Effect of intermittent fasting on lipid profile and hematological parameters in healthy volunteers in Jordan

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1 Universal Journal of Medicine and Dentistry Vol. 1(1) pp , January, 2012 Available online Copyright 2012 Transnational Research Journals Full Length Research Paper Effect of intermittent fasting on lipid profile and hematological parameters in healthy volunteers in Jordan Mohammad A. Fararjeh*, Abdulrahim AlJamal, "Mo'ez Al-Islam" E. Faris**, Ref'at A. Al-Kurd**, Mohammad Khalil*** and yasser Al-Bustanji*** * Faculty of Medical Laboratory Technology, Hashemite University, Zarka, Jordan. **Department of Nutrition, Faculty of Pharmacy and Medical Sciences, Petra University. *** Department of clinical pharmacy, Faculty of Pharmacy, University of Jordan.Jordan. Accepted 21 November, 2011 The Purpose of this study is to show the effects of fasting on lipid profiles and hematological parameters in healthy volunteers. Eighty Healthy subjects (50 male and 30 female) volunteered to participate in all of three stages of the study. Volunteers aged from 18 to 60 were included. Blood samples were collected as follows, each volunteer at each visit gives 5 ml blood placed in EDTA tube and 10 ml in a plain tube, from all healthy volunteers one week before, on the third week of, and one month after the end of. All participants were chosen from the same living community, Rusaifa city, Jordan, so that the socioeconomic levels were highly similar. Anthropometric measurements that are measured for volunteers showed no significant differences between results before and after except for the body fat (%) in males (P=0.051). The packed cell volume shows significant reduction in males and females (P=0.052, P=0.04) respectively, while RBCs showed significant reduction in females only (P=0.01). White blood cells and the differential count showed no significant effect of fasting except for the monocots absolute count as well as percentage in males which show significant increase(p<0.001). The results of the lipid profile showed an important significant increase in the concentration of high density lipoprotein cholesterol (P=0.006). Keywords: fasting, Hematological parameters, HDL-Cholesterol, lipids profile. INTRODUCTION is a religious month during which all Muslims refrain from eating, drinking, and smoking during the daylight hours for a month. The duration of restricted food and beverage intake is approximately 12 h/day and changes depending on the geographical location (Aksungar, et al., 2005). During the fast, Muslims eat two meals a day, one before dawn and the other shortly after sunset (Haghdoost, and PoorRanjbar, 2009). The fasting is considered as a unique model of intermittent fasting (Aksungar, et al., 2005 ). As food and fluid intake became exclusive at nocturnal time without restriction on the type or amount of food intake. *Corresponding author aljamalzpu@yahoo.com Tel: Ext. 1814, Mobile +962-(0) fasting as associated with alteration in meal frequency, sleep duration and reduction in physical activity during the day (El Ati, et al., 1995). Intermittent is considered an alternative to caloric restriction regimen (Varady and Hellerstein, 2007), while other considered as a type of caloric restriction (Anson, et al., 2002). In general, caloric restriction is define as restricting food intake to a level below that would be consumed voluntarily ( Anson, et al., 2002). Studies have shown that caloric restriction can increase life span, reduce the incidence of various age-related diseases and reduce oxidative stress and inflammation in rodents and non-human primates (Wan, et al., 2003). The effect of intermittent fasting on oxidative stress in humans has been demonstrated in limited number of studies. Johnson, et al. (2007) has shown a significant decreases in serum level of 15-F 2t -IsoP in asthmatic over

