Beneficial changes in serum apo A-1 and its ratio to apo B and HDL in stable hyperlipidaemic subjects after Ramadan fasting in Kuwait

Background: In patients with metabolic and nutritional disorders such as di abetes and hyperlipidaemia, where strict compliance to advice on timing and composition of food intake is important, the prolonged daylight fasting du ring the month of Ramadan could produce undesirable biochemical consequence s. Aim: The study aimed to compare pre- and post-Ramadan lipid and lipoprotein profiles in stable Kuwaiti hyperlipidaemic subjects attending a Lipid Clin ic. Subjects and methods: The study population comprised 64 adult Kuwaitis (33 M, 31 F) who had been attending a Lipid Clinic for at least 12 months and w ere considered stable, without any acute systemic illness. At each clinic v isit, the following parameters were measured: weight, total cholesterol (TC ), triglycerides (TG), HDL, LDL, apo A-1, apo B, glucose and uric acid. The se biochemical parameters were measured by routine automated analyzer techn iques. The pre-Ramadan values comprised the means of two measurements taken at about 3 month and 1 month before commencement of Ramadan. Post-Ramadan values were obtained within 1 month of the end of the Ramadan fast. The par ameters so obtained were compared in the whole group, and then according to gender, glycaemic status and modality of treatment (diet alone or with a f ibrate or statin). Results and discussion: In the nondiabetic subjects, apo A-1 and apo A-1/ap o B and apo A-1/HDL ratios were increased post-Ramadan (P < 0.001). Weight did not change and the other lipid parameters - TC, TG, LDL, apo B-did not worsen. These observations, more consistent in the men than in the women, a nd in subjects treated with a fibrate or a statin rather than on diet alone , indicate a favorable coronary heart disease (CHD) risk profile. In the di abetic patients, these changes in the apo,A-1 level and its ratio to HDL an d apo B were also present, but TC and apo B levels increased, the latter si gnificantly (P < 0.05). These divergent effects in diabetic patients could variably influence CHD risk liability. Serum uric acid levels were also sim ultaneously reduced post-Ramadan in the non-diabetic subjects and those on statin treatment. Conclusion: When pre- and post-Ramadan lipid and lipoprotein profiles were compared in stable hyperlipidaemic subjects attending a Lipid Clinic in Kuw ait, the most consistent changes post-Ramadan were increased levels of apo A-1 and apo A-1/apo B and apo A-1/HDL ratios and reduced uric acid levels. Body weight remained essentially unchanged and the other lipoprotein and li pid parameters were not worsened. These results suggest that Ramadan fastin g in hyperlipidaemic subjects might favorably influence CHD risk. Descriptors: Ramadan; hyperlipidaemia; lipoproteins; coronary heart disease ; Arabs.