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The impact of Ramadan fasting on the metabolic syndrome severity in relation to ethnicity and sex: Results of a systematic review and meta-analysis

Published:September 10, 2022DOI:https://doi.org/10.1016/j.numecd.2022.09.001

      Abstract

      Aims

      The primary goal of this meta-analysis was to examine the changes in various components of metabolic syndrome (MetS) in healthy adults who observed Ramadan fasting (RF) before Ramadan (T1) and at the end of RF (T2). A secondary goal was to assess the impact of RF on MetS severity in various ethnic and sex groups using the MetS z-score.

      Data synthesis

      Using PRISMA2020, seven databases were searched for relevant studies published between January 1950 and March 2022. Data extraction involved high-density lipoprotein cholesterol (HDL), triglycerides (TG), fasting blood glucose (FBG), waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) for T1 and T2, respectively. The MetS z-score was computed according to international diabetes federation criteria. At T1, the pooled estimates of HDL, TG, FBG, WC, SBP, DBP, and MAP were 1.20 [1.13; 1.27] mmol/L, 1.32 [1.23; 1.42] mmol/L, 4.98 [4.82; 5.15] mmol/L, 87.21 [84.21; 90.21] Cm, 114.22 [101.45; 126.99] mmHg, 76.80 [70.12; 83.47] mmHg, and 89.27 [80.56; 97.98] mmHg, respectively. At T2, the pooled estimates of HDL, TG, FBG, WC, SBP, DBP, and MAP were 1.24 [1.18; 1.31] mmol/L, 1.24 [1.14; 1.34] mmol/L, 4.77 [4.55; 4.99] mmol/L, 85.73 [82.83; 88.64] Cm, 109.48 [97.20; 121.75] mmHg, 74.43 [68.01; 80.85] mmHg, and 86.11 [77.74; 94.48] mmHg, respectively. The MetS z-score showed improvement at T2 for all ethnic groups and both sexes by −0.22 [-0.24; −0.01].

      Conclusions

      The current meta-analysis suggests that the RF positively impact the MetS components and the overall MetS z-score.

