European Journal of Cardiovascular Medicine

It is popularly known and documented those dietary habits and nutrition plays important role in maintaining health and preventing diseases. Nutrition is the process by which food is assimilated and used for growth of body cells, development, synthesis of enzymes, production of energy, reproduction and source of energy required for optimal activities relating to maintenance of a sense of well-being. Inadequate nutrition however, can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduce productivity. A healthy human diet entails preparation of quality food and good storage system that preserve nutrients in the food from oxidation or leaching out and thereby reducing the risk of food borne illnesses (Iloabanafor, C 2017).

Unhealthy diets to humans can cause deficiency related diseases such as scurvy, blindness, anaemia, cretinism, or excessive health threatening nutrition conditions such as obesity and metabolic syndrome, and such common chronic systemic diseases which include cardiovascular diseases, diabetes and bone diseases.

In the context of a healthy lifestyle, nutrition plays an important role in the development of young people. Eating behavioural patterns developed as adolescents and young adults influence long-term behaviour and have a great impact on adult life [Hamulka, et.al 2018].

A college student’s diet is typically lacking in fruits, vegetables, and dairy products, and high in fat, sodium and sugar (Anding,et.al 2001; Brunt & Rhee, 2008). Many college students consume a diet that is limited in variety, which increases the likelihood of not meeting dietary recommendations and may play a role in weight gain resulting in obesity (Brunt & Rhee, 2008).An unhealthy diet and a low level of physical activity during university years predispose students to future health issues [Aljadani,et al 2013].

During their academic years, students experiment greater freedom of choice concerning their food choices, health-related behaviours, practicing sports, and shaping their ownlifestyle. Consequently, the transition to a new living environment, with busy schedules, unhealthy food offers, and the risk of skipping meals, is likely to change eating behaviours over time [Tanton, et al.2015 and El Ansari, et.al 2012]. The years spent in the college are a critical period for weight gain [Deliens, et.al2014] thus weight is strongly related to eating behaviours. An unhealthy diet and excessive contribute significantly to the energy intake and, consequently, can facilitate the student’s weight gain [Butler,et.al 2013).Knowledge about the importance of physical activity, healthy eating habits, and nutrition was found to be the keys to a healthy lifestyle of young adults [Yahia et.al 2016].

Behaviours adopted by students during their university education have the potential to make an additional impact on the community because young adults can play important roles in society as well as being decision-makers and having significant behaviour patterns and attitudes, and therefore the health and lifestyle behaviours of university students are of interest to public health. Thus, strategies specifically designed to improve nutrition competence are needed, especially regarding information relating to sources of nutrition and healthy weight management.

Although it has been observed that students’ food habits change over the years of study, the research has generally focused on physical education students or has been conducted on students in general. Of all the specialities medical students should be the best-informed individuals and adopt a healthy lifestyle, which they can then promote in their professional careers

Nutrients are chemical compounds in food that are used by the body to function properly, grow and maintain health (MedlinePlus, Nutrition 2019). They are broadly classified into two viz; Macronutrient and Micro nutrient 

Macronutrient refers to those nutrients which are required in relatively large amounts (grams or ounces). EgCarbohydrates, Proteins, Fat, Water.

Micronutrient refers to those nutrients required by the body in small quantities (milligrams or micrograms) daily. They include vitamins and minerals. Vitamins: are broadly divided into two groups according to solubility

• Water soluble vitamins -Vitamin B1 or Thiamine, Vitamin B2 or Riboflavin, Vitamin B3 or Niacin, Vitamin B5 or Pantothenic acid, Vitamin B6 or Pyridoxine, Vitamin B7 or Biotin, Vitamin B9 or Folate, Vitamin B12 or Cobalamin.
• Fat soluble vitamins-Vitamins A, D, E and K

Minerals: Minerals are a class of micronutrients required by the body for growth and development. The major minerals include; calcium, phosphorus, potassium, sodium, magnesium, chloride, and sulphur. The minor minerals include; iron, zinc, iodine, copper, manganese, molybdenum, selenium and fluoride.

The college years are filled with many significant changes for students. One of the most prominent changes that college students face is making one’s own food choices (Freedman, 2010). Students living both on and off campus are faced with deciding their own eating patterns and habits. This sometimes results in poor quality diets that lack essential nutrients and/or unwanted weight gain (Grace, 1997). Poor dietary habits practiced by college students may carry long term health consequences, such as increased risk for the development of cardiovascular disease, diabetes, hypertension, and/or obesity (Engeland, et.al 2004).There is a general perception amongst the common masses that the students of health sciences have a greater knowledge about the correct dietary habits and healthy lifestyle as compared with nonmedical students, thus the medical practitioner is regarded as the epitome of correct food habits and lifestyle. This is significant as they are the future physicians and the students who personally adopt a healthy lifestyle are likely to positively influence their patients.

