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Eating habits, health attitudes and obesity indices among medical students in northern Greece

Eating habits, health attitudes and obesity indices among medical students in northern Greece

Eating habits, health attitudes and obesity indices among medical students in northern Greece

Social and psychological factors affecting eating habits among university students in a Malaysian medical school:a cross-sectional study

Kurubaran Ganasegeran 1,Sami AR Al-Dubai 1*,Ahmad M Qureshi 2,Al-abed AA Al-abed 3,Rizal AM 3and Syed M Aljunid 3,4

Background

Poor eating habits is a major public health concern among young adults who experienced transition into university life [1],during which,they are exposed to stress and lack of time [2,3].These factors pose a barrier against adoption of healthy behaviors,such as poor eat-ing habits and substance abuse [1].Although these beha-viors of students are considered temporary,as part of university life;unhealthy habits picked up at this age generally persist in older adult life [4].

Rapid changes in physical growth and psychosocial de-velopment have placed these young adults as nutritionally

vulnerable groups with poor eating habits,that fails to meet dietary requirements [5-7].Some common un-healthy eating patterns among young adults included meal skipping,eating away from home,snacking and fast food consumption [6,7].

Environmental factors also contribute to adoption of unhealthy eating habits among university students [8].The mushrooming of shopping malls,convenience stores,vending machines and fast food outlets have cre-ated an alarming situation for young adults to practice unhealthy eating habits [9].

University students tend to make their own food choices [10]based on cost of food and availability of fast food [11].They lack knowledge of healthy food choices that may affect eating habits and nutritional status negatively [11].Previous studies revealed that university

*Correspondence:samidobaie@http://www.wendangku.net/doc/bc465efe360cba1aa811da67.html 1

Department of Community Medicine,International Medical School,

Management and Science University (MSU),Off Persiaran Olahraga,Section 13,40100Shah Alam,Selangor,Malaysia

Full list of author information is available at the end of the

Eating habits, health attitudes and obesity indices among medical students in northern Greece

Eating habits, health attitudes and obesity indices among medical students in northern Greece

article

?2012Ganasegeran et al.;licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://www.wendangku.net/doc/bc465efe360cba1aa811da67.html/licenses/by/2.0),which permits unrestricted use,distribution,and reproduction in any medium,provided the original work is properly cited.

Ganasegeran et al.Nutrition Journal 2012,11:48http://www.wendangku.net/doc/bc465efe360cba1aa811da67.html/content/11/1/48

students failed to meet the recommended intakes of fruits and vegetables[12,13].University students had fre-quent snacking habits[14]and had a higher frequency of fast food consumption[15].

It has been assumed that medical students would prac-tice healthy dietary habits compared to non-medical stu-dents[16].Some studies have found otherwise.A previous study in China revealed that medical students exhibited early risk factors for chronic diseases due to poor eating habits[17].It was found that although med-ical students had sufficient knowledge regarding good dietary habits,they failed to apply this knowledge into practice[2].Stress of university life and medical study load would be factors that negatively influence their diet[18].

In2011,Gan et al.highlighted the presence of un-healthy eating behaviours and inadequate nutrient intake among university students[11].The study concluded that there was a need to promote healthy eating habits among young adults to achieve a healthy nutritional sta-tus.Chin&Nasir(2009)[5]revealed that meal skipping; particularly breakfast,snacking and various weight loss dietary behaviours were some of the unhealthy eating behaviours depicted by Malaysian adolescent girls.The study concluded that promotion of healthy eating was crucial for future health well-being.There was no study in Malaysia that investigated the relationship between eating habits and the psychological factors among uni-versity medical students.The current study is aimed at assessing the patterns of eating habit and its associated factors,with focus on psychological factors among med-ical students in a Malaysian university.

Methodology

Study setting and population

This cross-sectional study was conducted among140 medical students at a private university in Malaysia by using universal sampling.After arrangement with course co-coordinator and lecturers,students from the first year medical faculty were approached in the classroom after lectures.They were asked to participate in this study voluntarily.Objectives and benefits of the study were explained to respondents orally and in a written form attached to the questionnaire.They were assured that information obtained would be confidential and their participation would not affect their course progress.A written consent was obtained from those who agreed to participate.Approval of the study was obtained from the ethics committee of the University(approval number: JMS5/0182).

