Design: This is a cross-sectional, descriptive and correlation study that was conducted between June 1st and September 20th, 2014.

Setting: Four Universities were chosen to collect this data. Eating behaviors were assessed by a questionnaire adapted to the Lebanese diet. A measure of weight, height, and waist circumference was conducted to determine the nutritional status of these students.

Subjects: A sample of 400 students was selected randomly at the four universities.

Results: Students living independently were significantly more likely to be obese compared to students living at their parental home (17.5 vs 3 %), more likely to smoke (52 vs 36%), more likely to skip breakfast (34 vs 22%), and to eat cake and sugar based foods (69 vs 28%). Furthermore, the students living at the parental home were more likely to exercise regularly (78 vs 58%), eat at regular meal times (51 vs 20%) and less likely to binge on food in response to stress.

Conclusions: This study shows a correlation between obesity and eating behaviors with the place of residence during the university years. Students living at the parental home displayed healthier nutritional habits and less likelihood of obesity.

Residence; Nutritional behavior; Obesity; Nutritional habits

Mikhael Z, Wehbe T, Jaoude EA (2018) Nutritional Behaviors and Living Arrangements during the University Years: A Correlation Study. Ann Public Health Res 5(1): 1071.

BMI: Body Mass Index; SPSS: Statistical Package for Social Sciences

The academic years present a critical period for developing nutritional and exercise habits, smoking and weight gain. Eating practices among university students refer to a set of learned behaviors, by necessity or by living constraints, which might affect the health status of a person. During the transition from high school to college or university, students adapt new habits, influenced by new environmental stressors and behavioral determinants and pressures. This process of adaptation may shape a number of health behaviors like smoking, food binging, alcohol consumption, eating frequency, types of food chosen and subsequent health status [1-4]..

The eating practices of university students are key determinants of the current and future health. These behaviors are dictated by the person’s preferences and knowledge, schedule, availability of food in or near the university campus, availability of money, smoking and alcohol use, residence in selfcontained housing or in the family home, peer pressures along with the interactions of all these factors together [5-8].

Due to the expansion of fast foods in the market, students are often faced with few poor eating choices high in unsaturated, trans-fat and carbohydrates with rare fruits, vegetables and fibers in general. As a result, diet becomes a set of nibbling and binge eating, with excessive consumption of fats, soft drinks and alcohol. Due to the time constraints, eating on the run with little time spent on chewing may become habitual. As students move from the parental to independent living, many develop poorer eating habits with little awareness of how future carriers are being shaped to the detriment of future health [9-10].

The objectives of this study is to compare and correlate the nutritional and health habits, of a cohort of Lebanese university students, living alone, or in the parental home, in the regions of Mount and North Lebanon. We aim to correlate weight, abdominal adiposity reflected by waist circumference, BMI, smoking, drinking alcohol, and exercise as good indicators of health with the living conditions [11,12].

This study has a cross-sectional, correlative, and analytical design. It was conducted between June 1st and September 20th, 2014, with a sample of 400 Lebanese university students, divided equally between those living with their families and those living alone. The subjects were recruited from four universities located in the regions of Mount and North Lebanon namely the Holy Spirit University of Kaslik, Jounieh, Mount Lebanon, the Balamand University, Balamand al Kurah, North Lebanon, the LebaneseAmerican University, Byblos, Mount Lebanon, and the Lebanese University, Tripoli, North Lebanon. The sampling used was random, where each university student had an equal chance of being included within the sample. The study was based on a confidential and anonymous questionnaire. The questionnaire consisted of eight parts:

The subjects were classified based on their BMI as underweight with BMI less than 18.5 kg / m2 , normal weight as BMI between 18.5 and 24.9 kg / m2 , overweight as BMI between 25 and 29.9 kg / m2 , and obese with BMI of 30 kg / m2 or higher. Abdominal obesity was defined as a waist circumference greater than or equal to 102 cm for men, and 88 cm for women.

We studied the relationship between each eating habit, and the place of residence looking for any correlations.

Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 21.0 (SPSS Inc., Chigaco, IL). Descriptive statistics were used to examine the sociodemographic characteristics of the sample, behavioral patterns, nutritional status and abdominal obesity. X2 (chi-square) tests were used to assess the association between dwelling type, and (i) socio-demographic characteristics, (ii) meal habits, (iii) behavioral habits, and (iv) abdominal adiposity. An alpha level of 5% was considered significant.

Our subjects consisted of four hundred university students recruited from the four universities located in two different regions of Lebanon: Mount Lebanon and North Lebanon as mentioned above. The average age of these students was 20.8 ± 1.5 years. The males were 36.2% of our subjects and the females 63.7%. The main academic majors of the respondents were Business Management and Commercial Sciences (33.2 %) followed by engineering (28.2 %). One third of the students (34%) were in their senior year (Table 1). Of the 400 university students, 8.3% were underweight, 61.2% were normal weight, 20.2% were overweight, and 10.3% were obese. In addition, 20% of the students had abdominal obesity based on waist circumference.

In this study, most students were in the normal range of body weight (47.6% of males and 69% of females). In addition, 42.1% of male students were found to be overweight, and 12.9% of female students were underweight.

Nutritional status was significantly associated with dwelling type (p = 0.000). Students living independently were significantly more likely to be obese compared to students living at home (17.5 vs 3 %). Twenty seven percent (27%) of the students living alone had abdominal obesity compared to 13% of those living with their families. This relationship was highly significant ( p = 0.000 0.05). In contrast, the relationship was significant between fried food consumption and abdominal obesity (p <0.01) (Tables 3,4). Our results also indicate that 34% of students living alone missed breakfast compared to 22.5% of those living with their families. Fruits, vegetables, legumes, and fish, characterizing the traditional Mediterranean diet were also more likely to be consumed by students living in the parental home (Table 5).

