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

Moien A B Khan 1, Ahmed S BaHammam 2, Asma Amanatullah 3, Khaled Obaideen 4, Teresa Arora 5, Habiba Ali 1, Leila Cheikh Ismail 6, Dana N Abdelrahim 7, Mohammed Al-Houqani 8, Kholoud Allaham 9, Rand Abdalrazeq 10, Wahid Sharif Aloweiwi 11, Somayea Sultana Mim 12, Ammar Mektebi 13, Sohrab Amiri 14, Sahabi Kabir Sulaiman 15, Syed Fahad Javaid 16, Mohammad Delwer Hossain Hawlader 17, Fatimah Isma'il Tsiga-Ahmed 18, Iffat Elbarazi 19, Saskiyanto Manggabarani 20, Gamechu Atomsa Hunde 21, Sabrina Chelli 22, Mitra Sotoudeh 23, MoezAlIslam Ezzat Faris 6; Ramadan Intermittent Fasting Collaborators

Affiliations

08 March 2023

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doi: 10.3389/fnut.2023.1040355

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.

Keywords: Ramadan; diet; fasting; intermittent fasting; lifestyle and behavior; sleep.

Figures

FIGURE 1 Worldmap showing the number of participants using color density for the 27 participating countries.

FIGURE 1 Worldmap showing the number of participants using color density for the 27 participating countries.

FIGURE 2 Sociodemographic characteristics of the 24,500 study participants.

FIGURE 2 Sociodemographic characteristics of the 24,500 study participants.

FIGURE 3 Structural equation modeling (SEM) for the relationships between sleep components and the dietary and lifestyle behaviors during Ramadan fasting month among the 24,500 study participants.

FIGURE 3 Structural equation modeling (SEM) for the relationships between sleep components and the dietary and lifestyle behaviors during Ramadan fasting month among the 24,500 study participants.

