The Impact of Ramadan on the Lifestyle and Dietary Patterns in a Population in Najran, Saudi Arabia

Ramadan is the holy month for Muslims where adults fast from dawn to dusk, refraining from consumption of food and fluids from dawn till dusk. This month can have a major impact on the lifestyle and health of people. Very little is known about the impact of Ramadan on lifestyle and dietary habits of people living in Najran, which is a major city in the Southern region of the Kingdom of Saudi Arabia (KSA). The aim of the current interdisciplinary study was to assess dietary pattern, lifestyle habits, some biochemical changes (among fasting Type 2 diabetic patients) and the contents of essential and toxic elements in some foods commonly consumed during Ramadan. A validated questionnaire was used to obtain information on dietary and lifestyle habits during Ramadan for 316 students, staff and visitors at Najran University Hospital (NUH). The impact of Ramadan on glycated haemoglobin (HbA1c), lipid levels, body weight and blood pressure of a group of Type 2 diabetic patients (n=289) who fasted during Ramadan was monitored. Blood samples were collected twice, one month before Ramadan and one month after Ramadan. The study participants also completed a separate questionnaire containing questions related to their lifestyle and dietary habits. The four most commonly consumed foods during Ramadan were purchased from Najran city markets. These were then analysed to determine the content of essential (Se, Mn, Zn, Cu) and toxic elements (As, Cd, Cr, Pb) using inductively coupled plasma-mass spectrometry (ICP-MS). The study participants reported an increase in the consumption of sweets and sugary drinks (224 participants/70.1%), rice (185 participants/85.5%) and red meat (159 participants/50.3%). However, a decrease in the consumption of fish (255 participants/80.7%), fruits (230 participants/72.8%) and vegetables (196 participants/62.0%) was seen. The majority of the participants reported no change in their weight after Ramadan. However, they reported a decrease in physical activity and smoking. The vast majority of the study participants reported an increase in sleeping time during Ramadan. For Type 2 diabetic patients, the mean percentage of HbA1c before (9.85±2.37%) and after (7.65±1.70%) Ramadan, showed a significant decrease in the period after Ramadan (P<0.05). This reflects a better glycaemic control after Ramadan. The fasting blood glucose (FBG) mean concentrations before (13.24±5.97mmol/L) and after (7.75±3.82mmol/L) Ramadan showed a significant improvement. A statistically significant difference (P<0.05) was detected in the mean concentrations of the low-density lipoprotein (LDL) before Ramadan (3.39±1.06mmol/L) and after Ramadan (2.40±0.83mmol/L). The mean concentrations of high-density lipoprotein (HDL) before Ramadan (1.78±0.74mmol/L) and after Ramadan (2.23±0.38 mmol/L) also showed a significant increase after Ramadan (P<0.05). Both total cholesterol and triglyceride mean concentrations showed a significant improvement after Ramadan (P<0.05). Body weight and both systolic and diastolic blood pressure showed no significant change. The concentrations (mg/kg wet weight) of toxic elements (As, Cd, Cr and Pb) in the four selected staple foods (rice, wheat, meat and chicken) were as follows: As (0.01-0.03), Cd (0.01-0.06), Cr (0.14-0.25) and Pb (0.01-0.62). The mean estimated dietary intakes (EDIs) of these elements in rice, wheat, meat and chicken were 1.1×10−6–2.6×10−5, 1.42×10−5–2.2 ×10−4, 3.4×10−4–8.0×10−4, and 2.3×10−5–2.1×10−3mg/kg bw/day, respectively. Hazard quotients (HQ) for all the elements did not exceed one. The EDIs of essential elements were also investigated in the four staple foods. The concentrations (mg/kg wet weight) of Se, Zn, Mn and Cu in the four selected staple foods were as follows: Se (0.07-0.24), Zn (3.91-20.89), Mn (0.63-14.69) and Cu (0.69-2.41). The calculated ranges of EDIs (mg/kg bw/day) for the essential elements were as follows: Se 9.55x10-5-5.75x10-4; Zn 1.33x10-2-5.83x10-2; Mn 1.49x10-3-3.31x10-2; Cu 1.65x10-3-5.42x10-3. In conclusion, the finding of this study shows that Ramadan has a major impact on the diet and lifestyle of a group of people from Najran. The self-reported increase in the consumption of sugary drinks and carbohydrate rich foods is a cause for concern that needs to be addressed by the public health professionals in the future. Despite this, the study shows that there is a significant improvement in different biomarkers of diabetes (HbA1c, cholesterol, LDL, HDL etc.) suggesting beneficial effects of Ramadan on Type 2 diabetes patients. Public health professionals can raise public awareness that Ramadan can be a good opportunity to improve the health of the general population and Type 2 diabetic patients, especially by adopting a healthier diet that is not excessive in the consumption of sugary drinks and carbohydrate rich foods. The study also showed that there is no excessive exposure to toxic elements from the four staple foods analysed. The EDIs for all toxic elements in rice, wheat, meat and chicken were below the provisional tolerable weekly intakes (PTWI) set by the WHO. The EDIs related to measured essential elements in selected staple foods among the population in Najran city also did not exceed the PTWI set by WHO. More detailed studies with a larger population and wider range of food samples needs to be carried out in the future to assess the impact of Ramadan on the diet, nutrition and health of the public in different parts of the world.

Name dc:type.qualificationname

PhD

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

De Montfort University

Year dc:date.issued

2018

Author dc:creator

• Mohamed, Hatem

Licence

• https://dora.dmu.ac.uk/bitstreams/c57bce3b-47aa-4215-a6ff-5b60b83e2b15/download