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Asymmetric dimethylarginine and Ramadan fasting

European Journal of Clinical Nutrition volume 68, page 1368 (2014)Cite this article

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We read the article by Yousefi et al.1 with great interest. The authors investigated the effects of Ramadan fasting, as a diet intervention, on endothelial function as assessed by plasma asymmetric dimethylarginine (ADMA), vascular endothelial growth factor, nitric oxide (NO) and malondialdehyde (MDA) concentrations. The authors found that post-Ramadan levels of ADMA decreased significantly, while post-Ramadan levels of NO increased significantly in comparison to pre-Ramadan levels. In addition, VGEF and MDA concentrations also decreased during Ramadan fasting, but it did not reach a statistically significant level.

Ramadan is the holiest month in the Islamic calendar, during which healthy Muslims all over the world abstain from eating, drinking, conjugal relationships and smoking from dawn until sunset as a sign of restraint and introspection for a period of 29–30 days.2 Depending on the season and the geographical location of the country, day fasting varies from 11 to 18 h, being longer in the summer and in temperate regions. During the month of Ramadan, there are profound alterations in dietary habits and lifestyle, with the common practice being to consume one lighter meal before dawn (Sahour meal) and a larger meal after sunset (Iftar meal). In addition, physical activity and night sleep usually decrease as a result of the phase shift in food and fluid intake.2 Previous studies have shown that Ramadan fasting is associated with improvements in serum lipids and oxidative stress, which can be easily assessed by ADMA and NO.3,4 In the study by Yousefi et al., ADMA and NO has been shown to reduce during Ramadan fasting. However, it should be stated that since ADMA and NO are clearly tightly related to the oxidative–inflammatory mechanisms of atherosclerosis,5 it would have been very helpful to have measured other relevant biomarkers such as high-sensitivity C-reactive protein, lipoprotein(a), lipoprotein-associated phospholipase A2 and homocysteine to help determine whether ADMA and NO covary with these other biomarkers, and whether differences in ADMA and NO levels post Ramadan exist and remain statistically significant after adjustment for them.

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References

  1. Yousefi B, Faghfoori Z, Samadi N, Karami H, Ahmadi Y, Badalzadeh R et al. The effects of Ramadan fasting on endothelial function in patients with cardiovascular diseases. Eur J Clin Nutr 2014; 68: 835–839.

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  4. Al-Shafei AI . Ramadan fasting ameliorates oxidative stress and improves glycemic control and lipid profile in diabetic patients. Eur J Nutr 2014; e-pub ahead of print 19 January 2014; doi:10.1007/s00394-014-0650-y.

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  5. Böger RH, Sullivan LM, Schwedhelm E, Wang TJ, Maas R, Benjamin EJ et al. Plasma asymmetric dimethylarginine (ADMA) and incidence of cardiovascular disease and mortality in the community. Circulation 2009; 119: 1592–1600.

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Authors and Affiliations

  1. Department of Cardiology, Malatya State Hospital, Malatya, Turkey

    E Kurtoglu & Y Karakus

  2. Department of Cardiology, Eskisehir Military Hospital, Eskisehir, Turkey

    S Balta

  3. Department of Cardiology, Sivas State Hospital, Sivas, Turkey

    K Erdem

Authors
  1. E Kurtoglu
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  2. S Balta
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  3. K Erdem
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  4. Y Karakus
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Correspondence to E Kurtoglu.

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Kurtoglu, E., Balta, S., Erdem, K. et al. Asymmetric dimethylarginine and Ramadan fasting. Eur J Clin Nutr 68, 1368 (2014). https://doi.org/10.1038/ejcn.2014.175

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