      PROSPERO registration number

      ID CRD42022329297

      Open Science Framework Identifier

      DOI 10.17605/OSF.IO/U9H7T

      Keywords

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      References

        • Furqan Z.
        • Awaad R.
        • Kurdyak P.
        • Husain M.I.
        • Husain N.
        • Zaheer J.
        Considerations for clinicians treating Muslim patients with psychiatric disorders during Ramadan.
        Lancet Psychiatr. 2019; 6: 556-557
        • Patterson R.E.
        • Sears D.D.
        Metabolic effects of intermittent fasting.
        Annu Rev Nutr. 2017; 37: 371-393
        • Kul S.
        • Savas E.
        • Ozturk Z.A.
        • Karadag G.
        Does Ramadan fasting alter body weight and blood lipids and fasting blood glucose in a healthy population? A meta-analysis.
        J Relig Health. 2014; 53: 929-942
        • Mirmiran P.
        • Bahadoran Z.
        • Gaeini Z.
        • Moslehi N.
        • Azizi F.
        Effects of Ramadan intermittent fasting on lipid and lipoprotein parameters: an updated meta-analysis.
        Nutr Metabol Cardiovasc Dis. 2019; 29: 906-915
        • Faris M.A.E.
        • Jahrami H.A.
        • Alsibai J.
        • Obaideen A.A.
        Impact of Ramadan diurnal intermittent fasting on the metabolic syndrome components in healthy, non-athletic Muslim people aged over 15 years: a systematic review and meta-analysis.
        Br J Nutr. 2020; 123: 1-22
        • Fernando H.
        • Zibellini J.
        • Harris R.
        • Seimon R.
        • Sainsbury A.
        Effect of ramadan fasting on weight and body composition in healthy non-athlete adults: a systematic review and meta-analysis.
        Nutrients. 2019; 11: 478
        • Correia J.M.
        • Santos I.
        • Pezarat-Correia P.
        • Silva A.M.
        • Mendonca G.V.
        Effects of ramadan and non-ramadan intermittent fasting on body composition: a systematic review and meta-analysis.
        Front Nutr. 2021; 7
        • Al-Jafar R.
        • Zografou Themeli M.
        • Zaman S.
        • Akbar S.
        • Lhoste V.
        • Khamliche A.
        • et al.
        Effect of religious fasting in ramadan on blood pressure: results from LORANS (london ramadan study) and a meta-analysis.
        J Am Heart Assoc. 2021; 10e021560
        • Faris M.A.E.
        • Jahrami H.
        • BaHammam A.
        • Kalaji Z.
        • Madkour M.
        • Hassanein M.
        A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on glucometabolic markers in healthy subjects.
        Diabetes Res Clin Pract. 2020; 165108226
        • Jahrami H.A.
        • Faris M.E.
        • Janahi A I.
        • Janahi I.M.
        • Abdelrahim D.N.
        • Madkour M.I.
        • et al.
        Does four-week consecutive, dawn-to-sunset intermittent fasting during Ramadan affect cardiometabolic risk factors in healthy adults? A systematic review, meta-analysis, and meta-regression.
        Nutr Metabol Cardiovasc Dis. 2021; 31: 2273-2301
      1. Third report of the national cholesterol education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report.
        Circulation. 2002; 106: 3143-3421
        • Alberti K.G.M.M.
        • Zimmet P.
        • Shaw J.
        Metabolic syndrome—a new world-wide definition. A consensus statement from the international diabetes federation.
        Diabet Med. 2006; 23: 469-480
        • Balkau B.
        • Charles M.A.
        Comment on the provisional report from the WHO consultation. European group for the study of insulin resistance (EGIR).
        Diabet Med. 1999; 16: 442-443
        • Alberti K.G.
        • Zimmet P.Z.
        Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.
        Diabet Med. 1998; 15: 539-553
        • DeBoer M.D.
        • Filipp S.L.
        • Gurka M.J.
        Use of a metabolic syndrome severity Z score to track risk during treatment of prediabetes: an analysis of the diabetes prevention Program.
        Diabetes Care. 2018; 41: 2421-2430
        • Nishikawa-Pacher A.
        Research questions with PICO: a universal mnemonic. vol. 10. Publications, 2022: 21
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • Boutron I.
        • Hoffmann T.C.
        • Mulrow C.D.
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        Int J Surg. 2021; 88105906
        • Ouzzani M.
        • Hammady H.
        • Fedorowicz Z.
        • Elmagarmid A.
        Rayyan—a web and mobile app for systematic reviews.
        Syst Rev. 2016; 5: 210
        • Supak Smolcić V.
        Salami publication: definitions and examples.
        Biochem Med. 2013; 23: 237-241
        • Williams L.
        Clinical handbook for brunner & suddarth's textbook of medical-surgical nursing.
        Wolters Kluwer Health, 2017
        • Pedder H.
        • Sarri G.
        • Keeney E.
        • Nunes V.
        • Dias S.
        Data extraction for complex meta-analysis (DECiMAL) guide.
        Syst Rev. 2016; 5: 212
        • Rohatgi A.
        WebPlotDigitizer. Austin, Texas, USA.
        2017
        • Drevon D.
        • Fursa S.R.
        • Malcolm A.L.
        Intercoder reliability and validity of WebPlotDigitizer in extracting graphed data.
        Behav Modif. 2017; 41: 323-339
        • Altman D.
        Diagnostic tests.
        Statistics with confidence. 2000; : 116-118
        • Mallen C.
        • Peat G.
        • Croft P.
        Quality assessment of observational studies is not commonplace in systematic reviews.
        J Clin Epidemiol. 2006; 59: 765-769
        • Egger M.
        • Higgins J.P.
        • Smith G.D.
        Systematic reviews in health research: meta-analysis in context.
