{"publication_id":"60d2c379-d1f7-471e-9252-90414e695085","content_hash":"sha256:bb02d367f817adfd1776a3c4ffa8de862cf866f5336b03060e1482d5507eb286","nodes":[{"id":"60d2c379-d1f7-471e-9252-90414e695085","type":"publication","title":"Hypothesis-Generating Brief: Ramadan Fasting Effects"},{"id":"claim_1","type":"claim","text":"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."},{"id":"claim_2","type":"claim","text":"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."},{"id":"claim_3","type":"claim","text":"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."},{"id":"claim_4","type":"claim","text":"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."},{"id":"claim_5","type":"claim","text":"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."},{"id":"claim_6","type":"claim","text":"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."},{"id":"claim_7","type":"claim","text":"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."},{"id":"claim_8","type":"claim","text":"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."},{"id":"claim_9","type":"claim","text":"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."},{"id":"claim_10","type":"claim","text":"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."},{"id":"claim_11","type":"claim","text":"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."},{"id":"claim_12","type":"claim","text":"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."},{"id":"claim_13","type":"claim","text":"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."},{"id":"claim_14","type":"claim","text":"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."},{"id":"claim_15","type":"claim","text":"This paper synthesizes evidence on ramadan fasting effects across 48 included source papers and 2090 high-confidence extracted claims."},{"id":"claim_16","type":"claim","text":"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."},{"id":"claim_17","type":"claim","text":"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."},{"id":"claim_18","type":"claim","text":"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."},{"id":"claim_19","type":"claim","text":"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."},{"id":"claim_20","type":"claim","text":"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."},{"id":"claim_21","type":"claim","text":"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."},{"id":"claim_22","type":"claim","text":"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."},{"id":"claim_23","type":"claim","text":"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."},{"id":"claim_24","type":"claim","text":"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."},{"id":"claim_25","type":"claim","text":"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."},{"id":"claim_26","type":"claim","text":"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."},{"id":"claim_27","type":"claim","text":"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."},{"id":"claim_28","type":"claim","text":"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."},{"id":"claim_29","type":"claim","text":"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."},{"id":"claim_30","type":"claim","text":"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."},{"id":"source_1","type":"source","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."},{"id":"source_2","type":"source","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."},{"id":"source_3","type":"source","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."},{"id":"source_4","type":"source","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."},{"id":"source_5","type":"source","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."},{"id":"source_6","type":"source","study":"A Systematic Review of Insulin Management Recommendations to Improve Glycemic Control and Reduce Hypoglycemic Events During Ramadan Fasting in Patients With Insulin-Requiring Type 2 Diabetes","year":2022,"doi":"10.3389/fnut.2022.846600","url":"https://doi.org/10.3389/fnut.2022.846600","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":"Kieu 2022","excerpt":"BACKGROUND: Muslims with insulin-requiring type 2 diabetes are at high risk of hypo- and hyperglycemia while fasting during the month of Ramadan. Although a few reviews on diabetic management during Ramadan have been published, surveys reveal knowledge gaps remain among physicians. AIM: This systematic review qualitatively analyzes what insulin dosing recommendations are likely to reduce hypoglycemic events and improve glycemic control during the Ramadan fasting for this high-risk group. METHODS: A comprehensive search in six databases and gray sources was performed from August 10, 2001, to August 10, 2021, for studies assessing which types of insulin and/or what dosing recommendations reduce hypoglycemic events and improve glycemic control during Ramadan. We excluded studies focusing mainly on oral antihyperglycemic medications, type 1 diabetes, persons with insulin pumps, and studies older than 20 years. Hypoglycemic event rates, pre-, and post-iftar blood glucose levels, overall average blood glucose, and hemoglobin A1c were analyzed, and a narrative synthesis was performed."},{"id":"source_7","type":"source","study":"Effects of Walking Football During Ramadan Fasting on Heart Rate Variability and Physical Fitness in Healthy Middle-Aged Males","year":2022,"doi":"10.1177/15579883221103418","url":"https://doi.org/10.1177/15579883221103418","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":"Kammoun 2022","excerpt":"This study aimed to investigate the effect of a walking football (WF) program during Ramadan fasting (RF) on heart rate variability (HRV) indices, body composition, and physical fitness in middle-aged males. Thirty-one healthy sedentary men were randomized to WF ( n = 18) and control ( n = 13) groups. Both groups participated in RF. The WF group were involved in a training program (small-sided games) of three sessions a week during RF. The time and frequency domains of HRV, body composition, handgrip, lumbar strength, Modified Agility Test (MAT), and 6-minute walk test (6MWT) were measured before Ramadan (BR), during Ramadan (DR), and after Ramadan (AR). We reported that RF has significantly altered some parameters of HRV DR; the mean HR decreased while the mean RR, LF, and HF increased. WF had a significant effect on HRV and mean HR DR compared with BR and AR decreased while mean RR, HF and LF increased. DR, body mass decreased in both groups, while body mass index (BMI) decreased and lean mass increased only in WF group. Lower body mass and BMI levels were reported AR only in WF group."},{"id":"source_8","type":"source","study":"Effects of Time-Restricted Feeding and Ramadan Fasting on Body Weight, Body Composition, Glucose Responses, and Insulin Resistance: A Systematic Review of Randomized Controlled Trials","year":2022,"doi":"10.3390/nu14224778","url":"https://doi.org/10.3390/nu14224778","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":"Tsitsou 2022","excerpt":"Time-restricted feeding (TRF) and Ramadan fasting (RF) have been recently associated with several health outcomes. However, it is not yet clear if they are superior to existing treatments in terms of glucose metabolism, insulin action, and weight loss. This review aims to summarize the current data on the effects of these regimes on body weight, body composition, and glycemia. An electronic search was conducted in PUBMED and SCOPUS databases up to August 2022. Twenty-four records met the inclusion criteria and underwent a risk-of-bias assessment. The main outcomes were: (a) TRF may result in moderate weight loss in individuals with overweight/obesity; when TRF is combined with caloric restriction, weight loss is >5% of the initial body weight, (b) 14 h of fasting may be as effective as 16 h in terms of weight loss, and (c) TRF may lead to improved insulin sensitivity and glycemic responses/variability throughout the day in individuals with overweight/obesity. Concerning RF, only two studies were available and thus, conclusions were not drawn."