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

Changes in Diet, Body Composition, Sleep, and Activity with Onset of Ramadan Intermittent Fasting in Female University Students: A Prospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Changes in Diet, Body Composition, Sleep, and Activity with Onset of Ramadan Intermittent Fasting in Female University Students: A Prospective Cohort Study Rand Abu Farha, Morgambal Padayachee, Haneen Hussein, Kowther Ismail, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6717648/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Feb, 2026 Read the published version in Journal of the Egyptian Public Health Association → Version 1 posted 7 You are reading this latest preprint version 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. body composition dietary intake physical activity Ramadan Intermittent Fasting sleep quality Figures Figure 1 Introduction Religious fasting is an age-old practice primarily observed for spiritual purposes. Yet, the health effects of religious fasting have been the subject of scientific inquiry in the past few decades ( 1 ). Intermittent fasting (IF) involves alternating cycles between fasting and non-fasting over a given period. Ramadan intermittent fasting (RIF) is an obligatory dry diurnal fasting observed during the ninth month of the Islamic calendar by healthy and capable Muslims. During Ramadan, individuals refrain from food and drinks, including water, from dawn to sunset, depending on the geographical location and season. This daytime fasting is followed by unrestricted food and beverage consumption from dusk to dawn ( 2 ). The restricted time for eating can impact meal composition and nutrient distribution ( 3 ). For instance, the quality and quantity of food consumed may vary, with higher intakes of sugary and energy-dense foods and beverages ( 4 ). Recently, healthy participants were followed from a few days prior to Ramadan to 8 to 12 days post-Ramadan in the United Kingdom, reporting considerable changes in nutritional intake, including a 62% increase in sugar consumption and a significant reduction in starch intake ( 5 ). The metabolic impact of these dietary changes can be significant, as RIF-linked shifts in mealtime result in several mild to moderate alterations affecting multiple physiological systems. RIF-linked changes include fluctuations in body weight( 6 ) and body composition ( 7 ). An average post-Ramadan weight loss of 1.7 kg and a body fat percentage reduction of 1.1% were recorded( 5 ) Similarly, RIF may alter glucoregulatory parameters ( 7 ), cardiometabolic markers ( 8 , 9 ), and inflammatory and oxidative stress biomarkers ( 10 ). Furthermore, the shift to nighttime eating and altered meal timing and frequency can significantly impact an individual's circadian rhythm, physical activity patterns, and cognitive function ( 11 ), creating a complex interplay between metabolic and behavioral adaptations during the fasting period. A prospective one-month post-Ramadan study in Sudan demonstrated a notable reduction of 30 minutes in total sleep time among healthy adults during Ramadan compared to the following month ( 12 ). Furthermore, physical activity, as measured by walking steps, decreased significantly two months after Ramadan compared to the fasting month ( 13 ). Moreover, a meta-analysis showed that the beneficial effects of RIF were only short-term; for example, pre-Ramadan weight loss and body composition parameters like fat-free mass (FFM) returned to baseline one month after Ramadan ( 14 ). Body weight is an example of the longest follow-up of changes after Ramadan, as observed in a study conducted in Jordan that spanned an entire year, beginning in the month of Ramadan. This study reported a weight gain of 0.53 kg throughout the first two weeks of Ramadan and a substantial 2.7 kg drop between weeks 26 and 28 ( 15 ). Changes in daily lifestyle during Ramadan are evident among people in the Gulf Cooperation Council countries, including dietary intake ( 16 ), sleep patterns ( 17 ), and physical activity ( 18 ). In the United Arab Emirates (UAE) academic environment, where Ramadan is celebrated with great cultural significance, university students face unique challenges as they balance the requirements of fasting with their ongoing academic commitments. These challenges are particularly pronounced for female students, who must manage menstrual periods during Ramadan while maintaining their academic responsibilities. Female university students also experience higher stress levels compared to their male counterparts, as reported in both the United States ( 19 ) and the UAE ( 20 ).The initial adaptation to RIF presents additional complexities as students navigate abrupt shifts in eating schedules, sleep patterns, and physical activity levels while managing coursework and assessments. This creates a multifaceted challenge that requires careful consideration and support. The first two weeks of Ramadan represent a critical adaptation period when the most significant physiological and behavioral changes occur. This initial period is particularly challenging as the body adjusts to the new feeding-fasting cycle while maintaining academic responsibilities. Female university students face unique challenges during Ramadan, including hormonal fluctuations and menstrual cycles that can impact their fasting schedule and overall well-being ( 19 ). Additionally, female students typically report higher stress levels and greater difficulty in maintaining regular sleep patterns compared to their male counterparts ( 20 ). Sleep architecture and daytime alertness were selected as primary outcomes because they directly impact academic performance and cognitive function, with changes in sleep patterns being one of the earliest manifestations of RIF-induced circadian rhythm disruption ( 17 ). Little is known about when these RIF-linked changes first occur, from the inception of Ramadan. Understanding the dynamics of the early weeks of Ramadan could assist the university authorities in customizing initiatives for RIF-practicing students to adapt favorably to the initial challenges of fasting in optimally managing their dietary habits, optimizing sleep patterns, and maintaining physical activity levels, thus enabling them to focus academically better and perform favorably during the Ramadan period. To test these hypotheses, the primary objective of this study was to assess the immediate changes in dietary intake, body composition, physical activity, sleep architecture, and daytime alertness during the baseline (pre-Ramadan) and the first two weeks of RIF among female university students. This study was conducted in an unconstrained free-living environment, where participants maintained their usual daily routines, dietary habits, sleep schedules, and physical activity during Ramadan. While this approach may introduce some variability due to individual lifestyle choices, it provides valuable real-world data about the immediate RIF-linked changes in diet, body composition, physical activity, sleep architecture, and daytime alertness under naturalistic conditions. Based on previous studies of changes in daily routines during Ramadan in free-living, unconstrained environments, we hypothesized that dietary intake, body composition, physical activity, sleep architecture, and daytime alertness differ significantly during the first two weeks of Ramadan compared to baseline. We further hypothesized that daytime alertness decreases during the initial weeks of RIF. This study uniquely combines multiple objective measurements to assess early adaptations to RIF comprehensively. While previous studies have largely relied on subjective assessments or single measurement tools, our approach integrates bioelectrical impedance analysis (BIA) for body composition assessment, skin-contact actimetry for continuous monitoring of sleep and physical activity, and detailed quantitative dietary records’ analysis. This multimodal objective assessment provides unprecedented insight into the physiological and behavioral adaptations that occur during the critical first two weeks of RIF, particularly in the understudied population of female university students during an active academic semester. Methods Ethics Statement The research protocol was approved by the Human Research Ethics Committee of the United Arab Emirates University (ERH-2024-4361). All participants signed informed consent prior to data collection and were free to quit at any time without facing any consequences. No monetary or non-monetary incentives were given to the study participants. Research Design and Setting A cohort prospective follow-up research design was employed, and the study was conducted at the United Arab Emirates University (UAEU) in Al Ain, United Arab Emirates. Study Period and Follow-Up This study took place over three weeks, starting at baseline in the first week of March 2024, a week prior to Ramadan (pre-RIF). Twice, follow-ups were done at the ends of the first (RIF-week 1) and second (RIF-week 2) weeks of Ramadan. Sample Size The sample size used was based on a G*Power 3.1.9.7 software calculation for ANOVA: Repeated measures (3 times) between factors (large Cohen’s effect size = 0.8, α = 0.05), and 16 participants were sufficient to minimize the probability of type II error for all the variables. Considering drop-outs and/or incorrect/incomplete data, 30 students studying at UAEU were recruited. Study Participants Thirty unmarried female university students who were native Arabic-speaking UAE citizens or residents were selected via non-probability convenience sampling. Non-athlete, healthy female students aged 18–25 years who regularly fasted during Ramadan were included. Students were screened through medical history and excluded those who reported a diagnosis of chronic medical conditions (diabetes, hypertension, thyroid disorders, psychiatric conditions). Students reported to be taking medications affecting sleep or metabolism (hypnotics, sedatives, antidepressants, anxiolytics, stimulants, weight-loss medications, or hormonal medications except contraceptives), or were on any special diets, were excluded. Additional exclusion criteria included irregular menstrual cycles (cycles 35 days in the previous 3 months) and reporting of diagnosed sleep disorders. Five of the recruited students dropped out, resulting in 25 participants completing the dietary intake, body composition, and daytime sleepiness aspects of the study. Further, six students dropped out, and 19 completed the sleep and physical activity aspects of the study. The days of the menstrual cycle were excluded from the follow-up due to religious exemption from practicing RIF during this period. Figure 1 shows the participant recruitment process. Data Collection Tools Participants were invited to the Nutrition Assessment and Body Composition Laboratory at the UAEU once a week, including a week prior to RIF, at the end of RIF week 1, and at the end of RIF week 2, respectively. The data were collected on dietary intake and body composition analysis. Sleep quality, physical activity, and daytime sleepiness were also determined. An attempt was made to ensure that all measurements were conducted at the same time of day (± 1 hour) for each participant across all three time points, thereby controlling for circadian and other variations. Participants characteristics A proforma was self-administered once at the beginning of the study to obtain information on the socio-demographic characteristics of participants, including age, nationality, educational level (Major and Year of study), and Emirate (Trucial States) of residence. Marital status (single) and medical status (no diagnosis of a chronic medical condition, not on any medical treatment/medication, and/or on any special diet, no irregular menstrual cycle in last 3 months or sleep disorder based on student reporting) described above in study participants section were confirmed for exclusion purposes. Dietary intake Each participant provided a total of nine 24-hour food records, including two weekday and one weekend food record from consecutive weeks (pre-RIF, RIF week 1, and RIF week 2). Each of them recorded all the food items they ate and drank, as well as the supplements they consumed, on the selected days. These records were then entered and analyzed using the Food Processor Nutrition Analysis Software (version 11.13; ESHA Research LLC.). The averages of three-day records per week were compared for any differences during the 3-week study period in terms of the intake of the five food groups and selected nutrients: energy, protein, carbohydrates, fats, and selected vitamins (A, D, B 1 , B 2 , B 3 , B 6 , B 12 , folate) and minerals (calcium, iron, sodium). Body Composition Height was measured as an input variable once at pre-RIF week using a stadiometer (Model: Seca 217). The participants were asked to stand erect with their heads in the Frankfort horizontal plane, with their shoulders relaxed, arms to the side, legs straight, and heels together, parallel to the vertical rod of the stadiometer. Before the measurement was taken, the participants were requested to inhale deeply, hold their breath, and maintain an erect posture. At the same time, the headboard was lowered to the highest point of the head with enough pressure to compress the hair. The measurement was recorded to the nearest 0.1 cm, and a mean value of either three consecutive readings or two concordant readings ( 21 ). Weight was recorded as an output measure of the body composition analysis. Participants were requested to wear light clothing and repeat the same on all three occasions. They were asked to stand barefoot on the center of the scale, ensuring equal distribution of their body weight. The weight measurement was recorded to the nearest 0.1 kg as a mean value of either three consecutive readings or two concordant readings ( 21 ). The height and weight measurements were used to determine the body mass index (BMI) using the standard formula: weight (kg)/height (m) 2 and World Health Organization classification: underweight (< 18.50 kg/m 2 ), normal (18.50-24.99 kg/m 2 ), overweight (25.00-29.99 kg/m 2 ), or obese ( ≥ 30.00 kg/m 2 ) ( 22 ). Body composition was analyzed at pre-RIF, RIF-week 1, and RIF-week 2 using the principle of the four-compartment bioelectrical impedance analysis (BIA) method (Model: InBody 720). BIA is a non-invasive method used to assess body composition by measuring the resistance of the body to a low-intensity alternating current (≤ 1 mA; 50 kHz) passing through tissues. Since FFM is an excellent conductor because it contains water and electrolytes, the impedance reflects the body's water content, making it possible to estimate body composition ( 23 ). Participants were asked to refrain from exercising, eating, and drinking for two hours prior and to come to the laboratory after voiding their bladder and bowels. During the testing process, participants were asked to stand at the center of the platform, maintaining appropriate contact with the eight electrodes on their palms, fingers, and foot soles while standing comfortably without flexing their muscles. Laboratory temperature was kept at a normal range of 20–25℃ ( 24 ). The output data included weight, BMI, total body water (TBW), percent body fat (PBF), skeletal muscle mass (SMM), waist-hip ratio (WHR), visceral fat area (VFA), and basal metabolic rate (BMR). Changes in fat distribution, muscle mass, and hydration status were observed throughout the three weeks. Daytime sleepiness The Epworth Sleepiness Scale (ESS) was self-administered at three time points during the study to assess daytime sleepiness in participants. It consists of 8 scenarios, rating the chances of participants dozing off on a 4-point scale (0 = no chance of dozing, 1 = slight chance of dozing, 2 = moderate chance of dozing, 3 = high chance of dozing), with a minimum score of 0 (normal sleep) and a maximum of 24 (very sleepy). A higher total score reflects more daytime sleepiness, classified as follows: low level of normal sleepiness (0–7), higher level of normal sleepiness ( 8 – 9 ), excessive sleepiness ( 10 – 15 ), and severe excessive sleepiness ( 16 – 24 ) ( 25 ). The original English version of ESS was administered, as all participants were enrolled in English-taught programs at the UAEU. Sleep Quality and Physical Activity Accelerometer-based, cost-effective wearable technologies have emerged as valid tools to quantify physical activity behaviors and sleep patterns directly and objectively in daily life ( 26 ) The actimetry device utilizes a triaxial accelerometer to monitor movement patterns, enabling the estimation of sleep and physical activity parameters ( 27 , 28 ). Concurrent validity has been reported for actigraphy measures of sleep and physical activity using 3D accelerometer data ( 29 ). While actigraphy provides a non-invasive and practical means of assessing sleep in free-living conditions, it does not directly measure sleep stages or detect brief awakenings that do not involve significant movement ( 30 ). Furthermore, accelerometry has been found to have moderate validity in assessing physical activity, particularly for moderate-to-vigorous physical activity ( 31 ). A thigh-mounted accelerometer may provide greater accuracy for determining and differentiating between sedentary postures ( 32 ). The device's placement and continuous monitoring capability made it well-suited for this longitudinal study; however, variations in physical activity estimations may occur due to individual movement patterns, posture, and sensitivity settings ( 31 , 33 ). Recently, the potential of using actimetry was evaluated to understand better the intercultural sleep habits and activity patterns ( 34 ). In this study, sleep quality and physical activity were assessed using the portable actigraphy-based device (eTact®, BodyCAP Medical, Hérouville-Saint-Clair, France) containing a tri-axial accelerometer enabling to record every acceleration from the body (sampling frequency: 25 Hz, measurement range: 0.1-2G, sample measurement: 1 minute). To obtain an accurate estimation of locomotion activity excluding hand gesticulation, participants were asked to continuously wear the device as a skin patch on the middle area of the front thigh throughout the three-week study period (total 21 days, including seven non-fasting pre-RIF days and first 14 days of RIF), except during showering, water-based activities, or charging. Valid sleep quality and physical activity data required a minimum wear time of 20 hours per day for at least 5 days each week. The actual duration for which students wore the device was a minimum of 22 hours daily during the three-week study period. Non-wear periods were identified using the device's proprietary algorithm. Accelerometer measures were averaged over the valid number of days worn for each week of wear. The device required approximately 120 minutes to charge fully. To minimize data loss, participants were instructed to charge the