results were observed regarding the effect of dietary fat on blood
cholesterol and uric acid levels, which may be due to lack or insufficient
consideration of (a) the body-weights of the subjects, and (b) energy
intake levels in relation to the requirements. Further, researchers noted
that the general guide-line for energy intake through fat - not more than
30 percent of the total, may be appropriate for the general population but
not during the Ramadan fasting period or other situations that involve
restricted energy intake. Higher intake of fat-energy, around 36 percent
of the total intake, which includes poly-unsaturated fat may prevent
elevation of blood cholesterol and uric acid levels and allow better
retention of protein in the body. These findings can be applicable among
diverse racial, religious or gender groups. They can also apply to other
restricted energy intake conditions, such as found among subjects with
anorexia nervosa or those following prolonged low-calorie weight-control
diet. Int J Ramadan Fasting Res. 1(1):1-6, 1997
Ramadan fasting can serve as an excellent
research model for the study of human metabolism and behavior. One of the
earliest published research findings on Ramadan fasting is from East Pakistan,
now Bangladesh, reported by Muazzam and Khaleque (1). During the last twenty
years there has been growing realization on the part of many scientists for
further research in this area. Recently, a Ramadan fasting model has been used
for various metabolic studies, Iraki et al (2), Ayabak et al (3), Husain et al.
(4), Malik et al (5), El Ati et al (6), Nomani (7), Nomani et al (8), Sweileh et
al (9) and Malhotra eta al (10) and for behavior modification, Afifi (11) Farren
and Naidoo (12) and Daradkeh (13).
High blood cholesterol and uric acid have
been considered health risk factors in cardiovascular diseases and gout,
respectively. Conflicting results have been reported on the effect of dietary
fat on changes in blood cholesterol levels, Gurr et al (14) and Kritchevsky
(15). In 1979, Nomani et al (16) hypothesized that there is an increase in blood
cholesterol levels with either increasing or decreasing level of energy intake
in relation to the requirement. The recent findings of Ramadan fasting research,
Nomani (7), Nomani et al (8) and Hallak and Nomani (17), confirm the hypothesis
and help in resolving the dilemma of conflicting findings. The dietary
regulation of blood cholesterol and uric acid levels are not only useful for
Muslims but also for others throughout the world, irrespective of religion,
race, color, gender or ethnic group.
According to the 1995 dietary guidelines,
from the U. S. Department of Agriculture and Department of Health and Human
Services (18) - energy from fat should not to be more than 30 percent, a level
that is appropriate for the general population; however, this level may be
inappropriate during Ramadan fasting or similar restricted energy intake
situations. Under restricted energy intake conditions, such as Ramadan fasting,
anorexia nervosa, prolonged weight control dieting and low energy intake
conditions in underdeveloped or developing countries, there is a need for
One of the major problems that contributes
to conflicting results on the effect of quantity or quality of dietary fat on
blood cholesterol level is a failure to examine the effect of dietary fat in
relation to body weight or changes in body weight. There is an increase in blood
cholesterol levels with increasing or decreasing weight from normal weight
levels. Hallak and Nomani (17) noted increased blood cholesterol level with
weight loss during the fasting month of Ramadan. Other investigators also noted
increased blood cholesterol level with weight loss, Fedail et al. (19), Shoukry
(20) and El Arnaoty and Johnson (21). Among non-Muslim American female subjects
there was increase in blood cholesterol level with lowering of the body
mass-index below 18.5, Nomani et al. (22). During Ramadan, when no significant
difference was noticed in blood cholesterol levels, before and after fasting
period, there was no significant difference in body weight as well, Maislos, et
Dietary fat and blood cholesterol level
Another omitted or insufficiently
considered factor is statement of the energy intake in relation to the
requirement. Under limited energy intake conditions, several studies on rats and
humans, which include Muslims and non-Muslims, have indicated beneficial effects
of a high fat-diet. In rats when the energy intake was ~70 percent of the
requirement, blood cholesterol level was negatively associated with dietary fat
energy, Nomani et al (24). In another study from the same laboratory, Forbes et
al (25), found no significant difference in blood cholesterol levels of rats on
diet with 40 percent of the total energy intake through fat (corn and coconut
oils, 1.4:2) as compared to the group consuming 21 percent fat-energy from corn
oil. Total energy intake was around 67-75 percent of the requirement. Further,
this study indicates that there was significantly higher, p<0.05, nitrogen
retention in the body in the high-fat diet group.