2 006. Univers. J. Med. Dent. weight patients after 8 weeks of alternative day caloric restriction (ADCR). The decrease in levels of oxidative stress in subjects may have contributed to the improvement in their asthmatic symptoms on the ADCR diet. The quality of ingested nutrients can also differ during compared with the rest of the year, with a tendency to consume foods that are richer in carbohydrate and lipids (Lamri-Senhadji, et al., 2009). The daily energy intake during varies according to the food habits in different Islamic countries. Many physiological and psychological changes are observed during. It has been established that these changes occur at the end of the first week and adaptations require at least 10 days and remain the same for at least 10 days after (Aksungar, et al., 2005).The effects of fasting during on serum glucose showed reduction in serum glucose ceases due to increased gluconeognesis in the liver. This occurs due to the decrease in insulin secretion with the rise in glucagon and sympathetic activity during fasting state (Mansi, 2007). The effects of fasting on lipid profiles are different in published articles and this may be due to a change in the dietary regimen during, decreased activity and some cultural parameters. fasting showed to have a beneficial effect on lipid profile by increasing HDL and decreasing LDL levels (Ibrhim, et al., 2008; Lamri-Senhadji, et al., 2009; Mansi, 2007). A significant change observed during is the increase of serum uric acid, which could be explained by the increased intake of protein and fat during and the concomitant dehydration (El ati et al 1995). Only few studies investigated the effects of on hematological parameters, (Unalacak M, et al. 2011).Our study will inspect the effect of fasting on the overall hematological parameters that could be considered as a complete blood count (CBC) to evaluate the effect of this type of fasting on these important cellular as well as hematological parameters in healthy Jordanian population. Lipid profile will also be tested before, during, and after to study the effect of this type of intermitting fasting on these important biochemical parameters, in addition anthropometric measurements for the study subjects before, during, and after, will be conducted and subdivided according to sex. Subjects Eighty healthy subjects (50 male and 30 female) volunteered to participate in this study. All were in the age range 18 to 60 were included. Volunteers who have diabetes, hypertension or metabolic disorders were excluded. None of the subjects were on any medication or took antioxidant. Female subjects were not pregnant or using contraceptives. This study was carried out in the month of of August/September 2010, and the average duration of fasting was hours a day. The main climate temperature and humidity was 26.3C and 44.6%, and 23.7 C and 55.8% during August and September respectively. There were no special nutritional regimens and recommendations during the whole study. To maintain a sample of homogeneity, all participants were chosen from the same living community, Rusaifa city, Jordan, so that the socioeconomic levels were highly similar. All participants were required to provide a written informed consent before the study started. A questionnaire was administered, in which medical history was recorded through a personal interview with the each subject by well-trained personnel. At the beginning of the study, the number of participants was 120, while 40 subjects decided not to undergo the study. So that, the 80 remaining subjects did undergo all of three stages (before, during and after ) of the study. Blood sampling protocol Blood samples were collected as follows, each volunteer at each visit gives 5 ml blood placed in EDTA tube and 10 ml in a plain tube, from all healthy volunteers one week before, on the third week of, and one month after the end of. Anthropometric measurements (body weight, height, waist and hip circumferences), and body fat % were performed by well-trained personnel. Each subject served as his /hers own control by comparing before values with those during and after. At each visit, systolic and diastolic blood pressures were measured, hip circumference HC, waist circumference WC and Body mass index BMI were measured with the subject in a seated position after 5 min rest. Blood sampling and processing was conducted in Al-Quds Medical Laboratories center between 10 am and 4 pm each time. The blood samples were collected and the serum was separated within an hour. MATERIALS AND METHODS The blood samples collected in EDTA tubes were determined the complete blood count (CBC) for each volunteer by using auto hematology analyzer (Mindray BC-3000, Plus). While the blood samples in plain tubes were centrifuged at room temperature for 5 min. at 4000 rpm and serum was collected and stored at refrigerator for analysis of lipid profile. Triglycerides were assayed using enzymatic methods (Roche Diagnostics, Mannheim, Germany). High-density lipoprotein cholesterol was measured enzymatically after

