Intermittent fasting and the liver: Focus on the Ramadan model

Intermittent fasting(IF)is an intervention that involves not only dietary modific-ations but also behavioral changes with the main core being a period of fasting alternating with a period of controlled feeding.The duration of fasting differs from one regimen to another.Ramadan fasting(RF)is a religious fasting for Muslims,it lasts for only one month every one lunar year.In this model of fasting,observers abstain from food and water for a period that extends from dawn to sunset.The period of daily fasting is variable(12-18 hours)as Ramadan rotates in all seasons of the year.Consequently,longer duration of daily fasting is observed during the summer.In fact,RF is a peculiar type of IF.It is a dry IF as no water is allowed during the fasting hours,also there are no calorie restrictions during feeding hours,and the mealtime is exclusively nighttime.These three variables of the RF model are believed to have a variable impact on different liver diseases.RF was evaluated by different observational and interventional studies among patients with non-alcoholic fatty liver disease and it was associated with improve-ments in anthropometric measures,metabolic profile,and liver biochemistry regardless of the calorie restriction among lean and obese patients.The situation is rather different for patients with liver cirrhosis.RF was associated with adverse events among patients with liver cirrhosis irrespective of the underlying etiology of cirrhosis.Cirrhotic patients developed new ascites,ascites were increased,had higher serum bilirubin levels after Ramadan,and frequently developed hepatic encephalopathy and acute upper gastrointestinal bleeding.These complications were higher among patients with Child class B and C cirrhosis,and some fatalities occurred due to fasting.Liver transplant recipients as a special group of patients,are vulnerable to dehydration,fluctuation in blood immunosuppressive levels,likelihood of deterioration and hence observing RF without special precautions could represent a real danger for them.Patients with Gilbert syndrome can safely observe RF despite the minor elevations in serum bilirubin reported during the early days of fasting.

Fasting and Cancer: Practice and Patients’ Quality of Life during Ramadan

Introduction: Ramadan is the ninth lunar month of the Muslim calendar, and fasting during Ramadan is one of the five pillars of Islam. Muslim cancer patients and health professionals are faced with a dilemma between the necessity of fasting and its possible adverse effects during Ramadan on the health status of cancer patients. We believe that addressing the issue of fasting in cancer patients is of global interest. Objectives: Prevalence of fasting in cancer patients during Ramadan;Predictive factors of Ramadan fasting in cancer patients;The effect of fasting during Ramadan on the quality of life of cancer patients. Materials and Methods: A structured questionnaire was used to interview adult cancer patients who received chemotherapy IV—or oral treatment at the medical oncology department at the Hassan II University Hospital in Fez during the month of Ramadan 1443 Hijri (April to May 2022). The quality of cancer patients’ lives during their fasting practice in Ramadan was evaluated via the QLQ-C30 questionnaires. Results: 48% of patients did not fast during Ramadan, 22% and 30% were partial and complete fasters respectively. Patients, with OMS 0 to 1, who receive outpatient treatment, non-metastatic patients and patients on oral treatment were more frequent in the completely fasted group. All these factors showed statistically significant values (p < 0.05). 44% of patients sought advice from the treating oncologist if they could fast, while only 15% of patients during Ramadan asked an imam if they could be excused from fasting. A comparison of the QLQ-C30 data showed a significant improvement in emotional functioning with fasting, however, patients had clinically more but not significantly fatigue after fasting. Conclusion: Female gender, good WHO, non-metastatic disease, and oral or outpatient treatment were more likely to be fasting. This study argues that fasting did not influence the quality of life, and appears to significantly improve emotional functioning in cancer patients during Ramadan.