},{"id":"source_9","type":"source","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","year":2024,"doi":"10.1186/s10194-024-01886-0","url":"https://doi.org/10.1186/s10194-024-01886-0","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":"Alwhaibi 2024","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."},{"id":"source_10","type":"source","study":"Real-world evidence on the effectiveness and safety of gliclazide MR 60 mg in Bangladeshi patients with Type II diabetes during fasting: a sub-analysis from the global DIA-RAMADAN study","year":2024,"doi":"10.57264/cer-2023-0132","url":"https://doi.org/10.57264/cer-2023-0132","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":"Uddin 2024","excerpt":"Aim: Many Muslims with Type II diabetes (T2DM) fast during Ramadan, which can put them at increased risk of hypoglycemia. This sub-analysis of the global DIA-RAMADAN study assessed the effectiveness and safety of gliclazide modified release (MR) 60 mg in the Bangladeshi cohort. Materials & methods: DIA-RAMADAN was an international, prospective, observational study conducted in adult T2DM patients intending to fast and receiving gliclazide MR 60 mg once daily for ≥90 days before Ramadan. Dosing was switched from morning to evening at the start of Ramadan. The primary outcome was the proportion of patients with ≥1 symptomatic hypoglycemic event. Secondary outcomes included changes between inclusion (V0) and end of study visit (V1) in glycated hemoglobin (HbA1c), body weight and fasting plasma glucose (FPG). Results: Among the 98 Bangladeshi patients, 80 (81.6%) were at moderate/low-risk (category 3) for fasting and 18 (18.4%) were high-risk (category 2), as per International Diabetes Federation and Diabetes and Ramadan International Alliance (IDF-DAR) guidelines. Gliclazide MR was being prescribed as monotherapy to 59 (60.2%) patients and in combination with metformin to 39 (39.8%)."},{"id":"source_11","type":"source","study":"Effects of Modified Ramadan Fasting on Mental Well-Being and Biomarkers in Healthy Adult Muslims — A Randomised Controlled Trial","year":2024,"doi":"10.1007/s12529-024-10296-0","url":"https://doi.org/10.1007/s12529-024-10296-0","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":"Lauche 2024","excerpt":"BACKGROUND: Ramadan fasting has seen increased attention in research, often with inconsistent findings. This study aims to investigate whether dietary and lifestyle modifications during Ramadan can improve well-being and health in healthy adult Muslims. METHOD: A randomised controlled trial with two parallel groups was conducted in an outpatient clinic of a university hospital in Essen, Germany, in 2016. Healthy adult Muslims (n = 114) aged 18-60 years were randomised to a modified fasting group; i.e., they received educational material prompting dietary and lifestyle modifications pre-Ramadan, and a control group who undertook Ramadan fasting as usual. Primary outcome was quality of life (WHO-5 Well-Being Index). Secondary outcomes included sleep quality, spirituality, and mindfulness (all self-report), body weight, body mass index, body fat, waist circumference, hip circumference, blood pressure, and heart rate, as well as blood serum biomarkers. Safety was examined via adverse events. RESULTS: The modified fasting group reported significantly higher quality of life (WHO-5) compared to the control after Ramadan (MD 5.9; 95% CI, 0.02-11.8; p < 0.05)."},{"id":"source_12","type":"source","study":"Effects of protein sources at sahur on anaerobic power and strength during Ramadan in combat sport athletes: A single blind, randomized, placebo-controlled, counterbalanced crossover study design","year":2026,"doi":"10.1371/journal.pone.0340961","url":"https://doi.org/10.1371/journal.pone.0340961","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":"Demirli 2026","excerpt":"This study investigated the acute effects of different protein sources consumed at sahur on anaerobic power and strength performances in trained male combat sport athletes during Ramadan fasting. Using a single blind, randomized, placebo-controlled, counterbalanced crossover study design, 24 male combat sports' athletes (mean age: 27.3 ± 3.8 years, Tier 3 national level) completed four experimental conditions: (1) non-fasting control, (2) fasting + placebo (maltodextrin), (3) fasting + whey protein isolate (WPI), and (4) fasting + micellar casein (MC). In each condition, a standardized sahur meal (6.3-7.7 kcal/kg body weight) and supplementation (0.4 g/kg for WPI/MC and 0.4 g/kg for Placebo) were administered. Physical Performances was assessed 11-13 hours post-sahur (or 3-5 hours post-lunch for control) including the Wingate anaerobic test, bench press, leg press, and countermovement jump (CMJ), and handgrip strength tests. Ramadan fasting significantly lowered Wingate peak power, mean power, and bench press strength compared to the non-fasting control."},{"id":"source_13","type":"source","study":"Metabolomics of Ramadan fasting and associated risk of chronic diseases","year":2024,"doi":"10.1016/j.ajcnut.2024.01.019","url":"https://doi.org/10.1016/j.ajcnut.2024.01.019","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":"Al-Jafar 2024","excerpt":"BACKGROUND: The dramatic change in lifestyle associated with Ramadan fasting raises questions about its effect on metabolism and health. Metabolites, as the end product of metabolism, are excellent candidates to be studied in this regard. OBJECTIVE: This study aims to investigate the effect of Ramadan fasting on the metabolic profile and risk of chronic diseases. METHODS: The London Ramadan study (LORANS) is an observational study in which 2 blood samples were collected from 72 participants a few days before and after the fasting month of Ramadan. We conducted metabolomic profiling using nuclear magnetic resonance spectroscopy to assess the change in individual metabolites from before to after Ramadan. Also, we generated metabolic scores (scaled from 0 to 100) for 7 chronic diseases in the UK Biobank and assessed the association of Ramadan fasting with these scores in LORANS. RESULTS: Of the 72 participants, 35 were male (48.6%); the mean (± standard deviation) age was 45.7 (±16) y."},{"id":"source_14","type":"source","study":"Impacts of Ramadan fasting during pregnancy on pregnancy and birth outcomes: An umbrella review","year":2025,"doi":"10.1002/ijgo.16127","url":"https://doi.org/10.1002/ijgo.16127","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":"AlTaiar 2025","excerpt":"BACKGROUND: Despite a large number of primary research studies, and systematic and narrative reviews, there is no consensus on the impact of fasting during Ramadan while pregnant on pregnancy and birth outcomes. Currently, there is no evidence-based guideline for Muslim women regarding Ramadan fasting during pregnancy and clinicians cannot provide firm recommendations. OBJECTIVES: To review the current evidence regarding the impact of Ramadan fasting during pregnancy on pregnancy and birth outcomes. SEARCH STRATEGY: We conducted an umbrella review of all systematic and narrative reviews examining the impacts of fasting during Ramadan while pregnant on pregnancy and birth outcomes by searching PubMed, CINAHL, and Cochrane Registry of Systematic Reviews databases between November 2023 and February 2024. SELECTION CRITERIA: We included all systematic and narrative reviews examining the impacts of Ramadan fasting on pregnancy and birth outcomes. The primary outcome was the change in birth weight, gestational age at birth, fetal growth indices, and Apgar score as well as the risk of delivery by cesarean section and the risks of gestational diabetes and pre-eclampsia."