Eating breakfast, fruit and vegetable intake and their relation with happiness in college students

Abstract

Purpose:
Nutrition plays a major role in physical and mental health. The aim of this study was to evaluate the relationships between happiness and fruit and vegetable intake as well as eating breakfast in students.

Methods:
In this cross-sectional web-based study, all students of Qazvin University of Medical Sciences in Iran who attended course classes were invited to participate in the study. Five hundred forty-one students filled out the web-based questionnaire which included questions related to measurement of happiness, breakfast, fruit and vegetable consumption and socio-economic and demographic information. Analysis of covariance was used to assess the relationship between happiness and breakfast, fruit and vegetable consumption by adjustments for covariates.

Results:
Measure of happiness was positively associated with eating breakfast, number of meals eaten daily and the amount of fruit and vegetable consumption (P values were <0.001, 0.008, 0.02, and 0.045 respectively). Students who ate breakfast every day, more than 8 servings of fruit and vegetables daily, and had 3 meals in addition to 1-2 snacks per day had the highest happiness score.

Conclusion:
Healthier behavior pattern was associated with higher happiness scores among medical students.

Full text

ORIGINAL ARTICLE
Eating breakfast, fruit and vegetable intake and their relation
with happiness in college students
Azadeh Lesani
1
•Asghar Mohammadpoorasl
2,3
•Maryam Javadi
1,4
•
Jabiz Modaresi Esfeh
5
•Ali Fakhari
6
Received: 27 December 2015 / Accepted: 9 February 2016
ÓSpringer International Publishing Switzerland 2016
Abstract
Purpose Nutrition plays a major role in physical and
mental health. The aim of this study was to evaluate the
relationships between happiness and fruit and veg-
etable intake as well as eating breakfast in students.
Methods In this cross-sectional web-based study, all
students of Qazvin University of Medical Sciences in Iran
who attended course classes were invited to participate in
the study. Five hundred forty-one students filled out the
web-based questionnaire which included questions related
to measurement of happiness, breakfast, fruit and
vegetable consumption and socio-economic and demo-
graphic information. Analysis of covariance was used to
assess the relationship between happiness and breakfast,
fruit and vegetable consumption by adjustments for
covariates.
Results Measure of happiness was positively associated
with eating breakfast, number of meals eaten daily and the
amount of fruit and vegetable consumption (Pvalues were
\0.001, 0.008, 0.02, and 0.045 respectively). Students who
ate breakfast every day, more than 8 servings of fruit and
vegetables daily, and had 3 meals in addition to 1–2 snacks
per day had the highest happiness score.
Conclusion Healthier behavior pattern was associated
with higher happiness scores among medical students.
Keywords Happiness Breakfast Fruit and vegetable 
Nutrition Life satisfaction Diet
Introduction
During the recent decades, happiness and psychological
wellbeing have been among the most attractive issues for
researchers in the fields of social sciences [1] and health [2].
It is widely acknowledged that psychological factors may
play an important role in physical performance, and mental
health positively affects physical wellbeing [3]. According
to the World Health Organization (WHO), health is a state
of general physical, psychological and social wellbeing [4].
Happiness can predict longevity among healthy people
though this is not true for those who are sick. While hap-
piness cannot treat severe disease, it may protect people
against becoming sick. In other words, happiness strongly
affects longevity in healthy population. The size of effect is
comparable to being a smoker or not [3].
&Asghar Mohammadpoorasl
ampoorasl@gmail.com
Azadeh Lesani
a.lesani@qums.ac.ir
Maryam Javadi
mjavadi@qums.ac.ir
Jabiz Modaresi Esfeh
drmodaresi@gmail.com
Ali Fakhari
a_fakhari@yahoo.cpm
1
Department of Human Nutrition, Faculty of Health, Qazvin
University of Medical Sciences, Qazvin, Iran
2
Tabriz Health Services Management Research Center, Tabriz
University of Medical Sciences, Tabriz, Iran
3
Department of Statistics and Epidemiology, Tabriz
University of Medical Sciences, Tabriz 14711, Iran
4
Children Growth Research Center, Qazvin University of
Medical Sciences, Qazvin, Iran
5
Department of Public Health, Alborz University of Medical
Sciences, Karaj, Iran
6
Clinical Psychiatry Research Center, Tabriz University of
Medical Sciences, Tabriz, Iran
123
Eat Weight Disord
DOI 10.1007/s40519-016-0261-0

