Nutritional Habits and Weight Status among Jazan University Students: Eating Patterns and Healthy lifestyle Assessment

Background: The purpose of this study is to assess the prevalence of underweight, overweight and obesity and to evaluate the nutritional habits and related factors among Jazan University students. Methods: This cross-sectional study was carried out during the 2014/2015 academic year in Jazan University in Gizan in the southwest of the Kingdom of Saudi Arabia (KSA). A total of 436 students 19–25 years were examined. The questionnaire involved items on eating habits, lifestyle and socio-demographic characteristics; these were completed by the students. Data on weight and height were also collected. The data were analysed using descriptive statistics and a Chi-square test. The differences were considered statistically significant at p-value < 0.05. Results: The mean weight for males and females were 67.84 and 54.79 kg, respectively, with significant differences between males and females (p-value <0.05). The mean BMI for all study participants was reported as 23.31 kg/ m² with a significant difference according to gender. About 45% of the students were normal weight; the rate of underweight and obesity among students was very high (21.1% and 33.6% respectively). The dietary habits were unhealthy. The regularity of meals was only 16.5% and 20.4% and reported snacking during the day was 83.3% and 95.1% for males and females, respectively. Conclusion: The results show that the prevalence of overweightness and obesity were very high among the university students. The study shows the need for health education programs to increase student’s awareness towards healthy eating and lifestyle changes.


INTRODUCTION
It is well known that what a person eats has a profound effect on his/her health. The human choice of foods is a complex process involving a multiplicity of influencing factors such as socioeconomic factors, cultural effects, access to and availability of food as well as education and a person's age [1,2] Maintaining a healthy weight is an important way to make sure that the person will stay in good health and e11658-1 reduce the likelihood of developing a number of long-term health problems. Being overweight or obese increases the risk of developing health problems including coronary heart disease, stroke, type 2 diabetes, osteoarthritis and some types of cancer [3][4][5][6]. On the other hand, being underweight is associated with increased mortality relative to the normal weight category [3,7].
The literature suggests that admission to the university is a new stage of life for students that is generally associated with independence, social activities, changes in lifestyle and behavior including changes in nutritional habits [8,9]. The nutritional habits of university students is affected by a complex web of factors involving exposure to more stress that can lead to increased or decreased food intake as well as spending more time on studying with less physical activity-especially for medical students. This can cause dependence on fast food with less nutritional value and rich in fat and sugar. Prolonged travel time including simply sitting or spending a long time in vehicles during trips to and from colleges are also important factors affecting the nutritional status of university students [10].
Many domestic and international studies have assessed the nutritional habits and weight status among university students [10][11][12][13][14][15][16][17][18], but until now there is no study conducted in the Jazan region in southwest Saudi Arabia. The main objective of this study was to assess the nutritional habits, weight status and associated factors among Jazan university students.

Study design and place
This was an observational cross-sectional study conducted in Jazan University. Jazan University is a leading educational institution in Jazan region, which is located in southwest Saudi Arabia. The university was established in 2006 and is now populated by more than 50,000 students. It has 18 colleges and four research centers. All students in this study had registered for the academic year 2014/2015 and were 19 -25 years old.

Sampling
The sample size for this study was calculated to be 450 students based on a sample size formula for cross-sectional study design [19]. Parameters used for sample size estimates: P=50%, 95% Confidence Interval (C.I.), error below 5% and a non-response rate of 10%. The sampling design was stratified random sampling where university faculties were divided into three groups-clinical, scientific and other colleges. Two colleges were randomly selected from each stratum. The selected colleges were the college of Medicine and Applied Medical Sciences College. These represent the clinical sections. Two scientific colleges were selected to represent the scientific sector. The colleges of Engineering and Arts represented the other sectors of the university. The final sample size was distributed among the selected colleges proportionate to the actual student's size in the different colleges. Systematic random sampling was used for selecting students from each selected college.

Data collection
A standardised self-administered questionnaire was used for data collection. The questionnaire was designed after consulting a number of previous studies conducted in the same domain [12][13][14][15]18]. The final questionnaire contained approximately 40 multiple-choice questions. The questions include social and demographic information, dietary (food) habits and physical activity. Other information included anthropometric data, measurements, nutritional habits as well as student weight and height. Height and weight were measured using standardised instruments and the work was conducted by the study team.

Statistical analysis
To ensure the quality of the data collection stage, the fieldwork supervisor reviewed the questionnaires daily. Any errors or inconsistencies were reviewed and corrected immediately. At the data entry stage, data were reviewed for errors and entered into an excel database by the study team. The SPSS version 20 (SPSS Inc, Chicago, IL, USA) was used for data analysis. Statistical analysis involved descriptive statistics as well as inferential statistics. Descriptive statistics included simple tabulation, frequencies and proportion for categorical variables including cross-tabulations. Data on underweight and overweight students as well as differences in nutritional habits and other categorical variables were compared for significance using the Chi Square test. The Yates correction term was also used to ensure the accuracy of the Chi Square test. P-value less than 0.05 was used to indicate statistical significance. The Body Mass Index (BMI) was categorised according to World Health Organization (WHO). These guidelines suggest that individuals with (BMI< 16.0 kg/m2) are severely underweight, (BMI= 16.0-18.4 kg/m2) as underweight, (BMI= 18.5-24.9 kg/m2) as normal weight, (BMI= 25.0-30.0 kg/m2) as overweight, and (BMI≥ 30.0 kg/m2) as obese [20].

