Singapore Med J 2007; 48 (10) : 907
Singapore Med J 2007; 48 (10) : 906
O r i g i n a l A r t i c l e
Introduction: Muslims abstain from food
and fluid between the hours of sunrise to
sunset, and usually eat a large meal after
sunset and a lighter meal before sunrise.
The purpose of this study was to assess body
composition, nutrient intake and physical
activity patterns during Ramadan fasting.
Methods: This study was carried out during
Ramadan in October 2004. A total of
57 female subjects were recruited from
The Hashemite University in Jordan. Body
weight, fat percentage, muscle mass, and
percentage body water
measured, and body mass index (BMI)
was calculated. Estimated food records
over a duration of three days were used to
assess the intake of energy, carbohydrates,
protein, fat, and sugars before and during
Ramadan fasting. Physical activity patterns
were determined from a three-day activity
diary before and during Ramadan fasting;
the amount of physical
expressed as the physical activity level.
Results: Body weight and BMI decreased
significantly during Ramadan fasting. The
mean energy and nutrients intake before
Ramadan (energy; percent carbohydrates:
protein: fat was 1,252; 56:12:33) and
during Ramadan (1,171; 56:13:34) were not
significantly different. The mean physical
activity level was 1.54 before Ramadan and
1.51 during Ramadan, and this was also not
there was a significant weight loss during
Ramadan. Estimates of energy, carbohydrates,
protein, fat and sugar did not change,
despite the reduction in the number of
meals taken. The overall activity patterns
This study revealed that
nutrient intake, physical activity, Ramadan,
body composition, fasting,
Singapore Med J 2007; 48(10):906–910
During Ramadan, able-bodied Muslims abstain from
food and fluids between the hours of sunrise and sunset,
and usually eat a large meal after sunset and a lighter
meal before sunrise. The length of fasting time varies
with the geographical position of the country and the
season in which the month of Ramadan falls. Therefore,
the length of the fast may vary from ten to 19 hours
a day. Modification of meal frequency and eating
patterns during Ramadan may affect different aspects
of human health. Studies related to Ramadan fasting
monitor for body weight changes during and after
Ramadan in healthy subjects.(1-13) There have been
many studies on metabolic changes during and after
Ramadan, which manifested as changes in serum and
urinary parameters.(5,6,8-12,14-19) The reduction in body
weight has been reported quite frequently, but the
connection of this weight loss to a loss of body fat
was not often studied.(4,11) Studies in physical activity
patterns, energy levels and nutrient intake during
fasting are few.(2-3,11,20) Most studies had been conducted
on men. This study was carried out in the month of
Ramadan in October–November 2004 (Hijra 1425),
and the average duration of fasting was 12 hours a day.
In Jordan, working hours are reduced during Ramadan.
The practice is to eat two meals, one before dawn
(Sahour) and one just after sunset (Iftar). The aim of
this study was to determine the effect of Ramadan
fasting on body fat and water composition, nutrient
intake and physical activity patterns in young women.
The subjects consisted of 57 female college students at
The Hashemite University. All of them volunteered for
this study, none of them had chronic disease, nor was on
a therapeutic diet. All the measurements were made on
four different weeks: one week before Ramadan (T1),
the first week of Ramadan (T2), the end of the second
week of Ramadan (T3), and the end of the last week
Body composition, nutrient intake
and physical activity patterns in
young women during Ramadan
Al-Hourani H M, Atoum M F
Faculty of Allied
PO Box 150459,
Atoum MF, MSc, PhD
Dr Huda M Al
Tel: (962) 77 778 7416
Fax: (962) 5 382 6613
Singapore Med J 2007; 48 (10) : 907
(T4). Nutrient intake and physical activity patterns
were measured at T1 and T3. Measurements for
women exempted from fasting during their menstrual
period were not taken during these days. Body
weight, body fat percentage, body water percentage,
and muscle mass were measured at the same time
(between 09:00 and 11:00), using Tanita BC-532
total inner scan (Tanita Company, UK). Body mass
index (BMI) was calculated using the standard
formula: weight (kg)/height2 (m2). Each subject was
requested to keep two three-day records of food
intake and activity patterns; once during the pre-fasting
week and the second time during the second week of
Ramadan, or on other fasting days for female subjects
who were menstruating during the second week.
Subjects recorded the approximate quantities of all
food and beverages consumed, expressed in household
measures, for three consecutive days; two weekdays
and one weekend day. Nutrient intakes were estimated
by using WinDiets software with values based mainly
on the food-composition tables for use in the Middle
East, published by the American University of Beirut
Activity diary records were kept for three
consecutive days, two weekdays and one weekend day.
