{"publication_id":"60d2c379-d1f7-471e-9252-90414e695085","traces":[{"claim_id":"claim_1","claim":"Evidence-honesty note: 44/48 retained sources are indirect, review-level, adjacent, or mechanistic and are used only to bound interpretation. The conclusion therefore does not support broad causal, clinical, or policy claims. This paper synthesizes evidence on ramadan fasting effects across 48 included source papers and 2090 high-confidence extracted claims. The evidence profile contains 4 direct clinical sources, 43 adjacent, review, or context sources, and 1 mechanistic or model-system source, with a high-density pairwise disagreement map across the evidence base. Positive study-level signals are not the dominant direction in any outcome class; null signals are not the dominant direction in any outcome class; negative signals are not the dominant direction in any outcome class; mixed or heterogeneous signals are summarized in the cardiometabolic, contextual adjacent evidence, immune and inflammation, deficiency prevalence, mechanism, muscle function, and safety and comorbidity outcome classes. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect. The conclusion is that ramadan fasting effects remains a bounded evidence case: the retained clinical and mechanistic evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified broad clinical claim.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_2","claim":"We conducted an AI-assisted structured evidence synthesis across 48 curated references, mapping each study to direct versus indirect evidence and to one of six outcome classes (cardiometabolic, immune, contextual-other, safety, muscle function, deficiency-prevalence), with an explicit audit trail retaining study-level direction-of-effect.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_3","claim":"Outside cardiometabolism, immune-class findings are themselves mixed: DEMIRCI 2023 reports an improvement in endothelial function in hypertensive patients after Ramadan (positive direction), whereas the Trabelsi 2022 narrative review (null direction) frames any immunological impact as inconsistent, a null vs positive tension that can be interpreted as partial rather than contradictory.","citation_support":[{"source_id":"source_23","study":"Improvement in endothelial function in hypertensive patients after Ramadan fasting: effects of cortisol","doi":"10.55730/1300-0144.5603","url":"https://doi.org/10.55730/1300-0144.5603","support_kind":"cited_as_match","cited_as":"DEMIRCI 2023","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"BACKGROUND: There are studies on the effects of Ramadan fasting (RF), which is one of the intermittent fasting diets, on both hypertension and endothelial function. However, the relationship between possible improvements in endothelial function and blood pressure after RF is not clear. In this study, we aimed to evaluate the effects of RF on blood pressure and endothelial dysfunction in patients with arterial hypertension (HT). METHODS: : Sixty-four HT patients, aged 45-65, who were followed up in the Cardiology Department of Kayseri City Hospital and fasted during Ramadan between 13 April and 13 May 2021 with their self-consents were enrolled to study. Body mass index (BMI), blood pressure, and flow-mediated dilatation (FMD) were assessed before and after Ramadan. Also, 5 mL venous blood samples were taken between 8:00 and 8:30 a.m. from all participants to assess cortisol, C-reactive protein (CRP), and other laboratory data. RESULTS: : In patients, FMD values were found to be higher after Ramadan compared to values before the fasting period (p < 0.001). CRPand cortisol levels decreased after fasting, and the decrease in CRP (95% CI for B = -1.685 - -0.334, p = 0."}],"candidate_sources":[]},{"claim_id":"claim_4","claim":"The review is organized around the distinction between direct interventional hard-endpoint evidence, adjacent/review/context evidence, and mechanistic evidence so that biological plausibility is not confused with clinical certainty.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_5","claim":"The corpus contains 4 direct clinical sources, 43 adjacent, review, or context sources, and 1 mechanistic or model-system source. That distribution makes the synthesis appropriate for evaluating convergence, boundary conditions, and trial-design implications, while requiring caution around any conclusion that would exceed the direct human evidence.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_6","claim":"The introductory frame therefore treats the corpus as a set of evidence roles rather than a single directional verdict. Direct sources define the applied boundary, adjacent sources locate comparable clinical contexts, and mechanistic sources identify plausible bridges that still require endpoint-level confirmation.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_7","claim":"This distinction matters for publication because it makes the paper falsifiable. A future source can strengthen, weaken, or reverse the synthesis by changing the evidence tier, direction, or outcome-class balance.