        John Wiley & Sons, 2022
        • Turin T.C.
        • Ahmed S.
        • Shommu N.S.
        • Afzal A.R.
        • Al Mamun M.
        • Qasqas M.
        • et al.
        Ramadan fasting is not usually associated with the risk of cardiovascular events: a systematic review and meta-analysis.
        J Family Community Med. 2016; 23: 73-81
        • Luchini C.
        • Stubbs B.
        • Solmi M.
        • Veronese N.
        Assessing the quality of studies in meta-analyses: advantages and limitations of the newcastle Ottawa scale.
        World J Meta-Anal. 2017; 5: 80-84
        • McGuinness L.A.
        • Higgins J.P.
        Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments.
        Res Synth Methods. 2021; 12: 55-61
        • Borenstein M.
        • Hedges L.V.
        • Higgins J.P.
        • Rothstein H.R.
        A basic introduction to fixed-effect and random-effects models for meta-analysis.
        Res Synth Methods. 2010; 1: 97-111
        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials revisited.
        Contemp Clin Trials. 2015; 45: 139-145
        • Jackson D.
        • Bowden J.
        Confidence intervals for the between-study variance in random-effects meta-analysis using generalised heterogeneity statistics: should we use unequal tails?.
        BMC Med Res Methodol. 2016; 16: 118
        • IntHout J.
        • Ioannidis J.P.A.
        • Rovers M.M.
        • Goeman J.J.
        Plea for routinely presenting prediction intervals in meta-analysis.
        BMJ Open. 2016; 6e010247
        • IntHout J.
        • Ioannidis J.P.A.
        • Borm G.F.
        • Goeman J.J.
        Small studies are more heterogeneous than large ones: a meta-meta-analysis.
        J Clin Epidemiol. 2015; 68: 860-869
        • Higgins J.P.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Higgins J.P.T.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Cochran W.G.
        The combination of estimates from different experiments.
        Biometrics. 1954; 10: 101-129
        • Cumpston M.
        • Li T.
        • Page M.J.
        • Chandler J.
        • Welch V.A.
        • Higgins J.P.
        • et al.
        Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. vol. 10. Cochrane Database Syst Rev., 2019
        • Lewis S.
        • Clarke M.
        Forest plots: trying to see the wood and the trees.
        Br Med J. 2001; 322: 1479-1480
        • Hedges L.V.
        • Olkin I.
        Statistical methods for meta-analysis.
        Academic press, 2014
        • Viechtbauer W.
        Conducting meta-analyses in R with the metafor package.
        J Stat Software. 2010; 36: 1-48
        • Viechtbauer W.
        • Cheung M.W.
        Outlier and influence diagnostics for meta-analysis.
        Res Synth Methods. 2010; 1: 112-125
        • Sterne J.A.
        • Sutton A.J.
        • Ioannidis J.P.
        • Terrin N.
        • Jones D.R.
        • Lau J.
        • et al.
        Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials.
        Br Med J. 2011; 343: d4002
        • Kendall M.
        • Gibbons J.D.
        Rank correlation methods edward arnold. A division of Hodder & Stoughton.
        A Charles Griffin title, London1990: 29-50
        • Egger M.
        • Davey Smith G.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        Br Med J. 1997; 315: 629-634
        • Duval S.
        • Tweedie R.
        A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis.
        J Am Stat Assoc. 2000; 95: 89-98
        • Van Houwelingen H.C.
        • Arends L.R.
        • Stijnen T.
        Advanced methods in meta-analysis: multivariate approach and meta-regression.
        Stat Med. 2002; 21: 589-624
        • da Costa B.R.
        • Rutjes A.W.S.
        • Johnston B.C.
        • Reichenbach S.
        • Nüesch E.
        • Tonia T.
        • et al.
        Methods to convert continuous outcomes into odds ratios of treatment response and numbers needed to treat: meta-epidemiological study.
        Int J Epidemiol. 2012; 41: 1445-1459
        • Team R.C.
        R foundation for statistical computing Vienna, Austria. vol. 3. 2013
        • Balduzzi S.
        • Rücker G.
        • Schwarzer G.
        How to perform a meta-analysis with R: a practical tutorial.
        Evid Base Ment Health. 2019; 22: 153-160
        • Haddaway N.
        • McGuinness L.
        • Pritchard C.
        PRISMA2020: R package and ShinyApp for producing PRISMA 2020 compliant flow diagrams.
        2021
        • AbdulKareem N.G.
        • Khalil N.S.
        • Jasim A.E.
        • Alkabban M.
        Some biochemical changes during summer islamic fasting in diseased patients in comparison with normal.
        Am J Med Sci. 2017; 5: 27-34
        • Abubakar M.
        • Hassan A.
        • Saddique M.U.
        • Enabi J.M.K.
        Comparison of sugar level and blood lipids while fasting in 1st and 4th week of holy month of ramadhan at services hospital, lahore.
        Indo American Journal of Pharmaceutical Sciences. 2018; 5: 5693-5697
        • Adlouni A.
        • Ghalim N.
        • Benslimane A.
        • Lecerf J.M.
        • Saïle R.
        Fasting during Ramadan induces a marked increase in high-density lipoprotein cholesterol and decrease in low-density lipoprotein cholesterol.
        Ann Nutr Metab. 1997; 41: 242-249
        • Agoumi A.
        • Martinez Martinez F.
        • Garcia de la Serrana H.L.
        The assessment of the follow-up of muslim population during the period of ramadan.
        Nutrition & Food Sciences, 2013
        • Akaberi A.
        • Golshan A.
        • Moojdekanloo M.
        • Hashemian M.
        Does fasting in Ramadan ameliorate Lipid profile? A prospective observational study.