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References

  1.  
    1. World Population Review. Muslim Population by Country. (2022). Available online at: https://worldpopulationreview.com/
  2.  
    1. Abdelrahim D, Faris ME, Hassanein M, Shakir AZ, Yusuf AM, Almeneessier AS, et al. Impact of Ramadan diurnal intermittent fasting on hypoglycemic events in patients with type 2 diabetes: a systematic review of randomized controlled trials and observational studies. Front Endocrinol (Lausanne). (2021) 12:624423. 10.3389/fendo.2021.624423 - DOI - PMC - PubMed
  3.  
    1. Osman F, Haldar S, Henry CJ. Effects of time-restricted feeding during Ramadan on dietary intake, body composition and metabolic outcomes. Nutrients. (2020) 12:2478. 10.3390/nu12082478 - DOI - PMC - PubMed
  4.  
    1. Sakr AH. Fasting in Islam. J Am Diet Assoc. (1975) 67:17–21. 10.1016/S0002-8223(21)14634-6 - DOI - PubMed
  5.  
    1. Ismail S, Manaf RA, Mahmud A. Comparison of time-restricted feeding and Islamic fasting: a scoping review. East Mediterr Health J. (2019) 25:239–45. 10.26719/emhj.19.011 - DOI - PubMed
  6.  
    1. De Cabo R, Mattson MP. Effects of intermittent fasting on health, aging, and disease. N Engl J Med. (2019) 381:2541–51. 10.1056/NEJMra1905136 - DOI - PubMed
  7.  
    1. Patterson RE, Sears DD. Metabolic effects of intermittent fasting. Annu Rev Nutr. (2017) 37:371–93. 10.1146/annurev-nutr-071816-064634 - DOI - PubMed
  8.  
    1. Obaideen K, Abu Shihab KH, Madkour MI, Faris ME. Seven decades of Ramadan intermittent fasting research: bibliometrics analysis, global trends, and future directions. Diabetes Metab Syndr Clin Res Rev. (2022) 16:102566. 10.1016/j.dsx.2022.102566 - DOI - PubMed
  9.  
    1. Faris M, Jahrami HA, Alsibai J, Obaideen AA. Impact of Ramadan diurnal intermittent fasting on metabolic syndrome components in healthy, non-athletic Muslim people aged over 15 years: a systematic review and meta-analysis. Br J Nutr. (2019) 123:1–51. 10.1017/S000711451900254X - DOI - PubMed
  10.  
    1. Jahrami HA, Alsibai J, Clark CC, Faris ME. A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on body weight in healthy subjects aged 16 years and above. Eur J Nutr. (2020) 59:2291–316. 10.1007/s00394-020-02216-1 - DOI - PubMed
  11.  
    1. Fernando H, Zibellini J, Harris R, Seimon R, Sainsbury A. Effect of Ramadan fasting on weight and body composition in healthy non-athlete adults: a systematic review and meta-analysis. Nutrients. (2019) 11:478. 10.3390/nu11020478 - DOI - PMC - PubMed
  12.  
    1. Faris M, Madkour MI, Obaideen AK, Dalah EZ, Hasan HA, Radwan HM, et al. Effect of Ramadan diurnal fasting on visceral adiposity and serum adipokines in overweight and obese individuals. Diabetes Res Clin Pract. (2019) 153:166–75. 10.1016/j.diabres.2019.05.023 - DOI - PubMed
  13.  
    1. Faris M, Jahrami HA, Obaideen AA, Madkour MI. Impact of diurnal intermittent fasting during Ramadan on inflammatory and oxidative stress markers in healthy people: systematic review and meta-analysis. J Nutr Intermed Metab. (2019) 15:18–26. 10.1016/j.jnim.2018.11.005 - DOI
  14.  
    1. Faris M, Jahrami H, BaHammam A, Kalaji Z, Madkour M, Hassanein M. A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on glucometabolic markers in healthy subjects. Diabetes Res Clin Pract. (2020) 165:108226. - PubMed
  15.  
    1. Faris M, Jahrami H, Abdelrahim D, Bragazzi N, BaHammam A. The effects of Ramadan intermittent fasting on liver function in healthy adults: a systematic review, meta-analysis, and meta-regression. Diabetes Res Clin Pract. (2021) 178:108951. 10.1016/j.diabres.2021.108951 - DOI - PubMed