device every 2 days during their regular shower or bathing time. Sleep characteristics were obtained using the eTact® Analysis software (BodyCap, Caen, France), which assesses individual sleep quality based on actigraphy data collected over selected periods. Considered sleep parameters were the total sleep time (TST) (i.e., duration of effective daytime and nocturnal sleep period) and sleep efficiency (i.e., percentage of time spent sleeping during the rest period). Additionally, physical activity was quantified using time above threshold (TAT) extracted from the software during wake periods calculated as the accumulated time in each activity band, with a maximum value set at 1500 (25 Hz*60 seconds), categorizing activity levels as low ( 500 TAT). Data Analysis The data were analyzed to assess and compare the immediate RIF-linked changes in dietary intake, body composition, daytime sleepiness, sleep quality, and physical activity of the participants during the 3-week study period. IBM SPSS Statistics version 29.0 (SPSS Inc., Chicago, IL, USA) was used. Data were checked for normality and variance using the Shapiro-Wilk test for normality. Descriptive statistics were expressed as means ± standard deviations (SDs). Categorical variables were analyzed in terms of frequencies and percentages. Paired t-tests were used to compare outcomes between time points (pre-RIF vs. RIF-week 1; pre-RIF vs. RIF-week 2; RIF-week 1 vs. RIF-week 2). A one-way repeated measures analysis of variance (ANOVA) test was performed across the three-time points (pre-RIF and RIF weeks 1 and 2). Further, post-hoc comparisons were performed using the Least Significant Difference (LSD) test with Bonferroni correction for multiple comparisons. Partial eta squared (η²p) was used as a measure of effect size to determine the magnitude of observed changes, interpreted as follows: small (0.01–0.05), medium (0.06–0.13), and large (≥ 0.14). Missing data were handled on an analysis-by-analysis basis. Statistical significance was set at a p-value of less than 0.05. Results Participants Characteristics Table 1 summarizes the socio-demographic characteristics of the twenty-five study participants. The mean age of the participants was 20.58 ± 1.37 years. All were registered in undergraduate programs, with a distribution of 48% at the junior academic level and 52% at the senior academic level. Most (76%) were studying majors in nutrition, dietetics, or food science. While 56% were UAE nationals, the remaining 44% represented a diverse array of Arab nationalities, including Bahrain (8%), Egypt (8%), Jordan (12%), Oman (4%), Sudan (4%), and Syria (8%). Participants were full-time university students, 76% of whom resided in the Emirate of Abu Dhabi, where the university is located. Table 1 Socio-demographic characteristics of the study participants (n = 25) Variable Description N % Age Mean ± SD 20.58 ± 1.37 Major of study Nutrition, Dietetics, Food Science 19 76.0 Science and IT 4 16.0 Humanities 2 8.0 Year of study Freshman 3 12.0 Sophomore 2 8.0 Junior 7 28.0 Senior 13 52.0 Nationality UAE National 14 56.0 UAE Non-Nationals 11 44.0 Emirate of residence Abu Dhabi 19 76.0 Dubai 1 4.0 Fujairah 2 8.0 Ras Al Khaimah 1 4.0 Ajman 2 8.0 Dietary Intake Table 2 compares the average daily intake of food groups during the three follow-up weeks. Among the five major food groups analyzed, significant changes were observed only in the categories of fruits and vegetables. While fruit consumption more than doubled in the first week of RIF (p = 0.018), vegetable intake showed a progressive decline across the three weeks (p = 0.037). Furthermore, a paired t-test between pre-RIF and RIF-week 2 for protein intake revealed a significant decrease of almost one ounce equivalent; however, this significance disappeared in ANOVA (p = 0.282). Grains and dairy intake remained stable during the three weeks. Table 2 Comparison of food groups intake at pre-, week 1, and week 2 of Ramadan intermittent fasting (RIF) using one-way repeated measures ANOVA (n = 25) Variable Period Mean ± SD Type III Sum of Squares df Mean Square F η²p p-value Grain (oz equivalent) Pre RIF 4.70 ± 2.36 4.52 2 2.26 0.53 0.84 0.595 RIF-Week 1 4.35 ± 3.13 RIF-Week 2 4.10 ± 2.26 Vegetables (cups) Pre RIF 1.02 ± 0.59 2.14 2 1.07 3.52 0.78 0.037 RIF-Week 1 0.92 ± 0.78 RIF-Week 2 0.62 ± 0.52 $# Fruit (cups) Pre RIF 0.85 ± 0.75 12.56 2 6.28 4.37 0.65 0.018 RIF-Week 1 1.83 ± 1.51 * RIF-Week 2 1.50 ± 1.84 Dairy (cups) Pre RIF 0.71 ± 0.58 5.77 2 2.89 0.99 0.39 0.378 RIF-Week 1 0.61 ± 0.53 RIF-Week 2 1.24 ± 2.96 Protein (oz equivalent) Pre RIF 3.75 ± 1.84 20.10 2 10.05 1.30 0.80 0.282 RIF-Week 1 3.97 ± 4.31 RIF-Week 2 2.78 ± 1.81 $ Based on the Least Significant Difference (LSD) post−hoc test, the mean difference is significant at p<0.05 *Significant difference between Pre−RIF and RIF−Week 1; $Significant difference between Pre−RIF and RIF−Week 2; #Significant difference between RIF−Week 1 and RIF−Week 2 Table 3 summarizes the comparison of average daily intake of selected nutrients during the three consecutive weeks. Mostly, the intake of nutrients remained similar in the first fortnight of RIF. Nonetheless, some significant improvements were observed. Total dietary fiber intake increased significantly between 13.49 ± 5.31 g/day in the pre-RIF period and 19.54 ± 11.62 g/day in RIF week 1 (p = 0.022). Similarly, a significant difference was observed in total fat intake using a paired t-test between pre-RIF (67.42 ± 32.33 g/day) and RIF-week 2 (52.55 ± 26.79 g/day) (p = 0.044). However, this significance disappeared when the three groups were compared using ANOVA (p = 0.136). Conversely, folate showed a significant decrease between pre-RIF and RIF-week 1 from 158.82 ± 95.88 to 118.00 ± 85.24 µg/day and 118.20 ± 73.98 µg/day at RIF-week 2 (p = 0.036). Table 3 Comparison of nutrient intakes at pre-, week one, and week two of Ramadan intermittent fasting (RIF) using one-way repeated measures ANOVA (n = 25) Variable Period Mean ± SD Type III Sum of Squares df Mean Square F η²p P-value Calories (kcal/day) Pre RIF 1626.48 ± 563.04 66439.36 2 33219.68 0.07 0.90 0.930 RIF-Week 1 1632.22 ± 561.80 RIF-Week 2 1692.29 ± 1104.84 Protein (g/day) Pre RIF 58.00 ± 19.01 774.79 2 387.40 0.75 0.89 0.480 RIF-Week 1 62.34 ± 36.52 RIF-Week 2 54.48 ± 26.90 Total Fat (g/day) Pre RIF 67.42 ± 32.33 2804.77 2 1402.38 2.08 0.88 0.136 RIF-Week 1 61.52 ± 34.59 RIF-Week 2 52.55 ± 26.79 $ Saturated fat (g/day) Pre RIF 23.33 ± 13.54 459.35 2 229.68 2.40 0.86 0.102 RIF-Week 1 18.10 ± 10.99 RIF-Week 2 18.07 ± 9.76 Carbohydrates (g/day) Pre RIF 202.35 ± 65.06 42279.73 2 21139.87 1.26 0.80 0.293 RIF-Week 1 241.20 ± 121.02 RIF-Week 2 259.25 ± 241.50 Total sugars (g/day) Pre RIF 68.02 ± 41.29 34585.08 2 17292.54 1.37 0.46 0.263 RIF-Week 1 112.84 ± 115.46 RIF-Week 2 114.28 ± 212.60 Added sugar (g/day) Pre RIF 21.94 ± 14.02 343.69 2 171.85 1.09 0.74 0.344 RIF-Week 1 18.42 ± 14.84 RIF-Week 2 16.81 ± 17.16 Total fiber (g/day) Pre RIF 13.49 ± 5.31 570.60 2 285.30 4.16 0.80 0.022 RIF-Week 1 19.54 ± 11.62 * RIF-Week 2 19.10 ± 14.31 Vitamin A (µg /day) Pre RIF 299.10 ± 584.13 2149.81 2 1074.91 0.00 0.30 0.996 RIF-Week 1 302.07 ± 511.23 RIF-Week 2 289.52 ± 772.88 Vitamin D (µg /day) Pre RIF 1.81 ± 5.23 12.15 2 6.08 0.81 0.24 0.450 RIF-Week 1 1.18 ± 1.42 RIF-Week 2 0.84 ± 1.20 Vitamin B 1 (mg/day) Pre RIF 0.76 ± 0.52 1.83 2 0.91 0.7 0.54 0.504 RIF-Week 1 1.11 ± 1.92 RIF-Week 2 0.81 ± 0.91 Vitamin B 2 (mg/day) Pre RIF 0.60 ± 0.31 0.38 2 0.19 1.24 0.54 0.299 RIF-Week 1 0.77 ± 0.68 RIF-Week 2 0.65 ± 0.55 Vitamin B 3 (mg/day) Pre RIF 10.33 ± 4.52 183.28 2 91.64 1.04 0.77 0.362 RIF-Week 1 11.83 ± 15.15 RIF-Week 2 8.03 ± 4.46 Vitamin B 6 (mg/day) Pre RIF 0.83 ± 0.57 193.74 2 96.87 1.26 0.15 0.292 RIF-Week 1 4.33 ± 15.14 RIF-Week 2 1.01 ± 1.39 Vitamin B 12 (µg/day) Pre RIF 1.79 ± 3.39 16.37 2 8.19 0.45 0.21 0.644 RIF-Week 1 1.12 ± 1.17 RIF-Week 2 2.26 ± 7.74 Folate (µg/day) Pre RIF 158.82 ± 95.88 27633.62 2 13816.81 3.57 0.79 0.036 RIF-Week 1 118.00 ± 85.24 * RIF-Week 2 118.20 ± 73.98 $ Calcium (mg/day) Pre RIF 487.38 ± 222.67 1670951.98 2 835475.99 1.48 0.58 0.239 RIF-Week 1 487.84 ± 251.37 RIF-Week 2 804.24 ± 1349.79 Iron (mg/day) Pre RIF 7.92 ± 2.71 138.22 2 69.11 2.65 0.79 0.081 RIF-Week 1 9.93 ± 9.93 RIF-Week 2 11.22 ± 9.64 Sodium (mg/day) Pre RIF 2605.50 ± 1048.96 692079.61 2 346039.81 0.50 0.86 0.612 RIF-Week 1 2746.42 ± 1400.30 RIF-Week 2 2839.15 ± 1422.01 Based on the Least Significant Difference (LSD) post−hoc test, the mean difference is significant at p<0.05 *Significant difference between Pre−RIF and RIF−Week 1; $Significant difference between Pre−RIF and RIF−Week 2 Body Composition As evident from Table 4 , the most notable change in body composition was the improvement in WHR from 0.88 ± 0.06 to 0.87 ± 0.06 (p = 0.049), suggesting a reduction in central adiposity. All other body composition parameters remained stable during the initial two weeks of RIF. Table 4 Comparison of body composition at pre-, week one, and week two of Ramadan intermittent fasting (RIF) using one-way repeated measures ANOVA (n = 25) Measure Period Mean ± SD Type III Sum of Squares df Mean Square F η²p p-value Weight (kg) Pre RIF 56.68 ± 10.01 0.99 2 0.49 1.32 0.97 0.277 RIF-Week 1 56.95 ± 10.25 RIF-Week 2 56.73 ± 10.30 Body Mass Index (kg/m 2 ) Pre RIF 22.31 ± 3.78 0.15 2 0.07 0.41 0.97 0.663 RIF-Week 1 22.30 ± 3.98 RIF-Week 2 22.21 ± 3.95 Total body water (L) Pre RIF 27.57 ± 2.68 0.47 2 0.23 0.48 0.99 0.621 RIF-Week 1 27.74 ± 2.61 RIF-Week 2 27.56 ± 2.85 Skeletal muscle mass (kg) Pre RIF 20.21 ± 2.21 0.24 2 0.12 0.35 0.99 0.704 RIF-Week 1 20.33 ± 2.13 RIF-Week 2 20.20 ± 2.30 Percent body fat (%) Pre RIF 33.13 ± 7.29 0.83 2 0.41 0.11 0.95 0.892 RIF-Week 1 32.91 ± 8.13 RIF-Week 2 33.15 ± 8.01 Basal metabolic rate (kcal/day) Pre RIF 1183.17 ± 79.58 410.58 2 205.29 0.50 0.99 0.611 RIF-Week 1 1188.33 ± 77.81 RIF-Week 2 1183.38 ± 84.48 Waist-hip-ratio Pre RIF 0.88 ± 0.06 0.00 2 0.00 3.23 0.99 0.049 RIF-Week 1 0.87 ± 0.06 * RIF-Week 2 0.87 ± 0.06 $ Visceral fat area (cm 2 ) Pre RIF 78.06 ± 27.03 3.90 2 1.95 0.10 0.89 0.903 RIF-Week 1 77.57 ± 28.01 RIF-Week 2 77.57 ± 27.98 Based on the Least Significant Difference (LSD) post−hoc test, the mean difference is significant at p<0.05 *Significant between Pre−RIF and RIF−Week 1; $Significant difference between Pre−RIF and RIF−Week 2 Daytime Sleepiness Excessive daytime sleepiness was recorded; however, scores significantly improved (p = 0.032) from pre-RIF (13.76 ± 4.22) to RIF weeks 1 and 2 (11.92 ± 4.01; 11.88 ± 4.96), indicating increased daytime alertness under academic pressures coinciding with RIF (Table 5 ). Table 5 Comparison of daytime sleepiness at pre-, week one, and week 2 of Ramadan intermittent fasting (RIF) using one-way repeated measures ANOVA (n = 25) Variable Period Mean ± SD Type III Sum of Squares df Mean Square F η²p p-value ESS score Pre RIF 13.76 ± 4.22 57.680 2 28.840 3.705 0.92 0.032 RIF-Week 1 11.92 ± 4.01 * RIF-Week 2 11.88 ± 4.96 $ ESS: Epworth Sleepiness Scale Based on the Least Significant Difference (LSD) post hoc test, the mean difference is significant at p<0.05 *Significant between Pre−RIF and RIF−Week 1; $Significant difference between Pre−RIF and RIF−Week 2 Sleep Quality and Physical Activity Table 6 presents the effects of RIF on sleep quality and physical activity, as recorded using a skin-contact actimetry eTact® device. Of the 25 initial participants, 19 provided complete actigraphy data for analysis of sleep and physical activity. While TST showed a substantial increase of 2.5 hours (from 6.7 to 8.2 hours), this change did not reach statistical significance (p = 0.122). Similarly, sleep efficiency remained stable at almost 85% through the three consecutive weeks. No statistically significant alterations were observed in either total activity time or intensity when performing low-, medium-, or high-intensity physical activity. Yet, it was evident that students engaged in sedentary activities more frequently, followed by moderate and then high-intensity activities. Table 6 Comparison of sleep quality and physical activity at pre-, week 1, and week 2 of Ramadan intermittent fasting (RIF) using one-way repeated measures ANOVA (n = 19) Variable Period Mean ± SD Type III Sum of Squares df Mean Square F η²p p-value Sleep Quality Total Sleep Time (min) Pre RIF 673.21 ± 267.94 231430.56 2 115715.28 2.33 0.92 0.122 RIF – Week 1 698.42 ± 260.15 RIF – Week 2 819.21 ± 315.23 Sleep Efficiency (%) Pre RIF 85.67 ± 7.83 16.62 2 8.31 0.16 0.99 0.850 RIF – Week 1 84.55 ± 5.93 RIF – Week 2 85.72 ± 8.23 Physical Activity Total Activity Time (min) Pre RIF 526.53 ± 198.02 20242.77 2 10121.39 0.16 0.92 0.855 RIF – Week 1 555.89 ± 271.32 RIF – Week 2 510.37 ± 302.74 Low Activity (min) Pre RIF 443.95 ± 211.76 35720.56 2 17860.28 0.36 0.89 0.698 RIF – Week 1 501.53 ± 252.61 RIF – Week 2 454.47 ± 266.14 Medium Activity (min) Pre RIF 36.74 ± 21.83 258.63 2 129.32 0.22 0.85 0.801 RIF – Week 1 41.95 ± 21.80 RIF – Week 2 39.58 ± 32.53 High Activity (min) Pre RIF 14.44 ± 20.88 144.16 2 72.08 0.21 0.60 0.808 RIF – Week 1 12.42 ± 13.96 RIF – Week 2 16.32 ± 21.78 Based on the Least Significant Difference (LSD) post−hoc test, the mean difference is significant at p<0.05 Six out of 25 participants dropped out of actimetry monitoring; therefore, the above analysis is for 19 participants Discussion This study evaluated the immediate RIF-related changes in multiple parameters in female university students during the first two weeks of Ramadan. The key findings reveal significant changes in dietary patterns, particularly in fruit and vegetable consumption, as well as improvements in waist-to-hip ratio and enhanced daytime alertness. Meanwhile, sleep architecture and physical activity remained relatively stable. Dietary changes during early Ramadan Overall, the early dietary intake adaptations in our participants to RIF were mixed when compared with the literature. Additionally, their average daily consumption of food groups and nutrients was inadequate according to both the UAE’s Food-Based Dietary Guidelines (FBDGs) and the United States Dietary Reference Intakes (DRIs) ( 35 ). On examining the changes in individual food groups, we found that fruit intake increased significantly with the onset of Ramadan. Earlier, a notable enhancement in fruit intake was reported among Ghanaian adolescents, attributed to the religious and traditional practice of breaking the Ramadan fast with dates, as well as the physiological need for a source of simple carbohydrates after the fasting hours ( 36 ). Additionally, a significant change was observed, particularly in the intake of dried fruits, such as dates, from 0.5–4.8%, contributing to increased dietary fiber during Ramadan compared to the rest of the year among healthy Lebanese adults ( 37 ). On the other hand, a significant reduction in vegetable intake among our participants in the first two weeks of RIF differed from the adaptations reported in previous studies. A substantial increase from 8.2% on regular days to 13.9% during Ramadan ( 37 ), and no reduction in the consumption of vegetables among Indonesian university students three months post-Ramadan was observed ( 38 ). Further, despite the significant increase in fiber intake by almost 6 g/day at the end of RIF-week 1, the mean values remained below the recommended DRI of 25 g/day for adult females ( 35 ). Our findings suggest that female university students tend to prefer fruits over vegetables as a source of fiber during the Ramadan fasting period. We observed a decline in the intake of the protein food group by the end of the RIF, specifically at week 2; however, this significant trend disappeared during the analysis of the three weeks. A similar conclusion was drawn in a meta-analysis of 85 studies on individuals aged 9–58 years, encompassing fifteen countries from diverse cultural settings worldwide ( 39 ). Our participants did not witness immediate significant changes in their macronutrient intake. However, a steady increase in carbohydrate intake through the initial weeks of RIF may be attributed to students’ efforts to offset energy deficits by increasing their carbohydrate intake outside of fasting hours. Similarly, medical students at a university in Saudi Arabia adopted a dietary approach that increased carbohydrate intake, likely aiding in maintaining energy levels and alleviating hunger sensations, particularly during extended fasting periods ( 40 ). Further, we observed a trend toward a reduction in the intake of total fat and saturated fat. Specifically, the significant decrease of 15 g/day in total fat intake between pre-RIF and RIF-week 2 disappeared when compared over the three weeks. Conversely, a substantial 22.6% reduction was found in daily fat intake during Ramadan compared to the rest of the year among Lebanese adults, likely due to a greater preference for sugary foods over starchy or fatty foods among Arabs( 37 ) Furthermore, it was suggested that the decline in fat intake during fasting periods may result from dietary adjustments aimed at optimizing nutrient intake within the constrained eating windows of Suhoor and Iftar ( 40 ). However, the meta-analysis also concluded that there were no significant changes in carbohydrate and fat consumption before and after Ramadan ( 39 ). Regarding the early adaptations in micronutrient intake, we did not observe significant changes during the three-week follow-up period, except for a considerable reduction in folate and marginal increases in calcium, sodium, and iron. Our findings disagreed with the study that documented a significant decrease in the levels of most major vitamins, minerals, and trace elements between pre-RIF and after the third week of RIF among Saudi women ( 42 ). The considerable reduction in folate consumption between the pre-RIF phase and weeks 1 and 2 of RIF in our study could potentially be attributed to abrupt shifts in dietary preferences, wherein foods rich in folate, such as green leafy vegetables, legumes, and fortified grains may not be prioritized during the limited eating windows of suhoor and iftar ( 42 ). Literature supports that cultural and traditional practices often shape dietary preferences during Ramadan; for example, samosa , baklava , and kunafa , popularly consumed during Ramadan in the Middle East, may not necessarily include folate-rich plant foods, leading to their inadequate consumption ( 42 , 43 ). Body composition alterations Our findings both align with and differ from previous research on early Ramadan adaptations in body composition. In our study, body composition, as analyzed using BIA, did not significantly change between the pre-RIF period and the subsequent two weeks of RIF, as indicated by total weight, BMI, PBF, TBW, SMM, VFA, and BMR. Concordantly, a study from Saudi Arabia on healthy male graduate and undergraduate students examined the effect of RIF at four-time points, including before Ramadan, 2nd week, 3rd week, and six weeks after Ramadan, and also reported minimal shifts in body mass, BMI, waist circumference, and PBF, coupled with a