BackgroundFasting during the month of Ramadan for Muslims is a unique metabolic model that includes abstinence from food and fluid intake during the period from dawn to sunset as well as a reduction in meal frequency and alterations in the sleep-wakefulness cycle. Leptin, neuropeptide-Y and insulin are thought to play an important role in long-term regulation of caloric intake and energy expenditure. However, the long-term changes and interactions between these factors during this pattern of fasting are not known.Subjects and MethodsThe study was conducted on 46 healthy female volunteers (age, 22±2 years; BMI, 25.3±0.7 kg/m2). Anthropometrical measurements, estimation of body fat and fasting serum levels of neuropeptide Y, leptin, insulin and glucose were estimated at baseline (day 1), days 14 and 28 of the month of Ramadan and 2 weeks after Ramadan.ResultsBaseline serum levels of leptin correlated positively with body fat (r=0.87, P=0.0002). Serum leptin levels exhibited a significant increase by approximately 41 % and neuropeptide-Y levels were decreased by 30.4% throughout the month of Ramadan. In addition, a significant correlation (r=0.63, P=0.0001) was found between changes in serum leptin and serum insulin. However, changes in serum neuropeptide-Y levels did not correlate with those of leptin or insulinConclusionsLong-term fasting with interrupted nocturnal eating is associated with significant elevations in serum leptin and insulin and reduction in serum neuropeptide-Y. The changes in serum leptin are likely mediated through insulin. However, changes in neuropeptide-Y appears to be mediated independently of leptin or insulin during this type of fasting

The results necessitate further studies in determining the cause of PHC. We predict a genetic element contributing to the high percentage of PHC in the current study.

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BACKGROUNDMaternal hyperglycemia is considered a risk factor for fetal morbidity. Since there is a high prevalence of diabetes mellitus among the population of Bahrain, we conducted a prospective population-based study of gestational diabetes mellitus (GDM) in non-diabetic pregnant women.SUBJECTS AND METHODSAll non-diabetic pregnant women attending antenatal clinics during January 2001 to December 2002 (n=10 495) were screened for GDM during the 24th to 28th weeks of gestation. All positive subjects based on a 50-g glucose challenge test (GCT) were further evaluated by a diagnostic 75-g oral glucose tolerance test (OGTT). The birth weight of the child and post-delivery insulin resistance were monitored. The homeostasis model of insulin resistance (HOMA-IR) was used to assess insulin resistance.RESULTSOf 10 495 non-diabetic pregnant women screened, 32.8% (n=3443) had plasma glucose ≥7.8 mmol/L (140 mg/dL) in the GCT. The 75-g OGTT found a prevalence of GDM of 13.5%. There were twice as many Bahrainis as expatriates. Of children born to women with GDM, 6.5% had a birth weight >4000 g. Post-delivery evaluation of insulin resistance indicated that 33% of women with GDM had a HOMA-IR value >2.CONCLUSIONThe population of Bahrain is a high-risk ethnic group for GDM. The association of insulin resistance in the post-gravid state with GDM among 33% of the study population suggests that insulin resistance, the possible cause of the pathophysiological mechanism underlying the development of gestational diabetes, continues in the post gravid state.

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