The Relationship between Dietary Intake and Cognitive Performance Before and During Ramadan Fasting among Healthy Adult Population in Kuala Nerus, Terengganu

Abstract

Ramadan is the ninth month of the Islamic lunar calendar, during which healthy adolescents and adult Muslims fast from dawn to dusk for a month. During Ramadan fasting, dietary intake and cognitive performance changes can be seen related to many factors. This cross-sectional study aimed to determine the comparison between dietary intake and cognitive performance among healthy adult populations in Kuala Nerus before and during Ramadan fasting and the possible correlation between these parameters.   This study was conducted among a healthy adult population in Kuala Terengganu and mainly at University Sultan Zainal Abidin (UniSZA). Socio-demographics data, dietary data, and cognitive assessment were measured. Energy and macronutrient intakes were measured by using a three-day food record while cognitive performance was measured by using Stroop Color and Word Test (SCWT) and Trail-Making Test (TMT) through a face-to- face activity-based survey. All the measurements were taken in the two-time interval which is before Ramadan fasting (one to two weeks prior to Ramadan month) and during Ramadan fasting (week two to four of Ramadan Month)   A total of 113 participants with a mean age of 23.1 ± 4.9 years old were recruited in this cross-sectional study consisting of 23 males (20.4%) and 90 females (79.6%). The majority of the participants were Malay (97.3%), and still single (92.9%). Most of the participants also still pursuing their degrees (92%) and has no income (92%). Almost all of the participants were non-smokers (99.1%).   The dietary data shows that the energy intake was significantly reduced during Ramadan by 293.8 kcal compared to before Ramadan (p<0.001). Regarding macronutrients, a significant reduction in carbohydrates, protein, and fat was reported, p=0.003, p=0.011, and p<0.001 respectively. Next, the results of cognitive performances varied according to Stroop congruent and incongruent test; and Trail Making Test A and B. Stroop Congruent Test (word test) showed that the reaction time was significantly higher before Ramadan compared to during Ramadan (p<0.001), meanwhile the reaction time for Trail-making Test A and B showed that there were significantly lower before Ramadan compared to during Ramadan (p<0.001). But there were no significant differences in others' tests. In addition, the result for correlation showed that the reaction time for Trail Making B was significantly negatively correlated with energy intake (p=0.002) and protein intake (p=0.007) while positively correlated with fat intake (p=0.004). In conclusion, according to the results, most participants reported a decrease in their dietary intake during Ramadan, similar to what was observed in cognitive performance, with most participants reporting a slower reaction time during Ramadan. Hence, the consumption of sufficient energy is critical for good cognitive performance because diet can influence cognitive abilities.