A Comparative Study of Nutritional Status, Knowledge Attitude and Practices (KAP) and Dietary Intake between International and Chinese Students in Nanjing, China
Abstract
:1. Introduction
2. Methods
2.1. Ethical Approval
2.2. Study Population and Inclusion Criteria
2.3. Data Collection
2.3.1. Pretesting of Questionnaire
2.3.2. Socio-Demographic Economic Characteristics
2.3.3. Anthropometry
2.3.4. Students’ Nutrition Knowledge, Attitude and Practices Scores
2.3.5. Dietary Assessment Tool
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics of International and Chinese Students
3.2. Comparison of Anthropometric and Life Style Variables According to Gender in International and Chinese Students
3.3. Comparison of Nutritional KAP between International and Chinese Students
3.4. Comparison of Dietary Consumption between International and Chinese Students
3.5. Association of Nutritional Status with Determinants
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- De Vriendt, T.; Matthys, C.; Verbeke, W.; Pynaert, I.; De Henauw, S. Determinants of nutrition knowledge in young and middle-aged Belgian women and the association with their dietary behaviour. Appetite 2009, 52, 788–792. [Google Scholar] [CrossRef] [PubMed]
- Perlstein, R.; McCoombe, S.; Shaw, C.; Nowson, C. Medical students’ perceptions regarding the importance of nutritional knowledge and their confidence in providing competent nutrition practice. Public Health 2016, 140, 27–34. [Google Scholar] [CrossRef] [PubMed]
- Edwards, J.S.; Hartwell, H.L.; Brown, L. Changes in food neophobia and dietary habits of international students. J. Hum. Nutr. Diet. 2010, 23, 301–311. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Worsley, A. Nutrition knowledge and food consumption: Can nutrition knowledge change food behaviour? Asia Pac. J. Clin. Nutr. 2002, 11 (Suppl. S3), S579–S585. [Google Scholar] [CrossRef] [PubMed]
- Kearney, J.M.; Gibney, M.J.; Livingstone, B.E.; Robson, P.J.; Kiely, M.; Harrington, K. Attitudes towards and beliefs about nutrition and health among a random sample of adults in the Republic of Ireland and Northern Ireland. Public Health Nutr. 2001, 4, 1117–1126. [Google Scholar] [CrossRef] [PubMed]
- ZarrazquinArizaga, I.; Atucha, A.F.; Kortajarena, M.; Torres-Unda, J.; Irazusta, A.; Ruiz-Litago, F.; Irazusta, J.; Casis, L.; Fraile-Bermúdez, A.B. Associations of Anthropometric Characteristics, Dietary Habits, and Aerobic Capacity With Cardiovascular Risk Factors of Health-Science Students. Biol. Res. Nurs. 2018. [Google Scholar] [CrossRef] [PubMed]
- Musaiger, A.O.; Awadhalla, M.S.; Al-Mannai, M.; AlSawad, M.; Asokan, G.V. Dietary habits and sedentary behaviors among health science university students in Bahrain. Int. J. Adolesc. Med. Health 2017, 29. [Google Scholar] [CrossRef] [PubMed]
- El Ansari, W.; Stock, C.; Mikolajczyk, R.T. Relationships between food consumption and living arrangements among university students in four European countries—A cross-sectional study. Nutr. J. 2012, 11, 28. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Perez-Cueto, F.; Verbeke, W.; Lachat, C.; Remaut-De Winter, A.M. Changes in dietary habits following temporal migration. The case of international students in Belgium. Appetite 2009, 52, 83–88. [Google Scholar] [CrossRef] [PubMed]
- Lee, J.; Gao, R.R.; Kim, J.H. Acculturation and changes in dietary behavior and anthropometric measures among Chinese international students in South Korea. Nutr. Res. Pract. 2015, 9, 304–312. [Google Scholar] [CrossRef] [PubMed]
- Almohanna, A.; Conforti, F.; Eigel, W.; Barbeau, W. Impact of Dietary Acculturation on the Food Habits, Weight, Blood Pressure, and Fasting Blood Glucose Levels of International College Students. J. Am. Coll. Health 2015, 63, 307–314. [Google Scholar] [CrossRef] [PubMed]
- Department of Education and Training, Austrailian Government. China-Outbound and Inbound International Students. 2016. Available online: https://internationaleducation.gov.au/research/Research-Snapshots/Documents/China_outbound%20and%20inbound%20tertiary%20students.pdf (accessed on 1 August 2016).
