Qualified clinical dietitians were assigned to administer the questionnaires and perform anthropometric measurements. A standardized questionnaire-based face-to-face interview was conducted by the clinical dietitians for each participant. The questionnaire was composed of: (a) sociodemographic data such as age, sex, nationality, marital status, education level, occupation and medical history. (b) Anthropometric data such as height, weight, BMI, waist circumference hip circumference, Waist Hip Ratio (WHR), and Waist Height Ratio (WHtR) (c) Body composition such as fat mass, 0% fat mass, muscle mass, % muscle mass, fat free mass, 0% fat free mass and body water. Data related to anthropometry based on actual measurements, all these data were done over three stages of the study: Before, during and after Ramadan fasting.

Height was measured in centimeters using electronic height scale (SECA, Germany) while the patient was standing bare feet and with normal straight posture. Weight was measured in kilograms using a weight scale (SECA), (BMI) was calculated as the ratio of weight (kg) to the square of height (m). A person was considered obese if the BMI value was at least 30 kg/m2 and overweight if BMI was greater than 25 kg/m2 and less than 30 kg/m2. Waist Circumference (WC) was measured midway between the lower rib margin and the iliac crest. Body composition was determined based on actual measurements by a medical body composition Analyzer Seca mBCA514 (Germany) including Fat Mass (FM), Muscle Mass (MM), Fat Free Mass (FFM) and Total Body Water (TBW). The analysis was performed each time under standardized conditions i.e, 2 hours fasting and no intense physical exercise 12 hours prior to the test. Nutrient intake using 24-hour recall in the three stages of the study one week prior the study (Before-Ramadan), after two weeks of fasting (During- Ramadan) and one week later (after-Ramadan) through faceto- face interview with each participant. Food quantities were explained using household measurements (slice, plates, glass, spoons, cups, etc.) and food models to get the correct quantities of each food item consumed. All the food recalls were reviewed by clinical dieticians and nutrient analysis was carried out using My Net Diary 2019.

Data were entered and analyzed using SPSS version 21 (IBM Corp., Armonk, New York, USA). The nominal or ordinal variables were reported as proportions, and the numerical variables were reported as mean values and standard deviations or medians with minimum and maximum values. The numerical variables that were measured at, before, during and after Ramadan were compared using paired t tests for normal data distribution (parametric analysis). For the abnormal data distribution, the Wilcoxon test was used as the non-parametric analysis. Unpaired t tests, one-way Analysis of Variance (ANOVA) and repeated ANOVA were used for two independent, K-independent and K-dependent sample analyses, re¬spectively. Statistical significance was associated with a P value below 0.05.

With Regards,
Joseph Kent
Journal Manager
Journal of Clinical Nutrition & Dietetics