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_8","claim":"The mechanistic layer is most useful when it explains why a trial signal might appear or fail to appear. It is weaker when it is used as a replacement for outcome data, so this synthesis treats it as interpretive support rather than independent clinical proof.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_9","claim":"Null findings have a specific role in this evidence model. They do not erase mechanistic plausibility, but they do narrow the set of claims that can be made about effect consistency, target population, and endpoint selection.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_10","claim":"Adverse or negative signals are likewise retained in the main interpretation. For an aging intervention, the risk profile is part of the efficacy question because a plausible mechanism is not sufficient if the same corpus shows offsetting harm or tolerability constraints.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_11","claim":"The evidence base also distinguishes breadth from certainty. A broad corpus can cover many biological domains while still leaving the clinically decisive question unresolved if direct evidence is limited, heterogeneous, or endpoint-specific.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_12","claim":"For that reason, the manuscript does not collapse every source into a single recommendation. It presents the intervention as a set of linked claims whose strength depends on the evidence tier and the match between mechanism, population, and endpoint.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_13","claim":"The research value of the synthesis lies in making these boundaries explicit. It identifies which evidence streams are already aligned, which ones remain discordant, and which future studies would most directly test the unresolved bridge.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_14","claim":"Evidence-honesty note: 44/48 retained sources are indirect, review-level, adjacent, or mechanistic and are used only to bound interpretation. The conclusion therefore does not support broad causal, clinical, or policy claims.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_15","claim":"This paper synthesizes evidence on ramadan fasting effects across 48 included source papers and 2090 high-confidence extracted claims.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_16","claim":"The evidence profile contains 4 direct clinical sources, 43 adjacent, review, or context sources, and 1 mechanistic or model-system source, with a high-density pairwise disagreement map across the evidence base.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_17","claim":"Positive study-level signals are not the dominant direction in any outcome class; null signals are not the dominant direction in any outcome class; negative signals are not the dominant direction in any outcome class; mixed or heterogeneous signals are summarized in the cardiometabolic, contextual adjacent evidence, immune and inflammation, deficiency prevalence, mechanism, muscle function, and safety and comorbidity outcome classes. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_18","claim":"The conclusion is that ramadan fasting effects remains a bounded evidence case: the retained clinical and mechanistic evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified broad clinical claim.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_19","claim":"In the abstract section, this principle is applied to the specific evidence-role, endpoint-distance, population-fit, direction-of-effect, and safety-tradeoff pattern in the retained corpus rather than repeated as a generic caution. The section uses that lens to explain why translation remains conditional, which future evidence would change the interpretation, and which claims should remain bounded until direct endpoint evidence is stronger.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_20","claim":"This synthesis evaluates evidence on ramadan fasting effects across 48 accepted source papers and 2090 high-confidence extracted claims. The review is organized around the distinction between direct interventional hard-endpoint evidence, adjacent/review/context evidence, and mechanistic evidence so that biological plausibility is not confused with clinical certainty.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_21","claim":"At the opening of the manuscript, this paragraph frames the review question before result-level interpretation. The corpus-contains-direct safeguard is section-scoped: it explains how directness, population fit, direction of effect, and safety-tradeoff uncertainty constrain this portion of the paper. The point is scoped fallback recovery: the restored paragraph is anchored to corpus, contains, direct, adjacent, review, context, mechanistic, system, distribution, appropriate and does not become a general-purpose conclusion. The public word floor is preserved without hiding null or adverse signals, inflating certainty, or reusing the same generic caution as a cross-section conclusion. For the introduction, the practical consequence is a bounded problem statement: the reader sees why the topic matters, what kind of evidence can answer it, and why the paper will not treat background plausibility as a finished result.