Journal of Sports Sciences, December 2008; 26(S3): S29–S38

Dietary intake and body composition of football players during the holy
month of Ramadan

RONALD J. MAUGHAN1, ZAKIA BARTAGI2, JIRI DVORAK3, & YACINE ZERGUINI4

1
School of Sport and Exercise Sciences, Loughborough University, Loughborough, UK, 2National Centre for Medicine and
Scientific Research in Sport, Tunis, Tunisia, 3FIFA Medical Assessment and Research Centre, Schulthess Clinic, Zurich,
Switzerland and 4Centre d’Evaluation et d’Expertise en Médecine du Sport, Algiers, Algeria

(Accepted 14 August 2008)

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Abstract
Healthy young male football players who were either fasting (n ¼ 59) or not fasting (n ¼ 36) during the month of Ramadan
were studied. Body mass, body composition, and dietary intake were assessed at each time point. Energy intake was relatively
stable in the fasting participants, but there was a small decrease of approximately 0.7 kg in body mass during Ramadan.
Mean daily energy intake increased from 14.8 MJ (s ¼ 2.9) to 18.1 MJ (s ¼ 3.2) during Ramadan in non-fasting participants,
with concomitant increases in body mass and body fat content of about 1.4 kg and 1% respectively over the month. The
fractional intake of protein increased and the fractional contribution of carbohydrate decreased for both groups in Ramadan.
Estimated mean daily water intake was high (about 3.8 litres) throughout the study period. Water intake increased on average
by 1.3 litres  day71 in line with the greater energy intake in the non-fasting group in Ramadan. Daily sodium intake fell
during Ramadan in the fasting participants from 5.4 g (s ¼ 1.1) before Ramadan to 4.3 g (s ¼ 1.0) during Ramadan, but
increased slightly by about 0.7 g  day71 in the non-fasting group. Dietary iron decreased in the fasting group and increased
in the non-fasting group, reflecting the difference in energy intake in both groups during Ramadan. These data suggest that
Ramadan fasting had some effects on diet composition, but the effects were generally small even though the pattern of eating
was very different. After Ramadan, the dietary variables reverted to the pre-Ramadan values.

Keywords: Ramadan fasting, body composition, energy intake, carbohydrate

those involved in sport, there are some clear

Introduction
One of the most obvious effects of the observation of
the holy month of Ramadan is a change in dietary
practice, with the intake of food and fluid being
avoided during the hours of daylight for the duration
of the month. This involves a change in the timing of
food intake, and a disruption of the normal circadian
rhythm. These changes can lead to a reduction in
total energy intake and a loss of body mass (Husain,
Duncan, Cheah, & Ch’ng, 1987; Sweileh, Schnitzler,
Hunter, & Davis, 1992; Ziaee et al., 2006), but other
researchers have found no change in these variables
(Beltaifa et al., 2002; Finch, Day, Welch, & Rogers,
1998; Karli, Guvenc, Aslan, Hazir, & Acicada, 2007;
Meckel, Ismaeel, & Eliakim, 2008). To further
confuse the picture, Chaouachi et al. (2008) reported
that energy intake of young elite judo athletes
remained constant during Ramadan but observed
significant losses in body mass and body fat. For
implications for performance in both training and
competition. Although there have been several
studies on the nutritional, metabolic, and body
composition changes during the month of Ramadan,
there has been little work on the responses in athletes
who continue to train throughout this period. Meckel
et al. (2008), however, reported no change in energy
intake during the month of Ramadan, but did
observe some negative effects on components of
performance in young football players.
The duration of each day’s period of fasting during
Ramadan is relatively short, and it is not entirely
clear whether short periods of fasting have any effect
on competitive sports performance, although it is
well established that carbohydrate oxidation is
decreased and fatty acid oxidation increased by even
a few hours of fasting (Coyle, Coggan, Hemmert,
Lowe, & Walters, 1985). There is anecdotal evidence
of an increase in road traffic accidents during

