Eating Habits of Adolescent Students

Abstract

Background: To assess eating habits of adolescent students of Rawalpindi. Methods: In this descriptive study 276 students of both genders, aged between 13-16 yrs were selected through two stage cluster sampling technique. Data was collected by means of structured questionnaire. Questionnaire asked information regarding demographics and eating habits i.e. the type of the food group being consumed and the frequency of consumption of these foods, based on United States Department of Agriculture (USDA) food guide pyramid. Results: Majority(75.7%) had unhealthy eating habits, while 19.9 had satisfactory and only 4.4% had healthy eating habits. Majority of the students(40.6%) ate fruits and vegetables 2-3 times a week, while 32.6% never drank milk and 13% never ate meat. Conclusion: Majority of the adolescent students had unhealthy eating habits and did not take the food groups as recommended by United States Department of Agriculture (USDA) food guide pyramid (FGP).

Full text

Journal of Rawalpindi Medical College (JRMC); 2018;22(4): 357-360
357
Original Article
Eating Habits of Adolescent Students
Omera Naseer1, Fazal Mahmood2, Masood Fazil2,Sana Bilal 1, Afifa Kulsoom1, Sidra Hamid 3
1.Department of Community Medicine Rawalpindi Medical University, Rawalpindi; Department of Community;2.
Department of Community Medicine HBS Medical College, Islamabad ;3. Department of Physiology, Rawalpindi Medical
University
Abstract
Background: To assess eating habits of adolescent
students of Rawalpindi.
Methods: In this descriptive study 276 students of
both genders, aged between 13-16 yrs were selected
through two stage cluster sampling technique. Data
was collected by means of structured questionnaire.
Questionnaire asked information regarding
demographics and eating habits i.e. the type of the
food group being consumed and the frequency of
consumption of these foods, based on United States
Department of Agriculture (USDA) food guide
pyramid.
Results: Majority( 75.7%) had unhealthy eating
habits, while 19.9 had satisfactory and only 4.4%
had healthy eating habits. Majority of the
students(40.6%) ate fruits and vegetables 2-3 times a
week, while 32.6% never drank milk and 13% never
ate meat.
Conclusion: Majority of the adolescent students had
unhealthy eating habits and did not take the food
groups as recommended by United States
Department of Agriculture (USDA) food guide
pyramid (FGP).
Key Words: Eating habits, Students, Adolescent
Introduction
The healthy eating habits of the adolescents lead to
healthy and speedy growth of the individuals and
decrease the disease risk in adulthood. Adolescence
(10-19 years) is the period of transition from childhood
to adulthood .It is a phase of rapid growth and
maturation in which final growth spurts occurs. This
phase requires high nutrient and energy to cope up
with the accelerated physical and intellectual
development of the adolescents.1,2 Ample energy and
macronutrients intake is required during adolescents
for proper muscle and brain development, hemoglobin
production, bone mineralization (calcium), and growth
(zinc).3The well-established healthy eating habits
include regular fruit, vegetable, and whole-grain and
dairy food consumptions.4
A lot of research work has been done across the globe
to assess the eating habits of the adolescents, one of the
studies of South Mediterranean country has shown
that most of the adolescents are inclined to unhealthy
eating habits, which ultimately affect their nutritional
status.5 In another study done on Brazilian adolescents,
23.26% were found to have unhealthy eating habits
while only 6.9% had healthy eating habits.6 In a study
done on Pakistani adolescents it was found that
dietary intake of majority of adolescents is inadequate
in terms of meeting the standards of adequacy.7
Irregular eating pattern and poor food choices are
badly affecting the health of our adolescents leading to
micronutrient deficiencies on one hand and obesity on
the other, resulting in impairment of physical and
mental growth, ultimately affecting their nutritional
status. Understanding the characteristics of
adolescents consuming specific dietary patterns is
important as this knowledge will help determine what
subgroups and specific modifiable characteristics
should be targeted in dietary interventions, to enhance
better growth.
Subjects and Methods
This descriptive cross-sectional study was conducted
on students of government high schools of Rawalpindi
city for duration of 6 months from August 2016 to
February 2017. The sample size was calculated by
using World Health Organization’s (WHO) statistical
sample size calculator, reference population was 6.96,
margin of error 3% , the calculated sample size was
276. Two stage cluster sampling technique was
adopted. Students of both genders between ages 13 to
16 years were included. Students’ age more than 16
years, students less than 13 years, those from other
than sampled schools and students having any acute
or chronic sickness i.e. chronic tonsillitis, tuberculosis
etc. were excluded. Two strata one of boys’ and
another of girls’ school were made. From these two
strata a total of 6 schools, 3 of boys and 3 of girls were
selected by simple random sampling. Students were
approached by visiting the selected government high

