The effect of observing religious or faith-based fasting on cardiovascular disease risk factors: A systematic review and meta-analysis

Cardiometabolic and obesity risk outcomes of dawn-to-dusk, dry intermittent fasting: Insights from an umbrella review

BACKGROUND & AIMS

This umbrella review comprehensively and systematically summarizes meta-analyses on the impact of dawn-to-dusk, dry intermittent fasting of Ramadan (RIF) on cardiometabolic and glucose homeostasis indicators.

METHODS

Twenty meta-analyses were examined on the effects of RIF on body fat percentage (BFP), fat mass, fat-free mass, body mass index (BMI), body weight (BW), waist circumference (WC), systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG), and very low-density lipoprotein cholesterol (VLDL-C), fasting blood glucose (FBG), glycated hemoglobin (HbA1c), insulin resistance (HOMA-IR), serum insulin, leptin, and adiponectin. Results of continuous outcomes were pooled from included meta-analyses. We employed random-effects meta-analysis using the restricted maximum likelihood method to estimate heterogeneity. P-values were derived from standard meta-analytic tests, including Egger's test for small-study effects and the excess significance test for potential publication bias. Additionally, we applied criteria from Ioannidis' evidence classification to assess the credibility of the findings.

RESULTS

In healthy subjects, RIF was associated with significant reductions in BW (Hedges' G = -0.33; 95 % confidence interval (CI) = -0.37, -0.29; p-value = 2.63 × 10-52), WC (Hedges' G = -0.30; 95 % CI = -0.38, -0.23; p-value = 5.73 × 10-15), BFP (Hedges' G = -0.26; 95 % CI = -0.37, -0.14; p-value = 6.81 × 10-06), DBP (n = 3,456; Hedges' G = -0.26; 95 % CI = -0.38, -0.15; p-value = 9.18 × 10-06), TC (n = 9,314; Hedges' G = -0.16; 95 % CI = -0.25, -0.07; p-value = 6.27 × 10-04), and TG levels (n = 9,020; Hedges' G = -0.16; 95 % CI = -0.24, -0.08; p-value = 6.87 × 10-05). Moreover, in general population, TG (n = 16,688; Hedges' G = -0.15; 95 % CI = -0.22, -0.08; p-value <0.01) and FBG (n = 16,106; Hedges' G = -0.23; 95 % CI = -0.33, -0.13; p-value <0.01) were significantly reduced.

CONCLUSIONS

Dawn-to-dusk, dry RIF shows promise as a complementary therapy and preventive measure for reducing cardiometabolic and obesity-related risks. However, controlled studies are necessary to validate its effectiveness and fully understand its health implications.

Predictors of Vitamin D Status in Religious and Intermittent Fasting: A Comparative Study in Orthodox Nuns and Women from the General Population

Background: Vitamin D plays a key role in bone metabolism and immune regulation. Populations with restricted sun exposure or limited dietary intake are particularly vulnerable to vitamin D deficiency. Orthodox Christian nuns represent a unique group in this regard, due to traditional clothing, limited outdoor activity, and prolonged religious fasting. However, few studies have compared them with lay individuals following similar dietary practices. Objective: This study aimed to investigate predictors of serum 25-hydroxyvitamin D [25(OH)D] concentrations in two female populations: Orthodox Christian nuns and women from the general population practicing intermittent (religious or non-religious) fasting. We also aimed to develop predictive models of vitamin D status for each group based on lifestyle and biochemical parameters. Methods: A total of 85 women (40 Orthodox nuns and 45 laywomen), aged 30-50 years, were enrolled. Serum 25(OH)D, parathyroid hormone (PTH), calcium levels, and anthropometric indices, including body mass index (BMI), total body fat, and visceral fat, were measured. Dietary calcium and vitamin D intake, as well as sun exposure, were assessed using validated questionnaires. Separate stepwise multiple regression models were constructed for each group to identify independent predictors of 25(OH)D concentrations. An additional combined model, including all participants, was also explored. Results: PTH was the most significant predictor, negatively correlating with 25(OH)D concentrations in both groups (p = 0.038), highlighting its regulatory role in vitamin D metabolism. When analyzed separately, the model for Orthodox nuns showed stronger explanatory power (adjusted R2 = 0.718; p = 0.013) compared with the control group (adjusted R2 = 0.362; p = 0.038), with PTH emerging as a key predictor in both. Conclusions: Distinct predictors of vitamin D status were identified in each group, reflecting the complex interplay between lifestyle and physiological factors. These findings suggest that targeted interventions, such as addressing PTH regulation in fasting populations or enhancing sun exposure in the general population, may be more effective in preventing vitamin D deficiency depending on the context.

The effect of Ramadan fasting on anthropometric and body composition of healthy adults within different time points: A systematic review and meta-analysis

To date, the effect of Ramadan fasting (RF) on anthropometric and body compositions remains inconsistent. This review aimed to investigate the impact of RF on anthropometric and body composition of healthy adults within different time points during and after RF. Qualified studies from MEDLINE, Web of Science, Embase, CINAHL Complete, ProQuest, and Scopus were included. We involved prospective observational studies with pre- and post-test design. The anthropometric and body composition parameters consist of weight, BMI, waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), absolute fat mass (FM), fat percentage (FP), fat-free mass (FFM), and total body water (TBW). Fifty-four studies involving 2857 subjects were identified and conducted in 21 countries between 1987 and 2024. RF exerts a significant reduction in weight and BMI, starting within the second and third week of RF, peaking in the first week after RF, and gradually returning to the pre-Ramadan value in the weeks afterward. Meanwhile, WC, HC, and WHR were significantly alleviated within the last week of RF and the first week post-RF for HC. In body composition, RF elicits a significant but small reduction of absolute FM and FP within the third and fourth week of RF, while FFM and TBW were not affected. During Ramadan, anthropometric and body composition changes are transient and elicit only a short-term effect. Such leverages need to be maintained to achieve a long-term benefit of RF on the anthropometric and body composition of healthy adults.