Correspondence: R. J. Maughan, School of Sport and Exercise Sciences, Loughborough University, Loughborough LE11 3TU, UK.
E-mail: r.j.maughan@lboro.ac.uk
ISSN 0264-0414 print/ISSN 1466-447X online Ó 2008 Taylor & Francis
DOI: 10.1080/02640410802409675
 S30 R. J. Maughan et al.
Ramadan (Arab News, 2007) and some evidential
support for the idea that lifestyle changes around
Ramadan may lead to an increase in accidents
(Tolon & Chernoff, 2006). This implies some loss
of cognitive function and/or motor control, both of
which are important elements of performance in
many sports. Under controlled laboratory condi-
tions, moderate periods of fasting (i.e. 24–36 h) have
been shown to impair endurance (Maughan &
Gleeson, 1988) and high-intensity (Gleeson, Green-
haff, & Maughan, 1988) exercise performance.
It is recognized that the intakes of protein, amino
acids, and carbohydrate in the period just before or
just after training will influence the rates of protein
synthesis and degradation (Tipton et al., 2001). This,
in turn, can influence the metabolic and functional
adaptations taking place in response to the training
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stimulus (Andersen et al., 2005; Candow, Burke,
Smith-Palmer, & Burke, 2006). Most sports nutri-
tion guidelines recommend intake of protein (Haw-
ley, Tipton, & Millard-Stafford, 2006), carbohydrate
(Burke, Loucks, & Broad, 2006), and fluid (Shir-
reffs, Sawka, & Stone, 2006) in the period after
training to promote recovery and to stimulate the
process of adaptation taking place within the
exercised muscles. These may have long-term con-
sequences, but where there is adequate time for
recovery, the need for food and fluid intake in the
immediate post-exercise period is less urgent.
The absence of fluid intake over the course of the
day may have greater implications for performance
than the absence of food intake. Daily water turnover
for sedentary individuals living in a temperate climate
is typically about 2–3 litres, but this may increase
several-fold for active individuals exposed to hot
climates (Maughan & Shirreffs, 2004). Although
there is much debate about the effects of mild
hypohydration on exercise performance (Noakes,
2007; Sawka et al., 2007), there is no doubt that both
physical and mental performance will be impaired if
hypohydration is sufficiently severe. Where either
exercise or heat exposure is unavoidable during the
day, it is therefore likely that an individual who avoids
fluid intake over the course of a day will perform less
well if called upon to exercise late in the day.
The combined effects of food and fluid restriction
are therefore of importance to the Muslim athlete
who must train and compete throughout Ramadan.
The aim of this part of the study was to assess
changes in dietary intake, body mass, and body
composition in young professional football players
over the course of Ramadan.
Methods and materials
The general methods and materials for this study are
described elsewhere (Leiper et al., 2008) and are
covered here only briefly. Dietary data were collected
from 95 (59 fasting, 36 non-fasting) healthy young
male volunteers who played football for one or other
of four teams based in Tunis. The nature of the study
was explained to all participants, who then gave their
written consent to participate. Ethical approval was
granted by the National Research Ethics Committee.
Throughout the study period, players trained or
played in competitive matches on a daily basis. In the
last week before Ramadan, only one team trained in
the morning (at approximately 10.00 h; n ¼ 22) and
the rest in the afternoon (at approximately 18.00 h;
n ¼ 73), but in the 2-week period prior to this, two of
the teams trained in the morning and two in the
afternoon. During Ramadan, all four teams trained
in the afternoon (between 13.00 and 18.00 h).
Training varied on a daily basis, but typically lasted
about 60 min. Ramadan began on 23 September
2006, and the body composition measurements
reported here were made during the week before
the beginning of Ramadan, during weeks 2 and 4 of
Ramadan, and again 3 weeks after the end of
Ramadan. The climatic conditions varied little on a
daily basis over the study period. For the month of
October, the average temperature was 268C, with a
daily average minimum temperature of 188C and an
average maximum temperature of 288C. Average
relative humidity was 72%, and total rainfall during
the month was 49 mm.
During the initial measurement period, all parti-
cipants in the study were provided with breakfast at
approximately 07.30 h, lunch at 12.30 h, and dinner
at 18.30 h. The non-fasting group maintained this
eating schedule throughout, but during Ramadan the
fasting group were provided with a meal between
04.00 and 07.00 h (before sunrise – Souhour) and
another meal between 19.00 and 20.00 h (Foutour).
Snacks and drinks were permitted at other times, but
the fasting group abstained from all food and fluid
between Souhour and Foutour. During Ramadan,
special meals were provided for the fasting players to
break their fast, and these were available also to the
non-fasting players.
Dietary intake of foods and nutrients was assessed
before, during, and after Ramadan using a 24-h
recall method on each occasion for three separate
days during each of the three phases of the study
(Bingham & Nelson, 1991), which was completed by
interview with the same experienced dietician. The
3-day record has been shown to be accurate to within
10% of the energy intake values obtained with 7-day
records (Burnett, O’Connor, Koltyn, Raglin, &
Morgan, 1994). A standard format was used for
each 24-h recall according to the principles described
in Cameron and van Staveren (1988). Players were
asked to report, in as detailed a manner as possible,
all foods and fluids consumed during the preceding
 Nutritional effects of Ramadan fasting S31

24 h. For each food item mentioned by the players,

further information was asked about its type, the size
of the portion, and the amount consumed, with two-
and three-dimensional food models being shown to
help the interviewee in his estimation. Dietary
records were analysed for energy intake by the use
of a food database created in the National Centre for
Medicine and Scientific Research in Sport, Tunis,
with values based mainly on the food composition
tables published by the National Institute of Statistics
of Tunisia in 1978 and on other published data
(Food Standards Agency, 2002). Body mass was
measured to the nearest 100 g with an electronic
balance (Seca Instruments Ltd., Hamburg, Ger-
many) and standing height was determined to the
nearest 0.001 m using a stadiometer. The percentage
of body fat mass was estimated from four measure-
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Results
The descriptive data were checked and found to be
normally distributed. The fasting (n ¼ 59) and non-
fasting (n ¼ 36) groups at the start of the study were
found to be matched for age (P ¼ 0.66), body mass
(P ¼ 0.13), height (P ¼ 0.75), body mass index
(P ¼ 0.07), and percent body fat content (P ¼ 0.87)
(Table I).
Body mass and body composition
Relative to the pre-Ramadan measure, body mass
(Table II) had marginally decreased in the fasting
group by the second week of Ramadan (P ¼ 0.002)
and remained at this level in the last week of
Ramadan (P ¼ 0.88). In the non-fasting group, body

ments of skinfold thickness (Harpenden caliper,
Lange, Cambridge, MA, USA) using the Durnin
and Womersley (1974) equation.
Statistical analysis of all the data was assessed
using the Statistical Package for the Social Sciences
(SPSS). The data were initially tested for distribu-
tion (Shapiro-Wilks test) and homogeneity of
variance (Levene’s test). Where the assumption that
the data were normally distributed was reasonably
met, the data were analysed using two-way or one-
way analysis of variance (ANOVA) as appropriate.
Where applicable, this was followed by application
of the Tukey multiple range test to assess any
differences between groups or phases in the study.
All the data in the present study were found to be
essentially normally distributed and are reported as
means and standard deviations. All tests were two-
tailed and statistical significance was set at
P 5 0.05.
mass had increased (P 5 0.001) by the second week
of Ramadan and was slightly higher still in the last
week of Ramadan (P 5 0.001). This resulted in an
overall increase in average body mass for the non-
fasting group of about 1.4 kg during the month of
Ramadan. However, no differences could be de-
tected in body mass between the two groups at each
measurement occasion during the study (P ¼ 0.74).
Based on the time of day when the players were
weighed, the body mass of the players measured in
the morning and those measured in the afternoon
remained similar in the fasting group (P ¼ 0.59) and
in the non-fasting group (P ¼ 0.81) throughout the
study (Table III). No differences in body mass were
detected between the fasting and non-fasting group
when compared by time of day of measurement
throughout the study (P ¼ 0.83).
Compared with the body fat content measured
before Ramadan (Table IV), no differences were

Table I. Baseline participant characteristics (mean, standard deviation in parentheses, and range in brackets).

Parameter Fasting group (n ¼ 59) Non-fasting group (n ¼ 36)

Age (years) 18 (1) [17–21] 18 (1) [17–20]

Body mass (kg) 71.9 (8.5) [58.0–94.5] 69.6 (7.4) [54.5–86.1]
Height (m) 1.78 (0.06) [1.66–1.89] 1.78 (0.06) [1.65–1.91]
BMI (kg  m72) 22.8 (2.3) [17.9–31.0] 21.8 (1.8) [18.5–24.7]
Body fat (%) 12.3 (3.5) [6.6–21.7] 12.4 (2.8) [8.3–18.4]

Table II. Body mass (kg), body fat content (%), and BMI (kg  m72) measured during the study (mean values with standard deviations in
parentheses).