Journal of Rawalpindi Medical College (JRMC); 2018;22(4): 357-360
358
schools and equal number of boys and girls (46 from
each school) were included using the simple random
sampling technique,done by using (World Health
Organization) WHO random number generator
Table 1: Types of foods consumed
One Serving
Fruits
1 medium fruit/size of base ball/half
cup chopped
Vegetables
1 cup of raw green vegetables&1/2
cup of other vegetables
Chapatti
CDsize
Bread
1 small slice
Cereals
½ cup
Rice
½ cup
Butter
1 tea spoon
Cheese
1 ounce/3 dices
Egg
1
Fish
2-3 ounces
Chicken
1 ounce
Nuts
One hand full
Beans
½
Legumes/lentils
¼ cup cooked
Milk
1 cup
Yogurt
1 cup
Executive Director Education (EDO) was approached
for ethical permission of carrying out study. Before
filling the questionnaire, information regarding
serving size of the food items was given to them by
displaying and explaining through poster display. Any
queries regarding the questionnaire were addressed.
Confidentiality of information was maintained and
assured. Questions regarding eating habits i.e. the
type of the food group consumed and number of
servings per food group (Table 1). For qualitative
variables like gender, type of eating habits,
socioeconomic status, frequency and percentages were
calculated. P ≤ 0.05 taken as significant
Results:
Majority (53.33%) had body mass index less than 18.5
(Table 2).Most (48.1%) of the students were from lower
socioeconomic group, 35.14% were from lower middle
while 16.67% were from middle socioeconomic class.
Table 2. Body mass index (BMI) of students
BMI
Frequency
Percentage
<18.5
161
58.33%
18.5 – 29.9
107
38.77%
>30
8
2.90%
The mean number of meals eaten per day by the
students was 3.46 with standard deviation of 0.667,
and the mean number of food groups eaten were
3.1920 with standard deviation of 0.75 (Table 3). Only
4% (n=11) of the students have healthy eating habit
(Table 4). Satisfactory easting habits were found in
19.9% (Table 5). Unhealthy eating habits were found
in 75.7% (Table 6).
Table 3: Frequency of eating different foods
Food
Once a day
1-2 times a day
3-4times a day
>4times a day
Once a week
2-3times a week
4-6 times a week
Never
No (%)
No (%)
No (%)
No(%)
o (%))
No(%)
No(%)
No(%)
Fruit
53 (19.2%)
32(11.6)
14(1.4)
0(0)
49(17.8)
112(40.6)
19(6.9)
7(2.5)
Chapati
79(28.6)
85(30.8)
92(33.3)
0(0)
3(1.1)
1(0.4)
4(1.4)
12(4.3)
Bread
77(27.9)
5(1.8)
0(0%)
0(0)
31(11.2)
34(12.3)
5(1.8)
124(44.9)
Rice
16(5.8)
16(1.8)
4(1.4)
0(0)
92(33.3)
113(40.9)
31(11.2)
15(5.4)
Butter
43(15.6)
2(0.7)
0(0)
0(0)
37(13.4)
27(9.8)
3(1.1)
164(59.4)
Egg
99(35.9)
6(2.2)
1(0.4)
0(0)
54(19.6)
59(21.4)
14(5.1)
43(15.6)
Fish
67(24.3)
0(0)
6(2.2)
0(0)
0(0)
0(0)
1(0. 4)
202(73.2)
Chicken
8(2.9)
3(1.1)
4(1.4)
1(0.4)
80(29)
139(50.4)
5(1.8)
36(13)
Legumes
9(3.3)
1(0.4)
0(0)
0(0)
73(26.4)
129(46.7)
13(4.7)
51(18.5)
Beans
4(1.4)
0(0)
0(0)
0(0)
88(31.9)
60(21.7)
7(2.5)
117(42.2)
Milk
124(44.9)
5(1.8)
0(0)
0(0)
22(8)
29(10.5)
6(2.2)
90(32.6)
Yogurt
108(39.1)
6(2.2)
2(0.7)
0(0)
33(12.7)
51(18.5)
17(6.2)
57(20.7)

