Changes in diet, body composition, sleep, and activity with onset of Ramadan intermittent fasting in female university students: a prospective cohort study

Ramadan intermittent fasting (RIF) significantly impacts daily routines and health parameters. The immediate adaptations during early Ramadan, particularly among university students maintaining academic commitments, remain understudied. Twenty-five healthy female students (aged 20.58 ± 1.37 years) were followed over three weeks: one pre-Ramadan (pre-RIF) and the first two weeks (RIF-week 1 and RIF-week 2) of Ramadan. To objectively measure sleep duration and physical activity (skin-contact actimetry), daytime sleepiness (Epworth Sleepiness Scale), anthropometric assessment (bioelectrical impedance), and dietary intakes (3-day food records) were assessed over the three timepoints. Sleep efficiency remained stable at 85%. Daytime sleepiness scores significantly decreased from pre-RIF (13.76 ± 4.22) to RIF weeks 1 and 2 (11.92 ± 4.01; 11.88 ± 4.96, p = 0.032). Waist-to-hip ratio significantly decreased from 0.88 ± 0.06 in pre-RIF to 0.87 ± 0.06 (p = 0.049) during the following two weeks. Significant dietary changes were reported between pre-RIF and RIF-week 1, including increased fruit intake (0.85 ± 0.75 to 1.83 ± 1.51 cups/day, p = 0.018) and fiber consumption (13.49 ± 5.31 to 19.54 ± 11.62 g/day, p = 0.022), while intake of vegetables decreased from pre-RIF to RIF-weeks 1 and 2 (1.02 ± 0.59 to 0.92 ± 0.78 and 0.62 ± 0.52 cups/day, p = 0.037), and folate (158.82 ± 95.88 to 118.00 ± 85.24 and 118.20 ± 73.98 µg/day, p = 0.036); and there was marginal decrease in fat intake between pre-RIF and RIF-week 2 (67.42 ± 32.33 to 52.55 ± 26.79 g/day, p = 0.136). Commencement of Ramadan intermittent fasting (RIF) during the first two weeks is associated with a significant increase in daytime alertness and fruit intake, and reduced vegetable intake among female university students. This initial period of Ramadan is a critical time, requiring supportive strategies in academic settings to monitor students effectively.