Happiness can improve the function of the immune
system [5]. Several studies have shown that happiness
might be affected by numerous factors such as: family and
friend relationships, exercise, food quality (highly nutri-
tious foods), recreational activities [2] religion [6], gov-
ernment [7], health, age, social status genetics [8,9],
employment, education [10] and the lack of stress in the
last 6 months [11].
Nutrition plays a major role in physical [12] and mental
health [13] and breakfast consumption is one of the key
components of healthy nutrition. It is well associated with
less body mass index (BMI) and skipping breakfast is a
common behavior among overweight and obese people.
Furthermore, breakfast consumption can positively affect
cognitive function, particularly memory. In addition,
breakfast eating is associated with less depression [14].
Several studies have reported that eating fruit and veg-
etables containing considerable amounts of antioxidants
[15], can protect against acute illnesses such as coronary
heart disease and cancer [16]. Some researchers have found
a positive association between lower risks of depression
and higher intake of antioxidants [17]. Previous research
has shown that diet quality among Iranian young people
[18,19] has changed as they consume fewer amounts of
some micro- nutrients and eat more carbohydrate or fat
[20]. Additionally, thinness tendency is on rise as a body
image style preferred by females. People who have positive
body image perception will follow a healthier diet in
competition with others [19]. Therefore nutrition education
strategies may be required to promote diet quality espe-
cially among young [21] and adolescent [18].
In an international research Iranian happiness has been
reported to be 5.3. This is lower than the highest score of
happiness (8.2) which belongs to Danes [7]. Many studies
have evaluated the state of happiness and its related factors,
including cultural, economic, educational and social factors
in different age groups in Iran; however, the association
between breakfast, fruit and vegetable consumption and
happiness has not been investigated yet.
The aim of the present study was to evaluate the rela-
tionships between happiness and fruit and vegetable intake
as well as eating breakfast in a group of students in Qazvin
University of Medical Sciences.
Methods
In this cross-sectional web-based study, a questionnaire
was created to assess the relationship between happiness
and breakfast, fruit and vegetable consumption among the
students. All of the questions were based on scientific lit-
erature and expert opinions which have been used in other
studies previously. In order to assess the content validity of
the questionnaire, it was sent to 5 content experts, 6 experts
in methodology and development of the questionnaire and
10 lay experts (nutrition advisors and students) with a
response form to comment on clarity and relevancy of
questions. After receiving responses and revising the
questionnaire the final questionnaire was designed in
Google Drive. Then a few students (n=26) were asked to
fill out the web-based questionnaire for feasibility
approving. The Institutional Review Board (IRB) at the
Qazvin University of Medical Sciences (QUMS) approved
the study protocol and the related questionnaire.
All students of Qazvin University of Medical Sciences
in Iran who had course class were invited to participate in
the study. The total number of invited students was 1086.
Participation was voluntary and anonymous. After prepar-
ing the class list the researchers had a meeting with each
class in order to explain the purposes of the study. An
informed consent was received from all of the interested
participants. Then, the students’ email addresses were
obtained and papers containing the link address of the
questionnaire were delivered to them. The link address was
also emailed to the students on the same day and a
reminder was sent to the students for the following
3 weeks. The questionnaire consisted from the following
parts: demographic characteristics, health status, stress
experience in the past 6 months, weight, height, breakfast
intake, food pattern, fruit consumption, vegetable con-
sumption, physical activity (RAPA: The Rapid Assessment
of Physical Activity), socio-economic questions (household
income and assets) and Oxford Happiness Questionnaire
(OHQ). It took 15–20 min to complete the questionnaires.
All participants were encouraged to provide honest
responses [22].
Happiness was measured by Oxford Happiness Ques-
tionnaire (OHQ), which contains 29 statements to be ran-
ged from 1 ‘‘strongly disagree’’ to 6 ‘‘strongly agree’’. A
few examples of these items are ‘‘Life is good,’’ and ‘‘I am
well satisfied about everything in my life’’. Happiness
score ranges from 29 to 174, where higher scores indicate a
higher level of happiness. The reliability and validity of
this questionnaire among university students in Iran have
been confirmed by Liaghatdar [23].
Breakfast eating was assessed by a breakfast survey for
students which included 10 questions. In this self-report
questionnaire the participants were asked about their fre-
quency of breakfast consumption per week, the reasons for
skipping breakfast and the consequences they faced when
they didn’t have breakfast. In addition, it was inquired
whether the students had any snack in the morning and, if
the answer was positive they were asked about its content.
Food habits were assessed by two questions. The first
question was ‘how many meals and snacks do you usually
eat in a day?’ responses were categorized as ‘3 meals ?2
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123