        Pakistan J Med Sci. 2014; 30: 708-711
        • Akanji A.
        • Mojiminiyi O.
        • Abdella N.
        Beneficial changes in serum apo A-1 and its ratio to apo B and HDL in stable hyperlipidaemic subjects after Ramadan fasting in Kuwait.
        Eur J Clin Nutr. 2000; 54: 508-513
        • Akhtar P.
        • Kazmi A.
        • Sharma T.
        • Sharma A.
        Effects of Ramadan fasting on serum lipid profile.
        J Fam Med Prim Care. 2020; 9: 2337
        • Akhtaruzzaman M.
        • Hoque N.
        • Choudhury M.
        • Uddin M.J.
        • Parvin T.
        Effect of ramadan fasting on serum lipid profile of Bangladeshi female volunteers.
        Bangladesh Journal of Medical Biochemistry. 2014; 7: 47-51
        • Akkoca M.
        • Metin Z.
        • Topaloglu O.
        • Tokgoz S.
        • Cihan G.
        • San I.
        An evaluation of the effects of Ramadan fasting on anthropometric, metabolic and endocrine parameters.
        2018
        • Aksungar F.B.
        • Eren A.
        • Ure S.
        • Teskin O.
        • Ates G.
        Effects of intermittent fasting on serum lipid levels, coagulation status and plasma homocysteine levels.
        Ann Nutr Metab. 2005; 49
        • Aksungar F.B.
        • Topkaya A.E.
        • Akyildiz M.
        Interleukin-6, C-reactive protein and biochemical parameters during prolonged intermittent fasting.
        Ann Nutr Metab. 2007; 51: 88-95
        • Alam I.
        • Gul R.
        • Chong J.
        • Tan C.T.Y.
        • Chin H.X.
        • Wong G.
        • et al.
        Recurrent circadian fasting (RCF) improves blood pressure, biomarkers of cardiometabolic risk and regulates inflammation in men.
        J Transl Med. 2019; 17: 1-29
        • Al-barha N.S.
        • Aljaloud K.S.
        The effect of ramadan fasting on body composition and metabolic syndrome in apparently healthy men.
        Am J Men's Health. 2018; 1557988318816925
        • AlNahari H.
        • Kouja H.
        Impact of Ramadan fasting on some biochemical aspects in healthy subjects.
        Int J Med Health Sci Res. 2014; 1: 144-154
        • Al-Numair N.
        Body weight and some biochemical changes associated with Ramadan fasting in healthy Saudi men.
        J Med Sci. 2006; 6: 112-116
        • Al-Rawi N.
        • Madkour M.
        • Jahrami H.
        • Salahat D.
        • Alhasan F.
        • BaHammam A.
        • et al.
        Effect of diurnal intermittent fasting during Ramadan on ghrelin, leptin, melatonin, and cortisol levels among overweight and obese subjects: a prospective observational study.
        PLoS One. 2020; 15e0237922
        • SaA Alsubheen
        • Ismail M.
        • Baker A.
        • Blair J.
        • Adebayo A.
        • Kelly L.
        • et al.
        The effects of diurnal Ramadan fasting on energy expenditure and substrate oxidation in healthy men.
        Br J Nutr. 2017; 118: 1023-1030
        • Alzoughool F.
        • Hourani H.
        • Atoum M.
        • Abdelqader R.
        • Alanagreh La
        Irisin, leptin and adiponectin levels are reduced significantly during fasting.
        Mediterr J Nutr Metabol. 2019; 12: 1-8
        • Asgary S.
        • Aghaei F.
        • Naderi G.A.
        • Kelishadi R.
        • Gharipour M.
        • Azali S.
        Effects of Ramadan fasting on lipid peroxidation, serum lipoproteins and fasting blood sugar.
        Medical Journal of Islamic World Academy of Sciences. 2000; 13: 35-38
        • Aybak M.
        • Türkoğlu A.
        • Şermet A.
        • Denli O.
        Effect of Ramadan fasting on platelet aggregation in healthy male subjects.
        Eur J Appl Physiol Occup Physiol. 1996; 73: 552-556
        • Azizi F.
        • Rasouli H.
        Serum glucose, bilirubin, calcium, phosphorus, protein and albumin concentrations during Ramadan.
        Med J Islam Repub Iran. 1987; 1: 38-41
        • Babaei A.A.
        • Ghasemi M.
        • Ghouchani H.T.
        • Yousefi A.
        Evaluation of the effects of Islamic fasting on the biochemical markers of health.
        Journal of Fasting and Health. 2016; 4: 88-91
        • BaHammam A.S.
        • Pandi-Perumal S.R.
        • Alzoghaibi M.A.
        The effect of Ramadan intermittent fasting on lipid peroxidation in healthy young men while controlling for diet and sleep: a pilot study.
        Ann Thorac Med. 2016; 11: 43
        • Bahijri S.
        • Borai A.
        • Ajabnoor G.
        • Khaliq A.A.
        • AlQassas I.
        • Al-Shehri D.
        • et al.
        Relative metabolic stability, but disrupted circadian cortisol secretion during the fasting month of Ramadan.
        PLoS One. 2013; 8e60917
        • Bakki B.
        • Goni B.W.
        • HarunaYusuph F.B.
        Ramadan fasting: effect on the metabolic profile of healthy medical students in north east, Nigeria.
        Saudi Journal of Medicine. 2017; –2: 133-137
        • Barkia A.
        • Mohamed K.
        • Smaoui M.
        • Zouari N.
        • Hammami M.
        • Nasri M.
        Change of diet, plasma lipids, lipoproteins, and fatty acids during Ramadan: a controversial association of the considered Ramadan model with atherosclerosis risk.
        Journal of health, population, nutrition & Metabolism. 2011; 29: 486
        • Ara T.
        • Jahan N.
        • Sultana N.
        • Choudhury R.
        • Yeasmin T.
        Effect of ramadan fasting on total cholesterol (TC) low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) in healthy adult male.
        J Bangladesh Soc Physiol. 2015; 10: 46-50
        • Bilto Y.Y.
