The Effect of Ramadan Fasting on Non-alcoholic Fatty Liver Disease (NAFLD) Patients

Document Type: Research Paper

Authors

Department of Biochemistry and Nutrition Sciences. Mashhad University of Medical Sciences. Mashhad, Iran

Abstract

Introduction: The aim of this study was to compare biochemical tests, body composition and anthropometric parameters in Nonalcoholic Fatty Liver Disease (NAFLD) patients before and after Ramadan fasting. Methods: fifty NAFLD patients including 33 males and 17 females aged 18-65 year, were recruited. Subjects attended after diagnosis based on  ultrasound imaging, with at least 10 hour fasting, before and after Ramadan who were been fasting for at least 10 days. A fasting blood sample was obtained, blood pressure was measured and body mass index(BMI) and fat mass (FM) and fat free mass (FFM) were calculated. Lipid profile, fasting blood sugar (FBS),insulin, ALT and AST enzymes were analyzed on all blood samples. Result: There was a significant increase in HDL-c in females and  higher total plasma cholesterol, triglyceride (TG) and FBS in both gender while lower systolic blood pressure (SBP), diastolic blood pressure (DBP) and ALT  decreasing after Ramadan (P<0.05, t test), the change in BMI, LDL- c, FM and FFM after Ramadan were not significant (P>0.05, t test). Conclusion: This study shows significant effects on NAFLD patient  parameters during Ramadan fasting  such as decreasing in insulin, ALT enzyme, SBP and DBP and increasing in HDL-c  after an average of 27 d fasting, Result from this study suggested that Ramadan fasting may be useful to improve NAFLD, so further studies are needed in this area.

