Religious Fasting of Muslim Patients After Metabolic and Bariatric Surgery: a Modified Delphi Consensus

Kermansaravi M 1 , Omar I 2 , Mahawar K 3 , Shahabi S 4 , Bashir A 5 , Haddad A 5 Show all authors , Abbass A 6 , Abbas SI 7 , Abbas M 8 , Abouzeid T 6 , Akin F 9 , Aghajani E 10 , Aminian A 11 , AlAnsari M 12 , Asghar ST 13 , Balta AZ 14 , Bukhari W 15 , Elfawal MH 16 , Gado W 17 , Gawdat K 6 , Gee T 18 , Ghavami B 19 , Goel R 20 , AlHadad M 21 , AlHadhrami B 22 , AlHaifi M 23 , AlHamdani A 24 , Hassan I 25 , Illan SJ 26 , Inam A 27 , Ismaeil A 28 , Kayyal Y 29 , Mohammad K 30 , Khan AU 31 , Khoursheed M 32 , Khwaja H 33 , Kular KS 34 , Layani LA 35 , Maazulhassan 36 , Mahdy T 37 , Maher M 38 , Mansoor E 39 , Mirza S 31 , Niam MS 40 , Omarov T 41 , Pazouki A 1 , Alqahtani AR 42 , Qassem M 6 , Rezvani M 43 , Sabry K 6 , Salim S 44 , Shabbir A 45 , Skalli M 46 , Taha O 47 , Talebpour M 48 , Taskin HE 49 , Taskin M 49 , Yunus T 50 , Jazi AHD 4 , Kassir R 51 , Nimeri A 52

Affiliations 

  • 1 Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
  • 2 Wirral University Teaching Hospital, NHS Foundation Trust, Birkenhead, Wirral, UK
  • 3 Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK
  • 4 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
  • 5 Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Queen Noor Street, Amman, 11152, Jordan
  • 6 Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
  • 7 Iranian Hospital, Alwasl Road, Dubai, UAE
  • 8 University Hospitals Cleveland Medical Center, Cleveland, OH, USA
  • 9 Bariatric and Metabolic Surgery, Istanbul, Turkey
  • 10 Department of Surgery, Aleris Hospital, Fredrik Stangs gate 11-13, 0264, Oslo, Norway
  • 11 Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
  • 12 Robotic Surgery Academy, International Modern Hospital, Baghdad, Iraq
  • 13 Capital Hospital, CDA, Islamabad, Pakistan
  • 14 Faculty of Health Sciences, Istanbul Rumeli University, Istanbul, Turkey
  • 15 International Medical Center, Jeddah, Saudi Arabia
  • 16 Makassed General Hospital, Beirut, Lebanon
  • 17 Endocrine and Bariatric Surgery Unit, Mansoura University, Mansoura, Egypt
  • 18 Department of Medical Science, School of Healthcare and Medical Sciences, Sunway UniversityJalan UniversitySelangor Darul Ehsan, 47500, Bandar SunwayPetaling Jaya, Malaysia
  • 19 , Vinet Lausanne, Switzerland
  • 20 Wockhardt Hospitals, Mumbai, India
  • 21 Healthpoint Hospital, Mubadala Health Care, Abu Dhabi, UAE
  • 22 Royal Hospital, Muscat, Oman
  • 23 Alhaifi Private Clinic, Kuwait, Kuwait
  • 24 Wellington Hospital, Wellington, UK
  • 25 Sidra Hospital, Kuwait, Kuwait
  • 26 International Center of Excellence in Bariatric and Metabolic Surgery, Hospital BC, Tijuana, Mexico
  • 27 In Charge Metabolic, Thoracic and General Surgery Unit III, Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
  • 28 Faculty of Medicine, Aswan University, Aswan, Egypt
  • 29 Cork University Hospital, Cork, Ireland
  • 30 Ministry of Health, Kuwait, Kuwait
  • 31 Walsall Healthcare NHS Trust, Walsall, UK
  • 32 Health Sciences Center, Department of Surgery, Kuwait, Kuwait
  • 33 Chelsea and Westminster Hospital, London, UK
  • 34 Founding President MGB-OAGB Club, Kular Research Institute, Bija, India
  • 35 HOD Surgical Bariatric Department, Dubai, UAE
  • 36 Shalimar Medical and Dental College, Lahore, Pakistan
  • 37 Sharjah University Hospital, Mansoura Faculty of Medicine, Sharjah, UAE
  • 38 South City Hospital, Karachi, Pakistan
  • 39 Private Practice, Durban, South Africa
  • 40 Faculty of Medicine, Brawijaya University, Dr Saiful Anwar General Hospital, Malang, Indonesia
  • 41 First Surgical Disease Department, Azerbaijan Medical University, Baku, Azerbaijan
  • 42 New You Medical Center, King Saud University, Obesity Chair, Riyadh, Saudi Arabia
  • 43 Inova Fair Oaks Hospital, COE Bariatric Center, 14904 Jefferson Davis Hwy, Suite 205, Woodbridge, VA, 22191, USA
  • 44 Alsadir Teaching Hospital, Najaf, Iraq
  • 45 Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
  • 46 CHU de Montpellier, Montpellier, France
  • 47 Bariatric Unit, Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt
  • 48 Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • 49 Cerrahpasa Medical Faculty, Department of Surgery, Istanbul University Cerrahpasa, Istanbul, Turkey
  • 50 Evercare Hospital, Lahore, Pakistan
  • 51 Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
  • 52 Chief, Bariatric and Metabolic Surgery Carolinas Medical Center, Ballantyne and Gastonia Director, Atrium Health University of North Carolina-Charlotte Campus Director, Bariatric Fellowship Program Carolinas Medical Center-Mercy, Atrium Health Weight Management Charlotte, ConcordCharlotte, NC, USA. [email protected]
Obes Surg, 2021 Dec;31(12):5303-5311.
PMID: 34617207 DOI: 10.1007/s11695-021-05724-z

Abstract

BACKGROUND: Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS.

METHODS: A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus.

RESULTS: The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient's situation and surgeon's experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively.

CONCLUSION: Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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