, AGP showed high glucose exposure, wide variation and marked instability after both traditional meals of dawn time (Suhor) and sunset (Iftar) particularly in the later. A variably slow downward trend throughout the day was observed. The differences in the AGP's reflected both biological and behavioral differences between patients within the general picture. AGP's before, during and after Ramadan in 3 patients revealed distinctly-different profiles reflecting the Middle Eastern meal pattern, Ramadan meal pattern and Eid feasting respectively. For patients these findings were discussed with them and used to plan glycemic management. Conclusions: This is the first comprehensive demonstration of glucose changes during Ramadan fasting using AGP. The visually illustrated data give insights into glucoses homeostasis in diabetes and related disorders throughout whole day of Ramadan. This may help inform therapeutic decisions on individual basis and help plan future studies.

Time-restricted feeding improves insulin resistance and hepatic steatosis in a mouse model of postmenopausal obesity

BackgroundMenopause is associated with significant hormonal changes that result in increased total body fat and abdominal fat, amplifying the risk for metabolic syndrome and diseases such as diabetes, cardiovascular disease and cancer in postmenopausal women. Intermittent fasting regimens hold significant health benefit promise for obese humans, however, regimens that include extreme daytime calorie restriction or daytime fasting are generally associated with hunger and irritability, hampering long-term compliance and adoption in the clinical setting. Time-restricted feeding (TRF), a regimen allowing eating only during a specific period in the normal circadian feeding cycle, without calorie restriction, may increase compliance and provide a more clinically viable method for reducing the detrimental metabolic consequences associated with obesity. MethodsWe tested TRF as an intervention in a mouse model of postmenopausal obesity. Metabolic parameters were measured using Clinical Laboratory Animal Monitoring System (CLAMS) and we carried out glucose tolerance tests. We also stained liver sections with oil red O to examine steatosis and measured gene expression related to gluconeogenesis. ResultsPreexisting metabolic disease was significantly attenuated during 7 weeks of TRF. Despite having access to the same high fat diet (HFD) as ad libitum fed (ALF) mice, TRF mice experienced rapid weight loss followed by a delayed improvement in insulin resistance and a reduced severity of hepatic steatosis by having access to the HFD for only 8h during their normal nocturnal feeding period. The lower respiratory exchange ratio in the TRF group compared with the ALF group early in the dark phase suggested that fat was the predominant fuel source in the TRF group and correlated with gene expression analyses that suggested a switch from gluconeogenesis to ketogenesis. In addition, TRF mice were more physically active than ALF fed mice. ConclusionsOur data support further analysis of TRF as a clinically viable form of intermittent fasting to improve metabolic health due to obesity.

Impact of Socializing, Fasting and Feasting on Day to Day Blood Glucose Profiles in Diabetes Elucidated by the FreeStyle® Libre™ System

Background: Total day-time fasting is observed by millions of adult Muslims during the whole lunar month of Ramadan. However, many people, particularly elderly men and women, do fast isolated or somehow consistent days outside Ramadan. This may pose clinical management challenges. Case Report: A case of an elderly diabetic man observing day-time Ramadan-type fasting on Mondays and Thursdays throughout the year is described. Detailed blood glucose (BG) profiles over a 10 week period were captured using the FreeStyle® Libre™ Flash glucose monitoring system. Detailed study of these profiles revealed three distinctly different BG patterns every week. One pattern on the two fasting days (Mondays and Thursdays) with blood glucose peaking after dawn and after sunset with a downward trend throughout the day. A second pattern on Fridays with the BG levels that peak and remain high for a few hours in the early afternoon following the large and rich weekly family meal. The third pattern was seen on the remaining 4 non-fasting days where BG starts to rise in the midmorning reflecting the patient's life style of hosting and sharing with his business clients. Such detailed and visually presented information gave insights into his BG daily patterns enabling his therapeutic plans for hyperglycemia to be tailored on daily basis. Conclusions: This is the first documentation of glucose profiles during “Ramadan-type fasting” and feasting using the flash glucose monitoring system. In addition to detailed clinical and social history, use of medical technology may occasionally help resolve some difficult blood glucose patterns.

The effect of Ramadan fasting and maternal hypoalbuminaemia on neonatal anthropometric parameters and placental weight

In Islamic religion, daytime fasting during the month called Ramadan is an annual practice. In this study, we aimed to investigate the effect of Ramadan fasting and maternal hypoalbuminaemia on neonatal growth parameters. A prospective case–control study was conducted in Diyarbakir and Istanbul, Turkey. The sample size of fasting group was 168 and that of non-fasting group was 170. Demographic characteristics, obstetrics ultrasonographic findings and laboratory parameters of the participants were recorded. Neonatal anthropometric parameters and placental weight were noted. The mean placental weight was significantly higher in the fasting group (p = 0.037). Also, in the fasting group, pregnant women with hypoalbuminaemia had significantly higher placental weight (p = 0.009). In conclusion, the mean placental weight in the fasting group was significantly higher. Also a significant correlation between placental weight and maternal serum albumin level was observed in the fasting group.