The years leading to adulthood, including university life, influence the eating attitudes and behaviors that shape food choices and may predispose to certain obesity levels for life. Weight gain seen during the university years have been shown to result in considerable long term overweight and obesity in several published studies [13-17].

Our study shows that living independently or at the parental home correlates with weight, body mass index, smoking, exercise and the choice of foods consumed. Students living independently in Lebanon were not only more likely to be overweight or obese, but also more likely to develop unhealthy habits like smoking and leading a sedentary lifestyle. The excessive weight, in our study, correlated also with poor nutritional choices like fried and fast food, high fat cold cuts and full fat Dairy products resulting in a higher incidence of obesity.

Our study found that students living alone were more likely to be obese (17.5%) compared to those living at home (3%). These findings are consistent with the other studies, in which an association between residency type and nutritional status was clearly found [18]

Missing meals was also seen more frequently among students living alone (34%) compared to students living with their family (22.5%). This is another feature seen in the literature, in a study conducted in Malisie in which students living alone were more likely to skip breakfast l (56.3%), compared to those living at home (36.7%) [19].

It has been suggested that lack of time may lead to inadequate nutrition in the group of young adults living independently leading to fast, unhealthy food choices, as well as reduced consumption of home prepared nutritious meals. These results are similar to that of Papadaki et al., who showed that Greek students living with their family consumed an average of 5.2 fruit servings and 8.3 servings of vegetables a week, compared to students living alone consuming only 4.7 servings of fruits and 4.3 servings of vegetables weekly [20].

Nelson et al., showed that weight gain seen during the university years will result in students with considerable overweight and obesity. It is interesting to note that among the 400 students, 52.5% reported taking two snacks a day, which consisted mostly of sweets, fruits, and coffee. contrasted with the report of Delva et al. who reported that 63% of the subjects studied snacked on chips (26.2%), crackers (16.4%), and nuts (12.7%). [21,22].

Our results showed that the prevalence of alcohol consumption three times per week or more was slightly higher among students living alone (10.5%) compared to those living in the family home (4.5%). This is similar to the findings of Deshpande et al., who showed that students living alone consume more alcohol (23.4%), compared to those living with their families (12.5%), but it contradicts the results reported by Jelinic et al. in 2008, where the prevalence of alcohol consumption was high in both groups (p = 0.021), with a trend of higher consumption among students living with their families (33.3% vs 22.6%) [23,24].

Economos et al., showed that alcohol consumption was linked to a weight gain of 1.90 kg.

Although many studies have highlighted the negative impact of sugary drinks consumption on the nutritional status of students (West et al., 2006, Malik et al., 2006), our study did not show such an effect [25-27]. Our results indicated that smoking was associated with the dwelling type as well. Independently living students smoked more (52%) than those living at home (36.5%). This is in agreement with the results obtained by Boot et al., which revealed that students living alone in Amsterdam smoked more (61.7%), compared to those residing with their families (45.3%) [28].

Students living at home were significantly more physically active compared to those living alone. Similar to the study by Bagordo et al., students living with their families practiced more sports (1.78 times per week), compared to those residing alone (1.25 times per week). Students exercising less than three times weekly, had more likelihood of abdominal obesity (31.7%) compared to those who did (8.1%) [2].

Students living alone were more likely to eat when stressed than those living with their families. These results are consistent with the study by Tavolacci et al., who found that students living alone were more exposed to stress (35.6%), compared to those living with their families (23.4%) [29].

Finally, this study has shown that consumption of fried foods was significantly associated with abdominal obesity similar to the study by Ansari et al. showing that students who consumed fried foods were more likely to be obese (66.7%), compared to those who reported no consumption of these foods (33.3%) [7].

The cross-sectional design of this study helped us establish the association between feeding practices and the nutritional status of university students, without revealing clearly the causes of this association. It is unclear whether unbalanced nutritional status precedes unhealthy dietary practices or vice versa. Prospective studies should complete this study and add interventional tools to use these findings to stop the development of obesity and the group of poor eating behaviors.

Table 1: Socio-demographics by place of residence.

Table 2: Correlation between the nutritional status and place of residence.

Table 3: Relationship between abdominal obesity and food diversity.

Table 4: Eating Habits and Place of Residence.

Table 5: Place of residence and Snack choices.

Controlling obesity as one of the major health problems of this century should start by understanding the complex set of behaviors leading to the consumption of food and calories in excess of our body’s needs. Our study focuses on the housing during college and university years as a key to the behavioral etiologies of overweight.

We showed that university students living in independent housing were more likely to pick up poor lifestyle habits including smoking, excessive alcohol drinking, binging on food with stress, eating fast with less chewing, consuming more fried foods, cake, sweet snacks, full fat Dairy, non-Turkey cold cuts and performing less exercise. All these undesirable dietary habits resulted in a higher incidence of obesity and overweight that is likely to be kept for the years to come [30-33]. Many of these findings were reported by others [22,34].

Our study revealed a significant relationship between nutritional status and abdominal adiposity and the type of residence. Controlling obesity should start with education and making healthier foods more readily available. Personal choices and independent living will always be though by young men and women reaching their maturity. It is a huge challenge, as they cross this life barrier, into colleges and universities for them to make the healthier choices and for the community to make those options more readily available. Investing in the future of health habits may be as or more important than investing in future careers and professions

We appreciate the contribution of Dr. Elie Maalouf in the statistical analysis and its interpretation

1- Mrs. Zeina Mikhael collected the original data, analyzed it and summarized the findings

2- Dr. Tarek Wehbe performed the analysis, editorial preparation and literature searches

3- Dr. Elizabeth Abou Jaoude supervised the data collection, literature review and interpretation of the data

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