Diabetes among Muslims during Ramadan:A narrative review

Fasting during the month of Ramadan is one of the five fundamental principles of Islam,and it is obligatory for healthy Muslim adults and adolescents.During the fasting month,Muslims usually have two meals a day,suhur(before dawn)and iftar(after dusk).However,diabetic patients may face difficulties when fasting,so it is important for medical staff to educate them on safe fasting practices.Prolonged strict fasting can increase the risk of hypoglycemia and diabetic ketoacidosis,but with proper knowledge,careful planning,and medication adjustment,diabetic Muslim patients can fast during Ramadan.For this review,a literature search was conducted using PubMed and Google Scholar until May 2023.Articles other than the English language were excluded.Current strategies for managing blood sugar levels during Ramadan include a combination of patient education on nutrition,regular monitoring of blood glucose,medications,and insulin therapy.Insulin therapy can be continued during fasting if properly titrated to the patients’needs,and finger prick blood sugar levels should be assessed regularly.If certain symptoms such as hypoglycemia,hyperglycemia,dehydration,or acute illness occur,or blood glucose levels become too high(>300 mg/dL)or too low(<70 mg/dL),the fast should be broken.New insulin formulations such as pegylated insulin and medications like tirzepatide,a dual agonist of gastric-inhibitory peptideand glucagonlike-peptide 1 receptors,have shown promise in managing blood sugar levels during Ramadan.Non-insulin dependent medications like sodium-glucose-cotransporter-2 inhibitors,including the Food and Drug Administration-approved ertugliflozin,are also being used to provide additional cardiovascular benefits in patients with type 2 diabetes.

Do not forget diet and exercise during Ramadan

We conducted an analysis of internet search trends spanning from January 2022 to June 2023 in the ten most populous Muslim countries.Our study focused on key terms,including the prominent GLP1 analog"ozempic™",as well as"diet","exercise",and"diabetes".The findings revealed a substantial increase in searches for the GLP1 analog in eight countries.Concurrently,searches for"diet"and"exercise"predominantly exhibited a decline in nine and four countries,respectively.Notably,searches for"diabetes"displayed positive trends in only two countries.These patterns indicate a growing reliance on pharmaceutical interventions for managing diabetes and weight,often to the detriment of diet and exercise.Healthcare professionals and clinicians in Muslim countries should emphasize the importance of maintaining dietary and exercise regimens for patients with diabetes,even during the observance of Ramadan.

Herding behavior in Ramadan and financial crises: the case of the Pakistani stock market

This study examines herding behavior in the Pakistani Stock Market under different market conditions,focusing on the Ramadan effect and Crisis period by using data from 2004 to 2014.Two regression models of Christie and Huang(Financ Analysts J 51:31-37,1995)and Chang et al.,(J Bank Finance 24:1651-1679,2000)are used for herding estimations.Results based on daily stock data reveal that there is an absence of herding behavior during rising(up)and falling(down)market as well as during high and low volatility in market.While herding behavior is detected during low trading volume days.Yearly analysis shows that herding existed during 2005,2006 and 2007,while it is not evident during rest of the period.However,herding behavior is not detected during Ramadan.Furthermore,during financial crisis of 2007-08,Pakistani Stock Market exhibits herding behavior due to higher uncertainty and information asymmetry.

Diabetic patients and Ramadan fasting:how they live it?

Objective:To quantify the prevalence of fasting during Ramadan month among diabetic patients and to observe the factors which were deferring between fasting and non-fasting diabetic patients.Methods:A cross-sectional study was carried out at primary health care clinics.The diabetic patients were interviewed with a structured data form by trained research assistants.Patients’age,gender,marital status,weight and height,diabetes type,medication,compliance,follow up,self monitoring and any complication faced during the fasting were collected.Cardiovascular risk factors including smoking habit,hypertension,dyslipidemia and pre-existing cardiovascular diseases were also recorded.Results:Out of 920 diabetic patients,95%were suffering from DM type 2.Overall patients who fasted the whole month of Ramadan were 84%.The proportion of type 1 and type 2 was 71%and 85%respectively.About 63%of DM type 2 patients were treated with oral hypoglycemic agents(OHAs) alone and 2.4%with combination of OHAs and insulin.Only 42%of DM type 1 and 36%of DM type 2 patients has visited their physicians prior to their fast for advice.The significant differing factors which make non-fasting in diabetic patients,were medication(insulin),complications,hyperglycemia,retinopathy, neuropathy,nephropathy and vascular problems.Conclusions:This study has identified the factors in diabetic patients,were being compliant with medication,oral treatments and family support which lead to more likely to fast in Ramadan month.Factors which reduce fasting by these patients were acute and chronic complications,time since diagnosis and insulin treatment.Fasting would be acceptable for patients who are compliant with their diet and medication.

