Ramadan Fasting: Physical and Performance Maintained, Health Challenged in Elite Adolescent Football

Abstract

Objectives: Adolescent Muslim athletes participating in elite sports during Ramadan Fasting (RF) face unique physiological and developmental challenges. This prospective cohort study aimed to observe the changes in body composition, hydration status, physiological performance, and hematological profiles in 20 elite Malaysian adolescent footballers (17.8 ± 0.8 years).  

Methods: Measurements were taken at four phases (two weeks before Ramadan, BRF-2; mid, 2^nd weeks of Ramadan, RF-2; late, 4^th weeks of Ramadan, RF-4; and two weeks after Ramadan, ARF-6) using dual-time-point (morning/evening) blood and urine sampling, bioelectrical impedance, skinfolds, and the Yo-Yo Intermittent Run (YYIR) test.

Results: Results showed that energy balance, body composition, and aerobic performance (YYIR distance and HRmax) were successfully maintained throughout RF (p>0.05). However, significant dynamic fluid shifts were observed: morning measurements showed hemodilution, while late-afternoon Urine Specific Gravity was significantly higher in RF-4, indicating daily hemoconcentration and dehydration stress. Furthermore, while red blood cells (RBC) and haemoglobin (HB) showed transient morning reductions during RF, the most critical finding was the delayed post-fasting reduction in Mean Cell Volume (MCV) and persistent low Hematocrit (HCT) at ARF-6.

Conclusions: These findings suggest that elite performance is preserved through strong physiological adaptation and effective energy intake, but the RF period induced a subclinical iron deficiency stress that manifested as microcytosis post-Ramadan. Coaches and medical staff must implement rigorous post-Ramadan nutritional and detailed hematological screening to safeguard the long-term health of adolescent footballers.