Nutritional knowledge, food habits and

health attitude of Chinese university

students –a cross sectional study–
 Ruka Sakamaki,
 Kenji Toyama,
 Rie Amamoto,
 Chuan-Jun Liu &
 Naotaka Shinfuku

Nutrition Journalvolume 4, Article number: 4 (2005) | Download Citation

Abstract

Background
We have previously shown that irregular lifestyle of young Japanese female students are
significantly related to their desire to be thinner. In the present study, we examined the
nutritional knowledge and food habits of Chinese university students and compared
them with those of other Asian populations.

Methods
A self-reported questionnaire was administered to 540 students, ranging in age from 19-
24 years. Medical students from Beijing University (135 men and 150 women) in
Northern China and Kunming Medical College in southern China (95 men and 160
women) participated in this study. The parametric variables were analyzed using the
Student's t-test. Chi-square analyses were conducted for non-parametric variables

Results
Our results showed that 80.5% of students had a normal BMI and 16.6 % of students
were underweight with the prevalence of BMI>30 obesity being very low in this study
sample. Young Chinese female students had a greater desire to be thinner (62.0%) than
males (47.4%). Habits involving regular eating patterns and vegetable intake were
reported and represent practices that ought to be encouraged.

Conclusions
The university and college arenas represent the final opportunity for the health and
nutritional education of a large number of students from the educator's perspective. Our
findings suggest the need for strategies designed to improve competence in the area of
nutrition.
Open Peer Review reports

Background

The increasing problem of obesity has been observed in many lower-income countries
during the last decades. China has adopted an open-market policy and experienced
explosive economic growth, which has led to less food scarcity at the national level and
to a remarkable transition in the structure of the diet of Chinese [1]. The composition of
the Chinese diet has been shifting towards a diet higher in fat and meat, and lower in
carbohydrates and fiber [2]. Additionally, decreased levels of physical activity and
leisure are linked to increases in the prevalence of an overweight condition, obesity and
diet-related non-communicable diseases [3].

In previous reports, we examined eating habits and dietary knowledge of female

students in Japan. Our results showed that irregular lifestyle was significantly related to
indefinite complaint, with the majority of students having a desire to be thinner
although the prevalence of students who were overweight was very low in this study
sample [4]. Universities and colleges are potentially important targets for the promotion
of healthy lifestyles of the adult population. However, little is known concerning the
body mass index (BMI) distribution and nutritional and health-related behavior of
Chinese university students. The purpose of this study was to obtain a preliminary
understanding of the relative level of BMI distribution of Chinese university students
and to determine the nutritional knowledge and body-shape perceptions.

Material and Methods

This study was carried out between February 2001 and April 2002. Medical students
from Beijing University (135 men and 150 women) in Northern China and Kunming
Medical College in southern China (95 men and 160 women) participated in this study.
A sample of 540 students aged 19 – 24 years were administered a self-reported
questionnaire. The questionnaire consisted of 21 questions regarding eating, drinking
and smoking habits (19 questions), with 2 questions related to dieting (trying to lose
weight). Self-reported height and weight were used to calculate BMI (kg/m2). The
questionnaire was designed by the authors and based on a national dietary survey held
by the Health and Labor Ministry of Japan. Some of the authors also traveled to China
to investigate the dietary life of Chinese to facilitate questionnaire design. The
questionnaire was first written in Japanese and then translated to Chinese utilizing
fluent bilingual linguistic services. The translated Chinese version was back-translated
to insure the original meaning was not lost. Informed consent was obtained from all
participants of this study according to the Declaration of Helsinki. The statistical
software package SPSS 10.0 was used for the analysis of data [5]. In this study,
parametric variables were analyzed using the Student's t-test. Chi-square analyses were
conducted for non-parametric variables. All analyses were two-tailed, and a 'p' value less
than 0.05 was considered statistically significant.
Results

