RESEARCHOpenAccess - PDF document

RESEARCHOpenAccess Socialandpsychologicalfactorsaffectingeating habitsamonguniversitystudentsinaMalaysian medicalschool:across-sectionalstudy KurubaranGanasegeran 1 ,SamiARAl-Dubai 1* ,AhmadMQureshi 2 ,Al-abedAAAl-abed 3 ,RizalAM 3 andSyedMAljunid 3,4 Abstract Background: Eatinghabitshavebeenamajorconcernamonguniversitystudentsasadeterminantofhealth status.Theaimofthisstudywastoassessthepatternofeatinghabitsanditsassociatedsocialandpsychological factorsamongmedicalstudents. Methods: Acrosssectionalstudywasconductedamong132medicalstudentsofpre-clinicalphaseataMalaysian university.Aself-administeredquestionnairewasusedwhichincludedquestionsonsocio-demography, anthropometry,eatinghabitsandpsychosocialfactors. Results: Mean(±SD)ageoftherespondentswas22.7(±2.4)yearsand(theage)rangedfrom18to30years.More thanhalfhadregularmealsandbreakfast(57.6%&,56.1%respectively).Majority(73.5%)consumedfruitslessthan threetimesperweek,51.5%hadfriedfoodtwiceormoreaweekand59.8%drankwaterlessthan2litersdaily. Eatinghabitsscorewassignificantlylowamongyoungerstudents(18 – 22years),smokers,alcoholdrinkersand thosewhodidnotexercise.( p 0.05).Fourpsychologicalfactorsoutofsix,weresignificantlyassociatedwitheating habits( p 0.05).Inmultivariateanalysis,ageand ‘ eatingbecauseoffeelinghappy ’ eatinghabitsscore( p 0.05). Conclusion: Mostofthestudentsinthisstudyhadhealthyeatinghabits.Socialandpsychologicalfactorswere importantdeterminantsofeatinghabitsamongmedicalstudents. Keywords: Eatinghabits,Lifestyle,Malaysiamedicalstudents,Socialandpsychological Background Pooreatinghabitsisamajorpublichealthconcern amongyoungadultswhoexperiencedtransitioninto universitylife[1],duringwhich,theyareexposedto stressandlackoftime[2,3].Thesefactorsposeabarrier againstadoptionofhealthybehaviors,suchaspooreat- inghabitsandsubstanceabuse[1].Althoughthesebeha- viorsofstudentsareconsideredtemporary,aspartof universitylife;unhealthyhabitspickedupatthisage generallypersistinolderadultlife[4]. Rapidchangesinphysicalgrowthandpsychosocialde- velopmenthaveplacedtheseyoungadultsasnutritionally vulnerablegroupswithpooreatinghabits,thatfailsto meetdietaryrequirements[5-7].Somecommonun- healthyeatingpatternsamongyoungadultsincluded mealskipping,eatingawayfromhome,snackingandfast foodconsumption[6,7]. Environmentalfactorsalsocontributetoadoptionof unhealthyeatinghabitsamonguniversitystudents[8]. Themushroomingofshoppingmalls,convenience stores,vendingmachinesandfastfoodoutletshavecre- atedanalarmingsituationforyoungadultstopractice unhealthyeatinghabits[9]. Universitystudentstendtomaketheirownfood choices[10]basedoncostoffoodandavailabilityoffast food[11].Theylackknowledgeofhealthyfoodchoices negatively[11].Previousstudiesrevealedthatuniversity *Correspondence: samidobaie@yahoo.com 1 DepartmentofCommunityMedicine,InternationalMedicalSchool, ManagementandScienceUniversity(MSU),OffPersiaranOlahraga,Section 13,40100ShahAlam,Selangor,Malaysia Fulllistofauthorinformationisavailableattheendofthearticle ©2012Ganasegeranetal.;licenseeBioMedCentralLtd.ThisisanOpenAccessarticledistributedunderthetermsofthe CreativeCommonsAttributionLicense(http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse, distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited. Ganasegeran etal.NutritionJournal 2012, 11 :48 http://www.nutritionj.com/content/11/1/48 