The objective of this study is to determine the dietary habits, and its effects on the nutritional status amongst first year medical students of SMS Medical College of Jaipur Rajasthan

3.1 STUDY SETTING

This study was carried out in SMS Medical College of Jaipur Rajasthan.

3.2 STUDY DEIGN

A cross-sectional study among medical student, of SMS Medical College of Jaipur Rajasthan

3.3 SAMPLING TECHNIQUE AND SAMPLE SIZE CALCULATION

The convenient sampling technique was used in this study, randomly selecting eligible participants from the class who will be present within the sampling time and adequate sample size of 100 was calculated using the formula n =Z2pq/d2

3.4 RESEARCH INSTRUMENTS –

3.4.1 A QUESTIONNAIRE

A self-administered questionnaire was designed for the collection of participants data. The data for this study were collected which was divided into the following sections: Socio-demographic characteristics, Dietary knowledge, food habits and frequency, Weight and height readings.

1. Socio-demographic characteristics included- weight and height measurements which was collected by using the Portable weighing scale and a stadiometer;race; religion; living arrangements; family pattern and family history of diabetes and hypertension, dietary knowledge, habits and frequency.
2. Dietary knowledge incudes knowledge about balanced diet, organic foods, genetically modified foods and methods of food processing. On basis of knowledge about diet we access their dietary knowledge as poor, moderate and good.
3. Food frequency method- Food frequency method was also used to find the frequency of consumption of different food- daily, weekly, fortnightly, monthly, occasionally. The food frequency questionnaire consists of foods which were important contributors to the population; intake of energy and other nutrients. The subject was allowed to tick their options in questionnaire correctly depending on their frequency of consumption of different foods. The amount consumed on an average each time can also be indicated.
4. 24-hour recall method

The two days 24-hour recall method was used to collect information regarding the food intake for the previous day at each meal and in between meal. The individual recalls what food was eaten and other details related to food intake. Quantities were stated in house hold units such as glass of milk, two slice of bread, one katori pulse etc. The nutrients values for these amounts were calculated using ICMR “Nutrients Composition Table” .The day’s total intake of different nutrients were assessed and compared with the RDA by ICMR of those nutrients for the various age groups. The hour recall included two days; both are working days.24 hour dietary recalls calculate intake by taking into account detailed food descriptions including brand names, ingredients, methods of food preparation, and portion sizes.

LIFE STYLE RELATED HABITS

Life style related habits of the medical students were studied to assess the lifestyle, health problem and eating habits among the subjects. The informationabout life style habits was obtained by allowing them to tick options in thequestionnaire.

3.5 DATA COLLECTION AND ANALYSIS –

The data for this study were collected through self-administered questionnaire. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 20.

The nature, objectives and process of the study was explained to every respondent, after which a verbal consent was obtained. Confidentiality, privacy and anonymity of the information provided were assured to all respondents.

The study was conducted among first year medical students at SMS Medical College Jaipur Rajasthan aged 17-22 years old. 100 Students have participated in the study and their responses were analysed and used in the study to assess their dietary habits, nutritional status and dietary knowledge. Results were obtained from the collected data. Results were presented in the form of tables and graps.

Table 1 describes participants' sociodemographic characteristic. Overall, a total of 100 participant (69 male and 31 females) of mean age (19 Yrs.) 19 ± 1 yrs. (17-22 years) and BMl (20.6) 20.06 ± 3.3 participated in this study. Essentially, almost all the participant were single (100%) in which 52% students were in General, 12 % students were in SC, 10 % students were in ST, and 26 % students were in OBC category and majority (91 %) of them were Hindu. Majority (45%) and (52) % of students were belongs to the joint and nuclear family.Most of the participants reported no family history of Diabetes (85%), hypertension (86%) Thyroid (94%) and PCOD (100%). Most of the students (48%) were day scholar,23% students were hosteller and 29 % students were stay in PG Accommodation during the survey.

Table 1.Sociodemographic Characteristics of the Medical Students.

Table. 2Participant’s Knowledge Regarding Dietary Habits

Table no. 2 illustrates knowledge of participants on diet. Almost all the participants (100 %) noted that at some point, they have heard of the phrase balanced diet. Major sources of information regarding the balanced diet are books, friends, the internet, or the television.

