Dietary Habits of Saudi Medical Students at King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia

Introduction:

"Dietary habits are the total consumption of food, and an analysis of dietary habits provide evidence related to the food consumption habits within a large population, important for predicting disease risk [1]." "Food consumption differs between communities, depending on culture or personal preference. Every diet can be helpful or harmful to a person [2]." "An individual’s health depends to a large degree on the food they consume, which may produce a feeling of wellbeing or diseases and conditions such as diabetes mellitus, obesity and hypertension [2] with a high risk of morbidity and mortality [3]." "Food is known to play a major role in the development of such diseases [4]."

"Dietary habits in younger age groups have public health implications because poor nutrition in childhood causes obesity and increased risk for type 2 diabetes, metabolic syndrome, and cardiovascular diseases [5]." "Younger people, including college students, frequently consumes an unhealthy diet, which may affect their health and increase their risk of obesity, diabetes and coronary heart disease [6.7]."

"Due to the accelerated growth in Saudi Arabia, food consumption and lifestyle have changed, affecting all age groups but mainly children and adolescents [8,9]." "Previous studies from Saudi Arabia investigating the dietary habits and lifestyle of children, adolescents and university students, reported that younger age groups tend to consume an unhealthy diet[10,11]."

"Reviewing the literature, few studies focused on medical students asit is accepted that they are exposed to clinical knowledge related tothe benefits of a healthy lifestyle and are knowledgeable about the poor outcomesrelated to an unhealthy diet [12,13]." Local studies in Saudi Arabia are limited. "Only one study which was from Al Qahtani (2016) [3] which reported that medical students, regardless of gender and academic year, are consuming an unhealthy diet and had a lifestyle compared with the population." The aim of the current study was to assess the dietary habits and physical activity, and their relationship with the gender, economic status, and academic level of the medical students at KSAU-HS. Knowing more about the dietary habits and lifestyle choices of Saudi medical students will facilitate the development of initiatives to create or increase awareness.

Materials and methods:

"This was a cross-sectional survey study of Saudi medical students at KSAU-HS. The data-collecting instrument was a pre-validated questionnaire [3], implemented after receiving permission to use the questionnaire from the corresponding author. "In addition to demographic data, the questionnaire included questions related to fast food consumption and physical activity, the frequency, income and academic level. The calculated sample size for this study was 259 medical students from both genders and all academic levels. Quota sampling has been used in the selection of the sample for using gender and academic year as strata. The population was firstly divided in male and female subgroups, and a specified proportion was selected for each academic year. The questionnaires were distributed to the students by the study authors, and they invited to completethe questionnaire after an explanation of the aims and objectives of the study, and assurance of confidentiality.

Statistical analysis:

An Excel spread sheet was used for data entry and SPSS 20 for the data management and analysis. Mean and standard deviation (SD) are used to describe numerical data (age and academic year), frequency and percentage to describe categorical data.

Results:

The sample size realized as 259 participants. Just more than half (54%) was male with the mean age of the sample22±2.12 years. Only a small proportion (1.9%) was married. Just more than half (52.9%, n=137) was pre-clinical students (2nd, 3rd and 4th year medical students) and 47.1% (n=122) was clinical students (5th and 6th year medical students). The majority (63.7%) of the sample reported a high income (≥20000 SAR) (Table 1).

Table 1: Sample characteristics (n=259)
Characteristic
Age (years)	Mean ± SD*	22±2.12
		n	%
Gender	Male	145	56
Female	114	44
College year	Pre-clinical	137	52.9
Clinical	122	47.1
Marital Status	Single	254	98.1
Married	5	1.9
Family income (SAR)	≤20000	94	36.3
> 20000	165	63.7

The dietary habits of the sample are displayed in Table 2. More males (69.7%) are consuming red meat compared to females (43%). Red meat consumption was also higher in the high-income group (61.2%) compared to 52.1% in the low-income group. Similar results were obtained for fried food consumption. A higher proportion of the male (64.1) and high-income (66.7%) groups consumed fried food and pastries compared to female (50%) and lower income group (45.7%). The differences were statistically significant (p-value<0.05 for both). In terms of breakfast, more females (50%) regularly ate a breakfast compared to males (42.1%). Notably, a statistically significant higher percentage of females had coffee in the morning than male (74.6% vs.55.2%, respectively, p-value=0.001).

Table 2: Details of dietary Habits

Variable	n*	%
Gender and Red meat	Male	101	69.7
Female	49	43.0
Income and Red meat	High income	101	61.2
Low income	49	52.1
Gender and Fried food	Male	93	64.1
Female	57	50.0
Income and Pastries	High Income	110	66.7
Low income	43	45.7
Gender and Breakfast	Male	61	42.1
Female	57	50.0
Gender and Coffee	Male	80	55.2
Female	85	74.6

The details of the fast food consumption in the sample are displayed in Table 3. The vast majority (95.2%) of the male group reported consuming fast foods, compared to 80.7% of the female group (Figure 1 and 2). Regarding the relationship between the academic year and fast food consumption, a similar proportion of pre-clinical and clinical students reported consuming fast foods(88.4%, and 89.3% respectively).The frequency of fast food consumption was higher in the male group, with more than half (53.8%) reporting a consumption of three times or more per week. For the female group, more than half (58.8%) reported consumption once or twice per week. For both genders, the highest consumption occurred during dinner. For both low and high-income groups, the fast food related expenditure was between 100-500 SAR per month.

