The Effect of Observing Religious or Faith-based Fasting on Cardiovascular Disease Risk Factors: A Systematic Review and Meta-analysis

Aims: Cardiovascular diseases (CVD) are the leading cause of death worldwide. Fasting is common in many religions and is associated with health benefits. This systematic review to compares the impact of different religious fasting practices, on risk of cardiometabolic diseases. Data synthesis: The search covered five databases following PRISMA guidelines to identify papers published in English from inception to March 2023 (updated January 2024). Inclusion criteria were healthy adults in observational studies, who engaged in religious fasting practices, studies were included where data on matched non-fasting individuals was available. Outcomes were systolic and diastolic blood pressure, body mass index (BMI), triglycerides, total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), and fasting plasma glucose levels. A meta-analysis was conducted, and the review was registered (CRD42022352197). Fourteen studies were met the inclusion criteria with ten studies data being suitable for meta-analysis, reporting on 755 adults participating in fasting practices and 661 non-fasting controls. Religious fasting was associated with a reduction in BMI (−0.40 kg/m ², 95% CI [-0.70, −0.10], p < 0.01). Observance of Ramadan fasting was associated with decreased systolic blood pressure (−3.83 mmHg, 95% CI [-7.44, −0.23], p = 0.04). The observance of Orthodox Christian fasting was associated with a reduction in TC (−0.52 mmoL/l, 95%CI [–0.64, −0.39], p < 0.01). No difference was found for the other outcomes. Conclusion: This review found religious fasting practices which were associated with a reduction in some biomarkers of cardiometabolic diseases risk. Further research on other fasting practices is needed due to limited data.