studentsfailedtomeettherecommendedintakesoffruitsandvegetables[12,13].Universitystudentshadfre-quentsnackinghabits[14]andhadahigherfrequencyoffastfoodconsumption[15].Ithasbeenassumedthatmedicalstudentswouldprac-ticehealthydietaryhabitscomparedtonon-medicalstu-dents[16].Somestudieshavefoundotherwise.ApreviousstudyinChinarevealedthatmedicalstudentsexhibitedearlyriskfactorsforchronicdiseasesduetopooreatinghabits[17].Itwasfoundthatalthoughmed-icalstudentshadsufficientknowledgeregardinggooddietaryhabits,theyfailedtoapplythisknowledgeintopractice[2].Stressofuniversitylifeandmedicalstudyloadwouldbefactorsthatnegativelyinfluencetheirdiet[18].In2011,Ganetal.highlightedthepresenceofun-healthyeatingbehavioursandinadequatenutrientintakeamonguniversitystudents[11].Thestudyconcludedthattherewasaneedtopromotehealthyeatinghabitsamongyoungadultstoachieveahealthynutritionalsta-tus.Chin&Nasir(2009)[5]revealedthatmealskipping;particularlybreakfast,snackingandvariousweightlossdietarybehavioursweresomeoftheunhealthyeatingbehavioursdepictedbyMalaysianadolescentgirls.Thestudyconcludedthatpromotionofhealthyeatingwascrucialforfuturehealthwell-being.TherewasnostudyinMalaysiathatinvestigatedtherelationshipbetweeneatinghabitsandthepsychologicalfactorsamonguni-versitymedicalstudents.Thecurrentstudyisaimedatassessingthepatternsofeatinghabitanditsassociatedfactors,withfocusonpsychologicalfactorsamongmed-icalstudentsinaMalaysianuniversity.MethodologyStudysettingandpopulationThiscross-sectionalstudywasconductedamong140medicalstudentsataprivateuniversityinMalaysiabyusinguniversalsampling.Afterarrangementwithcourseco-coordinatorandlecturers,studentsfromthefirstyearmedicalfacultywereapproachedintheclassroomafterlectures.Theywereaskedtoparticipateinthisstudyvoluntarily.Objectivesandbenefitsofthestudywereexplainedtorespondentsorallyandinawrittenformattachedtothequestionnaire.Theywereassuredthatinformationobtainedwouldbeconfidentialandtheirparticipationwouldnotaffecttheircourseprogress.Awrittenconsentwasobtainedfromthosewhoagreedtoparticipate.ApprovalofthestudywasobtainedfromtheethicscommitteeoftheUniversity(approvalnumber:JMS5/0182).StudyinstrumentsWeusedaself-administeredquestionnaireoneatinghabitswhichwasadoptedfrompreviouspublishedstudies[14,15].Thequestionnaireconsistedofthreeparts.Thefirstpartincludedquestionsondemographicdata;suchasage,gender,educationlevel,maritalstatus,ethnicityandlivingcircumstances.Bodymassindex(BMI)andlifestyle;suchassmoking,alcoholintakeandexercisewerealsoincludedinthispart.Thesecondpartincludesquestionsoneatinghabitsandtypeofmealsconsumed(10items),suchasfrequencyofmeals,typeofmeal,vegetablesandfruitsconsumption,dailywaterintake,consumptionoffastfood,etc.Thethirdpartincludedquestionsonpsychologicalfactorsthatinflu-enceddietaryhabitsofrespondents.QuestionswereselectedfromthevalidatedCompulsiveEatingScale(CES)[16]thatwasusedtomeasureuncontrolledeatingpatternsamongcollegestudents;itemsincludedinthisstudywere:eatbecauseoffeelinglonelyfeeloutofcontrolwheneatingeatsomuchuntilstomachhurtseatbecauseoffeelingupsetornervouseatbecauseoffeelingboredeatbecauseoffeelinghappy.TheresponseoptionswereStatisticalanalysisTheStatisticalPackageforSocialSciences(SPSS)version16.0wasusedtoanalysethedatainthisstudy.TheBMIwascalculatedasweightinkilogramsdividedbyheightinsquaremetres(kg/m).Inthisstudy,basedontheWHOBMIcut-offsfortheAsianpopulation,aBMI18.5kg/mwascategorisedasunderweight,189kg/mthenormalrange,23.027