},{"id":"source_15","type":"source","study":"Effect of Ramadan fasting in patients with type 2 diabetes mellitus treated with sodium–glucose cotransporter 2 inhibitors: A systematic review and meta‐analysis","year":2022,"doi":"10.1111/jdi.13741","url":"https://doi.org/10.1111/jdi.13741","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":"Gad 2022","excerpt":"AIMS/INTRODUCTION: Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) improve glycemic control and weight, but might be associated with dehydration, hypotension and ketoacidosis, especially in patients with type 2 diabetes mellitus who fast during Ramadan. This meta-analysis evaluates the effects of Ramadan fasting on patients with type 2 diabetes mellitus treated with SGLT-2i. MATERIALS AND METHODS: A literature search was carried out in PubMed, Embase and the Cochrane Library. Quality assessment was carried out using the ROBINS-I and Cochrane tools for risk of bias, and analyses were carried out using RevMan version 5.3. RESULTS: A total of five studies were included in this meta-analysis. During Ramadan, there was a significant reduction in glycated hemoglobin (P < 0.00001) and diastolic blood pressure (P = 0.006), with a non-significant trend for a reduction in weight (P = 0.44) and systolic blood pressure (P = 0.67). The number and severity of hypoglycemic episodes was lower in patients with type 2 diabetes mellitus treated with SGLT-2i compared with sulfonylureas."},{"id":"source_16","type":"source","study":"Maternal Ramadan fasting and fetal cardiac function: subclinical hemodynamic alterations revealed by doppler evaluation","year":2026,"doi":"10.1186/s12884-026-08683-4","url":"https://doi.org/10.1186/s12884-026-08683-4","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":"Tasdemir 2026","excerpt":"BACKGROUND AND OBJECTIVES: To assess the association between maternal Ramadan fasting and fetal cardiac function and hemodynamics using comprehensive Doppler echocardiography, with a focus on subclinical myocardial and circulatory changes. MATERIALS AND METHODS: In this cross-sectional Doppler ultrasound study, 203 healthy singleton pregnancies between 24 and 32 weeks of gestation were examined, comprising 102 women who fasted for ≥ 10 days during Ramadan and 101 non-fasting controls. The study was prospectively registered with the National Clinical Trial (ClinicalTrials.gov Identifier: NCT06900257, registration date 23 March 2025). Doppler assessments included umbilical artery, middle cerebral artery, and ductus venosus pulsatility indices (PI), cerebroplacental ratio, and fetal cardiac parameters, including left and right myocardial performance indices (LV MPI, RV MPI), tricuspid and mitral annular plane systolic excursions (TAPSE, MAPSE), cardiothoracic ratio (CTR), and amniotic fluid index (AFI). Statistical analyses were performed using IBM SPSS v25.0 and Python 3."},{"id":"source_17","type":"source","study":"Effects of fasting on endothelial function in type 2 diabetes mellitus patients: cohort study","year":2026,"doi":"10.3389/fcvm.2025.1646786","url":"https://doi.org/10.3389/fcvm.2025.1646786","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":"Lamti 2026","excerpt":"BACKGROUND: The aim of this study was to investigate the effect of Ramadan fasting (RF) on markers of endothelial function and metabolic parameters in patients with type 2 diabetes mellitus (T2DM) and healthy controls. METHODS: This cohort study involved 305 subjects: 167 T2DM and 138 healthy volunteers subjects. The following parameters were evaluated: body mass index (BMI), diet inflammatory index (DII), serum glucose and lipid profile and high-sensitivity C-reactive protein (hs-CRP) during three separate visits, before Ramadan (baseline), the last week of Ramadan, and during the last week of the month following Ramadan. In each visit, reactive hyperaemia index (RHI) in all participants was assessed. In diabetic patients, serum homocyteine (Hcys) was mesured at baseline and during RF. The primary endpoint was change in RHI, a validated and non-invasive measure of endothelial function. The secondary end point was change in clinical, metabolic parameters, and Hcys. Analyses used non-parametric tests and multivariable regression with multiple imputation. RESULTS: RF significantly decreased RHI [-0.2 UI (95% CI -0.3 to -0.09); p < 0.001] and increased serum homocysteine [1."},{"id":"source_18","type":"source","study":"Safety and effectiveness of apixaban use for stroke prevention during Ramadan fasting (the API-RAM study)","year":2025,"doi":"10.3389/fphar.2025.1565094","url":"https://doi.org/10.3389/fphar.2025.1565094","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":"Ghrab 2025","excerpt":"INTRODUCTION: Patients receiving anticoagulation for atrial fibrillation (AF) are required to consult their doctor before starting Ramadan fasting to get their authorization for fasting and adapt their treatment. More often, a once-daily regimen is proposed to facilitate their intake schedule. Apixaban, a direct oral anticoagulant, prescribed twice daily with an optimal benefit/risk ratio in numerous situations, has very limited data regarding its use during Ramadan. AIM: The aim of this study was to evaluate the safety and the efficacy of apixaban for stroke prevention in AF patients during the month of Ramadan. METHODS: An observational, multicentric study was performed in Tunisia during two consecutive years during the specific month of Ramadan. The API-RAM study included AF patients who were on apixaban and fasted at least 10 days. Efficacy was defined by the absence of ischemic events, and safety was established by classifying bleeding events using the BARC (Bleeding Academic Research Consortium) classification during the study period. RESULTS: A total of 257 patients were included in our study. No ischemic events were reported during the study period."},{"id":"source_19","type":"source","study":"Effectiveness of empagliflozin in reducing hypoglycemic events as compared to sulfonylurea in type 2 diabetes patients during fasting in Ramadan: a single-center study","year":2025,"doi":"10.1186/s12902-025-02134-5","url":"https://doi.org/10.1186/s12902-025-02134-5","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":"indirect","cited_as":"Kiran 2025","excerpt":"BACKGROUND: This study aimed to compare the reduction in hospital admissions due to hypoglycemia and the decrease in HbA1c levels between empagliflozin and sulfonylurea, alongside the standard care provided to patients with type 2 diabetes during fasting. METHODOLOGY: A single-center prospective observational cohort study was conducted from March to June 2022. Patients were treated with stable doses of empagliflozin, sulfonylureas, metformin, and DPP-4 inhibitors at least two months before fasting. Stability was defined as unchanged doses for at least one month. Participants' BMI distribution and treatment regimens were clarified. The eGFR cutoff of < 60 ml/min/1.73 m² was chosen based on international standards for renal function in diabetes. RESULTS: Females were in the majority (60.3%) in the intervention (case) group. Most had ages ranging from 41 to 60 years; the empagliflozin group reported slightly fewer hypoglycemic events (26.5%) compared to the sulfonylurea group (31%), and both groups demonstrated statistically significant reductions in HbA1c levels (p < 0.0001), with a similar mean decrease of approximately 0."},{"id":"source_20","type":"source","study":"Effect of Religious Fasting in Ramadan on Blood Pressure: Results From LORANS (London Ramadan Study) and a Meta‐Analysis","year":2021,"doi":"10.1161/JAHA.120.021560","url":"https://doi.org/10.1161/JAHA.120.021560","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":"AlJafar 2021","excerpt":"Background Ramadan fasting is practiced by hundreds of millions every year. This ritual practice changes diet and lifestyle dramatically; thus, the effect of Ramadan fasting on blood pressure must be determined. Methods and Results LORANS (London Ramadan Study) is an observational study, systematic review, and meta-analysis. In LORANS, we measured systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 85 participants before and right after Ramadan. In the systematic review, studies were retrieved from PubMed, Embase, and Scopus from inception to March 3, 2020. We meta-analyzed the effect from these studies and unpublished data from LORANS. We included observational studies that measured SBP and/or DBP before Ramadan and during the last 2 weeks of Ramadan or the first 2 weeks of the month after. Data appraisal and extraction were conducted by at least 2 reviewers in parallel. We pooled SBP and DBP using a random-effects model. The systematic review is registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD42019159477). In LORANS, 85 participants were recruited; mean age was 45.6±15.9 years, and 52.9% ( n =45) of participants were men."