3 Fararjeh et al. 007 Table(1). Predicts that Anthropometric characteristics of Study Subjects before, during, and after. Parameter Before MeanSD During MeanSD After MeanSD Male Female Male Female Male Female a P b P Body weight (kg) BMI (kg/m2) HC (cm) WC (cm) Body fat (%) HC: hip circumference, WC: waist circumference, BMI: Body mass index P 0.05 is considered to be statistically significant. a P significant for male and b P significant for female. precipitation of LDL and very low-density lipoprotein with Mg2+-dextran (Roche Diagnostics). LDL-C was calculated by Friedewald s formula. During each of the three visits, anthropometric measurements (body weight, height, waist and hip circumferences), and body fat % were performed by well-trained personnel. Body fat was measured by Body Fat Analyzer (GIMA, Italy). Body mass index (BMI) and waist to hip ratio were calculated. BMI was calculated as body weight (in kg) divided by body height (in meters) squared. Volunteers with BMI 25 Kg/m2 are considered to have normal weight, and those with BMI 25 are considered to be overweight (WHO, 2007). RESULTS Table (1) shows that all the anthropometric measurements that are measured for the volunteers showed no significant differences between results before and after except for the body fat (%) in males ( P=0.051). The table (2) shows the result of hematology parameters (complete blood count), the results were divided into two parts hemoglobin and RBCs indices and other for white blood cells and the differential counts percentage and as absolute counts. The comparison was between each parameter before and after fasting for both sexes. The packed cell volume shows significant reduction in males and females (P=0.052, P=0.04) respectively, while RBCs showed significant reduction in females only (P=0.01). The platelets showed no any significant changes. Table (2) also shows the total white blood cells and the differential count showed no significant effect of fasting except for the monocyts absolute count as well as percentage in males which show significant increase(p<0.001). The results of the lipid profile as indicated in the table (3) showed an important significant (P=0.006) increase in the concentration of the high density lipoprotein cholesterol HDL-C after fasting of compared to those before. While the total cholesterol, LDL-cholesterol and Triglycerides showed no any significant changes. DISCUSSION The anthropometric measurements that are measured for the volunteers showed no significant differences between results before and after except for the body fat (%) in males. These results are in concordance with (Heilbronn, et al., 2005) founded that alternative day fasting is usually associated with weight loss and increased fat oxidation which is translated to fat mass loss. While (Haghdoost, and PoorRanjbar, 2009) shows more foods rich in fat and dietary cholesterol were consumed during this period. Despite the marked changes in food intake habits some studies showed that fasting had no effect on body weight or BMI (El ati, et al., 1995; Aksungar, et al., 2005; Lamri-Senhadji, et al., 2009; Ibrhim, et al., 2008), while other studies

4 008. Univers. J. Med. Dent. Table (2). Predicts that The hematological parameters results for males and females before, during, and after. CBC Parameter Before MeanSD During MeanSD Male Female Male Female Male After MeanSD a P Female b P Hb( g/dl) PCV(%) RBCs (x10 12 /L) MCV (fl) MCH(pg) MCHC (g/dl) RDW-CV(%) RDW-SD(fL) Platelets MPV(fL) WBCs (10 9 /L) Lymph# Mono# Gran# Lymph. (%) Mono(%) Gran(%) < < Hb: Hemoglobin; PCV: Packed cell volume; RBCs: Red blood cells; MCV: Mean corpuscular volume; MCH; Mean corpuscular hemoglobin; MCHC: Mean corpuscular hemoglobin concentration;rdw: Red blood cell distribution width; MPV: Mean platelet volume (p <0.05), * Significant difference Table (3). Predicts that Lipid profile concentration results for males and females before, during, and after. Biochemical test Before During After P Total cholesterol HDL-Cholesterol LDL-Cholesterol Triglycerides showed that fasting was associated with significant weight loss (Ziaee, et al., 2006; Mansi, 2007; Al-Hourani and Atoum, 2007). These studies agree with our study, because of increase in fat oxidation, the body needs energy to free fat. The hematological parameters (complete blood count), results were divided to hemoglobin and RBCs indices while the second for white blood cells and the differential counts percentage. The packed cell volume shows significant reduction in both sexes, while RBCs showed significant reduction in females only. The significant reduction in the PCV and RBCs count may because of the disturbance in the body homeostasis in volunteers during and after fasting, this is agree with Unalacak et. al.