The activity diary was a modification of the method
originally described by Bouchard et al.(22) Subjects
chose the number that best described the type of
exercise they did every 15 minutes on a record sheet,
which was divided into 96 periods for each day
(1,440 minutes). Subjects were given a detailed
explanation and demonstration of the activity diary
before the commencement of the study. The physical
activity diaries were analysed using WinDiets for
Windows computer programme (Robert Gordon
University, Aberdeen, UK). In this programme, age,
weight, and gender of the subject were specified. The
physical activity level (PAL) was calculated. Statistical
analysis was performed using the Statistical Package
for Social Sciences version 10.0 (SPSS Inc, Chicago,
IL, USA). Results were expressed as mean and standard
deviation (SD). ANOVA and Student’s paired t-test
were used for data analysis. A p-value of less than
0.05 was considered to be statistically significant.
The mean age of subjects was 21.6 (range 18–29,
SD 4.14) years. Both the body weight and BMI were
decreased significantly during Ramadan fasting,
compared with values observed before the beginning
of fasting (Table I). Body fat percentage and total body
water content were altered significantly during the first
week of fasting as compared with values observed
before the beginning of fasting. Muscle mass was
unaffected. Data showed that the total daily energy
intake remained comparable before and during Ramadan,
despite the decrease in meal frequency (Table II).
Qualitative analysis of food consumed showed that
the percentage of energy as carbohydrates, protein,
and fat remained unaffected by Ramadan fasting; the
amount of carbohydrates, protein and fat consumed also
remained similar (Table II). Sugar consumption showed
an insignificant increase during Ramadan fasting when
compared to pre-Ramadan levels (Table II).
The activity patterns of the subjects before and
during Ramadan fasting are shown in Table III. There
was no significant effect of Ramadan fasting on PAL;
analysis of time spent on each activity categories
showed that standing and praying (category 3) were
increased significantly (p = 0.033) during Ramadan
fasting, compared with values observed before the
beginning of fasting. The time spent on lying, sitting
and watching TV (category 2) was longer during
Ramadan, while the time spent on household chores
(dusting and cleaning; category 4) was low during
Ramadan, compared to before Ramadan fasting.
However, these differences were also not significant.
Our study findings indicated Ramadan fasting affected
body weight, BMI, body water percentage and body fat
percentage. Interestingly, these changes were effected
despite insignificant changes in energy and macronutrient
intake. This study showed a significant weight
reduction with Ramadan fasting, which was consistent
with findings of other studies.(1,2,8,10,11,13,14) It has been
suggested that this decrease in body weight could
be attributed to a decrease in fluid intake.(11,14) It can
also be attributed to a decrease in glycogen-bound
water stores, extracellular volume contraction secondary
to a lower sodium intake, and a moderate degree
of hypohydration with little loss of body tissue.(23)
Ramadan fasting is characterised by changes in
meal schedule and frequency. Meals are exclusively
nocturnal and less frequent, and consequently, this may
affect energy and nutrient intake. In this study, total
energy intake was not significantly different between
the pre-Ramadan and Ramadan periods; this observation
was consistent with many studies.(2,3) These findings
are contrary to the common belief that Muslims tend to
overcompensate in terms of food intake during Ramadan
fasting. However, our results did run contrary to previous
findings, which showed an increase in total energy
intake in Saudi,(13) Moroccan,(9) and Turkish subjects.(24)
On the other hand, some studies have reported a
significant decrease in energy intake instead.(10,11,20,25)
There was no significant
carbohydrate, protein and fat consumption during
Singapore Med J 2007; 48 (10) : 909
and before Ramadan fasting. Nevertheless, previous
studies had found an increased intake of fat during
probably be attributed to the unique food habits
peculiar to different Islamic countries. Analysis of
dietary intake data showed that subjects expressed
an average energy intake below the recommended
daily energy intake for adult females, which is 2,000
kcal.(26) The mean energy intake of the subjects during
Ramadan was 58% of the recommended dietary
allowances (RDA) and
fasting. Interestingly, the mean intake composition
of carbohydrates, protein and fat were within normal
values when compared to the RDA,(26) which are
45%–65%, 10%–35% and 20%–35%, respectively.
However, under-reporting may be expected among
the subjects of this study. Other food intake studies
carried out on non-fasting subjects showed that
underestimation of food intake has been noticed more
in females than in males.(27-29)
PAL is calculated by summing the various activities
during the day, and multiplying by the time spent in
each activity as a proportion of the day. The average
These differences can
62% before Ramadan
PAL of healthy, well-nourished adults is a major
determinant of their total energy requirement, especially
when growth does not contribute to energy needs in
adulthood. The PAL values that can be sustained for a
Table I. Body composition of the subjects.