},{"id":"source_21","type":"source","study":"Ramadan fasting model modulates biomarkers of longevity and metabolism in male obese and non-obese rats","year":2024,"doi":"10.1038/s41598-024-79557-y","url":"https://doi.org/10.1038/s41598-024-79557-y","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":"mechanistic","cited_as":"Alasmari 2024","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."},{"id":"source_22","type":"source","study":"Effect of Acute Ramadan Fasting on Muscle Function and Buffering System of Male Athletes","year":2021,"doi":"10.3390/healthcare9040397","url":"https://doi.org/10.3390/healthcare9040397","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":"Fashi 2021","excerpt":"The aim of this study was to investigate the effect of acute Ramadan fasting (RF) on the muscle function and buffering system. Twelve male athletes with 8 years of professional sports experience (age, 23.2 ± 1.3 years, body mass index: 24.2 ± 2.2 kg/m 2 ) participated in this study. The subjects were tested twice, 3 weeks after the beginning of RF and 2 weeks after the end RF. Muscle function, buffering capacity, and rating of perceived exertion (RPE) were measured during and after RF by using the Biodex isokinetic machine, blood gas analyzer, and RPE 6-20 Borg scale, respectively. Venous blood samples for pH and bicarbonate (HCO 3 - ) were measured during and after RF by using the Biodex isokinetic machine, blood gas analyzer, and RPE 6-20 Borg scale, respectively. Venous blood samples for pH and bicarbonate (HCO 3 - ) were taken immediately after 25 repetitions of isokinetic knee flexion and extension. Measures taken during isokinetic knee extension during RF were significantly lower than those after RF in extension peak torque (t = -4.72, p = 0.002), flexion peak torque (t = -3.80, p = 0.007), extension total work (t = -3.05, p = 0.019), extension average power (t = -4."},{"id":"source_23","type":"source","study":"Improvement in endothelial function in hypertensive patients after Ramadan fasting: effects of cortisol","year":2023,"doi":"10.55730/1300-0144.5603","url":"https://doi.org/10.55730/1300-0144.5603","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":"DEMIRCI 2023","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."},{"id":"source_24","type":"source","study":"Use of automated insulin delivery systems in people with type 1 diabetes fasting during Ramadan: An observational study","year":2022,"doi":"10.1111/jdi.13720","url":"https://doi.org/10.1111/jdi.13720","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":"Aldibbiat 2022","excerpt":"Fasting among people with type 1 diabetes imposes the risk of metabolic decompensation. Automated insulin dosing systems can allow better glycemic control without safety concerns. The utility in prolonged and repetitive fasting has not been studied. In this observational study, validated glycemic data were reviewed and analyzed from people with type 1 diabetes who observed fasting during Ramadan in 2019 and 2020 using automated insulin dosing systems. Six profiles met the inclusion criteria. The average age was 33.7 ± 4.8 years, diabetes duration was 23.5 ± 7.9 years, body mass index 23.6 ± 1.9 kg/m 2 and glycated hemoglobin was 6.3 ± 0.2% (45 ± 5 mmol/mol). The average glucose during Ramadan was 7.0 ± 0.5 mmol/L (126 ± 9 mg/dL), coefficient of variation 28.5%, percentage of time in range 3.9-10 mmol/L (70-180 mg/dL) 88.8 ± 7.3% and percentage time <3.9 mmol/L (<70.0 mg/dL) 2.5 ± 1.3%. The number of fasting days was 27.3 ± 3.3, and the number of days where fasting was broken due diabetes was 1 ± 1.5/participant. No significant differences in glycemic outcomes were noted between Ramadan and non-Ramadan periods."},{"id":"source_25","type":"source","study":"Ramadan fasting as a form of time-restricted eating during pregnancy and long-term health effects in offspring: a narrative systematic review","year":2024,"doi":"10.1186/s12889-024-20367-2","url":"https://doi.org/10.1186/s12889-024-20367-2","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":"Abassi 2024","excerpt":"BACKGROUND: Fasting and time-restricted eating (TRE) are popular practices that have health benefits, but may also carry a risk of harm. Little is known about the impact of TRE during pregnancy on the long-term health of offspring beyond the immediate post-natal period. METHODS: We conducted a systematic review and narrative synthesis of research on the health impact of time-restricted eating (TRE) during pregnancy and its potential long-term effects on offspring. We searched three electronic databases on 20 January 2023, and updated the search on 6 May 2024, combining search terms for pregnancy and fasting. Risk of bias was assessed using the ROBINS-E tool. We adhered to PRISMA and Synthesis Without Meta-analysis (SWiM) guidelines and the protocol was registered on PROSPERO (CRD42023387174). RESULTS: We identified 16 studies with data for 1,895,744 total participants mainly set in countries around or close to the equator, published between 2004 and 2023. All studies focused on fasting during Ramadan, a religious custom practiced among Muslims worldwide that consists of refraining from food and drink from sunrise to sunset, that represents the most studied form of TRE."},{"id":"source_26","type":"source","study":"Differential effect of ramadan fasting on intercellular adhesion molecule-1 (ICAM-1) in diabetes mellitus and non-diabetes mellitus patients","year":2023,"doi":"10.1016/j.heliyon.2023.e17273","url":"https://doi.org/10.1016/j.heliyon.2023.e17273","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":"Tahapary 2023","excerpt":"BACKGROUND: The month of Ramadan is a holy month for Muslims. During this month, Muslims do not eat, drink, or smoke from sunrise to sunset. Patients with type 2 diabetes mellitus (T2DM) will also fast from dawn to dusk, creating a unique opportunity to study the effects of dietary changes during fasting period. One of the interesting results of Ramadan fasting is its effect on endothelial dysfunction, measured using Intercellular Adhesion Molecule-1 (ICAM-1) as a biological marker of endothelial function. AIM: To determine the changes ICAM-1 levels in T2DM and non-DM patients during Ramadan fasting. METHODS: A retrospective cohort study was performed on 26 T2DM patients and 21 non-DM, age-matched patients (aged 19-60 years). Measurement of metabolic parameters (systolic and diastolic blood pressure, total calorie intake, and intensity of physical activity), anthropometry (body weight, body mass index (BMI) and abdominal circumference), total dietary intake, and laboratory analysis (blood glucose fasting, HbA1c, lipid profile, ICAM-1) were done at 4 weeks before (T0) and 14 days after Ramadan fasting (T1). RESULT: The median ICAM-1 level in T2DM patients at T0 was 340."},{"id":"source_27","type":"source","study":"Ramadan Fasting Improves Health‐Related Quality of Life in Patients With Secondary Adrenal Insufficiency: A Prospective Interventional Case‐Control Study","year":2025,"doi":"10.1111/cen.15286","url":"https://doi.org/10.1111/cen.15286","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":"Mabrouk 2025","excerpt":"INTRODUCTION: Intermittent fasting (IF) exposes patients with adrenal insufficiency (AI) to complications related to undertreatment. We aimed to determine the effect of IF during Ramadan on the quality of life of patients with secondary adrenal insufficiency (SAI) compared to healthy controls. SUBJECTS AND METHODS: It is a prospective case-control study conducted at the Department of Endocrinology of La Rabta University Hospital in Tunisia. Fifty patients with SAI and 100 age-, sex- and body mass index-matched controls were enrolled and followed up throughout Ramadan 2023. All participants answered the Addison's disease quality of life questionnaire (AddiQoL) before Ramadan and during the third week of fasting. RESULTS: There were 33 women and 17 men, median age: 43 years (IQR: 34-55), median duration of SAI: 7.5 years (IQR: 4-12.5), treated with hydrocortisone at a median dose of 0.24 mg/kg/day (IQR: 0.20-0.27). Before Ramadan, there was no significant difference between patients and controls in the global AddiQoL score, fatigue score, and emotional sphere score (89 vs. 93, p = 0.196; 24 vs. 24, p = 0.354, and 24 vs. 25, p = 0.536, respectively)."