Objective: After the Ramadan fasting period, there is an increasing prevalence of diabetes in Cote d’Ivoire, in diabetes care centers. The objective of this study was to assess the consumption of sugary foods during this period and to determine the risks of diabetes in Muslim populations. Methods: Information was collected on the type and amount of sugary foods consumed. Methods for the preparation of these foods have been determined. Intake frequencies and postprandial glycemic responses were studied. The usual statistical methods were used. Results: Between 70% and 85% of the “fasters” consume plenty of these sugary foods during this period, with an average added sugar level varying between 10% and 35% and a daily consumption of between 250 cl and 0.5 l. The added sugar leads to hyperglycemia in both healthy subjects and pre diabetics. Conclusion: Regular consumption of these sugary foods results in significant hyperglycaemia throughout the month of fasting with a significantly higher blood glucose level in pre diabetic subjects. This makes pre diabetics people more at risk of diabetes among Muslim populations during Ramadan fasting.
Fasting during the month of Ramadan is the most observed religious ritual by Muslims. It is characterized by a water and energy deprivation from dawn to sunset, which varies from 12 to 18 hours throughout the “sacred month” [
The biological material used in this study consisted in the material used to make the sweet foods studied. These include Hibiscus sabdariffa chalices, ginger rhizomes (Zingiber officinale), millet grains (Panicum miliaceum), corn kernels (Zea mays), millet and sweet banana (Musa sapientum) respectively for the preparation of “bissap infusion”, “gengimbre juice”, millet porridge, corn porridge, millet fritters called “womi”. These foods were purchased from the markets of Abobo and Adjamé, in the district of Abidjan in Côte d'Ivoire
The study on the consumption of sweet foods (Study 1) was conducted in 20 mosques in Abidjan (Port Bouet, Koumassi, Plateau, Adjamé, Abobo, Cocody, Riviéra) and 10 mosques (Anyama, Yamoussoukro, Abengourou, Daloa, Gagnoa, Bouake, Korhogo, San Pedro). The experimental study on postprandial glycemia of sweet foods (Study 2) was conducted at the Nutrition Laboratory of Nangui Abrogoua University.
Two types of study have been carried out. This is a prospective descriptive study for Study 1, which took place in the fasting months of Ramadan in 2012, 2013 and 2014 precisely during the periods from 20 July to 19 August 2012, from 9 July August 8, 2013, June 29 to July 28, 2014, and a comparative cohort study for Study 2 that ran for a 2 week period from March 7 to 21, 2014.
Study 1 was carried out on the basis of a questionnaire given by 653 people, consisting of fasted people and women selling these sweet foods in the vicinity of the mosques. Included were nationals, aged 18 to 65 years. Study 2 was conducted with two groups of 10 volunteers, aged between 18 and 40 years, healthy and pre diabetic.
Study 1:
Using a “24-hour dietary recall” questionnaire and a questionnaire on the frequency of food consumption by the weekly method, information on food consumption was collected. The information is related to the nature, order, quantities and frequencies of consumption of sugary foods. Methods of preparation of these dishes have also been detailed.
Study 2:
For the determination of the postprandial glycemic response of the foods studied, two groups of 10 volunteers, regardless of sex between 18 and 40 years of age, were recruited. On the day of the test, subjects had been fasting for 12 hours and were taken to consume average amounts of food consumed during the Muslim fast, as determined by the previous survey. To get into the fasting conditions, the various subjects were asked not to practice unusual physical activity and to keep a normal diet. The first measurement t = 0, of the capillary blood glucose was carried out before the ingestion of the meal. Then the calm subjects ingested the food with 250 ml of water for solid foods (womi, dates), without adding water for semi-liquid foods (millet porridge, maize porridge) and liquids (Ginger juice, bissap juice). Capillary samples were taken at t = 15 min, 30 min, 45 min, 60 min, 75 min, 90 min, 105 min and 120 min. The energy requirements of the individual subjects in the study were then calculated by taking into account the age (in years), weight (in kg), size (in m), physical activity level Individual according to the formulas of Harris and Benedict modified by Roza and Shizgal (1994): This was done in two steps:
Step 1: Calculation of 24-hour basic energy expenditure:
1) Man = 13.707 * Weight (kg) + 492.3 * Size (m) − 6.673 * Age (years) + 77. 607
2) Woman = 9.740 * Weight (kg) + 172.9 * Size (m) − 4.737 * Age (year) + 667.051
Step 2: Calculation of energy requirements for 24 hours:
3) Sedentary men and women = Basic metabolism (resting energy expenditure = DER) * 1.375
4) Active male and female = Basic metabolism (resting energy expenditure = DER) * 1.55
Data have been collected from survey forms. For the proportion comparison, t tests were applied between the values obtained. The significance level was set at 5%.