Fasting group (n ¼ 59) Non-fasting group (n ¼ 36)

Study week Body mass Body fat BMI Body mass Body fat BMI

Before Ramadan 71.9 (8.5) 2.3 (3.5) 2.8 (2.3) 69.6 (7.4) 12.4 (2.8) 21.8 (1.8)
Week 2 of Ramadan 71.2 (8.5)** 12.3 (3.9) 22.4 (2.3) 70.2 (7.6)*** 13.1 (3.0)* 21.8 (2.7)
Week 4 of Ramadan 71.1 (8.0)** 12.1 (3.5) 22.6 (2.3) 71.0 (7.6)*** 13.4 (2.9)* 22.4 (2.0)

Note: Compared with the pre-Ramadan value: *P 5 0.05; **P 5 0.005; ***P 5 0.001.
 S32 R. J. Maughan et al.

Table III. Body mass (kg) measured in the morning (am) or afternoon (pm) during the study (mean values with standard deviations in
parentheses).

Fasting group Non-fasting group

Study week am (n ¼ 34) pm (n ¼ 25) am (n ¼ 19) pm (n ¼ 17)

Before Ramadan 72.4 (6.8) 71.1 (10.8) 69.8 (8.6) 68.6 (6.2)
Week 2 of Ramadan 71.9 (7.1) 70.1 (10.5) 70.6 (8.9) 69.8 (6.3)
Week 4 of Ramadan 72.2 (7.1) 69.5 (9.1) 71.5 (8.8) 70.5 (6.5)

Table IV. Body fat (%) measured in the morning (am) or afternoon (pm) during the study (mean values with standard deviations in
parentheses).

Fasting group Non-fasting group

Study week am (n ¼ 34) pm (n ¼ 25) am (n ¼ 19) pm (n ¼ 17)

Before Ramadan 13.0 (2.9) 11.2 (4.1) 12.6 (3.1) 12.2 (2.6)
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Week 2 of Ramadan 13.1 (3.4) 11.0 (4.2) 13.5 (3.7) 12.7 (2.3)
Week 4 of Ramadan 12.8 (3.0) 11.2 (4.4) 14.0 (3.6) 12.8 (1.9)

found in body fat in the fasting (P ¼ 0.37) group
during the second and last week of Ramadan. In
contrast, players in the non-fasting group increased
their percent body fat slightly during the first half of
Ramadan (P ¼ 0.03) and maintained this level of
adiposity throughout the rest of the study (P ¼ 0.60).
Percent body fat was, however, similar between the
two groups on each measurement occasion during
the study (P ¼ 0.17). Based on the time of day when
the players were measured (Table IV), percent body
fat content of the players measured in the morning
and those measured in the afternoon remained
similar in the non-fasting group throughout the
study (P ¼ 0.53). There was a tendency for percent
body fat to be greater in the fasting group of players
measured in the morning than those in the afternoon
before Ramadan (P ¼ 0.09) and in the second week
(P ¼ 0.06) but not in the fourth week of Ramadan
(P ¼ 0.12). The percent body fat of the fasting group
of players measured in the morning was similar
throughout the study (P ¼ 0.73), as was that of the
players measured in the afternoon (P ¼ 0.81).
Compared with the body mass index (BMI)
measured before Ramadan, no change was found in
BMI in the fasting (P ¼ 0.56) or non-fasting
(P ¼ 0.42) groups during the second or last week of
Ramadan. The BMI was similar between the two
groups on each measurement occasion during the
study (P ¼ 0.49). Based on the time of day when the
players were measured, the BMI of the players
measured in the morning and those in the afternoon
remained similar in the fasting group throughout the
study (P ¼ 0.31). However, the BMI in the non-
fasting players measured in the morning was slightly
lower than that of the players measured in the
afternoon (P ¼ 0.03) throughout the study. No
significant difference was detected on any of the
Table V. Daily energy intake (MJ  day71) (mean values with
standard deviations in parentheses).
Pre-Ramadan Ramadan Post-Ramadan
Fasting 14.6 (2.4) 14.2 (2.7) 14.8 (3.3)
Non-fasting 14.8 (2.9) 18.1 (3.2){# 14.4 (2.5)
Note: Compared with the pre-Ramadan value: {P 5 0.001.
Compared with the fasting group during Ramadan: #P 5 0.001.
measurement occasions in the BMI values measured
in the morning (P ¼ 0.75) or in the afternoon
(P ¼ 0.62) in the non-fasting group or fasting group
(P ¼ 0.84 and P ¼ 0.73, respectively) during the study.
Energy and macronutrient intake
Dietary recall data for this part of the study were
complete for all 95 players before and during
Ramadan. In the period after Ramadan, dietary data
for 86 (52 fasting group, 34 non-fasting group)
players were collected.
Estimated mean daily energy intake before Rama-
dan was similar (P ¼ 0.65) in the fasting and non-
fasting groups (Table V). Overall during Ramadan,
the players in the non-fasting group increased
(P 5 0.001) their daily energy intake by an average
of 3.3 MJ (s ¼ 3.5), while that of the fasting group
remained essentially the same as before Ramadan
(P ¼ 0.47). The increase in energy intake in the non-
fasting group meant that the energy intake of this
group was higher than that of the fasting group
during Ramadan (P 5 0.001). After Ramadan, the
energy intake of the fasting (P ¼ 0.38) and non-
fasting (P ¼ 0.72) groups returned to essentially their
pre-Ramadan values and were similar in the two
groups (P ¼ 0.91).

