The burden of non-communicable diseases is increasing globally and poses a major public health concern, a large part of which is preventable^1,2. The rapid increase of overweight and obesity, especially in the younger generation, in many low and middle-income countries like India, due to inappropriate diet and inactive lifestyle, foretells us overwhelming chronic disease burden in the next 10–20 years if no intervention is carried out³. These diseases have been strongly associated with unhealthy dietary habits, including inappropriate nutrition, caffeine overuse, skipping meals and snacking between meals^1,4.

Approximately 80% of heart diseases, stroke and type-2 diabetes and 40% of cancer could be avoided through a healthy diet, appropriate nutrition, regular physical activity, avoidance of tobacco use and alcohol consumption^1,2. Universities and colleges are potentially important targets for the promotion of healthy lifestyles of the adult population⁵. Inappropriate diet and irregularities in diet are independent risk factors for obesity, which is multi-factorial in origin⁶. Obesity is a key risk factor in natural history of other chronic and non-communicable diseases⁷.

College life is an important stage for adolescents, as at this time their behaviours are conducive to change⁸. It is also a period during which individuals are, for the most part, exposed to stress and lack of time, posing a barrier to adoption of healthy practices⁴. These barriers prevent them from practicing healthy habits, despite being equipped with knowledge⁸. Although behaviours of students are considered a temporary part of college life, however, unhealthy habits learnt during this period generally persist in the adult life⁹. Medical students are assumed to have a greater knowledge about healthy lifestyle and dietary habits when compared with non-medical students. However, there is no evidence to indicate that this knowledge translates into practices in medical students; this is even more important as they are the future physicians, and the students who personally ignore adopting healthy lifestyle are not likely to influence their patients⁸.

The present study is an endeavour to study the dietary habits and the factors that influence them among the undergraduate medical students of the PES Medical College, Kuppam.

A cross-sectional study was carried out in the PES Institute of Medical Sciences and Research (PESIMSR), Kuppam, Chittoor District, Andhra Pradesh, India, from January to December 2011. The study population comprised of undergraduate medical students from first to final year part II MBBS. The study was approved by the Institutional Ethics Committee of the PESIMSR. All undergraduate medical students present in the college during this period were included in the study. Interns, repeaters and chronic absentees were not included.

A pilot study was conducted on a batch of 19 students. After explaining the purpose of the study and taking written informed consent, the students were given a self-administered questionnaire. All students of that batch participated in the study. Based on the practical experience of the pilot study, the proforma was redesigned.

Table 1 shows the socio demographic profile of the students. Majority of the students (51.1%) were from town, while 30.7% of the students came from city and the rest were from village background. Approximately 88% of the students belonged to nuclear families, while 12% of the students belonged to joint families. Majority of the students belonged to Hindu religion. The students predominantly resided in hostel premises (98.7%) within the college campus and consumed food from the hostel mess.

Table 2 shows that 83% of the students were taking mixed diet, i.e. both vegetarian and non-vegetarian foods. A total of 10% of the students were taking vegetarian foods along with eggs. Only 7% of the students were pure vegetarians, who were not consuming non-vegetarian foods in any form. This pattern of dietary habit was similar across all the years of MBBS. Pure-vegetarian and eggetarian diet was consumed more by female students (8.8 and 10.8%, respectively), while mixed diet was consumed more by males.

The mean calorie consumption in males was 2171 ± 278 kcal and in females 1892 ± 264 kcal. The mean protein consumption in males was 52.58 ± 7.6 g and in females 45.5 ± 7.4 g.

Table 3 depicts that only 58.9 and 43.7% of the students consumed diet adequate in calories and proteins, respectively. Male students consumed diet deficient in calories more than females (33.8 vs. 22.3%), whereas, female students’ diet was more deficient in proteins than males (62.2 vs. 49.5%).

When questioned about their food (menu) preferences, if given a choice, the students’ preferences were as follows:

Nearly 13 and 31% of the students preferred to have non-vegetarian foods for lunch and dinner, respectively.

A total of 73% of the students had snacks once a day, while 18.9% of the students, twice daily and the rest (8.1%) did not have snacks regularly. When asked about their snacks, 68.5% liked to have milk and milk products and only 13.1% consumed fresh fruits and vegetables as snacks.

This study reports that 9.1% of the students liked to have junk foods every day, with ice cream (18.8%), chats (16.8%) and chocolates (16.2%) quoted as favourite choices.

Majority of the students’ menu is influenced by themselves (62.5%), while 14.4% are influenced by their parents and 5.4% by their friends. In total, 6.2% responded that finance and time are the important driving influences while selecting foods. Only 1.5% of the students are influenced by their teachers or curriculum in selecting diet.

