Title: Effect of Ramadan intermittent fasting on inflammatory markers, disease severity,
depression, and quality of life in patients with inflammatory bowel diseases: A prospective
cohort study
Version: 1 Date: 24 Feb 2022
Reviewer's report:
This is a prospective study that aimed at assessing the effects of intermittent fasting in Ramadan
on clinical disease activity and objective markers of inflammatory bowel disease patients.
The authors concluded that intermittent fasting had deleterious effects on clinical activity in
UC patients. Objective inflammatory markers were unchanged after fasting. The authors are
congratulated on the prospective design of the study and a well-written manuscript. However,
there are many limitations that need to be addressed. The major limitation is sample sample
size and numerous confounders that can affect the results including type and amount of dietary
intake during non-fasting period.
Major comments:
- A dietary intake questionnaire/journal for each patient would have enhanced this trial.
Alternatively unified dietary guidance would have also helped. Dietary indiscretion and
overeating can occur during the non-fasting periods in Ramadan which can account for the
lack of difference in objective markers and worsening clinical parameters in some UC patients.
Do you have information on body weight/BMI prior to and after Ramadan as this can act as a
surrogate to this question of overeating?
- I would change the wording of the conclusion as it can be misleading to say that fasting had
a deleterious effect in UC. This study showed that in patients with objectively active UC at the
start of Ramadan, fasting was associated with worsening clinical parameters but not objective
inflammatory markers
-  What is the rationale of using an age cut-off of 32?? This seems like an effort to get statistical
significance. Would suggest using more traditional cutoffs in IBD such as age 30 or 65
- Any data on who developed clinical flares, required steroids, hospitalizations or ED visits for
IBD??
- Baseline demographic information is missing in terms of disease location and phenotypes
- What is the effect of being on steroids at the start of the study?
- A log of medication adherence would have also enhanced the study
Minor comments:
- Abstract, results section line 30: need a period after “after fasting”
- Please use “p=” format instead of “p:”
- There are a few grammar errors that should be addressed. Ex line 64: change “fast for” to
“fast from”
Title: Effect of Ramadan intermittent fasting on inflammatory markers, disease severity,
depression, and quality of life in patients with inflammatory bowel diseases: A prospective
cohort study
Version: 1 Date: 24 Feb 2022
Reviewer's report:
This is a prospective study that aimed at assessing the effects of intermittent fasting in Ramadan
on clinical disease activity and objective markers of inflammatory bowel disease patients.
The authors concluded that intermittent fasting had deleterious effects on clinical activity in
UC patients. Objective inflammatory markers were unchanged after fasting. The authors are
congratulated on the prospective design of the study and a well-written manuscript. However,
there are many limitations that need to be addressed. The major limitation is sample sample
size and numerous confounders that can affect the results including type and amount of dietary
intake during non-fasting period.
Major comments:
- A dietary intake questionnaire/journal for each patient would have enhanced this trial.
Alternatively unified dietary guidance would have also helped. Dietary indiscretion and
overeating can occur during the non-fasting periods in Ramadan which can account for the
lack of difference in objective markers and worsening clinical parameters in some UC patients.
Do you have information on body weight/BMI prior to and after Ramadan as this can act as a
surrogate to this question of overeating?
- I would change the wording of the conclusion as it can be misleading to say that fasting had
a deleterious effect in UC. This study showed that in patients with objectively active UC at the
start of Ramadan, fasting was associated with worsening clinical parameters but not objective
inflammatory markers
-  What is the rationale of using an age cut-off of 32?? This seems like an effort to get statistical
significance. Would suggest using more traditional cutoffs in IBD such as age 30 or 65
- Any data on who developed clinical flares, required steroids, hospitalizations or ED visits for
IBD??
- Baseline demographic information is missing in terms of disease location and phenotypes
- What is the effect of being on steroids at the start of the study?
- A log of medication adherence would have also enhanced the study
Minor comments:
- Abstract, results section line 30: need a period after “after fasting”
- Please use “p=” format instead of “p:”
- There are a few grammar errors that should be addressed. Ex line 64: change “fast for” to
“fast from”
Please review this paper.
user
Title: Effect of Ramadan intermittent fasting on inflammatory markers, disease severity,
depression, and quality of life in patients with inflammatory bowel diseases: A prospective
cohort study
Version: 1 Date: 24 Feb 2022
Reviewer's report:
This is a prospective study that aimed at assessing the effects of intermittent fasting in Ramadan
on clinical disease activity and objective markers of inflammatory bowel disease patients.
The authors concluded that intermittent fasting had deleterious effects on clinical activity in
UC patients. Objective inflammatory markers were unchanged after fasting. The authors are
congratulated on the prospective design of the study and a well-written manuscript. However,
there are many limitations that need to be addressed. The major limitation is sample sample
size and numerous confounders that can affect the results including type and amount of dietary
intake during non-fasting period.
Major comments:
- A dietary intake questionnaire/journal for each patient would have enhanced this trial.
Alternatively unified dietary guidance would have also helped. Dietary indiscretion and
overeating can occur during the non-fasting periods in Ramadan which can account for the
lack of difference in objective markers and worsening clinical parameters in some UC patients.
Do you have information on body weight/BMI prior to and after Ramadan as this can act as a
surrogate to this question of overeating?
- I would change the wording of the conclusion as it can be misleading to say that fasting had
a deleterious effect in UC. This study showed that in patients with objectively active UC at the
start of Ramadan, fasting was associated with worsening clinical parameters but not objective
inflammatory markers
-  What is the rationale of using an age cut-off of 32?? This seems like an effort to get statistical
significance. Would suggest using more traditional cutoffs in IBD such as age 30 or 65
- Any data on who developed clinical flares, required steroids, hospitalizations or ED visits for
IBD??
- Baseline demographic information is missing in terms of disease location and phenotypes
- What is the effect of being on steroids at the start of the study?
- A log of medication adherence would have also enhanced the study
Minor comments:
- Abstract, results section line 30: need a period after “after fasting”
- Please use “p=” format instead of “p:”
- There are a few grammar errors that should be addressed. Ex line 64: change “fast for” to
“fast from”
assistant