The estimated daily amount of carbohydrate in the
diet was similar on all measurement occasions in the
fasting group (P ¼ 0.29; Table VI). Dietary carbohy-
drate intake was similar in the fasting and non-fasting
group before Ramadan (P ¼ 0.35). During Rama-
dan, carbohydrate intake was higher in the non-
fasting group than it was before Ramadan
(P 5 0.001), after Ramadan (P 5 0.001), and com-
pared with the intake of the fasting group at the same
time point (P 5 0.001). There was no difference in
the estimated dietary carbohydrate intake between
the fasting and non-fasting players after Ramadan
(P ¼ 0.39) or between pre- and post-Ramadan values
for the fasting (P ¼ 0.82) and non-fasting (P ¼ 0.86)
groups.
The estimated proportion of daily energy supplied
by carbohydrate in the players’ diet was similar in the
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two groups before Ramadan (P ¼ 0.11), and re-
mained similar during (P ¼ 0.76) and after (P ¼ 0.16)
Ramadan. In the fasting group, the fractional
contribution of carbohydrate to the daily diet was
marginally greater before than during Ramadan
(P 5 0.001). Similarly, the proportion of carbohy-
drate in the diet of the non-fasting group was slightly
greater before than during Ramadan (P 5 0.001).
After Ramadan, the percentage of carbohydrate in
the diet had essentially returned to that consumed in
the period before Ramadan in both the fasting
(P ¼ 0.93) and non-fasting (P ¼ 0.77) groups.
The estimated daily amount of protein in the diet
was similar (P ¼ 0.80) before Ramadan in the fasting
and non-fasting groups (Table VII). During Rama-
dan, the protein content of the diet in the non-fasting
Table VI. Estimated daily carbohydrate (g) content of the diets and estimated fraction of total energy intake accounted for by carbohydrate
(mean values with standard deviations in parentheses).
Pre-Ramadan
g %
Fasting 489 (90) 55 (4)
Non-Fasting 508 (101) 57 (4)
Note: Compared with the pre-Ramadan value: {P 5 0.001.
Compared with the fasting group during Ramadan: #P 5 0.001.
Table VII. Estimated daily protein content (g) of the diets and estimated fraction of total energy intake accounted for by protein (mean values
with standard deviations in parentheses).
Pre-Ramadan
g %
Fasting 116 (21) 13 (2)
Non-fasting 115 (22) 13 (1)
Note: Compared with the pre-Ramadan value: {P 5 0.001.
Compared with the fasting group during Ramadan: #P 5 0.001.
Nutritional effects of Ramadan fasting S33
group was higher than that before Ramadan
(P 5 0.001), and was higher than that in the fasting
group at the same period (P 5 0.001). In the fasting
group, daily protein intake during Ramadan was
slightly greater than before Ramadan (P 5 0.001).
After Ramadan, the amount of protein in the diet
returned to pre-Ramadan values in both the fasting
(P ¼ 0.08) and non-fasting (P ¼ 0.68) groups, which
were similar (P ¼ 0.35).
The estimated proportion of daily energy supplied
by protein in the players’ diet was similar in the two
groups (P ¼ 0.40) before Ramadan. In the fasting
group, the percentage of protein in the daily diet was
greater during Ramadan (P 5 0.001) than before
Ramadan. Similarly, the proportion of protein in the
diet of the non-fasting group was greater during
Ramadan (P 5 0.001) than before Ramadan. The
percentage of protein in the diet was similar for
fasting and non-fasting players during Ramadan
(P ¼ 0.99). After Ramadan, the percentage of daily
energy supplied by protein returned to pre-Ramadan
values in the non-fasting (P ¼ 0.54) and fasting
(P ¼ 0.40) groups, which were similar (P ¼ 0.08).
The estimated daily amount of fat in the diet was
similar (P ¼ 0.59) before Ramadan in the fasting and
non-fasting groups (Table VIII). During Ramadan,
the dietary fat content of the non-fasting group
increased relative to that before Ramadan
(P 5 0.001), and was higher than that of the fasting
group at the same period (P 5 0.001). Estimated
daily fat intake in the fasting group was similar before
and during Ramadan (P ¼ 0.97). After Ramadan,
estimated daily fat intake was essentially the same as
Ramadan Post-Ramadan
g % g %
482 (83) 52 (4){ 481 (106) 55 (4)
579 (115){# 52 (4){ 504 (79) 57 (5)
Ramadan Post-Ramadan
g % g %
126 (27){ 16 (1){ 123 (36) 14 (2)
158 (29){# 16 (1){ 117 (25) 13 (2)
 S34 R. J. Maughan et al.

Table VIII. Estimated daily fat (g) content of the diets and estimated fraction of total energy intake accounted for by fat (mean values with
standard deviations in parentheses).

Pre-Ramadan Ramadan Post-Ramadan

g % g % g %

Fasting 123 (22) 31(3) 124 (24) 33 (3) 122 (33) 31 (3)
Non-fasting 120 (29) 30 (3) 158 (39){# 32 (3){ 118 (31) 30 (4)

Note: Compared with the pre-Ramadan value: {P 5 0.05; {P 5 0.001.

Compared with the fasting group during Ramadan: #P 5 0.001.

Table IX. Estimated total daily water intake (litres) from foods and fluids (mean values with standard deviations in parentheses).

Pre-Ramadan Ramadan Post-Ramadan

Fasting 3.85 (0.91) 3.66 (0.73) 3.48 (0.98)

Non-fasting 3.86 (0.91) 5.17 (0.75){# 3.68 (0.99)
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Note: Compared with the pre-Ramadan value: {P 5 0.001.

Compared with the fasting group during Ramadan: #P 5 0.001.

Table X. Estimated daily sodium (mg) and iron (mg) content of the diets (mean values with standard deviations in parentheses).

Pre-Ramadan Ramadan Post-Ramadan

Sodium Iron Sodium Iron Sodium Iron

Fasting 5369 (1129) 27 (6) 4299 (970){ 22 (4) 5173 (1420) 26 (6)
Non-fasting 4950 (1190) 25 (5) 5674 (1139){# 27 (5) 4752 (1137) 24 (6)

Note: Compared with the pre-Ramadan value: {P 5 0.001.

