Ramadan Fasting and Acute Pancreatitis: Clinical and Biochemical Correlates From a Five-Year Cohort

Ramadan fasting involves daily abstinence from food and fluids between dawn and sunset for approximately 1 month each year. The physiological and metabolic changes occurring during Ramadan may be associated with the occurrence of acute pancreatitis, but data remain limited and inconsistent.

We conducted a 5-y retrospective study (2019-2023) at the Department of General and Digestive Surgery, Trauma and Burn Center of Ben Arous, Tunisia. All adult patients admitted for acute pancreatitis were included. Hospital admission rates during Ramadan were compared with those during other months. Subgroup analyses were performed according to etiology, sex, and comorbidities. Biochemical parameters and timing of symptom onset were analyzed to explore potential clinical and biochemical correlates.

A total of 632 patients were included (mean age 51.8 ± 14.2 y; 75% women). Eighty-five episodes (13.4%) occurred during Ramadan, corresponding to a hospital admission rate of 0.13% compared with 0.08% during the rest of the year (odds ratio = 1.83; 95% confidence interval 1.12-2.24; P = 0.027). The increase was most pronounced in biliary pancreatitis and among women aged >50 y. The mean triglyceride (2.01 ± 1.2 mmol/L versus 1.72 ± 0.9 mmol/L; P = 0.036) and hematocrit levels (0.43 ± 0.05 versus 0.41 ± 0.04; P = 0.041) were significantly higher during Ramadan. Most attacks (64%) occurred within 4 hours after the evening meal (iftar). Disease severity and mortality were similar between groups.

Ramadan-period admissions were associated with a higher hospital admission rate of acute pancreatitis, particularly of biliary origin. Higher hematocrit and triglyceride levels observed during Ramadan may reflect biological processes potentially contributing to this association. Disease severity and clinical outcomes were similar between Ramadan and non-Ramadan admissions.