Body composition T1 (n = 47) T2 (n = 47) T3 (n = 47) T4 (n = 47)
Weight (kg) 57.5 ± 8.2 57.2 ± 7.9* 57.0 ± 7.7* 56.9 ± 7.4*
Body fat (%) 24.9 ± 6.6 23.6 ± 6.8* 24.4 ± 6.3 24.5 ± 6.8
Muscle mass (kg) 40.5 ± 3.4 41.0 ± 2.6 40.5 ± 2.6 40.4 ± 2.2
Body water (%) 52.7 ± 4.3 53.6 ± 4.4* 52.9 ± 4.2 52.8 ± 4.3
Body mass index (BMI) 22.2 ± 3.1 22.1 ± 3.0* 22.0 ± 2.9* 22.0 ± 2.8*
Data expressed as mean value ± SD.
* significantly different from before Ramadan, p < 0.05.
Table II. Energy and nutrient consumption.
Consumption Before Ramadan (n = 22) During Ramadan (n = 22) p-value
Energy (kcal) 1252 ± 271 1171 ± 268 0.680
Consumption (g/day) 174.2 ± 40.8 164.3 ± 42.5 0.574
% of energy 55.8 ± 6.4 56.2 ± 6.8 0.801
Consumption (g/day) 39.3 ± 10.9 37.7 ± 11.5 0.943
% of energy 12.2 ± 2.2 12.9 ± 3.1 0.959
Consumption (g/day) 45.7 ± 13.9 44.8 ± 13.9 0.440
% of energy 32.8 ± 6.7 34.2 ± 5.3 0.468
Consumption (g/day) 47.7 ± 14.8 59.4 ± 22.6 0.070
Data expressed as mean value ± SD.
Table III. Activity pattern of females before and during
(n = 21)
(n = 21) p-value
Physical activity level 1.54 1.51 0.387
1 550 ± 76 569 ± 67 0.203
2 415 ± 154 469 ± 148 0.299
3 107 ± 80 145 ± 91 0.033
4 210 ± 130 160 ± 88 0.095
5 71 ± 63 77 ± 57 0.703
6 48 ± 63 47 ± 40 0.965
7 36 ± 88 26 ± 45 0.433
8 2 ± 7 2 ± 4 1.000
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Table IV. Classification of lifestyles in relation to
the intensity of habitual physical activity or PAL.(30)
Category PAL value
Sedentary or light activity lifestyle 1.40–1.69
Active or moderately active lifestyle 1.70–1.99
Vigorous or vigorously active lifestyle 2.00–2.40*
* PAL values > 2.40 are difficult to maintain over a long period
long period of time by free-living adult populations
range from about 1.40 to 2.40.(30) The average PAL for
both before and during Ramadan was 1.54 and 1.51,
respectively. These values were not significantly
different from The Food and Agriculture Organisation/
World Health Organisation/United
University recommendations for light activity (i.e.
1.56) for women.(31) Consequently, subjects of this
study are classified as having a sedentary or light
activity lifestyle either during or before Ramadan, as
shown in Table IV.
This study explores an important issue on physical
activity and lifestyle. The subjects who volunteered
in this study were young females (i.e. mean age is
21.6 years), and their being classified as having a
light activity lifestyle underlines an important health
concern. The practice of maintaining regular physical
activity is associated with the maintenance of adequate
body weight, cardiovascular and respiratory health,
fitness, and a lower risk of developing chronic
diseases associated with diet and lifestyle.(32-35) Dietary
energy recommendations should be accompanied
by recommendations to perform adequate amounts of
physical activity regularly. Time spent on activities
did not differ between pre-Ramadan and during
Ramadan fasting for all activities except for the time
spent on category 3, which includes praying. Muslims
spend more time praying during Ramadan, thus
the mean time spent on this type of activity was
significantly higher compared
periods. Results from other studies corroborate with
our findings as well.(10,20)
It is reasonable to expect that the obligation to eat
only during the night will lead to a definite change in
normal lifestyle activities, such as sleeping. However,
in this study, no significant variation in total sleeping
time before and during Ramadan was found (category
1). These findings were also consistent with other
studies, which reported no differences in total sleeping
time.(36,37) In conclusion, our results demonstrate that
although no reduction in calorie intake was applied
to the subjects, Ramadan fasting contributed to weight
loss in healthy subjects. These findings may find an
application in weight loss programmes among subjects
complaining of obesity.
This study was funded by the Scientific Deanship at
The Hashemite University. We are grateful to the subjects
who volunteered for this study.
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