European Journal of Cardiovascular Medicine

Nutrition is a cornerstone of health, particularly for young adults navigating critical developmental stages. Medical and paramedical students, as future healthcare professionals, are expected to model healthy behaviors. However, their demanding academic schedules, clinical rotations, and hostel living often lead to irregular eating patterns, fast-food dependency, and inadequate fruit and vegetable intake[1]. These habits increase the risk of obesity, anemia, and other non-communicable diseases, potentially compromising academic performance and professional competence[2-3].

In India, where lifestyle-related diseases are rising, understanding the dietary habits of health sciences students is vital. Limited research exists in Tamilnadu, a region with a growing number of health institutes[4-5]. This study addresses this gap by evaluating the dietary habits, nutritional status, and nutritional knowledge of medical and paramedical students, and identifying associated sociodemographic and lifestyle factors. By highlighting the disconnect between knowledge and practice, this research aims to inform interventions to promote healthier lifestyles among future healthcare providers.

Aim:

To assess the dietary habits and nutritional status of medical and paramedical students at a health sciences university in Tamilnadu, India, and to identify factors influencing their dietary practices.

Objectives:

1. To evaluate the dietary habits of medical and paramedical students, including meal frequency, food choices, and consumption patterns.
2. To assess the nutritional status of students through anthropometric measurements and hemoglobin levels.
3. To determine the level of nutritional knowledge among students and its correlation with dietary practices.
4. To identify socio-demographic and lifestyle factors associated with unhealthy dietary habits.
5. To propose recommendations for improving dietary habits and nutritional status among health sciences students.

A cross-sectional study was conducted from July 2023 to June 2024 at a health sciences university in Tamilnadu, India.

Study Population:

The study included 300 undergraduate students (150 medical [MBBS], 150 paramedical [nursing and medical laboratory science]) aged 18–25 years. Inclusion criteria were enrollment in the 2023–2024 academic year and provision of written informed consent. Exclusion criteria included chronic illnesses (e.g., diabetes, hypertension) or unwillingness to participate.

Sample Size Calculation:

The sample size was calculated using Cochran’s formula: n = (Z² × p × q) / d² where Z = 1.96 (95% confidence level), p = 0.214 (prevalence of good nutritional knowledge from prior studies), q = 1 - p = 0.786, and d = 0.05 (margin of error). This yielded a minimum sample size of 258. Accounting for a 15% non-response rate, 300 participants were recruited.

Sampling Technique

Stratified random sampling was used, with the student population divided into medical and paramedical strata. From each stratum, 150 students were randomly selected using class registers.

Data Collection

Data were collected using a pre-validated, self-administered questionnaire adapted from the General Nutrition Knowledge Questionnaire (GNKQ). The questionnaire included:

• Socio-demographic and Lifestyle Data: Age, gender, academic year, living arrangement (hostel, home, rented accommodation), and monthly allowance.
• Dietary Habits: Meal frequency, breakfast consumption, fruit and vegetable intake, fast-food consumption, and meal skipping, assessed via a modified Food Frequency Questionnaire (FFQ) and 24-hour dietary recall.
• Nutritional Knowledge: Questions on nutrient content, healthy cooking methods, and diet-related diseases, scored out of 100.
• Anthropometric and Clinical Measurements: Height (stadiometer, nearest 0.1 cm), weight (digital scale, nearest 0.1 kg), waist and hip circumference, and hemoglobin levels (spectroscopy).

BMI was calculated as: weight (kg) / height (m)² BMI categories followed WHO criteria: underweight (<18.5 kg/m²), normal (18.5–24.9 kg/m²), overweight (25–29.9 kg/m²), and obese (≥30 kg/m²). Waist-Hip Ratio (WHR) risk thresholds were >0.90 for males and >0.85 for females. Anemia was defined as hemoglobin <13 g/dL (males) or <12 g/dL (females).

Ethical Considerations

The study was approved by the Institutional Ethics Committee Government Erode Medical College Hospital, Perundurai,Erode,Tamilnadu (IEC No. 09/IEC/GEMCH/2024, dated 11/12/2024). Informed consent was obtained, and confidentiality was maintained.

Data Analysis

Data were analyzed using SPSS v24. Descriptive statistics (frequencies, percentages, means, standard deviations) summarized socio-demographic, dietary, and nutritional data. Chi-square tests compared categorical variables, and logistic regression identified factors associated with unhealthy dietary habits. A p-value ≤ 0.05 was considered significant.

Socio-Demographic Characteristics

Of the 300 participants, 50% (n=150) were medical students, and 50% (n=150) were paramedical students. The mean age was 20.6 ± 1.8 years. Females comprised 58% (n=174), and males 42% (n=126). Most students (62%, n=186) lived in hostels, 30% (n=90) with family, and 8% (n=24) in rented accommodations. The majority (55%, n=165) had a monthly allowance of <10,000 INR (Table 1).

Table 1: Demographic Characteristics of Study Participants (N = 300)

Dietary Habits

• Meal Frequency: 49% (n=147) consumed two meals daily, 38% (n=114) three meals, and 13% (n=39) one or irregular meals. Breakfast was consumed daily by 68% (n=204), but 32% (n=96) skipped breakfast ≥3 times/week.
• Fruit and Vegetable Intake: Only 25% (n=75) met the WHO recommendation of ≥5 portions daily (mean: 1.8 ± 0.9 portions).
• Fast-Food Consumption: 42% (n=126) consumed fast food ≥2 times/week, with males (48%) more likely than females (37%) (p=0.046).
• Meal Skipping: 35% (n=105) skipped meals, primarily due to time constraints (70%) or academic stress (49%) (Table 2).