marginal increase in FFM ( 44 ). In contrast, significant post-RIF decreases were demonstrated in body weight, BMI, FFM, and resting energy expenditure in Turkish adults ( 45 ); although their follow-up period was extended until a post-Ramadan month, unlike the 2 weeks of Ramadan in our study. However, a limitation worth acknowledging is that BIA measurements are sensitive to hydration status, which fluctuates during RIF. The prolonged daytime fluid restriction could influence BIA readings, potentially masking subtle body composition changes ( 46 ). Furthermore, the mean WHR values of our participants exceeded the WHO cut-off of 0.85, indicating abdominal obesity ( 22 ). Interestingly, within a week of Ramadan's inception, a significant reduction in WHR from 0.88 ± 0.06 at pre-RIF to 0.87 ± 0.06 was evident, which was sustained in RIF week 2. This substantial improvement in WHR, despite the stable weight, suggests an early preferential reduction in visceral fat during RIF. Given that WHR is highly correlated with cardiometabolic risk variables that are independent of BMI, this specific decrease in central adiposity may have significant metabolic implications ( 46 ). Comparatively, healthy Qatari adults significantly improved their body shape; however, this decline in WHR at the end of Ramadan could not be established because of a sub-group of participants with type 2 diabetes ( 16 ). Sleep architecture and alertness Ramadan, coinciding with an ongoing academic semester, significantly increased daytime alertness among our university participants. However, the TST and sleep efficiency remained stable. Yet, evidence on the early adaptations to sleep patterns and daytime alertness during RIF is inconclusive. Although our participants reported a significant reduction in ESS scores of 1.88, reflecting increased daytime alertness, their mean ESS scores above 11 indicated excessive daytime sleepiness throughout the study period. This could be attributed to the fact that daytime alertness is expected to be higher among university students in an ongoing academic semester, even if it coincides with RIF. Previous studies have reported conflicting findings regarding the impact of fasting on daytime sleepiness. A systematic review and meta-analysis of 24 studies on the effects of diurnal fasting on daytime sleepiness across 12 countries concluded that there was a significant increase in daytime somnolence, as evidenced by a one-point increase in the ESS score among healthy adults with a median age of 23.7 years ( 47 ). Similarly, an increase was reported in the percentage of medical students in Saudi Arabia, from 15–36%, who fell asleep in class during the first two weeks of Ramadan ( 4 ). Moreover, decreased alertness between 09:00 and 16:00 and increased at 23:00 among young subjects was reported in Morocco ( 48 ). Regarding sleep patterns, an average sleep efficiency of almost 85% was maintained throughout the study period. Additionally, a steady increase of about 2.5 hours in TST through the 2-week RIF follow-up period did not reach statistical significance. On the other hand, a systematic review of 24 studies concluded that there was a reduction of one hour in TST during Ramadan ( 48 ). Earlier, in the UAE, researchers studied sleep time and daytime sleepiness in medical college students ( 49 ). They reported experiencing longer nocturnal sleep and increased daytime sleep hours during the month of Ramadan. Further, 51% of adults in Saudi Arabia reported poor sleep quality during Ramadan ( 50 ). However, these studies only used subjective measures of assessment. Conversely, actigraphy ( 52 ) and sleep diaries ( 52 ) were employed to measure TST; both showed no significant changes in TST concurrent to the current study. Moreover, the alterations in sleep quality and fluctuations in TST among fasting individuals could occur due to disruptions in mealtime ( 53 ), sleeping on a full stomach ( 54 ), and late-night dining ( 55 ). Physical activity patterns RIF-related changes in physical activity patterns have been investigated using subjective and objective assessment methods; however, outcomes have been inconsistent. We did not find early RIF changes in daily physical activity using an actimetry device. Similarly, a self-reported lifestyle questionnaire was used previously, showing no significant change in the physical activity levels of male adults before Ramadan, during Ramadan (at weeks 2 and 3), and extending up to six weeks after Ramadan ( 44 ). Additionally, no significant changes were seen in physical activity in eleven men at two months before, during, and after Ramadan ( 58 ). In contrast, a significant decrease in the average steps per day of − 385 ± 158 among adults during Ramadan was recorded using pedometers and questionnaires ( 57 ). Further, exercise logs maintained for male distance runners showed a significant decrease in daily training duration by the end of Ramadan ( 58 ). This study has several strengths and limitations that should be considered when interpreting the results. The major strengths include the prospective cohort design, with participants serving as their controls and providing internal validity through measurements taken before and during the first two weeks of Ramadan. The use of objective measurements, as measured by actimetry, in a free-living environment provided ecological validity and real-world applicability to the findings. Additionally, the utilization of validated assessment tools, including advanced BIA for body composition, skin-contact actimetry for sleep and physical activity monitoring, and rigorous three-day 24-hour diet records coupled with computerized nutrient analysis, strengthened the quality of our data collection. Study limitations Several limitations should be acknowledged. The relatively small sample size (n = 25) and the inclusion of only female students from a single university may limit the generalizability of our findings to broader populations. The reliance on self-reported dietary intake and daytime sleepiness measurements may have introduced reporting bias, particularly given the burden of maintaining detailed food records during Ramadan. The intended short follow-up period of only two weeks into Ramadan would not have captured the full extent of the adaptation process. While conducting the study during an academic semester could affect sleep patterns and daily routines, this reflects the real-world conditions under which many students practice RIF. The loss of six participants for sleep and physical activity data collection should be taken into account when interpreting these specific outcomes. These methodological constraints, along with differences in participant demographics and study duration, may help explain some disparities between our findings and those of previous research. Future research should focus on three key areas. First, longitudinal studies with larger sample sizes and both sexes are needed to track the progression of adaptations from pre-Ramadan through the entire month, using objective measures of sleep architecture and metabolism. Second, controlled studies comparing fasting and non-fasting students during academic semesters would help distinguish the effects of RIF from academic-related changes. However, this remains challenging in Muslim-majority countries, where most students observe fasting. Third, research incorporating continuous glucose monitoring and cognitive performance measures could better elucidate the relationship between metabolic adaptations and academic functioning during the early stages of Ramadan. These studies should include detailed documentation of sleep timing, dietary and physical activity patterns, and academic schedules to understand better the complex interactions between fasting, lifestyle, sleep, and academic performance in university students. Conclusion This observational study of female university students during the first two weeks of Ramadan revealed several notable changes in dietary patterns and lifestyle measures. Specifically, we observed increased fruit consumption, decreased vegetable intake, improved daytime alertness scores, and a modest reduction in the waist-to-hip ratio. While total sleep duration showed a slight increasing trend, physical activity levels remained stable. These preliminary findings from a free-living environment provide insights into early adaptations to Ramadan fasting among university students during an academic semester. The observed changes suggest the need for targeted support strategies to help students maintain balanced nutrition and healthy lifestyle habits during Ramadan, particularly when it coincides with academic commitments. Future controlled studies with larger, more diverse populations are needed to better understand these early adaptations to Ramadan fasting and develop evidence-based recommendations for university students. Declarations Author Contributions AA, MEF, and ABH contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by RAF, MP, HH, KI, MAR, MAS, NUA, and SAA. AA supervised this study. AA and RAF wrote the first draft of the manuscript. MEF and ABH revised the manuscript. All authors read and approved the final manuscript. Author Declarations Ethics and Consent to Participate This study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Approval was granted by the Human Research Ethics Committee of United Arab Emirates University ((ERH-2024 -4361). Written informed consent was obtained from all individual participants before commencing the data collection for the study. Consent to Publish Not applicable. Data Availability The data that support the findings of this study are available from United Arab Emirates University- Human Research Ethics Committe (UAEU-HREC), but restrictions apply to the availability of these data, which were used under ethics for the current study and so are not publicly available. The data are, however, available from the authors upon reasonable request and with the permission of UAEU-HREC. Competing Interest Statement The authors declare they have no competing interests. Funding The authors declare that the publication of this manuscript was supported by the United Arab Emitrates University-Asian Universities Alliance (UAEU-AUA grant #G00004590) from the UAEU Research and Sponsored Projects Office. Acknowledgments The authors acknowledge the individuals at the Department of Nutrition and Health at the UAE University, specifically Dr. Moath Bataineh for statistical analysis, Ms. Fatima Al Meqbaali for facilitating the laboratory work, and Ms. Monia Kittana and Ms. Asma Ahmadani for their technical assistance. The authors extend their appreciation to the participants of this study. References Trepanowski JF, Bloomer RJ. The impact of religious fasting on human health. Vol. 9, Nutrition Journal. 2010. Obaideen K, Abu Shihab KH, Madkour MI, Faris ME. Seven decades of Ramadan intermittent fasting research: Bibliometrics analysis, global trends, and future directions. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2022 Aug 1;16(8). Schuppelius B, Peters B, Ottawa A, Pivovarova-Ramich O. Time Restricted Eating: A Dietary Strategy to Prevent and Treat Metabolic Disturbances. Vol. 12, Frontiers in Endocrinology. Frontiers Media S.A.; 2021. Alzhrani A, Alhussain MH, BaHammam AS. Changes in dietary intake, chronotype and sleep pattern upon Ramadan among healthy adults in Jeddah, Saudi Arabia: A prospective study [Internet]. 2022. Available from: www.ipaq.ki.se Al-Jafar R, Yuqi W, Elliott P, Tsilidis KK, Dehghan A. The dietary changes during Ramadan and their impact on anthropometry, blood pressure, and metabolic profile. Front Nutr. 2024;11. Jahrami HA, Alsibai J, Clark CCT, Faris ME. A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on body weight in healthy subjects aged 16 years and above. Vol. 59, European Journal of Nutrition. Springer Science and Business Media Deutschland GmbH; 2020. p. 2291–316. Faris ME, Jahrami H, BaHammam A, Kalaji Z, Madkour M, Hassanein M. A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on glucometabolic markers in healthy subjects. Diabetes Res Clin Pract [Internet]. 2020;165:108226. Available from: https://doi.org/10.1016/j.diabres.2020.108226 Faris ME, Abdelrahim DN, El Herrag SE, Khaled MB, Shihab KA, AlKurd R, et al. Cardiometabolic and obesity risk outcomes of dawn-to-dusk, dry intermittent fasting: Insights from an umbrella review. Clin Nutr ESPEN. 2025 Jun 1;67:127–45. Jahrami HA, Faris MAIE, I. Janahi A, I. Janahi M, Abdelrahim DN, Madkour MI, et al. Does four-week consecutive, dawn-to-sunset intermittent fasting during Ramadan affect cardiometabolic risk factors in healthy adults? A systematic review, meta-analysis, and meta-regression. Nutrition, Metabolism and Cardiovascular Diseases [Internet]. 2021;31(8):2273–301. Available from: https://doi.org/10.1016/j.numecd.2021.05.002 Faris ME, Kacimi S, Al-Kurd RA, Fararjeh MA, Bustanji YK, Mohammad MK, et al. Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects. Nutrition Research [Internet]. 2012;32(12):947–55. Available from: http://dx.doi.org/10.1016/j.nutres.2012.06.021 Qasrawi SO, Pandi-Perumal SR, BaHammam AS. The effect of intermittent fasting during Ramadan on sleep, sleepiness, cognitive function, and circadian rhythm. Vol. 21, Sleep and Breathing. Springer Verlag; 2017. p. 577–86. Kaloda YS, Ahmed AAE. Psychological and Socio-Religious Effects of Ramadan Fasting Among Healthy Non-Smoker Adults. Egypt Acad J Biol Sci C Physiol Mol Biol. 2024 Jul 14;16(2):29–37. Lessan N, Saadane I, Alkaf B, Hambly C, Buckley AJ, Finer N, et al. The effects of Ramadan fasting on activity and energy expenditure. American Journal of Clinical Nutrition. 2018 Jan 1;107(1):54–61. Fernando HA, Zibellini J, Harris RA, Seimon R V., Sainsbury A. Effect of ramadan fasting on weight and body composition in healthy non-athlete adults: A systematic review and meta-analysis. Vol. 11, Nutrients. MDPI AG; 2019. Zoughbie DE, James Ng TL, Thompson JY, Watson KT, Farraj R, Ding EL. Ramadan fasting and weight change trajectories: Time-varying association of weight during and after Ramadan in low-income and refugee populations. PLOS Global Public Health. 2022 Oct 1;2(10 October). Daradkeh GA, Abuzaid HO, Abuhmaira M, Acido H, Daradkeh G, Abuzaid H, et al. Effect of Ramadan Fasting on Body Composition and Dietary Intake: A Prospective Study in the State of Qatar. 2021; Available from: https://www.researchgate.net/publication/352680444 Bahammam AS, Alaseem AM, Alzakri AA, Sharif MM. The effects of Ramadan fasting on sleep patterns and daytime sleepiness: An objective assessment. Journal of Research in Medical Sciences. 2013. Sadiya A, Ahmed, Siddieg, Joy, Carlsson. Effect of Ramadan fasting on metabolic markers, body composition, and dietary intake in Emiratis of Ajman (UAE) with metabolic syndrome. Diabetes Metab Syndr Obes. 2011 Dec;409. Graves BS, Hall ME, Dias-Karch C, Haischer MH, Apter C. Gender differences in perceived stress and coping among college students. PLoS One. 2021 Aug 1;16(8 August). Alalalmeh SO, Hegazi OE, Shahwan M, Hassan N, Humaid Alnuaimi GR, Alaila RF, et al. Assessing mental health among students in the UAE: A cross-sectional study utilizing the DASS-21 scale. Saudi Pharmaceutical Journal. 2024 Apr 1;32(4). Nieman DC. Nutritional assessment. McGraw-Hill Education; 2019. 480 p. WHO. Waist circumference and waist-hip ratio : report of a WHO expert consultation, Geneva, 8-11 December 2008. World Health Organization; 2011. 39 p. Rahal L. Methods and Interests of Bioelectric Impedance in Medical Practice. In MDPI AG; 2023. p. 3. InBody [Internet]. 1996. Available from: http://www.e-inbody.com Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep. 1991;14(6):540–5. Castaneda D, Esparza A, Ghamari M, Soltanpur C, Nazeran H. A review on wearable photoplethysmography sensors and their potential future applications in health care. Int J Biosens Bioelectron. 2018;4(4). Martin JL, Hakim AD. Wrist actigraphy. Vol. 139, Chest. American College of Chest Physicians; 2011. p. 1514–27. Smith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heald JL, et al. Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine. 2018 Jul 15;14(7):1231–7. Shah V V., Brumbach BH, Pearson S, Vasilyev P, King E, Carlson-Kuhta P, et al. Opal Actigraphy (Activity and Sleep) Measures Compared to ActiGraph: A Validation Study. Sensors. 2023 Feb 1;23(4). Marino M, Li Y, Rueschman MN, Winkelman JW, Ellenbogen JM, Solet JM, et al. Measuring sleep: Accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. Sleep. 2013 Nov 1;36(11):1747–55. Lee XK, Chee NIYN, Ong JL, Teo TB, Van Rijn E, Lo JC, et al. Validation of a consumer sleep wearable device with actigraphy and polysomnography in adolescents across sleep opportunity manipulations. Journal of Clinical Sleep Medicine. 2019 Sep 15;15(9):1337–46. Steeves JA, Bowles HR, McClain JJ, Dodd KW, Brychta RJ, Wang J, et al. Ability of thigh-worn actigraph and activpal monitors to classify posture and motion. Med Sci Sports Exerc. 2015 May 21;47(5):952–9. Stone JD, Rentz LE, Forsey J, Ramadan J, Markwald RR, Finomore Jnr VS, et al. Evaluations of commercial sleep technologies for objective monitoring during routine sleeping conditions. Nat Sci Sleep. 2020;12:821–42. Topalidis P, Florea C, Eigl ES, Kurapov A, Leon CAB, Schabus M. Evaluation of a low-cost commercial actigraph and its potential use in detecting cultural variations in physical activity and sleep. Sensors. 2021 Jun 1;21(11). Otten JJ, Hellwig JP, Meyers LD. Dietary Reference Intakes DRI Dietary Reference Intakes : The Essential Guide to Nutrient Requirements [Internet]. 2006. Available from: http://ebookcentral.proquest.com/lib/uaeu-ebooks/detail.action?docID=3378838. Ali Z, Abizari AR. Ramadan fasting alters food patterns, dietary diversity and body weight among Ghanaian adolescents. Nutr J. 2018 Aug 11;17(1). Shatila H, Baroudi M, El Sayed Ahmad R, Chehab R, Forman MR, Abbas N, et al. Impact of Ramadan Fasting on Dietary Intakes Among Healthy Adults: A Year-Round Comparative Study. Front Nutr. 2021 Aug 5;8. Septiasari A, Alfiah E, Yusuf AM, Puspa AR. Ramadan Fasting Did Not Lessen Vegetable and Fruit Consumption, Sleep Duration, and Physical Activity on Adolescents in Al-Azhar Indonesia University. Indonesian Journal of Public Health Nutrition. 2023 Oct 30;4(1). Abdelrahim DN, El Herrag SE, Khaled MB, Radwan H, Naja F, Alkurd R, et al. Changes in energy and macronutrient intakes during Ramadan fasting: a systematic review, meta-analysis, and meta-regression. Nutr Rev. 2023 Nov 1; Alotaibi MI, Elsamad G, Aljardahi AN, Alghamdi AN, Alotaibi AI, Alorabi HM, et al. Changes in dietary and lifestyle behaviors and mental stress among medical students upon Ramadan diurnal intermittent fasting: a prospective cohort study from Taif/Saudi Arabia. BMC Public Health. 2023 Dec 1;23(1). AlZunaidy NA, Al-Khalifa AS, Alhussain MH, Mohammed MA, Alfheeaid HA, Althwab SA, et al. The Effect of Ramadan Intermittent Fasting on Food Intake, Anthropometric Indices, and Metabolic. Medicina (Lithuania). 