Almost all the participant rightly identified all true components of balanced diet. Whereas 91% of theparticipantshave heard of the phrase organic food in the past, only 7% students of the participants were able to define it as food produced naturally and 67% students defined it as food produced without any artificial alterations. 5% students of the participants were defined it as Food produced without any genetically modified foods or Foods that avoid the use of man-made fertilizers or Foods that avoid the use of livestock feed additives.

Regarding genetically modified foods, majority (91%) of the students noted that they have heard of such phrase as genetically modified foods. However, more than half of theparticipantswere able to rightly define that as food produced from organisms that have had their genes altered to produced traits that are not naturally produced (70%) or as foods produced from or using genetically modified organism (13) or they are genetically engineered foods (8). Again, the majority of the participants (>60%) could rightly identify various food processing methods.

Regarding participants overall dietary knowledge, majority (52) of the participants had excellent dietary knowledge while (31) had moderate knowledge. Only (17) of the participantshad poor dietary knowledge.

Table 3. Dietary Habits of the Medical Students

Table no.3 describes the participants dietary habits. Out of 100 students 79% students Were vegetarian and 21% are non-vegetarian. Whereas about (77%) of the participants reported regular feeding habits, most of the participants reported that they eat breakfast regularly (60 %). Most of the students (45%) reported that they eat at least 3 times each day.

Almost all the participant noted that they skip meals (65). Prominent reasons for skipping meals involved weight control (9%), lack of food (39%), lack of time (48%) and loss of appetite (22%). Interestingly, 82 % of the participant reported skipping meals up to once times a day, with breakfast as the most skipped meal (51%).

About 71% of the participants reported that they take snacks. However, most of the students (55) of the respondents reported consuming snacks once in a day.

Almost all the participants reported that they consume vegetables (85). About half of the (47) students will consume the fruits. However, less than half of the participants acknowledged that they eat either fruits or vegetable once in a day. Again, almost all the participants (21%) reported that they eat fresh fish once in a week. Dairy products consumed by (95%) of the students. However (55%) of the participants reported consuming dairy products once in day. Most of the participant reported that they consume fast food (85%). However, majority (73%) of the participant reported eating fast food once in a day. Only about 1 to 2% students were reported eating fast food less than times a day.

More than (54%) of theparticipantsnoted that they consume soft drinks. However, not more than (13%) of the participant reported consumption beyond 3 times per week. Also (45%) participants reported that they consume coffee, majority (30%) of them taking tea or coffee once in a day and less than (03%) reporting consumption that is beyond 3 time’s day.

About (21%) of the participant reported consuming nutrient supplements however only 14% students were reported to take health supplements not more than once in a day. Protein powder with water (02%), protein powder with milk (06%), multivitamin supplement (08%) and other supplements (11%). About (35%) of the participant reported consuming 6-8 glass of water daily. Also majority of students (36%) of the participant spent 15-20 minutes while eating.

Overall, only 2 participantswere judged to have poor dietary habits. However, 70 of the participants were judged as having moderate dietary habits. While 28 of the participants were judged to have poor dietary habits.

Table .no.4 provides the association between selected variable (gender, family history of diabetes, family history of hypertension, family history of thyroid, family history of PCOD and overall dietary knowledge) and respondents’ dietary habits.

There was a significant association between gender and dietary habit (X2 = 0.428; p = 0.01). Surprisingly neither family history of diabetes hypertension, thyroid and PCOD nor respondents knowledge of dieting showed a significant association with their overall dietary habits (P more than 0.05).

Table 4.5: Correlation between participant’s age and BMI with their overall feeding habits (Spearman's Correlation analysis)

Table 5: Correlation between participant’s age and BMI with their overall feeding habits (Spearman's Correlation analysis) Dietary Habit Age (r .259 p value < 0.001) and participant' BMl and their dietary habit (r = 0.325; p < 0.01).

Table no.5 illustrates the relationship between age and BMl and participants' overall dietary habit. There was a significantly weak and positive relationship between respondents' age and their dietary habit (r = 0.235; p < 0.001) and participant' BMl and their dietary habit (r = 0.325; p < 0.01) 

This study aimed to evaluate the eating habits of medical students of a health university in SMS MEDICAL COLLEGE JAIPUR RAJASTHAN. Diet and nutrition are important aspects of medical practice, and the budding medical professional is expected to lead by example.

A total of 100 questionnaires were distributed and giving a response rate of 100%. This study showed that almost all the participants (100 %) noted that at some point, they have heard of the phrase balanced diet. Major sources of information regarding the balanced diet are books, friends, the internet or the television. Almost all the participant (100%) rightly identified all true components of balanced diet. Regarding respondents overall dietary knowledge, (52%) of the participants had excellent dietary knowledge while (31%) had moderate knowledge. Only (17%) of the respondents had poor dietary knowledge (p value 0.06).