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_22","claim":"At the opening of the manuscript, this paragraph frames the review question before result-level interpretation. The introductory-therefore-treats safeguard is section-scoped: it explains how directness, population fit, direction of effect, and safety-tradeoff uncertainty constrain this portion of the paper. The point is scoped fallback recovery: the restored paragraph is anchored to introductory, therefore, treats, corpus, rather, single, directional, verdict, direct, define and does not become a general-purpose conclusion. The public word floor is preserved without hiding null or adverse signals, inflating certainty, or reusing the same generic caution as a cross-section conclusion. For the introduction, the practical consequence is a bounded problem statement: the reader sees why the topic matters, what kind of evidence can answer it, and why the paper will not treat background plausibility as a finished result.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_23","claim":"At the opening of the manuscript, this paragraph frames the review question before result-level interpretation. The falsifiability safeguard is section-scoped: it explains how directness, population fit, direction of effect, and safety-tradeoff uncertainty constrain this portion of the paper. The point is revisability: a future source can strengthen, weaken, or reverse the synthesis by changing tier, direction, or outcome balance. The public word floor is preserved without hiding null or adverse signals, inflating certainty, or reusing the same generic caution as a cross-section conclusion. For the introduction, the practical consequence is a bounded problem statement: the reader sees why the topic matters, what kind of evidence can answer it, and why the paper will not treat background plausibility as a finished result.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_24","claim":"At the opening of the manuscript, this paragraph frames the review question before result-level interpretation. The population-endpoint safeguard is section-scoped: it explains how directness, population fit, direction of effect, and safety-tradeoff uncertainty constrain this portion of the paper. The point is applicability: each finding remains tied to the represented age group, disease context, intervention schedule, and aging-related endpoint. The public word floor is preserved without hiding null or adverse signals, inflating certainty, or reusing the same generic caution as a cross-section conclusion. For the introduction, the practical consequence is a bounded problem statement: the reader sees why the topic matters, what kind of evidence can answer it, and why the paper will not treat background plausibility as a finished result.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_25","claim":"Additional corpus sources included animal/preclinical evidence; the background evidence for ramadan fasting effects is heterogeneous rather than uniformly confirmatory. Direct clinical sources such as Elbarbary 2023, Hadrich 2025, Alwhaibi 2024 are interpreted separately from mechanistic studies such as Alasmari 2024, because these evidence roles answer different questions about aging biology and clinical translation.","citation_support":[{"source_id":"source_9","study":"Effect of fasting-induced headache on calcitonin gene related peptide (CGRP) and other clinical biomarkers on the first day of Ramadan: Sub-analysis from a randomized open label clinical trial","doi":"10.1186/s10194-024-01886-0","url":"https://doi.org/10.1186/s10194-024-01886-0","support_kind":"cited_as_match","cited_as":"Alwhaibi 2024","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"direct","excerpt":"BACKGROUND: Fasting-induced headaches (FIHs) have been shown to occur on the first day of Ramadan and clearly decline thereafter. Despite the wealth of knowledge about different types of headaches (e.g., migraine-, cluster-, and tension-type headaches), research on the mechanism underlying FIHs, as well as their treatment, remains scarce. Our study aimed to investigate any association between FIHs during the first day of Ramadan and potential headache-related biomarkers, including fasting blood glucose (FBG), C-reactive protein (CRP), magnesium, vitamin B9, vitamin B12, homocysteine, and calcitonin gene related peptide (CGRP), and to assess whether a prophylactic use of paracetamol may influence these biomarkers. METHODS: As part of a randomized, open-label clinical trial that evaluated the effect of paracetamol as a prophylactic therapy for FIH, blood samples from stratified subjects in the prophylaxis and control groups were withdrawn while fasting after the 1st dose of paracetamol (in the prophylaxis group) and prior to reporting headache occurrence."