2023;59(7). Sibal V, Andrew’ S. FOOD: IDENTITY OF CULTURE AND RELIGION [Internet]. 2018. Available from: https://www.researchgate.net/publication/327621871 Shipman D, Durmus B. The Effect of Culture on Food Consumption; a Case of Special Religious Days in Turkey. J Food Res. 2017 Mar 17;6(2):92. Al-barha NS, Aljaloud KS. The Effect of Ramadan Fasting on Body Composition and Metabolic Syndrome in Apparently Healthy Men. Am J Mens Health. 2019 Jan 1;13(1). Aǧagündüz D, Acar-Tek N, Bozkurt O. Effect of Intermittent Fasting (18/6) on Energy Expenditure, Nutritional Status, and Body Composition in Healthy Adults. Evidence-based Complementary and Alternative Medicine. 2021;2021. Al Hariri M, Al-Sulaiti H, Anwardeen N, Naja K, A. Elrayess M. Comparing the metabolic signatures of obesity defined by waist circumference, waist-hip ratio, or BMI. Obesity (Silver Spring) [Internet]. 2024 Aug 1 [cited 2025 Apr 16];32(8):1494–507. Available from: https://pubmed.ncbi.nlm.nih.gov/38967317/ Faris ME, Jahrami HA, Alhayki FA, Alkhawaja NA, Ali AM, Aljeeb SH, et al. Effect of diurnal fasting on sleep during Ramadan: a systematic review and meta-analysis. Vol. 24, Sleep and Breathing. Springer; 2020. p. 771–82. Roky R, Iraki L, Hajkhlifa R, Ghazal NL, Hakkou F. Daytime Alertness, Mood, Psychomotor Performances, and Oral Temperature during Ramadan Intermittent Fasting. Source: Annals of Nutrition & Metabolism. 2000;44(3):101–7. Margolis SA, Reed RL. Effect of religious practices of ramadan on sleep and perceived sleepiness of medical students. Vol. 16, Teaching and Learning in Medicine. Lawrence Erlbaum Associates Inc.; 2004. p. 145–9. Al Harbi KM, Saleh LS, Alsaidan AI, Almalki BS, Qutub R, Alammari Y. Quality of Sleep in the Saudi Population During the Holy Month of Ramadan. Cureus. 2023 Dec 21; Almeneessier A, Bahammam A, Sharif M, Bahammam S, Nashwan S, Pandi Perumal S, et al. The influence of intermittent fasting on the circadian pattern of melatonin while controlling for caloric intake, energy expenditure, light exposure, and sleep schedules: A preliminary report. Ann Thorac Med. 2017 Jul 1;12(3):183–90. Hsouna H, Abdessalem R, Boukhris O, Trabelsi K, Chtourou L, Tahri N, et al. Short-term maximal performance, alertness, dietary intake, sleep pattern and mood states of physically active young men before, during and after Ramadan observance. PLoS One. 2019 Jun 1;14(6). Pilorz V, Helfrich-Förster C, Oster H. The role of the circadian clock system in physiology. Vol. 470, Pflugers Archiv European Journal of Physiology. Springer Verlag; 2018. p. 227–39. Nakajima K. Unhealthy eating habits around sleep and sleep duration: To eat or fast? World J Diabetes. 2018 Nov 15;9(11):190–4. Almeneessier AS, Bahammam AS. How does diurnal intermittent fasting impact sleep, daytime sleepiness, and markers of the biological clock? Current insights. Vol. 10, Nature and Science of Sleep. Dove Medical Press Ltd; 2018. p. 439–52. Racinais S, Périard JD, Li CK, Grantham J. Activity patterns, body composition and muscle function during Ramadan in a middle-east Muslim Country. Int J Sports Med. 2012;33(8):641–6. Farooq A, Chamari K, Sayegh S, El Akoum M, Al-Mohannadi AS. Ramadan daily intermittent fasting reduces objectively assessed habitual physical activity among adults. BMC Public Health. 2021 Dec 1;21(1). Al-Nawaiseh AM, Bataineh MF, Kilani HA, Bellar DM, Judge LW. Time-Restricted Feeding and Aerobic Performance in Elite Runners: Ramadan Fasting as a Model. Front Nutr. 2021 Sep 21;8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Feb, 2026 Read the published version in Journal of the Egyptian Public Health Association → Version 1 posted Editorial decision: Revision requested 19 Nov, 2025 Reviews received at journal 18 Oct, 2025 Reviewers agreed at journal 17 Oct, 2025 Reviewers invited by journal 16 Oct, 2025 Editor assigned by journal 04 Jun, 2025 Submission checks completed at journal 04 Jun, 2025 First submitted to journal 21 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6717648","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":532033194,"identity":"08fa16b2-f703-4915-a342-8c9b4254dd58","order_by":0,"name":"Rand Abu Farha","email":"","orcid":"","institution":"United Arab Emirates University","correspondingAuthor":false,"prefix":"","firstName":"Rand","middleName":"Abu","lastName":"Farha","suffix":""},{"id":532033196,"identity":"bcf7d76c-155d-4173-ba90-2b0e8ed8533b","order_by":1,"name":"Morgambal Padayachee","email":"","orcid":"","institution":"United Arab Emirates University","correspondingAuthor":false,"prefix":"","firstName":"Morgambal","middleName":"","lastName":"Padayachee","suffix":""},{"id":532033200,"identity":"cb32535e-b4aa-4900-b941-58843594aad5","order_by":2,"name":"Haneen Hussein","email":"","orcid":"","institution":"United Arab Emirates University","correspondingAuthor":false,"prefix":"","firstName":"Haneen","middleName":"","lastName":"Hussein","suffix":""},{"id":532033201,"identity":"b5513c7e-92d8-4ae6-8610-a8c49c395352","order_by":3,"name":"Kowther Ismail","email":"","orcid":"","institution":"United Arab Emirates University","correspondingAuthor":false,"prefix":"","firstName":"Kowther","middleName":"","lastName":"Ismail","suffix":""},{"id":532033202,"identity":"64c10917-329f-4ce1-8ac7-843935cbc9fa","order_by":4,"name":"Manal Alrind","email":"","orcid":"","institution":"United Arab Emirates University","correspondingAuthor":false,"prefix":"","firstName":"Manal","middleName":"","lastName":"Alrind","suffix":""},{"id":532033203,"identity":"5b3ea2cb-44df-4328-b776-db1ceb9873a6","order_by":5,"name":"Meera Alsaadi","email":"","orcid":"","institution":"United Arab Emirates University","correspondingAuthor":false,"prefix":"","firstName":"Meera","middleName":"","lastName":"Alsaadi","suffix":""},{"id":532033204,"identity":"590e4f38-331e-4485-836a-eb336c422982","order_by":6,"name":"Nour Ul Aiman","email":"","orcid":"","institution":"United Arab Emirates University","correspondingAuthor":false,"prefix":"","firstName":"Nour","middleName":"Ul","lastName":"Aiman","suffix":""},{"id":532033205,"identity":"14b9e0f8-68ca-48aa-bae4-6abfba0b9d2b","order_by":7,"name":"Salma Al Azzani","email":"","orcid":"","institution":"United Arab Emirates University","correspondingAuthor":false,"prefix":"","firstName":"Salma","middleName":"Al","lastName":"Azzani","suffix":""},{"id":532033206,"identity":"ee565262-ed54-4d56-b2e5-e95378e156af","order_by":8,"name":"Ahmed S. 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1","display":"","copyAsset":false,"role":"figure","size":471285,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParticipant recruitment process\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6717648/v1/7766d5fa70626792e197442f.png"},{"id":103251209,"identity":"cafb1922-46b1-44f4-95e7-e3a77c5acb3e","added_by":"auto","created_at":"2026-02-23 16:06:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2160523,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6717648/v1/2a7cff58-2827-4ec1-ba19-3529ba0e3dc9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Changes in Diet, Body Composition, Sleep, and Activity with Onset of Ramadan Intermittent Fasting in Female University Students: A Prospective Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eReligious fasting is an age-old practice primarily observed for spiritual purposes. Yet, the health effects of religious fasting have been the subject of scientific inquiry in the past few decades (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Intermittent fasting (IF) involves alternating cycles between fasting and non-fasting over a given period. Ramadan intermittent fasting (RIF) is an obligatory dry diurnal fasting observed during the ninth month of the Islamic calendar by healthy and capable Muslims. During Ramadan, individuals refrain from food and drinks, including water, from dawn to sunset, depending on the geographical location and season. This daytime fasting is followed by unrestricted food and beverage consumption from dusk to dawn (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe restricted time for eating can impact meal composition and nutrient distribution (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). For instance, the quality and quantity of food consumed may vary, with higher intakes of sugary and energy-dense foods and beverages (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Recently, healthy participants were followed from a few days prior to Ramadan to 8 to 12 days post-Ramadan in the United Kingdom, reporting considerable changes in nutritional intake, including a 62% increase in sugar consumption and a significant reduction in starch intake (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe metabolic impact of these dietary changes can be significant, as RIF-linked shifts in mealtime result in several mild to moderate alterations affecting multiple physiological systems. RIF-linked changes include fluctuations in body weight(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) and body composition (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). An average post-Ramadan weight loss of 1.7 kg and a body fat percentage reduction of 1.1% were recorded(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Similarly, RIF may alter glucoregulatory parameters (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), cardiometabolic markers (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), and inflammatory and oxidative stress biomarkers (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, the shift to nighttime eating and altered meal timing and frequency can significantly impact an individual's circadian rhythm, physical activity patterns, and cognitive function (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), creating a complex interplay between metabolic and behavioral adaptations during the fasting period. A prospective one-month post-Ramadan study in Sudan demonstrated a notable reduction of 30 minutes in total sleep time among healthy adults during Ramadan compared to the following month (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Furthermore, physical activity, as measured by walking steps, decreased significantly two months after Ramadan compared to the fasting month (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMoreover, a meta-analysis showed that the beneficial effects of RIF were only short-term; for example, pre-Ramadan weight loss and body composition parameters like fat-free mass (FFM) returned to baseline one month after Ramadan (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Body weight is an example of the longest follow-up of changes after Ramadan, as observed in a study conducted in Jordan that spanned an entire year, beginning in the month of Ramadan. This study reported a weight gain of 0.53 kg throughout the first two weeks of Ramadan and a substantial 2.7 kg drop between weeks 26 and 28 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eChanges in daily lifestyle during Ramadan are evident among people in the Gulf Cooperation Council countries, including dietary intake (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), sleep patterns (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and physical activity (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In the United Arab Emirates (UAE) academic environment, where Ramadan is celebrated with great cultural significance, university students face unique challenges as they balance the requirements of fasting with their ongoing academic commitments. These challenges are particularly pronounced for female students, who must manage menstrual periods during Ramadan while maintaining their academic responsibilities. Female university students also experience higher stress levels compared to their male counterparts, as reported in both the United States (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and the UAE (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).The initial adaptation to RIF presents additional complexities as students navigate abrupt shifts in eating schedules, sleep patterns, and physical activity levels while managing coursework and assessments. This creates a multifaceted challenge that requires careful consideration and support.\u003c/p\u003e\u003cp\u003eThe first two weeks of Ramadan represent a critical adaptation period when the most significant physiological and behavioral changes occur. This initial period is particularly challenging as the body adjusts to the new feeding-fasting cycle while maintaining academic responsibilities. Female university students face unique challenges during Ramadan, including hormonal fluctuations and menstrual cycles that can impact their fasting schedule and overall well-being (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Additionally, female students typically report higher stress levels and greater difficulty in maintaining regular sleep patterns compared to their male counterparts (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Sleep architecture and daytime alertness were selected as primary outcomes because they directly impact academic performance and cognitive function, with changes in sleep patterns being one of the earliest manifestations of RIF-induced circadian rhythm disruption (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLittle is known about when these RIF-linked changes first occur, from the inception of Ramadan. Understanding the dynamics of the early weeks of Ramadan could assist the university authorities in customizing initiatives for RIF-practicing students to adapt favorably to the initial challenges of fasting in optimally managing their dietary habits, optimizing sleep patterns, and maintaining physical activity levels, thus enabling them to focus academically better and perform favorably during the Ramadan period.\u003c/p\u003e\u003cp\u003eTo test these hypotheses, the primary objective of this study was to assess the immediate changes in dietary intake, body composition, physical activity, sleep architecture, and daytime alertness during the baseline (pre-Ramadan) and the first two weeks of RIF among female university students. This study was conducted in an unconstrained free-living environment, where participants maintained their usual daily routines, dietary habits, sleep schedules, and physical activity during Ramadan. While this approach may introduce some variability due to individual lifestyle choices, it provides valuable real-world data about the immediate RIF-linked changes in diet, body composition, physical activity, sleep architecture, and daytime alertness under naturalistic conditions. Based on previous studies of changes in daily routines during Ramadan in free-living, unconstrained environments, we hypothesized that dietary intake, body composition, physical activity, sleep architecture, and daytime alertness differ significantly during the first two weeks of Ramadan compared to baseline. We further hypothesized that daytime alertness decreases during the initial weeks of RIF.\u003c/p\u003e\u003cp\u003eThis study uniquely combines multiple objective measurements to assess early adaptations to RIF comprehensively. While previous studies have largely relied on subjective assessments or single measurement tools, our approach integrates bioelectrical impedance analysis (BIA) for body composition assessment, skin-contact actimetry for continuous monitoring of sleep and physical activity, and detailed quantitative dietary records\u0026rsquo; analysis. This multimodal objective assessment provides unprecedented insight into the physiological and behavioral adaptations that occur during the critical first two weeks of RIF, particularly in the understudied population of female university students during an active academic semester.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eEthics Statement\u003c/h2\u003e\u003cp\u003e The research protocol was approved by the Human Research Ethics Committee of the United Arab Emirates University (ERH-2024-4361). All participants signed informed consent prior to data collection and were free to quit at any time without facing any consequences. No monetary or non-monetary incentives were given to the study participants.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eResearch Design and Setting\u003c/h3\u003e\n\u003cp\u003eA cohort prospective follow-up research design was employed, and the study was conducted at the United Arab Emirates University (UAEU) in Al Ain, United Arab Emirates.\u003c/p\u003e\n\u003ch3\u003eStudy Period and Follow-Up\u003c/h3\u003e\n\u003cp\u003eThis study took place over three weeks, starting at baseline in the first week of March 2024, a week prior to Ramadan (pre-RIF). Twice, follow-ups were done at the ends of the first (RIF-week 1) and second (RIF-week 2) weeks of Ramadan.\u003c/p\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eThe sample size used was based on a G*Power 3.1.9.7 software calculation for ANOVA: Repeated measures (3 times) between factors (large Cohen\u0026rsquo;s effect size\u0026thinsp;=\u0026thinsp;0.8, α\u0026thinsp;=\u0026thinsp;0.05), and 16 participants were sufficient to minimize the probability of type II error for all the variables. Considering drop-outs and/or incorrect/incomplete data, 30 students studying at UAEU were recruited.\u003c/p\u003e\n\u003ch3\u003eStudy Participants\u003c/h3\u003e\n\u003cp\u003eThirty unmarried female university students who were native Arabic-speaking UAE citizens or residents were selected via non-probability convenience sampling. Non-athlete, healthy female students aged 18\u0026ndash;25 years who regularly fasted during Ramadan were included. Students were screened through medical history and excluded those who reported a diagnosis of chronic medical conditions (diabetes, hypertension, thyroid disorders, psychiatric conditions). Students reported to be taking medications affecting sleep or metabolism (hypnotics, sedatives, antidepressants, anxiolytics, stimulants, weight-loss medications, or hormonal medications except contraceptives), or were on any special diets, were excluded. Additional exclusion criteria included irregular menstrual cycles (cycles\u0026thinsp;\u0026lt;\u0026thinsp;21 or \u0026gt;\u0026thinsp;35 days in the previous 3 months) and reporting of diagnosed sleep disorders. Five of the recruited students dropped out, resulting in 25 participants completing the dietary intake, body composition, and daytime sleepiness aspects of the study. Further, six students dropped out, and 19 completed the sleep and physical activity aspects of the study. The days of the menstrual cycle were excluded from the follow-up due to religious exemption from practicing RIF during this period. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the participant recruitment process.