Table 3: Details about fast food consumption

Fast Food Consumption	n*	%
Gender and Fast food	Male	138	95.2
Female	92	80.7
Academic year and Fast food	Pre-clinical years	121	88.4
Clinical years	109	89.3
Gender and Fast food per week	Male	Once or twice	60	41.4
3 times or more	78	53.8
Female	Once or twice	67	58.8
3 times or more	24	21.9
Income and Fast food per week	High Income	Once or twice	79	47.9
3 times or more	69	41.8
Low income	Once or twice	48	51.1
3 times or more	34	36.2
Gender and Fast food meal	Male	Lunch	25	18.2
Dinner	70	51.1
Lunch and Dinner	42	30.7
Female	Lunch	24	26.1
Dinner	40	43.5
Lunch and Dinner	28	30.4
Income and Fast food money	High income	>100SR	24	15.1
100-500 SR	108	67.9
<500 SR	27	17.0
Low income	>100SR	32	35.6
100-500 SR	44	48.9
<500 SR	14	15.6

In terms ofexercise and dietary habits, only 37.1% indicated regular physical activity. A higher proportion (66.7%) of the healthy eating habits group, reported regular physical activity compared to the fast foods group with 63.2% reporting no physical activity. More than half of the breakfast and coffee drinking groups (54.2%, and 68.8%) reportedphysical activity. The results highlighted that participants eating less fast foods, reported a higher level of physical activity. In contrast, the group reporting no physical activity (48.5%) indicated consuming more than three fast food meals per week (Table 4).

Table 4: Exercise and dietary habits
Factor	n	%
Exercise regularly	Yes	96	37.1
No	163	62.9
Exercise per week	One to 3 time	32	14.0
More than 3 times	85	37.3
Exercise and healthy food	Exercise	64	66.7
Do not exercise	74	45.4
Exercise and fried food	Exercise	47	49.0
Do not exercise	103	63.2
Exercise and pastries	Exercise	49	51.0
Do not exercise	104	63.8
Exercise and breakfast	Exercise	52	54.2
Do not exercise	66	40.5
Exercise and coffee	Exercise	66	68.8
Do not exercise	99	60.7
Exercise and fast food per week	1-2 times weekly	61	63.5
3 or more weekly	24	25.0
Not exercising and fast food consumption per week	1-2 times weekly	66	40.5
3 or more weekly	79	48.5

Discussion:

"The current study aimed to evaluate the eating habits of medical students at a health sciences university in Riyadh, Saudi Arabia. Knowing dietary habits of future medical practitioners will support the development of an intervention to achieve potential health benefits for their future life [14]."

Irrespective of academic year and gender, there was a high consumption of an unhealthy diet in the sample. The unhealthy diet included consuming fast food and pastries frequently, with a low level of regular physical activities. "Our findings reflect the changed lifestyle of the whole Kingdom [15,18]." The medical knowledge acquired in the pre-clinical, clinical academic years failed to prevent the sample from adopting such emerging lifestyle habits." In a comparable Indian study, assessing the dietary habits, and physical activity of medical students at a teaching hospital, reported that healthy lifestyle practices including the awareness and practice of physical activity was good [19]." "This finding is in contrast to the current study with a high prevalence of unhealthy eating habits. More than half of sample did not have breakfast regularly; supported by Saranya et al [19] who reported that nearly half of the sample did not regularly have breakfast, as well as Ganasegeran et al. and Chhaya et al [20,21]." "Students may associate skipping breakfast with weight control; however, it is known that participants who do not eat breakfast are more likely to eat unhealthy foods, resulting in weight gain [22]." "Breakfast is considered as the most important meal of the day, providing energy for the brain and improving learning. Breakfast contributes significantly to the total daily energy and nutrient intake, and omitting breakfast may affect the performance throughout the day [23]."

"Recent studies highlighted an association between the consumption of unprocessed red meat and processed meat and adverse health consequences, increasing risk for cancer [24], stroke [25], and all-cause [26] and cardiovascular mortality [27]." "Generally, dietary guidelines endorse limiting meat intake [28-30]." The current study revealed a high prevalence of red meat consumption, especially in males and high-income students." Morse and Driskell investigating gender differences in fast food consumption in college students found that a larger percentage of males reported eating at fast food restaurants [31]." This is in line with the current study findings.

"Physical activities play an important role in maintaining health; however, Saudi adolescents tend to have a sedentary lifestyle and decreased physical activity [32]." "In a local study by Al-Nakeeb [33], a younger age in both genders had a decreased level of physical activity and a high percentage of obesity, compared to the same age group in the Birmingham and Coventry study in the United Kingdom."

Fast food consumption, sedentary lifestyle, and obesity related diseases are increasing globallyand Saudi Arabia is not an exception. Modern food processing technologies contribute to this public health problem." Overall, young Saudi population, which includes tertiary students, developed unhealthy dietary habits in addition to a sedentary lifestyle, created by the economic status improvement in the Kingdom of Saudi Arabia over the last 10 to 20 years [34]."

The current study has some limitations. The sample was restricted to medical students from one university in Riyadh, andthe findings cannot be generalized to the whole Kingdom. The body mass index (BMI) was not recorded and it was not possible to correlate the BMIwith fast food consumption and physical activity in the sample. Finally, fruit and vegetable consumption was not investigated.

Conclusion:

Fast food consumption was highly prevalent in Saudi medical student sample, specifically in the male and high-income groups, regardless of their academic level. In addition, only a small proportion of the sample was physically activity. Health promotion interventions targeting medical students arehighly recommended, with a strong focus on the dietary pattern ofthe students. The current study reinforces the urgent need to encourage healthy lifestyles, healthy food habits and a physically active daily routine.

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Tables:

*Standard Deviation

*n refers to yes responses

*n refers to a yes response