        Effects of Ramadan fasting on body weight and the biochemical and haematological parameters of the blood.
        Arab Gulf J Sci Res. 1998; 16: 1-14
        • Celik A.
        • Saricicek E.
        • Saricicek V.
        • Sahin E.
        • Ozdemir G.
        • Bozkurt S.
        • et al.
        Effect of Ramadan fasting on serum concentration of apelin-13 and new obesity indices in healthy adult men.
        Med Sci Mon Int Med J Exp Clin Res: international medical journal of experimental and clinical research. 2014; 20: 337
        • Dasgupta A.
        • Garg S.
        • Pal B.
        • Maharana S.P.
        • Bandhopadhayay L.
        • Mallick N.
        Is ramadan fasting cardio-protective? A study in a village of West Bengal.
        Indian J Community Health. 2017; 29
        • Dewanti L.
        • Watanabe C.
        • Ohtsuka R.
        Unexpected changes in blood pressure and hematological parameters among fasting and nonfasting workers during Ramadan in Indonesia.
        Eur J Clin Nutr. 2006; 60: 877
        • El Ati J.
        • Beji C.
        • Danguir J.
        Increased fat oxidation during Ramadan fasting in healthy women: an adaptative mechanism for body-weight maintenance.
        Am J Clin Nutr. 1995; 62: 302-307
        • Esmaeilzadeh F.
        • Van De Borne P.
        Does intermittent fasting improve microvascular endothelial function in healthy middle-aged subjects?.
        Biol Med. 2016; 8: 1
        • Fakhrzadeh H.
        • Larijani B.
        • Sanjari M.
        • Baradar-Jalili R.
        • Amini M.
        Effect of Ramadan fasting on clinical and biochemical parameters in healthy adults.
        Ann Saudi Med. 2003; 23: 223
        • Fararjeh M.A.
        • Al-Jamal A.
        • Faris M.
        • Al-Kurd R.
        • Khalil M.
        • Al-Bustanji Y.
        Effect of intermittent fasting on lipid profile and hematological parameters in healthy volunteers in Jordan.
        Univ J Med Dent. 2012; 1: 5-9
        • Faris M.
        • Hussein R.N.
        • Al-Kurd R.A.
        • Al-Fararjeh M.A.
        • Bustanji Y.K.
        • Mohammad M.K.
        Impact of Ramadan intermittent fasting on oxidative stress measured by urinary 15-isoprostane.
        Journal of Nutrition and Metabolism. 2012; 2012
        • Faris M.A.E.
        • Madkour M.I.
        • Obaideen A.K.
        • Dalah E.Z.
        • Hasan H.A.
        • Radwan H.
        • et al.
        Effect of Ramadan diurnal fasting on visceral adiposity and serum adipokines in overweight and obese individuals.
        Diabetes Res Clin Pract. 2019; 153: 166-175
        • Farshidfar G.
        • Yousfi H.
        • Vakili M.
        • Asadi Noughabi F.
        The effect of Ramadan fasting on hemoglobin, hematocrit and blood biochemical parameters.
        J Res Health Sci. 2006; 6: 21-27
        • Fedail S.S.
        • Murphy D.
        • Salih S.
        • Bolton C.
        • Harvey R.
        Changes in certain blood constituents during Ramadan.
        AJCN (Am J Clin Nutr). 1982; 36: 350-353
        • Feizollahzadeh S.
        • Rasuli J.
        • Kheirouri S.
        • Alizadeh M.
        Augmented plasma adiponectin after prolonged fasting during ramadan in men.
        Health Promot Perspect. 2014; 4: 77
        • Furuncuoglu Y.
        • Karaca E.
        • Aras S.
        • Yönem A.
        Metabolic, biochemical and psychiatric alterations in healthy subjects during Ramadan.
        Pakistan J Nutr. 2007; 6: 209-211
        • Ganjali N.
        • Mozaffari-Khosravi H.
        • Afkhami Ardakani M.
        • Shahraki M.
        • Fallahzadeh H.
        Effect of islamic fasting on glucose, lipid profiles and Body Mass Index, adiponectin and leptin in obese individuals.
        Journal of Nutrition, Fasting and Health. 2016; 4: 57-63
        • Haouari-Oukerro F.
        • Ben-Attia M.
        • Kaâbachi N.
        • Haouari M.
        Ramadan fasting influences on food intake consumption, sleep schedule, body weight and some plasma parameters in healthy fasting volunteers.
        Afr J Biotechnol. 2013; 12
        • Hassan M.B.
        • Isawumi M.A.
        Effects of fasting on intraocular pressure in a black population.
        Middle East Afr J Ophthalmol. 2014; 21: 328
        • Hejazi K.
        • Darzabi T.
        Effects of ramadan fasting on apolipoproteins A and B and atherogenic index in fasting and non-fasting students.
        Physical Treatments: Specific Physical Therapy Journal. 2020; : 59-68
        • Hosseini S.R.A.
        • Sardar M.A.
        • Hejazi K.
        • Farahati S.
        The effect of Ramadan fasting and physical activity on body composition, serum osmolarity levels and some parameters of electrolytes in females.
        Int J Endocrinol Metabol. 2013; 11: 88
        • Hosseini S.R.A.
        • Sardar M.A.
        • Hejazi K.
        • Farahati S.
        The effects of aerobic exercise during ramadan on the levels of leptin and adiponectin in overweight women.
        Journal of Fasting Health. 2015; 3: 35-42
        • Al Hourani H.M.
        • Atoum M.F.
        • Akel S.
        • Hijjawi N.
        • Awawdeh S.
        Effects of Ramadan fasting on some haematological and biochemical parameters.
        Jordan J Biol Sci. 2009; 2: 103-108
        • Ibrahim W.H.
        • Habib H.M.
        • Jarrar A.H.
        • Al Baz S.A.
        Effect of Ramadan fasting on markers of oxidative stress and serum biochemical markers of cellular damage in healthy subjects.
        Ann Nutr Metabol. 2008; 53
      2. Ismail WI, Haron N. Effect of ramadan fasting on serum lipid profile among healthy students in UiTM. International conference on biological, chemical and environmental Sciences2014. p. 51-53.