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Collection Tools\u003c/h2\u003e\u003cp\u003eParticipants were invited to the Nutrition Assessment and Body Composition Laboratory at the UAEU once a week, including a week prior to RIF, at the end of RIF week 1, and at the end of RIF week 2, respectively. The data were collected on dietary intake and body composition analysis. Sleep quality, physical activity, and daytime sleepiness were also determined. An attempt was made to ensure that all measurements were conducted at the same time of day (\u0026plusmn;\u0026thinsp;1 hour) for each participant across all three time points, thereby controlling for circadian and other variations.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants characteristics\u003c/h3\u003e\n\u003cp\u003eA proforma was self-administered once at the beginning of the study to obtain information on the socio-demographic characteristics of participants, including age, nationality, educational level (Major and Year of study), and Emirate (Trucial States) of residence. Marital status (single) and medical status (no diagnosis of a chronic medical condition, not on any medical treatment/medication, and/or on any special diet, no irregular menstrual cycle in last 3 months or sleep disorder based on student reporting) described above in study participants section were confirmed for exclusion purposes.\u003c/p\u003e\n\u003ch3\u003eDietary intake\u003c/h3\u003e\n\u003cp\u003eEach participant provided a total of nine 24-hour food records, including two weekday and one weekend food record from consecutive weeks (pre-RIF, RIF week 1, and RIF week 2). Each of them recorded all the food items they ate and drank, as well as the supplements they consumed, on the selected days. These records were then entered and analyzed using the Food Processor Nutrition Analysis Software (version 11.13; ESHA Research LLC.). The averages of three-day records per week were compared for any differences during the 3-week study period in terms of the intake of the five food groups and selected nutrients: energy, protein, carbohydrates, fats, and selected vitamins (A, D, B\u003csub\u003e1\u003c/sub\u003e, B\u003csub\u003e2\u003c/sub\u003e, B\u003csub\u003e3\u003c/sub\u003e, B\u003csub\u003e6\u003c/sub\u003e, B\u003csub\u003e12\u003c/sub\u003e, folate) and minerals (calcium, iron, sodium).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eBody Composition\u003c/h2\u003e\u003cp\u003eHeight was measured as an input variable once at pre-RIF week using a stadiometer (Model: Seca 217). The participants were asked to stand erect with their heads in the Frankfort horizontal plane, with their shoulders relaxed, arms to the side, legs straight, and heels together, parallel to the vertical rod of the stadiometer. Before the measurement was taken, the participants were requested to inhale deeply, hold their breath, and maintain an erect posture. At the same time, the headboard was lowered to the highest point of the head with enough pressure to compress the hair. The measurement was recorded to the nearest 0.1 cm, and a mean value of either three consecutive readings or two concordant readings (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWeight was recorded as an output measure of the body composition analysis. Participants were requested to wear light clothing and repeat the same on all three occasions. They were asked to stand barefoot on the center of the scale, ensuring equal distribution of their body weight. The weight measurement was recorded to the nearest 0.1 kg as a mean value of either three consecutive readings or two concordant readings (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe height and weight measurements were used to determine the body mass index (BMI) using the standard formula: weight (kg)/height (m)\u003csup\u003e2\u003c/sup\u003e and World Health Organization classification: underweight (\u0026lt;\u0026thinsp;18.50 kg/m\u003csup\u003e2\u003c/sup\u003e), normal (18.50-24.99 kg/m\u003csup\u003e2\u003c/sup\u003e), overweight (25.00-29.99 kg/m\u003csup\u003e2\u003c/sup\u003e), or obese (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;30.00 kg/m\u003csup\u003e2\u003c/sup\u003e) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBody composition was analyzed at pre-RIF, RIF-week 1, and RIF-week 2 using the principle of the four-compartment bioelectrical impedance analysis (BIA) method (Model: InBody 720). BIA is a non-invasive method used to assess body composition by measuring the resistance of the body to a low-intensity alternating current (\u0026le;\u0026thinsp;1 mA; 50 kHz) passing through tissues. Since FFM is an excellent conductor because it contains water and electrolytes, the impedance reflects the body's water content, making it possible to estimate body composition (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Participants were asked to refrain from exercising, eating, and drinking for two hours prior and to come to the laboratory after voiding their bladder and bowels. During the testing process, participants were asked to stand at the center of the platform, maintaining appropriate contact with the eight electrodes on their palms, fingers, and foot soles while standing comfortably without flexing their muscles. Laboratory temperature was kept at a normal range of 20\u0026ndash;25℃ (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The output data included weight, BMI, total body water (TBW), percent body fat (PBF), skeletal muscle mass (SMM), waist-hip ratio (WHR), visceral fat area (VFA), and basal metabolic rate (BMR). Changes in fat distribution, muscle mass, and hydration status were observed throughout the three weeks.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eDaytime sleepiness\u003c/h2\u003e\u003cp\u003eThe Epworth Sleepiness Scale (ESS) was self-administered at three time points during the study to assess daytime sleepiness in participants. It consists of 8 scenarios, rating the chances of participants dozing off on a 4-point scale (0\u0026thinsp;=\u0026thinsp;no chance of dozing, 1\u0026thinsp;=\u0026thinsp;slight chance of dozing, 2\u0026thinsp;=\u0026thinsp;moderate chance of dozing, 3\u0026thinsp;=\u0026thinsp;high chance of dozing), with a minimum score of 0 (normal sleep) and a maximum of 24 (very sleepy). A higher total score reflects more daytime sleepiness, classified as follows: low level of normal sleepiness (0\u0026ndash;7), higher level of normal sleepiness (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), excessive sleepiness (\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and severe excessive sleepiness (\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21 CR22 CR23\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The original English version of ESS was administered, as all participants were enrolled in English-taught programs at the UAEU.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSleep Quality and Physical Activity\u003c/h2\u003e\u003cp\u003eAccelerometer-based, cost-effective wearable technologies have emerged as valid tools to quantify physical activity behaviors and sleep patterns directly and objectively in daily life (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) The actimetry device utilizes a triaxial accelerometer to monitor movement patterns, enabling the estimation of sleep and physical activity parameters (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Concurrent validity has been reported for actigraphy measures of sleep and physical activity using 3D accelerometer data (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). While actigraphy provides a non-invasive and practical means of assessing sleep in free-living conditions, it does not directly measure sleep stages or detect brief awakenings that do not involve significant movement (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Furthermore, accelerometry has been found to have moderate validity in assessing physical activity, particularly for moderate-to-vigorous physical activity (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). A thigh-mounted accelerometer may provide greater accuracy for determining and differentiating between sedentary postures (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The device's placement and continuous monitoring capability made it well-suited for this longitudinal study; however, variations in physical activity estimations may occur due to individual movement patterns, posture, and sensitivity settings (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Recently, the potential of using actimetry was evaluated to understand better the intercultural sleep habits and activity patterns (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn this study, sleep quality and physical activity were assessed using the portable actigraphy-based device (eTact\u0026reg;, BodyCAP Medical, H\u0026eacute;rouville-Saint-Clair, France) containing a tri-axial accelerometer enabling to record every acceleration from the body (sampling frequency: 25 Hz, measurement range: 0.1-2G, sample measurement: 1 minute). To obtain an accurate estimation of locomotion activity excluding hand gesticulation, participants were asked to continuously wear the device as a skin patch on the middle area of the front thigh throughout the three-week study period (total 21 days, including seven non-fasting pre-RIF days and first 14 days of RIF), except during showering, water-based activities, or charging. Valid sleep quality and physical activity data required a minimum wear time of 20 hours per day for at least 5 days each week. The actual duration for which students wore the device was a minimum of 22 hours daily during the three-week study period. Non-wear periods were identified using the device's proprietary algorithm. Accelerometer measures were averaged over the valid number of days worn for each week of wear. The device required approximately 120 minutes to charge fully. To minimize data loss, participants were instructed to charge the device every 2 days during their regular shower or bathing time.\u003c/p\u003e\u003cp\u003eSleep characteristics were obtained using the eTact\u0026reg; Analysis software (BodyCap, Caen, France), which assesses individual sleep quality based on actigraphy data collected over selected periods. Considered sleep parameters were the total sleep time (TST) (i.e., duration of effective daytime and nocturnal sleep period) and sleep efficiency (i.e., percentage of time spent sleeping during the rest period). Additionally, physical activity was quantified using time above threshold (TAT) extracted from the software during wake periods calculated as the accumulated time in each activity band, with a maximum value set at 1500 (25 Hz*60 seconds), categorizing activity levels as low (\u0026lt;\u0026thinsp;250 TAT), moderate (250\u0026ndash;500 TAT), or intense/high (\u0026gt;\u0026thinsp;500 TAT).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe data were analyzed to assess and compare the immediate RIF-linked changes in dietary intake, body composition, daytime sleepiness, sleep quality, and physical activity of the participants during the 3-week study period. IBM SPSS Statistics version 29.0 (SPSS Inc., Chicago, IL, USA) was used. Data were checked for normality and variance using the Shapiro-Wilk test for normality. Descriptive statistics were expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations (SDs). Categorical variables were analyzed in terms of frequencies and percentages. Paired t-tests were used to compare outcomes between time points (pre-RIF vs. RIF-week 1; pre-RIF vs. RIF-week 2; RIF-week 1 vs. RIF-week 2). A one-way repeated measures analysis of variance (ANOVA) test was performed across the three-time points (pre-RIF and RIF weeks 1 and 2). Further, post-hoc comparisons were performed using the Least Significant Difference (LSD) test with Bonferroni correction for multiple comparisons. Partial eta squared (η\u0026sup2;p) was used as a measure of effect size to determine the magnitude of observed changes, interpreted as follows: small (0.01\u0026ndash;0.05), medium (0.06\u0026ndash;0.13), and large (\u0026ge;\u0026thinsp;0.14). Missing data were handled on an analysis-by-analysis basis. Statistical significance was set at a p-value of less than 0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eParticipants Characteristics\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the socio-demographic characteristics of the twenty-five study participants. The mean age of the participants was 20.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37 years. All were registered in undergraduate programs, with a distribution of 48% at the junior academic level and 52% at the senior academic level. Most (76%) were studying majors in nutrition, dietetics, or food science. While 56% were UAE nationals, the remaining 44% represented a diverse array of Arab nationalities, including Bahrain (8%), Egypt (8%), Jordan (12%), Oman (4%), Sudan (4%), and Syria (8%). Participants were full-time university students, 76% of whom resided in the Emirate of Abu Dhabi, where the university is located.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics of the study participants (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e20.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eMajor of study\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNutrition, Dietetics, Food Science\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScience and IT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHumanities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eYear of study\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFreshman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSophomore\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSenior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eNationality\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUAE National\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUAE Non-Nationals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eEmirate of residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbu Dhabi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDubai\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFujairah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRas Al Khaimah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAjman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eDietary Intake\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e compares the average daily intake of food groups during the three follow-up weeks. Among the five major food groups analyzed, significant changes were observed only in the categories of fruits and vegetables. While fruit consumption more than doubled in the first week of RIF (p\u0026thinsp;=\u0026thinsp;0.018), vegetable intake showed a progressive decline across the three weeks (p\u0026thinsp;=\u0026thinsp;0.037). Furthermore, a paired t-test between pre-RIF and RIF-week 2 for protein intake revealed a significant decrease of almost one ounce equivalent; however, this significance disappeared in ANOVA (p\u0026thinsp;=\u0026thinsp;0.282). Grains and dairy intake remained stable during the three weeks.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of food groups intake at pre-, week 1, and week 2 of Ramadan intermittent fasting (RIF) using one-way repeated measures ANOVA (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriod\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eType III Sum of Squares\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean Square\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eη\u0026sup2;p\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGrain \u003c/p\u003e\u003cp\u003e(oz equivalent)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c10\" namest=\"c9\" rowspan=\"3\"\u003e\u003cp\u003e0.595\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVegetables (cups)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c10\" namest=\"c9\" rowspan=\"3\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003csup\u003e$#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFruit (cups)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e12.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e6.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c10\" namest=\"c9\" rowspan=\"3\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDairy (cups)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e5.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c10\" namest=\"c9\" rowspan=\"3\"\u003e\u003cp\u003e0.378\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eProtein (oz equivalent)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e20.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e10.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e0.282\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c9\" namest=\"c8\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csub\u003eBased on the Least Significant Difference (LSD) post\u0026minus;hoc test, the mean difference is significant at p\u0026lt;0.05\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csub\u003e*Significant difference between Pre\u0026minus;RIF and RIF\u0026minus;Week 1; $Significant difference between Pre\u0026minus;RIF and RIF\u0026minus;Week 2; #Significant difference between RIF\u0026minus;Week 1 and RIF\u0026minus;Week 2\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes the comparison of average daily intake of selected nutrients during the three consecutive weeks. Mostly, the intake of nutrients remained similar in the first fortnight of RIF. Nonetheless, some significant improvements were observed. Total dietary fiber intake increased significantly between 13.49\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31 g/day in the pre-RIF period and 19.54\u0026thinsp;\u0026plusmn;\u0026thinsp;11.62 g/day in RIF week 1 (p\u0026thinsp;=\u0026thinsp;0.022). Similarly, a significant difference was observed in total fat intake using a paired t-test between pre-RIF (67.42\u0026thinsp;\u0026plusmn;\u0026thinsp;32.33 g/day) and RIF-week 2 (52.55\u0026thinsp;\u0026plusmn;\u0026thinsp;26.79 g/day) (p\u0026thinsp;=\u0026thinsp;0.044). However, this significance disappeared when the three groups were compared using ANOVA (p\u0026thinsp;=\u0026thinsp;0.136). Conversely, folate showed a significant decrease between pre-RIF and RIF-week 1 from 158.82\u0026thinsp;\u0026plusmn;\u0026thinsp;95.88 to 118.00\u0026thinsp;\u0026plusmn;\u0026thinsp;85.24 \u0026micro;g/day and 118.20\u0026thinsp;\u0026plusmn;\u0026thinsp;73.98 \u0026micro;g/day at RIF-week 2 (p\u0026thinsp;=\u0026thinsp;0.036).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of nutrient intakes at pre-, week one, and week two of Ramadan intermittent fasting (RIF) using one-way repeated measures ANOVA (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriod\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eType III Sum of Squares\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean Square\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eη\u0026sup2;p\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCalories (kcal/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1626.48\u0026thinsp;\u0026plusmn;\u0026thinsp;563.