- Zhang, J.; Qi, Q.; Delprino, R.P. Psychological health among Chinese college students: A rural/urban comparison. J. Child Adolesc. Ment. Health 2017, 29, 179–186. [Google Scholar] [CrossRef] [PubMed]
- Pi-Sunyer, X.F. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. Obes. Res. 1998, 6 (Suppl. S2), 51S–209S. [Google Scholar]
- Yahia, N.; Brown, C.A.; Rapley, M.; Chung, M. Level of nutrition knowledge and its association with fat consumption among college students. BMC Public Health 2016, 16, 1047. [Google Scholar] [CrossRef] [PubMed]
- Amiri, P.; Asghari, G.; Sadrosadat, H.; Karimi, M.; Amouzegar, A.; Mirmiran, P.; Azizi, F. Psychometric Properties of a Developed Questionnaire to Assess Knowledge, Attitude and Practice Regarding Vitamin D (D-KAP-38). Nutrients 2017, 9, 471. [Google Scholar] [CrossRef] [PubMed]
- Son, S.; Ro, Y.; Hyun, H.; Lee, H.; Song, K. A comparative study on dietary behavior, nutritional knowledge and life stress between Korean and Chinese female high school students. Nutr. Res. Pract. 2014, 8, 205–212. [Google Scholar] [CrossRef] [PubMed]
- Gautreau, S.; Monsen, E.R. Priorities of nutritional concepts assigned by health professionals and students. J. Med. Educ. 1979, 54, 607–612. [Google Scholar] [CrossRef] [PubMed]
- Moss, S.; Prosser, H.; Costello, H.; Simpson, N.; Patel, P.; Rowe, S.; Turner, S.; Hatton, C. Reliability and validity of the PAS-ADD Checklist for detecting psychiatric disorders in adults with intellectual disability. J. Intellect. Disabil. Res. 1998, 42 Pt 2, 173–183. [Google Scholar] [CrossRef]
- El Ansari, W.; Berg-Beckhoff, G. Nutritional Correlates of Perceived Stress among University Students in Egypt. Int. J. Environ. Res. Public Health 2015, 12, 14164–14176. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lupi, S.; Bagordo, F.; Stefanati, A.; Grassi, T.; Piccinni, L.; Bergamini, M.; De Donno, A. Assessment of lifestyle and eating habits among undergraduate students in northern Italy. Annali dell’Istituto Superiore di Sanita 2015, 51, 154–161. [Google Scholar] [PubMed]
- Weber, K.S.; Buyken, A.E.; Nowotny, B.; Strassburger, K.; Simon, M.C.; Pacini, G.; Szendroedi, J.; Mussig, K.; Roden, M.; GDS Group. The Impact of Dietary Factors on Glycemic Control, Insulin Sensitivity and Secretion in the First Years after Diagnosis of Diabetes. Exp. Clin. Endocrinol. Diabetes 2016, 124, 230–238. [Google Scholar] [PubMed]
- Sakamaki, R.; Toyama, K.; Amamoto, R.; Liu, C.J.; Shinfuku, N. Nutritional knowledge, food habits and health attitude of Chinese university students—A cross sectional study. Nutr. J. 2005, 4, 4. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Jingya, B.; Ye, H.; Jing, W.; Xi, H.; Tao, H. Quantitative analysis and comparison of BMI among Han, Tibetan, and Uygur university students in Northwest China. Sci. World J. 2013, 2013, 180863. [Google Scholar] [CrossRef] [PubMed]
- Lolokote, S.; Hidru, T.H.; Li, X. Do socio-cultural factors influence college students’ self-rated health status and health-promoting lifestyles? A cross-sectional multicenter study in Dalian, China. BMC Public Health 2017, 17, 478. [Google Scholar] [CrossRef] [PubMed]
