European Journal of Cardiovascular Medicine

College students navigate a critical transitional phase marked by academic pressures, lifestyle changes, and newfound independence, which can significantly influence their eating behaviors, sleep patterns, and overall health[1]. Disordered eating attitudes, poor sleep quality, and variations in body mass index (BMI) are prevalent among this population, often exacerbated by socioeconomic factors, stress, and inadequate physical activity[2]. These issues can have long-term implications for physical and mental health, including increased risks of obesity, eating disorders, and sleep-related disorders[3].

In India, where rapid urbanization and changing dietary patterns are reshaping lifestyles, college students are particularly vulnerable to health challenges. Previous studies have highlighted the interplay between eating behaviors, sleep quality, and BMI, yet data specific to Indian college populations remain limited [4]. This study, conducted at Nandha Medical College and Hospital, Erode, Tamil Nadu, India, from January to February 2025, aimed to assess the prevalence of abnormal eating attitudes and poor sleep quality among college students and to explore their associations with BMI and demographic variables. The Eating Attitude Test (EAT-26) and Pittsburgh Sleep Quality Index (PSQI) were employed to evaluate eating attitudes and sleep quality, respectively. The findings provide insights into the health challenges faced by college students and inform strategies for promoting healthy lifestyles.

Study Design and Setting

A cross-sectional study was conducted at the Department of Community Medicine, Nandha Medical College and Hospital, Erode, Tamil Nadu, India, from January 2025 to February 2025. The study population included students enrolled in medical, nursing, allied health, arts and science, and engineering programs.

Participants

A total of 263 students participated. Inclusion criteria included students aged 18 years and older who provided informed consent. Exclusion criteria included students with diagnosed eating disorders or sleep disorders prior to the study.

Data Collection

Data were collected using a structured questionnaire comprising four sections: demographic information, anthropometric measurements, the Eating Attitude Test (EAT-26), the Pittsburgh Sleep Quality Index (PSQI), and the International Physical Activity Questionnaire (IPAQ). Anthropometric measurements included height (measured to the nearest 0.1 cm) and weight (measured to the nearest 0.1 kg) to calculate BMI (kg/m²). The EAT-26, a validated 26-item tool, assessed eating attitudes, with scores ≥20 indicating abnormal behaviors (Garner et al., 1982). The PSQI evaluated sleep quality across seven domains (subjective sleep quality, sleep latency, duration, efficiency, disturbances, use of sleep medication, and daytime dysfunction), with scores ≥5 indicating poor sleep quality (Buysse et al., 1989). The IPAQ measured physical activity levels over the past seven days, categorizing activity as vigorous, moderate, or walking.

Statistical Analysis

Descriptive statistics, including mean, standard deviation (SD), median, interquartile range (IQR), and percentages, were used to summarize demographic characteristics, EAT-26 scores, PSQI scores, and IPAQ results. The Mann-Whitney U test and Kruskal-Wallis H test were employed to compare EAT-26 and PSQI scores across demographic groups (e.g., sex, BMI categories, family income). Chi-square tests assessed associations between categorical variables, such as abnormal eating attitudes and poor sleep quality. Spearman’s rank correlation coefficient evaluated relationships between continuous variables (EAT-26 scores, PSQI scores, weight, and BMI). A p-value ≤0.05 was considered statistically significant. All analyses were performed using SPSS version 26 (IBM Corp., Armonk, NY, USA).

Ethical Considerations

The study was approved by the Institutional Ethical Committee (IEC) of Nandha Medical College and Hospital, adhering to the Declaration of Helsinki. Written informed consent was obtained from all participants prior to enrollment. Data were anonymized to ensure confidentiality.

Demographic Characteristics

The study included 263 participants with a mean age of 19.63 ± 1.86 years. Table 1 summarizes the demographic profile. Females comprised 66.54% (n=175) of the sample, and males 33.46% (n=88). The mean BMI was 22.10 ± 4.05 kg/m², with 17.11% (n=45) underweight, 62.36% (n=164) normal weight, 17.49% (n=46) overweight, and 3.04% (n=8) obese. Most students (75.67%, n=199) lived in nuclear families, and 79.85% (n=210) were enrolled in medical courses.