Characteristics of the sample and BMI categories

The response rate was 96% (512 / 540). The characteristics of the subjects are shown in
Table 1. A total of 212 men and 300 women, with a mean age of 20 ± 1.9 years,
participated in this study. The average height was 165.8 ± 7.8 cm, while the average
weight was 56.9 ± 9.2 kg. Mean BMI was 20.6 ± 2.2. To analyze the distribution of BMI
and health-related behavior, BMI was categorized into 4 groups according to mean BMI
of ± 1 standard deviation (SD) (Figure 1). The average BMI for male students was 21.4 ±
2.5 and was highest in the categories 18.9≤BMI<21.4 (37.7%) and 21.4≤BMI<23.9
(32.5%). The average BMI for female students was 20.0 ± 1.8, with the categories
18.2≤BMI<20.0 (37.5%) and 20.0≤BMI<21.8 (31.4%) displaying high values. According
to WHO BMI classifications [6], 97.1% of students were classified into the underweight
or normal weight categories. 2.5% (13/512) students were overweight (BMI>25) and
0.4% (2/512) of students were obese (BMI>30). BMI values of deviations from the
average sample show the presence of few extreme values.

Table 1 Characteristics of Participants

Full size table

Figure 1

BMI distribution of Chinese university students. The BMI of male and female
students was categorized into 4 groups according to mean BMI ± 1 standard deviation
(SD).

Full size image

Eating habit
The life style practices were compared by gender (see additional file 1). The majority of
students (83.6 %) reported taking meals regularly, with 79.0% eating meals 3 times per
day; there were no gender differences. However, a significant gender difference was
found in the response relating to breakfast intake, with 66.8% of males and 82.3% of
females reporting eating breakfast regularly (p < 0.0006). The frequency of snacking
rate was significantly higher in females (31.1%) than in males (11.5%; p < 0.0001). The
present sample demonstrated high consumption of vegetable and fruits. A total of 47.9%
of students reported the consumption of colored vegetables such as spinach and carrots,
and 32.5% of subjects reported eating fruit daily. Female students tend to eat more fruit
than males (p < 0.0001). In addition, female students tend to eat with friends and
family more frequently than males (p < 0.01). Few subjects smoke or drink alcohol.
When the students eat out, female students are more likely to consider the calorie
content of the menu than males (data not shown). Although 85.6% of students are aware
of the concept of nutritionally balanced food, only a small number of students (7%)
apply this concept when selecting food from a menu. Moreover, only 51% of students
showed a desire to learn about healthy diets.

Body image and health consciousness

When subjects were asked about their history of dieting, 22.7% of respondents reported
that they had dieted (see additional file 2). The proportion of female students having a
dieting experience (29.8%) was more than twice as great as that of male subjects (12.7%;
p < 0.0006). In total, 56% of the students selected 'thin or slim is beautiful'. The
percentage by gender was, 47.4% for male and 62.0% for female students. Female
students have a significantly greater desire to be thinner than males (p < 0.001). More
than half of the respondents reported a desire to adopt healthier dietary habits.
Moreover, a question regarding the degree of consciousness pertaining to health and
diet was asked; 45.2% of male students and 48.3% of female students wish to learn
about health and diet. Among female subjects, BMI<18.2 strongly showed their
consciousness of health and diet (p < 0.03).

Discussion

This study aimed to determine the health, nutritional knowledge and dietary behavior of
university students in China. As a result, we recorded the distribution of BMI among
Chinese students and found a low prevalence of obesity, a finding that is consistent with
a study of Japanese female students (BMI≥25 overweight was 5.8%, BMI>30 of obesity
was 0%) [4]. In the United States, 35% of the college students are reported to be
overweight or obese (BMI≥25) [7]. According to the WHO definition of obesity, BMI>30
is the cut-off point [6]. The definition is based on research of Caucasian populations.
Asian populations are reported to have a higher body fat (%) at a lower BMI compared
to Caucasians [8]. The WHO expert consultation reported that BMI in Asian
populations is related to disease at a lower level [9]. In order to compare obesity
prevalence between ethnic groups, BMI cut-off points for Asians need to be considered
by well constructed and standardized body composition studies. It is notable that in
China, the prevalence of overweight individuals increased from 1991 to 1997, with the
increasing rate changing from 6.4 to 7.7 [10]. The proportion of energy derived from the
fat of both vegetable and animal sources increased each year. A recent study revealed
that energy derived from dietary fat accounted for more than 30% of the total energy
[11]. Changes in dietary composition, which correspond to socioeconomic growth, may
accelerate the prevalence of obesity in China.