Compared with the fasting group during Ramadan: #P 5 0.001.

that before Ramadan in the fasting (P ¼ 0.86) and
non-fasting (P ¼ 0.85) groups, and was similar for
the two groups (P ¼ 0.59).
The estimated proportion of daily energy supplied
by fat in the players’ diets was similar in the two
groups (P ¼ 0.11) before Ramadan. In the fasting
group, the estimated percentage of fat in the diet
during Ramadan was similar (P ¼ 0.093) to that
before Ramadan. The proportion of energy supplied
by fat was marginally greater in the non-fasting group
during Ramadan (P ¼ 0.02) than before Ramadan,
but similar to that in the fasting group at the same
time point (P ¼ 0.06). After Ramadan, the estimated
percentage of fat in the diet was essentially the same
as before Ramadan in the fasting (P ¼ 0.36) and non-
fasting (P ¼ 0.58) groups, with the two groups similar
(P ¼ 0.21).
Estimated daily total water intake from ingested
food and fluids before Ramadan was similar
(P ¼ 0.86) in the two groups (Table IX). Estimated
daily total water intake of the fasting group remained
essentially the same before and during Ramadan
(P ¼ 0.17). In the non-fasting group, total water
intake increased during Ramadan compared with
before Ramadan (P ¼ 0.01). Estimated daily water
intake was therefore greater during Ramadan in the
non-fasting group than in the fasting group
(P 5 0.001), but was similar between the two groups
after Ramadan (P ¼ 0.45).
Estimated daily dietary sodium intake before
Ramadan was similar (P ¼ 0.09) in the two groups
(Table X). Compared with before Ramadan, esti-
mated sodium intake of the fasting group was lower
during Ramadan (P 5 0.001), while it was higher in
the non-fasting group (P ¼ 0.006). This resulted in a
significant difference between the two groups during
Ramadan (P 5 0.001). After Ramadan, sodium
intake returned to pre-Ramadan values in both the
fasting (P ¼ 0.43) and non-fasting (P ¼ 0.55) groups,
which were similar (P ¼ 0.15).
The estimated daily iron intake from the diet was
similar (P ¼ 0.08) in the two groups before Ramadan
(Table X). Compared with before Ramadan, daily
dietary intake of iron was lower during Ramadan in
the fasting group (P 5 0.001), while it was higher in
the non-fasting group (P ¼ 0.02). Intake during
Ramadan was therefore significantly different be-
tween the two groups during this phase of the study
(P 5 0.001). After Ramadan, the intake of dietary
iron was similar to that ingested before Ramadan in