  16.  
    1. Al-Rawi N, Madkour M, Jahrami H, Salahat D, Alhasan F, BaHammam A, et al. Effect of diurnal intermittent fasting during Ramadan on ghrelin, leptin, melatonin, and cortisol levels among overweight and obese subjects: a prospective observational study. PLoS One. (2020) 15:e0237922. 10.1371/journal.pone.0237922 - DOI - PMC - PubMed
  17.  
    1. Almeneessier AS, Bahammam AS, Sharif MM, Bahammam SA, Nashwan SZ, Perumal SRP, et al. The influence of intermittent fasting on the circadian pattern of melatonin while controlling for caloric intake, energy expenditure, light exposure, and sleep schedules: a preliminary report. Ann Thorac Med. (2017) 12:183. 10.4103/atm.ATM_15_17 - DOI - PMC - PubMed
  18.  
    1. Jahrami H, BaHammam A, Kalaji Z, Madkour M, Hassanein M. A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on glucometabolic markers in healthy subjects. Diabetes Res Clin Pract. (2020) 165:108226. - PubMed
  19.  
    1. Qasrawi SO, Pandi-Perumal SR, BaHammam AS. The effect of intermittent fasting during Ramadan on sleep, sleepiness, cognitive function, and circadian rhythm. Sleep Breath. (2017) 21:577–86. 10.1007/s11325-017-1473-x - DOI - PubMed
  20.  
    1. Faris ME, Jahrami HA, Alhayki FA, Alkhawaja NA, Ali AM, Aljeeb SH, et al. Effect of diurnal fasting on sleep during Ramadan: a systematic review and meta-analysis. Sleep Breath. (2020) 24:771–82. 10.1007/s11325-019-01986-1 - DOI - PubMed
  21.  
    1. Shatila H, Baroudi M, Ahmad RES, Chehab R, Forman MR, Abbas N, et al. Impact of Ramadan fasting on dietary intakes among healthy adults: a year-round comparative study. Front Nutr. (2021) 8:689788. 10.3389/fnut.2021.689788 - DOI - PMC - PubMed
  22.  
    1. Chattu VK, Sakhamuri SM, Kumar R, Spence DW, BaHammam AS, Pandi-Perumal SR. Insufficient sleep syndrome: is it time to classify it as a major noncommunicable disease? Sleep Sci. (2018) 11:56–64. 10.5935/1984-0063.20180013 - DOI - PMC - PubMed
  23.  
    1. Almeneessier AS, Pandi-Perumal SR, BaHammam AS. Intermittent fasting, insufficient sleep, and circadian rhythm: interaction and effects on the cardiometabolic system. Curr Sleep Medicine Rep. (2018) 4:179–95. 10.1007/s40675-018-0124-5 - DOI
  24.  
    1. Faris ME, Vitiello MV, Abdelrahim DN, Cheikh Ismail L, Jahrami HA, Khaleel S, et al. Eating habits are associated with subjective sleep quality outcomes among university students: findings of a cross-sectional study. Sleep Breath. (2022) 26:1365–76. 10.1007/s11325-021-02506-w - DOI - PubMed
  25.  
    1. Masaad AA, Yusuf AM, Shakir AZ, Khan MS, Khaleel S, Cheikh Ismail L, et al. Sleep quality and dietary inflammatory index among university students: a cross-sectional study. Sleep Breath. (2021) 25:2221–9. 10.1007/s11325-020-02169-z - DOI - PubMed
  26.  
    1. Chaabane S, Chaabna K, Abraham A, Mamtani R, Cheema S. Physical activity and sedentary behaviour in the middle east and North Africa: an overview of systematic reviews and meta-analysis. Sci Rep. (2020) 10:1–24. 10.1038/s41598-020-66163-x - DOI - PMC - PubMed
  27.  
    1. Romdhani M, Rae DE, Nédélec M, Ammar A, Chtourou H, Al Horani R, et al. COVID-19 lockdowns: a worldwide survey of circadian rhythms and sleep quality in 3911 athletes from 49 countries, with data-driven recommendations. Sports Med. (2022) 52:1433–48. 10.1007/s40279-021-01601-y - DOI - PMC - PubMed
  28.  
    1. Peltzer K, Pengpid S. Sleep duration, sleep quality, body mass index, and waist circumference among young adults from 24 low-and middle-income and two high-income countries. Int J Environ Res Public Health. (2017) 14:566. 10.3390/ijerph14060566 - DOI - PMC - PubMed