Study instruments

We used a self-administered questionnaire on eating habits which was adopted from previous published studies[14,15].The questionnaire consisted of three parts.The first part included questions on demographic data;such as age,gender,education level,marital status, ethnicity and living circumstances.Body mass index (BMI)and lifestyle;such as smoking,alcohol intake and exercise were also included in this part.The second part includes questions on eating habits and type of meals consumed(10items),such as frequency of meals,type of meal,vegetables and fruits consumption,daily water intake,consumption of fast food,etc.The third part included questions on psychological factors that influ-enced dietary habits of respondents.Questions were selected from the validated Compulsive Eating Scale (CES)[16]that was used to measure uncontrolled eating patterns among college students;items included in this study were:“eat because of feeling lonely”,“feel out of control when eating”,“eat so much until stomach hurts”,“eat because of feeling upset or nervous”,“eat because of feeling bored”and“eat because of feeling happy”.The response options were‘Yes’or‘No’.

Statistical analysis

The Statistical Package for Social Sciences(SPSS)version 16.0was used to analyse the data in this study.The BMI was calculated as weight in kilograms divided by height in square metres(kg/m2).In this study,based on the WHO BMI cut-offs for the Asian population,a BMI<18.5kg/m2 was categorised as underweight,18á5–22á9kg/m2as the normal range,23.0–27.4kg/m2as pre-obese,27.5–34.9kg/m2as obese Class I,35.0–39.9kg/m2as obese Class II and≥40kg/m2as obese Class III[19].To check for the validity of the Compulsive Eating Scale(CES) among the Malaysian population,an exploratory factor analysis was performed using principal component method with varimax rotation and Cronbach’s alpha was used to test the internal consistency of the scale.Each item of eating habits was scored(1)if the response was healthy or(0)if non healthy.All items were summed and the total score was obtained(minimum=0and maximum=10).Thus,a higher score on eating habits indicated better eating habits.Descriptive analysis was performed for all variables.Student t-test and ANOVA test were used to compare mean eating habits across socio-demographic variables.Test of normal distribu-tion of the total score of eating habits was also con-ducted.Hierarchical multivariate linear regression was used to obtain factors associated significantly with eat-ing habit score.Age,working status of mother,drink-ing alcohol,exercise and smoking status were entered in the first step.In the second step,five out of six psy-chological factors affecting eating behavior were en-tered.Multicollinearity was checked between independent variables.

Results

Socio-demographic characteristics

One hundred and thirty two out of140students partici-pated in this study with a response rate of94.0%.The majority was females(70.5%)and aged more than 22years(old61.4%).Most of them were Malays(61.4%) while Indians and Chinese constituted(of)31.8%and 2.3%respectively.Regarding mother’s education level, 44.7%had tertiary education,37.9%had high school or less and the rest had non-formal education(17.4%). Regarding father’s education,majority had tertiary edu-cation(51.5%),33.3%had high school or less and15.2% had non-formal education.The majority of mothers were not working(57.6%).The majority had an average monthly household income of RM3000or less(59.1%) and living with their families(64.4%).The majority had denied smoking(94.7%)and alcohol consumption(97%).

A lot of them performed regular exercise(78%),but some did not(22%).More than half(53%)had a normal BMI,22.7%were under weights,16.7%were pre-obese and7.6%were obese Class I(Table1).

Eating habits

More than half took meals and breakfast regularly (57.6%,56.1%respectively).About57.6%had snacks less than three times per week and42.4%took snacks three or more times per week.The majority consumed vegeta-bles and legumes three or more times per week(81.8%). Almost half of them(51.5%)consumed fruits less than three times per week;the rest(48.5%)took it three times or more.Many had fried food twice a week or more (73.5%),while26.2%took it less than two times.The majority(78.8%)had fast food rarely and took meals with family or friends daily(81.1%).Most of them had a balanced variety of foods(60.6%)while18.9%preferred meat and5.3%preferred vegetables.The majority had less than two liters water intake daily(59.8%)(Table2). Psychological factors affecting eating behavior Cronbach’s alpha coefficient of the Compulsive Eating Scale(CES)was0.80.The exploratory factor analyses yielded one factors with given values greater than1 (3.1).The two-factor solution accounted for51.0%of the variance.Factor loading ranged from0.41to0.50. Nearly48.5%ate because of feeling lonely,62.1%felt completely out of control when it comes to food,53.8% ate till stomach hurts,53%ate because of feeling upset or nervous and59.1%ate because of feeling bored.The majority ate because of feeling happy(80.3%)(Table3). Association between eating habits and socio-

demographic factors

Mean total score of eating habit for all the participant was 6.3(SD±1.8)and ranged from2to10.Mean with(SD)total score of eating habits was compared across the cat-egorical variables in the study.Mean for those aged ≥22years and those aged18–21years was6.68(SD±1.66) Table1Socio-demographic characteristics of respondents(n=132)

