The effectiveness of Sunnah intermittent fasting in reducing elevated blood pressure among civil servants in Aceh, Indonesia / Dharina Baharuddin

Dharina , Baharuddin (2024) The effectiveness of Sunnah intermittent fasting in reducing elevated blood pressure among civil servants in Aceh, Indonesia / Dharina Baharuddin. PhD thesis, Universiti Malaya.

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Abstract

Hypertension is increasing in prevalence worldwide, including in Aceh, one of the provinces in Indonesia. Elevated blood pressure (EBP) is the first stage that occurs before the onset of hypertension and is often undetected, leading to cardiovascular disease and organ damage. Since only hypertension information was available in Aceh, it was assumed that the prevalence of hypertension was equal to the prevalence of EBP. Several recent studies have suggested intermittent fasting (IF) to be effective in decreasing metabolic factors compared to non-interventions. Therefore, this study aimed to determine the effectiveness of IF in the form of Islamic Sunnah intermittent fasting (Sunnah-IF) compared to usual dietary intake in reducing EBP among workingaged adults after 12 weeks of intervention and a further 12 weeks of the maintenance phase. This study was a quasi-experiment conducted among employees of two separate civil departments in Banda Aceh. Employees aged 18–60 at the Governor's office in Banda Aceh were assigned as the intervention group (IG), while those at the Aceh Besar Regency secretariat office were appointed as the control group (CG). The IG was required to perform two days of Sunnah-IF in a week, amounting to 14 hours of fast. The CG followed the usual healthy lifestyle recommended by Indonesia's Ministry of Health, without requiring fasting. The required sample size was estimated based on the findings of recent studies with the largest sample size for 1.5 kg weight loss, using b=80% and a=5% (106 participants-53 per arm). Considering a 30% attrition rate, the total sample size needed was 140 participants (70 per arm). The primary outcomes were the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP). The secondary outcomes were the change in body weight (BW), body mass index (BMI), waist circumference (WC), and energy intake. All outcomes were measured at baseline, week 12, and week 24, with the data imputation method was the last observation carried forward. Data were analysed using inferential statistics and a generalized estimating equation (GEE) adjusted for potential confounding. All five outcomes showed a significant reduction (p<0.05) at week 12 and remained constant at week 24. The IG showed a reduction in SBP, DBP, BW, BMI, and energy intake by 5.3%, 5.2%, 7.3%, 7.3%, and 9.4%, however, the CG has no reduction for the outcomes at 12 and 24 weeks. There was, however, a non-significant reduction in WC in both IG and CG (p>0.05). The interaction between time and group was significant for SBP (p=0.03), DBP (p=0.03), BW (p<0.001), BMI (p<0.001), and energy intake (p<0.001). Based on the findings of this study, it was concluded that Sunnah-IF was effective compared to a usual dietary intake in reducing SBP, DBP, BW, BMI, and energy intake during 24 weeks of study duration. The findings provide crucial evidence for the Indonesian government to promote Sunnah-IF as a healthy lifestyle and alternative option to reduce EBP in Aceh and Sumatra island office workers. It is recommended to conduct this study with a longer duration to determine the long-term effects of Sunnah-IF.

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