},{"id":"source_28","type":"source","study":"The impact of Ramadan fasting on glucose variability in type 2 diabetes mellitus patients on oral anti diabetic agents","year":2020,"doi":"10.1371/journal.pone.0234443","url":"https://doi.org/10.1371/journal.pone.0234443","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":"Harbuwono 2020","excerpt":"Ramadan fasting is associated with changes in eating, physical activity, sleeping patterns, and medication. Unfortunately, only limited studies examine glucose variability in subjects with type 2 diabetes who fast in Ramadan. Our study aims to evaluate glucose variability in subjects with type 2 diabetes on oral antidiabetic agents using continuous glucose monitoring system (CGMS) during and after Ramadan fasting. This observational study was done in The Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, which recruited 10 subjects with type 2 diabetes who underwent Ramadan fasting in 2019. These subjects were free from cardiovascular disease, kidney disease, severe liver disease, chronic gastrointestinal disease and autoimmune disease. Insertion of CGMS for measuring interstitial glucose was performed after at least 2 weeks of Ramadan fasting and 4 weeks after the end of the Ramadan fasting, with a minimum of 3 days observation. The mean amplitude of glycemic excursion (MAGE) during and after Ramadan were similar (p = 0.94). In line with this, the average interstitial glucose (p = 0."},{"id":"source_29","type":"source","study":"Ramadan Fasting during Pregnancy and Health Outcomes in Offspring: A Systematic Review","year":2021,"doi":"10.3390/nu13103450","url":"https://doi.org/10.3390/nu13103450","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":"Oosterwijk 2021","excerpt":"Ramadan is one of the five pillars of Islam, during which fasting is obligatory for all healthy individuals. Although pregnant women are exempt from this Islamic law, the majority nevertheless choose to fast. This review aims to identify the effects of Ramadan fasting on the offspring of Muslim mothers, particularly on fetal growth, birth indices, cognitive effects and long-term effects. A systematic literature search was conducted until March 2020 in Web of Science, Pubmed, Cochrane Library, Embase and Google Scholar. Studies were evaluated based on a pre-defined quality score ranging from 0 (low quality) to 10 (high quality), and 43 articles were included. The study quality ranged from 2 to 9 with a mean quality score of 5.4. Only 3 studies had a high quality score (>7), of which one found a lower birth weight among fasting women. Few medium quality studies found a significant negative effect on fetal growth or birth indices. The quality of articles that investigated cognitive and long-term effects was poor. The association between Ramadan fasting and health outcomes of offspring is not supported by strong evidence."},{"id":"source_30","type":"source","study":"Walking Football During Ramadan Fasting for Cardiometabolic and Psychological Health Benefits to the Physically Challenged and Aged Populations","year":2022,"doi":"10.3389/fnut.2021.779863","url":"https://doi.org/10.3389/fnut.2021.779863","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":"Zainudin 2022","excerpt":"Concurrent exercise and intermittent fasting regimens for long periods have been shown to enhance cardiometabolic health in healthy individuals. As exercise and fasting confer health benefits independently, we propose that Muslims who are fasting, especially those experiencing health and clinical challenges, continually engage in physical activity during the Ramadan month. In this opinion piece, we recommend walking football (WF) as the exercise of choice among Muslims who are fasting. WF can be played by any individual regardless of the level of fitness, skills, and age. WF has been shown to elicit cardiovascular and metabolic stress responses, which are suitable for populations with low fitness levels. Most importantly, WF has the inherent characteristics of being a fun team activity requiring social interactions among participants and, hence, likely to encourage long-term consistent and sustainable participation."},{"id":"source_31","type":"source","study":"Sex as a Biological Factor in the Changes in Disease Patients During Ramadan Intermittent Fasting: A Systematic Review","year":2022,"doi":"10.3389/fnut.2022.908674","url":"https://doi.org/10.3389/fnut.2022.908674","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":"Roky 2022","excerpt":"BACKGROUND: During Ramadan, many patients with diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy choose to fast even against their doctor's advice. The impact of this intermittent fasting on health and disease could be different in men and women. The aim of this study was to determine the effect of sex as a factor in diseases outcomes of patients who opt to fast during Ramadan. MAIN BODY: The articles included in this study reported data on six diseases: diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy. A systematic search was performed on PubMed and Scopus for observational and clinical studies mentioning Ramadan, diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy in both men and women. Data was extracted by two independent reviewers using a standardized data-collection form. From 381 original articles, 38 studies were selected, including 25,023 patients of which 44.4% were women."},{"id":"source_32","type":"source","study":"The Alteration of the Gut Microbiome during Ramadan Offers a Novel Perspective on Ramadan Fasting: A Pilot Study","year":2023,"doi":"10.3390/microorganisms11082106","url":"https://doi.org/10.3390/microorganisms11082106","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":"Jo 2023","excerpt":"An intermittent fasting regimen is widely perceived to lead to various beneficial health effects, including weight loss, the alleviation of insulin resistance, and the restructuring of a healthy gut microbiome. Because it shares certain commonalities with this dietary intervention, Ramadan fasting is sometimes misinterpreted as intermittent fasting, even though there are clear distinctions between these two regimens. The main purpose of this study is to verify whether Ramadan fasting drives the same beneficial effects as intermittent fasting by monitoring alterations in the gut microbiota. We conducted a study involving 20 Muslim individuals who were practicing Ramadan rituals and assessed the composition of their gut microbiomes during the 4-week period of Ramadan and the subsequent 8-week period post-Ramadan. Fecal microbiome analysis was conducted, and short-chain fatty acids (SCFAs) were assessed using liquid-chromatography-mass spectrometry."},{"id":"source_33","type":"source","study":"Impact of Ramadan Diurnal Intermittent Fasting on Hypoglycemic Events in Patients With Type 2 Diabetes: A Systematic Review of Randomized Controlled Trials and Observational Studies","year":2021,"doi":"10.3389/fendo.2021.624423","url":"https://doi.org/10.3389/fendo.2021.624423","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":"Abdelrahim 2021","excerpt":"Ramadan is the 9th month of the lunar calendar during which Muslims abstain from food and drink between dawn and sunset for 30 consecutive days. Ramadan fasting is observed by all healthy Muslim adults, as well many Muslims with type 2 diabetes (T2DM). Hypoglycemic events (HE) are a serious complication associated with diabetes management and are associated with increased cardiovascular disease risk. Conflicting results have been reported concerning the incidence of HE among people with T2DM observing Ramadan fasting. This review summarizes available scientific evidence on the occurrence of HE and the effects of different moderators on the incidence of HE among patients with T2DM during Ramadan. We conducted a systematic review of available observational studies and randomized controlled trials (RCTs) for patients with T2DM who fasted during Ramadan, with HE as the primary outcome. Ten databases were searched for relevant studies from inception until October 31, 2020. In total, 68 studies (35 RCTs and 33 observational studies) met the inclusion criteria."