Does Fasting During Ramadan Increase the Risk of the Development of Sialadenitis?

Michael V. Joachim; Yasmine Ghantous; Suleiman Zaaroura; Kutaiba Alkeesh; Tameem Zoabi; Imad Abu el-Na'aj


BMC Oral Health. 2020;20(156) 

In This Article


This study was approved by Poriya Medical Center Institutional Review Board (approval # POR-18-0061) and was performed in accordance with the Declaration of Helsinki, seventh revision (2013). This is a retrospective study prepared according to STROBE guidelines. The hospitals involved in this study are uniquely positioned to address the hypothesis that Ramadan fasting corresponds to an increased frequency of acute sialadenitis since a large portion of their patient base are Muslim. Baruch Padeh Medical Center is a public hospital, run by the Israeli Ministry of Health, serving the area of Eastern Galilee and Golan Heights and is a multi-regional centre for oral and maxillofacial surgery. It is estimated that 40–60% of its patients come from the Muslim community. St. Vincent de Paul (French) Hospital is a public hospital, run by the Catholic Church Trust, located in the heart of Nazareth, the largest Arab city in Israel, and provides exclusive otolaryngology service in that area. More than 80% of its patients come from the Muslim community.

The research sample included all adolescent and adult (> 14 yrs) cases of acute sialadenitis (identified by the International Classification of Diseases, Ninth Revision (ICD-9) code 527.2 – Sialadenitis) diagnosed in Muslims (data on patient religion was received from the Israeli Ministry of Interior database) in the emergency rooms of Baruch Padeh Medical Center, Poriya and St. Vincent de Paul (French) Hospital, Nazareth (both affiliated with the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel and located in the northern part of Israel) during the Hijri years 1434–1438 (15/11/2012–20/09/2017). The age filter was chosen to increase the probability of fasting and to rule out juvenile conditions. Patients with other conditions that might lead to acute dehydration (diarrhea, gastroenteritis, hyperemesis) were excluded from the analysis. Pregnant women are exempt from fasting and thus were not included in this study.

For this sample (sialadenitis diagnosis, Muslim, > 14 years age) we calculated the frequency of ER admissions due to acute sialadenitis for each Hijri month in the timeframe and compared Ramadan months to other months of the year. For the sake of accuracy, analysis was carried out based on Hijri calendar months since the month of Ramadan is part of this lunar calendar which is 11 days shorter than the standard Gregorian solar calendar. It is important to note that we cannot be sure of the fasting status of each patient, but given that Ramadan fasting is one of the main pillars of Islam and is practised by the vast majority of Israeli Muslims we assumed that the majority of the patients included in this study were indeed fasting during the month of Ramadan.

Additionally, in order to exclude the possibility of comorbidities whose prevalence may rise in an older population, we assessed for significant differences in the mean age of patients admitted during Ramadan and during other months of the year.

Statistics were calculated using Microsoft Excel™ (2010 version, Redmond, WA, USA) and IBM SPSS™ (25.0 version, Armonk, NY, USA) software. The comparison between subgroups was made using the following non-parametrical tests: ANOVA, t test, Kruskal-Wallis test, Wilcoxon signed-rank test, Fisher's exact test and Mann-Whitney U test. Adjustment factors were calculated by Pearson's method. A p value < 0.05 was considered significant.