Effect of Fasting during Ramadan on Migraine Sufferers

Background: Fasting during Ramadan in Muslim communities is distinct from regular voluntary or experimental fasting. Its consequent caffeine withdrawal, stress and low blood glucose level (hypoglycemia) may trigger headache in patients with migraine. Objectives: The main aim of this study was to evaluate the effect of the Ramadan fasting on the frequency of migraine attacks among observant Muslim migraine sufferers. Material and Methods: This research study was based on fasting Muslims;both genders were aged between 18 and 65 years. Fifty migraineurs were selected, participated and gave consent at Internal Medicine and Neurology Clinics in Riyadh National Hospital, KSA. Those patients were recruited over three consecutive months of Ragab, Shaban and Ramadan during the period of 2010 and 2013. The effect of fasting and special eating pattern during the month of Ramadan compared with the preceding two months (Ragab and Shaban) was studied. The primary parameters used for comparisons were migraine attack count, duration of migraine attacks in days, attack duration and severity of the attacks. Results: Only forty three migraine sufferers completed the current study to the end, 4 patients of them were males (9.3%) and 39 were females (90.7%). They were aged between 18 and 44 years (Mean ± SD, 30.9 ± 6.9 years). Most of the fasting migraineurs during Ramadan were caffeine drinkers (n = 36, 83.7%), cigarette smokers (n = 2, 4.6%), overweight or obese (with BMI?> 25) n = 27, 62.8%), under stress (n = 29, 67.4%) and with low to moderate physical activities (No exercise) (n = 31, 72%). The worst time for the fasting individuals was afternoon between 2:00 PM to 4:30 PM because majority of them had headache during these hours. This study showed a significant reduction in migraine attack count, number of headache days, number of attacks with acute medication and total medication intake among migraineurs during the month of Ramadan compared with the two pre-Ramadan months. However, attack severity and attack duration did not change significantly between all three months. Conclusion: In conclusion, the present study did not find any negative effects of fasting during Ramadan on the migraine sufferers.

Pharmacist Role in Pharmaceutical Care during Ramadan

Introduction: Ramadan is the ninth month in the Islamic Hijri calendar where Muslims are ex-pected to fast every day from dawn to sunset. The eating behavior changes during Ramadan and the abstinence of food affects the oral drugs administration and other convenience dosage forms. There is a need to highlight and illustrate the role of the pharmacists in medication adjustment challenges that the patients conquer in the Holy month of Ramadan. Objectives: To estimate the awareness of pharmacists’ role in providing pharmaceutical care during Ramadan;moreover, to explore pharmacists’ perspective on the importance of medication regimen adjustment along with the proper counseling required to optimize patients’ health throughout fasting. Method: This is an observational study that was done through dissemination of a cross-sectional survey among 130 pharmacists covering Abu Dhabi, Dubai, Sharjah, Ajman, and Northern Emirates regions. The targeted population consisted of practicing community pharmacists and hospital pharmacists across UAE. Results: Among pharmacists participated in the study 115 pharmacists (88.5%) were Muslims and 79 pharmacists (60.8%) were Arabs. 126 pharmacists (97%) reported performing one or more kinds of medication regimen adjustment around Ramadan for at least one patient. Changing the frequency had the highest percentage by the pharmacist compared to other methods of regimen adjustment (39%). Moreover, the results revealed that 46.9% of the pharmacists chose not to change the medication itself. Nineteen percent of Muslim pharmacists initiated the conversation about medication regimen adjustment (P = 0.0448) compared to non-Muslims, while14% of pharmacists were Arabs who showed no statistically significant difference. Conclusion: In conclusion, pharmacists are more qualified to adjust and manage medication regimens than what they are presently performing. Utilization of such skill is required to adjust patients’ medication regimen during fasting the Holy month of Ramadan and to ensure safe transition for fasting patients into and out of Ramadan.

