Changes in Diet, Body Composition, Sleep, and Activity with Onset of Ramadan Intermittent Fasting in Female University Students: A Prospective Cohort Study

Abstract Background 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. Methods 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. Objectively measured 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. Results 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 decreased intake of vegetables from pre-RIF to RIF-weeks 1 and 2 (1.02 ± 0.59 to 0.92 ± 0.78 and 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 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). Conclusions Commencement of RIF during the first two weeks is associated with significant changes in daytime alertness and dietary intakes among female university students. This initial period of Ramadan represents a critical time, necessitating supportive strategies within academic settings to monitor students effectively.