},{"id":"source_34","type":"source","study":"The impacts of Ramadan fasting for patients with non-alcoholic fatty liver disease (NAFLD): a systematic review","year":2024,"doi":"10.3389/fnut.2023.1315408","url":"https://doi.org/10.3389/fnut.2023.1315408","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":"Lin 2024","excerpt":"BACKGROUND: Numerous studies have explored the impacts of Ramadan fasting on Non-alcoholic fatty liver disease (NAFLD). Therefore, the objective of this systematic review was to analyze and summarize all clinical studies regarding the impacts of Ramadan fasting for patients with NAFLD. METHODS: We performed a comprehensive search of the Embase, Cochrane, and PubMed databases from inception to September 1, 2023. All clinical studies concerning the impacts of Ramadan fasting on patients with NAFLD were included. RESULTS: In total, six studies with 397 NAFLD patients comprising five prospective studies and one retrospective study were included in the systematic review. All six studies were assessed as high-quality. Ramadan fasting may offer potential benefits for patients with NAFLD, including improvements in body weight, body composition, cardiometabolic risk factors, glucose profiles, liver parameters, and inflammation markers. CONCLUSION: Ramadan fasting might be an effective dietary intervention for NAFLD. However, the number of studies examining the impacts of Ramadan fasting for patients with NAFLD is relatively limited."},{"id":"source_35","type":"source","study":"Religious fasting and its impacts on individual, public, and planetary health: Fasting as a “religious health asset” for a healthier, more equitable, and sustainable society","year":2022,"doi":"10.3389/fnut.2022.1036496","url":"https://doi.org/10.3389/fnut.2022.1036496","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":"Trabelsi 2022","excerpt":"Religious fasting is practiced by people of all faiths, including Christianity, Islam, Buddhism, Jainism, as well as Hinduism, Judaism, and Taoism. Individual/clinical, public, global, and planetary health has traditionally been studied as separate entities. Nevertheless, religious fasting, in conjunction with other religious health assets, can provide several opportunities, ranging from the individual to the population, environmental, and planetary levels, by facilitating and supporting societal transformations and changes, such as the adoption of healthier, more equitable, and sustainable lifestyles, therein preserving the Earth's systems and addressing major interconnected, cascading, and compound challenges. In this review, we will summarize the most recent evidence on the effects of religious fasting, particularly Orthodox and Ramadan Islamic fasting, on human and public health. Further, we will explore the potential effects of religious fasting on tackling current environmental issues, with a special focus on nutrition/food restriction and planetary health."},{"id":"source_36","type":"source","study":"Effect of fasting on cardiovascular risk factors among healthy adult Muslims attending primary care, Kano, Northern Nigeria","year":2024,"doi":"10.1186/s12872-024-04325-9","url":"https://doi.org/10.1186/s12872-024-04325-9","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":"Abdulkadir 2024","excerpt":"BACKGROUND: Cardiovascular diseases (CVD) are among the most prevalent and preventable chronic diseases in the 21st century The global burden of disease: 2004 update. The Report in Sections. A person's risk of developing CVD can be reduced by adopting healthy lifestyles, spiritual and religious practices The American Heart Association Life's Simple 7 in African Americans of the Jackson Heart Study. Fasting as a spiritual practice is not exempted from these benefits. Most world's religions recommend a period of fasting. The obligatory Ramadan fasting in Islam may provide an interesting opportunity to reduce food intake and increase physical activity. The main objective of this study is to investigate the effect of Ramadan fasting on cardiovascular risk factors on healthy adult Muslims. METHOD: The study was pre/post-test single arm intervention conducted at the staff clinic of Family Medicine department, AKTH, and Northwest, Nigeria. Kano. The study recruited healthy adults 18yrs and above not on any medications that can affect metabolic profiles consecutively from two weeks before Ramadan fasting of 2018 and the last week of Ramadan of the same year."},{"id":"source_37","type":"source","study":"The Window Matters: A Systematic Review of Time Restricted Eating Strategies in Relation to Cortisol and Melatonin Secretion","year":2021,"doi":"10.3390/nu13082525","url":"https://doi.org/10.3390/nu13082525","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":"Chawla 2021","excerpt":"Time-Restricted Eating is an eating pattern based on the circadian rhythm which limits daily food intake (usually to ≤12 h/day), unique in that no overt restriction is imposed on the quality, nor quantity, of food intake. This paper aimed to examine the effects of two patterns of TRE, traditional TRE, and Ramadan fasting, on two markers of circadian rhythm, cortisol and melatonin. PubMed and Web of Science were searched up to December 2020 for studies examining the effects of time restricted eating on cortisol and melatonin. Fourteen studies met our inclusion criteria. All Ramadan papers found statistically significant decrease in melatonin ( p < 0.05) during Ramadan. Two out of the three Ramadan papers noted an abolishing of the circadian rhythm of cortisol ( p < 0.05). The non-Ramadan TRE papers did not examine melatonin, and cortisol changes were mixed. In studies comparing TRE to control diets, Stratton et al. found increased cortisol levels in the non-TRE fasting group ( p = 0.0018) and McAllister et al. noted no difference. Dinner-skipping resulted in significantly reduced evening cortisol and non-significantly raised morning cortisol."},{"id":"source_38","type":"source","study":"The Impacts of Ramadan Intermittent Fasting on Saliva Flow-Rate and Metabolic Data: A Systematic Review","year":2022,"doi":"10.3389/fnut.2022.873502","url":"https://doi.org/10.3389/fnut.2022.873502","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":"Besbes 2022","excerpt":"The aim of this systematic review was to report the impacts of Ramadan intermittent fasting (RIF) on salivary flow-rate (SFR) and metabolic parameters. A thorough literature search was carried out using the databases PubMed and Scopus from their inception up to 15 July 2021. The Boolean connectors used in PubMed were (Saliva [Mesh] AND Fasting [Mesh]). The same keywords were used in Scopus . Inclusion criteria were defined using PICOS. The research included all original studies involving \"healthy\" adults and published in English. Methodological quality assessment was performed utilizing the Joanna Briggs Institute Critical Appraisal Tool, which allows attributing scores from 1 to 11 to the selected studies. Two authors carried out the literature search, study selection, and data extraction. Differences on issues were resolved by a third author if necessary. The systematic review protocol was registered within the \"Open Science Framework\" (Doi: 10.17605/OSF.IO/DE7BH). Six articles met the inclusion criteria. All studies were heterogeneous and had a high score of bias and several methodological differences."