Among those surveyed, 6.12% were already known to be diabetic (
Frequency of consumption and proportions of the most consumed sugary foods.
Sweet, sugary, sugary liquid foods have been consumed extensively (
There is a significant interaction between the type of sweet food ingested and the time of the glycemic response (
Family past history | Personal past history | |||||||
---|---|---|---|---|---|---|---|---|
Obesity | Diabetes | Hyper-tension | (kcal/day) | Normal blood sugar | Prediabetic | Diabetic | ||
Men (n = 425) percentage | 159 37.41% | 58 13.64% | 107 25.17% | 2678 ± 103 | 358 84.23% | 34 08.00% | 23 05.41% | |
Wwomen (n = 228) Percentage | 99 43.42% | 43 18.85% | 72 31.57% | 2016 ± 98 | 201 88.15% | 20 08.77% | 17 07.45% | |
Grand Total (n = 653) Percentage | 258 39.50% | 101 15.46% | 179 27.41% | 2347 ± 101 | 559 85.60% | 54 08.26% | 40 06.12% |
Family history of obesity: a person with at least one obese parent; Family history of diabetes: person with at least one diabetic parent Family history of hypertension: person aged hypertensive parents; E N: energy needs.
Percentages of people who consume | Amount of added refined sugar | Place of consumption | |||
---|---|---|---|---|---|
Home | Out home | ||||
Liquid food | Bissap | 75% | 20% - 35% | 55% | 45% |
Ginger juice | 60% | 20% - 35% | 53% | 47% | |
Tomi | 15% | 20% - 35% | 30% | 70% | |
Juice Passion | 05% | 20% - 35% | 80% | 20% | |
Zoumkoum | 08% | 20% - 35% | 30% | 70% | |
Soda | 22% | - | 70% | 30% | |
Coffee shop | 70% | 10% - 15% | 99% | 01% | |
Tea | 45% | 10% - 15% | 98% | 02% | |
Herbal teas | 10% | 10% - 15% | 98% | 02% | |
Semi-liquid food | Millet porridge | 85% | 15% - 20% | 59% | 41% |
Mush | 30% | 15% - 20% | 15% | 85% | |
Rice porridge | 15% | 15% - 20% | 95% | 05% | |
Quaker | 05% | 15% - 20% | 100% | 0% | |
Solid food | Womi | 85% | 15% - 20% | 25% | 75% |
date | 85% | - | 25% | 75% |
“bissap” Hibiscus sabdariffa juice; “Tomi” tamarind juice; “zoumkoum” made from millet and rice juice; “Womi” millet cakes
and 30 and 90 minutes after ingestion. In healthy subjects, the plasma glucose concentration increased from 0.9 g/L ± 0.07 to 0.85 g/L ± 0.03 and from 0.93 g/L ± 0.05 to 0.83 g/L ± 0.03 respectively after ingestion of 0.5 l of sugar-free ginger juice and 0.5 l of sugar-free bissap juice. During the first 30 minutes after ingestion of juices to which sugar was added, blood glucose curves tend to increase with a peak difference, higher in pre diabetic subjects than in healthy subjects. For periods ranging from 30 to 90 minutes, the positions of the curves drop and the blood glucose curves according to the two juices decrease significantly.