snacks’,’ 3 meals ?one snack’, ‘3 meals’, ‘2 meals (in-
cluding breakfast)’, ‘2 meals (but not breakfast) and ‘one
meal’. The second question was a multiple choice one:
’which of following meals and snacks are your usual food
habits?’’ Responses were categorized as breakfast, morning
snack, lunch, afternoon snack, evening snack, dinner, late
night snack.
Fruit consumption was measured by two questions:
‘How many days of week do you usually eat fruit? Answers
were scored from 0 (never eat fruit) to 7 days a week. Then
a serving of fresh, canned fruit and juice fruit were
explained and the participants were asked ‘in a day that you
consume fruit, how many servings of fruit do you usually
eat?’ and the responses were categorized as ‘less than 1
serving’, ‘1–2 serving’, ‘2–3 serving’, ‘3–4 serving’ and’
more than 5 servings’.
Vegetable consumption was measured by two questions.
The first question was: ‘How many days of week do you
usually eat vegetable?’’ The answers were scored from 0
(don’t eat any vegetable in a usual week) to 7 days a week.
Then after explaining a serving of fresh, canned veg-
etable and juice vegetable, the second question was asked
as follows: ‘On a day when you eat vegetables, how many
serves of vegetables do you usually eat?’ and the responses
were categorized as ‘less than 1 serving’, ‘1–2 serving’,
‘2–3 serving’, ‘3–4 serving’,’ more than 5 servings’.
Physical activity was measured by RAPA [22]. This is a
9-item, self-administered questionnaire regarding current
levels of physical activity. RAPA evaluates a wide range of
physical activity levels, from sedentary to vigorous activity
and assesses the number of reported days of moderate
activity (for at least 30 min) and vigorous activity (for at
least 20 min), as well as strength and flexibility training.
Each question has a ‘Yes’ or ‘No’ option. The total score of
the first seven items are out of 7; participants choose the
question corresponding to their activity level. Any score
less than 6 is considered suboptimal. Strength training and
flexibility are scored separately (strength training =1,
flexibility =2, both =3).
A principal component analysis (PCA) was employed to
measure socioeconomic status of the students based on the
information collected about the household income and
assets. Based on the PCA results, the students were clas-
sified into three SES groups being high, middle, and low
socioeconomic status.
Analysis of covariance was used to assess the relation-
ship between happiness and breakfast, fruit and vegeta-
bles consumption and adjustments were made for BMI,
marital status, socio-economic status, physical activity,
experience of stress in the last 6 months and having a
defined disease. SPSS 22 software was used for statistical
analyses.
Results
Out of a total of 1086 students, 541 participated in the
study and filled out the web-based questionnaire (49.82 %
response rate). The mean and standard deviation of the
participants’ age were 24.14 ±4.88 (the range was
18–46 years old). Four hundred and three students
(75.4 %) were female and 138 (25.5 %) were male. The
mean of happiness score was 114.59 ±18.31 (min 44, max
157). Table 1shows frequency of demographic character-
istics and key variables of the students.
Table 2shows the adjusted mean of the happiness score
by breakfast, fruit and vegetables consumption. As it is
depicted in this table, after adjustment for BMI, mari-
tal status, socio-economic status, physical activity, expe-
rience of stress in the last 6 months and having a defined
disease, happiness scores were statistically different in
various categories including the number of meals eaten
daily, breakfast eating, fruit consumption and
vegetable consumption.
Table 1 Demographic and key variables of students
Variable n%
Gender
Male 138 25.6
Female 403 74.4
Marital status
Single 456 84.3
Married 85 15.7
Socio-economic status
Low 134 24.8
Medium 271 50.2
High 135 25.0
Body mass index
Low weight 56 10.4
Normal 387 71.5
Over weight 83 15.3
Obesity 15 2.8
Physical activity
Sedentary 39 7.2
Light and regular activity 128 23.7
Insufficient activity 151 27.9
Sufficient activity 223 41.2
Stress experience in the last 6 months
Yes 368 68.0
No 173 32.0
Having a defined disease
No 505 93.3
Yes 36 6.7
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123

