Ramadan Fasting Improves Health‐Related Quality of Life in Patients With Secondary Adrenal Insufficiency: A Prospective Interventional Case‐Control Study

Abstract

INTRODUCTION: Intermittent fasting (IF) exposes patients with adrenal insufficiency (AI) to complications related to undertreatment. We aimed to determine the effect of IF during Ramadan on the quality of life of patients with secondary adrenal insufficiency (SAI) compared to healthy controls. SUBJECTS AND METHODS: It is a prospective case-control study conducted at the Department of Endocrinology of La Rabta University Hospital in Tunisia. Fifty patients with SAI and 100 age-, sex- and body mass index-matched controls were enrolled and followed up throughout Ramadan 2023. All participants answered the Addison's disease quality of life questionnaire (AddiQoL) before Ramadan and during the third week of fasting. RESULTS: There were 33 women and 17 men, median age: 43 years (IQR: 34-55), median duration of SAI: 7.5 years (IQR: 4-12.5), treated with hydrocortisone at a median dose of 0.24 mg/kg/day (IQR: 0.20-0.27). Before Ramadan, there was no significant difference between patients and controls in the global AddiQoL score, fatigue score, and emotional sphere score (89 vs. 93, p = 0.196; 24 vs. 24, p = 0.354, and 24 vs. 25, p = 0.536, respectively). The score of AI symptoms was altered in patients (27 vs. 30, p = 0.021). During fasting, the global AddiQoL score (8.2% vs. 0%, p = 0.005), the fatigue score (8% vs. -1.7%, p = 0.003), the emotional sphere score (4.2% vs. 0%, p = 0.009), and the AI symptoms' score (9.1% vs. 0%, p = 0.017) improved in patients compared to controls. CONCLUSION: Ramadan fasting improved the quality of life in SAI patients by reducing fatigue, emotional stress, and AI symptoms. TRIAL REGISTRATION: Registered on 'ClinicalTrials.gov' under the identifier ID: NCT05827965.