AUTHOR=Khan Moien A. B. , BaHammam Ahmed S. , Amanatullah Asma , Obaideen Khaled , Arora Teresa , Ali Habiba , Cheikh Ismail Leila , Abdelrahim Dana N. , Al-Houqani Mohammed , Allaham Kholoud , Abdalrazeq Rand , Aloweiwi Wahid Sharif , Mim Somayea Sultana , Mektebi Ammar , Amiri Sohrab , Sulaiman Sahabi Kabir , Javaid Syed Fahad , Hawlader Mohammad Delwer Hossain , Tsiga-Ahmed Fatimah Isma’il , Elbarazi Iffat , Manggabarani Saskiyanto , Hunde Gamechu Atomsa , Chelli Sabrina , Sotoudeh Mitra , Faris MoezAlIslam Ezzat , Ramadan Intermittent Fasting Collaborators , Udoyen Abasi-Okot Akpan , Janem Abdelrhman Muwafaq , Zayed Abdullah Taha , Skafi Adriana Johny , Elmoghazy Ahmed Ashraf , Nawaz Ahmed Daniyal , AlKaabi Ahmed Juma , Mohd Sabri Amalin Najiha Binti , Human-Hoveidaeiv Amir , Attia Amir N , Mektebi Ammar , Zadjali Amna Mohammed Al , Riahi Anis , Hadi Anto Jamma , Dubey Ashish Ramesh , Iqbal Ayesha , El ali Bachar Jalal , Jamal Bakri Yahia Roumi , Hajjar Baraa Moujahed , Madekwe Chika Chizitelu , Purnamasari Cicih Bhakti , Purnamasari Cicih Bhakti , Saeed Dawlah Qasem Murshed Ahmed , Shah Dhaval Maunishkumar , Ibrahim Dima , Khadri Diyae , Al-Fahdi Eman Younis , Mazrouei Fatema Al , Mazrouei Fatema Al , Radhi Fatema Muneer , Aljanabi Fatema Yusuf , Zaabi Fatima Al sheriff Al , Zaabi Fatima Al sheriff Al , Hanifa Fatima Alzhra Mohamed , Ridha Fatma Mustafa , Momand Fayaz Ahmad , Hasan Fayeza , Gerges Filopater Mar , Firmansyah Firmansyah Firmansyah , Wijaya Frederick Putra , Nagy Hassan B , Kiwan Hussam , Din Ibrahim Khaled Salah El , Hasan Israa Hasan , Samhouri Jehad Firas , Sannah Kamil , Rahman Lamisa , Munir M , Bendak Malik , elsayed Maram sirelkhatim , morgom Marwa Mohammed , Alassadi Maya Shahadeh , Gounni Meryem , Aldafas Moath Ahmed , Jarrah Mohammad Mahmoud , Shahrour Mohammad , Wardak Mohammad Elyas , Pourfridoni Mohammad , Haider Mohammad Zulqurnain , Chakir Mohammed , Abueissa Mohammed Al-Rsheed mostafa Omar , Shaban Mohannad Abdalfdeeel Almahie , Shaban Mohannad Abdalfdeel Almahie , Mohammed Monzir Musa Hamdan , Ahmed Mosab Salah elmahi , Khan Muhammad Daniyal , Amer Muhammad Sameh , Shah Muttahid , Ghenimi Nadirah Ghenimi , Mahmood Nailah , Afifi Nermeen Mohammed , Mahmood Noran Omar , Kanjo Noura Ahmad , Abughosh Rahaf Ziad , Yassa Ramy Rafaat , Gizi Rani Rahmasari Tanuwijaya M , Heidari-Soureshjani Reza , Riyaz Romana , Tareen Rutab , Khan Sajjad Ahmed , Qureshi Sana Kalim , Badani Sara Mohammed Ahmed Musleh Al , Ataallah Sara Nazmy , Alwatban Saud Mohammed , Alwatban Saud Mohammed , Alwatban Saud Mohammed , Kamal Sayed Mustafa , Noori Shams Ul Haq , Okafor Somto Judith , Lydia Tadjadit , Habsi Tariq Ali Al , Ashok Tejaswini , Benti Tujuba Diribsa , Ahmed Waseem N , Giacaman Yazan William , Kareem Yesiru Adeyemi , AlRabeea Zainab Sadeq TITLE=Examination of sleep in relation to dietary and lifestyle behaviors during Ramadan: A multi-national study using structural equation modeling among 24,500 adults amid COVID-19 JOURNAL=Frontiers in Nutrition VOLUME=10 YEAR=2023 URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1040355 DOI=10.3389/fnut.2023.1040355 ISSN=2296-861X ABSTRACT=Background

Of around 2 billion Muslims worldwide, approximately 1.5 billion observe Ramadan fasting (RF) month. Those that observe RF have diverse cultural, ethnic, social, and economic backgrounds and are distributed over a wide geographical area. Sleep is known to be significantly altered during the month of Ramadan, which has a profound impact on human health. Moreover, sleep is closely connected to dietary and lifestyle behaviors.

Methods

This cross-sectional study collected data using a structured, self-administered electronic questionnaire that was translated into 13 languages and disseminated to Muslim populations across 27 countries. The questionnaire assessed dietary and lifestyle factors as independent variables, and three sleep parameters (quality, duration, and disturbance) as dependent variables. We performed structural equation modeling (SEM) to examine how dietary and lifestyle factors affected these sleep parameters.

Results

In total, 24,541 adults were enrolled in this study. SEM analysis revealed that during RF, optimum sleep duration (7–9 h) was significantly associated with sufficient physical activity (PA) and consuming plant-based proteins. In addition, smoking was significantly associated with greater sleep disturbance and lower sleep quality. Participants that consumed vegetables, fruits, dates, and plant-based proteins reported better sleep quality. Infrequent consumption of delivered food and infrequent screen time were also associated with better sleep quality. Conflicting results were found regarding the impact of dining at home versus dining out on the three sleep parameters.

Conclusion

Increasing the intake of fruits, vegetables, and plant-based proteins are important factors that could help improve healthy sleep for those observing RF. In addition, regular PA and avoiding smoking may contribute to improving sleep during RF.