Lipids, Lipoprotein Distribution and Nutritional Parameters over the Ramadan Period in Hemodialysis Patients

Abstract

The period of Ramadan (R) is associated with dramatic changes in eating habits involving extended periods of fasting on a daily basis. The current study assessed whether lipids and lipoproteins were impacted during R in chronic hemodialysis (HD) patients. Forty-five subjects in an outpatient dialysis clinic in Saudi Arabia were evaluated for anthropometric and lipid changes on a monthly basis before, during as well as one and two months after R. In addition to routine biochemical measures, anthropometric assessments including hand-grip strength (HGS), mid-arm muscle circumference (MAMC), plasma lipids and lipoproteins were evaluated. Dietary assessment was carried out using 24 h recalls. Over the course of the study, changes in renal-related parameters (creatinine, albumin, Kt/V) were minor, as were changes in plasma lipids. Large high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs) accounted for the majority of their respective lipoproteins and their proportions did not change over the study period. Mean LDL particle diameters were higher during the R period, but the changes over the study period were small. Calorie intake during R (2139 ± 709 kcal/d) was significantly higher than the value noted two month post-R (1755 ± 424 kcal/d) and this was associated with significant increases in protein (69 ± 24 vs. 60 ± 24 g/d) and fat (97 ± 38, vs. 73 ± 35 g/d), respectively. No changes were noted with respect to HGS and MAMC. These data show that for HD patients, the period of R results in temporal or non-significant effects on plasma lipids, despite changes in nutrient intake.

Protein Energy Wasting in a Cohort of Maintenance Hemodialysis Patients in Dhaka, Bangladesh

“…In our study population, the mean age was 50 years and 19 Kg, which is ~10% lower as compared to what was found among healthy adult population. The value was also similar to HGS reported in HD patients from Saudi Arabia [ 36 ] and Malaysia [ 37 ] of comparable age.…”

“…The TG/HDL ratios observed in this study are considerably higher than our previous reports in HD patients from Malaysia, Saudi Arabia, as well as a cohort of African American HD patients in the USA [ 36 , 37 , 45 ]. As ours is a preliminary observational study, the underlying reason for this is not clear.…”

Exploring the experiences and perceptions of haemodialysis patients observing Ramadan fasting: a qualitative study

“…This includes the quality, quantity and type of foods permitted during this fasting month. Other quantitative studies have indicated that although total dietary energy and protein intakes decreased significantly during Ramadan, there was a notably increased intake of dietary potassium attributed to food and beverages with high potassium [ 14 , 15 ] content such as dates and fruit juices which are typically consumed during the breaking of fast [ 58 ].…”

“…With regard to the HD population, quantitative research findings indicate that Ramadan fasting lead to significant changes in nutritional status concerning body weight and biochemical profiles as well as dietary intake [ 14 , 15 ]. However, the exploration of HD patients’ views on Ramadan fasting practices is unknown.…”

“…Hence, HD patients have to adhere to prescribed diets with specific fluid and nutrient restrictions [11], that at the same time are adequate for energy and protein to prevent malnutrition [12]. Despite being at risk for malnutrition, around 40 to 70% of HD patients still choose to fast as observed in countries with Muslim populations [13][14][15]. Reports indicate Ramadan fasting appears to be well-tolerated but careful monitoring of serum electrolyte levels in particular is called for [16,17] .…”