Curves of glucose kinetics induced after ingestion of millet slurry and corn porridge showed an increase in postprandial blood glucose levels during the period of 0 to 30 minutes and a fall in blood glucose levels during the period 30 - 90 minutes in both healthy subjects and pre diabetic subjects (
diabetic subjects, it decreased from 1.17 g/L ± 0.05 to 1.39 g/L ± 0.11 and from 1.19g/L ± 0.04 to 1.42 g/L respectively ± 0.08 after the first 30 minutes.
between the sweet solid food and the time on the glycemic response. It results in the difference in the kinetics of glucose induced after ingestion of the “wom” i and the dates. The plasma glucose concentration increased from 0.91 g/L ± 0.10 to 1.23 g/L ± 0.07 and from 1.16 g/L ± 0.05 to 1.26 g/L ± 0, 10, 30 minutes after ingestion of 10 units of 20% “womi”, respectively in healthy subjects and pre-diabetic subjects. Postprandial glycemia induced by the consumption of dry dates is significantly higher than that of fresh dates in both healthy subjects and pre-diabetic subjects. During the first 30 minutes after ingestion of the sugary juices, blood glucose curves tend to increase with peak difference, higher in pre diabetic subjects than in healthy subjects. For periods ranging from 30 to 90 minutes, curve positions drop and blood glucose curves for food decline significantly.
This study assessed the risk of diabetes occurrence among Muslim populations after regular and substantial consumption of sugary foods during fasting Ramadan.
Liquid, semi-liquid and solid foods to which sugar is added are regularly consumed during the fasting month of Ramadan. In addition to fatty foods, this type of sweet food is much consumed because “fasters” are encouraged to eat during meals before dawn, large amounts of foods high in fat and carbohydrates can provide them with enough “Energy for several hours”. This would allow them to bear more easily this period of restriction. These same observations were made by [
The consumption of ginger juice and bissap infusion without added sugar did not lead to an increase in blood glucose. However, ingestion of millet, corn and sugar-free womi intake resulted in increased blood glucose levels in both healthy and pre-diabetic subjects after 30 minutes. This difference in the hyperglycaemic power of foods can be explained by the nature of the foods studied. Indeed, [
The addition of commercial sugar into the juices, porridge and womi caused a significant rise in blood glucose levels during the first 30 minutes following ingestion, followed by a gradual decrease in blood glucose over time. This increase in blood glucose levels was 0.43 g/L and 0.33 g/L for bissap and ginger juice; +0.38 g/L and +0.40 g/L for millet and maize slurries; +0.12 g/L for the sweet womi. The increase in blood glucose after ingestion of sweetened juices is mainly due to the degradation of sucrose added in these juices to fructose and glucose, which are fast simple sugars that pass directly into the blood to increase the plasma glucose level. As for the increase in blood glucose after ingestion of sweetened porridge and womi, it would be the combined action of the digestion of the starch contained in the cereals and the sucrose added to the preparation. Indeed, as soon as these foods are ingested, several digestive enzymes, including salivary α-amylase, pancreatic amylase, lactase, maltase, β-fructosidase, etc., hydrolyze throughout the gastrointestinal tract, Starch and sucrose in simple sugars (fructose but especially glucose) which pass directly into the blood through the small intestine, thus leading to a significant rise in blood sugar [
Comparative study of postprandial blood glucose trends in healthy subjects and pre-diabetic subjects showed that postprandial blood glucose levels in pre-dia- betic subjects increased more rapidly than healthy subjects after ingestion of the sweet foods studied. This difference in glucose kinetics may be explained by peripheral cell insulin resistance, hypo insulinemia, and increased liver glucose production in pre-diabetic subjects [
This study shows that among populations surveyed during Ramadan fasting period in Côte d’Ivoire, some are at risk of diabetes, including a family history of diabetes (15.46%) and undiagnosed pre-diabetes (8.26%). These people regularly engaged in this month like other fasters, with a high consumption of liquid, semi-liquid and sweet solids that cause regular hyperglycaemia, which can precipitate the onset of diabetes.
Abodo, J.R., Gbakayoro, J.B., Brou, K., Tiahou, G.G., Hué, A., Yao, A., Danho, J. and Lokrou, A. (2017) Modulation of Postprandial Glucose Bioavailability in a Cohort of Healthy and Pre- Diabetics Subjects during Ramadan Fasting in Côte d’Ivoire. Open Journal of Endocrine and Metabolic Diseases, 7, 127-139. https://doi.org/10.4236/ojemd.2017.75012