- Gazibara, T.; KisicTepavcevic, D.B.; Popovic, A.; Pekmezovic, T. Eating habits and body-weights of students of the University of Belgrade, Serbia: A cross-sectional study. J. Health Popul. Nutr. 2013, 31, 330–333. [Google Scholar] [CrossRef] [PubMed]
- Kiss, K.; Meszaros, Z.; Mavroudes, M.; Szmodis, M.B.; Zsidegh, M.; Ng, N.; Meszaros, J. Fitness and nutritional status of female medical university students. Acta Physiol. Hung. 2009, 96, 469–474. [Google Scholar] [CrossRef] [PubMed]
- Grygiel-Gorniak, B.; Tomczak, A.; Krulikowska, N.; Przyslawski, J.; Seraszek-Jaros, A.; Kaczmarek, E. Physical activity, nutritional status, and dietary habits of students of a medical university. Sport Sci. Health 2016, 12, 261–267. [Google Scholar] [CrossRef] [PubMed]
- Van Lee, L.; Chia, A.R.; Loy, S.L.; Colega, M.; Tham, E.K.H.; Cai, S.; Yap, F.; Godfrey, K.M.; Teoh, O.H.; Goh, D.; et al. Sleep and Dietary Patterns in Pregnancy: Findings from the GUSTO Cohort. Int. J. Environ. Res. Public Health 2017, 14, 1409. [Google Scholar] [CrossRef] [PubMed]
- Kristicevic, T.; Stefan, L.; Sporis, G. The Associations between Sleep Duration and Sleep Quality with Body-Mass Index in a Large Sample of Young Adults. Int. J. Environ. Res. Public Health 2018, 15, 758. [Google Scholar] [CrossRef] [PubMed]
- Dietary Guidelines for Americans. 2005. Available online: https://health.gov/dietaryguidelines/dga2005/document/ (accessed on 1 January 2005).
- Taguchi, C.; Kishimoto, Y.; Suzuki-Sugihara, N.; Saita, E.; Usuda, M.; Wang, W.; Masuda, Y.; Kondo, K. Regular egg consumption at breakfast by Japanese woman university students improves daily nutrient intakes: Open-labeled observations. Asia Pac. J. Clin. Nutr. 2018, 27, 359–365. [Google Scholar] [PubMed]
- Kowalcze, K.; Turyk, Z.; Drywien, M. Nutrition of students from dietetics profile education in the Siedlce University of Natural Sciences and Humanities compared with students from other academic centres. Roczniki Państwowego Zakładu Higieny 2016, 67, 51–58. [Google Scholar] [PubMed]
- Wang, X.; Ouyang, Y.; Liu, J.; Zhu, M.; Zhao, G.; Bao, W.; Hu, F.B. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: Systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 2014, 349, g4490. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nola, I.A.; Jelinic, J.D.; Matanic, D.; Pucarin-Cvetkovic, J.; Bergman Markovic, B.; Senta, A. Differences in eating and lifestyle habits between first- and sixth-year medical students from Zagreb. Coll. Antropol. 2010, 34, 1289–1294. [Google Scholar] [PubMed]
- Bergeron, N.; Al-Saiegh, S.; Ip, E.J. An Analysis of California Pharmacy and Medical Students’ Dietary and Lifestyle Practices. Am. J. Pharm. Educ. 2017, 81, 5956. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dugan, A. Fast Food Still Major Part of U.S. Diet. 2013. Available online: http://news.gallup.com/poll/163868/fast-food-major-part-diet.aspx (accessed on 6 August 2013).
