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 Frontiers in Nutrition
Abstract Materials and methods Results Author contributions Conflict of interest 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.
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Moien A. B. Khan, Ahmed S. BaHammam, Asma Amanatullah et al.. 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. Frontiers in Nutrition. (2023). https://doi.org/10.3389/fnut.2023.1040355 Moien A. B. Khan, Ahmed S. BaHammam, Asma Amanatullah, Khaled Obaideen, Teresa Arora, Habiba Ali, Leila Cheikh Ismail, Dana N. Abdelrahim, Mohammed Al-Houqani, Kholoud Allaham, Rand Abdalrazeq, Wahid Sharif Aloweiwi, Somayea Sultana Mim, Ammar Mektebi, Sohrab Amiri, Sahabi Kabir Sulaiman, Syed Fahad Javaid, Mohammad Delwer Hossain Hawlader, Fatimah Isma’il Tsiga-Ahmed, Iffat Elbarazi, Saskiyanto Manggabarani, Gamechu Atomsa Hunde, Sabrina Chelli, Mitra Sotoudeh, MoezAlIslam Ezzat Faris
National Pirogov Memorial Medical University, Vinnytsia, Ukraine; Faculty of Medicine, Al Quds University, Jerusalem, Palestine; Faculty of Medicine, Helwan University, Cairo, Egypt; Al-Quds University, Bethlehem, Palestine; Faculty of Medicine, Mansoura University Behbbit, Samannoud, Egypt; Qatar University, Mesaieed, Qatar; Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; RCSI-UCD, Ayer Keroh, Malaysia; Iran Sports Medicine Research Center, Neuroscience Institute Sports Medicine Research Center, Neuroscience Institute Tehran University of Medical Sciences, Tehran, Iran; Kasr Alainy Faculty of medicine, Cairo, Egypt; Kütahya Univerity of Health Sciences, kütahya, Türkiye; Trinity College Dublin, Dublin, Ireland; University of Tunis El Manar, Medical School of Tunis, Military Hospital of Tunis, Tunis, Tunisia; Department Public Health, Universitas Aufa Royhan Di Kota Padangsidimpuan, Padangsidimpuan, Indonesia; Orenburg state Medical University, Orenburg, Russia; Services Institute of Medical Sciences, Services Hospital Lahore House officer Services Institute of Medical Science, Lahore, Paksitan; Lebanese university, Beirut, Lebanon; University of Aleppo, Aleppo, Syria; Chemistry department, American University of Beirut, Beirut, Lebanon; Department of Medicine, Vinnytsia National Medical University, Abuja, Nigeria; Dentistry Programme of Mulawarman University Kerayan, Mulawarman University, Samarinda, Indonesia; Dentistry Programme, Mulawarman University Medical Education, Samarinda, Indonesia; Jordan University of Science and Technology, Irbid, Jordan; Sbks Medical College, Ahmedabad, India; Public Health Asharej, Jawarneh MPH UAEU, Al Ain, United Arab Emirates; Faculty of Medicine, Dental Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco; College of Medicine, National University for Science and Technology, Seeb, Oman; Ambulatory Healthcare Services, Abu Dhabi, United Arab Emirates; Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates; Dubai Medical College, Dubai, United Arab Emirates; Dubai medical college, Dubai, United Arab Emirates; Ambulatory Healthcare Services, Abu Dhabi, United Arab Emirates; Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates; Department of Endocrinology Syria, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria; Department of surgery, Jaber alahmed hospital, Kuwait City, Kuwait; Spinghar Thoracic Surgery Kabul, Kabul, Afghanistan; College of Food and Agriculture, United Arab Emirates University, Dubai, United Arab Emirates; Alexandria faculty of medicine, General practitioner, Alexandria, Egypt; Department of Nutrition Science, Universitas Muhammadiyah Surakarta, Sukoharjo, Indonesia; Tanjungpura University, Pontianak, Indonesia; MidHudson Family Medicine residency, Institute for family Health Family Medicine, Centerville, United States; OnDokuz Mayis University, Samsun, Turkey; Faculty of Medical Sciences, Lebanese university, Beirut, Lebanon; An-Najah National University, Nablus, Palestine; University of Jordan, Amman, Jordan; Ondokuz Mayis University, Samsun, Turkey; MPH, North South University, Dhaka, Bangladesh; Aljabili Saglik Bilimleri Üniversitesi, Istanbul, Turkey; Monash University, Fawkner, Australia; Ain Shams General Hospital House, Khartoum, Sudan; Tripoli central hospital, Tripoli, Libya; Aleppo University Hospital, Aleppo, Syria; Faculté de Médecine et de Pharmacie de Rabat, Temara, Morocco; NGHA, KAMC, Riyadh, Saudi