title: Obesity surgery and Ramadan: a prospective analysis of nutritional intake, hunger and satiety and adaptive behaviours during fasting.
abstract: BACKGROUND
  Fasting for religious or lifestyle reasons poses a challenge to people who have undergone bariatric surgery. A total fast (abstaining from all forms of nourishment including liquids) during long summer days puts these patients at risk of dehydration and poor calorie and nutrient intake.
  
  
  METHODS
  We undertook telephone surveys of 24-h food recall, hunger and satiety scores, medication use, adverse symptoms and depression scores on a fasting day in Ramadan and a non-fasting day subsequently.
  
  
  RESULTS
  We studied 207 participants (166 women) who had undergone sleeve gastrectomy. The mean (standard error) age was 35.2 (0.7) years. Men and women consumed 20.4 % (P = 0.018) and 16.9 % (P < 0.001) fewer calories and 44.8 % (P < 0.001) and 32.4 % (P < 0.001) less protein during fasting, respectively. There was no significant difference in the intake of fluids or incidence of adverse gastrointestinal, hypoglycaemic and sympathoadrenal symptoms. Of participants on pharmacotherapy, 89.5 % took their prescribed medications; 86.3 % made no changes to the doses, but 80.4 % changed the timing of the medications. Both women and men reported feeling less hungry and a preference for savoury foods during Ramadan. There was no difference in depression and work impairment scores.
  
  
  CONCLUSIONS
  Fasting was well tolerated in persons who had undergone sleeve gastrectomy. It may be advisable to raise awareness about dietary protein intake and managing medications appropriately during fasting.
authors.affiliation: Faculty of Medicine, Department of Medicine, Kuwait University, P.O. Box 24923, 13110, Kuwait City, Kuwait, alozairi@hsc.edu.kw.
authors.forename: Ebaa
authors.initials: E
authors.lastname: Al-Ozairi
authors.forename: Jumana
authors.initials: J
authors.lastname: Al Kandari
authors.forename: Dalal
authors.initials: D
authors.lastname: AlHaqqan
authors.forename: Obaid
authors.initials: O
authors.lastname: AlHarbi
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Masters
authors.forename: Akheel A
authors.initials: AA
authors.lastname: Syed
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D002149:Energy Intake / Q000502:physiology; D005215:Fasting / Q000009:adverse effects / Q000502:physiology*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D006815:Hunger / Q000502:physiology*; D007514:Islam; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D012068:Religion and Medicine; D012527:Satiation / Q000502:physiology