Changes in energy and macronutrient intakes during Ramadan fasting: a systematic review, meta-analysis, and meta-regression

Dana N Abdelrahim; Salah Eddine El Herrag; Meghit Boumediene Khaled; Hadia Radwan; Farah Naja; Refat Alkurd; Moien A B Khan; Falak Zeb; Katia H AbuShihab; Lana Mahrous; Khaled Obaideen; Faiza Kalam; Frank Granata Iv; Mohamed Madkour; MoezAlIslam E Faris

doi:10.1093/nutrit/nuad141

Changes in energy and macronutrient intakes during Ramadan fasting: a systematic review, meta-analysis, and meta-regression

Nutr Rev. 2023 Nov 20:nuad141. doi: 10.1093/nutrit/nuad141. Online ahead of print.

Authors

Dana N Abdelrahim¹, Salah Eddine El Herrag^{2

3}, Meghit Boumediene Khaled^{2

3}, Hadia Radwan^{1

4}, Farah Naja^{1

4

5}, Refat Alkurd⁶, Moien A B Khan⁷, Falak Zeb¹, Katia H AbuShihab¹, Lana Mahrous⁸, Khaled Obaideen⁹, Faiza Kalam^{10

11}, Frank Granata Iv¹², Mohamed Madkour^{1

13}, MoezAlIslam E Faris^{1

4}

Affiliations

¹ Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates.
² Laboratoire de Nutrition, Pathologie, Agro-biotechnologie & Santé (Lab-NuPABS), Djillali Liabes University, Sidi Bel Abbes, Algeria.
³ Department of Biology, Faculty of Life and Natural Science, Djillali Liabes University of Sidi Bel Abbes, Sidi Bel Abbes, Algeria.
⁴ Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
⁵ Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon.
⁶ Department of Nutrition, Faculty of Pharmacy and Medical Sciences, Petra University, Amman, Jordan.
⁷ Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
⁸ Department of Health Sciences/Track of Clinical Nutrition, College of Health and Rehabilitation, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
⁹ Sustainable Energy and Power Systems Research Centre, RISE, University of Sharjah, Sharjah, United Arab Emirates.
¹⁰ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹¹ Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.
¹² Department of Medical Education, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
¹³ Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.

PMID: 37986623
DOI: 10.1093/nutrit/nuad141

Abstract

Context: Ramadan fasting (RF) is associated with various physiological and metabolic changes among fasting Muslims. However, it remains unclear whether these effects are attributable to changes in meal timing or changes in dietary energy and macronutrient intakes. Furthermore, the literature on the associations between RF, meal timing, and energy and macronutrient intakes is inconclusive.

Objectives: This systematic review aimed to estimate the effect sizes of RF on energy and macronutrient intakes (carbohydrates, protein, fats, dietary fiber, and water) and determine the effect of different moderators on the examined outcomes.

Data sources: The Cochrane, CINAHL, EMBASE, EBSCOhost, Google Scholar, PubMed/MEDLINE, ProQuest Medical, Scopus, ScienceDirect, and Web of Science databases were searched from inception to January 31, 2022.

Data extraction: The studies that assessed energy, carbohydrate, protein, fat, fiber, and water intakes pre- and post-fasting were extracted.

Data analysis: Of the 4776 identified studies, 85 relevant studies (n = 4594 participants aged 9-85 y) were selected. The effect sizes for the studied variables were as follows: energy (number of studies [K] = 80, n = 3343 participants; mean difference [MD]: -142.45; 95% confidence interval [CI]: -215.19, -69.71), carbohydrates (K = 75, n = 3111; MD: -23.90; 95% CI: -36.42, -11.38), protein (K = 74, n = 3108; MD: -4.21; 95% CI: -7.34, -1.07), fats (K = 73, n = 3058; MD: -2.03; 95% CI: -5.73, 1.67), fiber (K = 16, n = 1198; MD: 0.47; 95% CI: -1.44, 2.39), and water (K = 17, n = 772; MD: -350.80; 95% CI: -618.09, 83.50). Subgroup analyses showed age significantly moderated the 6 dietary outcomes, and physical activity significantly moderated water intake. There were significant reductions in energy, carbohydrate, and protein intakes during RF.

Conclusions: The change in meal timing rather than quantitative dietary intake may explain various physiological and health effects associated with RF.

Keywords: caloric restriction; chrononutrition; dietary and lifestyle modification; energy-yielding nutrient; time-restricted eating.

Grants and funding

T32CA193193/National Health Institute