Iso-caloric intake during Ramadan-fasting leads to improvement in HbA1c and beneficial changes in body composition among individuals with type 2 diabetes

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 807-838-Diabetes - Diagnosis, Complications & Outcomes
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-831
Ester Chai Kheng Yeoh*1, Sueziani Binte Zainudin2, Win Nie Loh1, Chin Lian Chua1, Sharon Fun1, Subramaniam Tavintharan1, Chee Fang Sum1 and Su Chi Lim1
1Khoo Teck Puat Hospital, Singapore, 2Singapore General Hospital, Singapore
BACKGROUND: Millions of Muslim patients with diabetes mellitus fast between dawn and sunset during Ramadan. Notwithstanding its world-wide practice, little is known about the metabolic impact of Ramadan-fasting. We aimed to study the changes in body composition and metabolic profile in this group of patients.

METHODS: We studied 29 South-East Asian Muslim patients with type 2 diabetes.  Study variables were weight change, body composition (using multi-frequency bio-impedance method, InBodyS20, Biospace, Seoul, South Korea), blood pressure(BP), glycated hemoglobin(HbA1c), fasting lipid profile and caloric intake assessment using FoodWorks® nutrient analysis software (Xyris Software, Professional version 6.0.2539, Brisbane, Australia). These data were obtained pre- and end-Ramadan.

RESULTS: Complete data were available for 23 subjects (80%) who fasted for ≥ 15 days; mean age (SD) was 57(11) years, 52% were males. HbA1c improved significantly [pre- 8.6(2.4) vs. end-Ramadan 8.0(2.3)%, P=0.017]. Despite no significant change in body weight [82.3(17.5) vs. 82.1(18.9)kg, P=0.83], there was significant reduction in body fat mass (BFM) [30.9(11.0) vs. 29.2(12.2)kg, P=0.013]. Multi-variate analysis suggests that the reduction in HbA1c was partly attributable to reduction in BFM (β=-0.196, P=0.034). As a group, visceral adiposity [visceral fat area (VFA)] did not change throughout Ramadan but when stratified by gender, there was significant reduction in VFA amongst females [137.6(24.5) to 132.5(25.7)cm2, P=0.017). These changes in HbA1c and adiposity occurred despite similar total caloric intake before and during Ramadan [1473.9(565.4) vs 1473.1(460.4)kcal, p=0.995], with no significant difference in caloric intake between gender. There was no significant difference before and during Ramadan in proportion of carbohydrate [55.4(6.3) vs 53.3(7.5)%, p=0.250] and protein [17.6(4.1) vs 17.3(5.4)%, p=0.792] of total energy intake, although there was an increase in proportion of fat intake [11.9(2.4) vs 13.0(11.7)%, p=0.040]. Overall, there was no significant difference in BP and lipid profile.

CONCLUSION: Ramadan-fasting appears to confer benefits on metabolic profile and body composition (without appreciable change in total caloric intake), especially among females. These benefits may be postulated to be due to changes in circadian rhythm and physical activity, inclusive of multiple prayer activity performed during Ramadan, which should be evaluated in future studies.

Nothing to Disclose: ECKY, SBZ, WNL, CLC, SF, ST, CFS, SCL

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Sources of Research Support: This study was supported by a grant from the Endocrine and Metabolic Society of Singapore (EMSS). Glucometers (Accu-Check Performa) for self-monitoring of blood glucose by study subjects were provided by Roche.