  29.  
    1. Azizi F, Hadaegh F, Hosseinpanah F, Mirmiran P, Amouzegar A, Abdi H, et al. Metabolic health in the middle east and North Africa. Lancet Diabetes Endocrinol. (2019) 7:866–79. 10.1016/S2213-8587(19)30179-2 - DOI - PubMed
  30.  
    1. Trabelsi K, Ammar A, Masmoudi L, Boukhris O, Chtourou H, Bouaziz B, et al. Sleep quality and physical activity as predictors of mental wellbeing variance in older adults during COVID-19 lockdown: ECLB COVID-19 international online survey. Int J Environ Res Public Health. (2021) 18:4329. 10.3390/ijerph18084329 - DOI - PMC - PubMed
  31.  
    1. Trabelsi K, Ammar A, Masmoudi L, Boukhris O, Chtourou H, Bouaziz B, et al. Globally altered sleep patterns and physical activity levels by confinement in 5056 individuals: ECLB COVID-19 international online survey. Biol Sport. (2021) 38:495–506. 10.5114/biolsport.2021.101605 - DOI - PMC - PubMed
  32.  
    1. Sibai AM, Nasreddine L, Mokdad AH, Adra N, Tabet M, Hwalla N. Nutrition transition and cardiovascular disease risk factors in middle east and North Africa countries: reviewing the evidence. Ann Nutr Metab. (2010) 57:193–203. 10.1159/000321527 - DOI - PubMed
  33.  
    1. Gilbert PA, Khokhar S. Changing dietary habits of ethnic groups in Europe and implications for health. Nutr Rev. (2008) 66:203–15. 10.1111/j.1753-4887.2008.00025.x - DOI - PubMed
  34.  
    1. Ismail LC, Osaili TM, Mohamad MN, Al Marzouqi A, Jarrar AH, Zampelas A, et al. Assessment of eating habits and lifestyle during the coronavirus 2019 pandemic in the middle east and North Africa region: a cross-sectional study. Br J Nutr. (2021) 126:757–66. 10.1017/S0007114520004547 - DOI - PMC - PubMed
  35.  
    1. World Medical Association. Declaration of Helsinki. Ethical principles for medical research involving human subjects. Jahrb Für Wiss Und Ethik. (2009) 14:233–8. 10.1515/9783110208856.233 - DOI
  36.  
    1. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health. (2005) 8:94–104. 10.1111/j.1524-4733.2005.04054.x - DOI - PubMed
  37.  
    1. Masjedi MR, Ainy E, Zayeri F, Paydar R. Cigarette and hookah smoking in adolescent students using world health organization questionnaire global youth tobacco survey (GYTS): a pilot study in Varamin City, Iran in 2016. Asian Pac J Cancer Prev. (2020) 21:3033–7. 10.31557/APJCP.2020.21.10.3033 - DOI - PMC - PubMed
  38.  
    1. World Health Organization. Global Youth Tobacco Survey (GYTS), Bhutan Report, 2013. Geneva: World Health Organization; (2015).
  39.  
    1. Deschasaux-Tanguy M, Druesne-Pecollo N, Esseddik Y, De Edelenyi FS, Allès B, Andreeva VA, et al. Diet and physical activity during the coronavirus disease 2019 (COVID-19) lockdown (March–May 2020): results from the French nutrinet-santé cohort study. Am J Clin Nutr. (2021) 113:924–38. 10.1093/ajcn/nqaa336 - DOI - PMC - PubMed
  40.  
    1. Osler M, Heitmann B. The validity of a short food frequency questionnaire and its ability to measure changes in food intake: a longitudinal study. Int J Epidemiol. (1996) 25:1023–9. 10.1093/ije/25.5.1023 - DOI - PubMed
  41.  
    1. Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the international physical activity questionnaire short form (IPAQ-SF): a systematic review. Int J Behav Nutr Phys Act. (2011) 8:115. 10.1186/1479-5868-8-115 - DOI - PMC - PubMed
  42.  
    1. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen psychosocial questionnaire. Scand J Public Health. (2010) 38:8–24. 10.1177/1403494809349858 - DOI - PubMed
  43.  
