The Effect of Ramadan Fasting on the Health of a Predominant Muslim Population in the UK

Abstract

Background: Ramadan fasting, in which Muslims abstain from food and drinks from dawn to sunset, is one of the five Pillars of Islam. Millions of Muslims observe this month every year. However, little is known on the effect of Ramadan fasting on health. There is a lack of research investigating the effect of Ramadan on health. Ramadan fasting is associated with sudden changes in lifestyle includ- ing changes in mealtime and sleeping pattern. These changes lead to circadian misalignment that could lead to cardiometabolic dysfunction and cardiovascular disease. Moreover, dehydration re- sulting from the prolonged fasting is claimed to increase the risk of infection in Ramadan. The aims of this thesis are (1) to assess the impact of Ramadan fasting on different aspects of health (2) to strengthen the available evidence on the effect of Ramadan fasting on health using a robust method that have not previously been employed in Ramadan research. Methods: The overall methods (1) using The Health Improvement Network (THIN) database for a retrospective cohort design to explore the cardiometabolic profile of a predominate Muslim popu- lation in the UK, (2) systematic review to summarise the available evidence on the effect of Ramadan fasting on cardiovascular disease (CVD) and risk factors for CVD in patients with diabetes (3) con- trolled interrupted time series using THIN database and hospital data to explore (a) infection (all infections), using antibiotics prescriptions as a proxy measure and (b) ischemic heart disease (IHD) risks in a predominant South Asian Muslim population in the UK to a predominantly non-Muslim white ethnic population as a control group. 2 Results: The retrospective cohort study showed that compared to white population, South Asian (SA) are at higher risk of diabetes, hypertension and IHD with some variations between SA sub- groups. Systematic review showed that there is insufficient evidence suggesting that Ramadan fast- ing is associated with increased risk of CVD events in patients with diabetes. The interrupted time series studies show that there is no evidence that Ramadan fasting is associated with increased risk of infection or IHD. Conclusion: Up to date there is no evidence that Ramadan fasting is associated with detrimental effect on health. However, more well conducted studies are needed to validate the findings.