The Effect of Ethiopian Orthodox Christians ‘Abiy Tsom’ (Lent fasting) on Metabolic Syndrome Indices and Serum Electrolytes BY CHALA KENENISA A THESIS SUBMITTED TO DEPARTMENT OF MEDICAL BIOCHEMISTRY, ADDIS ABABA UNIVERSITY IN PARTIAL FULFILLMENT OF the degree of MASTER OF SCIENCE IN MEDICAL BIOCHEMISTRY ADDIS ABABA, ETHIOPIA AUGUST, 2017 1 ADDIS ABABA UNIVERSITY COLLEGE OF HEALTH SCIENCES DEPARTMENT OF BIOCHEMISTRY The Effect of Ethiopian Orthodox Christians ‘Abiy Tsom’ (Lent fasting) on Metabolic Syndrome Indices and Serum Electrolytes BY CHALA KENENISA EDAE SUPERVISORS: -1) DR SOLOMON GENET 2) MRS MARIA DEGEF i SIGNATURE PAGE This is to certify that the thesis prepared by Chala Kenenisa Edae entitled; The effects of Ethiopian Orthodox Christians ‘Abiy tsom’ (Lent fasting) on metabolic syndrome indices and serum electrolytes and submitted in partial fulfillment of the Degree of Masters of Science in Medical Biochemistry complies with the regulations of the University and meets the accepted standards with respect to originality and quality. Signed by Examining committee: Examiner____________________________Signature __________Date___________ Advisor Dr Solomon Genet Signature _________________Date __________ Advisor Mrs Maria Degef Signature __________Date ___________ Department Chairman or Graduate program coordinator ii ACKNOWLEDGEMENT First of all, I want to praise my Almighty Lord for His continual support and provision of all things, materials, opportunities and wisdom. Next, I extend my deepest gratitude to my supervisors Dr Solomon Genet and Mrs Maria Degef. I also thank Dr Wondyfrew Mekonnen and Dr Diresebechew Haile for their collaboration and networking during my project work without which this work will not have been concluded on time and with this quality. I forward my gratitude also to Mrs Bethlehem Tefera laboratory personnel at Core lab of College of Health Sciences and Fikedu, Jilal and Workineh, laboratory technicians of diagnostic lab Tikur Anbessa specialized Hospital for their cooperation during my laboratory work. I also express my heartfelt thanks for my study participants and appreciate their good and kind heart. I would like to thank Jimma University for sponsoring my study and Addis Ababa University for teaching me and funding my project. I specifically express my gratitude for Department of Biochemistry, College of Health Sciences, Addis Ababa University for their vital role. At last but not least, I want to thank my family members, friends and classmates for all- time encouragement and comfort they gave me. iii TABLE OF CONTENTS LIST OF FIGURES ............................................................................................................... vii LIST OF TABLES .................................................................................................................. viii Acronyms .................................................................................................................................. ix 1. Introduction .......................................................................................................................... 2 1.1 Background ...................................................................................................................... 2 1.2. Statement of the problem ................................................................................................ 5 1.3. Significance of study ....................................................................................................... 8 2. Literature review .................................................................................................................... 9 2.1. Definition and pathogenesis of metabolic syndrome ...................................................... 9 2.2. Factors Associated with Metabolic Syndrome .............................................................. 10 2.3. Religious Fasting and its effect on metabolic syndrome indices and level of serum electrolytes ........................................................................................................................... 12 2.3.1. Religious fasting .................................................................................................... 12 2.4. Fasting in Ethiopian Orthodox Christianity .................................................................. 21 3. Hypothesis and objectives .................................................................................................... 22 3.1. Hypothesis .................................................................................................................... 22 3.2. Objectives ..................................................................................................................... 22 3.2.1. General objective ................................................................................................... 22 3.2.2. Specific objectives ................................................................................................. 22 4. Materials and methods ......................................................................................................... 23 4.1. Study area and period .................................................................................................... 23 4.2. Study design .................................................................................................................. 23 4.3. Study populations and subjects ..................................................................................... 23 4.4. Sample size Determination and sampling technique .................................................... 23 4.5. Inclusion and exclusion criteria .................................................................................... 26 4.5.1. Inclusion criteria .................................................................................................... 26 4.5.2. Exclusion criteria ................................................................................................... 26 4.6. Measurements / variables .............................................................................................. 26 4.6.1. Dependent variable ................................................................................................ 26 4.6.2. Independent variable .............................................................................................. 27 4.7. Data Collection and Instruments for Data Collection ................................................... 27 iv 4.8. Anthropometry measurements ...................................................................................... 27 4.9. Physical/ Clinical examination ..................................................................................... 28 4.10. Laboratory Test ........................................................................................................... 28 4.10.1. Specimen Collection and Handling ...................................................................... 28 4.10.2. DETERMINATION OF FASTING BLOOD GLUCOSE (GOD-PAP METHOD) ......................................................................................................................................... 28 4.10.3. DETERMINATION OF LIPID PROFILE .......................................................... 29 4.10.4. TOTAL CHOLESTEROL ................................................................................... 29 4.10.5. TRIGLYCERIDES .............................................................................................. 30 4.10.6. HIGH DENSITY LIPOPROTEIN (HDL) CHOLESTEROL .............................. 30 4.10.7. LDL-CHOLESTEROL ........................................................................................ 31 4.10.8. DETERMINATION OF TOTAL PROTEIN BY BIURET METHOD............... 32 4.10.9. UREA ASSAY ..................................................................................................... 33 4.10.10. ASSAY OF ELECTROLYTES (Na+, K+, Ca2+ and Cl-) ................................... 35 4.11. Ethical Consideration .................................................................................................. 36 4.12. Data Quality Control ................................................................................................... 36 4. 13. Data Management ...................................................................................................... 37 4.14. Data Analysis and Report ........................................................................................... 37 4.15. Dissemination of the result ......................................................................................... 37 5. RESULTS ............................................................................................................................ 38 5.1. Socio demographic Characteristics of the Study participants ....................................... 38 5.2. Fasting type of study participants ................................................................................. 39 5.3. Comparison of Anthropometric Measurements During fasting and Non- Fasting ....... 40 5.4. Comparison of Systolic/Diastolic blood pressure and Pulse rate of the study participants ........................................................................................................................... 41 5.5. Comparison of Lipid Profile of the study subjects ....................................................... 42 5.6. Comparison of Urea level and total protein of the study participants