Table 2: Dietary Habits of Study Participants (N = 300)

Nutritional Status

• BMI Distribution: 12.3% (n=37) were underweight, 58.7% (n=176) normal, 18.3% (n=55) overweight, and 10.7% (n=32) obese. Overweight/obesity was higher among males (32%) than females (25%) (p=0.03).
• Anemia Prevalence: 28.6% (n=86) were anemic (females: 34%, males: 21%; p=0.01). Mild anemia was observed in 18% (n=54), moderate in 10.6% (n=32), with no severe cases (table 3).

Table 3: Nutritional Status of Study Participants (N = 300)

Nutritional Knowledge

The mean nutritional knowledge score was 62.4 ± 12.3/100. Adequate knowledge (≥60) was observed in 62% (n=186). Knowledge gaps included nutrient content (21% unsure about sugar, salt, fiber requirements) and healthy cooking methods (45% incorrectly identified sautéing as healthiest). Medical students scored higher (64.1 ± 11.8) than paramedical students (60.7 ± 12.6) (p=0.04) (Table 4).

Table 4: Nutritional Knowledge of Study Participants (N = 300)

Factors Associated with Unhealthy Dietary Habits

Logistic regression identified:

• Gender: Males had higher odds of irregular meal times (OR=1.5, p=0.046) and fast-food consumption (OR=1.7, p=0.012).
• Living Arrangement: Hostel residents had higher odds of meal skipping (OR=2.1, p=0.003).
• Academic Year: Third-year and above students had higher odds of insufficient fruit and vegetable intake (OR=2.2, p=0.003)(Table 5).

Table 5: Factors Associated with Unhealthy Dietary Habits (Logistic Regression Analysis)

Figure 1: Gender-wise Distribution of BMI Categories and Anemia Prevalence Among Study Participants

Figure 1: Gender-wise Distribution of BMI Categories and Anemia Prevalence Among Study Participants

Figure 1 illustrates the gender-wise distribution of BMI categories and anemia prevalence among the study participants. A slightly higher proportion of females (14%) were underweight compared to males (10%). Normal BMI was observed in 58% of males and 59% of females, indicating a similar distribution. Overweight status was more common among males (20%) than females (17%), and obesity was also slightly higher in males (12%) compared to females (10%). Notably, anemia prevalence was significantly higher among females (34%) compared to males (21%), highlighting a gender disparity in nutritional deficiencies.

This study reveals both strengths and concerns in the dietary habits of medical and paramedical students. The 68% daily breakfast consumption rate is encouraging, as breakfast supports cognitive function and academic performance[6-7] . However, only 25% met WHO fruit and vegetable intake recommendations, consistent with global trends among university students[8-9]. High fast-food consumption (42%) and meal skipping (35%) align with studies in Saudi Arabia (37.5% overweight/obesity) and Brunei (27%) [10-12].

The combined overweight/obesity prevalence (29%) reflects a global challenge, with males showing higher rates, possibly due to greater fast-food consumption. Anemia, particularly among females (34%), is concerning and likely linked to dietary iron deficiencies and irregular eating patterns, exacerbated by hostel living[13-14]. Despite 62% having adequate nutritional knowledge, the knowledge-practice gap persists, as seen in similar studies [15-16]. Hostel residents’ higher meal-skipping rates highlight the role of living arrangements.

Limitations:

This study has several limitations. Firstly, the cross-sectional design restricts the ability to draw causal inferences between variables. Secondly, reliance on self-reported dietary data introduces the possibility of recall bias, which may affect the accuracy of responses. Thirdly, as the study was conducted at a single institution, the findings may not be generalizable to broader student populations. Lastly, although the Food Frequency Questionnaire (FFQ) was pre-tested for clarity and relevance, it was not specifically validated for the study

Medical and paramedical students exhibit suboptimal dietary habits and nutritional status, despite adequate nutritional knowledge. High fast-food consumption, meal skipping, and low fruit and vegetable intake, combined with significant overweight, obesity, and anemia prevalence, underscore the need for targeted interventions. Universities should integrate practical nutrition education, improve campus food environments, and implement health promotion programs to foster healthier habits among future healthcare professionals.

Recommendations:

1. Integrate practical nutrition courses into curricula, focusing on healthy cooking and meal planning.
2. Increase access to affordable, nutritious food in canteens and vending machines.
3. Implement workshops and campaigns addressing meal skipping and fast-food consumption.
4. Conduct regular screening for anemia and obesity, with targeted interventions for at-risk groups.

Conflict of Interest:

The authors declare no conflicts of interest.

Funding:

This study was self-funded.

Ethical Approval:

Approved by the Institutional Ethics Committee Government Erode Medical College Hospital, Perundurai, Erode, Tamilnadu (IEC No. 09/IEC/GEMCH/2024, dated 11/12/2024).  

Acknowledgments:

I thank all the faculty, teaching and non-teaching staff of Physiology Department and participants of my study for their valuable contribution the authors would like to thank all of the study participants and the administration of Department of Physiology and Government Erode Medical College, Erode, Tamilnadu, India for granting permission to carry out the research work.

Authors’ contributions:

Conceptualization: Dr Gurmeet kaur

• Data curation: Dr. Panneerselvam Periasamy & Dr G. seralathan
• Formal analysis: Dr Gurmeet kaur
• Methodology: Dr Leena Jad
• Project administration: Dr.Panneerselvam Periasamy & Dr G. seralathan
• Resources: Loveleen kour
• Supervision: Dr Leena Jad
• Validation: Loveleen kour
• Visualization: Dr Gurmeet kaur
• Writing - original draft: Dr Leena Jad
• Writing - review and editing: Dr G. seralathan and Dr.Panneerselvam Periasamy.

Data Availability:

All datasets generated or analyzed during this study are included in the manuscript.

Informed Consent:

Written informed consent was obtained from the participants before enrolling in the study

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