Contents lists available at ScienceDirect European Journal of Integrative Medicine journal homepage: www.elsevier.com/locate/eujim Research paper The effects of Ramadan fasting on serum concentrations of vaspin and omentin-1 in patients with nonalcoholic fatty liver disease Sara Ebrahimi a,b , Bahram Pourghassem Gargari c , Azimeh Izadi c,d, ⁎ , Bahareh Imani e , Foad Asjodi f a Jahrom University of Medical Sciences, Motahari hospital, Jahrom, Iran b School of Exercise and Nutrition Science, Faculty of Health Science, Deakin University, Australia c Department of Biochemistry and Diet Therapy, Nutrition Research Center, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran d Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran e Mashhad University of Medical Sciences, Mashhad, Iran f Iran Football Medical Assessment and Research Center (IFMARC), Tehran, Iran ARTICLE INFO Keywords: Nonalcoholic fatty liver disease (NAFLD) Fasting Ramadan Vaspin Omentin-1 ABSTRACT Introduction: Nonalcoholic fatty liver disease (NAFLD) is the most frequent liver disease. Vaspin may modulate the inflammatory process, insulin resistance, and NAFLD. Omentin-1 is independently associated with hepato- cyte ballooning. There is evidence of improvement in the adipokines level and histological hepatic steatosis following energy intake restriction and weight loss. The aim of the study was to evaluate the effects of Ramadan fasting on various circulating adipokines in NAFLD patients. Methods: This study was conducted on 83 NAFLD patients, 42 cases who declared that they would fast during the month of Ramadan fasted and 41 controls who decided not to fast during Ramadan. Anthropometric parameters including weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR) and body fat percentage were measured before and after Ramadan. Dietary intake and physical activity levels were assessed by 24-h recall questionnaire and International physical activity questionnaire-short form (IPAQ-S), respectively. Serum adipokines including vaspin and omentin-1 were measured using commercial ELISA kit. Results: Patients who fasted displayed a lower mean hip circumference and body mass index and considerable changes in serum vaspin and omentin-1 (p-value < 0.05). The stepwise multivariate linear regression model revealed that the changes in weight, WHR, and dietary intakes were significant predictors of changes in serum adipokines. Conclusion: There is a potential for fasting in improving several anthropometric indices in NAFLD patients. Additionally, fasting during Ramadan resulted in decreased levels of adipokines including vaspin and omentin-1. Studies with longer follow-up periods are required. 1. Introduction Non-alcoholic fatty liver disease (NAFLD), the most common chronic liver disease, is a major public health concern. NAFLD is characterized by accumulation of liver fat exceeding 5% in the absence of significant alcohol intake, viral infection or any specific etiology of the liver [1]. The increased prevalence of obesity and sedentary lifestyle is asso- ciated with the increased prevalence of NAFLD [2,3]. Adipose tissue-derived inflammatory molecules contribute to obe- sity-related complications [4]. The main mechanisms involved in the epidemiological relationship between visceral fat mass and increased metabolic risk has been attributed to adipokines, which are predominantly expressed and secreted from visceral adipose tissue [5]. Several effects on insulin resistance have been attributed to vaspin (visceral adipose tissue-derived serine protease inhibitor) [6], ad- ditionally, the serum level of vaspin has been directly associated with aminotransferase concentrations as well as hepatocyte ballooning de- generation [7,8]. Vaspin is involved in the inflammatory process [7,9], and plays a mediating role in resting metabolic rate [10]. Omentin-1, which has the most expression in visceral adipose tissue, is reported to be an independent predictor of hepatocyte ballooning [7] and increased level of omentin-1 and vaspin has been observed in NAFLD [7,8]. The dietary and lifestyle modifications and proper weight man- agement are the first lines treatment of hepatic fat accumulation and prevention of NAFLD. According to the evidence, weight loss and https://doi.org/10.1016/j.eujim.2018.03.002 Received 2 December 2017; Received in revised form 9 March 2018; Accepted 9 March 2018 ⁎ Corresponding author at: Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran. E-mail address: izadia@tbzmed.ac.ir (A. Izadi). European Journal of Integrative Medicine 19 (2018) 110–114 1876-3820/ © 2018 Elsevier GmbH. All rights reserved. T