28 February 2014: Clinical Research
Effect of Ramadan fasting on serum concentration of apelin-13 and new obesity indices in healthy adult men
Ahmet Celik ABCDEFG , Edibe Saricicek ABC , Vahap Saricicek ABC , Elif Sahin ABC , Gokhan Ozdemir CDEF , Selim Bozkurt ABC , Mehmet Okumus ABE , Mustafa Haki Sucakli BD , Gurkan Cikim BE , Yasemin Coskun BF , Mustafa Saygin Deniz BF , Ekrem Dogan CE , Metin Kilinc AE
DOI: 10.12659/MSM.890139
Med Sci Monit 2014; 20:337-342
Abstract
BACKGROUND: The aim of this study was to determine how Ramadan fasting (RF) affected the recently described new obesity indices [visceral adiposity index (VAI), waist circumference to height ratio (WHtR), body adiposity index (BAI)], and serum concentration of apelin-13 (RF) in healthy adult men.
MATERIAL AND METHODS: For this purpose, 42 healthy adult men were selected. Anthropometric parameters were measured and a sample of venous blood was obtained for biochemical assays on the first and last days of Ramadan. When all subjects were evaluated, all anthropometric parameters changed except VAI. Serum apelin-13, triglyceride (TG), HDL-cholesterol (HDL-C), and insulin levels did not change. When patients were divided into 3 groups according to body mass index (BMI), BAI decreased in normal-weight subjects and WHtR decreased in other groups, but VAI and apelin-13 did not change in any groups.
RESULTS: We demonstrate for the first time that while some anthropometric parameters changed, VAI and serum apelin-13 levels did not change with RF. BMI, waist circumference (WC), TG, and HDL-C were evaluated together in calculation of VAI. TG, VAI, and HDL-C remained unchanged by RF. Even if body weight (BW) and BMI decreased, apelin-13 was not affected by RF. The data on serum apelin-13 may have been influenced by the small-percentage decrease in BW, as well as insignificant improvements in metabolic parameters such as lipid profiles, glucose, and insulin.
CONCLUSIONS: We found that Ramadan fasting in healthy adult men was associated with significant decreases in BW, BMI, WHtR, and BAI, but we found no significant changes in VAI and serum apelin-13 concentrations.
Keywords: Intra-Abdominal Fat, Adiposity - physiology, Fasting, Body Mass Index, Cholesterol, HDL - blood, Fasting - blood, Intercellular Signaling Peptides and Proteins - blood, Intra-Abdominal Fat - metabolism, Islam, Turkey, Waist-Height Ratio
Background
Ramadan is the holiest month in the Islamic calendar and Muslims fast during this month. They abstain from eating and drinking from Sahur (the meal taken just before dawn during the Ramadan fast) until Iftar (sunset) during Ramadan, which is a lunar month of 29 or 30 days. This is referred to as Ramadan fasting (RF), which lasts from 8 to 18 hours, according to the season and latitude. Ramadan fasting entails major changes in sleep pattern, physical activity, and eating habits, which may cause changes in metabolism. Many aspects of these changes have been studied.
Visceral adiposity index (VAI), waist circumference-to-height ratio (WHtR), and body adiposity index (BAI) are newly described obesity indices [1–5]. The VAI is postulated to be a good indicator of visceral obesity and insulin sensitivity and is significantly correlated with visceral adiposity. Increased VAI has been found to be strongly associated with cardio-metabolic risk [2–6].
Apelin is a bioactive peptide that is synthesized and secreted by adipocytes [7]. Its gene encodes a pre-proprotein that is processed to generate bioactive peptides consisting of 36, 17, or 13 amino acids (apelin-36, apelin-17, and apelin-13, respectively). Apelin-13 acts primarily in the peripheral and central nervous systems, playing important roles in regulating cardiovascular function, fluid homeostasis, and hypertension, as well as regulating eating behavior, gastrointestinal function, and insulin sensitivity [8–10].
We aimed to investigate how new anthropometric obesity parameters (VAI, WHtR and BAI) and serum concentration of apelin-13 are affected by RF in healthy adult men.
Material and Methods
SUBJECTS:
The study included 42 healthy males without any disease or drug use, with a mean age of 35.0±8.9 years, who declared that they would fast for the entire month of Ramadan. The subjects were divided into 3 groups according to the World Health Organization (WHO) criteria of BMI as normal (n=15), overweight (n=17) and obese (n=10).
ANTHROPOMETRIC PARAMETERS:
A 10-mL fasting blood sample of was collected twice from the median cubital vein by using a vacuum sampling method from each subject. Height, body weight (BW), waist circumference (WC), and hip circumference (HC) were measured for twice on the first day (R1) and last day (R2) of Ramadan at 11:00 a.m. (8–9 hours after the last meal [Sahur]). Serum aliquots were preserved at −80°C until biochemical analyses.
BMI, waist circumference-to-hip circumference ratio (WHR), WHtR, VAI, and BAI were calculated. The BW, height, WC (measured at a level midway between the lowest rib margin and the iliac crest), and HC (widest diameter over the greater trochanters) were measured using standardized procedures to calculate obesity indices as follows [5]:
BIOCHEMICAL ASSAYS:
Serum Triglyceride (TG), Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were analyzed using standard methods.
Serum apelin-13 levels were determined with ELISA (enzyme-linked immunosorbent assay) method by using a commercial kit (USCN Life Science Inc.), an automatic ELISA microplate reader (Thermo Scientific, Finland), and a computer program (Skanlt for Multiscan FC 2.5.1). Sensitivity was 37.2 pg/mL and the detection range was 98.8–8000 pg/mL. Intra-assay CV was <10% and inter-assay CV was <12%. Results were observed as ng/mL.
STATISTICAL ANALYSIS:
Results are expressed as mean ±SD, number, and percent. Data were analyzed in SPSS Program 15.0 (SPSS Inc., Chicago, IL, USA). Paired t test (in all subjects) and Wilcoxon t test (in groups according to BMI) were used to match variables between R1 and R2. Statistical significance was assumed when the p-value was less than 0.05.
Results
Demographic, anthropometric and biochemical data obtained from the subjects at R1 and R2 with p values are listed in Table 1. All anthropometric measurements except VAI were decreased at R2 (p<0.05). Glucose, TC, and LDL-C increased and TG, HDL-C, insulin, and apelin-13 remained unchanged.
The demographic, anthropometric, and biochemical data of groups according to BMI score with p values are listed in Table 2. BAI decreased in normal-weight subjects and WHtR decreased in overweight and obese subjects at R2.
BW was decreased in 35 subjects and increased in 7 subjects (2 normal-weight and 5 overweight). Mean decreases of BW were 2.61% in all subjects and 2.7%. 2.17%, and 2.61% in normal-weight, overweight, and obese subjects, respectively. VAI, WHtR, and BAI were decreased in subjects who lost weight, but there was no significant difference in subjects who gained weight. When subjects who gained weight were excluded, apelin-13 was not significantly different.
Discussion
LIMITATIONS:
We did not investigate the effects of calorie intake and energy expenditure, sleeping harmony, and diurnal rhythm-related hormones, and we did not follow up the effects of RF. Because all subjects were healthy, insulin resistance and sensitivity and their relation with apelin-13 were not examined.
Conclusions
There were significant decreases in BW, BMI, WHtR, and BAI, but no significant changes in VAI and serum apelin-13 concentrations during Ramadan fasting in healthy adult men.
Further studies considering the calorie intake and energy expenditure, physical activity, nutrition, and sleeping harmony, and recording the follow-up effects of RF may provide more detailed findings related to the effects of RF on health.
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