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. 2021 Dec;31(12):5303-5311.
doi: 10.1007/s11695-021-05724-z. Epub 2021 Oct 6.

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

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

Mohammad Kermansaravi et al. Obes Surg. 2021 Dec.

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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