Arabia; Surgery department (Intern doctor), Princess Basma teaching hospital, Irbid, Jordan; University of Aleppo, Aleppo, Syria; Medical Facuilty, Paktia University, Kabul, Afghanistan; Student Research Committee, Iran Clinical Research Development Center of Imam Khomeini Hospital, Jiroft University of Medical Sciences, Jiroft, Iran; College of Medicine, Qatar University, Doha, Qatar; Faculté de Médecine, de Pharmacie et de Médecine Dentaire de Fès, Fez, Morocco; Kas al aini Clinic, Cairo, Egypt; Department of Physiology, Alzaiem Alazhari University, Khartoum, North Sudan; Department of Human Physiology, Alzaiem Alazhari University, Khartoum, North Sudan; Ministry of Health Internship, Khartoum, Sudan; Ministry of Health, Khartoum, Sudan; The Department of Statistics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan; College of Medicine, Menoufia University, Al Minufiyah, Egypt; Psychology Department of Behavioral Science, Rehman College of Dentistry, Peshawar, Pakistan; CMHS Family Medicine, UAEU, Al Ain, United Arab Emirates; Healthcare Psychology, Abu Dhabi, United Arab Emirates; ICU department, Alexandria Main University Hospital, Alexandria, Egypt; Mosul medical collage, Mosul, Iraq; Ondokuz Mayis University, Samsun, Turkey; Emirates Health Services, Dubai, United Arab Emirates; Faculty of Medicine, Ain Shams University, Cairo, Egypt; Department of Nutrition, Pertamedika College of Health Sciences, Jakarta, Indonesia; School of Nursing and Midwifery, Tehran University of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Shadan Institute of Medical Sciences and Research Centre, Peeramcheru, India; CMH Institute of Medical Sciences, Multan, Pakistan; Birat Medical College and Teaching Hospital Sukhrampur, Krishnanagar, Nepal; Kuwait University, Kuwait City, Kuwait; Jordan University of Science and Technology, Irbid, Jordan; Alexandria Faculty of Medicine, Alexandria, Egypt; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Ministry National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Nangarhar Medical Faculty, Timergara, Pakistan; Khatam-Al-Nabieen University, Kabul, Afghanistan; University of Debrecen, Debrecen, Hungary; Faculté de médecine d’Alger, Algiers, Algeria; Sultan Qaboos University (Oman), Seeb, Oman; JSS Medical College, Mysore General Medicine, Kannur, India; Jimma University, Jimma, Ethiopia; DNB GEM Hospital General Medicine, Chennai, India; An-Najah National University, Bethlehem, Palestine; MWACP West African College of Physicians, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria; MBBCh Dubai Medical College, Manama, Bahrain 1College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates 2Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia 3Knowledge and Research Support Services Department, University of Management and Technology, Lahore, Pakistan 4Sustainable Energy and Power Systems Research Centre, RISE, University of Sharjah, Sharjah, United Arab Emirates 5Department of Psychology, Zayed University, Abu Dhabi, United Arab Emirates 6Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates 7Sharjah Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates 8Internal Medicine College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates 9Department of Neurology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates 10Faculty of Medicine, Mansoura University, Mansoura, Egypt 11School of Medicine, The University of Jordan, Amman, Jordan 12Chattogram International Medical College and Hospital, Chattogram, Bangladesh 13Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Türkiye 14Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran 15Department of Internal Medicine, Yobe State University Teaching Hospital, Damaturu, Nigeria 16Department of Psychiatry and Behavioral Science, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates 17Department of Public Health, North South University, Dhaka, Bangladesh 18Department of Community Medicine, Bayero University, Kano, Nigeria 19Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates 20Department of Nutrition, Sekolah Tinggi Ilmu Kesehatan Pertamedika, Jakarta, Indonesia 21Faculty of Health Sciences, School of Nursing, Institute of Health, Jimma University, Jimma, Ethiopia 22Royal College of Surgeons in Ireland (Bahrain), Al Muharraq, Bahrain 23Iranshahr University of Medical Sciences, Iranshahr, Iran 