Changes in Maternal Lifestyle during Ramadan Altered Placental Development

People born with low birth weight are at a greater risk of developing later life diseases such as hypertension, diabetes and cancer. Recent studies have pinpointed the placenta as a critical factor involved in developmental programming. Changes in maternal lifestyle or dietary habits can alter placental development and increase the risk of developmental programming of adult diseases. Saudi people, including pregnant women, change their lifestyle and eating habits during the holy month of Ramadan. Previous studies found that the exposure to Ramadan lifestyle reduces placental weight;however, effects on other placental aspects remained unknown. We aimed to further examine the effects of exposure to Ramadan lifestyle on full-term placental morphometrics, histology and gene expression of key glucose transporters. To examine this, fresh placentas were collected from 60 healthy Saudi women. Samples were equally classified into two groups;not exposed to Ramadan lifestyle (control) or exposed to Ramadan lifestyle in the first. Placental weight, length and breadth were recorded and placental surface area was calculated. Placental tissue was processed and stained with eosin and hematoxylin for histological examination. Apoptosis was assessed using TUNEL assay. The gene expression of the glucose transporters GLUT1 and GLUT3 was evaluated. The results show that women exposed to Ramadan lifestyle have more elongated placentas with less central cord insertion. Placental weight and surface area were significantly lowered in women exposed to Ramadan lifestyle. Placental length was not affected but the breadth was significantly smaller in than control. Placentas exposed to Ramadan lifestyle had fewer and less-developed syncytial knots and thicker syncytiotrophoblast cells. Apoptosis was detected in placentas exposed to Ramadan lifestyle. GLUT1 mRNA expression was unaltered, but GLUT3 was increased compared to control group. These findings suggest that changes in maternal lifestyle during Ramadan can alter placental structure at morphometric, histological and molecular levels. These structural changes are indication of placental adaptations for a suboptimal maternal environment. Such adaptations have been linked to adult diseases in various populations worldwide. Further studies are required to evaluate the possible link between exposure to Ramadan lifestyle and the risk of developing adulthood chronic diseases in the Saudi population.

London 2012 Olympic Games＂ Challenges Faced by Islamic Olympians Fasting for Ramadan

Fasting is a common practice among many religions in the world. In the ancient religions, fasting was observed as common religious practice associated with many religious festivals. Fasting was also observed in the Judaism and Christianity as part of the religious belief. Therefore, Islam has also prescribed fasting for Muslim in the form of a-month long period of obligatory acts of worship. Ramadan is the ninth month of the Muslim calendar, during which they observed the fasting among daylight hours. The paper has explored significance of Ramadan and impact it had on Muslim athletes during the London 2012 Olympic Games. The Olympic Games were scheduled during the month of Ramadan and the impact of the Olympic Games on Muslim athletes, visitors, and viewers was described, because main Olympic events were scheduled during the breaking of the fast. This paper presents the findings of the primary research undertaken to assess the views and opinions of both the Islamic religion and other religions, concerning the impact of religious festivals on the Olympic Games. The results concluded that most of the people have no idea that there could be an impact of religious festivals on the Olympic Games.