        • Kassab S.
        • Abdul-Ghaffar T.
        • Nagalla D.S.
        • Sachdeva U.
        • Nayar U.
        Serum leptin and insulin levels during chronic diurnal fasting.
        Asia Pac J Clin Nutr. 2003; 12
        • Kassab S.
        • Abdul-Ghaffar T.
        • Nagalla D.S.
        • Sachdeva U.
        • Nayar U.
        Interactions between leptin, neuropeptide-Y and insulin with chronic diurnal fasting during Ramadan.
        Ann Saudi Med. 2004; 24: 345
        • Khan N.
        • Rasheed A.
        • Ahmed H.
        • Aslam F.
        • Kanwal F.
        Effect of Ramadan fasting on glucose level, lipid profile, HbA1c and uric acid among medical students in Karachi, Pakistan.
        EMHJ-Eastern Mediterranean Health Journal. 2017; 23: 274-279
        • Khan N.
        • Rafi S.M.T.
        • Siddiqui S.
        • Shakeel S.
        • Rahman H-u
        • Hasan W.
        Effect of Ramadan on glucose levels, serum lipid profile, and blood pressure among fasting and nonfasting medical students in a public university of Karachi.
        Ibnosina J Med Biomed Sci. 2020; 12: 177
        • Kiyani M.M.
        • Memon A.R.
        • Amjad M.I.
        • Ameer M.R.
        • Sadiq M.
        • Mahmood T.
        Study of human biochemical parameters during and after ramadan.
        J Relig Health. 2017; 56: 55-62
        • Lamine F.
        • Bouguerra R.
        • Jabrane J.
        • Marrakchi Z.
        • Ben M.R.
        • Ben C.S.
        • et al.
        Food intake and high density lipoprotein cholesterol levels changes during ramadan fasting in healthy young subjects.
        La Tunisie Médicale. 2006; 84: 647-650
        • Lamri-Senhadji M.
        • El Kebir B.
        • Belleville J.
        • Bouchenak MJSmj
        Assessment of dietary consumption and time-course of changes in serum lipids and lipoproteins before, during and after Ramadan in young Algerian adults.
        SMJ (Singap Med J). 2009; 50: 288
        • Larijani B.
        • Zahedi F.
        • Sanjari M.
        • Amini M.
        • Jalili R.
        • Adibi H.
        • et al.
        The effect of Ramadan fasting on fasting serum glucose in healthy adults.
        Med J Malaysia. 2003; 58: 678-680
        • López-Bueno M.
        • González-Jiménez E.
        • Navarro-Prado S.
        • Montero-Alonso M.A.
        • Schmidt-RioValle J.
        Influence of age and religious fasting on the body composition of Muslim women living in a westernized context.
        Nutr Hosp. 2015; : 31
        • Lubis F.
        • Pase M.A.
        Effects of ramadan fasting on lipid profiles and interleukin-6 in obese patients: effects of ramadan fasting on lipid profiles and interleukin-6 in obese patients.
        Journal of Endocrinology, Tropical Medicine, and Infectiouse Disease (JETROMI). 2020; 2: 107-117
        • Madkour M.I.
        • Obaideen A.K.
        • Dalah E.Z.
        • Hasan H.A.
        • Radwan H.
        • Jahrami H.A.
        • et al.
        Effect of Ramadan diurnal fasting on visceral adiposity and serum adipokines in overweight and obese individuals.
        Diabetes Res Clin Pract. 2019; 153: 166-175
        • Mahboob S.
        • Sattarivand R.
        • Nouri M.
        • Arefhosseini S.
        Effect of Ramadan fasting on serum lipid profiles in normal and hyperlipidemic subjects.
        Saudi Med J. 1999; 20: 947-950
        • Maislos M.
        • Abou-Rabiah Y.
        • Zuili I.
        • Iordash S.
        • Shany S.
        Gorging and plasma HDL-cholesterol—the Ramadan model.
        Eur J Clin Nutr. 1998; 52: 127-130
        • Malekmakan L.
        • Sayadi M.
        • Pakfetrat M.
        • Moosavi B.
        • Mousavinezhad H.
        The effect of fasting on anthropometric parameters and blood pressure levels: a report from southern Iran.
        International Cardiovascular Research Journal. 2017; 11
        • Mansi K.
        • Amneh M.
        Impact of Ramadan fasting on metabolism and on serum levels of some hormones among healthy Jordanian students.
        J Med Sci. 2007; 7: 755-761
        • Mansoor A.J.
        • Hussein Y.K.
        • Jumaa A.M.
        • Marbut M.M.
        Effect of Ramadan fasting on pro-inflammatory cytokines in normal healthy non obese female medical students in college of medicineTikrit University.
        Annals of Tropical Medicine and Health. 2020; 23: 42-45
        • McNeil J.
        • Mamlouk M.M.
        • Duval K.
        • Schwartz A.
        • Nardo Junior N.
        • Doucet É.
        Alterations in metabolic profile occur in normal-weight and obese men during the Ramadan fast despite no changes in anthropometry.
        Journal of Obesity. 2014; 2014
        • Mohajeri F.A.
        • Ahmadi Z.
        • Hassanshahi G.
        • Mohajeri E.A.
        • Ravari A.
        • Ghalebi S.R.
        Dose Ramadan fasting affects inflammatory responses: evidences for modulatory roles of this unique nutritional status via chemokine network.