Journal of Rawalpindi Medical College (JRMC); 2018;22(4): 357-360
359
Table 4:Students with healthy eating habits
Gender
of
students
Healthy eating habits
Total
P value
Yes
No
M
4(1.44%)
134(48.55%)
138(50%)
0.356
F
7(2.53%)
131(47.46%)
138(50%)
Total
11(3.98%)
265(96.01%)
276(100%)
Table 5: Students with satisfactory eating habits
Gender of
students
Satisfactory eating habits
Total
P value
Yes
No
M
34(12.31%)
104 (37.68%)
138 (50%)
0.050
F
21(7.6%)
117(42.39%)
138(50%)
Total
55(19.92%)
221(80.07%)
276(100%)
Table 6: Students with unhealthy eating habits
Gender of
the
students
Unhealthy eating habits
Total No(%)
P value
Yes
No
M
100(36.23%)
38(13.76%)
138(50%)
0.206
F
109(39.49%)
29(10.50%)
138(50%)
Total
209(75.72%)
67(24.26%)
276(100%)
Discussion
Nutritional needs of the adolescence are different, due
to the fast growth rate during this period. In a
developing country like Pakistan it is one of the most
neglected segments of public health, resulting in a
number of nutritional deficiencies in our adolescent
population. During adolescence a healthy diet
according to the physical requirements can play a role
in the prevention of several chronic diseases, including
obesity, coronary heart disease, and certain types of
cancer, stroke, and type 2 diabetes later in life.
A study done in public schools of Karachi has shown
that undernourishment was more prevalent in male
students (33%) than female students(23%).8 Contrary
to the present study a study done on the adolescents
of Karachi and Lahore,the BMI of the majority of the
participants was found to be around 20.84±4.75 and
20.78±2.89 respectively.9The reason of difference in the
results of these two studies could be the difference in
socioeconomic status of the respondents as most of the
students of public schools of our study were from
lower socioeconomic status. Students whose parents’
monthly income was below fifteen thousand Pakistani
rupees were categorized as low socio economic group.
A study carried out on Asian students presented that
the prevalence of being underweight is more common
in boys within the South and West Asian countries,
while in the East Asian countries it was more
prevalent among girls.10 The gender in Southeast Asia
is the deciding factor concerning independence, ability
to work and even health. The inferior position of
women in this region impacts women’s health and a
male child is given priority over female child in all
aspects including health because he is considered as
the future bread winner and head of the family. The
reason of difference in our study could be that the girls
do not participate in physical activities and sports like
boys so their weight for age is better than boys. 11
In our research, 58.33% participants were
undernourished with their BMI <18.5, which is in
accordance with the results of the study conducted by
Dambhar et al. ,who had comparatively similar
findings with the present study, i.e. 51.7% of
adolescents of his study were undernourished while
only 48.3% of the adolescents were normal.12 Most of
the studies reveal a low BMI in girls. 13,14Studies also
revealed a direct association between socioeconomic
status and BMI. 15,16
In the current study majority of participants
consumed chapatti (92.75%) as daily food which is
same as in a study done on Indian adolescents where
94.5% of the adolescents consumed it on daily basis.16
The reason of similarity being the same cultural and
geographical environment of these South Asian
countries ,where wheat is considered as the staple
food which is consumed on daily basis by the majority
of the population in the form of chapati. Wheat is the
main staple food in Pakistan too and constitutes about
80 to 90 per cent of the food consumed by each
individual in every meal. Although it can be
consumed in many ways such as in the form of
chapatti, bread, biscuits, porridge, macaroni and
sweets, its use as 'chapati' is the most common and
popular among the majority of the population. Since it
constitutes the main bulk of the food intake especially
for the low income classes and is a key and major
source of energy and protein requirements to them,
who cannot afford protein-rich foods like meat, beans
and pulses.
Most of the adolescent students did not consume green
leafy vegetables, milk products fruits and eggs and
meat.Only 29.7% of boys and 20.65% of girls reported
eating meat 2-3 times a week . On the contrary ,a
study done in Karachi public school showed that a
higher proportion of the respondents i.e. 67% of boys
37% of girls ,consumed meat at least twice weekly8.
The reason being the better socioeconomic status of the
respondents of the Karachi public schools. It has been
shown in many researches that diet quality follows a
socioeconomic gradient. Whereas higher-quality diets
like lean meat and fish are associated with better
privileged circumstances and affluence , diets with
empty calories that are nutrient-poor are
preferentially eaten by persons of lower socioeconomic