    1. World Health Organization. Body Mass Index–BMI. Geneva: World Health Organization; (2022).
  44.  
    1. Rose S. The growing Size and Incomes of the Upper Middle Class. (Vol. 21). Washington, DC: Urban Institute; (2016). p. 10
  45.  
    1. Centers for Disease Control and Prevention Government Agency. Sleep and Sleep Disorders/How Much Sleep Do I Need?. Atlanta, GA: Centers for Disease Control and Prevention Government Agency; (2022).
  46.  
    1. Panel CC, Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American academy of sleep medicine and sleep research society. J Clin Sleep Med. (2015) 11:591–2. 10.5664/jcsm.4758 - DOI - PMC - PubMed
  47.  
    1. Beran TN, Violato C. Structural equation modeling in medical research: a primer. BMC Res Notes. (2010) 3:267. 10.1186/1756-0500-3-267 - DOI - PMC - PubMed
  48.  
    1. Fan Y, Chen J, Shirkey G, John R, Wu SR, Park H, et al. Applications of structural equation modeling (SEM) in ecological studies: an updated review. Ecol Processes. (2016) 5:19. 10.1186/s13717-016-0063-3 - DOI
  49.  
    1. Ringle CM, Wende S, Becker JM. SmartPLS. Boenningstedt: SmartPLS GmbH; (2015).
  50.  
    1. David Garson G. Partial Least Squares: Regression & Structural Equation Models. Raleigh, NC: Statistical Publishing Associates; (2016).
  51.  
    1. Henseler J, Ringle CM, Sarstedt M. A new criterion for assessing discriminant validity in variance-based structural equation modeling. J Acad Mark Sci. (2015) 43:115–35. 10.1007/s11747-014-0403-8 - DOI
  52.  
    1. Hair JF, Jr, Hult GTM, Ringle CM, Sarstedt M. A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM). Thousand Oaks, CA: Sage publications; (2021). 10.1007/978-3-030-80519-7 - DOI
  53.  
    1. Naja F, Hasan H, Khadem SH, Buanq MA, Al-Mulla HK, Aljassmi AK, et al. Adherence to the Mediterranean diet and its association with sleep quality and chronotype among youth: a cross-sectional study. Front Nutr. (2022) 8:805955. 10.3389/fnut.2021.805955 - DOI - PMC - PubMed
  54.  
    1. Brar K, Minaker LM. Geographic reach and nutritional quality of foods available from mobile online food delivery service applications: novel opportunities for retail food environment surveillance. BMC Public Health. (2021) 21:458. 10.1186/s12889-021-10489-2 - DOI - PMC - PubMed
  55.  
    1. Lachat C, Nago E, Verstraeten R, Roberfroid D, Van Camp J, Kolsteren P. Eating out of home and its association with dietary intake: a systematic review of the evidence. Obes Rev. (2012) 13:329–46. 10.1111/j.1467-789X.2011.00953.x - DOI - PubMed
  56.  
    1. Jaworowska A, Blackham T, Davies IG, Stevenson L. Nutritional challenges and health implications of takeaway and fast food. Nutr Rev. (2013) 71:310–8. 10.1111/nure.12031 - DOI - PubMed
  57.  
    1. Min C, Kim H-J, Park I-S, Park B, Kim J-H, Sim S, et al. The association between sleep duration, sleep quality, and food consumption in adolescents: a cross-sectional study using the Korea youth risk behavior web-based survey. BMJ Open. (2018) 8:e022848. 10.1136/bmjopen-2018-022848 - DOI - PMC - PubMed
  58.  
    1. Cao M, Zhu Y, Sun F, Luo J, Jing J. Short sleep duration is associated with specific food intake increase among school-aged children in China: a national cross-sectional study. BMC Public Health. (2019) 19:558. 10.1186/s12889-019-6739-8 - DOI - PMC - PubMed
  59.  
    1. Hever J, Cronise RJ. Plant-based nutrition for healthcare professionals: implementing diet as a primary modality in the prevention and treatment of chronic disease. J Geriatr Cardiol. (2017) 14:355–68. - PMC - PubMed
  60.  
