Impact of Ramadan Fasting on Mental Health, Body Composition, Physical Activity, and Sleep Outcomes Among University Students

Background: Over two billion Muslims across the world practice Ramadan fasting, which involves refraining from food and drink from dawn to sunset. This study was conducted to investigate the effects of Ramadan fasting on mental health (depression, anxiety, stress), body composition, physical activity, and sleep quality among Jordanian university students. Methods: This study utilized a quasi-experimental, pre-post-intervention design. It was conducted between March and April 2024 and included 77 students from the University of Petra (UOP) in Amman, Jordan. Bivariate analysis was performed to compare the variables pre-post Ramadan fasting. A linear mixed-effects model assessed the association between Ramadan fasting and each outcome. Results: The results indicated that Ramadan fasting was not associated with a change in the Depression Anxiety Stress Scales-21 (DASS-21 score). Ramadan fasting led to a decrease in sleep quality, indicated by an increase in the PSQI score (beta = 0.92; p-value = 0.0419). Component analysis revealed statistically significant changes in subjective sleep quality (p-value = 0.0009), sleep duration (p-value < 0.0001), and sleep disturbances (p-value = 0.025). Body composition: Ramadan fasting was significantly associated with a decrease in the number of fat components, such as weight (beta = -1.20; p-value = 0.0116), body mass index (beta = -0.55), waist circumference (beta = -1.79; p-value = 0.0029), fat mass index (beta = -0.43; p-value = 0.0279), visceral fat area (beta = -6.86; p-value = 0.0383), and body adiposity index (beta = -0.45; p-value = 0.0068) (all p-value < 0.05). No substantial alterations to the body's water-related properties were noted. Physical Activity: A marked decrease was noted in moderate- to high-intensity activity levels (p-value < 0.0001). Conclusion: In conclusion, Ramadan fasting can positively affect body composition through a reduction in weight, body mass index, waist circumference, and other parameters of fat, emphasizing its potential role in body composition improvement. However, fasting was also accompanied by poorer sleep quality, including, specifically, poorer subjective sleep quality and sleep duration and greater disturbance. The associated impairments to sleep revealed in these findings demand strategies to mitigate sleep impairments, alongside, where possible, potential beneficial effects of fasting on body composition.