Discussion
This study revealed a significant association between
happiness and breakfast, fruit and vegetable consumption.
Many studies have examined the association between
negative emotions and food intake. Furthermore, a number
of laboratory studies have shown that negative emotions
may result in increased consumption of high fat and high
sugar snacks as well as a tendency for consuming snacks
rather than meals [24] and a decreased consumption of fruit
and vegetables [25]. Similar results have been reported in
cross-sectional surveys [26].However, few studies have
examined the relationship between positive affect and food
consumption [27] or the possibility of bidirectionality of
this relationship. Biochemical studies have suggested that
foods high in carbohydrate cause a raise in brain serotonin
level which contributes to feeling well and happy [28].
Certain micronutrients found in fruit and vegetables might
ameliorate symptoms of depression in less than 10 weeks
when used in conjunction with antidepressant drugs [29]. It
has been reported that flavonols present in fruit and veg-
etables [30] and docosahexaenoic acid (an omega-3 fatty
acid) [31] can improve cognitive function which may
improve mood.
In the present study happiness was associated with eat-
ing breakfast in students. Those who used to eat breakfast
constantly (7 days a week) were the happiest, while those
who never had breakfast gained the lowest scores for
happiness. These findings are in harmony with those
reported among Chilean students [32] though these stu-
dents were divided into two groups while in our study the
subjects had been put into 4 different groups regarding
their frequency of eating breakfast (never, sometimes,
often or always). Smith et al. have shown that consumption
of three different types of breakfast with coffee can cause
increased heart rate, better mood and improved cognitive
memory and recall [33]. Breakfast is defined as the first
meal eaten before 10 am or 2 h after waking up and it
should contain about 20–35 percent of daily calorie
expenditure. According to nutritionist it is a critical energy
Table 2 Adjusted means of
happiness score by number of
meals eaten daily, breakfast
eating, fruits consumption and
vegetable consumption
Variable n% Mean
a
Standard error Pvalue
Number of meals eaten daily
3 Meals and 1–2 snakes 149 27.5 118.33 1.41 0.008
b
3 Meals 115 21.3 115.74 1.60
2 Meals involve breakfast 52 9.6 113.33 2.37
2 Meals except breakfast 71 13.1 110.97 2.03
1 Meal 154 28.5 112.22 1.38
Breakfast eating
Never 39 7.2 103.76 2.71 \0.001
c
Sometimes 57 10.5 110.86 2.26
Often 139 25.7 113.81 1.44
Always 306 56.6 117.01 0.96
Fruits consumption (per day)
\1 Serving 35 6.5 112.00 2.99 0.020
d
1 Serving 339 62.7 113.12 0.94
2–3 Serving 76 14.0 116.99 1.99
[3 serving 91 16.8 119.03 1.84
Vegetables consumption (per day)
\1 Serving 123 22.7 113.52 1.59 0.045
e
1 Serving 279 51.6 113.52 1.03
2–3 Serving 114 21.1 116.52 1.63
[3 Serving 25 4.6 122.96 3.54
a
Mean adjusted for BMI, marital status, socio-economic status, physical activity, experience of stress in
the last 6 months and having a defined disease
b
Bonferroni test showed that 3 meals and 1–2 snakes had significant difference with 2 meals except
breakfast and 1 meal (P\0.05)
c
Bonferroni test showed that had Never eater significant difference with often and always eater (P\0.05)
d
Bonferroni test showed that 1 serving consumption per day had significant difference with more than 3
serving (P\0.05)
e
Bonferroni test showed that 1 serving consumption per day had significant difference with more than
3serving (P\0.05)
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123

