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Introduction: Most Ramadan fasting studies are usually conducted over one-year periods and show the short-term effects of Ramadan fasting. There is no standard tool or questionnaire to evaluate people's fasting habits and Ramadan fasting long term effects. For the first time, we designed a study to develop and validate a questionnaire to evaluate people's fasting habits as a tool for the determination of shortterm and long-term Ramadan fasting effects. Methods: After designing the questionnaire, it was sent to 10 experts in this field for judging and commenting (content validity). The validity of the questionnaire was evaluated using the Content Validity Ratio (CVR) index> 0.62, which includes the questionnaire's essentiality, relevancy, clarity, and comprehensiveness. In order to check the questionnaire reliability, the "test-retest method" was applied among 10 individuals. Results: After multiple drafts, the questionnaire contained 16 items, categorized into "Basic information on fasting (demographic information)", and "Fasting nutritional habits" including 13 and 3 questions, respectively. The overall CVR for relevancy, clarity, and comprehensiveness of the tool were 0.92, 0.95, 0.97, and 0.95, respectively. The Pearson correlation coefficient of the test-retest stage was 0.85. Conclusions: This Ramadan fasting habits questionnaire demonstrated strong content validity and testretest reliability. It can be an appropriate instrument for the evaluation of Ramadan fasting basic information and nutritional habits in research or practice-oriented settings for the determination of short-term and long-term Ramadan fasting effects. [ABSTRACT FROM AUTHOR]

Background: Enteral feeding intolerance, energyprotein malnutrition, and muscle wasting are common conditions in the critical care setting. The primary aim of this study was to investigate the effect of synbiotic supplementation on enteral feed volume, energy and protein homeostasis, and muscle mass maintenance in critically ill adult patients. Methods: A consecutive of 42 patients admitted to the Edalatian Medical ICU, requiring enteral nutrition (EN) were prospectively randomized to receive the synbiotic capsule (containing a combination of Lactobacillus, Bifidobacterium, Streptococcus, and fructooligosaccharides) or placebo (21 patients in each group) for a maximum of 14 days. Results: Mean EN volume, energy, and protein intake were 962.5±533.82 ml, 770±427.05 kcal and 38.5±21.35 g (fourth day) vs. 590±321.1 ml, 472±256.81 kcal, and 23.6±12.84 g (first day) in the synbiotic group (p<0.05). Changes in the placebo group were not statistically significant. On day 1 nitrogen balance (NB) was -19.84±8.03 in the synbiotic vs. -10.99±9.12 in the placebo group (p=0.003). On day 14, NB was -14.18±13.05 in the synbiotic and -9.59±7.71 in the placebo group (p=0.41). Mid-arm circumference (MAC), 24-hour urine creatinine, and creatinine-height index were almost steady in the synbiotic group, while they decreased in the placebo group. Conclusion: Overall, it can be concluded that enteral nutrition supplemented with synbiotics may increase enteral feed volume, energy and protein intake during the first four days. It is also associated with nitrogen balance improvement and muscle mass maintenance of critically ill adult patients. [ABSTRACT FROM AUTHOR]

Background: Gut microbiota dysbiosis, endotoxemia, and systemic inflammation are major contributing factors to disease pathophysiology in critically ill patients. The present study aimed to assess the effects of synbiotic supplementation on the serum endotoxin and inflammation of critically ill adult patients. Materials: This double-blind, randomized, controlled trial was conducted at the intensive care unit (ICU) of Imam Reza Hospital in Mashhad, Iran. In the intervention group, 20 patients received synbiotic capsules (containing a combination of Lactobacillus, Bifidobacterium, Streptococcus, and fructooligosaccharides) twice per day for a maximum of 14 days. In the control group, 18 patients received placebo capsules. The serum levels of endotoxin and C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) were measured before and after the intervention. In addition, clinical outcomes and the scores of Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) were recorded. Results: Basic characteristics were similar in the intervention and control groups. The NLR and serum endotoxin levels significantly reduced in the synbiotic group (7.83 [4.58-12.57]-6.01 [4.25-9.38]; P= 0.04 and 11.98 [10.64-12.65]- 10.58 [9.41-12.34]; P=0.03, respectively). However, no significant changes were observed in the mentioned parameters in the placebo group. The clinical outcomes were also similar in the study groups, such as the length of hospital/ICU stay and hospital/28-day mortality rate. Conclusion: Although synbiotic supplementation (500 mg twice daily for 14 days) could reduce serum endotoxin and inflammatory markers, it had no effects on the clinical outcomes of the patients. [ABSTRACT FROM AUTHOR]