Effet du jeûne du Ramadan sur des patients atteints de maladies non transmissibles (Diabète, maladies cardiovasculaires, cancer)-Etude réalisée sur Constantine (2021/2022).

Abstract

This thesis examines the impact of Ramadan fasting on individuals with non-communicable diseases (NCDs), a topic of critical importance due to the abrupt disruption of chronobiological rhythms and the alteration of the activity/rest cycle during this period. The study was conducted in two parts. The first part involved a cross-sectional descriptive survey conducted in Constantine (eastern Algeria) among 63 patients with diabetes mellitus, of whom 41.3% were under 18 years old. Data were collected on general characteristics, behaviors and attitudes toward Ramadan fasting, dietary habits, blood glucose control, and complications or illnesses associated with COVID-19. The second part included 1,300 participants, comprising 650 healthy individuals and 650 individuals with NCDs (300 with cardiovascular diseases, 160 with cancer, and 190 with diabetes). The questionnaire covered various aspects, including fasting practices, physical activity level (assessed using the International Physical Activity Questionnaire, IPAQ), sleep quality (measured using the Pittsburgh Sleep Quality Index, PSQI), food consumption frequency, and anthropometric measurements. Data were analyzed using R software (version 3.2.4), with a significance level set at 0.05. The results of the first part of the study revealed that 77.8% of individuals with diabetes discussed their condition with those around them, and 58.7% had engaged in fasting prior to their diabetes diagnosis. Additionally, 73.3% monitored their blood glucose levels before breaking their fast. Following COVID-19 illness, hyperglycemia emerged as the most frequent complication, occurring in 9.5% of cases. The second part of the study demonstrated that fasting was practiced by 70.7% of individuals with cardiovascular diseases (CVD), 30.6% of cancer patients, and 53.2% of individuals with diabetes. Subjects with CVD exhibited a higher frequency of fasting outside Ramadan compared to other patient groups (10.4 ± 6.5 days; p=0.000). These individuals also displayed a greater tendency toward self-monitoring compared to healthy participants but showed a higher prevalence of smoking (39.67%) relative to other patients. Physical activity levels (PAL) were significantly higher in healthy subjects during Ramadan (1167.4 ± 119.1 min.week⁻¹) and outside Ramadan (1288.6 ± 58.6 min.week⁻¹; p<0.05) compared to subjects with NCDs. Among individuals with CVD, a strong, positive, and significant correlation was observed between sleep duration and the total hours spent in bed (r=0.709; p=0.000). Sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI), was generally poor across all groups during Ramadan (PSQI > 5). Significant alterations in dietary habits were also noted during Ramadan. Cancer patients reduced their consumption of sugary products (p=0.042), whereas individuals with diabetes (p=0.009) and CVD (p=0.000) increased their intake of animal protein sources. Healthy participants exhibited a marked increase in the consumption of fruits and vegetables (p=0.004) as well as sweet products (p=0.000). Notably, no significant differences in weight status were observed across any of the study groups regardless of the period. The present study underscores the necessity of a personalized approach to managing noncommunicable diseases during and outside Ramadan. The findings highlight the importance of enhanced medical surveillance and tailored therapeutic education that addresses specific requirements related to physical activity, sleep, and nutrition. Targeted intervention strategies should be developed to support patients in maintaining a healthy lifestyle while respecting their religious practices, thereby contributing to improved health management during this unique period.