This finding agrees with the study on Nutrition and Healthy Lifestyle: Knowledge, Attitude and Practice in Medical Students of Yenepoya Medical College, Mengalore12; 262 students (of both genders) in the age group of 19-24 years, were evaluated separately (using a self-administered questionnaire) on important aspects of knowledge, attitude and practices. The knowledge scores were analysed by the t-test and there was not much significant difference between the knowledge scores of both males and females had adequate knowledge about balanced diet and nutrition. 80% of the students answered correctly when asked about the composition of the balanced diet. Importance of vitamins and minerals in the diet was answered correctly by 70% of students. 90% knew how important fibre is for health. They had a fair knowledge about protein energy malnutrition and 68% wrote correctly about this condition.

While another study carried out on the knowledge, attitude and practice of dietary and lifestyle habits among medical students in king Abdulaziz University, Saudi Arabia13 shows 75-94% of the students were aware of the composition of balanced diet, identification of the healthiest frying method, healthiest feeding behaviour, importance of vitamin and weaning of organic food. It’s similar with this study in which 98.6% were aware of balanced diet, 88% knew of organic food which is in keeping with the study above done in Saudi Arabia (Alissa, et al 2015).

Almost all the participant rightly identified all true components of balanced diet. Whereas (91%)  of the respondent have heard of the phrase organic food in the past, only (97% )students of the participants were able to define it as food produced naturally and (67%) students defined it as food produced without any artificial alteration .One student say Food produced without any genetically modified foods or Foods that avoid the use of man-made fertilizers(5%)or Foods that avoid the use of livestock feed additives(5%).Regarding genetically modified foods, 91% of the students noted that they have heard of such phrase as genetically modified foods. However, more than half of the respondents were able to rightly define that as food produced from organisms that have had their genes altered to produced traits that are not naturally produced (70%) or as foods produced from or using genetically modified organism (13%) or they are genetically engineered foods (8%). Again, the majority of the respondents (>60) could rightly identify various food processing methods, which is in contrast with the study done in Saudi Arabia (Encyclopedia, Nutritional Status (Internet). 2019 (updated 2015).Available from https://www.encyclopedia.com/education/dictionaries-thesauruses-pictures-and-press-release/nutritional-status)

in which 18%-39% of the medical students knew of genetically modified food and healthy cooking method. My findings are logical and simple because the study was carried out among undergraduate clinical medical students who are well knowledgeable about the health conditions that come with unbalanced diet and poor dietary habit. The clinical implication of my findings is that it will tend to reduce health problems associated with poor dietary habit such as diabetes, hypertension, coronary artery disease etc with the participants because of their moderate knowledge about dietary habits.

Almost all the participant noted that they skip meals (65%). Prominent reasons for skipping meals involved weight control (9%), lack of food (39%), lack of time (48%) and loss of appetite (22%). Interestingly, 82% of the participants reported skipping meals up to once times a day, with breakfast as the most skipped meal (51%). About 71% of the participants reported that they take snacks. However, about (55%) of the respondents reported consuming snacks once in a day. Almost all the participants reported that they consume fruits (47%) and vegetables (85%) However, less than half of the participants acknowledged that they eat either fruits or vegetable up to 3 times in a day.  Very few students 21 % was reported to eat meat or fish, however only about 17% participants reported that they eat fresh fish or meat once in a week. Dairy products consumed by (95%) of the students. However, majority 55 % of the respondents reported eating dairy products once in day. The majority of the participant reported that they consume fast food (85%). However, majority 73% of the participant reported eating fast food once in day. Only about 1 or 2 students was reported to eating fast food less than 3 times a day. More than (54%) of the respondents noted that they consume soft drinks. However, not more than 13 of the participants reported consumption beyond 3 times per week. Also (45%) respondents reported that they consume coffee with (30%) was reporting once in a day. About (21%) of the participant reported consuming nutrient supplements however only 14% students were reported to take health supplements not more than once in a day. Protein powder with water (02%), protein powder with milk (06%), multivitamin supplement (08%) and other supplements (11%). About (35%) of the participant reported consuming 6-8 glass of water daily. Also, majority of students (36%) of the participant spent 15-20 minutes while eating.

Overall, only (2%) respondents were judged to have bad dietary habits. However, (70%) of the respondents were judged as having moderate dietary habits. While (28 %) of the respondents were judged to have good dietary habits.