.4kg/maspre-obese,27.534.9kg/masobeseClassI,35.039.9kg/masobeseClassIIand40kg/masobeseClassIII[19].TocheckforthevalidityoftheCompulsiveEatingScale(CES)amongtheMalaysianpopulation,anexploratoryfactoranalysiswasperformedusingprincipalcomponentmethodwithvarimaxrotationandCronbachsalphawasusedtotesttheinternalconsistencyofthescale.Eachitemofeatinghabitswasscored(1)iftheresponsewashealthyor(0)ifnonhealthy.Allitemsweresummedandthetotalscorewasobtained(minimum=0andmaximum=10).Thus,ahigherscoreoneatinghabitsindicatedbettereatinghabits.Descriptiveanalysiswasperformedforallvariables.Student-testandANOVAtestwereusedtocomparemeaneatinghabitsacrosssocio-demographicvariables.Testofnormaldistribu-tionofthetotalscoreofeatinghabitswasalsocon-ducted.Hierarchicalmultivariatelinearregressionwasusedtoobtainfactorsassociatedsignificantlywitheat-inghabitscore.Age,workingstatusofmother,drink-ingalcohol,exerciseandsmokingstatuswereenteredinthefirststep.Inthesecondstep,fiveoutofsixpsy-chologicalfactorsaffectingeatingbehaviorwereen-tered.Multicollinearitywascheckedbetweenindependentvariables.Ganasegeranetal.NutritionJournalPage2of7http://www.nutritionj.com/content/11/1/48 Socio-demographiccharacteristicsOnehundredandthirtytwooutof140studentspartici-patedinthisstudywitharesponserateof94.0%.Themajoritywasfemales(70.5%)andagedmorethan22years(old61.4%).MostofthemwereMalays(61.4%)whileIndiansandChineseconstituted(of)31.8%and2.3%respectively.Regardingmotherseducationlevel,44.7%hadtertiaryeducation,37.9%hadhighschoolorlessandtheresthadnon-formaleducation(17.4%).Regardingfatherseducation,majorityhadtertiaryedu-cation(51.5%),33.3%hadhighschoolorlessand15.2%hadnon-formaleducation.Themajorityofmotherswerenotworking(57.6%).ThemajorityhadanaveragemonthlyhouseholdincomeofRM3000orless(59.1%)andlivingwiththeirfamilies(64.4%).Themajorityhaddeniedsmoking(94.7%)andalcoholconsumption(97%).Alotofthemperformedregularexercise(78%),butsomedidnot(22%).Morethanhalf(53%)hadanormalBMI,22.7%wereunderweights,16.7%werepre-obeseand7.6%wereobeseClassI(Table1).EatinghabitsMorethanhalftookmealsandbreakfastregularly(57.6%,56.1%respectively).About57.6%hadsnackslessthanthreetimesperweekand42.4%tooksnacksthreeormoretimesperweek.Themajorityconsumedvegeta-blesandlegumesthreeormoretimesperweek(81.8%).Almosthalfofthem(51.5%)consumedfruitslessthanthreetimesperweek;therest(48.5%)tookitthreetimesormore.Manyhadfriedfoodtwiceaweekormore(73.5%),while26.2%tookitlessthantwotimes.Themajority(78.8%)hadfastfoodrarelyandtookmealswithfamilyorfriendsdaily(81.1%).Mostofthemhadabalancedvarietyoffoods(60.6%)while18.9%preferredmeatand5.3%preferredvegetables.Themajorityhadlessthantwoliterswaterintakedaily(59.8%)(Table2).PsychologicalfactorsaffectingeatingbehaviorCronbachsalphacoefficientoftheCompulsiveEatingScale(CES)was0.80.Theexploratoryfactoranalysesyieldedonefactorswithgivenvaluesgreaterthan1(3.1).Thetwo-factorsolutionaccountedfor51.0%ofthevariance.Factorloadingrangedfrom0.41to0.50.Nearly48.5%atebecauseoffeelinglonely,62.1%feltcompletelyoutofcontrolwhenitcomestofood,53.8%atetillstomachhurts,53%atebecauseoffeelingupsetornervousand59.1%atebecauseoffeelingbored.Themajorityatebecauseoffeelinghappy(80.3%)(Table3).Associationbetweeneatinghabitsandsocio-demographicfactorsMeantotalscoreofeatinghabitforalltheparticipantwas6.3(SD±1.8)andrangedfrom2to10.Meanwith(SD)totalscoreofeatinghabitswascomparedacrossthecat-egoricalvariablesinthestudy.Meanforthoseaged22yearsandthoseaged1821yearswas6.68(SD±1.66) Table1Socio-demographiccharacteristicsofrespondents(n=132)CharacteristicsN%Male3929.5Female9370.518-215138.6228161.4Malay8161.4Chinese32.3Indian4231.8Others64.5seducationlevelNon-formaleducation2317.4Highschoolorless5037.9Tertiaryeducation5944.7seducationlevelNon-formaleducation2015.2Highschoolorless4433.3Tertiaryeducation6851.5Monthlyhouseholdincome(RM)30007859.13001-49992216.750003224.2LivingarrangementLivingalone4735.6Livingwithfamily8564.4BodyMassIndex(BMI)*Underweight(18.5)3022.7Normal(18.522.9)7053.0Pre-obese(23.0-27.4)2216.7ObeseclassI(27.5-34.9)107.6MotherworkingYes5642.4Yes75.3Yes43.0RegularexerciseYes10378BMIiscalculatedbasedonWHOcriteriaforAsianpopulation.Ganasegeranetal.NutritionJournalPage3of7http://www.nutritionj.com/content/11/1/48 and5.86(SD±1.87)respectivelyandthisdifferencewassignificant(=0.01).Significantdifferenceineatinghabitsscorewasalsofoundbetweensmokers,4.86(SD±1.57)andnonsmokers,6.45(SD±1.76),(=0.02)andbetweenthosewhodrankalcohol,4.25(SD±2.06)andthosewhodidnot,6.43(SD±1.74),(=0.02).Nosignificantassoci-ationwasfoundbetweeneatinghabitsandothersocio-demographicfactors(Table4).AssociationbetweeneatinghabitsandPsychologicalMeanwith(SD)oftotalscoreofeatinghabitwascom-paredbetweenthosewhoansweredyesandthosewhoansweredoneachitemofthepsychologicalfactors.Meantotalscoreofeatinghabitforthosewhoatewhenlonelywas5.95(SD±1.78)andforthosewhodidnotwas6.75(SD±1.70)(=0.01).Meanforthoseatetillstomachhurtwas6.06(SD±1.76),andforthosewhodidnotwas6.72(SD±1.74)(=0.03).Meanforthosewhoatewhenupsetandthosewhodidnotwas6.07(SD±1.75)and6.69(SD±1.77)respectively(=0.04).Meanforthosewhoatewhenboredwas5.91(SD±1.67)andforthosewhodidnotwas7.02(SD±1.74)((Table5).FactorsassociatedwitheatinghabitsinthehierarchicalmultiplelinearregressionAge,workingstatusofmother,drinkingalcohol,exerciseandsmokingstatuswereenteredinthefirststep.Inthesecondstep,thefollowingfactorswereentered:eatbe-causeoffeelinglonelyfeeloutofcontrolwheneat-eatsomuchuntilstomachhurtseatbecauseoffeelingupsetornervouseatbecauseoffeeling.Theresultsfromthefirststepindicatedthatagewassignificantlyassociatedwitheatinghabitsscore=0.006).Inthesecondstep,factorsassociatedwitheatinghabitsscorewereage(=0.009),drinkingalcohol(p=0.037)andeatbecauseoffeelinghappy=0.009)(Table6).Thetotalmodelwassignificant(0.001)andaccountedfor19%ofthevariance.Therewasnomulti-collinearitybetweenvariables. Table2Eatinghabitsamongrespondents(n=132)CharacteristicsN%RegularmealsYes7657.6No5642.4DailybreakfastYes5843.9No7456.1FrequencyofdailymealsLessthanthreetimes7959.8Threeormoretimes5340.2Frequencyofhavingsnacks(perweek)Lessthanthreetimes7657.6Threeormoretimes5642.4Weeklyconsumptionofvegetables&legumesLessthanthreetimes2418.2Threeormoretimes10881.8WeeklyconsumptionoffruitsLessthanthreetimes6851.5Threeormoretimes6448.5WeeklyconsumptionoffriedfoodLessthantwice3526.5Twiceormore9773.5ConsumptionoffastfoodOften2821.2Rarely10478.8Mealswithfriends&familyDaily10781.1Notdaily2518.9TypeoffoodconsumedMainlymeat2518.9Mainlyvegetables75.3Carbohydrate(rice,bread)2015.2Varietyoffoodinbalance8060.6Waterintake(liters/day)27959.825340.2 Table3Psychologicalfactorsaffectingrespondentseatinghabitsamongrespondents(n=132)PsychologicalfactorsYesn(%)Non(%)Eatbecauseoffeelinglonely64(48.5)68(51.5)Feelcompletelyoutofcontrolwhenitcomestofood82(62.1)50(37.9)Eatsomuchuntilstomachhurts71(53.8)61(46.2)Eatbecauseoffeelingupsetornervous70(53.0)62(47.0)Eatbecauseoffeelingbored78(59.1)54(40.9)Eatbecauseoffeelinghappy106(80.3)26(19.7)Ganasegeranetal.NutritionJournalPage4of7http://www.nutritionj.com/content/11/1/48 