- Nergiz-Unal, R.; Akal Yildiz, E.; Samur, G.; Besler, H.T.; Rakicioglu, N. Trends in fluid consumption and beverage choices among adults reveal preferences for ayran and black tea in central Turkey. Nutr. Diet. 2017, 74, 74–81. [Google Scholar] [CrossRef] [PubMed]
- Malik, V.S.; Schulze, M.B.; Hu, F.B. Intake of sugar-sweetened beverages and weight gain: A systematic review. Am. J. Clin. Nutr. 2006, 84, 274–288. [Google Scholar] [CrossRef] [PubMed]
- Lim, L.; Banwell, C.; Bain, C.; Banks, E.; Seubsman, S.A.; Kelly, M.; Yiengprugsawan, V.; Sleigh, A. Sugar sweetened beverages and weight gain over 4 years in a Thai national cohort—A prospective analysis. PLoS ONE 2014, 9, e95309. [Google Scholar] [CrossRef] [PubMed]
- Góralska, K.; Klimczak, A.; Rachubinski, P.; Jaglowska, A.; Kwapiszewska, A. Consumption of sweetened beverages as a risk factor of colonization of oral cavity by fungi—Eating habits of university students. Ann. Parasitol. 2015, 61, 175–182. [Google Scholar]
- Hermann, S.; Rohrmann, S.; Linseisen, J.; May, A.M.; Kunst, A.; Besson, H.; Romaguera, D.; Travier, N.; Tormo, M.J.; Molina, E.; et al. The association of education with body mass index and waist circumference in the EPIC-PANACEA study. BMC Public Health 2011, 11, 169. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Deng, X.; Castelli, D.; Castro-Pinero, J.; Guan, H. University Students Meeting the Recommended Standards of Physical Activity and Body Mass Index. ICHPER-SD J. Res. 2011, 6, 20–26. [Google Scholar]
- Kanikowska, D.; Sikorska, D.; Kuczynska, B.; Grzymislawski, M.; Breborowicz, A.; Witowski, J. Do medical students adhere to advice regarding a healthy lifestyle? A pilot study of BMI and some aspects of lifestyle in medical students in Poland. Adv. Clin. Exp. Med. 2017, 26, 1391–1398. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Martinez-Moya, M.; Navarrete-Munoz, E.M.; Garcia de la Hera, M.; Gimenez-Monzo, D.; Gonzalez-Palacios, S.; Valera-Gran, D.; Sempere-Orts, M.; Vioque, J. Association between hours of television watched, physical activity, sleep and excess weight among young adults. Gaceta Sanitaria 2014, 28, 203–208. [Google Scholar] [PubMed]
- Valmorbida, J.L.; Goulart, M.R.; Busnello, F.M.; Pellanda, L.C. Nutritional knowledge and body mass index: A cross-sectional study. Rev. Assoc. Med. Bras. 2017, 63, 736–740. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Variables | International | Chinese | p Value | |
---|---|---|---|---|
Age (years) | 20.7 ± 2.3 | 19.8 ± 1.3 | <0.001 a | |
Sex | Male | 110 (35.7) | 115 (29.3) | 0.069 b |
Female | 198 (64.3) | 278 (70.7) | ||
Education | 1st year | 89 (28.9) | 58 (14.8) | <0.001 b |
2nd year | 79 (25.6) | 164 (41.7) | ||
3rd year | 79 (25.6) | 132 (33.6) | ||
4th year | 61 (19.8) | 39 (10.0) | ||
Financial status | Not satisfactory | 3 (1.0) | 12 (3.1) | 0.015 b |
