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

Mohammad Kermansaravi 1, Islam Omar 2, Kamal Mahawar 3, Shahab Shahabi 4, Ahmad Bashir 5, Ashraf Haddad 5, Alaa Abbass 6, Syed Imran Abbas 7, Mujjahid Abbas 8, Tarek Abouzeid 6, Faki Akin 9, Ebrahim Aghajani 10, Ali Aminian 11, Mohanad AlAnsari 12, Syed Tanseer Asghar 13, Ahmet Ziya Balta 14, Waleed Bukhari 15, Mohamad Hayssam Elfawal 16, Waleed Gado 17, Khaled Gawdat 6, Tikfu Gee 18, Bijan Ghavami 19, Ramen Goel 20, Mohammed AlHadad 21, Bader AlHadhrami 22, Mohammad AlHaifi 23, Ali AlHamdani 24, Ibrahim Hassan 25, Selim Jalil Illan 26, Atif Inam 27, Aiman Ismaeil 28, Yasser Kayyal 29, Khaleel Mohammad 30, Amir Ulhagh Khan 31, Mousa Khoursheed 32, Haris Khwaja 33, K S Kular 34, Laurent Abram Layani 35, Maazulhassan 36, Tarek Mahdy 37, Mumtaz Maher 38, Ebrahim Mansoor 39, Salman Mirza 31, Muhammad S Niam 40, Taryel Omarov 41, Abdolreza Pazouki 1, Aayed R Alqahtani 42, Mohamed Qassem 6, Masoud Rezvani 43, Karim Sabry 6, Safauldeen Salim 44, Asim Shabbir 45, Mehdi Skalli 46, Osama Taha 47, Mohammad Talebpour 48, Halit Eren Taskin 49, Mustafa Taskin 49, Tahir Yunus 50, Amir Hossein Davarpanah Jazi 4, Radwan Kassir 51, Abdelrahman Nimeri 52

Affiliations

01 December 2021

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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.

Keywords: Bariatric surgery; Calorie restriction; Consensus statement; Fasting; Metabolic surgery; Obesity; Ramadan.

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