5 Fararjeh et al Table 2 also showed that the total white blood cells and the differential count showed no significant effect of fasting except for the monocyts in males which shows significant increase in their number. this could be because the fasting stimulates some cytokine production which stimulates the production of the monocytes. The results of the lipid profile show an important significant increase in the concentration of the high density lipoprotein cholesterol. These promising results are with concordance with the results of Mansi et. al 2007 that showed increased in HDL-cholesterol levels, suggest a beneficial effect on coronary heart disease (CHD) patients. As a matter of fact, Temizhan and colleagues (1999) have evaluated the effect of fasting on a population of CHD patients. They found that the number of cases with acute CHD events was lower in, thus confirming the beneficial effect of fasting in such population. While other studies showed no significant changes in TG and LDL levels with significant elevation in HDL levels (Aksungar, et al., 2005).These founding agree with our study. These findings should be taken into account when evaluating the effects of on the general population. To avoid the adverse effects of anemia, increased intake of iron-rich food is recommended during the month, regardless of fasting practice. Further investigations concerning the effect of the fasting on the function of the immune cells including the monocytes, types of cytokine stimulation and the mechanism of increasing the high density lipoprotein cholesterol are also recommended. CONCLUSION In summary, intermittent fasting had positive effects on lipid profile and hematological parameters level in all the participants, the authors recommended all peoples to fasting 2 days a week. ACKNOWLEDGMENTS The authors wish to acknowledge the valuable technical efforts by M'moun Abu-Baker Hassan Al-Zebin and Bushra al Reemawi from alquds laboratory REFERENCES Aksungar FB, Eren A, Ure S, Teskin O, Ates G(2005). Effects of Intermittent Fasting on Serum Lipids, Coagulation Status and Plasma Homocysteine Levels. Annals of Nutrition and Metabolism. 49: Al Hourani HM, Atoum MF(2007), Body Composition, Nutrient Intake and Physical Activity Patterns in Young Women during. Singap. Med. J. 58(10): Anson RM, Guo Z, De Cabo R, Iyun T, Rios M, Hagepanos A, Ingram DK, Lane MK, Mattson MK(2002), Intermittent Fasting Dissociates Beneficial Effects of Dietary Restriction on Glucose Metabolism and Neuronal Resistance to Injury From Calorie Intake. Proceedings of the National Academy of Sciences, 100(10): El Ati J, Beji C, Danguir F(1995). Increased Fat Oxidation During Fasting in Healthy Women: An Adaptative Mechanism For Body Weight Maintenance. Am. J. Clin. Nutri. 63(2): Haghdoost A A, PoorRanjbar M (2009). The interaction between physical activity and fasting on the serum lipid profile during, Singap. Med. J. 50(9) : 897:901 Heilbronn KL, Smith RS, Martin KC, Anton DS, Ravussin E(2005). Alternate-Day Fasting in Non Obese Subjects: Effects on Body Weight, Body Composition, and Energy Metabolism. Am. J. Clin. Nutri. 81(1): Heilbronn LK, de Jonge L, Frisard MI(2006). Effect of 6-month calorie restriction on biomarkers of longevity, metabolic adaptation, and oxidative stress in overweight individuals: a randomized controlled trial. JAMA. 295: Ibrahim WH, Habib HM, Jarrar AH, Al Baz SA(2008), Effect of Fasting on Markers of Oxidative Stress and Serum Biochemical Markers of Cellular Damage in Healthy Subjects. Annals of Nutrition and Metabolism. 53(3-4): Lamri-Senhadji MY, El Kebir B, Belleville J, Bouchenak M(2009), Assessment of Dietary Consumption and Time-Course of Changes in Serum Lipids and Lipoproteins Before, During and After in Young Algerian Adults. Singap. Med. J. 50(3): Mansi KMS(2007), Study the Effects of Fasting on Serum Glucose and Lipid Profile among Healthy Jordanian Students. Am. J. Appl. Sci. 4(8), Temizhan A, Donderici O, Ouz O, Demirbas B(1999). Is There any Effect of Fasting on Acute Coronary Heart Disease Events? Int. J. Cardiol. 70(2): Unalacak M, Kara IH, Baltaci D, Erdem O, Bucaktepe PG(2011). Effects of Fasting on Biochemical and Hematological Parameters and Cytokines in Healthy and Obese Individuals. Metabolic Syndrome and Related Disorders. Apr;9(2): Varady KA, Roohk DJ, Hellerstein MK(2007). Dose Effects of Modified Alternate-Day Fasting Regimens on In Vivo Cell Proliferation and Plasma Insulin-Like Growth Factor-1 in Mice. J. Appl. Physiol. 103(2), Wan R, Ismail A, Brown M, Cheng A, Kamimura N, Talan M, Mattson MP (2010). Cardioprotective Effect of Intermittent Fasting is Associated With an Elevation of Adiponectin Levels in Rats. J. Nutri. Biochem. 21(5): OWH, Ziaee V, Razaei M, Ahmadinejad Z, Shaikh H, Yousefi R, Yarmohammadi L, Bozorgi F, Behjati MJ (2006). The Changes of Metabolic Profile and Weight During Fasting. Singap. Med. J. 47(5),