},{"id":"source_39","type":"source","study":"Impact of Ramadan fasting on serum levels of major endocrinology hormonal and biochemical parameters in healthy non-athlete adults: A systematic review and meta-analyses","year":2024,"doi":"10.1371/journal.pone.0299695","url":"https://doi.org/10.1371/journal.pone.0299695","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":"Poursalehian 2024","excerpt":"BACKGROUND: Ramadan Intermittent Fasting (RIF) has the potential to alter hormonal levels in the body. This study investigates the impact of RIF on hormonal levels among healthy individuals during Ramadan. METHODS: A systematic review and meta-analysis of previously published studies were conducted, focusing on healthy non-athlete adults. The intervention examined was Ramadan Intermittent Fasting, and the primary outcomes assessed were changes in endocrine hormonal and biochemical parameters. The pooled effect measure was expressed as odds ratio (OR) and 95% confidence interval (CI) using the random-effects model. RESULTS: A total of 35 original articles were retrieved, with a combined sample size of 1,107 participants eligible for the meta-analysis. No significant relationship was found between pre- and post-Ramadan hormonal levels of T3, T4, TSH, FT3, FT4, Testosterone, LH, FSH, Prolactin, PTH, Calcium, and Phosphorus (P-value<0.05). However, a substantial decrease in morning cortisol levels was observed across the studies (P-value: 0.08, Hedges' g = -2.14, 95% CI: -4.54, 0.27)."},{"id":"source_40","type":"source","study":"Effect of calorie restriction and intermittent fasting on glucose homeostasis, lipid profile, inflammatory, and hormonal markers in patients with polycystic ovary syndrome: a systematic review","year":2024,"doi":"10.3389/fnut.2024.1362226","url":"https://doi.org/10.3389/fnut.2024.1362226","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":"Kalsekar 2024","excerpt":"BACKGROUND AND OBJECTIVE: Polycystic ovary syndrome (PCOS) is a complex hormonal disorder that leads to ovarian cysts, irregular ovulation, and hormonal swings in women. It is a complex and heterogeneous condition that affects 4 to 20% of women of reproductive age worldwide and relates to reproductive, metabolic, and psychosocial dysfunction. Dietary and lifestyle modifications have been proposed to play a central role in the management of PCOS. This study aimed to provide a comprehensive systemic overview of the existing literature on the effects of intermittent fasting (IF) and calorie restriction (CR) regimens on disease markers of PCOS. DESIGNS AND METHODS: Several databases, such as CINAHL, Cochrane, EBSCOhost, EMBASE, Google Scholar, ProQuest Medical, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science databases were searched for clinical trials and observational studies examined the effects of IF regimens such as time-restricted eating and Ramadan model of IF (RIF) on glucose homeostasis, lipid profile, inflammatory and hormonal markers in patients with PCOS."},{"id":"source_41","type":"source","study":"The effect of fasting Ramadan on type 2 diabetes: A narrative review and practice update","year":2026,"doi":"10.4103/jfmpc.jfmpc_1118_25","url":"https://doi.org/10.4103/jfmpc.jfmpc_1118_25","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":"Abdulrahman 2026","excerpt":"Ramadan fasting, observed by Muslims worldwide for over 1,400 years, involves abstaining from food, drink, and other physical needs from dawn to sunset. Despite exemptions for individuals with chronic conditions, many patients with type 2 diabetes mellitus (T2DM) choose to fast, raising concerns regarding safety and metabolic control. To synthesize recent literature (2021-2024) on the physiological impact of Ramadan fasting on individuals with T2DM and offer evidence-based recommendations for safe fasting practices. This narrative review evaluates recent clinical studies on the effects of Ramadan fasting in T2DM patients. Key areas include metabolic outcomes, potential risks, and strategies for pre-Ramadan assessment and individualized care. Emerging evidence suggests that Ramadan fasting may offer metabolic benefits to T2DM patients, including improved insulin sensitivity, reductions in body weight, fat mass, blood pressure, and proinflammatory cytokines. Positive changes in gut microbiota and hormonal regulation have also been reported. However, without proper medical oversight, fasting may increase the risk of hypoglycemia, hyperglycemia, dehydration, and diabetic ketoacidosis."},{"id":"source_42","type":"source","study":"Metabolism and diabetes in Ramadan fasting: Exploring health trends and relationships through systematic literature network analysis","year":2024,"doi":"10.52225/narra.v4i2.850","url":"https://doi.org/10.52225/narra.v4i2.850","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":"Baharuddin 2024","excerpt":"Ramadan fasting is widely acknowledged for its positive impacts on health, yet it also presents inherent risks, prompting a need for comprehensive exploration into its metabolic implications and its effects on diabetes. This study introduces a novel methodology called systematic literature network analysis (SLNA), which merges bibliometric analysis with systematic literature review (SLR). The aim of this study was to examine the global research landscape concerning Ramadan fasting, metabolism, and diabetes. Through the systematic search strategy, 206 relevant documents were analyzed. Through co-occurrence analysis mapping, the study uncovered four distinct cluster groups, revealing intricate relationships and evolving trends within the field. Moreover, the trajectory of research publications on Ramadan fasting from 2001 to 2023 was tracked, highlighting a growing interest in this domain. The bibliometric analysis emphasized a consensus regarding the beneficial effects of Ramadan fasting on individual health, particularly in improving lipid profiles, managing body weight, regulating glucose levels, and nutrient intake."},{"id":"source_43","type":"source","study":"The effect of observing religious or faith-based fasting on cardiovascular disease risk factors: A systematic review and meta-analysis.","year":2024,"doi":"10.1016/j.numecd.2024.02.002","url":"https://doi.org/10.1016/j.numecd.2024.02.002","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":"Gholampoor 2024","excerpt":"AIMS: Cardiovascular diseases (CVD) are the leading cause of death worldwide. Fasting is common in many religions and is associated with health benefits. This systematic review to compares the impact of different religious fasting practices, on risk of cardiometabolic diseases. DATA SYNTHESIS: The search covered five databases following PRISMA guidelines to identify papers published in English from inception to March 2023 (updated January 2024). Inclusion criteria were healthy adults in observational studies, who engaged in religious fasting practices, studies were included where data on matched non-fasting individuals was available. Outcomes were systolic and diastolic blood pressure, body mass index (BMI), triglycerides, total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), and fasting plasma glucose levels. A meta-analysis was conducted, and the review was registered (CRD42022352197). Fourteen studies were met the inclusion criteria with ten studies data being suitable for meta-analysis, reporting on 755 adults participating in fasting practices and 661 non-fasting controls."},{"id":"source_44","type":"source","study":"Intermittent fasting and liver disease: Insights from the Ramadan model","year":2025,"doi":"10.4103/sjg.sjg_120_25","url":"https://doi.org/10.4103/sjg.sjg_120_25","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":"Khalifa 2025","excerpt":"Intermittent fasting (IF) has gained growing interest for its potential metabolic benefits. However, the unique physiological aspects of Ramadan fasting (RF), a culturally and religiously significant form of dry IF, remain underexplored, particularly regarding liver disease. RF imposes distinct metabolic and circadian challenges through prolonged daily fasting and altered meal timing, placing considerable demands on hepatic adaptability. Given the liver’s essential role in energy balance, metabolism, and inflammation, as well as the high prevalence of liver disease in many Muslim-majority regions, it is crucial to better understand how RF impacts liver health. This review synthesizes current evidence on how RF can impact liver function, including its effects on insulin sensitivity, autophagy, gut microbiota, gene expression, and inflammation-related pathways. We further reviewed the clinical implications of RF across the broad spectrum of liver conditions, from metabolic dysfunction-associated steatotic liver disease (MASLD) to advanced cirrhosis, hepatocellular carcinoma (HCC), and post-transplant states."