    1. Zuraikat FM, Makarem N, St-Onge M-P, Xi H, Akkapeddi A, Aggarwal B. A Mediterranean dietary pattern predicts better sleep quality in US women from the American heart association go red for women strategically focused research network. Nutrients. (2020) 12:2830. 10.3390/nu12092830 - DOI - PMC - PubMed
  61.  
    1. St-Onge M-P, Mikic A, Pietrolungo CE. Effects of diet on sleep quality. Adv Nutr. (2016) 7:938–49. 10.3945/an.116.012336 - DOI - PMC - PubMed
  62.  
    1. Chiu Y-L, Chuang Y-F, Fang K-C, Liu S-K, Chen H-Y, Yang J-Y, et al. Higher systemic inflammation is associated with poorer sleep quality in stable haemodialysis patients. Nephrol Dial Transplant. (2009) 24:247–51. 10.1093/ndt/gfn439 - DOI - PubMed
  63.  
    1. D’Antono B, Bouchard V. Impaired sleep quality is associated with concurrent elevations in inflammatory markers: are post-menopausal women at greater risk? Biol Sex Differ. (2019) 10:34. 10.1186/s13293-019-0250-x - DOI - PMC - PubMed
  64.  
    1. Dzierzewski JM, Donovan EK, Kay DB, Sannes TS, Bradbrook KE. Sleep inconsistency and markers of inflammation. Front Neurol. (2020) 11:1042. 10.3389/fneur.2020.01042 - DOI - PMC - PubMed
  65.  
    1. Banno M, Harada Y, Taniguchi M, Tobita R, Tsujimoto H, Tsujimoto Y, et al. Exercise can improve sleep quality: a systematic review and meta-analysis. PeerJ. (2018) 6:e5172. 10.7717/peerj.5172 - DOI - PMC - PubMed
  66.  
    1. Wang F, Boros S. The effect of physical activity on sleep quality: a systematic review. Eur J Physiother. (2021) 23:11–8. 10.1080/21679169.2019.1623314 - DOI
  67.  
    1. Flynn MG, McFarlin BK, Markofski MM. State of the art reviews: the anti-inflammatory actions of exercise training. Am J Lifestyle Med. (2007) 1:220–35. 10.1177/1559827607300283 - DOI - PMC - PubMed
  68.  
    1. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. (2012) 2:1143. 10.1002/cphy.c110025 - DOI - PMC - PubMed
  69.  
    1. Ammar K, Hermassi S, Kolahi A, Mansournia MA, Jahrami H, Boukhris O, et al. Global disease burden attributed to low physical activity in 204 countries and territories from 1990 to 2019: insights from the global burden of disease 2019 study. Biol Sport. (2023) 40:835–55. 10.5114/biolsport.2023.121322 - DOI
  70.  
    1. Liao Y, Xie L, Chen X, Kelly BC, Qi C, Pan C, et al. Sleep quality in cigarette smokers and nonsmokers: findings from the general population in central China. BMC Public Health. (2019) 19:808. 10.1186/s12889-019-6929-4 - DOI - PMC - PubMed
  71.  
    1. Sabanayagam C, Shankar A. The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep. Sleep Med. (2011) 12:7–11. 10.1016/j.sleep.2010.09.002 - DOI - PMC - PubMed
  72.  
    1. Elisia I, Lam V, Cho B, Hay M, Li MY, Yeung M, et al. The effect of smoking on chronic inflammation, immune function and blood cell composition. Sci Rep. (2020) 10:1–16. 10.1038/s41598-020-76556-7 - DOI - PMC - PubMed
  73.  
    1. Lee J, Taneja V, Vassallo R. Cigarette smoking and inflammation: cellular and molecular mechanisms. J Dent Res. (2012) 91:142–9. 10.1177/0022034511421200 - DOI - PMC - PubMed
  74.  
    1. Zaidalkilani AT, Alhaj OA, Serag El-Dine MF, Fekih-Romdhane F, AlRasheed MM, Jahrami HA, et al. Arab Women adherence to the Mediterranean diet and insomnia. Medicina. (2021) 58:17. 10.3390/medicina58010017 - DOI - PMC - PubMed
  75.  
    1. Kim E-K, Kim H, Vijayakumar A, Kwon O, Chang N. Associations between fruit and vegetable, and antioxidant nutrient intake and age-related macular degeneration by smoking status in elderly Korean men. Nutr J. (2017) 16:1–9. 10.1186/s12937-017-0301-2 - DOI - PMC - PubMed
  76.  