both the fasting (P ¼ 0.45) and non-fasting
(P ¼ 0.31) groups, which were similar (P ¼ 0.08).
Discussion
Changes in energy intake and the dietary intakes of
macro- and micro-nutrients during the period of
Ramadan were generally rather small. Similarly,
there was no profound effect on body mass or on
body composition, although some subtle changes
were observed. It is important to note the limitations
to the sensitivity of the methodologies used, and
changes in body composition over this short time-
scale are unlikely to be detected reliably, while
changes in body mass will be influenced by the
normal day-to-day variations in hydration status that
occur. The results of this study are consistent with
Downloaded By: [Canadian Research Knowledge Network] At: 17:23 31 July 2010
numerous reports in the literature that suggest that
neither energy intake nor body mass changes
substantially during Ramadan fasting. Ramadan
(2002) reported that no change in body composition
occurred during observance of Ramadan in a group
of healthy but sedentary adult males, suggesting that
energy intake was not affected. El Ati and colleagues
(El Ati, Beji, & Danguir, 1995) also reported that
energy intake and body composition did not change
in female players during Ramadan. Ramadan and
colleagues (Ramadan, Telahoun, Al-Zaid, & Barac-
Nieto, 1999) observed no statistically significant
change in body mass during Ramadan in small
samples of active and sedentary players. Maislos and
colleagues (Maislos, Khamaysi, & Assali, 1993)
reported similar findings. More recently, Furuncuo-
glu and colleagues (Furuncuoglu, Ender, Sükrü, &
Arif, 2007) reported no change in body mass in 39
players during 26 days of fasting when the mean
duration of fasting each day was 14 h. Yucel and
colleagues (Yucel, Degirmenci, Acar, Albayrak, &
Haktanir, 2004) found no effect of Ramadan fasting
on body mass or abdominal fat distribution, as
assessed by computed tomography scanning, in a
mixed group of males and females, but they did find
small reductions in the visceral fat compartment in
female participants and in young participants.
In contrast to these observations, there are a
number of reports of reduced energy intake and/or
loss of body mass during Ramadan. Sweileh et al.
(1992) reported that participants experienced a
reduction in body mass of 1.92 kg and a decrease
in body fat content with no loss of lean tissue. They
reported an exceptionally low daily energy intake
(1220 kcal  day71) during Ramadan, but no data
were provided to indicate the participants’ normal
intakes. Most (1.13 kg) of the body mass loss
occurred during the first week, and based on changes
in blood parameters the authors concluded that a
state of dehydratation existed during the first week of
Nutritional effects of Ramadan fasting S35
Ramadan, although this returned to normal by the
end of the month. Sulemani (1988) and Fedail
and colleagues (Fedail, Murphy, Salih, Bolton, &
Harvey, 1982) also reported a total reduction of
about 1 kg in body mass during Ramadan. In a
group of 10 adult male university professors in
Pakistan, mean energy intake fell by 857 kcal
(s ¼ 410) during Ramadan, and body mass fell by
3.2 kg (s ¼ 1.7) over the month (Khan and Khattak,
2002). In a small (n ¼ 9) group of young male rugby
players, a significant fall in energy intake, accom-
panied by falls in body mass and in body fat
content, was observed at the end of Ramadan by
Bouhlel et al. (2006).
There are reports of increased energy intake
during Ramadan in Saudi Muslims (Frost & Pirani,
1987) and decreases in Indian Muslims (Chandalia,
Bhargau, & Kataria, 1987), suggesting that there may
be regional and cultural variations in dietary prac-
tices. It is important to note also that the participants
in the study of Chandalia and colleagues were
diabetic, and a reduced total energy intake may
reflect changes in the composition of the foods on
offer at this time. In the present study, the non-
fasting players were more likely to change dietary
habits, body mass, and body composition during
Ramadan and an increase, rather than a decrease, in
food intake was observed.
The reported values for energy intake and dietary
composition during the pre-Ramadan period are
similar to many of the values reported for football
players in the literature. Energy intake of a typical
male player is about 13–16 MJ  day71, equivalent to
160–200 kJ  kg71  day71 (Burke et al., 2006).
These intake data, however, are prone to reporting
error and to fluctuations across the competitive
season, making comparisons between data sets
difficult. There was a significant increase in the
energy intake (by 3.3 MJ  day71) of the non-fasting
players during Ramadan, and this reflected the
mixed social setting, whereby non-fasting players
tended to eat their own meals and then join their
fasting colleagues for a further meal. This behaviour
was most apparent during the first week of Ramadan,
suggesting a high degree of self-regulation of energy
intake once the initial novelty wore off. The higher
energy intake resulted in an increase of about 1.3 kg
in body mass over the month of Ramadan. However,
while the rise in body mass over the first half of
Ramadan (*0.6 kg) appeared to be entirely due to
an augmentation in body fat (*0.6 kg), the further
increase of approximately 0.7 kg in body mass
during the second half of Ramadan was apparently
accompanied by an increase of only 0.3 kg of body
fat. This might be due to a change in glycogen
storage, hydration status or other lean tissue compo-
nents, allied to measurement errors and random
 S36 R. J. Maughan et al.
fluctuations. Changes in bowel and bladder habits
may also play some role.
There was a substantial increase in the carbohy-
drate intake of the non-fasting players during Rama-
dan, due mainly to the increased total energy intake
rather than to any major change in the composition of
the diet. Intakes of fat and protein also increased in the
non-fasting group during Ramadan. The increase in
carbohydrate intake averaged 70 g  day71, or about
1.0 g  kg71  day71. Throughout the study, the
carbohydrate intake of both the fasting and non-
fasting players was about 7–8 g  kg71  day71. This
is consistent with the recommendation that players
should eat about 5–7 g  kg71  day71 during periods
of light training and 7–12 g  kg71  day71 during
periods of heavy training (Burke et al., 2006; Hawley
et al., 2006), and suggests that the normal dietary
Downloaded By: [Canadian Research Knowledge Network] At: 17:23 31 July 2010
carbohydrate intake of these players is probably
adequate to sustain their training. It is important to
recognize, however, that these are mean values and it
may be misleading to focus on such values because
there was a large inter-individual variability in both
total energy intake and in the composition of the diets
eaten. While some players achieved high carbohydrate
intakes, some failed to do so. Thirty-five players in the
present study reported carbohydrate intakes of
6 g  kg71  day71 or less during the pre-Ramadan
period. The change in the composition of foods
during Ramadan meant that there was a slight
decrease in the contribution of carbohydrate to energy
intake, with increased relative contributions of protein
and fat, at this time in both groups. However,
the amount of carbohydrate ingested by most of the
fasting players appeared to be sufficient for the
training load that they undertook: there were no
changes over time in the performance tests that the
players completed during this study (Kirkendall,
Leiper, Zerguini, Bartagi, & Dvorak, 2008). There
was, nevertheless, a trend for the fasting players to lose
on average about 0.7 kg over the first half of
Ramadan. While this might suggest that energy intake
was slightly less than the energy expenditure required
by the players, it is more likely that the apparent
weight loss of about 1% of body mass was due to the
acute dehydration that is known to occur throughout
the hours of daylight during Ramadan (Cheah, Ch’ng,
Husain, & Duncan, 1990; Leiper, Molla, & Molla,
2003).
In a population of healthy but sedentary Tunisian
women, El Ati et al. (1995) reported an increase in
the relative content of fat and protein in the diet
during Ramadan, with a corresponding decrease in
carbohydrate as total energy intake was unchanged.
It is clear, however, that there are considerable
cultural differences in the observation of Ramadan,
and the types of foods eaten may or may not differ
markedly from the normal dietary pattern. The
fasting adolescent Tunisian football players in the
present study appear to have followed a pattern of
food intake that is similar to that of the sedentary
Tunisian women reported by El Ati and colleagues
(1995). This is presumably due to the type of foods
that are traditionally eaten by Tunisians during
Ramadan.
The mean values for dietary protein intake also
tend to suggest that players are achieving target
intakes, as mean daily protein intake was typically
about 1.6–1.8 g  kg71. This is about the upper end
of the recommended range for athletes in all sports
(Tarnopolsky, 2004) and also at the upper end of the
recommended range for football players (Hawley
et al., 2006; Lemon, 1994). It is also similar to other
values reported in the literature for protein intakes of
football players (Maughan, 1997; Rico-Sanz et al.,
1998). The fractional contribution of protein to
energy intake was highest during Ramadan. Once
again, however, it is important not to let the mean
values deflect attention from those individuals at the
extremes of the ranges. Some players had rather low
protein intakes, although there is no suggestion that
these were inadequate. The available evidence
suggests that nitrogen balance can be maintained
with a wide range of protein intakes provided that
energy intake is adequate (for a review, see Tipton &
Witard, 2007).
The average daily water intake of these players was
relatively high compared with values typically ob-
served in young men (Åstrand & Rodahl, 1986), but
was not especially high compared with total daily
water turnover values measured in active men living in
a temperate climate (Leiper, Carnie, & Maughan,
1996). The water losses of players in training can be
high, especially in warm environmental conditions:
some players may lose more than 3 litres of sweat
during a single training session (Shirreffs et al., 2006).
The fluid balance of players in this study is discussed
in more detail by Shirreffs and Maughan (2008).
The dietary sodium intake of the fasting players fell
during Ramadan even though energy intake was
maintained, suggesting a lower salt content of the
foods eaten at this time. Even though the total energy
intake increased in the non-fasting group during
Ramadan, their sodium increased less than might
have been expected. This is consistent with a lower
salt content of the foods prepared for the fasting
players, as the non-fasting players tended to consume
some of these foods in addition to their own meals
during Ramadan. Salt intakes are generally quite
high, relative to guidelines for sedentary individuals
(Scientific Advisory Committee on Nutrition, 2003;
Institute of Medicine, 2005), and this is discussed in
more detail by Shirreffs and Maughan (2008).
There was a fall in dietary iron intake during
Ramadan in the fasting group, but this is unlikely to

