Ramadan Intermittent Fasting and Injury Epidemiology in Mid and Late Adolescent Elite Male Football Players: A Prospective Cohort Study of Incidence, Burden, Training Load, and Psychophysiological Well-Being.

This study investigated the influence of Ramadan fasting on injury incidence, training load, subjective well-being, postural control, and dietary intake in competitive mid- and late elite male adolescent football players across three study phases. A prospective observational cohort design was employed over 13 consecutive weeks in 101 elite male youth football players (U17, n = 56; U19, n = 22; U21, n = 23). Three phases were identified: Pre-Ramadan (Weeks 1-4), Ramadan (Weeks 5-8), and Post-Ramadan (Weeks 9-13). Weekly session-RPE training load, Hooper Index, anthropometrics, and 3-day dietary records were collected prospectively. Injury surveillance was conducted according to the UEFA guidelines. Forty-six players (45.5%) sustained ≥ 1 time-loss injury over 10.419.3 h of exposure. Injury incidence increased during Ramadan from 3.76 to 6.83/1.000 h (RR = 1.816, 95% CI: 0.904-3.651; + 81.6%), with injury burden doubling from 55.16 to 111.68 days/1.000 h (+102.5%). Perceived training load (+134.3 AU; χ2 = 106.77, p < 0.001; d = 1.79) and Hooper Index (+1.99 points; χ2 = 122.16, p < 0.001; d = 8.97) increased significantly. Muscular injuries represented 69.6% of Ramadan injuries, while osseous injuries occurred exclusively during Ramadan. Protein intake decreased (26.30%-23.01%; p < 0.001; d = 3.68), with increased carbohydrate contribution (49.36%-54.13%; p < 0.001). Ramadan intermittent fasting was associated with a clinically significant elevation in injury incidence and burden in mid- and late elite male adolescent football players, occurring concurrently with increased perceived training load, progressive psychophysiological deterioration, and reduced dietary protein intake. These findings underscore increased injury risk during Ramadan and the need for tailored prevention.