Approximately 56% students skipped meals, as shown in Table 4. Meal skipping pattern among males and females was almost equal (50.6 vs. 49.4%). In the first three academic years (65, 54 and 62%, respectively), the meal skipping pattern was similar. However, final year part II students were regular in taking meals (36% skipped meals) when compared with the first three academic years. There was a statistically significant association between skipping meals and MBBS years.

Of the students who skipped meals, 74.6% of the students skipped breakfast, while 14.3% skipped lunch and the rest dinner. Majority of the students (46.1%) quoted ‘disliking food’ as the most common reason for skipping meals, followed by ‘no time’ by 32.9% of the students. In all, 14% of the students missed meals voluntarily because they were conscious of their body image and 4% of the students missed meals only during exams. A total of 3% of the students give ‘non-availability of foods’ as the reason for missing meals.

When asked about the most important meal of the day, 294 students (48%) responded that breakfast was most important, followed by lunch (37.5%) and dinner (14.5%). Though this knowledge seems to be satisfactory, when split according to MBBS year wise, it was seen that there was a gradual increase in the knowledge as the academic years passed by. Majority of the correct responses were from the final year students (57%) and least from the first year students (41.7%). There was a statistically significant association (X² = 18.688, df = 6, P = 0.005) observed between this knowledge and MBBS years.

Regardless of the predisposing factors, dietary habits have a great influence on the morbidity and mortality in life. Due to the cumulative effect of adverse factors throughout the life of an individual, it is particularly important to adopt a healthy diet and dietary habit. This study assessed the dietary habits of medical students who represent a significant community of future health practitioners. We observed that most of the students did not meet the recommended dietary allowance of calories and proteins. This was observed in many studies conducted in university settings, wherein most college students have poor nutritional habits^10–14. Sajwani et al.⁸ report that in their comparative study between medical and non-medical students, non-medical students’ diet practices were better than medical students.

We found that majority of the students (73%) snacked once a day, which is in contrary to other studies, which report higher frequency of snacking^5,8,9,15. They report higher snacking rate among females than males, with consumption of coloured fruits and vegetables^5,16. In our study, only 13% of the students liked to have fruit juices and fresh vegetables, and no gender differences were observed.In a study conducted by Nisar et al. ¹⁷ among medical students, 96.4% of the students consumed junk foods daily in contrast to our study, wherein only 9% of the students consumed junk foods daily. Junk food consumption was associated with being four times overweight as compared with those who did not consume junk food (OR=4.47, 95% CI= 0.93–29.5)¹⁷.

As far as the meal skipping patterns are considered, many studies report that more than half of the medical students skip their meals atleast once a day and breakfast was the common missed meal^8,9,17,18 similar to this study. University non-medical students take meals regularly three times daily, with less frequency of meal skipping^5,8,16. In contrary to our study which reported disliking foods, ‘lack of time’ was identified as the most important reason for skipping meals in many studies^8,9. Skipping breakfast has been associated with lower nutritional status and an increased risk of developing cardiovascular diseases in the future¹⁹. It has also been reported that less adequate breakfast habits may contribute to obesity²⁰.

Many studies have reported that, in terms of eating habits, medical students usually do not follow healthy eating habits^6,8,17,18. Sajwani et al.⁸ reported that medical students did not consciously make an extra effort to choose a healthier lifestyle (e.g. by restricting salt, sugar, spice and fat) or to eat healthy food (i.e. by reading food labels). The typical medical student diet is high in fat and low in fruits and vegetables. Students often select fast food due to its palatability, availability and convenience²¹. These findings are cause for concern because there is ample data suggesting that fruit and vegetable consumption may be protective against most cancers and cardiovascular disease due to variousantioxidants, folate, fibre, potassium, flavonoids and numerous other phytochemicalspresent in them^22,23.

This study was carried out to ascertain the dietary habits of undergraduate medical students who are enrolled in a 5-year health sciences programme. It was observed that majority of the students did not meet the recommended dietary allowance of calories and proteins. Skipping meals, particularly breakfast,and junk food consumption was common and consumption of fruits and vegetables was minimal. Their food habits in general were poor. Medical students have a greater know-how on health issues and their implications, but they are not putting knowledge into practice. The university and college arenas represent the final opportunity for nutritional education of a large number of students. Our findings suggest the need for strategies designed to improve competence in the area of nutrition, especially with respect to information relating to sources of nutrition and healthy weight management.

SES - Socio economic status, AICPI - All India Consumer Price Index

X² = 21.266, df = 3, P<0.0001

References