be of any clinical significance, for two reasons. First,
the dietary iron intakes of all players were relatively
high compared with the recommended intakes. The
US recommended dietary allowance for iron is
8 mg  day71 for men (Panel on Micronutrients,
2001), while the Reference Nutrient Intake in the
UK is 9 mg  day71 for young men (Department of
Health, 1991). Even the lower value in the fasting
players during Ramadan is well in excess of this.
Second, even if there was a reduction during
Ramadan in some players, the relatively short
duration of this altered food intake pattern would
be unlikely to substantially alter iron status.
In conclusion, our results show that there were
some small changes in body mass and body
composition over the course of Ramadan, but these
changes were generally small and of limited physio-
Downloaded By: [Canadian Research Knowledge Network] At: 17:23 31 July 2010
logical significance. Ramadan fasting had some
effects on diet composition, but the effects were
generally small even though the pattern of eating was
very different. After Ramadan, the dietary variables
reverted to pre-Ramadan values.
Acknowledgements
The costs of this study were met by grants from F-
MARC (FIFA Medical Assessment and Research
Centre) and from the Tunisian Football Federation.
R. J. Maughan is a member of the Science Advisory
Board of the Gatorade Sports Science Institute, for
which he receives a small honorarium. None of the
other authors has a real or potential conflict of
interest to declare.
References
Andersen, L. L., Tufekovic, G., Zebis, M. K., Crameri, R. M.,
Verlaan, G., Kjaer, M. et al. (2005). The effect of resistance
training combined with timed ingestion of protein on muscle
fiber size and muscle strength. Metabolism, 54, 151–156.
Arab News (2007). Doctors tell of accident spike during Ramadan
(available at: http://www.arabnews.com/?page¼1&section¼0&
article¼101983&d¼3&m¼10&y¼2007).
Åstrand, P.-O., & Rodahl, K. (1986). Textbook of work physiology:
Physiological bases of exercise (3rd edn.). New York: McGraw-Hill.
Beltaifa, L., Bouguerra, R., Ben Slama, C., Jabrane, H., El-Khadi,
A., Ben Rayana, M. C. et al. (2002). Food intake, anthro-
pometrical and biological parameters in adult Tunisians during
fasting at Ramadan. Eastern Mediterranean Health Journal, 8,
603–611.
Bingham, S. A., & Nelson, M. (1991). Assessment of food
consumption and nutrient intake. In B. M. Margetts & M.
Nelson (Eds.), Design concepts in nutritional epidemiology (pp.
153–192). Oxford: Oxford University Press.
Bouhlel, E., Salhi, Z., Bouhlel, H., Mdella, S., Amamou, A.,
Zouali, M. et al. (2006). Effect of Ramadan fasting on fuel
oxidation during exercise in trained male rugby players.
Diabetes and Metabolism, 32, 617–624.
Burke, L. M., Loucks, A. B., & Broad, N. (2006). Energy and
carbohydrate for training and recovery. Journal of Sports
Sciences, 24, 675–685.
Nutritional effects of Ramadan fasting S37
Burnett, K. F., O’Connor, P. J., Koltyn, K. F., Raglin, J. A., &
Morgan, W. A. (1994). Use of three-day food records as
estimates of seven-day caloric intake during physical training.
Medicine, Exercise, Nutrition and Health, 3, 185–193.
Cameron, M. E., & van Staveren, W. A. (Eds.) (1988). Manual on
methodology for food consumption studiesNew York: Oxford
Medical Publications.
Candow, D. G., Burke, N. C., Smith-Palmer, T., & Burke, D. G.
(2006). Effect of whey and soy protein supplementation
combined with resistance training in young adults. International
Journal of Sports Nutrition and Exercise Metabolism, 16, 233–244.
Chandalia, H. B., Bhargau, A., & Kataria, V. (1987). Dietary
pattern during Ramadan fasting and its effects on the metabolic
control of diabetes. Practical Diabetes, 4, 287–289.
Chaouachi, A., Chamari, K., Roky, R., Wong, P., Mbazaa, A.,
Bartagi, Z., & Amri, M. (2008). Lipid profiles of judo
athletes during Ramadan. International Journal of Sports
Medicine, 29, 282–288.
Cheah, H., Ch’ng, S. L., Husain, R., & Duncan, N. T. (1990).
Effects of fasting during Ramadan on urinary excretion in
Malaysian Muslims. British Journal of Nutrition, 63, 329–337.
Coyle, E. F., Coggan, A. R., Hemmert, M. K., Lowe, R. C., &
Walters, T. J. (1985). Substrate usage during prolonged
exercise following a preexercise meal. Journal of Applied
Physiology, 59, 429–433.
Department of Health. (1991). Dietary reference values for food
energy and nutrients for the United Kingdom. Report on Health
and Social Subjects #41. London: HMSO.
Durnin, J. V. A., & Womersley, J. (1974). Body fat assessed from
total body density and its estimation from skinfold thickness:
Measurements on 481 men and women aged from 16 to 72
years. British Journal of Nutrition, 32, 77–97.
El Ati, J., Beji, C., & Danguir, J. (1995). Increased fat oxidation
during Ramadan fasting in healthy women: An adaptive
mechanism for body-weight maintenance. American Journal of
Clinical Nutrition, 62, 302–307.
Fedail, S. S., Murphy, D., Salih, S. Y., Bolton, H. C., &
Harvey, R. F. (1982). Changes in certain blood constituents
during Ramadan. American Journal of Clinical Nutrition, 36,
350–353.
Finch, G. M., Day, J. E. L., Welch, D. A., & Rogers, P. J. (1998).
Appetite changes under free-living conditions during Ramadan
fasting. Appetite, 31, 159–170.
Food Standards Agency. (2002). McCance and Widdowson’s the
composition of foods. Cambridge: Royal Society of Chemistry.
Frost, G., & Pirani, S. (1987). Meal frequency and nutritional
intake during Ramadan: A pilot study. Human Nutrition:
Applied Nutrition, 41A, 47–50.
Furuncuoglu, Y., Ender, K., Sükrü, A., & Arif, Y. (2007). Metabolic,
biochemical and psychiatric alterations in healthy subjects during
Ramadan. Pakistan Journal of Nutrition, 6, 209–211.
Gleeson, M., Greenhaff, P. L., & Maughan, R. J. (1988).
Influence of a 24-hour fast on high-intensity cycle exercise
performance in man. European Journal of Applied Physiology, 57,
653–659.
Hawley, J. A., Tipton, K. D., & Millard-Stafford, M. L. (2006).
Promoting training adaptations through nutritional interven-
tions. Journal of Sports Sciences, 24, 709–721.