Improving cultural humility in pharmacy education: A focus on diabetes management during religious fasting

BACKGROUND

Cultural humility is an increasingly important focus of healthcare education, aiming to equip students with the tools they need to provide care to diverse groups of people. There is a growing need for healthcare providers to understand Islamic religious practices that influence heath decision-making, especially religious fasting during Ramadan. However, there are limited efforts in pharmacy curriculums to address this. The objective of this project is to describe a cultural humility activity focusing on increasing students' confidence in managing patients' diabetes medications during religious fasting.

METHODS

A case-based activity was delivered within a pharmaceutical skills lab. Pre- and post-activity surveys assessed self-efficacy in student's confidence in communication, creating therapeutic plans, and identifying challenges and opportunities in the context of Ramadan fasting. Confidence was rated on a five-point Likert scale. Paired t-tests were used to compare mean confidence scores before and after the activity.

RESULTS

A total of 56 of 63 students completed the survey. The results showed improvements in confidence across all areas: initiating conversations about medication management (mean change +1.11 [0.20]; t = 5.475; P < .0001), developing therapeutic plans (mean change +1.29 [0.19]; t = 6.822; P < .0001), identifying challenges (mean change +1.02 [0.20]; t = 5.136; P < .0001), and recognizing opportunities (mean change +1.07 [0.20]; t = 5.318; P < .0001).

CONCLUSION

This study demonstrated a successful activity designed to increase cultural humility in future pharmacists for the purpose of delivering high quality healthcare to diverse patient groups. To address disparities in pharmacists' ability to deliver culturally mindful care to Muslim populations, additional activities should be designed incorporating this topic into curricula.

Fasting recovers age-related hypertension in the rats: reset of renal renin-angiotensin system components and klotho

BACKGROUND

The renal renin-angiotensin system (RAS) plays a vital part in the control of blood pressure and is known to be affected by aging. This study aimed to investigate the effects of intermittent fasting on age-related hypertension and the expression of local renal RAS components.

METHODS

The Wistar rats were categorized into three main age groups (young, middle aged, and elderly) and three dietary treatment models, including ad libitum feeding (AL), every other day fasting (EOD), and one day per week of fasting (FW). After three months, blood pressure (BP) was assessed. Some genes and proteins of the renal RAS system were measured by using Real time PCR and Western blot. α-klotho and Ang II proteins were assessed by ELISA method.

RESULTS

Old rats exhibited significantly increase in BP and Ang II (P < 0.001 vs. young rats) and a significant reduction in circulating levels of α-klotho and kidney AT2R protein (P < 0.001, P < 0.01, vs. young rats, respectively). Additionally, they respond to aging by increasing the AT1aR/AT2R proteins ratio (P < 0.05). Two model of feeding reduced BP in old rats and circulating Ang II in middle-aged and older rats. Moreover, by fasting, ACE2 protein expression was elevated in old rats. EOD fasting also significantly elevated the AT2 receptor protein and reduced the AT1aR/AT2R proteins ratio in the older rats (P < 0.001, P < 0.01, respectively).

CONCLUSION

Our findings suggest that fasting, particularly EOD, can attenuate age-related hypertension, partly through reset of the local renal RAS and increase of klotho protein expression.

Effect of fasting on cardiovascular risk factors among healthy adult Muslims attending primary care, Kano, Northern Nigerian

BACKGROUND

Cardiovascular diseases (CVD) are among the most prevalent and preventable chronic diseases in the 21st century The global burden of disease: 2004 update. The Report in Sections. A person's risk of developing CVD can be reduced by adopting healthy lifestyles, spiritual and religious practices The American Heart Association Life's Simple 7 in African Americans of the Jackson Heart Study. Fasting as a spiritual practice is not exempted from these benefits. Most world's religions recommend a period of fasting. The obligatory Ramadan fasting in Islam may provide an interesting opportunity to reduce food intake and increase physical activity. The main objective of this study is to investigate the effect of Ramadan fasting on cardiovascular risk factors on healthy adult Muslims.

METHOD

The study was pre/post-test single arm intervention conducted at the staff clinic of Family Medicine department, AKTH, and Northwest, Nigeria. Kano. The study recruited healthy adults 18yrs and above not on any medications that can affect metabolic profiles consecutively from two weeks before Ramadan fasting of 2018 and the last week of Ramadan of the same year. The questionnaire included information on sociodemographic, clinical parameters and Lifestyle pattern.

RESULT

Thirty healthy volunteers were included in this study, 25 males (83.3%) and 5 females (16.7%). The mean age was 38.23 ± 6.35(SD). Twenty-five participants were married (83.3%) with 4 singles (13.3%) and 1 divorcee (3.3%). During Ramadan fasting, weight reduced (67.90 ± 11.61 versus 66.53 ± 12.13 4th week of Ramadan p-value < 0.002) Body Mass Index (22.89 ± 3.63 versus 4th week of Ramadan 22.38 ± 3.64 p-value < 0.002) and systolic blood pressure (120.33 ± 19.91versus 4th week of Ramadan 115.33 ± 14.32 p-value 0.003) reduced significantly compared to baseline. The waist circumference, pulse rate, fasting blood sugar and cholesterol were reduced but were not statistically significant.

CONCLUSION

The result from this study suggested that Ramadan fasting may be a useful means of reducing burden of cardiovascular diseases, as the improved cardiovascular risk factors associated with fasting may translate into a significant health benefit.