},{"id":"source_45","type":"source","study":"Safety of Ramadan fasting in young patients with type 1 diabetes: A systematic review and meta‐analysis","year":2019,"doi":"10.1111/jdi.13054","url":"https://doi.org/10.1111/jdi.13054","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":"Loh 2019","excerpt":"AIMS/INTRODUCTION: Although patients with type 1 diabetes are medically exempt, many insist on fasting during Ramadan. Multiple daily insulin injections (MDI), premixed insulin and continuous subcutaneous insulin infusion (CSII) are commonly used. To date, little is known about the safety of Ramadan fasting in these patients. MATERIALS AND METHODS: We pooled data from 17 observational studies involving 1,699 patients treated with either CSII or non-CSII (including premixed and MDI) regimen. The study outcomes were the frequencies of hypoglycemia, hyperglycemia and/or ketosis. Given the lack of patient-level data, separate analyses for premixed and MDI regimen were not carried out. RESULTS: The CSII-treated group (n = 203) was older (22.9 ± 6.9 vs 17.8 ± 4.0 years), and had longer diabetes duration (116.7 ± 66.5 vs 74.8 ± 59.2 months) and lower glycated hemoglobin (7.8 ± 1.1% vs 9.1 ± 2.0%) at baseline than the non-CSII-treated group (n = 1,496). The non-CSII-treated group had less non-severe hypoglycemia than the CSII-treated group (22%, 95% CI 13-34 vs 35%, 95% CI 17-55). Of the non-CSII-treated group, 7.1% (95% CI 5.8-8."},{"id":"source_46","type":"source","study":"The Safety and Impact of a Model of Intermittent, Time-Restricted Circadian Fasting (“Ramadan Fasting”) on Hidradenitis Suppurativa: Insights from a Multicenter, Observational, Cross-Over, Pilot, Exploratory Study","year":2019,"doi":"10.3390/nu11081781","url":"https://doi.org/10.3390/nu11081781","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":"Damiani 2019","excerpt":"Hidradenitis suppurativa (HS) is a chronic-relapsing and debilitating disease, which affects the components of the folliculopilosebaceous unit and severely impacts on the perceived health-related quality of life. Among the possible treatments, dietary interventions, such as fasting, have been described to positively impact on HS. However, nothing is known about the effects of circadian, intermittent fasting, such as the Ramadan fasting. A sample of 55 HS patients (24 males (43.6%) and 31 females (56.4%), mean age 39.65 ± 8.39 years, average disease duration 14.31 ± 7.03 years) was recruited in the present study. The \"Severity of International Hidradenitis Suppurativa Severity Score System\" (IHS4) decreased significantly from 11.00 ± 5.88 (before Ramadan) to 10.15 ± 6.45 (after Ramadan), with a mean difference of -0.85 ± 0.83 ( p < 0.0001)."},{"id":"source_47","type":"source","study":"Effects of Ramadan fasting on aspirin resistance in type 2 diabetic patients","year":2018,"doi":"10.1371/journal.pone.0192590","url":"https://doi.org/10.1371/journal.pone.0192590","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":"Bouida 2018","excerpt":"AIMS: Ramadan fasting (RF) may affect aspirin resistance. We conducted this study in patients with cardiovascular risk (CVR) factors to assess the effect of RF on aspirin resistance and explore whether type 2 diabetes mellitus (DM) would influence this effect. METHODS: A total of 177 stable patients with ≥2 CVR factors were recruited. All patients observed RF and were taking aspirin. Physical exam and standard biological tests including glycaemia and serum lipids data were performed before Ramadan (Pre-R), at the last week of Ramadan (R) and four weeks after the end of Ramadan (Post-R). In the same visits caloric intake was calculated and platelet reactivity to aspirin was assessed using Verify Now point-of-care assay. RESULTS: In the overall population, there was no significant change in absolute aspirin reaction unit (ARU) values and in metabolic parameters. In DM patients (n = 127), ARU change from Pre-R values was+19.7 (p = 0.01) and +14.4 (p = 0.02) respectively at R and Post-R. During Ramadan, glycaemia, triglycerides, and cholesterol levels increased significantly and returned to Pre-R values thereafter. These changes were not observed in non-DM patients."},{"id":"source_48","type":"source","study":"The effect of Ramadan fasting during pregnancy on perinatal outcomes: a systematic review and meta-analysis","year":2018,"doi":"10.1186/s12884-018-2048-y","url":"https://doi.org/10.1186/s12884-018-2048-y","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":"Glazier 2018","excerpt":"BACKGROUND: Although exempt, many pregnant Muslim women partake in the daily fast during daylight hours during the month of Ramadan. In other contexts an impoverished diet during pregnancy impacts on birth weight. The aim of this systematic review was to determine whether Ramadan fasting by pregnant women affects perinatal outcomes. Primary outcomes investigated were perinatal mortality, preterm birth and small for gestational age (SGA) infants. Secondary outcomes investigated were stillbirth, neonatal death, maternal death, hypertensive disorders of pregnancy, gestational diabetes, congenital abnormalities, serious neonatal morbidity, birth weight, preterm birth and placental weight. METHODS: Systematic review and meta-analysis of observational studies and randomised controlled trials was conducted in EMBASE, MEDLINE, CINAHL, Web of Science, Google Scholar, the Health Management Information Consortium and Applied Social Sciences Index and Abstracts. Studies from any year were eligible. Studies reporting predefined perinatal outcomes in pregnancies exposed to Ramadan fasting were included."}],"edges":[{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_1","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_2","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_3","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_4","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_5","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_6","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_7","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_8","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_9","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_10","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_11","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_12","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_13","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_14","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_15","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_16","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_17","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_18","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_19","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_20","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_21","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_22","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_23","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_24","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_25","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_26","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_27","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_28","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_29","type":"contains_claim"},{"from":"60d2c379-d1f7-471e-9252-90414e695085","to":"claim_30","type":"contains_claim"}],"screening":{"identified":48,"screened":48,"excluded":0,"included":48,"included_or_retained":48,"flow":["identified","screened","excluded_with_reasons","included"],"wording":"48 candidate receipts retained after source retrieval, deduplication, and topic filtering. 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