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e66439.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e33219.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.930\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1632.22\u0026thinsp;\u0026plusmn;\u0026thinsp;561.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1692.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1104.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eProtein (g/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58.00\u0026thinsp;\u0026plusmn;\u0026thinsp;19.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e774.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e387.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.480\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.34\u0026thinsp;\u0026plusmn;\u0026thinsp;36.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54.48\u0026thinsp;\u0026plusmn;\u0026thinsp;26.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTotal Fat (g/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67.42\u0026thinsp;\u0026plusmn;\u0026thinsp;32.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2804.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1402.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.136\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.52\u0026thinsp;\u0026plusmn;\u0026thinsp;34.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.55\u0026thinsp;\u0026plusmn;\u0026thinsp;26.79\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSaturated fat (g/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e459.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e229.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.102\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.10\u0026thinsp;\u0026plusmn;\u0026thinsp;10.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.07\u0026thinsp;\u0026plusmn;\u0026thinsp;9.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCarbohydrates (g/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e202.35\u0026thinsp;\u0026plusmn;\u0026thinsp;65.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e42279.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e21139.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.293\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e241.20\u0026thinsp;\u0026plusmn;\u0026thinsp;121.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e259.25\u0026thinsp;\u0026plusmn;\u0026thinsp;241.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTotal sugars (g/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.02\u0026thinsp;\u0026plusmn;\u0026thinsp;41.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e34585.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e17292.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.263\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112.84\u0026thinsp;\u0026plusmn;\u0026thinsp;115.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e114.28\u0026thinsp;\u0026plusmn;\u0026thinsp;212.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAdded sugar (g/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.94\u0026thinsp;\u0026plusmn;\u0026thinsp;14.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e343.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e171.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.344\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.42\u0026thinsp;\u0026plusmn;\u0026thinsp;14.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.81\u0026thinsp;\u0026plusmn;\u0026thinsp;17.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTotal fiber (g/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.49\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e570.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e285.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.022\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.54\u0026thinsp;\u0026plusmn;\u0026thinsp;11.62\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.10\u0026thinsp;\u0026plusmn;\u0026thinsp;14.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVitamin A\u003c/p\u003e\u003cp\u003e(\u0026micro;g /day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e299.10\u0026thinsp;\u0026plusmn;\u0026thinsp;584.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2149.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1074.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.996\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e302.07\u0026thinsp;\u0026plusmn;\u0026thinsp;511.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e289.52\u0026thinsp;\u0026plusmn;\u0026thinsp;772.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVitamin D\u003c/p\u003e\u003cp\u003e(\u0026micro;g /day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.450\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVitamin B\u003csub\u003e1\u003c/sub\u003e (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.504\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVitamin B\u003csub\u003e2\u003c/sub\u003e (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.299\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVitamin B\u003csub\u003e3\u003c/sub\u003e (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e183.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e91.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.362\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.83\u0026thinsp;\u0026plusmn;\u0026thinsp;15.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVitamin B\u003csub\u003e6\u003c/sub\u003e (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e193.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e96.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.292\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.33\u0026thinsp;\u0026plusmn;\u0026thinsp;15.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVitamin B\u003csub\u003e12\u003c/sub\u003e (\u0026micro;g/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.79\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.644\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.26\u0026thinsp;\u0026plusmn;\u0026thinsp;7.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFolate (\u0026micro;g/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e158.82\u0026thinsp;\u0026plusmn;\u0026thinsp;95.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27633.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13816.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118.00\u0026thinsp;\u0026plusmn;\u0026thinsp;85.24\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118.20\u0026thinsp;\u0026plusmn;\u0026thinsp;73.98\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCalcium (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e487.38\u0026thinsp;\u0026plusmn;\u0026thinsp;222.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1670951.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e835475.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.239\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e487.84\u0026thinsp;\u0026plusmn;\u0026thinsp;251.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e804.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1349.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIron (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.92\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e138.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e69.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.081\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.93\u0026thinsp;\u0026plusmn;\u0026thinsp;9.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.22\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSodium (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2605.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1048.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e692079.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e346039.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.612\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2746.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1400.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2839.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1422.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csub\u003eBased on the Least Significant Difference (LSD) post\u0026minus;hoc test, the mean difference is significant at p\u0026lt;0.05\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csub\u003e*Significant difference between Pre\u0026minus;RIF and RIF\u0026minus;Week 1; $Significant difference between Pre\u0026minus;RIF and RIF\u0026minus;Week 2\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eBody Composition\u003c/h2\u003e\u003cp\u003eAs evident from Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the most notable change in body composition was the improvement in WHR from 0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06 to 0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06 (p\u0026thinsp;=\u0026thinsp;0.049), suggesting a reduction in central adiposity. All other body composition parameters remained stable during the initial two weeks of RIF.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of body composition at pre-, week one, and week two of Ramadan intermittent fasting (RIF) using one-way repeated measures ANOVA (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeasure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriod\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eType III Sum of Squares\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean Square\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eη\u0026sup2;p\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eWeight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.68\u0026thinsp;\u0026plusmn;\u0026thinsp;10.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.277\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.95\u0026thinsp;\u0026plusmn;\u0026thinsp;10.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.73\u0026thinsp;\u0026plusmn;\u0026thinsp;10.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eBody Mass Index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.663\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTotal body water (L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.621\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSkeletal muscle mass (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.704\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePercent body fat (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.13\u0026thinsp;\u0026plusmn;\u0026thinsp;7.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.892\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.91\u0026thinsp;\u0026plusmn;\u0026thinsp;8.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.15\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eBasal metabolic rate (kcal/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1183.17\u0026thinsp;\u0026plusmn;\u0026thinsp;79.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e410.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e205.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.611\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1188.33\u0026thinsp;\u0026plusmn;\u0026thinsp;77.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1183.38\u0026thinsp;\u0026plusmn;\u0026thinsp;84.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eWaist-hip-ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVisceral fat area (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78.06\u0026thinsp;\u0026plusmn;\u0026thinsp;27.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.903\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.57\u0026thinsp;\u0026plusmn;\u0026thinsp;28.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.57\u0026thinsp;\u0026plusmn;\u0026thinsp;27.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csub\u003eBased on the Least Significant Difference (LSD) post\u0026minus;hoc test, the mean difference is significant at p\u0026lt;0.05\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csub\u003e*Significant between Pre\u0026minus;RIF and RIF\u0026minus;Week 1; $Significant difference between Pre\u0026minus;RIF and RIF\u0026minus;Week 2\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eDaytime Sleepiness\u003c/h2\u003e\u003cp\u003eExcessive daytime sleepiness was recorded; however, scores significantly improved (p\u0026thinsp;=\u0026thinsp;0.032) from pre-RIF (13.76\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22) to RIF weeks 1 and 2 (11.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01; 11.88\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96), indicating increased daytime alertness under academic pressures coinciding with RIF (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of daytime sleepiness at pre-, week one, and week 2 of Ramadan intermittent fasting (RIF) using one-way repeated measures ANOVA (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriod\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eType III Sum of Squares\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean Square\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eη\u0026sup2;p\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eESS score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.76\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e57.680\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e28.840\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3.705\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRIF-Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.88\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csub\u003eESS: Epworth Sleepiness Scale\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csub\u003eBased on the Least Significant Difference (LSD) post hoc test, the mean difference is significant at p\u0026lt;0.05\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csub\u003e*Significant between Pre\u0026minus;RIF and RIF\u0026minus;Week 1; $Significant difference between Pre\u0026minus;RIF and RIF\u0026minus;Week 2\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eSleep Quality and Physical Activity\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e presents the effects of RIF on sleep quality and physical activity, as recorded using a skin-contact actimetry eTact\u0026reg; device. Of the 25 initial participants, 19 provided complete actigraphy data for analysis of sleep and physical activity. While TST showed a substantial increase of 2.5 hours (from 6.7 to 8.2 hours), this change did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.122). Similarly, sleep efficiency remained stable at almost 85% through the three consecutive weeks.\u003c/p\u003e\u003cp\u003eNo statistically significant alterations were observed in either total activity time or intensity when performing low-, medium-, or high-intensity physical activity. Yet, it was evident that students engaged in sedentary activities more frequently, followed by moderate and then high-intensity activities.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of sleep quality and physical activity at pre-, week 1, and week 2 of Ramadan intermittent fasting (RIF) using one-way repeated measures ANOVA (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriod\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eType III Sum of Squares\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMean Square\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eη\u0026sup2;p\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003eSleep Quality\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Sleep Time (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e673.21\u0026thinsp;\u0026plusmn;\u0026thinsp;267.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e231430.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e115715.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.122\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e698.42\u0026thinsp;\u0026plusmn;\u0026thinsp;260.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e819.21\u0026thinsp;\u0026plusmn;\u0026thinsp;315.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSleep Efficiency (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85.67\u0026thinsp;\u0026plusmn;\u0026thinsp;7.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.850\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85.72\u0026thinsp;\u0026plusmn;\u0026thinsp;8.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePhysical Activity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Activity Time (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e526.53\u0026thinsp;\u0026plusmn;\u0026thinsp;198.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20242.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10121.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.855\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e555.89\u0026thinsp;\u0026plusmn;\u0026thinsp;271.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e510.37\u0026thinsp;\u0026plusmn;\u0026thinsp;302.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow Activity (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e443.95\u0026thinsp;\u0026plusmn;\u0026thinsp;211.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e35720.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17860.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.698\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e501.53\u0026thinsp;\u0026plusmn;\u0026thinsp;252.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e454.47\u0026thinsp;\u0026plusmn;\u0026thinsp;266.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedium Activity (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.74\u0026thinsp;\u0026plusmn;\u0026thinsp;21.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e258.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e129.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.801\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.95\u0026thinsp;\u0026plusmn;\u0026thinsp;21.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.58\u0026thinsp;\u0026plusmn;\u0026thinsp;32.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh Activity (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePre RIF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.44\u0026thinsp;\u0026plusmn;\u0026thinsp;20.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e144.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e72.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.808\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.42\u0026thinsp;\u0026plusmn;\u0026thinsp;13.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRIF \u0026ndash; Week 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.32\u0026thinsp;\u0026plusmn;\u0026thinsp;21.