supply for the brain as the brain relies mainly on glucose
[14,34] Studies have shown that breakfast omission will
cause fatigue and disturbance in concentration required for
daily tasks, as well as a negative impact on learning and
memory [14]. Better physical health, doing daily activities
more energetically, better academic performance,
improved learning and getting higher scores are factors
which result from breakfast consumption all of which may
affect the students’ happiness. On the other hand, some
surveys have shown that in the majority of people happi-
ness causes healthier eating behaviors. Thus, the relation-
ship might be bidirectional.
Our findings clarifies that there is a significant rela-
tionship between the numbers of daily meals and happi-
ness. Those who had 3 meals and 1–2 snacks per day
were the happiest while a decrease in the number of meal
and snack intake would lead to lower happiness scores. In
addition, students who had skipped their breakfast, having
only 2 main meals per day, and those who had only one
meal a day, had the lowest level of happiness. Among
those who had only consumed 2 meals a day, those who
had skipped breakfast had lower scores of happiness than
those who had eaten breakfast and had skipped another
meal and this association was statistically significant. This
shows a correlation between the two variables yet, it does
not clarify whether positive emotions promote a healthier
diet or healthy eating patterns leads to more positive
feelings. Piqueras’s study in Chile has revealed that daily
lunch and breakfast consumption is significantly associ-
ated with happiness [32]. Moreover, some studies have
shown that skipping meals, especially breakfast, is asso-
ciated with the risk of overweight and obesity in children
[35] and adults [14]. This can also cause accumulation of
fat in the abdominal area which increases the risk of
metabolic syndrome [36]. Finally, skipping meals has
been reported to be associated with increased appetite
[34]. There is some evidence that a direct relationship
exists between depression and missing breakfast [37].
Glucose is the main energy supply for the brain. Thus,
more frequent meal intake provides the brain with a more
constant energy source which will affect a person’s
physical and mental health. Previous studies support a
significant relationship between physical and mental
health with happiness.
Our results showed a significant association between
daily fruit and vegetable consumption and happiness.
Students who consumed 4 servings or more from each
group gained the highest scores for happiness. A 30 day
online survey showed that more daily fruit and veg-
etable intake could improve positive emotions which led to
a better mood [38]. The results from a study performed in
Chili are in agreement with our findings apart from the fact
that in that study, consuming more than 5 servings of each
of these food groups a day was accompanied by more
happiness [32]. Similar results have been reported by
Blanch flower [39]. In another study which has been car-
ried out among Iranian youth, significant relationship
between happiness and daily fruit and vegetable consump-
tion was observed [40]. Eating more fruit and vegeta-
bles (more than usual amounts) leads to feeling calmer,
happier and more energetic and these positive emotions
will last until the next day. The daily recommended intake
for fruit and vegetables is about 7–8 servings. It has been
approved that fruit and vegetables are rich in fiber, various
types of vitamins, polyphenols and antioxidants. As a
result, these food items may play a role in food-mood
relationship [41]. Another study has shown that people who
eat more fruit and vegetables are happier, more satisfied
with their lives and less depressed [42]. There is some
evidence that more consumption of fruit and vegetables is
associated with increased curiosity, more creativity and
feeling more prosperous which can improve the quality of
life among youth [43]. A higher blood antioxidant level is
associated with significantly more optimism [44]. Fruit and
vegetables contain some beneficial nutrients and an asso-
ciation has been reported to exist between lack of some of
these items, such as group B vitamins, especially folic acid,
and depression which is caused by a reduction in access to
s-adenosine methionine. S-adenosine methionine is
required for reduction of methyl a critical component in
production of myelin, neurotransmitters and phospholipid
membrane [45]. Various surveys have found a relationship
between fruit and vegetable consumption and physical
health. This is because consuming these healthy food items
may result in weight maintenance or weight loss in over-
weight or obese people and a better regulation of blood
sugar, blood lipids and blood pressure all of which can
reduce the risk of various diseases and deaths caused by
them [46]. Thus, physical and mental health of individuals
who eat more fruit and vegetables may be protected. Pre-
vious studies have confirmed that not only there is a rela-
tionship between these two variables but also happiness
can strengthen positive behavioral patterns such as healthy
eating.
There are several limitations to be noted regarding this
study. This has been a web-based study. Students should
have had access to the internet in order to read and com-
plete the questionnaire and also net speed played an
important role in successfully saving the data. A great
number of student complained that they had completed the
form but had failed to send the completed questionnaire
due to a limited internet speed. Moreover, 50 percent of the
student community did not participate in this study and its
possible impact on the results of the study shouldn’t be
overlooked. Moreover, this study was a cross-sectional one
which is another limitation of this research.
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123

Conclusions
Happiness was positively correlated with having breakfast
on most days of the week, consuming more daily meals (3
meals and snacks) and eating more fruit and vegetables (a
total of 8 serving or more). Although a considerable
number of researchers have studied the relationship
between happiness and fruit and vegetable intake among
adolescents, young people and adults in different countries
few studies have examined the relationship between hap-
piness and the number of meals eaten daily. Previous
studies have emphasized that people with higher happiness
scores or more positive feelings tend to follow a healthier
lifestyle. It is also probable that healthier food choices
promote positive emotions and happiness through provid-
ing essential micronutrients for the body. Similarly, nutri-
tion education programs may lead to improvement in
mental and physical health.
Acknowledgments This article is a main part of M.Sc thesis sup-
ported by Qazvin University of Medical Sciences. We would like to
thank Deputy of Research and Technology of Qazvin University of
Medical Sciences. We also wish to thank all of the students for their
valuable collaboration with this study.
Compliance with ethical standards
Conflict of interest The authors declare that there are no conflicts
of interests.
Ethical approval The Institutional Review Board (IRB) at the
Qazvin University of Medical Sciences (QUMS) approved the study
protocol and the related questionnaire.
Informed consent Informed consent was obtained from all partic-
ipants in the study.
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