        Iranian Journal of Basic Medical Sciences. 2013; 16: 1217
        • Mohammadzade F.
        • Vakili M.
        • Seyediniaki A.
        • Amirkhanloo S.
        • Farajolahi M.
        • Akbari H.
        Effect of prolonged intermittent fasting in Ramadan on biochemical and inflammatory parameters of healthy men.
        J Clin Basic Res (JCBR). 2017; 1: 38-46
        • Nachvak S.M.
        • Pasdar Y.
        • Pirsaheb S.
        • Darbandi M.
        • Niazi P.
        • Mostafai R.
        • et al.
        Effects of Ramadan on food intake, glucose homeostasis, lipid profiles and body composition composition.
        Eur J Clin Nutr. 2018; : 1
        • Norouzy A.
        • Salehi M.
        • Arabi H.
        • Shiva F.
        • Mehrnoosh S.
        • Mohajeri S.M.R.
        • et al.
        Effects of ramadan fasting on anthropometric indices.
        in: FASTING and SUSTAINABLE HEALTH CONFERENCE. 2010: 65
        • Norouzy A.
        • Salehi M.
        • Philippou E.
        • Arabi H.
        • Shiva F.
        • Mehrnoosh S.
        • et al.
        Effect of fasting in R amadan on body composition and nutritional intake: a prospective study.
        J Hum Nutr Diet. 2013; 26: 97-104
        • Norouzy A.
        • Hasanzade Daloee M.
        • Khoshnasab A.H.
        • Khoshnasab A.
        • Farrokhi J.
        • Nematy M.
        • et al.
        Trend of blood pressure in hypertensive and normotensive volunteers during Ramadan fasting.
        Blood Pres Monit. 2017; 22: 253-257
        • Ongsara S.
        • Boonpol S.
        • Prompalad N.
        • Jeenduang N.
        The effect of Ramadan fasting on biochemical parameters in healthy Thai subjects.
        J Clin Diagn Res: J Clin Diagn Res. 2017; 11: BC14
        • Pathan M.
        • Patil R.
        Effect of Ramadan fasting on body weight and lipid profile.
        Biomedical and Pharmacology Journal. 2015; 3: 167-170
        • Pirsaheb S.
        • Pasdar Y.
        • Navabi S.J.
        • Rezaei M.
        • Darbandi M.
        • Niazi P.
        Fasting consequences during Ramadan on lipid profile and dietary patterns.
        Journal of Nutrition, Fasting and Health. 2013; 1: 6-12
        • Prasetya G.
        • Sapwarobol S.
        Intermittent fasting during ramadan improves insulin sensitivity and anthropometric parameters in healthy young muslim men.
        Am J Lifestyle Med. 2018; 1559827618815430
        • Qujeq D.
        • Bijani K.
        • Kalavi K.
        • Mohiti J.
        • Aliakbarpour H.
        Effects of Ramadan fasting on serum low-density and high-density lipoprotein-cholesterol concentrations.
        Ann Saudi Med. 2002; 22: 297-299
        • Rabiee S.
        • Afghari N.
        • Rastmanesh R.
        Short-term and mid-term effects of fasting and downset meal pattern on lipid profile in Iranian fasted women.
        J Relig Health. 2014; 53: 654-657
        • Rahbar A.R.
        • Safavi E.
        • Rooholamini M.
        • Jaafari F.
        • Darvishi S.
        • Rahbar A.
        Effects of intermittent fasting during ramadan on insulin-like growth factor-1, interleukin 2, and lipid profle in healthy Muslims.
        Int J Prev Med. 2019; 10: 2-6https://doi.org/10.4103/ijpvm.IJPVM_252_17
        • Rahman M.
        • Rashid M.
        • Basher S.
        • Sultana S.
        • Nomani M.
        Improved serum HDL cholesterol profile among Bangladeshi male students during Ramadan fasting.
        2004
        • Ramadan J.
        • Practice
        Does fasting during Ramadan alter body composition, blood constituents and physical performance?.
        Med Princ Pract. 2002; 11: 41-46
        • Rohin M.A.K.
        • Rozano N.
        • Abd Hadi N.
        • Nor M.
        • Nasir M.
        • Abdullah S.
        • et al.
        Anthropometry and body composition status during Ramadan among higher institution learning centre staffs with different body weight status.
        Sci World J. 2013; 2013
        • Roy A.S.
        • Bandyopadhyay A.
        Effect of ramadan intermittent fasting on haematological parameters, lipid profile and renal markers in young muslim males of Kolkata, India.
        Indian J Physiol Pharmacol. 2017; 61: 361-367
        • Salahuddin M.
        • Masood-ul-Hassan J.
        Effects of Ramadan fasting on some physiological and biochemical parameters in healthy and hypertensive subjects in Aurangabad district of Maharashtra, India.
        Journal of Fasting and Health. 2014; 2: 7-13
        • Saleh S.A.
        • Elsharouni S.A.
        • Cherian B.
        • Mourou M.
        Effects of Ramadan fasting on waist circumference, blood pressure, lipid profile, and blood sugar on a sample of healthy Kuwaiti men and women.
        Malaysian Journal of Nutrition. 2005; 11: 143-150
        • Salehi M.
        • Neghab M.