In humans, Murray et al (26) reported no
significant difference between the mean blood cholesterol levels of Anagamba
nomads, consuming 73% of the energy as fat, mainly from milk, and Kanouri
sedentary men, both from East-Niger and of the same genetic stock, consuming
only 9% of energy as fat. The total energy intake was around 18,00 kcal/day and
mean weight of 52.3 kg and 51.4, respectively. Among Americans, Grundy (27)
noted that when body weight was kept constant, a diet rich in monounsaturated
fatty acids was as effective in lowering plasma cholesterol as was a diet low in
fat and high in carbohydrate.
Hallak and Nomani (17) found that during
the last two weeks of Ramadan fasting, when the subjects were on high-fat diets
(1834 Kcal/day), there was no significant difference in blood cholesterol levels
and body weights from beginning and end of this period. In another Ramadan
study, when there was no significant change in body weight, Nomani et al. (8)
noted change in serum cholesterol level inversely related to fat energy intake
(coefficient of correlation, r = - 0.77, p<0.02). In a concave curve-linear
model change in total-cholesterol: HDL-cholesterol ratio was the lowest and
optimal at 36 percent of the energy from fat, coefficient of determination, r2
= 0.86, p<0.01. In the multiple regression r2 value further
improved (0.98) with the inclusion of total energy intake, change in
= 4118.28 - 6.009 Fat, g/day - 3.077 Energy, Kcal/day. + 0.0007 Energy
(Kcal/day)2, p<0.001, Nomani (7). This suggest that fat and total
energy level independently affected changes in the ratio. Maislos, et al (23)
found that not only was there no significant difference in blood cholesterol
level but the HDL-cholesterol profile improved during the fasting period. The
dietary records were not available. However, the authors had the impression that
the food consumed during Ramadan was of higher fat and carbohydrate content than
that consumed during the rest of the year. In a recent study, El Ati et al. (6)
showed that during Ramadan fasting the body develops adaptive mechanisms and
there is an increased and decreased oxidation of fat and carbohydrate,
The findings of the above studies have
lead to hypothesize that when energy is a limited, increased dietary fat level
favors reduced breakdown of body protein, including labile proteins. Low-density
lipoprotein (LDL) cholesterol-receptors , which are protein in nature, also may
be affected. Thus, high-fat diet contributes in preventing the elevation of
blood cholesterol level at restricted energy conditions, including Ramadan
fasting. The findings have probable usefulness not only among Muslims observing
Ramadan fast but also non-Muslims with anorexia nervosa, hospital in-patient
subjects with low-weight or under-weight, populations in under-developed or
developing countries, persons on prolonged low-calorie diets in weight-control
programs and in many other situations with restricted energy intake conditions.
BLOOD URIC ACID
During Ramadan fasting increased blood
uric acid have been observed by Fedail et al (19), El Ati et al (6), Gumaa et al
(28), Nomani et al (29) and Al-Hader et al (30) . Nomani et al (29) noted change
in blood uric levels negatively related to the changes in body weight, r = 0.52,
p<0.05. In other words, increase in blood uric acid level was positively
associated with body weight loss. During the last two weeks of Ramadan fasting,
blood uric acid level in subjects with high uric acid level was prevented from
further rise with the inclusion of high-fat diet, Nomani et al (7). Uric acid is
a product of purine metabolism. Dietary-fat may be helpful in preventing the
catabolism of these nitrogen containing compounds and protein during the fasting
period. El Ati et al (6) noted the uric acid level returned back to normal one
month after Ramadan period.
The findings of Ramadan fasting among
Muslims and similar limiting energy intake situations among non-Muslims suggest
that a high-fat diet around 36 percent of energy through fat, which includes
poly-unsaturated fat, may be beneficial in preventing elevation of blood
cholesterol or uric acid level and better retention of protein in the body.
Mohammad Zafar A. Nomani, is Professor Emeritus, West Virginia University;
and recipient of the first King Hassan II award for outstanding research
contributions on Ramadan fasting, honored by Hassan II Foundation for Scientific
and Medical Research on Ramadan, Casablanca, Morocco, at the First World
Congress on Health and Ramadan.
Source: International Journal of Ramadan Fasting Research
Disclaimer: The IslamiCity
editorial board does not support or oppose the views expressed in this article.
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