Satisfactory | 225 (72.4) | 307 (78.1) | ||
Very good | 80 (26) | 74 (18.8) | ||
BMI (Kg/m2) | <18.5 | 34 (10.9) | 65 (16.5) | <0.001 b |
18.5–24.9 | 196 (63.2) | 289 (73.5) | ||
25.0–29.9 | 50 (16.1) | 30 (7.6) | ||
>30 | 28 (9.0) | 9 (2.3) | ||
Sleeping time | <4 h/d | 5 (1.6) | 3 (0.8) | <0.001 b |
4–6 h/d | 103 (33.4) | 19 (4.8) | ||
6–8 h/d | 182 (59.1) | 336 (85.5) | ||
>8 h/d | 18 (5.8) | 35 (8.9) | ||
Physical exercise | ≥5 days/week | 61 (19.8) | 80 (20.4) | 0.195 b |
3–4 days/week | 93 (30.2) | 96 (24.4) | ||
1–2 days/week | 98 (31.8) | 152 (38.7) | ||
No exercise | 56 (18.2) | 65 (16.5) | ||
Total | 308 (43.9) | 393 (56.1) |
Variables | International Students | Chinese Students | |||||||
---|---|---|---|---|---|---|---|---|---|
Male | Female | p Value | Male | Female | p Value | P1 | P2 | ||
Percent body fats | 21.1 ± 7.5 | 33.1 ± 6.9 | 0.001 a | 18.0 ± 6.2 | 27.9 ± 4.8 | <0.001 a | 0.001 a | <0.001 a | |
BMI (kg/m2) | 22.8 (5.2) | 21.5 (4.5) | 0.02 b | 21.0 (3.8) | 20.5 (3.3) | <0.001 b | <0.001 b | <0.001 b | |
Sleeping time | <4 h/d | 3.6 | 0.5 | 0.079 c | 0.0 | 1.1 | 0.227 c | <0.001 c | <0.001 c |
4–6 h/d | 34.5 | 32.8 | 7.8 | 3.6 | |||||
6–8 h/d | 53.3 | 62.1 | 83.5 | 86.3 | |||||
>8 h/d | 8.2 | 4.5 | 8.7 | 9.0 |
Determinants of BMI | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
ß | p Value | ß | p Value | |
Sex | −1.035 | 0.001 | −0.724 | 0.022 |
Age | 0.262 | 0.001 | 0.177 | 0.052 |
Educational level | 0.426 | 0.005 | 0.365 | 0.036 |
Financial status | 0.121 | 0.694 | ||
Sleeping duration | −0.752 | 0.007 | −0.562 | 0.047 |
Physical exercise | −0.247 | 0.094 | −0.311 | 0.036 |
Nutritional KAP scores | −0.208 | 0.008 | −0.203 | 0.012 |
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Ul Haq, I.; Mariyam, Z.; Li, M.; Huang, X.; Jiang, P.; Zeb, F.; Wu, X.; Feng, Q.; Zhou, M. A Comparative Study of Nutritional Status, Knowledge Attitude and Practices (KAP) and Dietary Intake between International and Chinese Students in Nanjing, China. Int. J. Environ. Res. Public Health 2018, 15, 1910. https://doi.org/10.3390/ijerph15091910
Ul Haq I, Mariyam Z, Li M, Huang X, Jiang P, Zeb F, Wu X, Feng Q, Zhou M. A Comparative Study of Nutritional Status, Knowledge Attitude and Practices (KAP) and Dietary Intake between International and Chinese Students in Nanjing, China. International Journal of Environmental Research and Public Health. 2018; 15(9):1910. https://doi.org/10.3390/ijerph15091910
Chicago/Turabian StyleUl Haq, Ijaz, Zahula Mariyam, Min Li, Xiaojia Huang, Pan Jiang, Falak Zeb, Xiaoyue Wu, Qing Feng, and Ming Zhou. 2018. "A Comparative Study of Nutritional Status, Knowledge Attitude and Practices (KAP) and Dietary Intake between International and Chinese Students in Nanjing, China" International Journal of Environmental Research and Public Health 15, no. 9: 1910. https://doi.org/10.3390/ijerph15091910