Table 1: Demographic Information of Study Participants

Eating Attitudes (EAT-26)

The prevalence of abnormal eating attitudes (EAT-26 score ≥20) was 13.31% (Table 2). The mean EAT-26 score was 10.92 ± 8.63, with a median of 8.00 (IQR 5–16). Overweight and obese students had significantly higher EAT-26 scores (p=0.02 and p=0.05, respectively) (Table 3). Family income was significantly associated with abnormal eating attitudes (p=0.02), with higher prevalence in lower and higher income groups.

Table 2: Eating Attitude Test (EAT-26) Scores

Table 3: EAT-26 scores by BMI

Sleep Quality (PSQI)

The prevalence of poor sleep quality (PSQI score ≥5) was 33.31% (Table 4). The mean PSQI score was 5.17 ± 3.39, with a median of 5.00 (IQR 2–9). Underweight students and those with lower weight (<50 kg) had significantly higher PSQI scores (p=0.05), indicating poorer sleep quality (Table 5).

Table 4: Pittsburgh Sleep Quality Index (PSQI) Scores

Table 5: PSQI Scores by BMI

Correlations

Table 6 shows significant positive correlations between EAT-26 scores and weight (rho=0.32, p=0.01) and BMI (rho=0.29, p=0.01). Significant negative correlations were found between PSQI scores and weight (rho=-0.25, p=0.05) and BMI (rho=-0.27, p=0.05). No significant correlation was observed between EAT-26 and PSQI scores (rho=-0.14, p=0.21).

Table 6: Correlation Between EAT-26, PSQI, Weight, and BMI

Dietary Habits and Physical Activity

Most students (82.13%) followed a mixed diet, and 72.62% consumed pre-packaged or fast food, with 52.09% consuming it one day per week. Physical activity levels were low, with 61.60% reporting no vigorous activity and 46.01% reporting no moderate activity (Table 7).

Table 7: International Physical Activity Questionnaire (IPAQ) Summary

This study provides critical insights into the health challenges faced by college students at Nandha Medical College and Hospital. The prevalence of abnormal eating attitudes (13.31%) aligns with previous studies reporting disordered eating behaviors among young adults [7]. The significant association between higher EAT-26 scores and increased BMI among overweight and obese students suggests that disordered eating may contribute to weight gain, potentially through irregular eating patterns or overeating triggered by stress[8]. The influence of family income on eating attitudes (p=0.02) highlights the role of socioeconomic factors, which may affect access to nutritious foods or exacerbate academic stress in lower and higher income groups[9].

The high prevalence of poor sleep quality (33.31%) is concerning, particularly among underweight students, who exhibited significantly higher PSQI scores (p=0.05). This finding is consistent with prior research linking poor sleep to inadequate nutrition or heightened stress levels[10]. The negative correlations between PSQI scores and both weight and BMI suggest that lower body weight may be associated with sleep disturbances, possibly due to dietary deficiencies or psychological stress[11]. The lack of significant correlation between EAT-26 and PSQI scores (p=0.21) indicates that eating attitudes and sleep quality may operate independently in this population, warranting further investigation.

Low physical activity levels (61.60% with no vigorous activity) and frequent consumption of pre-packaged foods (72.62%) are alarming, as these behaviors are known risk factors for obesity and poor health outcomes[12-13]. These findings underscore the need for comprehensive lifestyle interventions that address dietary habits, physical activity, and sleep hygiene to mitigate health risks among college students.

Limitations

The cross-sectional design limits causal inferences, and self-reported data may introduce recall bias. The study was conducted at a single institution, potentially limiting generalizability. Future research should employ longitudinal designs and include diverse populations

Abnormal eating attitudes and poor sleep quality are prevalent among college students at Nandha Medical College and Hospital, with significant associations with BMI, weight, and family income. These findings underscore the importance of promoting healthy eating and sleep habits through targeted interventions, such as nutritional counseling and stress management programs, to enhance student well-being.

Acknowledgments

We express gratitude to the students of Nandha Medical College and Hospital for their participation and to the Department of Community Medicine for their support.

Ethical approval:

This study was conducted in accordance with the Declaration of Helsinki‑Ethical principle for medical research involving human subjects. Accordingly, the ethical clearance was obtained from a joint ethical review committee intuitional ethical committee (IEC), Nandha Medical College and Hospital, Erode.

Financial support and sponsorship:

Nil

Conflicts of interest:

There are no conflicts of interest.

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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