Effect of Fasting of Ramadan on Infertile Women Undergoing In-Vitro Fertilization/Intracytoplasmic Sperm Injection Cycles: A Prospective Cohort Study

Objective: To determine the effects of fasting of Ramadan in patients undergoing in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Design: A prospective cohort study conducted during Ramadan. Setting: Ain Shams University IVF centre. Population: Three hundred fasting, infertile women undergoing their first trial of IVF/ICSI and 300 non-fasting matched controls undergoing the same procedure during Ramadan. Methods: Anxiety and depression were measured by the Hospital Anxiety and Depression Scale, at the start of the induction protocol. All the successful pregnant women were followed up until delivery. Main Outcome Measures: The primary outcome measure was the live birth rate. Results: The live birth rate was higher in the fasting group than in the non-fasting group;this was not significant (43% vs. 40%, P = 0.46). The fasting group needed higher doses and durations of induction. Embryo quality did not differ between both groups. The pregnancy complication rate among successful cases was higher in the fasting group (52.9% vs. 40.4%, P = 0.03);however, the frequencies of anxiety and depression were significantly lower than those in the non-fasting group (18% vs. 38%, P P < 0.00001, respectively). Conclusion: Fasting during Ramadan does not seem to significantly affect the IVF/ICSI outcome;however, it significantly decreased the anxiety and depression usually associated with these procedures.

Fasting in Ramadan Affects Cognitive and Physiological Function in Normal Subjects (Pilot Study)

Purpose: Our study aimed to investigate the effects of Ramadan fasting on cognitive and physiological function in a group of healthy Muslim subjects. Methods: We measured demographic, physiological (blood pressure), and cognitive function including attention switching task (AST) and delayed matching to sample (DMS) using the Cambridge Neuropsychological Test Automated Battery (CANTAB) at two periods of the study (before Ramadan, at the second week in Ramadan) in 15 subjects. Results: During fasting, performance on the AST test improved significantly for switching cost (p = 0.030) and for congruent condition of AST task (p = 0.043), for diastolic pressure decreased (p = 0.069) in healthy subjects. There was no significant effect for incongruent condition and number of errors and percent to complete task for DMS test and systolic blood pressure. Conclusions: The results suggest that Ramadan fasting is associated with significant changes in cognition, and causes a drop in diastolic blood pressure in healthy subject.

Modulation of Postprandial Glucose Bioavailability in a Cohort of Healthy and Pre-Diabetics Subjects during Ramadan Fasting in cote d'Ivoire

Objective: After the Ramadan fasting period, there is an increasing prevalence of diabetes in Cote d’Ivoire, in diabetes care centers. The objective of this study was to assess the consumption of sugary foods during this period and to determine the risks of diabetes in Muslim populations. Methods: Information was collected on the type and amount of sugary foods consumed. Methods for the preparation of these foods have been determined. Intake frequencies and postprandial glycemic responses were studied. The usual statistical methods were used. Results: Between 70% and 85% of the “fasters” consume plenty of these sugary foods during this period, with an average added sugar level varying between 10% and 35% and a daily consumption of between 250 cl and 0.5 l. The added sugar leads to hyperglycemia in both healthy subjects and pre diabetics. Conclusion: Regular consumption of these sugary foods results in significant hyperglycaemia throughout the month of fasting with a significantly higher blood glucose level in pre diabetic subjects. This makes pre diabetics people more at risk of diabetes among Muslim populations during Ramadan fasting.

Safety of Empagliflozin in Patients with Type 2 Diabetes Mellitus in Saudi Arabia: A Post-Authorisation Safety Study