Breakfast is often thought to be the most important meal of the day as it is known to provide energy for the brain and improve learning and contribute significantly to the total daily energy and nutrient intake. Skipping breakfast may affect performance during the rest of the day (Ackuaku‑Dogbe EM, Abaidoo B2014) .In our study, it was heartening to note that (49%) responders replied in positive regarding daily breakfast consumption. These findings are similar to the descriptive cross‑sectional study conducted by Ackuaku‑Dogbe and Abaidoo among 317 medical students at the University of Ghana Medical School, Korle Bu‑Accra where they found that the overall breakfast skipping among the students was 71.92% [ Ackuaku‑Dogbe EM, Abaidoo B 2014] . Knowledge of actual consumption of fruits and vegetables among future medical practitioners assists in framing intervention to achieve potential health benefits for their future life.[ Omar, et.al.2017] While a descriptive cross sectional study among medical students at the University of Ghana medical school (Alissa E, et al 2015)showed about 71.92%of the students skipped breakfast attributing it more to early morning lectures, this is in conflict with this study where 51% of the respondents skip breakfast, 09% attributing it with weight loss probably because 21 % of my respondents where females who will always want to put up a weight which is socially acceptable by everyone and having this mentality that been slim gives one a perfect shape and therefore being fat as shapeless.

In our study 47 students take fruits, which is in conflict to the study conducted in University of Dammam, Saudi Arabia Al-Qahtani M. 2016, where 65.15% made use of fruits and vegetables and 59.25% made use of dairy products. While in this study 02 took vegetables 3 times a day and 42 was take vegetables 2 times in a day. This is partly because of our mentality in this part of the world where we think that fruits and vegetables are only meant for the rich who can always afford it and not for a common man.

In a similar study carried out amongst 494 undergraduate students at the University of Malta in 2011, half of the students had less fruit and vegetable servings per day, one‑third 2–4 servings, while only 15% had 5 or more servings. [ Al‑Otaibi HH 2011] All these figures are lacking and fall short of the five daily servings of fruit and vegetables as recommended by the World Health Organization.

Also worthy of note is that 95% of the students made use of dairy products once in day and The dairy products we use here are mostly imported but this products are very expensive making it difficult for my respondents to purchase and take it regularly therefore bringing about the disparity.

A cross sectional study conducted amongst medical students in Mangalore showed that 74.8% of the students had normal weight, 10.3% were overweight, 11.1% were underweight, and 3.1% were in obesity category and 0.4% were morbidly obese (Ali S, Kotian G, Rao N.2017) , it is not in keeping with the findings of this study in which 64% were of normal weight, 14% underweight, 22% overweight. In a study conducted on the eating habits among Lebanese University students (Yahia, et al.2008). The outcome indicated that 64.7% were of normal weights, which is a little above that seen in this study in which 64 were within the normal weight range. The findings are logical given that when people age, it makes one become susceptible to some disease entity and therefore makes the individuals conscious of what he or she eats, however, adopting a good eating habit which is in line with body mass index. BMI greater than 28 can predispose one to some chronic illness such as diabetes, hypertension and obesity and this keeps an individual at his feet in other to modify his dietary habit and live a disease-free life.

Future study should seek to find out if the current findings could also hold true in a larger population of growing adults.

Surprisingly family history of diabetes and hypertension showed a significant association with their overall dietary habits (P≤0.5). However, Synergistic Effect of Family History of Diabetes (FHD) and Dietary Habits on the Risk of Type 2 Diabetes in Central China is in agreement with this index research stating that the risk of T2DM was synergistically affected by FHD and dietary habits. Nutrition educational intervention may decrease the prevalence of T2DM in the Chinese with FHD (Yanyan ,et.al 2017). Surprisingly, Association between family history of diabetes and cardiovascular disease and lifestyle risk factors in the United States population: The 2009–2012 National Health and Nutrition Examination Survey shows that there was no association between family history of diabetes and hypertension with dietary factors or physical activity (Eboselume,et.al 2009-2012) 

Dietary habits of the medical students were healthy, though some lacunae were present. Barriers for faulty dietary habits were discussed. Students should be educated properly about healthy eating, so that they can guide their patients properly in future. The findings of the study indicate that the knowledge and practice of these students regarding healthy diet and nutrition does not bode well and is a cause of concern as these future primary‑care physicians lack adequate preparation as far as this vital component of modern medical practice is concerned. It is essential to bridge this lack in knowledge and practice of correct nutritional and dietary practices since the significance of these subjects in prevention of obesity and other lifestyle diseases is well known. Improvingnutrition knowledge, attitude and dietary practices throughnutritional education may help to prevent many nutritionrelateddiseases. Construction of health education materials for the prevention of non-communicable chronic diseases among young youth, and most of all, for the provision of nutrition education to thestudents for adoption of healthy eating among the medical students.

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