DiscussionInthisstudy,morethanhalfofrespondentshadmealsregularlyand40.2%hadmealsofatleastthreetimesperday.ThisfindingwascomparativelylowerthanthatreportedbyaChinesestudyinwhich83.6%ofuniversitystudentsconsumedregularmeals,with79%ofthemtookatleastthreetimesperday[17].Anotherstudyreportedthat61.4%ofLebaneseuniversitystudentshadregularmealsdaily[14].Regularbreakfastconsumptionamongmedicalstudentsisimportantforsufficientenergyintaketoovercomefa-tigueduetobusy(daily)learningschedule[20].Inthisstudy,lessthanhalfofrespondents(43.9%)hadbreakfastdaily.Thisfindingwashigherincomparisontoapreviousstudy[14]whichfoundthat31.8%ofstudypopulationhadbreakfastdaily.However,somestudiesfromMalaysiafoundhigherratesofdailybreakfastconsumptionamongMalayundergraduatestudentsinSelangor(75.6%)[21]andfemaleadolescentsinPahang(52.6%)[5].Thefrequentconsumptionofsnacksandlightmealsisarecognizableaspectofteenagefoodbehavior[22].Sur-prisingly,ourstudyfoundthatonly42.4%ofrespon-dentshadsnackingatleastthreetimesperweek.Thisfindingwascomparativelylowerthanpreviousstudiesfromdifferentcountries,whichfoundgreaterproportionofSyrianadolescents(53.0%)andLebanonstudents(53.2%)[14,23]consumedsnacksregularly.Themajorityofrespondentsinourstudyconsumedvegetablesandlegumesfrequently(81.8%).ThisfindingwashighincomparisontopreviousstudiesfromChina(47.9%)[17]andBahrain(26.3%)[22].However,onestudyfromMalaysiafoundthatonly19%ofuniversitystudentsconsumedvegetablesmorethanthreetimesperweek[11].Ourstudyalsofoundthat48.5%ofrespondentsconsumedfruitsatleastthreetimesperweek.SimilarfindingwasreportedbyYahiaetal.,(2008)[14].Itwasreportedthatlowintakeoffruitsandvegeta-blesisassociatedwithseveralchronicdiseasesatadult-hood[24].Ourstudydisclosedthatmajorityofmedicalstudentswereawareofthishealthrisk.Thetypicaluniversitystudentdietisusuallyhighinfat[25].Studentsoftenselectfastfoodduetoitspalat-ability,availabilityandconvenience[14].Surprisingly,ourstudyfoundthatonly21.2%ofrespondentscon-sumedfastfoodoften.ChinandNasir,(2009)[5]reportedthatonly4.7%ofrespondentsvisitedfastfoodrestaurantsfrequently.Incontrast,Moyetal.,(2009)[12]reportedthat60-70%ofprimaryschoolstudentswerefondoffastfood.However,ourstudyalsofoundthatmajorityofrespondents(73.5%)consumedfriedfoodatleasttwiceaweekormore,whichwasinlinewiththatfoundbyapreviousstudy[14].Mostoftherespondentsinthisstudy(81.8%)hadmealswiththeirfamilyorfriends.Thisiscomparativelyhighertothatfoundbyapreviousstudyinwhich42.7%ofuniversitystudentshadmealswiththeirfamiliesorpeers[14].Smokingandalcoholconsumptionweresignificantlyassociatedwitheatinghabitinthisstudy.Similarfind-ingswerereportedamongChineseuniversitystudents[17].Ourstudyalsofoundasignificantassociationbe-tweenageandeatinghabits. Table4Associationbetweeneatinghabitsscoreandcategoricalvariables(n=132)CategoricalvariableMean(SD)Male6.28(1.82)Female6.40(1.77)0.7318-215.86(1.87)226.68(1.66)0.01Ethnicity*Malay6.31(1.81)Chinese8.33(1.53)Indian6.33(1.75)Others6.33(1.51)0.29educationlevel*Non-formaleducation6.99(1.56)Highschoolorless6.32(1.58)Tertiaryeducation6.19(1.99)0.25educationlevel*Non-formaleducation7.05(1.76)Highschoolorless6.32(1.68)Tertiaryeducation6.19(1.99)0.16householdincome*30006.36(1.71)3001-49996.23(1.54)50006.47(2.11)0.88arrangementAlone6.40(1.79)Withfamily6.30(1.78)0.75Yes6.04(1.61)No6.61(1.87)0.07Yes4.86(1.57)No6.45(1.76)0.02Yes4.25(2.06)No6.43(1.74)0.02Yes6.51(1.81)No5.86(1.60)0.09BodyMassIndexUnderweight(18.5)6.23(1.57)Normal(18.522.9)6.47(1.90)Pre-obese(23.0-27.4)6.68(1.67)ObeseclassI(27.5-34.9)5.30(1.49)0.20OnewayANOVAtestwasusedtocomparemeanbetweencategories.Ganasegeranetal.NutritionJournalPage5of7http://www.nutritionj.com/content/11/1/48 