    1. Astori E, Garavaglia ML, Colombo G, Landoni L, Portinaro NM, Milzani A, et al. Antioxidants in smokers. Nutr Res Rev. (2022) 35:70–97. 10.1017/S0954422421000093 - DOI - PubMed
  77.  
    1. Myles IA. Fast food fever: reviewing the impacts of the western diet on immunity. Nutr J. (2014) 13:1–17. 10.1186/1475-2891-13-61 - DOI - PMC - PubMed
  78.  
    1. D’Angelo S, Motti ML, Meccariello R. ω-3 and ω-6 polyunsaturated fatty acids, obesity and cancer. Nutrients. (2020) 12:2751. 10.3390/nu12092751 - DOI - PMC - PubMed
  79.  
    1. Rafique N, Al-Asoom LI, Alsunni AA, Saudagar FN, Almulhim L, Alkaltham G. Effects of mobile use on subjective sleep quality. Nat Sci Sleep. (2020) 12:357. 10.2147/NSS.S253375 - DOI - PMC - PubMed
  80.  
    1. Höhn C, Schmid SR, Plamberger CP, Bothe K, Angerer M, Gruber G, et al. Preliminary results: the impact of smartphone use and short-wavelength light during the evening on circadian rhythm, sleep and alertness. Clocks Sleep. (2021) 3:66–86. 10.3390/clockssleep3010005 - DOI - PMC - PubMed
  81.  
    1. Vandewalle G, Maquet P, Dijk DJ. Light as a modulator of cognitive brain function. Trends Cogn Sci. (2009) 13:429–38. 10.1016/j.tics.2009.07.004 - DOI - PubMed
  82.  
    1. Hannibal J, Christiansen AT, Heegaard S, Fahrenkrug J, Kiilgaard JF. Melanopsin expressing human retinal ganglion cells: subtypes, distribution, and intraretinal connectivity. J Comp Neurol. (2017) 525:1934–61. 10.1002/cne.24181 - DOI - PubMed
  83.  
    1. Zhan Y, Ma H, Feng Y, Wang Y, Wu S, Cai S, et al. Dietary patterns in relation to gestational depression and sleep disturbance in Chinese pregnant women. J Obstet Gynaecol Res. (2020) 46:2618–28. 10.1111/jog.14508 - DOI - PubMed
  84.  
    1. Segovia-Siapco G, Khayef G, Pribis P, Oda K, Haddad E, Sabaté J. Animal protein intake is associated with general adiposity in adolescents: the teen food and development study. Nutrients. (2019) 12:110. 10.3390/nu12010110 - DOI - PMC - PubMed
  85.  
    1. Macho-González A, Garcimartín A, López-Oliva ME, Bastida S, Benedí J, Ros G, et al. Can meat and meat-products induce oxidative stress? Antioxidants (Basel). (2020) 9:638. 10.3390/antiox9070638 - DOI - PMC - PubMed
  86.  
    1. Miller V, Reedy J, Cudhea F, Zhang J, Shi P, Erndt-Marino J, et al. Global, regional, and national consumption of animal-source foods between 1990 and 2018: findings from the global dietary database. Lancet Planet Health. (2022) 6:e243–56. - PMC - PubMed
  87.  
    1. Teodorowicz M, Hendriks WH, Wichers HJ, Savelkoul HFJ. Immunomodulation by processed animal feed: the role of maillard reaction products and advanced glycation end-products (AGEs). Front Immunol. (2018) 9:2088. 10.3389/fimmu.2018.02088 - DOI - PMC - PubMed
  88.  
    1. Lana A, Struijk EA, Arias-Fernandez L, Graciani A, Mesas AE, Rodriguez-Artalejo F, et al. Habitual meat consumption and changes in sleep duration and quality in older adults. Aging Dis. (2019) 10:267–77. 10.14336/AD.2018.0503 - DOI - PMC - PubMed
  89.  
    1. Bollen KA, Pearl J. Eight myths about causality and structural equation models. In: Morgan SL. editor. Handbook of Causal Analysis for Social Research. (New York, NY: Springer; ) (2013). p. 301–28. 10.1007/978-94-007-6094-3_15 - DOI
  90.  
    1. Washif J, Pyne DB, Sandbakk Ø, Trabelsi K, Aziz AR, Beaven C, et al. Ramadan intermittent fasting induced poorer training practices during the COVID-19 lockdown: a global cross-sectional study with 5529 athletes from 110 countries. Biol Sport. (2022) 39:1103–15. 10.5114/biolsport.2022.117576 - DOI - PMC - PubMed

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