Gastrointestinal symptoms and eating patterns during Ramadan fasting among university students in Palestine: a cross-sectional study

BACKGROUND: Ramadan is one of the holiest months of the year for Muslims. It involves major dietary changes that may affect gastrointestinal (GI) health. This study aims to assess the relationship between eating habits and GI symptoms during Ramadan among university students. METHODS: A cross-sectional design study was conducted among university students at An-Najah National University in Palestine. Data were collected through an online questionnaire that included sociodemographic information, medical history, and Ramadan eating habits. GI symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS). Bivariate analyses were performed for GSRS subscales, while multiple linear regression was used to identify independent predictors of overall GSRS score, reflux, and abdominal pain. RESULTS: A total of 696 undergraduates were included. The mean age was 20.6 ± 1.7 years and 69.4% were female. The mean GSRS score was 2.07 ± 0.99, indicating mild GI symptoms. In bivariate analyses, GI symptoms were associated with sociodemographic and clinical factors, including sex, living area, working status, income, and chronic GI disease (p < 0.05). Several dietary behaviors were also associated with GI subscales, including Iftar starting items, soup and kibbeh intake, spices, bread and dessert consumption, meal quantity, juice intake after Iftar, fruit intake between Iftar and Suhoor, and Suhoor composition. In multivariate analyses, chronic GI disease was the most consistent predictor across all models. Total GSRS was independently associated with chronic GI disease, medication use, bread consumption at Iftar, and eating before sleep. Reflux was associated with chronic GI disease, Ramadan sweets, and plant-based protein at Suhoor. Abdominal pain was associated with chronic GI disease, medication use, bread, and kibbeh consumption. CONCLUSIONS: GI symptoms during Ramadan were generally mild. Chronic GI disease was the strongest predictor of symptoms, while specific dietary behaviors, particularly bread and sweet consumption, plant-based protein intake at Suhoor, and late-night eating, were independently associated with GI symptoms. These findings highlight the importance of dietary balance and meal timing during Ramadan.