        Effects of fasting and a medium calorie balanced diet during the holy month Ramadan on weight, BMI and some blood parameters of overweight males.
        Pakistan J Biol Sci. 2007; 10: 968-971
        • Sanchetee P.
        • Sanchetee P.
        • Garg M.
        Effect of jain fasting on anthropometric, clinical and biochemical parameters.
        Indian journal of endocrinology and metabolism. 2020; 24: 187
        • Sarraf-Zadegan N.
        • Atashi M.
        • Naderi G.A.
        • Baghai A.M.
        • Asgary S.
        • Fatehifar M.R.
        • et al.
        And interrelations between biochemical, coagulation.
        Ann Saudi Med. 2000; 20: 377-381
        • Sayedda K.
        • Kamal S.
        • Ahmed Q.S.
        Effect of Ramadan fasting on anthropometric parameters, blood pressure, creatine phosphokinase activity, serum calcium and phosphorus in healthy students of Shri Ram Murti smarak institute of medical sciences, Bareilly-UP.
        Natl J Physiol Pharm Pharmacol. 2013; 3: 48
        • Sezen Y.
        • Altiparmak I.H.
        • Erkus M.E.
        • Kocarslan A.
        • Kaya Z.
        • Gunebakmaz O.
        • et al.
        Effects of Ramadan fasting on body composition and arterial stiffness.
        JPMA (J Pak Med Assoc). 2016; 66: 1522-1527
        • Shariatpanahi Z.V.
        • Shariatpanahi M.V.
        • Shahbazi S.
        • Hossaini A.
        • Abadi A.
        Effect of Ramadan fasting on some indices of insulin resistance and components of the metabolic syndrome in healthy male adults.
        Br J Nutr. 2008; 100: 147-151
        • Shehab A.
        • Abdulle A.
        • El Issa A.
        • Al Suwaidi J.
        • Nagelkerke N.
        Favorable changes in lipid profile: the effects of fasting after Ramadan.
        PLoS One. 2012; 7e47615
        • Sijavandi M.S.A.
        • Shahsavan F.
        • Askarizadeh F.
        • Nematy M.
        • Heravian J.
        • Mahmodi Z.
        • et al.
        Effects of ramadan fasting on blood pressure and lipid profile.
        cardiovascular risk factors. 2015; 11: 14
        • Sülü B.
        • Öztürk B.
        • Güven A.
        • Kilic K.
        The effect of long-term controlled fasting (the Ramadan model) on body mass index, blood biochemistry and oxidative stress factors.
        Turkiye Klinikleri J Med Sci. 2010; 30: 855-863
        • Suriani I.
        • Shamsuddin K.
        • Latif K.A.
        • Saad H.A.
        The effect of the Malaysian Food Guideline guidance on a group of overweight and obese women during Ramadan.
        Saudi Med J. 2015; 36: 40
        • Ünalacak M.
        • Kara I.H.
        • Baltaci D.
        • Erdem Ö.
        • Bucaktepe P.G.E.
        Effects of Ramadan fasting on biochemical and hematological parameters and cytokines in healthy and obese individuals.
        Metab Syndr Relat Disord. 2011; 9: 157-161
        • Urooj A.
        • Pai Kotebagilu N.
        • Shivanna L.M.
        • Anandan S.
        • Thantry A.N.
        • Siraj S.F.
        Effect of ramadan fasting on body composition, biochemical profile, and antioxidant status in a sample of healthy individuals.
        Int J Endocrinol Metabol. 2020; 18
        • Yucel A.
        • Degirmenci B.
        • Acar M.
        • Albayrak R.
        • Haktanir A.
        The effect of fasting month of Ramadan on the abdominal fat distribution: assessment by computed tomography.
        Tohoku J Exp Med. 2004; 204: 179-187
        • Mohammed Z.J.
        The influence of Ramadan fasting on some hematological and biochemical parameters in healthy adult males.
        nursing national Iraqi specility. 2011; 24: 1-12
        • Ziaee V.
        • Razaei M.
        • Ahmadinejad Z.
        • Shaikh H.
        • Yousefi R.
        • Yarmohammadi L.
        • et al.
        The changes of metabolic profile and weight during Ramadan fasting.
        SMJ (Singap Med J). 2006; 47
        • Wannamethee S.G.
        • Shaper A.G.
        • Lennon L.
        • Morris R.W.
        Metabolic syndrome vs Framingham Risk Score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus.
        Arch Intern Med. 2005; 165: 2644-2650
        • Wannamethee S.G.
        The metabolic syndrome and cardiovascular risk in the British Regional Heart Study.
        Int J Obes. 2008; 32: S25-S29
        • Cheţa D.M.
        The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes: response to Kahn et al.
        Diabetes Care. 2006; 29: 176-177
        • DeBoer M.D.
        • Gurka M.J.
        • Golden S.H.
        • Musani S.K.
        • Sims M.
        • Vishnu A.
        • et al.
        Independent associations between metabolic syndrome severity and future coronary heart disease by sex and race.
        J Am Coll Cardiol. 2017; 69: 1204-1205
        • Lee A.M.
        • Gurka M.J.
        • DeBoer M.D.
        A metabolic syndrome severity score to estimate risk in adolescents and adults: current evidence and future potential.
        Expert Rev Cardiovasc Ther. 2016; 14: 411-413