Characteristics N% Gender

Male3929.5 Female9370.5 Age

18-215138.6≥228161.4 Ethnicity

Malay8161.4 Chinese3 2.3 Indian4231.8 Others6 4.5 Mother’s education level

Non-formal education2317.4 High school or less5037.9 Tertiary education5944.7 Father’s education level

Non-formal education2015.2 High school or less4433.3 Tertiary education6851.5 Monthly household income(RM)

≤30007859.1 3001-49992216.7≥50003224.2 Living arrangement

Living alone4735.6 Living with family8564.4 Body Mass Index(BMI)*

Underweight(<18.5)3022.7 Normal(18.5–22.9)7053.0 Pre-obese(23.0-27.4)2216.7 Obese class I(27.5-34.9)107.6 Mother working

Yes5642.4 Smoking

Yes7 5.3 Alcohol

Yes4 3.0 Regular exercise

Yes10378 *BMI is calculated based on WHO criteria for Asian population.

and 5.86(SD ±1.87)respectively and this difference was significant (p =0.01).Significant difference in eating habits score was also found between smokers,4.86(SD ±1.57)and non smokers,6.45(SD ±1.76),(p =0.02)and between those who drank alcohol,4.25(SD ±2.06)and those who did not,6.43(SD ±1.74),(p =0.02).No significant associ-ation was found between eating habits and other socio-demographic factors (Table 4).

Association between eating habits and Psychological factors

Mean with (SD)of total score of eating habit was com-pared between those who answered ‘yes ’and those who answered ‘no ’on each item of the psychological factors.Mean total score of eating habit for those who ate when lonely was 5.95(SD ±1.78)and for those who did not was 6.75(SD ±1.70)(p =0.01).Mean for those ate till stomach hurt was 6.06(SD ±1.76),and for those who did not was 6.72(SD ±1.74)(p =0.03).Mean for those who ate when upset and those who did not was 6.07(SD ±1.75)and 6.69(SD ±1.77)respectively (p =0.04).Mean for those who ate when bored was 5.91(SD ±1.67)and for those who did not was 7.02(SD ±1.74)(p <0.01)(Table 5).

Factors associated with eating habits in the hierarchical multiple linear regression

Age,working status of mother,drinking alcohol,exercise and smoking status were entered in the first step.In the second step,the following factors were entered:“eat be-cause of feeling lonely ”,“feel out of control when eat-ing ”,“eat so much until stomach hurts ”,“eat because of feeling upset or nervous ”and “eat because of feeling happy ”.The results from the first step indicated that age was significantly associated with eating habits score (p =0.006).In the second step,factors associated with eating habits score were age (p =0.009),drinking alcohol (p =0.037)and eat because of feeling happy (p =0.009)(Table 6).The total model was significant (p <0.001)and accounted for 19%of the variance.There was no multi-collinearity between variables.

Table 2Eating habits among respondents (n =132)

Characteristics N

%

Regular meals Yes 7657.6No

56

42.4

Daily breakfast Yes 5843.9No

74

56.1

Frequency of daily meals Less than three times 7959.8Three or more times

53

40.2

Frequency of having snacks (per week)Less than three times 7657.6Three or more times

56

42.4

Weekly consumption of vegetables &legumes Less than three times 2418.2Three or more times

108

81.8

Weekly consumption of fruits Less than three times 6851.5Three or more times

64

48.5

Weekly consumption of fried food Less than twice 3526.5Twice or more

97

73.5

Consumption of fast food Often 2821.2Rarely

104

78.8

Meals with friends &family Daily 10781.1Not daily

25

18.9

Type of food consumed Mainly meat 2518.9Mainly vegetables 7 5.3Carbohydrate (rice,bread)2015.2Variety of food in balance 80

60.6

Water intake (liters/day)<27959.8≥2

53

40.2

Table 3Psychological factors affecting respondents eating habits among respondents (n =132)

Psychological factors Yes n (%)No n (%)Eat because of feeling lonely

64(48.5)68(51.5)Feel completely out of control when it comes to food 82(62.1)50(37.9)Eat so much until stomach hurts 71(53.8)61(46.2)Eat because of feeling upset or nervous 70(53.0)62(47.0)Eat because of feeling bored 78(59.1)54(40.9)Eat because of feeling happy

106(80.3)

26(19.7)

Discussion

In this study,more than half of respondents had meals regularly and40.2%had meals of at least three times per day.This finding was comparatively lower than that reported by a Chinese study in which83.6%of university students consumed regular meals,with79%of them took at least three times per day[17].Another study reported that61.4%of Lebanese university students had regular meals daily[14].