Evaluation of safety of insulin degludec on undergoing total colonoscopy using continuous glucose monitoring

Aims/IntroductionThere is little information regarding how to use insulin degludec (D) when diabetic patients are preparing for total colonoscopy (TCS).Materials and MethodsA total of 12 patients with type 2 diabetes treated with insulin D and scheduled to undergo TCS were enrolled in the present study. A continuous glucose monitoring device was attached to each patient for 4 days, from two evenings before TCS to the morning after the procedure. The patients fasted for 24 h, starting after 18.00 h the day before TCS. Insulin D was only discontinued the morning of the day TCS was carried out.ResultsNo patients experienced hypoglycemia during the daytime fasting period (08.00–18.00 h the day of TCS); the hypoglycemic index, mean glucose level, and standard deviation were 0, 141.3 ± 31.5 mg/dL and 15.6 ± 6.5 mg/dL. The mean glucose level and standard deviation during the daytime fasting period were significantly lower than during the daytime control period (08.00–18.00 h the day before TCS; P = 0.003, P = 0.001, respectively). The mean fasting glucose and fasting plasma glucose levels were significantly correlated (r = 0.78, P = 0.002), as were both the mean glucose level and standard deviation during the daytime control period, and the change in the mean glucose level (fasting period minus control period; r = −0.79, P = 0.002, and r = −0.69, P = 0.01, respectively).ConclusionsPatients can safely undergo TCS when insulin D is discontinued only once on the day of the procedure.

Abstract P091: Food-Stimulated Neuronal Activation Differs by Feeding Status in Obese and Normal-Weight Women: An fMRI Study

Introduction: Neurological responses to food stimuli are complex and differ between lean, obese, and post-obese (weight-reduced) individuals. However, the neurological systems that regulate feeding in relation to weight status are not understood. The purpose of this study was to compare satiety mechanisms (fed&gt;fasted) in obese and lean women. Hypothesis: We assessed the hypotheses that food-specific neural signals affected by satiety are more active in lean than obese women. Methods: Eleven normal weight (BMI 22.8 ± 1.5 kg/m2) and 9 obese (BMI 33.0 ± 3.4 kg/m2) women completed a functional magnetic resonance imaging (fMRI) study. Fasted state scans were performed after an 8-h daytime fast for normal weight women whereas obese women were scanned after an overnight fast. Fed state scans were started 30 min after consumption of a liquid meal replacement providing 35% of resting energy requirements. Testing days were held 2 wk apart. Results: Overall, the neuronal activity in response to food stimuli was higher in the fed state than the fasted state for both groups. However, normal weight women had a greater number of activated regions than obese women in both the fed and fasted state. When fed and fasted states were contrasted (fed&gt;fasted) and compared between groups (normal weight&gt;obese), normal weight women had greater activation in the insula, cuneus, lingual gyrus, pre- and post-central gyrus, superior and middle temporal gyrus, and inferior frontal gyrus in the fed state than the obese. Conclusions: In conclusion, the findings of this study suggest that obese individuals recruit fewer brain centers in response to food stimuli when fed. This may be associated with a reduced ability to respond to internal satiety signals.

Diurnal Rhythms in Selected Physical Variables before and During Ramadan Fasting

The purpose of the present study was to assess diurnal variations in selected physical variables before and during Ramadan fasting. The physical variables (speed, speed endurance, agility and power) were documented around the clock at five 4-hourly intervals before Ramadan began and on the twenty-third day of Ramadan (daytime fasting). Ten healthy non-smoking male handball players volunteers were included in the study after routine clinical and laboratory examinations. These subjects were selected from Department of Physical Education and Sports Sciences, Annamalai University. Their ages averaged 27 ± 1.9 years. Time series were analysed with repeated measures ANOVA which revealed that there was a statistically significant changes as a result of Ramadan fasting among experimental days and times on speed, speed endurance, agility and power. Experimental day and time interaction showed that during Ramadan, compared with control period, time related variations of speed, speed endurance, agility and power changed significantly. To evaluate rhythmicity, the single cosinor method was used. Cosinor analysis clearly shows the shift in acrophase obtained from the subjects before to the 23rd day of Ramadan fasting. Ramadan induces day time changes in speed, speed endurance, agility and power.