• Melika Chihaoui, Mariam Mabrouk, Ibtissem Oueslati, Nadia Khessairi, Fatma Chaker, and Meriem Yazidi.
• Department of Endocrinology, Faculty of Medicine of Tunis, La Rabta University Hospital, University of Tunis El Manar, Tunis, Tunisia. Electronic address: melika.chihaoui@fmt.utm.tn.
• Nutrition. 2025 Jan 14; 132: 112688112688.

ObjectivesIntermittent fasting was associated with complications in patients with adrenal insufficiency (AI). The study aimed to evaluate the impact of therapeutic education and drug adjustment on Ramadan fasting outcomes in patients with secondary AI (SAI).MethodsA case-control prospective interventional study including patients with SAI willing to fast Ramadan 2023, and age-, gender-, and body mass index-matched healthy fasting controls. Before Ramadan, clinical examination, education for lifestyle measures, and hydrocortisone intake adjustment were performed. The occurrence of complications and the number of fasted days during Ramadan 2023 were reported and compared with those of Ramadan 2022 in patients and controls.ResultsA total of 50 patients; 33 women, median age: 43 years (34-55), median duration of SAI: 7.5 years (4-12.5), and 100 controls were enrolled, and fasted in 2023. Thirty-four patients and 100 controls fasted in 2022, corresponding to a 32% increase in fasting patients. Compared to 2022, there was a significant decrease in the frequency of complications in 2023 in patients compared to controls. The number of fasted days did not change. No severe event happened during the 2023 fasting. In patients, apart from the age that was higher in former fasters compared to new fasters, age, gender, body mass index, blood pressure levels, renal clearance, disease duration, and daily hydrocortisone dose were not associated with new versus former fasters, high versus low-risk patients, or incomplete versus complete month fasters.ConclusionsTherapeutic education enabled more patients with SAI to fast and reduced the frequency of complications during fasting. Registered on "clinical trials.gov," April 12, 2023, under the identifier ID: NCT05827965.Copyright © 2025 Elsevier Inc. All rights reserved.

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