Regular breakfast consumption among medical students is important for sufficient energy intake to overcome fa-tigue due to busy(daily)learning schedule[20].In this study,less than half of respondents(43.9%)had breakfast daily.This finding was higher in comparison to a previous study[14]which found that31.8%of study population had breakfast daily.However,some studies from Malaysia found higher rates of daily breakfast consumption among Malay undergraduate students in Selangor(75.6%)[21] and female adolescents in Pahang(52.6%)[5].

The frequent consumption of snacks and light meals is a recognizable aspect of teenage food behavior[22].Sur-prisingly,our study found that only42.4%of respon-dents had snacking at least three times per week.This finding was comparatively lower than previous studies from different countries,which found greater proportion of Syrian adolescents(53.0%)and Lebanon students (53.2%)[14,23]consumed snacks regularly.

The majority of respondents in our study consumed vegetables and legumes frequently(81.8%).This finding was high in comparison to previous studies from China (47.9%)[17]and Bahrain(26.3%)[22].However,one study from Malaysia found that only19%of university students consumed vegetables more than three times per week[11].Our study also found that48.5%of respondents consumed fruits at least three times per week.Similar finding was reported by Yahia et al.,(2008) [14].It was reported that low intake of fruits and vegeta-bles is associated with several chronic diseases at adult-hood[24].Our study disclosed that majority of medical students were aware of this health risk.

The typical university student diet is usually high in fat[25].Students often select fast food due to its palat-ability,availability and convenience[14].Surprisingly, our study found that only21.2%of respondents con-sumed fast food often.Chin and Nasir,(2009)[5] reported that only4.7%of respondents visited fast food restaurants frequently.In contrast,Moy et al.,(2009) [12]reported that60-70%of primary school students were fond of fast food.However,our study also found that majority of respondents(73.5%)consumed fried food at least twice a week or more,which was in line with that found by a previous study[14].

Most of the respondents in this study(81.8%)had meals with their family or friends.This is comparatively higher to that found by a previous study in which42.7%of university students had meals with their families or peers[14]. Smoking and alcohol consumption were significantly associated with eating habit in this study.Similar find-ings were reported among Chinese university students [17].Our study also found a significant association be-tween age and eating habits.

Table4Association between eating habits score and categorical variables(n=132)

Categorical variable Mean(SD)p value Gender Male 6.28(1.82)

Female 6.40(1.77)0.73 Age18-21 5.86(1.87)

≥22 6.68(1.66)0.01 Ethnicity*Malay 6.31(1.81)

Chinese8.33(1.53)

Indian 6.33(1.75)

Others 6.33(1.51)0.29 Mother’s

education level*

Non-formal education 6.99(1.56)

High school or less 6.32(1.58)

Tertiary education 6.19(1.99)0.25 Father’s

education level*

Non-formal education7.05(1.76)

High school or less 6.32(1.68)

Tertiary education 6.19(1.99)0.16 Monthly

household income*

≤3000 6.36(1.71)

3001-4999 6.23(1.54)

≥5000 6.47(2.11)0.88 Living

arrangement

Alone 6.40(1.79)

With family 6.30(1.78)0.75 Mother

working

Yes 6.04(1.61)

No 6.61(1.87)0.07 Smoking Yes 4.86(1.57)

No 6.45(1.76)0.02 Alcohol Yes 4.25(2.06)

No 6.43(1.74)0.02 Regular

exercise

Yes 6.51(1.81)

No 5.86(1.60)0.09 Body Mass Index

(BMI)*

Underweight(<18.5) 6.23(1.57)

Normal(18.5–22.9) 6.47(1.90)

Pre-obese(23.0-27.4) 6.68(1.67)

Obese class I(27.5-34.9) 5.30(1.49)0.20 *One way ANOVA test was used to compare mean between categories.