Attendingauniversityorcollegecanbeastressfulex-perienceformanycollegestudents[26].Previousstudiesfoundthatbehavioralconsequencesofstressmayaffecteatinghabits[27,28].Peoplelivinginastressfulsocietytendtoeatmoreasawayofcopingwithstress[26].ApossiblenewinnovationinthisstudywastheassociationbetweeneatinghabitsandpsychosocialfactorsamongMalaysianmedicalstudents;eatinghabitsscoreinthisstudywassignificantlyloweramongthosewhoansweredonthefollowingstatements:eatbecauseoffeelinglonelyeatuntilstomachhurtseatbecauseoffeelingupsetornervouseatbecauseoffeelingboredKagan&Squires,(1984)[16]suggestedthatuncon-trolledeatingpatternsamongcollegestudentscouldbeduetocompulsiveeatingbehaviors.Withtheparadigmshifttowardsindustrializationandculturalchangeglo-bally,informationonhealthydiethasbecomescarceinmanydevelopinganddevelopednations.Themostvul-nerablegroup,beinguniversitystudents,haveadoptedunhealthyeatingbehaviorsduetoreducedavailability,affordabilityandaccessibilityofhealthydietinuniversitycampusesandsurroundingfoodoutlets.Thisstudyexhibitedmulti-factorialcausesaffectingeatinghabitsamongMalaysianuniversitystudents.Understandingthecontextsofsuchmulti-factorialcausesmayhelphealthyfoodpromotionalactivitiesbyparents,universityauthor-ities,foodprovidersandhealthpromotionofficers.Resultsofthisstudymayhelptocreateafoundationforpossibleinterventionalprogramsonhealthyeatinghabitspromotions.Blendedwithdifferentsocio-culturalandpsychologicalattributesacrossdifferentregions,aunifiedhealthyeatingpolicyshouldbedrafted,beingpo-tentiallyamalgamatedandpracticedinallregionsin-cludingdevelopinganddevelopednations.Ingeneral,mostofthestudentsinthisstudyhadhealthyeatinghabitsexceptinfrequencyofmeals,fruitcon-sumption,waterintakeandconsumptionoffriedfood.Socialandpsychologicalfactorswereimportantdeter-minantsofeatinghabitsamongmedicalstudents.Nutri-tionaleducationamongmedicalstudentsshouldbeencouragedtopromotehealthiereatinghabitsandlife-styles,aswellasadherencetothehealthiertraditionalfood.Itisrecommendedthatthescopeoffutureresearchshouldbebroadenedtoincludealargerrepre-sentativesamplesizeofmedicalstudentsbyincludingstudentsfromdifferentmedicalcolleagesfromallMalaysia. Table6Resultsofthehierarchicalmultiplelinearregression;factorsassociatedwitheatinghabitsscore(n=132)Step1Step2BBetavalueBBeta22yearsold0.6750.2380.0060.6290.2220.009Motherworking0.3440.0960.2640.2830.0790.349Drinkingalcohol1.5140.1460.1392.0900.2020.037Exercise0.6190.1450.0830.5460.1280.121Smoking0.9060.1150.2510.3940.0500.613Eatbecauseoffeelinglonely0.2290.0650.478Eatbecauseoffeelingoutofcontrolwheneating0.5440.1490.096Eatsomuchuntilstomachhurts0.4100.1150.199Eatbecauseoffeelingupsetornervous0.0930.0260.778Eatbecauseoffeelinghappy0.931.2580.009Thereferencegroupforageis18-21years;forexerciseis;forallothervariablesis