Highlights
- •Intermittent fasting, as a dietary modification, helps in improving cardiometabolic risk factors.
- •Practicing diurnal intermittent fasting for at least 12 h for 28–30 consecutive days reduces TG, TC, LDL, VLDL, HR, DBP, and increases HDL.
- •Sex, fasting duration, and age of fasting people variably affect the impact of Ramadan fasting on cardiometabolic risk factors.
Abstract
Aims
This study aimed to evaluate the effects of Ramadan diurnal intermittent fasting (RDIF;
29–30 days) on cardiometabolic risk factors (CMRF) in healthy adults, and examine
the effect of various cofactors on the outcomes using sub-group meta-regression.
Data synthesis
We conducted a systematic review and meta-analysis to measure the effect sizes of
changes in CMRF in healthy adult Muslims observing RDIF. Ten scientific databases
(EBSCOhost, CINAHL, Cochrane, EMBASE, PubMed/MEDLINE, Scopus, Google Scholar, ProQuest
Medical, ScienceDirect, and Web of Science) were searched from the date of inception
(1950) to the end of November 2020. The CMRF searched and analyzed were total cholesterol
(TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density
lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C),
diastolic blood pressure (DBP), and heart rate (HR). We identified 91 studies (4431
adults aged 18–85 years) conducted between 1982 and 2020 in 23 countries distributed
over four continents. RDIF-induced effect sizes for CMRF were: TC (no. of studies
K = 77, number of subjects N = 3705, Hedge's g = −0.092, 95% confidence interval (CI):
−0.168, 0.016); TG (K = 74, N = 3591, Hedge's g = −0.127, 95% CI: −0.203, 0.051);
HDL-C (K = 68, N = 3528, Hedge's g = 0.138, 95% CI: 0.051, 0.224); LDL-C (K = 65,
N = 3354, Hedge's g = −0.115, 95% CI: −0.197, −0.034); VLDL-C (K = 13, N = 648, Hedge's
g = −0.252, 95% CI: −0.431, 0.073), DBP (K = 32, N = 1716, Hedge's g = −0.255, 95%
CI: −0.363, 0.147), and HR (K = 12, N = 674, Hedge's g = −0.082, 95% CI: −0.300, 0.136).
Meta-regression revealed that the age of fasting people was a significant moderator
of changes in both HDL-C (P = 0.02) and VLDL-C (P = 0.01). Male sex was the only significant moderator of changes in LDL-C (P = 0.055). Fasting time duration was the only significant moderator of HDL-C (P = 0.001) at the end of Ramadan.
Conclusions
RDIF positively impacts CMRF, which may confer short-term transient protection against
cardiovascular disease among healthy people.
Keywords
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Article info
Publication history
Published online: May 24, 2021
Accepted:
May 10,
2021
Received in revised form:
April 7,
2021
Received:
February 16,
2021
Handling Editor: A. SianiIdentification
Copyright
© 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