Husain, R., Duncan, M. T., Cheah, S. H., & Ch’ng, S. L. (1987).
Effects of fasting in Ramadan on tropical Asiatic Moslems.
British Journal of Nutrition, 58, 41–48.
Institute of Medicine of the National Academies. (2005). Dietary
reference intakes for water, potassium, sodium, chloride, and sulfate.
Washington, DC: National Academies Press.
Karli, U., Guvenc, A., Aslan, A., Hazir, T., & Acicada, C. (2007).
Influence of Ramadan fasting on anaerobic performance and
recovery following short time high intensity exercise. Journal of
Sports Science and Medicine, 6, 490–497.
 S38 R. J. Maughan et al.
Khan, A., & Khattak, A. M. A. K. (2002). Islamic fasting: An
effective strategy for prevention and control of obesity. Pakistan
Journal of Nutrition, 1, 185–187.
Kirkendall, D. T., Leiper, J. B., Bartagi, Z., Dvorak, J., &
Zerguini, Y. (2008). The influence of Ramadan on physical
performance measures in young Muslim footballers. Journal of
Sports Sciences, 26(suppl. 3), S15–S27.
Leiper, J. B., Carnie, A., & Maughan, R. J. (1996). Water turnover
rates in sedentary and exercising middle-aged men. British
Journal of Sports Medicine, 30, 24–26.
Leiper, J. B., Maughan, R. J., Kirkendall, D. T., Bartagi, Z.,
Zerguini, Y., Junge, A., & Dvorak, J. (2008). The F-MARC
study on Ramadan and football: Research design, population,
and environmental conditions. Journal of Sports Sciences,
26(suppl. 3), S7–S13.
Leiper, J. B., Molla, A. M., & Molla, A. M. (2003). Effects on
health of fluid restriction during fasting in Ramadan. European
Journal of Clinical Nutrition, 57(suppl. 2), S30–S38.
Lemon, P. (1994). Protein requirements of soccer. Journal of
Sports Sciences, 12, S17–S22.
Downloaded By: [Canadian Research Knowledge Network] At: 17:23 31 July 2010
Maislos, M., Khamaysi, N., & Assali, A. (1993). Marked increase
in plasma high density lipoprotein cholesterol after prolonged
fasting during Ramadan. American Journal of Clinical Nutrition,
57, 640–642.
Maughan, R. J. (1997). Energy and macronutrient intakes of
professional football (soccer) players. British Journal of Sports
Medicine, 31, 45–47.
Maughan, R. J., & Gleeson, M. (1988). Influence of a 36-hour fast
followed by refeeding with glucose, glycerol or placebo on
metabolism and performance during prolonged exercise in
man. European Journal of Applied Physiology, 57, 570–576.
Maughan, R. J., & Shirreffs, S. M. (2004). Exercise in the heat:
Challenges and opportunities. Journal of Sports Sciences, 22,
917–927.
Meckel, Y., Ismaeel, A., & Eliakim, A. (2008). The effects of the
Ramadan fast on physical performance and dietary habits in
adolescent soccer players. European Journal of Applied Physiol-
ogy, 102, 651–657.
Noakes, T. D. (2007). Hydration in the marathon: Using thirst to
gauge safe fluid replacement. Sports Medicine, 37, 463–466.
Panel on Micronutrients (2001). Dietary reference intakes for vitamin
A, vitamin K, arsenic, boron, chromium, copper, iodine, iron,
manganese, molybdenum, nickel, silicon, vanadium, and zinc.
Subcommittees on Upper Reference Intakes of Nutrients and
of Interpretation and the Uses of Dietary Reference Intakes,
and the Standing Committee on the Scientific Evaluation of
Dietary Reference Intakes. Washington, DC: National Acade-
mies Press (accessed at: http://www.nap.edu).
Ramadan, J. (2002). Does fasting during Ramadan alter body
composition, blood constituents and physical performance?
Medical Principles and Practice, 11(suppl. 2), 41–46.
Ramadan, J., Telahoun, G., Al-Zaid, N. S., & Barac-Nieto, M.
(1999). Responses to exercise, fluid, and energy balances
during Ramadan in sedentary and active males. Nutrition, 15,
735–739.
Rico-Sanz, J., Frontera, W. R., Mole, P. A., Rivera, M. A., Rivera-
Brown, A., & Meredith, C. N. (1998). Dietary and perfor-
mance assessment of elite soccer players during a period of
intense training. International Journal of Sport Nutrition, 8, 230–
240.
Sawka, M. N., Burke, L. M., Eichner, E. R., Maughan, R. J.,
Montain, S. J., & Stachenfeld, N. S. (2007). Exercise and fluid
replacement. Medicine and Science in Sports and Exercise, 39,
377–390.
Scientific Advisory Committee on Nutrition. (2003). Salt and
health. London: Department of Health.
Shirreffs, S. M., & Maughan, R. J. (2008). Water and salt balance
in young male football players in training during the holy month
of Ramadan. Journal of Sports Sciences, 26(suppl. 3), S47–S54.
Shirreffs, S. M., Sawka, M. A., & Stone, M. (2006). Water and
electrolyte needs for football training and match-play. Journal of
Sports Sciences, 24, 699–707.
Sulemani, R. A. (1988). The effects of Ramadan fasting on thyroid
functions in healthy male subjects. Nutrition Research, 8, 549–
552.
Sweileh, N., Schnitzler, A., Hunter, G. R., & Davis, B. (1992).
Body composition and energy metabolism in resting and
exercising Muslims during Ramadan Fast. Journal of Sports
Medicine and Physical Fitness, 32, 156–163.
Tarnopolsky, M. (2004). Protein requirements for endurance
athletes. Nutrition, 20, 662–668.
Tipton, K. D., Rasmussen, B. R., Miller, S. L., Wolf, S. E.,
Owens-Stovall, S. K., Petrini, B. E. et al. (2001). Timing of
amino acid–carbohydrate ingestion alters anabolic response of
muscle to resistance exercise. American Journal of Physiology:
Endocrinology and Metabolism, 281, E197–E206.
Tipton, K. D., & Witard, O. C. (2007). Protein requirements and
recommendations for athletes: Relevance of ivory tower
arguments for practical recommendations. Clinics in Sports
Medicine, 26, 17–36.
Tolon, M., & Chernoff, H. (2006). The effect of fasting during
Ramadan on automobile accidents in Turkey (accessed at:
http://micro5.mscc.huji.ac.il/*statconf/abstracts/chernoff.pdf).
Yucel, A., Degirmenci, B., Acar, M., Albayrak, R., & Haktanir, A.
(2004). The effect of fasting month or Ramadan on the
abdominal fat distribution: Assessment by computed tomogra-
phy. Tohoku Journal of Experimental Medicine, 204, 179–187.
Ziaee, V., Razaei, M., Ahmadinejad, Z., Shaikh, H., Yousefi, R.,
Yarmohammadi, L. et al. (1996). The changes of metabolic
profile and weight during Ramadan fasting. Singapore Medical
Journal, 47, 409–414.