Attending a university or college can be a stressful ex-perience for many college students [26].Previous studies found that behavioral consequences of stress may affect eating habits [27,28].People living in a stressful society tend to eat more as a way of coping with stress [26].A possible new innovation in this study was the association between eating habits and psychosocial factors among Malaysian medical students;eating habits score in this study was significantly lower among those who answered ‘yes ’on the following statements:“eat because of feeling lonely ”,“eat until stomach hurts ”,“eat because of feeling upset or nervous ”and “eat because of feeling bored ”.Kagan &Squires,(1984)[16]suggested that uncon-trolled eating patterns among college students could be due to compulsive eating behaviors.With the paradigm shift towards industrialization and cultural change glo-bally,information on healthy diet has become scarce in many developing and developed nations.The most vul-nerable group,being university students,have adopted unhealthy eating behaviors due to reduced availability,affordability and accessibility of healthy diet in university campuses and surrounding food outlets.This study exhibited multi-factorial causes affecting eating habits among Malaysian university students.Understanding the contexts of such multi-factorial causes may help healthy

food promotional activities by parents,university author-ities,food providers and health promotion officers.Results of this study may help to create a foundation for possible interventional programs on healthy eating habits promotions.Blended with different socio-cultural and psychological attributes across different regions,a unified healthy eating policy should be drafted,being po-tentially amalgamated and practiced in all regions in-cluding developing and developed nations.

Conclusion

In general,most of the students in this study had healthy eating habits except in frequency of meals,fruit con-sumption,water intake and consumption of fried food.Social and psychological factors were important deter-minants of eating habits among medical students.Nutri-tional education among medical students should be encouraged to promote healthier eating habits and life-styles,as well as adherence to the healthier traditional food.It is recommended that the scope of future research should be broadened to include a larger repre-sentative sample size of medical students by including students from different medical colleages from all Malaysia.

Table 6Results of the hierarchical multiple linear regression;factors associated with eating habits score (n =132)

Step 1

Step 2

B

Beta p value B Beta p value ≥22years old 0.6750.2380.0060.6290.2220.009Mother working 0.3440.0960.2640.2830.0790.349Drinking alcohol 1.5140.1460.139 2.0900.2020.037Exercise 0.6190.1450.0830.5460.1280.121Smoking

0.906

0.115

0.251

0.3940.0500.613Eat because of feeling lonely

0.2290.0650.478Eat because of feeling out of control when eating 0.5440.1490.096Eat so much until stomach hurts 0.4100.1150.199Eat because of feeling upset or nervous 0.0930.0260.778Eat because of feeling happy

0.931

.258

0.009

The reference group for age is ‘18-21years ’;for exercise is ‘no ’;for all other variables is ‘yes ’.

Table 5Association between eating habits score and psychological factors (n =132)

Psychological factors

Mean(SD)

Yes

No p value Eat because of feeling lonely

5.95(1.78)

6.75(1.70)0.01Feel completely out of control when it comes to food 6.32(1.85) 6.44(1.08)0.70Eat so much until stomach hurts 6.06(1.76) 6.72(1.74)0.03Eat because of feeling upset or nervous 6.07(1.75) 6.69(1.77)0.04Eat because of feeling bored 5.91(1.67)

7.02(1.74)<0.01Eat because of feeling happy

6.31(1.82)

6.58(1.63)

0.50

Abbreviations

CI:Confidence interval;OR:Odds ratio;CES:Compulsive Eating Scale;BMI:Body Mass Index;SD:Standard http://www.wendangku.net/doc/bc465efe360cba1aa811da67.htmlpeting interests

The authors have no competing interests to declare.

Acknowledgements

We would like to thank Fairuz Binti Yusoff (International Medical School,Management and Science University (MSU)for her participation in data collection.

Author details 1

Department of Community Medicine,International Medical School,

Management and Science University (MSU),Off Persiaran Olahraga,Section 13,40100Shah Alam,Selangor,Malaysia.2Community Medicine and Public Health,Cyberjaya University College of Medical Sciences,No.3410,Jalan Teknokrat 3,Cyber 4,63000Cyberjaya,Selangor,Malaysia.3Community Health Department,Faculty of Medicine,Universiti Kebangsaan Malaysia (UKM),Jalan Yaacob Latiff,56000Cheras,Kuala Lumpur,Malaysia.4United Nations University-International Institute for Global Health,Jalan Yaacob Latiff,56000Kuala Lumpur,Malaysia.

Authors ’contributions

SAR and KB designed the research study.AMQ and AAA conducted the data entry,data cleaning and descriptive analysis.SAR and KB were responsible for data analysis and interpretation of results.SAR,KB and AMQ wrote the paper.RAM and SMA revised the final draft critically for important intellectual content.All authors read and approved the final manuscript.Received:23April 2012Accepted:18July 2012Published:18July 2012

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