Background: Empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor is used as a monotherapy or in combination for lowering the elevated blood glucose level in patients with type 2 diabetes mellitus (T2DM). It is often associated with certain adverse reactions (urinary tract infection (UTI), diabetes ketoacidosis (DKA), and genital infections). Thus, the Saudi Food and Drug Administration requested a post-authorisation safety study to monitor the safety of empagliflozin during the defined observation period. Methodology: The local, comparator, non-interventional, regulatory post-marketing study using “new user” design was conducted in patients with T2DM, treated with empagliflozin (10 or 25 mg) and dipeptidyl peptidase-4 (DPP-4) inhibitors (NCT03764631). Study was conducted from 2018 to 2020, wherein each patient was followed up for 12 months after the index period. Incidence and occurrence of DKA, severe UTIs, volume depletion and dehydration were observed along with metformin, insulin and treatment complexity status and adverse events in the index and Ramadan period. All data collected were analysed using descriptive statistics. Results: Among the 1502 patients enrolled (empagliflozin [n = 751] and DPP-4 inhibitors [n = 751]), 0.1% patients (n = 1) in each group and Conclusion: Empagliflozin was well tolerated over a period of 12 months, with no safety concerns and a favourable benefit/risk ratio.

铁路接触网与电力贯通线同杆合设方案研究——以埃及斋月十日城铁路项目为例

埃及斋月十日城铁路是该国首条采用交流27.5 kV制式的电气化铁路,采用直供加回流的牵引供电模式,接触网采用全补偿简单链形悬挂。电力贯通线是用于铁路信号、通信及其他铁路综合用电的电力系统线路。一般距离铁路100 m以内,它引于公共电网或公共电网以外的发电厂、变电站及输配电线路,是铁路沿线连通两相邻变、配电所的主要对沿线铁路用电负荷供电的电力线路,不同于国内的10 kV电力系统,埃及采用20 kV电力系统。本项目采用了电气化铁路接触网系统与20 kV电力贯通线系统“同杆合架”的技术,兼顾了技术可靠性、经济性与视觉美观性,实现了埃及业主的需求。

EPC轻轨综合联调技术实施及组织管理

结合埃及斋月十日城铁路项目工程实践,总结综合联调的技术实施及组织管理,提炼出适用于EPC轻轨的联调方案与管理办法。进一步规范综合联调调试内容,优化机电系统的整体性能,提高工程从建设阶段到运营阶段过渡的可靠性,对今后EPC轻轨项目的综合联调起到很好的参考价值和指导作用。

缓和与1973年中东战争的爆发

缓和是冷战时期的特定阶段,美苏对缓和的认知影响了双方在中东地区的政策及解决中东危机的进程。1973年中东战争的爆发,既与美苏对缓和的认知与推动有关,也离不开埃及对缓和的追求。美苏缓和虽缓解了彼此间的紧张关系,但由于美苏对缓和的追求漠视了埃及的缓和努力与阿拉伯国家对被占领土的诉求,这成为促发战争爆发的外源性因素。美苏缓和对阿以僵局的维持,埃及缓和外交的失败与以色列的强硬立场,使萨达特放弃了外交努力而发动了斋月战争。

埃及城市轨道交通项目前期开发的思考与实践——以斋月十日城铁路项目为例

阐述了埃及斋月十日城铁路项目的背景及功能定位,分析了工程可行性研究报告编制的特殊性,结合项目的功能定位,总结和探讨了适应欧美技术标准、欧美管理体系下工程可行性研究报告编制及后续评估的主要特点和要求,提出了针对该项目的主要技术方案,给出了轨道交通项目前期开发的建议。

城市化背景下乡村回族寺坊斋月“开斋饭”的社会性意义

城市化背景下的乡村回族寺坊斋月"开斋饭"这一民俗事象,不仅有利于回族乡村社会关系网络的建构,而且也是其传统文化及价值观的延续,从而使回族乡村社会传统文化整合得以实现。

基于斋月仪式的沙甸回族社区建构与文化认同研究

仪式是一种特殊的社会活动和形式,是文化的行为展演,观念的具体实践,具有社会整合的能力。斋月仪式是沙甸回族最重要的宗教活动,人们通过斋戒提高自身境界,并在频繁的社会互动中增强族群认同感与内部凝聚力,对社区建构产生积极作用。