Table5Associationbetweeneatinghabitsscoreandpsychologicalfactors(n=132)PsychologicalfactorsMean(SD)YesNoEatbecauseoffeelinglonely5.95(1.78)6.75(1.70)0.01Feelcompletelyoutofcontrolwhenitcomestofood6.32(1.85)6.44(1.08)0.70Eatsomuchuntilstomachhurts6.06(1.76)6.72(1.74)0.03Eatbecauseoffeelingupsetornervous6.07(1.75)6.69(1.77)0.04Eatbecauseoffeelingbored5.91(1.67)7.02(1.74)Eatbecauseoffeelinghappy6.31(1.82)6.58(1.63)0.50Ganasegeranetal.NutritionJournalPage6of7http://www.nutritionj.com/content/11/1/48 Abbreviations CI:Confidenceinterval;OR:Oddsratio;CES:CompulsiveEatingScale; BMI:BodyMassIndex;SD:StandardDeviation. Competinginterests Theauthorshavenocompetingintereststodeclare. Acknowledgements WewouldliketothankFairuzBintiYusoff(InternationalMedicalSchool, ManagementandScienceUniversity(MSU)forherparticipationindata collection. Authordetails 1 DepartmentofCommunityMedicine,InternationalMedicalSchool, ManagementandScienceUniversity(MSU),OffPersiaranOlahraga,Section 13,40100ShahAlam,Selangor,Malaysia. 2 CommunityMedicineandPublic Health,CyberjayaUniversityCollegeofMedicalSciences,No.3410,Jalan Teknokrat3,Cyber4,63000Cyberjaya,Selangor,Malaysia. 3 Community HealthDepartment,FacultyofMedicine,UniversitiKebangsaanMalaysia (UKM),JalanYaacobLatiff,56000Cheras,KualaLumpur,Malaysia. 4 United NationsUniversity-InternationalInstituteforGlobalHealth,JalanYaacob Latiff,56000KualaLumpur,Malaysia. Authors ’ contributions SARandKBdesignedtheresearchstudy.AMQandAAAconductedthedata entry,datacleaninganddescriptiveanalysis.SARandKBwereresponsible fordataanalysisandinterpretationofresults.SAR,KBandAMQwrotethe paper.RAMandSMArevisedthefinaldraftcriticallyforimportantintellectual content.Allauthorsreadandapprovedthefinalmanuscript. Received:23April2012Accepted:18July2012 Published:18July2012 References 1.NelsonMC,StoryM,LarsonNI,Neumark-SztainerD,LytleLA: Emerging adulthoodandcollege-agedyouth:Anoverlookedagefor weight-relatedbehaviorchange. Obes 2008, 16 (10):2205 – 2211. 2.RubinaA,ShoukatS,RazaR,ShiekhMM,RashidQ,SiddiqueMS,PanjuS, RazaH,ChaudhryS,KadirM: Knowledgeandpracticeofhealthylifestyle anddietaryhabitsinmedicalandnon-medicalstudentsofKarachi, Pakistan. JPakMedAssoc 2009, 59 (9):650 – 655. 3.WebbE,AshtonCH,KellyP,KamahF: AnupdateonBritishmedical students ’ lifestyles. MedEduc 1998, 32 :325 – 331. 4.SillimanK,Rodas-FortierK,NeymanM: Asurveyofdietaryandexercise habitsandperceivedbarrierstofollowingahealthylifestyleinacollege population. CalifornianJHealthPromot 2004, 2 (2):10 – 19. 5.ChinYS,MohdNM: Eatingbehaviorsamongfemaleadolescentsin KuantanDistrict,Pahang,Malaysia. PakJNutr 2009, 8 (4):425 – 432. 6.SavigeGS,BallK,WorsleyA,CrawfordD: Foodintakepatternsamong Australianadolescents. AsiaPacJClinNutr 2007, 16 :738 – 747. 7.ShiZ,LienN,KumarBN,Holmboe-OttesenG: Socio-demographic differencesinfoodhabitspatternsofschoolchildrenandadolescentsin andpreferencesofschooladolescentsinJiangsuProvince,China. EurJ ClinNutr 2005, 59 :1439 – 1448. 8.DowdaM,AinsworthB,AddyC,SaundersR,RinerW: Environmental influences,physicalactivityandweightstatusin8to16yearolds. ArchivesofPediatricandAdolescentMedicine 2001, 155 :711 – 717. 9.KingKA,MohlK,BernardAL,VidourekRA: Doesinvolvementinhealthy eatingamonguniversitystudentsdifferbasedonexercisestatusand reasonsforexercise? CalifornianJournalofHealthPromotion 2007, 5 (3):106 – 119. 10.SatalicZ,BaricIC,KeserI: DietqualityinCroatianuniversitystudents: Energy,macro-nutrientandmicro-nutrientintakesaccordingtogender. IntJFoodSciNutr 2007, 58 (5):398 – 410. 