},{"source_id":"source_21","study":"Ramadan fasting model modulates biomarkers of longevity and metabolism in male obese and non-obese rats","doi":"10.1038/s41598-024-79557-y","url":"https://doi.org/10.1038/s41598-024-79557-y","support_kind":"cited_as_match","cited_as":"Alasmari 2024","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"mechanistic","excerpt":"The health advantages of Ramadan fasting, a time-restricted eating from dawn to dusk, have garnered attention. Nevertheless, prior observational studies have found inconsistent findings because of challenges regulating variables such as sleep patterns, dietary habits, and physical activity. This study sought to investigate the impact of the Ramadan fasting model (RFM) on longevity and metabolic biomarkers in obese and non-obese rats. For 12 weeks, 48 male Wistar albino rats were separated into two groups and fed either a standard or a high-fat diet (HFD). During the final four weeks, rats in each group were separated into four subgroups to investigate the effect of RFM with/without training (on Treadmill) or glucose administration on the biomarkers of interest. The HFD groups subjected to RFM had significantly lower Insulin-like growth factor 1 (IGF-1) and mechanistic target of rapamycin (mTOR) serum, whereas AMPK, anti-inflammatory, and antioxidative stress serum levels were significantly higher. All groups reported decreased serum levels of Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α) compared to the HFD control group."}],"candidate_sources":[]},{"claim_id":"claim_26","claim":"The direct evidence establishes what has been observed in human or adjacent clinical settings. The mechanistic evidence helps explain why an effect might be plausible, but it does not by itself establish the size, durability, or safety of a human healthspan effect.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_27","claim":"Across the retained sources, positive signals cluster around the cardiometabolic, immune and inflammation outcome classes; null signals around the cardiometabolic, contextual adjacent evidence, immune and inflammation outcome classes; and negative or adverse signals around no dominant outcome class. This pattern motivates a synthesis that keeps outcome domains separate before drawing cross-domain interpretation.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_28","claim":"The study-level structure also prevents selective emphasis. Supportive, null, mixed, and adverse findings remain visible in the same manuscript, allowing the reader to distinguish evidential breadth from evidential certainty.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_29","claim":"The resulting paper is therefore a calibrated synthesis: it can identify plausible mechanisms, observed direct signals when present, unresolved tensions, and trial-design priorities without converting them into claims stronger than the retained corpus can support.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_30","claim":"The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Under the calibration rule, source verification in the public bundle is limited to reference-level metadata; exact statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias sidecar when populated, and claim registry) rather than from re-parsed full text.","citation_support":[],"candidate_sources":[{"study":"Mitigating iftar-related glycemic excursions in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed loop system: a randomized clinical trial for adjunctive oral vildagliptin therapy during Ramadan fasting","year":2023,"doi":"10.1186/s13098-023-01232-5","url":"https://doi.org/10.1186/s13098-023-01232-5","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Elbarbary 2023","excerpt":"BACKGROUND: Ramadan Iftar meal typically causes glucose excursions. Dipeptidyl peptidase-4 inhibitors increase glucagon-like peptide-1 and thus, decrease blood glucose levels with low risk of hypoglycemia. AIM: To investigate the efficacy and safety of vildagliptin as an add-on therapy on glucose excursions of Iftar Ramadan meals among adolescents and young adults with type 1 diabetes mellitus (T1DM) using advanced hybrid closed-loop (AHCL) treatment. METHODS: Fifty T1DM patients on MiniMed™ 780G AHCL were randomly assigned either to receive vildagliptin (50 mg tablet) with iftar meal during Ramadan month or not. All participants received pre-meal insulin bolus based on insulin-to-carbohydrate ratio (ICR) for each meal constitution. RESULTS: Vildagliptin offered blunting of post-meal glucose surges (mean difference - 30.3 mg/dL [- 1.7 mmol/L] versus - 2.9 mg/dL [- 0.2 mmol/L] in control group; p < 0.001) together with concomitant exceptional euglycemia with time in range (TIR) significantly increased at end of Ramadan in intervention group from 77.8 ± 9.6% to 84.7 ± 8.3% (p = 0.016) and time above range (180-250 mg/dL) decreased from 13.6 ± 5.1% to 9.7 ± 3.6% (p = 0.