Keywords


  1. Sarraf-Zadegan N, Atashi M, Naderi GA, Baghai AM, Asgary S, Fatehifar MR, et al. The effect of fasting in Ramadan on the values and interrelations between biochemical, coagulation and hematological factors. Ann Saudi med. 2000;20(5-6):377-81.
  2. Bouhlel E, Salhi Z, Bouhlel H, Mdella S, Amamou A, Zaouali M, et al. Effect of Ramadan fasting on fuel oxidation during exercise in trained male rugby players. Diabetes metabo. 2006;32(6):617-24.
  3. Nelson W, Cadotte L, Halberg F. Circadian timing of single daily “meal” affects survival of mice. Proc Soc Exp Biol Med. 1973;144(3):766-9.
  4. Ahmed MH, Byrne CD. Modulation of sterol regulatory element binding proteins (SREBPs) as potential treatments for non-alcoholic fatty liver disease (NAFLD). Drug discov today. 2007;12(17):740-7.
  5. Choudhury J, Sanyal AJ. Clinical aspects of fatty liver disease. Semin Liver Dis; 2004;24(4):349-62.
  6. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2005;365(9468):1415-28.
  7. Fan J-G, Zhu J, Li X-J, Chen L, Li L, Dai F, et al. Prevalence of and risk factors for fatty liver in a general population of Shanghai, China. J Hepatol. 2005;43(3):508-14.
  8. Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37(4):917-23.
  9. Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, Lenzi M, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50(8):1844-50.
  10. Fan JG, Zhu J, Li XJ, Chen L, Lu YS, Li L, et al. Fatty liver and the metabolic syndrome among Shanghai adults. J Gastroenterol Hepatol. 2005;20(12):1825-32.
  11. Cohen JC, Horton JD, Hobbs HH. Human fatty liver disease: old questions and new insights. Science. 2011;332(6037):1519-23.
  12. Bugianesi E, Gastaldelli A, Vanni E, Gambino R, Cassader M, Baldi S, et al. Insulin resistance in non-diabetic patients with non-alcoholic fatty liver disease: sites and mechanisms. Diabetologia. 2005;48(4):634-42.
  13. Khaled MB, Belbraouet S. Ramadan fasting diet entailed a lipid metabolic disorder among type 2 diabetic obese women. Am J Applied Sci. 2009;6(3):471-477.
  14. Saleh SA, Elsharouni SA, 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. Mal J Nutr. 2005;11(2):143-50.
  15. 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(2):21-7.
  16. Momen HK, Elzouki ANY, Gatie J, El-Mansoury AM, Tashani A. Effect of Ramadan fasting on blood glucose and serum lipid profiles in Libyan diabetic patients. Journal of Science and its Applications. 2007;1(1):14-7.
  17. Tsai AC, Sandretto A, Chung Y-C. Dieting is more effective in reducing weight but exercise is more effective in reducing fat during the early phase of a weight-reducing program in healthy humans. Journal Nutr Biochem. 2003;14(9):541-9.
  18. Afrasiabi A, Hassanzadeh S, Sattarivand R, Mahboob S. Effects of Ramadan fasting on serum lipid profiles on 2 hyperlipidemic groups with or without diet pattern. Saudi Med J. 2003;24(1):23-6.
  19. Cahill Jr GF. Fuel metabolism in starvation. Annu Rev Nutr. 2006;26:1-22.
  20. Nematy M, Alinezhad-Namaghi M, Rashed MM, Mozhdehifard M, Sajjadi SS, Akhlaghi S, et al. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study. Nutr J. 2012;11:69.
  21. Lohman TG, Roche AF, Martorell R. Anthropometric Standardization Reference Manual. Human Kinetics Books, Champaign. 1988.
  22. 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 Monit. 2014;20:337-42.
  23. 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;7(10):e47615.
  24. Velayudhan M. Managing diabetes during the Muslim fasting month of Ramadan. Med J Malaysia. 2012;67(3):353-4.
  25. Shoukry MI. Effect of fasting in Ramadan on plasma lipoproteins and apoproteins. Saudi Med J. 1986;7(6):561-5.
  26. Gumaa KA, Mustafa KY, Mahmoud NA, Gader AMA. The effects of fasting in Ramadan. Br J Nutr. 1978;40(3):573-81.
  27. Markel A, Brook JG, Aviram M. Increased plasma triglycerides, cholesterol and apolipoprotein E during prolonged fasting in normal subjects. Postgrad Med J. 1985;61(715):395-400.
  28. Sorbris R, Petersson BG, Nilsson-Ehle P. Effects of weight reduction on plasma lipoproteins and adipose tissue metabolism in obese subjects. Eur J Clin Invest. 1981;11(6):491-8.
  29. Frost G, Pirani S. Meal frequency and nutritional intake during Ramadan: a pilot study. Hum Nutr Appl Nutr. 1987;41(1):47-50.
  30. Ziaee V, Razaei M, Ahmadinejad Z, Shaikh H, Yousefi R, Yarmohammadi L, et al. The changes of metabolic profile and weight during Ramadan fasting. Singapore Med J. 2006;47(5):409-14.
  31. Finegood DT, Bergman RN, Vranic M. Estimation of endogenous glucose production during hyperinsulinemic-euglycemic glucose clamps: comparison of unlabeled and labeled exogenous glucose infusates. Diabetes. 1987;36(8):914-24.
  32. Yasuhara M, Ohama T, Matsuki N, Saito H, Shiga J, Inoue K, et al. Induction of fatty liver by fasting in suncus. J Lipid Res. 1991;32(6):887-91.
  33. Elhazmi MAF, Alfaleh FZ, Almofleh IA. Effect of Ramadan fasting on the values of hematological and biochemical parameters. Saudi Med J. 1987;8(2):171-6.
  34. Maislos M, Khamaysi N, Assali A, Abou-Rabiah Y, Zvili I, Shany S. Marked increase in plasma high-density-lipoprotein cholesterol after prolonged fasting during Ramadan. Ame J Clin Nutr. 1993;57(5):640-2.
  35. Frick MH, Elo O, Haapa K, Heinonen OP, Heinsalmi P, Helo P, et al. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. N Engl J Med. 1987;317(20):1237-45.
  36. M'Guil M, Ragala MA, El Guessabi L, Fellat S, Chraibi A, Chebraoui L, et al. Is Ramadan Fasting Safe in Type 2 Diabetic Patients in View of the Lack of Significant Effect of Fasting on Clinical and Biochemical Parameters, Blood Pressure, and Glycemic Control?. Clin Exp Hypertens. 2008;30(5):339-57.
  37. Yarahmadi SH, Larijani B, Bastanhagh MH, Pajouhi M, Baradar JR, Zahedi F, et al. Metabolic and clinical effects of Ramadan fasting in patients with type II diabetes. J Coll Physicians Surg Pak. 2003;13(6):329-32.
  38. 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(2):302-7.
  39. Maughan RJ, Leiper JB, Bartagi Z, Zrifi R, Zerguini Y, Dvorak J. Effect of Ramadan fasting on some biochemical and haematological parameters in Tunisian youth soccer players undertaking their usual training and competition schedule. J Sports Sci. 2008;26(S3):S39-46.
  40. Unalacak M, Kara IH, Baltaci D, Erdem O, Bucaktepe PG. Effects of Ramadan fasting on biochemical and hematological parameters and cytokines in healthy and obese individuals. Metab Syndr Relat Disord. 2011;9(2):157-61.
  41. Furuncuoglu Y, Karaca E, Aras S, Yonem A. Metabolic, biochemical and psychiatric alterations in healthy subjects during Ramadan. Pak J Nutr. 2007;6(3):209-11.
  42. El-Mitwalli A, Zaher AA, El-Salammohamed MA, Elmenshawi E. The effect of Ramadan fasting on cerebral stroke: a prospective hospital-based study. Egypt J Neurol. 2009;46(1):51-56.
  43. Nobili V, Marcellini M, Devito R, Ciampalini P, Piemonte F, Comparcola D, et al. NAFLD in children: A prospective clinical pathological study and effect of lifestyle advice. Hepatology. 2006;44(2):458-65.
  44. Iraki L, Bogdan A, Hakkou F, Amrani N, Abkari A, Touitou Y. Ramadan Diet Restrictions Modify the Circadian Time Structure in Humans. A Study on Plasma Gastrin, Insulin, Glucose, and Calcium and on Gastric pH. J Clin Endocrinol Metab. 1997;82(4):1261-73.