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csub\u003eBased on the Least Significant Difference (LSD) post\u0026minus;hoc test, the mean difference is significant at p\u0026lt;0.05\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csub\u003eSix out of 25 participants dropped out of actimetry monitoring; therefore, the above analysis is for 19 participants\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the immediate RIF-related changes in multiple parameters in female university students during the first two weeks of Ramadan. The key findings reveal significant changes in dietary patterns, particularly in fruit and vegetable consumption, as well as improvements in waist-to-hip ratio and enhanced daytime alertness. Meanwhile, sleep architecture and physical activity remained relatively stable.\u003c/p\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eDietary changes during early Ramadan\u003c/h2\u003e\u003cp\u003e Overall, the early dietary intake adaptations in our participants to RIF were mixed when compared with the literature. Additionally, their average daily consumption of food groups and nutrients was inadequate according to both the UAE\u0026rsquo;s Food-Based Dietary Guidelines (FBDGs) and the United States Dietary Reference Intakes (DRIs) (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOn examining the changes in individual food groups, we found that fruit intake increased significantly with the onset of Ramadan. Earlier, a notable enhancement in fruit intake was reported among Ghanaian adolescents, attributed to the religious and traditional practice of breaking the Ramadan fast with dates, as well as the physiological need for a source of simple carbohydrates after the fasting hours (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Additionally, a significant change was observed, particularly in the intake of dried fruits, such as dates, from 0.5\u0026ndash;4.8%, contributing to increased dietary fiber during Ramadan compared to the rest of the year among healthy Lebanese adults (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). On the other hand, a significant reduction in vegetable intake among our participants in the first two weeks of RIF differed from the adaptations reported in previous studies. A substantial increase from 8.2% on regular days to 13.9% during Ramadan (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), and no reduction in the consumption of vegetables among Indonesian university students three months post-Ramadan was observed (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurther, despite the significant increase in fiber intake by almost 6 g/day at the end of RIF-week 1, the mean values remained below the recommended DRI of 25 g/day for adult females (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Our findings suggest that female university students tend to prefer fruits over vegetables as a source of fiber during the Ramadan fasting period.\u003c/p\u003e\u003cp\u003eWe observed a decline in the intake of the protein food group by the end of the RIF, specifically at week 2; however, this significant trend disappeared during the analysis of the three weeks. A similar conclusion was drawn in a meta-analysis of 85 studies on individuals aged 9\u0026ndash;58 years, encompassing fifteen countries from diverse cultural settings worldwide (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur participants did not witness immediate significant changes in their macronutrient intake. However, a steady increase in carbohydrate intake through the initial weeks of RIF may be attributed to students\u0026rsquo; efforts to offset energy deficits by increasing their carbohydrate intake outside of fasting hours. Similarly, medical students at a university in Saudi Arabia adopted a dietary approach that increased carbohydrate intake, likely aiding in maintaining energy levels and alleviating hunger sensations, particularly during extended fasting periods (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Further, we observed a trend toward a reduction in the intake of total fat and saturated fat. Specifically, the significant decrease of 15 g/day in total fat intake between pre-RIF and RIF-week 2 disappeared when compared over the three weeks. Conversely, a substantial 22.6% reduction was found in daily fat intake during Ramadan compared to the rest of the year among Lebanese adults, likely due to a greater preference for sugary foods over starchy or fatty foods among Arabs(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) Furthermore, it was suggested that the decline in fat intake during fasting periods may result from dietary adjustments aimed at optimizing nutrient intake within the constrained eating windows of \u003cem\u003eSuhoor\u003c/em\u003e and \u003cem\u003eIftar\u003c/em\u003e (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). However, the meta-analysis also concluded that there were no significant changes in carbohydrate and fat consumption before and after Ramadan (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegarding the early adaptations in micronutrient intake, we did not observe significant changes during the three-week follow-up period, except for a considerable reduction in folate and marginal increases in calcium, sodium, and iron. Our findings disagreed with the study that documented a significant decrease in the levels of most major vitamins, minerals, and trace elements between pre-RIF and after the third week of RIF among Saudi women (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). The considerable reduction in folate consumption between the pre-RIF phase and weeks 1 and 2 of RIF in our study could potentially be attributed to abrupt shifts in dietary preferences, wherein foods rich in folate, such as green leafy vegetables, legumes, and fortified grains may not be prioritized during the limited eating windows of \u003cem\u003esuhoor\u003c/em\u003e and \u003cem\u003eiftar\u003c/em\u003e (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Literature supports that cultural and traditional practices often shape dietary preferences during Ramadan; for example, \u003cem\u003esamosa\u003c/em\u003e, \u003cem\u003ebaklava\u003c/em\u003e, and \u003cem\u003ekunafa\u003c/em\u003e, popularly consumed during Ramadan in the Middle East, may not necessarily include folate-rich plant foods, leading to their inadequate consumption (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eBody composition alterations\u003c/h2\u003e\u003cp\u003eOur findings both align with and differ from previous research on early Ramadan adaptations in body composition. In our study, body composition, as analyzed using BIA, did not significantly change between the pre-RIF period and the subsequent two weeks of RIF, as indicated by total weight, BMI, PBF, TBW, SMM, VFA, and BMR. Concordantly, a study from Saudi Arabia on healthy male graduate and undergraduate students examined the effect of RIF at four-time points, including before Ramadan, 2nd week, 3rd week, and six weeks after Ramadan, and also reported minimal shifts in body mass, BMI, waist circumference, and PBF, coupled with a marginal increase in FFM (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). In contrast, significant post-RIF decreases were demonstrated in body weight, BMI, FFM, and resting energy expenditure in Turkish adults (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e); although their follow-up period was extended until a post-Ramadan month, unlike the 2 weeks of Ramadan in our study. However, a limitation worth acknowledging is that BIA measurements are sensitive to hydration status, which fluctuates during RIF. The prolonged daytime fluid restriction could influence BIA readings, potentially masking subtle body composition changes (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, the mean WHR values of our participants exceeded the WHO cut-off of 0.85, indicating abdominal obesity (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Interestingly, within a week of Ramadan's inception, a significant reduction in WHR from 0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06 at pre-RIF to 0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06 was evident, which was sustained in RIF week 2. This substantial improvement in WHR, despite the stable weight, suggests an early preferential reduction in visceral fat during RIF. Given that WHR is highly correlated with cardiometabolic risk variables that are independent of BMI, this specific decrease in central adiposity may have significant metabolic implications (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eComparatively, healthy Qatari adults significantly improved their body shape; however, this decline in WHR at the end of Ramadan could not be established because of a sub-group of participants with type 2 diabetes (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eSleep architecture and alertness\u003c/h2\u003e\u003cp\u003eRamadan, coinciding with an ongoing academic semester, significantly increased daytime alertness among our university participants. However, the TST and sleep efficiency remained stable. Yet, evidence on the early adaptations to sleep patterns and daytime alertness during RIF is inconclusive.\u003c/p\u003e\u003cp\u003eAlthough our participants reported a significant reduction in ESS scores of 1.88, reflecting increased daytime alertness, their mean ESS scores above 11 indicated excessive daytime sleepiness throughout the study period. This could be attributed to the fact that daytime alertness is expected to be higher among university students in an ongoing academic semester, even if it coincides with RIF. Previous studies have reported conflicting findings regarding the impact of fasting on daytime sleepiness. A systematic review and meta-analysis of 24 studies on the effects of diurnal fasting on daytime sleepiness across 12 countries concluded that there was a significant increase in daytime somnolence, as evidenced by a one-point increase in the ESS score among healthy adults with a median age of 23.7 years (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Similarly, an increase was reported in the percentage of medical students in Saudi Arabia, from 15\u0026ndash;36%, who fell asleep in class during the first two weeks of Ramadan (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Moreover, decreased alertness between 09:00 and 16:00 and increased at 23:00 among young subjects was reported in Morocco (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegarding sleep patterns, an average sleep efficiency of almost 85% was maintained throughout the study period. Additionally, a steady increase of about 2.5 hours in TST through the 2-week RIF follow-up period did not reach statistical significance. On the other hand, a systematic review of 24 studies concluded that there was a reduction of one hour in TST during Ramadan (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Earlier, in the UAE, researchers studied sleep time and daytime sleepiness in medical college students (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). They reported experiencing longer nocturnal sleep and increased daytime sleep hours during the month of Ramadan. Further, 51% of adults in Saudi Arabia reported poor sleep quality during Ramadan (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). However, these studies only used subjective measures of assessment. Conversely, actigraphy (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e) and sleep diaries (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e) were employed to measure TST; both showed no significant changes in TST concurrent to the current study. Moreover, the alterations in sleep quality and fluctuations in TST among fasting individuals could occur due to disruptions in mealtime (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e), sleeping on a full stomach (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e), and late-night dining (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003ePhysical activity patterns\u003c/h2\u003e\u003cp\u003eRIF-related changes in physical activity patterns have been investigated using subjective and objective assessment methods; however, outcomes have been inconsistent. We did not find early RIF changes in daily physical activity using an actimetry device. Similarly, a self-reported lifestyle questionnaire was used previously, showing no significant change in the physical activity levels of male adults before Ramadan, during Ramadan (at weeks 2 and 3), and extending up to six weeks after Ramadan (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Additionally, no significant changes were seen in physical activity in eleven men at two months before, during, and after Ramadan (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). In contrast, a significant decrease in the average steps per day of \u0026minus;\u0026thinsp;385\u0026thinsp;\u0026plusmn;\u0026thinsp;158 among adults during Ramadan was recorded using pedometers and questionnaires (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). Further, exercise logs maintained for male distance runners showed a significant decrease in daily training duration by the end of Ramadan (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study has several strengths and limitations that should be considered when interpreting the results. The major strengths include the prospective cohort design, with participants serving as their controls and providing internal validity through measurements taken before and during the first two weeks of Ramadan. The use of objective measurements, as measured by actimetry, in a free-living environment provided ecological validity and real-world applicability to the findings. Additionally, the utilization of validated assessment tools, including advanced BIA for body composition, skin-contact actimetry for sleep and physical activity monitoring, and rigorous three-day 24-hour diet records coupled with computerized nutrient analysis, strengthened the quality of our data collection.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eStudy limitations\u003c/h2\u003e\u003cp\u003eSeveral limitations should be acknowledged. The relatively small sample size (n\u0026thinsp;=\u0026thinsp;25) and the inclusion of only female students from a single university may limit the generalizability of our findings to broader populations. The reliance on self-reported dietary intake and daytime sleepiness measurements may have introduced reporting bias, particularly given the burden of maintaining detailed food records during Ramadan. The intended short follow-up period of only two weeks into Ramadan would not have captured the full extent of the adaptation process. While conducting the study during an academic semester could affect sleep patterns and daily routines, this reflects the real-world conditions under which many students practice RIF. The loss of six participants for sleep and physical activity data collection should be taken into account when interpreting these specific outcomes. These methodological constraints, along with differences in participant demographics and study duration, may help explain some disparities between our findings and those of previous research.\u003c/p\u003e\u003cp\u003eFuture research should focus on three key areas. First, longitudinal studies with larger sample sizes and both sexes are needed to track the progression of adaptations from pre-Ramadan through the entire month, using objective measures of sleep architecture and metabolism. Second, controlled studies comparing fasting and non-fasting students during academic semesters would help distinguish the effects of RIF from academic-related changes. However, this remains challenging in Muslim-majority countries, where most students observe fasting. Third, research incorporating continuous glucose monitoring and cognitive performance measures could better elucidate the relationship between metabolic adaptations and academic functioning during the early stages of Ramadan. These studies should include detailed documentation of sleep timing, dietary and physical activity patterns, and academic schedules to understand better the complex interactions between fasting, lifestyle, sleep, and academic performance in university students.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis observational study of female university students during the first two weeks of Ramadan revealed several notable changes in dietary patterns and lifestyle measures. Specifically, we observed increased fruit consumption, decreased vegetable intake, improved daytime alertness scores, and a modest reduction in the waist-to-hip ratio. While total sleep duration showed a slight increasing trend, physical activity levels remained stable. These preliminary findings from a free-living environment provide insights into early adaptations to Ramadan fasting among university students during an academic semester. The observed changes suggest the need for targeted support strategies to help students maintain balanced nutrition and healthy lifestyle habits during Ramadan, particularly when it coincides with academic commitments. Future controlled studies with larger, more diverse populations are needed to better understand these early adaptations to Ramadan fasting and develop evidence-based recommendations for university students.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eAuthor Contributions\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAA, MEF, and ABH contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by RAF, MP, HH, KI, MAR, MAS, NUA, and SAA. AA supervised this study. AA and RAF wrote the first draft of the manuscript. MEF and ABH revised the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthor Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics and Consent to Participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Approval was granted by the Human Research Ethics Committee of United Arab Emirates University ((ERH-2024 -4361). Written informed consent was obtained from all individual participants before commencing the data collection for the study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to Publish\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Availability \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from United Arab Emirates University- Human Research Ethics Committe (UAEU-HREC), but restrictions apply to the availability of these data, which were used under ethics for the current study and so are not publicly available. The data are, however, available from the authors upon reasonable request and with the permission of UAEU-HREC.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interest Statement\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the publication of this manuscript was supported by the United Arab Emitrates University-Asian Universities Alliance (UAEU-AUA grant #G00004590) from the UAEU Research and Sponsored Projects Office.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the individuals at the Department of Nutrition and Health at the UAE University, specifically Dr. Moath Bataineh for statistical analysis, Ms. Fatima Al Meqbaali for facilitating the laboratory work, and Ms. Monia Kittana and Ms. Asma Ahmadani for their technical assistance. The authors extend their appreciation to the participants of this study. