Effects of Intermittent Fasting on Patients with Sickle Cell Disease Single Center Experience

Background:

Sickle cell disease is an inherited hemoglobinopathy due to a mutation in the beta globin gene. Patients can be homozygote, sickle cell trait or compound heterozygote with other forms of hemoglobinopathy mutations. The most common complication of the disease is vaso-occlusive crisis (VOC) which presents with body pain of varying severity. The vast majority of patients with sickle cell disease in Qatar are Muslims and hence they practise intermittent fasting during the holy month of Ramadan to fulfil one of the five and most important pillars of the Islamic faith. There is paucity of literature describing the effect of intermittent fasting on the frequency of incidence of severe VOC. As a result, there is a lack of guidelines or standardized protocols that can help physicians advise patients with sickle cell disease who wish to practise intermittent fasting.

Methods:

We conducted a retrospective study for 45 Muslim patients with sickle cell disease in Qatar aged ≥18 years who were confirmed to be fasting during the holy month of Ramadan (confirmation of fasting was done through telephone interview) in any of the years 2019-2021. The difference in the occurrence of severe VOC, hemolytic crisis, other clinical, hematological, and metabolic parameters were studied one month before, during and one month after the intermittent fasting of Ramadan using the patients' medical records. Data entry and analysis were performed using SPSS 26. Because the data lacked normal distribution non-parametric tests were used for the analysis.

Results:

The median age of the study participants was 31 years, 43% were males and 57% were females. Seventy percent of the participants were of Arab ethnicity while the rest were either African or Asian. The majority of patients were homozygote (SS) (89%). The median number of the days fasted during Ramadan was 29 days. The median number of severe VOC and hemolytic crisis was not found to be significantly different before, during or after Ramadan (P=0.60) (P=0.45) respectively. The length of hospital stays, the total dose of morphine and the need for antibiotic use were also not found to be significantly different before, during or after intermittent fasting. The blood counts (WBCs, Hemoglobin, Platelets, Reticulocytes) as well as the metabolic parameters (Urea, creatinine, bilirubin) were also not found to be significantly different between the three time periods. Table 1 below gives more details about these results.

Conclusion:

We concluded that intermittent fasting does not seem to influence the rate of incidence of severe VOC, hemolytic crisis, blood values or metabolic parameters. However further studies with a bigger sample size are advised to confirm these results.

No relevant conflicts of interest to declare.