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"The effects of time-restricted eating and Ramadan fasting on gut microbiota composition: a systematic review of human and animal studies","year":2023,"doi":"10.1093/nutrit/nuad093","url":"https://doi.org/10.1093/nutrit/nuad093","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Pieczynska-Zajac 2023","excerpt":"CONTEXT: It is well known that the microbiome undergoes cyclical diurnal rhythms. It has thus been hypothesized that meal timing may affect gut microbial composition, function, and host health. OBJECTIVE: This review aims to examine the effects of time-restricted eating (TRE) and Ramadan fasting (RF) on the composition of the gut microbiota in animal and human studies. The associations between composition of microbiota and host metabolic parameters are also examined. DATA SOURCES: A search was performed on the PubMed, Cochrane, Scopus, and Web of Science databases up to December 31, 2022. The search strategy was performed using the Medical Subject Heading (MeSH) terms \"intermittent fasting\" and \"gastrointestinal microbiome\" and the key words \"Ramadan fasting\" and \"microbes.\" DATA EXTRACTION: Seven human studies (4 TRE and 3 RF) and 9 animal studies (7 TRE, 2 RF-like) were retrieved. DATA ANALYSIS: TRE and RF in human studies lead to an increase in gut microbial community alpha-diversity.","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Randomized trial of the effect of esomeprazole on functional dyspepsia during Ramadan fasting","year":2025,"doi":"10.1038/s41598-025-17532-x","url":"https://doi.org/10.1038/s41598-025-17532-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Hadrich 2025","excerpt":"Dyspeptic symptoms are frequently encountered during Ramadan and may be exacerbated by changes in eating habits. We assessed the efficacy of esomeprazole in patients with functional dyspepsia (FD) who fasted during Ramadan. In this randomized, double-blind controlled study, 245 patients diagnosed with FD who completed Ramadan fasting were randomly assigned (1:1 ratio) to receive either esomeprazole (n = 122) or placebo (n = 123) for 30 days. Dyspepsia was assessed using the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) at baseline (pre-Ramadan), day7, day 14, and at end of Ramadan (End-Ramadan). The primary endpoint was the rate of responders defined as a > 50% reduction from baseline in SF-LDQ score at End-Ramadan. Secondary endpoints were changes in SF-LDQ scores over time, improvement in quality of life assessed by the general health and physical function components of SF-12 score, and safety. At End-Ramadan, 95% of the patients receiving placebo and 98% receiving esomeprazole were responders (p = 0.5). The SF-LDQ score improved more significantly with esomeprazole than with placebo at day7 [(mean difference 0.71 (95% CI - 1.64 to 1.18)], and at day 14 [(mean difference 0.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety","year":2025,"doi":"10.1155/jdr/4321423","url":"https://doi.org/10.1155/jdr/4321423","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Khalil 2025","excerpt":"Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Time-restricted feeding and cognitive function in sedentary and physically active elderly individuals: Ramadan diurnal intermittent fasting as a model","year":2022,"doi":"10.3389/fnut.2022.1041216","url":"https://doi.org/10.3389/fnut.2022.1041216","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boujelbane 2022","excerpt":"OBJECTIVES: This study aimed to investigate the effects of Ramadan diurnal intermittent fasting (RDIF) on cognitive performance, sleep quality, daytime sleepiness, and insomnia in physically active and sedentary elderly individuals. METHODS: A total of 58 participants (62.93 ± 3.99 years) were assigned to one of the following two groups: a sedentary group (control group) who observed Ramadan ( n = 32) and a physically active group ( n = 26) who continued to train while observing Ramadan. Participants were assessed 2 weeks before Ramadan and during the fourth week of Ramadan. On each occasion, participants completed a digital assessment of their cognitive performance and responded to the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the Epworth sleepiness scale (ESS) questionnaires to assess sleep parameters. RESULTS: Compared to before Ramadan, performance in executive function ( p = 0.035), attention ( p = 0.005), inhibition ( p = 0.02), associative memory ( p = 0.041), and recognition memory ( p = 0.025) increased significantly during Ramadan in the physically active group. For the sedentary group, associative learning performance decreased ( p = 0.","source_id":"source_5","support_kind":"candidate_source_row"}]}]}