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTrepanowski JF, Bloomer RJ. The impact of religious fasting on human health. Vol. 9, Nutrition Journal. 2010. \u003c/li\u003e\n\u003cli\u003eObaideen K, Abu Shihab KH, Madkour MI, Faris ME. Seven decades of Ramadan intermittent fasting research: Bibliometrics analysis, global trends, and future directions. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2022 Aug 1;16(8). \u003c/li\u003e\n\u003cli\u003eSchuppelius B, Peters B, Ottawa A, Pivovarova-Ramich O. Time Restricted Eating: A Dietary Strategy to Prevent and Treat Metabolic Disturbances. Vol. 12, Frontiers in Endocrinology. Frontiers Media S.A.; 2021. \u003c/li\u003e\n\u003cli\u003eAlzhrani A, Alhussain MH, BaHammam AS. Changes in dietary intake, chronotype and sleep pattern upon Ramadan among healthy adults in Jeddah, Saudi Arabia: A prospective study [Internet]. 2022. Available from: www.ipaq.ki.se\u003c/li\u003e\n\u003cli\u003eAl-Jafar R, Yuqi W, Elliott P, Tsilidis KK, Dehghan A. The dietary changes during Ramadan and their impact on anthropometry, blood pressure, and metabolic profile. Front Nutr. 2024;11. \u003c/li\u003e\n\u003cli\u003eJahrami HA, Alsibai J, Clark CCT, Faris ME. A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on body weight in healthy subjects aged 16 years and above. Vol. 59, European Journal of Nutrition. Springer Science and Business Media Deutschland GmbH; 2020. p. 2291\u0026ndash;316. \u003c/li\u003e\n\u003cli\u003eFaris ME, Jahrami H, BaHammam A, Kalaji Z, Madkour M, Hassanein M. A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on glucometabolic markers in healthy subjects. Diabetes Res Clin Pract [Internet]. 2020;165:108226. Available from: https://doi.org/10.1016/j.diabres.2020.108226\u003c/li\u003e\n\u003cli\u003eFaris ME, Abdelrahim DN, El Herrag SE, Khaled MB, Shihab KA, AlKurd R, et al. Cardiometabolic and obesity risk outcomes of dawn-to-dusk, dry intermittent fasting: Insights from an umbrella review. Clin Nutr ESPEN. 2025 Jun 1;67:127\u0026ndash;45. \u003c/li\u003e\n\u003cli\u003eJahrami HA, Faris MAIE, I. Janahi A, I. Janahi M, Abdelrahim DN, Madkour MI, et al. Does four-week consecutive, dawn-to-sunset intermittent fasting during Ramadan affect cardiometabolic risk factors in healthy adults? A systematic review, meta-analysis, and meta-regression. Nutrition, Metabolism and Cardiovascular Diseases [Internet]. 2021;31(8):2273\u0026ndash;301. Available from: https://doi.org/10.1016/j.numecd.2021.05.002\u003c/li\u003e\n\u003cli\u003eFaris ME, Kacimi S, Al-Kurd RA, Fararjeh MA, Bustanji YK, Mohammad MK, et al. Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects. Nutrition Research [Internet]. 2012;32(12):947\u0026ndash;55. Available from: http://dx.doi.org/10.1016/j.nutres.2012.06.021\u003c/li\u003e\n\u003cli\u003eQasrawi SO, Pandi-Perumal SR, BaHammam AS. The effect of intermittent fasting during Ramadan on sleep, sleepiness, cognitive function, and circadian rhythm. Vol. 21, Sleep and Breathing. Springer Verlag; 2017. p. 577\u0026ndash;86. \u003c/li\u003e\n\u003cli\u003eKaloda YS, Ahmed AAE. Psychological and Socio-Religious Effects of Ramadan Fasting Among Healthy Non-Smoker Adults. Egypt Acad J Biol Sci C Physiol Mol Biol. 2024 Jul 14;16(2):29\u0026ndash;37. \u003c/li\u003e\n\u003cli\u003eLessan N, Saadane I, Alkaf B, Hambly C, Buckley AJ, Finer N, et al. The effects of Ramadan fasting on activity and energy expenditure. American Journal of Clinical Nutrition. 2018 Jan 1;107(1):54\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eFernando HA, Zibellini J, Harris RA, Seimon R V., Sainsbury A. Effect of ramadan fasting on weight and body composition in healthy non-athlete adults: A systematic review and meta-analysis. Vol. 11, Nutrients. MDPI AG; 2019. \u003c/li\u003e\n\u003cli\u003eZoughbie DE, James Ng TL, Thompson JY, Watson KT, Farraj R, Ding EL. Ramadan fasting and weight change trajectories: Time-varying association of weight during and after Ramadan in low-income and refugee populations. PLOS Global Public Health. 2022 Oct 1;2(10 October). \u003c/li\u003e\n\u003cli\u003eDaradkeh GA, Abuzaid HO, Abuhmaira M, Acido H, Daradkeh G, Abuzaid H, et al. Effect of Ramadan Fasting on Body Composition and Dietary Intake: A Prospective Study in the State of Qatar. 2021; Available from: https://www.researchgate.net/publication/352680444\u003c/li\u003e\n\u003cli\u003eBahammam AS, Alaseem AM, Alzakri AA, Sharif MM. The effects of Ramadan fasting on sleep patterns and daytime sleepiness: An objective assessment. Journal of Research in Medical Sciences. 2013. \u003c/li\u003e\n\u003cli\u003eSadiya A, Ahmed, Siddieg, Joy, Carlsson. Effect of Ramadan fasting on metabolic markers, body composition, and dietary intake in Emiratis of Ajman (UAE) with metabolic syndrome. Diabetes Metab Syndr Obes. 2011 Dec;409. \u003c/li\u003e\n\u003cli\u003eGraves BS, Hall ME, Dias-Karch C, Haischer MH, Apter C. Gender differences in perceived stress and coping among college students. PLoS One. 2021 Aug 1;16(8 August). \u003c/li\u003e\n\u003cli\u003eAlalalmeh SO, Hegazi OE, Shahwan M, Hassan N, Humaid Alnuaimi GR, Alaila RF, et al. Assessing mental health among students in the UAE: A cross-sectional study utilizing the DASS-21 scale. Saudi Pharmaceutical Journal. 2024 Apr 1;32(4). \u003c/li\u003e\n\u003cli\u003eNieman DC. Nutritional assessment. McGraw-Hill Education; 2019. 480 p. \u003c/li\u003e\n\u003cli\u003eWHO. Waist circumference and waist-hip ratio : report of a WHO expert consultation, Geneva, 8-11 December 2008. World Health Organization; 2011. 39 p. \u003c/li\u003e\n\u003cli\u003eRahal L. Methods and Interests of Bioelectric Impedance in Medical Practice. In MDPI AG; 2023. p. 3. \u003c/li\u003e\n\u003cli\u003eInBody [Internet]. 1996. Available from: http://www.e-inbody.com\u003c/li\u003e\n\u003cli\u003eJohns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep. 1991;14(6):540\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eCastaneda D, Esparza A, Ghamari M, Soltanpur C, Nazeran H. A review on wearable photoplethysmography sensors and their potential future applications in health care. Int J Biosens Bioelectron. 2018;4(4). \u003c/li\u003e\n\u003cli\u003eMartin JL, Hakim AD. Wrist actigraphy. Vol. 139, Chest. American College of Chest Physicians; 2011. p. 1514\u0026ndash;27. \u003c/li\u003e\n\u003cli\u003eSmith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heald JL, et al. Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine. 2018 Jul 15;14(7):1231\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eShah V V., Brumbach BH, Pearson S, Vasilyev P, King E, Carlson-Kuhta P, et al. Opal Actigraphy (Activity and Sleep) Measures Compared to ActiGraph: A Validation Study. Sensors. 2023 Feb 1;23(4). \u003c/li\u003e\n\u003cli\u003eMarino M, Li Y, Rueschman MN, Winkelman JW, Ellenbogen JM, Solet JM, et al. Measuring sleep: Accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. Sleep. 2013 Nov 1;36(11):1747\u0026ndash;55. \u003c/li\u003e\n\u003cli\u003eLee XK, Chee NIYN, Ong JL, Teo TB, Van Rijn E, Lo JC, et al. Validation of a consumer sleep wearable device with actigraphy and polysomnography in adolescents across sleep opportunity manipulations. Journal of Clinical Sleep Medicine. 2019 Sep 15;15(9):1337\u0026ndash;46. \u003c/li\u003e\n\u003cli\u003eSteeves JA, Bowles HR, McClain JJ, Dodd KW, Brychta RJ, Wang J, et al. Ability of thigh-worn actigraph and activpal monitors to classify posture and motion. Med Sci Sports Exerc. 2015 May 21;47(5):952\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eStone JD, Rentz LE, Forsey J, Ramadan J, Markwald RR, Finomore Jnr VS, et al. Evaluations of commercial sleep technologies for objective monitoring during routine sleeping conditions. Nat Sci Sleep. 2020;12:821\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eTopalidis P, Florea C, Eigl ES, Kurapov A, Leon CAB, Schabus M. Evaluation of a low-cost commercial actigraph and its potential use in detecting cultural variations in physical activity and sleep. Sensors. 2021 Jun 1;21(11). \u003c/li\u003e\n\u003cli\u003eOtten JJ, Hellwig JP, Meyers LD. Dietary Reference Intakes DRI Dietary Reference Intakes : The Essential Guide to Nutrient Requirements [Internet]. 2006. Available from: http://ebookcentral.proquest.com/lib/uaeu-ebooks/detail.action?docID=3378838.\u003c/li\u003e\n\u003cli\u003eAli Z, Abizari AR. Ramadan fasting alters food patterns, dietary diversity and body weight among Ghanaian adolescents. Nutr J. 2018 Aug 11;17(1). \u003c/li\u003e\n\u003cli\u003eShatila H, Baroudi M, El Sayed Ahmad R, Chehab R, Forman MR, Abbas N, et al. Impact of Ramadan Fasting on Dietary Intakes Among Healthy Adults: A Year-Round Comparative Study. Front Nutr. 2021 Aug 5;8. \u003c/li\u003e\n\u003cli\u003eSeptiasari A, Alfiah E, Yusuf AM, Puspa AR. Ramadan Fasting Did Not Lessen Vegetable and Fruit Consumption, Sleep Duration, and Physical Activity on Adolescents in Al-Azhar Indonesia University. Indonesian Journal of Public Health Nutrition. 2023 Oct 30;4(1). \u003c/li\u003e\n\u003cli\u003eAbdelrahim DN, El Herrag SE, Khaled MB, Radwan H, Naja F, Alkurd R, et al. Changes in energy and macronutrient intakes during Ramadan fasting: a systematic review, meta-analysis, and meta-regression. Nutr Rev. 2023 Nov 1; \u003c/li\u003e\n\u003cli\u003eAlotaibi MI, Elsamad G, Aljardahi AN, Alghamdi AN, Alotaibi AI, Alorabi HM, et al. Changes in dietary and lifestyle behaviors and mental stress among medical students upon Ramadan diurnal intermittent fasting: a prospective cohort study from Taif/Saudi Arabia. BMC Public Health. 2023 Dec 1;23(1). \u003c/li\u003e\n\u003cli\u003eAlZunaidy NA, Al-Khalifa AS, Alhussain MH, Mohammed MA, Alfheeaid HA, Althwab SA, et al. The Effect of Ramadan Intermittent Fasting on Food Intake, Anthropometric Indices, and Metabolic. Medicina (Lithuania). 2023;59(7). \u003c/li\u003e\n\u003cli\u003eSibal V, Andrew\u0026rsquo; S. FOOD: IDENTITY OF CULTURE AND RELIGION [Internet]. 2018. Available from: https://www.researchgate.net/publication/327621871\u003c/li\u003e\n\u003cli\u003eShipman D, Durmus B. The Effect of Culture on Food Consumption; a Case of Special Religious Days in Turkey. J Food Res. 2017 Mar 17;6(2):92. \u003c/li\u003e\n\u003cli\u003eAl-barha NS, Aljaloud KS. The Effect of Ramadan Fasting on Body Composition and Metabolic Syndrome in Apparently Healthy Men. Am J Mens Health. 2019 Jan 1;13(1). \u003c/li\u003e\n\u003cli\u003eAǧag\u0026uuml;nd\u0026uuml;z D, Acar-Tek N, Bozkurt O. Effect of Intermittent Fasting (18/6) on Energy Expenditure, Nutritional Status, and Body Composition in Healthy Adults. Evidence-based Complementary and Alternative Medicine. 2021;2021. \u003c/li\u003e\n\u003cli\u003eAl Hariri M, Al-Sulaiti H, Anwardeen N, Naja K, A. Elrayess M. Comparing the metabolic signatures of obesity defined by waist circumference, waist-hip ratio, or BMI. Obesity (Silver Spring) [Internet]. 2024 Aug 1 [cited 2025 Apr 16];32(8):1494\u0026ndash;507. Available from: https://pubmed.ncbi.nlm.nih.gov/38967317/\u003c/li\u003e\n\u003cli\u003eFaris ME, Jahrami HA, Alhayki FA, Alkhawaja NA, Ali AM, Aljeeb SH, et al. Effect of diurnal fasting on sleep during Ramadan: a systematic review and meta-analysis. Vol. 24, Sleep and Breathing. Springer; 2020. p. 771\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eRoky R, Iraki L, Hajkhlifa R, Ghazal NL, Hakkou F. Daytime Alertness, Mood, Psychomotor Performances, and Oral Temperature during Ramadan Intermittent Fasting. Source: Annals of Nutrition \u0026amp; Metabolism. 2000;44(3):101\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eMargolis SA, Reed RL. Effect of religious practices of ramadan on sleep and perceived sleepiness of medical students. Vol. 16, Teaching and Learning in Medicine. Lawrence Erlbaum Associates Inc.; 2004. p. 145\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eAl Harbi KM, Saleh LS, Alsaidan AI, Almalki BS, Qutub R, Alammari Y. Quality of Sleep in the Saudi Population During the Holy Month of Ramadan. Cureus. 2023 Dec 21; \u003c/li\u003e\n\u003cli\u003eAlmeneessier A, Bahammam A, Sharif M, Bahammam S, Nashwan S, Pandi Perumal S, et al. The influence of intermittent fasting on the circadian pattern of melatonin while controlling for caloric intake, energy expenditure, light exposure, and sleep schedules: A preliminary report. Ann Thorac Med. 2017 Jul 1;12(3):183\u0026ndash;90. \u003c/li\u003e\n\u003cli\u003eHsouna H, Abdessalem R, Boukhris O, Trabelsi K, Chtourou L, Tahri N, et al. Short-term maximal performance, alertness, dietary intake, sleep pattern and mood states of physically active young men before, during and after Ramadan observance. PLoS One. 2019 Jun 1;14(6). \u003c/li\u003e\n\u003cli\u003ePilorz V, Helfrich-F\u0026ouml;rster C, Oster H. The role of the circadian clock system in physiology. Vol. 470, Pflugers Archiv European Journal of Physiology. Springer Verlag; 2018. p. 227\u0026ndash;39. \u003c/li\u003e\n\u003cli\u003eNakajima K. Unhealthy eating habits around sleep and sleep duration: To eat or fast? World J Diabetes. 2018 Nov 15;9(11):190\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eAlmeneessier AS, Bahammam AS. How does diurnal intermittent fasting impact sleep, daytime sleepiness, and markers of the biological clock? Current insights. Vol. 10, Nature and Science of Sleep. Dove Medical Press Ltd; 2018. p. 439\u0026ndash;52. \u003c/li\u003e\n\u003cli\u003eRacinais S, P\u0026eacute;riard JD, Li CK, Grantham J. Activity patterns, body composition and muscle function during Ramadan in a middle-east Muslim Country. Int J Sports Med. 2012;33(8):641\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eFarooq A, Chamari K, Sayegh S, El Akoum M, Al-Mohannadi AS. Ramadan daily intermittent fasting reduces objectively assessed habitual physical activity among adults. BMC Public Health. 2021 Dec 1;21(1). \u003c/li\u003e\n\u003cli\u003eAl-Nawaiseh AM, Bataineh MF, Kilani HA, Bellar DM, Judge LW. Time-Restricted Feeding and Aerobic Performance in Elite Runners: Ramadan Fasting as a Model. Front Nutr. 2021 Sep 21;8. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-the-egyptian-public-health-association","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jepa","sideBox":"Learn more about [Journal of the Egyptian Public Health Association](http://jepha.springeropen.com)","snPcode":"42506","submissionUrl":"https://submission.nature.com/new-submission/42506/3","title":"Journal of the Egyptian Public Health Association","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"body composition, dietary intake, physical activity, Ramadan Intermittent Fasting, sleep quality","lastPublishedDoi":"10.21203/rs.3.rs-6717648/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6717648/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eRamadan 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eTwenty-five healthy female students (aged 20.58\u0026thinsp;\u0026plusmn;\u0026thinsp;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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSleep efficiency remained stable at 85%. Daytime sleepiness scores significantly decreased from pre-RIF (13.76\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22) to RIF weeks 1 and 2 (11.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01; 11.88\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96, p\u0026thinsp;=\u0026thinsp;0.032). Waist-to-hip ratio significantly decreased from 0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06 in pre-RIF to 0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06 (p\u0026thinsp;=\u0026thinsp;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\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75 to 1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51 cups/day, p\u0026thinsp;=\u0026thinsp;0.018) and fiber consumption (13.49\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31 to 19.54\u0026thinsp;\u0026plusmn;\u0026thinsp;11.62 g/day, p\u0026thinsp;=\u0026thinsp;0.022), while decreased intake of vegetables from pre-RIF to RIF-weeks 1 and 2 (1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59 to 0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78 and 62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52 cups/day, p\u0026thinsp;=\u0026thinsp;0.037), and folate (158.82\u0026thinsp;\u0026plusmn;\u0026thinsp;95.88 to 118.00\u0026thinsp;\u0026plusmn;\u0026thinsp;85.24 and 118.20\u0026thinsp;\u0026plusmn;\u0026thinsp;73.98 \u0026micro;g/day, p\u0026thinsp;=\u0026thinsp;0.036); and marginal decrease in fat intake between pre-RIF and RIF-week 2 (67.42\u0026thinsp;\u0026plusmn;\u0026thinsp;32.33 to 52.55\u0026thinsp;\u0026plusmn;\u0026thinsp;26.79 g/day, p\u0026thinsp;=\u0026thinsp;0.136).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eCommencement 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.\u003c/p\u003e","manuscriptTitle":"Changes in Diet, Body Composition, Sleep, and Activity with Onset of Ramadan Intermittent Fasting in Female University Students: A Prospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 18:14:23","doi":"10.21203/rs.3.rs-6717648/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-19T09:11:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-18T17:58:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"298965693136537303060965395263053797000","date":"2025-10-17T08:03:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-16T07:23:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-04T04:22:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-04T04:20:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of the Egyptian Public Health Association","date":"2025-05-21T14:46:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-the-egyptian-public-health-association","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jepa","sideBox":"Learn more about [Journal of the Egyptian Public Health Association](http://jepha.springeropen.com)","snPcode":"42506","submissionUrl":"https://submission.nature.com/new-submission/42506/3","title":"Journal of the Egyptian Public Health Association","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31c00442-8a2b-4c58-85b1-275814798bb5","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:02:50+00:00","versionOfRecord":{"articleIdentity":"rs-6717648","link":"https://doi.org/10.1186/s42506-026-00207-4","journal":{"identity":"journal-of-the-egyptian-public-health-association","isVorOnly":false,"title":"Journal of the Egyptian Public Health Association"},"publishedOn":"2026-02-16 15:57:12","publishedOnDateReadable":"February 16th, 2026"},"versionCreatedAt":"2025-10-29 18:14:23","video":"","vorDoi":"10.1186/s42506-026-00207-4","vorDoiUrl":"https://doi.org/10.1186/s42506-026-00207-4","workflowStages":[]},"version":"v1","identity":"rs-6717648","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6717648","identity":"rs-6717648","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}