11.GanWY,MohdNM,ZalilahMS,HaziziAS: Differencesineatingbehaviours, dietaryintakeandbodyweightstatusbetweenmaleandfemale Malaysianuniversitystudents. MalJNutr 2011, 17 (2):213 – 228. 12.MoyFM,JohariS,IsmailY,MahadR,TieFH,WanIsmailWMA: Breakfast skippinganditsassociatedfactorsamongundergraduatesinapublic universityinKualaLumpur. MalJNutr 2009, 15 (2):165 – 174. 13.HuangTTK,HarriesKJ,LeeRE,NazirN,BornW,KaurH: Assessing overweight,obesity,dietandphysicalactivityincollegestudents. JAm CollHealth 2003, 52 (2):83 – 86. 14.YahiaN,AchkarA,AbdallahA,RizkS: Eatinghabitsandobesityamong Lebaneseuniversitystudents. NutrJ 2008, 7 (32).doi:10.1186/1475-2891-7- 32.http://www.nutritionj.com/content/7/1/32. 15.AlizadehM,GhabiliK: HealthrelatedlifestyleamongtheIranianmedical students. ResBiolSci 2008, 3 (1):4 – 9. 16.KaganDM,SquiresRL: Compulsiveeating,dieting,stressandhostility amongcollegestudents. JCollStudPers 1984, 25 (3):213 – 220. 17.SakamakiR,ToyamaK,AmamotoR,LiuCJ,ShinfukuN: Nutritional knowledge,foodhabitsandhealthattitudeofChineseuniversitystudents: acrosssectionalstudy. NutrJ 2005, 4 (4).doi:10.1186/1475-2891-4-4. 18.MikolajczykR,ElAnsariW,MaxwellA: Foodconsumptionfrequencyand perceivedstressanddepressivesymptomsamongstudentsinthree Europeancountries. NutrJ 2009, 8 (1):31. 19.WHOExpertConsultation: Appropriatebody-massindexforAsian populationsanditsimplicationsforpolicyandinterventionstrategies. Lancet 2004, 363 :157 – 163. 20.TanakaM,MizunoK,FukudaS,ShigiharaY,WatanabeY: Relationships betweendietaryhabitsandtheprevalenceoffatigueinmedical students. Nutrition 2008, 24 :985 – 989. 21.AnuarK,GhazaliM: Theassociationofbreakfastconsumptionhabit, snackingbehaviorandbodymassindexamonguniversitystudents. Am. J.Food.Nutr 2011, 1 (2):55 – 60. 22.MusaigerAO,BaderZ,Al-RoomiK,D ’ SouzaR: Dietaryandlifestylehabits amongstadolescentsinBahrain. Food&NutritionResearch 2011, 55 :7122. doi:10.3402/fnr.v55i0.7122. 23.BashourHN: Surveyofdietaryhabitsofin-schooladolescentsin Damascus,SyrianArabRepublic. EasternMediterraneanHealthJournal 2004, 10 (6):853 – 862. 24.KerkadiA: EvaluationofnutritionalstatusofUnitedArabEmirates universityfemalestudents. EmiratesJAgriculturalSci 2003, 15 :42 – 50. 25.GaloreSR,WalkerC,ChandlerA: BriefCommunication:Dietaryhabitsof firstyearmedicalstudentsasdeterminedbycomputersoftwareanalysis ofthree-dayfoodrecords. JAmCollNutr 1993, 12 :517 – 520. 26.GowerB,HandCE,CrooksZK: Therelationshipbetweenstressandeating incollege-agedstudents. UndergraduateResearchJournalfortheHuman Sciences 2008, 7 :ISBN1-929083-13-0.http://www.kon.org/urc/v7/crooks.htm. 27.TorresS,NowsonC: Relationshipbetweenstress,eatingbehaviorand obesity. Nutrition 2007, 23 (11 – 12):887 – 894. 28.AdamT,EpelE: Stress,eatingandtherewardsystem. PhysiolBehav 2007, 91 :449 – 458. doi:10.1186/1475-2891-11-48 Citethisarticleas: Ganasegeran etal. : Socialandpsychologicalfactors affectingeatinghabitsamonguniversitystudentsinaMalaysian medicalschool:across-sectionalstudy. NutritionJournal 2012 11 :48. Submit your next manuscript to BioMed Central and take full advantage of: € Convenient online submission € Thorough peer review € No space constraints or color “gure charges € Immediate publication on acceptance € Inclusion in PubMed, CAS, Scopus and Google Scholar € Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit Ganasegeran etal.NutritionJournal 2012, 11 :48 Page7of7 http://www.nutritionj.com/content/11/1/48