Journal of Rawalpindi Medical College (JRMC); 2018;22(4): 357-360
360
status (SES) and of more limited financial means. In
these days of inflation and economic instability it is not
easy for a person from lower socioeconomic group to
incorporate meat in his daily meals, therefore the
respondents of our study consumed meat rarely as
compared to the respondents from affluent families.
In our study it has been revealed that milk was
consumed on an average by 67.39% of the
respondents and yogurt was eaten by 79.35% of
respondents which is the same as the results of a study
conducted on eating habits of adolescents of Poland,
where on average 66% of the adolescents consumed
milk on daily basis .17 The reason of the similarity in
results is that the milk is considered the basic and
essential nutrient for growth and bone health in all
cultural setups, thus milk and milk products are
consumed almost daily by the adolescents and
children across the globe.
In present study , the consumption of fruits and
vegetables was a bit low, as fruits were eaten daily by
32.24 %and vegetables by 30.08% of pupils ,while in a
study done in Poland and Czech Republic fruits and
vegetables were being consumed daily in a higher
proportion i.e. by 49.% and 36% of the adolescent
pupils respectively.18 Both lower socioeconomic status
and lower educational status of the parents can be the
factors responsible for low consumption of fruits and
vegetables in our study population . Lack of
nutritional knowledge regarding the importance of the
nutrients can also be one of the factors.
Conclusion
1.The overall nutritional status of the adolescents was
not satisfactory. The health and nutritional status
among the adolescents was found to be low, more in
girls than in boys.
2.The prevailing dietary practices of adolescents have
not been up to the mark. Such practices may be due to
differences in the food allocation at the family level
and because of individual likes and dislikes.
3. In study population both macro- and
micronutrients deficiencies were found. These
deficiencies lead to a decrease in the growth spurt, for
both physical and mental health
References
1. Rengini MR. Impact of nutrition education programme
conducted for adolescent girls and
parents.IJSRP.2014;4(1):381-84
2.
Cutler GJ, Flood A, Hannan P, Sztainer. Multiple Socio
demographic and socio environmental characteristics
correlation with dietary intake in adolescents.J Am Diet
Assoc. 2011;111:230-40
.
3. Tornaritis MJ, Philippou E, Hadjigeorgiou C. A study of the
dietary intake of Cypriot children and adolescents aged 6–18
years and the association of mother’s educational status and
children’s weight status on adherence to nutritional
recommendations. BMC Public Health. 2014;14(1):13-16.
4. Bruening M, Eisenberg M, MacLehoseR,Nanney MS.
Relationship between adolescents’ and their friends’ eating
behaviors: breakfast, fruit,vegetable, whole-grain, and dairy
intake. J Acad Nutr Diet. 2012;112:1608-13.
5. Skhiri HA, Traissac P, Ati JE, Duvernay SE. Nutrition
transition among adolescents of a south Mediterranean
country: dietary patterns, association with socio-economic
factors, overweight and blood pressure. A cross-sectional
study in Tunisia .Nutr J. 2011;10(38)11-17.
6. PinhoaLD,Silveirab MF, Botelhob ACC, Pinhoa AP.
Identification of dietary patterns of adolescents attending
publicschools . J Pediatr . 2014;90(3):267-72
7. Iqbal Z, Ali U. Dietary Intakes of Urban Adolescents of
Sialkot, Pakistan Do Not Meet the Standards of Adequacy.
PJN 2013;12(5):460-64
8. Paracha PI, Bakht S, Paracha SI, Vriesekoop F. Nutritional
status, dietary practices and physical activities of adolescents
in public and private schools of Karachi, Pakistan. Obesity
Research-Open Journal. 2016 ;3(2):30-39.
9. Aziz S, Umm-e-Rubab NW, Majid R, Hosain K. Dietary
pattern, height, weight centile and BMI of affluent school
children and adolescents from three major cities of Pakistan.
J Coll Physicians Surg Pak. 2010 ;20(1):10-16.
10. Mak KK, Tan SH. Underweight problems in Asian children
and adolescents. European Journal of Paediatrics
2012;171(5):779-85.
11. Dars S, Sayed K, Yousufzai Z. Relationship of menstrual
irregularities to BMI and nutritional status in adolescent
girls. Pakistan Journal of Medical Sciences. 2014
;30(1):141-44.
12. Dambhare DG, Bharambe MS, Mehendale AM. Nutritional
status and morbidity among school going adolescents.
Journal of Health and Allied Sciences. 2010;9(2):112-15
13. Grydeland M, Bjelland M, Anderssen SA. Effects of a 20-
month cluster randomised controlled school-based
intervention trial on BMI of school-aged boys and girls. Br J
Sports Med 2014 ;48(9):768-73.
14. Berkey CS, Rockett HR, Field AE, Gillman MW. Activity,
dietary intake, and weight changes in a longitudinal study of
preadolescent and adolescent boys and girls. Paediatrics.
2000 ;105(4):56-59.
15. Tharkar S, Viswanathan V. Impact of socioeconomic status
on prevalence of overweight and obesity among children
and adolescents in urban India. Open Obes J. 2009;1:9–14.
16. Deka MK, Malhotra AK, Yadav R, Gupta S. Dietary pattern
and nutritional deficiencies among urban adolescents.
Journal of Family Medicine and Primary Care.
2015;4(3):364-67.
17. Pysz K, Leszczynska T, Kopec A. Assessment of nutritional
habits and preferences of children and adolescents brought
up in Krakow’s orphanages. Roczniki Państwowego Zakładu
Higieny. 2015;66(3):901-05.
18. Szczepanska E, Deka M, Calyniuk B. Studies to determine
nutrition behaviour amongst middle school pupils living in
the border areas of Poland and the Czech Republic. Roczniki
Państwowego Zakładu Higieny. 2013;64(3):278-81.
.