Ethical aspects
Ethical approval for the current study was obtained from the college of Medicine, Jazan University. Participants were told that they have the right to not participate in the study or to withdraw from the study if they wish at any time. The participant's privacy was respected and data were kept confidentially and utilised for study purposes only. Participants were asked to read and sign a consent form. This was before the start of data collection.

RESULTS
The response rate was 96.9% (436 out of 450) students. Table 1 provides background characteristics of the study participants including age, college name, marital status, etc. The table showed that most students (61.0%) were 22-24 years old, 83.4% were single and 60.5% live in urban areas with 39.5% in rural areas. Their academic grades ranged from 3-4 with 45.7% in the three different colleges. The mean weight for males and females were 67.84 and 54.79 kg, with significant differences between males and females (P-value <0.05). The mean BMI for all study participants was 23.31 kg/m² also with a significant difference between males and females ( Table 1). Figure 1 illustrates the prevalence of overweight, underweight and normal weight among the students. According to this graph, 45% were normal weight and 21% were underweight [95% C.I. 17.1%-24.7%]; 34% were overweight [95% C.I. 28.9%-37.7%]. Severe underweight students accounted for 5% and obese students were 14% of the cohort (Figure 1). Table 2 compares weight status between males and females students and across faculties. There is a significant difference in the weight status between males and females. The men are more likely to be obese and women were more likely to be underweight. A comparison of these indicators across faculties showed no significant difference between males and females ( Table 2). Table 3 compares the nutritional habits between male and female students and across university colleges. The results showed that males consumed energy drinks more than females and females use snacks more than males. The results showed that there is no significant difference between colleges regarding nutritional habits. Moreover, the results showed a high per cent in the consumption of soft drinks. There is little meal regulatory with many reports of fast food and snacks (Table 3). Table 4 shows changes in the nutritional patterns and weight status after entry to the university-the results showed that 80.2% of students reported changes in their nutrition habits (8.6% improved, 71.6% worsened). Also, almost 86.2% of students reported changes in their weight (30.5% decrease, 55.7% increase) ( Table 4).

DISCUSSION
The aim of this study was to assess nutritional habits, weight status and related conditions among Jazan university students. The study provides new data on this important aspect of students' life. No similar study has been conducted in this region. It is well documented that being underweight or obese can lead to increased mortality [3,7].
The chance of admission to higher education is an outstanding opportunity for students and is usually associated with psychosocial development in young students where new behavior patterns are adopted [8]. The period of undergraduate study usually represents the first occasion for students to begin taking responsibility for their own eating behavior and behave independently regarding his/her personal affairs [9].
Our results showed that the prevalence of normal weight was 45%-21% were underweight and 34% were overweight. The rate of underweight is considered very high versus international studies [12,13]. The prevalence of being overweight is similar to national studies conducted in KSA [11,21], but higher than many international studies conducted in Turkey and Serbia [16,17].
When using female BMI values, 25.5% were underweight and 15.6% were overweight. This rate of underweight is high versus international and national studies conducted among university female students [9,21].
Regarding nutritional habits, the percentage of students consuming fast food was 29.6% for males and 20.5% for females-this pattern is similar to other international studies [22,23]. Also there is a high rate of consumption of energy drinks (55.6% and 35.5%) in men and in women, respectively-this is similar to other studies in KSA [24] and other Arabian countries [25].
One potential limitations of this study is that it was based on a cross-sectional survey design. The direction of  relationships and causal relationships cannot be determined. In addition, the use of a self-administered questionnaire on dietary assessment may produce subjective measurements that are less reliable than objective methods. Finally eating behaviour was investigated as a whole with no possibility to establish specific nutritional risks in these university students.
Despite these limitations, the study updated our knowledge about the nutritional status of university students in the Jazan region and highlights the role of health education in improving food consumption patterns in this population.

CONCLUSION
The results of this study showed the importance of promoting healthy nutrition among the college students. It underscores the importance of regular follow-up and training in healthy eating to remove unhealthy nutritional habits .The study emphasised the need for health education programs in nutritional education to increase awareness of healthy lifestyle and healthy eating habits. Better awareness may motivate them to practice healthy lifestyles and recognise the importance of preserving their own health. Finally, the university administration should confirm that appropriate healthy food is available in the college's cafeteria and incorporate courses on healthy lifestyle and nutrition.