The results of our study show that the majority of students regularly eat three times per
day, and almost 80% of students eat vegetables and fruit twice per day. These eating
habits ought to be encouraged. The traditional Chinese diet contains plenty of
vegetables and is rice-based. The present study reported a high proportion of Chinese
students eat breakfast daily. In contrast, a dietary survey of young Japanese subjects
revealed a low rate of individuals engaged in regular eating patterns [12]. The skipping
of breakfast has been associated with lower nutritional status and the risk of
cardiovascular diseases [13]. It has also been reported that less adequate breakfast
habits may contribute to the appearance and further development of obesity [14].
Therefore the importance of regular eating patterns cannot be overemphasized in
nutritional education.

Our results showed that body figure perception was significantly different between
female and male students. A number of researchers have investigated the relationship of
body image and gender role. Women tend to desire a thinner figure, express more
anxiety about becoming fat, and are more likely to diet than men [15, 16]. In contrast,
men have reported a desire for a heavier physique and muscularity [17]. In recent years,
eating disorders have been increasing dramatically among young women. The results of
our study did not confirm this suggestion to the level of statistical significance; however,
it is worth pointing out that 65.0% of female students with BMI<20, which is under to
normal weight range, indicated a desire to be thin. Dissatisfaction with body figure and
eating disorders are closely related [18–20]. Being young, female, and dieting are
identified risk factors that have been reliably linked to the development of eating
disorders [21]. It was speculated that some of the students who were preoccupied with a
thin body may develop eating disturbances. Thus, the promotion of healthy weight
management practices should be considered when developing health education
programs.

Conclusions

In conclusion, our findings reveal that the majority of students were classified into the
normal BMI group, with the prevalence of BMI >30 obesity being very low in this study
sample. Young female students had a greater desire to be thinner than male students.
Habits involving regular eating patterns and vegetable intake were found and represent
practices that ought to be encouraged. The meal and snack patterns in Chinese students
were very similar to the traditional eating pattern model, although diets are changing
rapidly in China and other low-income countries. The university and college arenas
represent the final opportunity for nutritional education of a large number of students
from the educator's perspective. 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. Furthermore, public
demand for health and nutritional information should be taken into consideration when
implementing strategies aimed at improving the nutritional well-being of individuals.

References

1. 1.

Popkin BM, Keyou G, Zhai F, Guo X, Ma H, Zohoori N: The nutrition transition

in China: a cross-sectional analysis. Eur J Clin Nutr. 1993, 47: 333-46.

o CAS
o PubMed
o Google Scholar
2. 2.

Du S, Mroz TA, Zhai F, Popkin BM: Rapid income growth adversely affects diet
quality in China – particularly for the poor!. Soc Sci Med. 2004, 59: 1505-15.
10.1016/j.socscimed.2004.01.021.

o Article
o PubMed
o Google Scholar
3. 3.

Du S, Lu B, Zhai F, Popkin BM: A new stage of the nutrition transition in China.

Public Health Nutr. 2002, 5: 169-74. 10.1079/PHN2001290.

o Article
o PubMed
o Google Scholar
4. 4.

Rie Amamoto , Mina Dozono , Kenji Toyama : The relationship between dietary
life and indefinite complaint in female Nutrition department students. Seinan Jo
Gakuin Bulletin. 2004, 75-85.
o Google Scholar
5. 5.

SPSS Inc: SPSS Base 7.5 Application guide Chicago. IL: SPSS. 1997, 53-56.

o Google Scholar
6. 6.

World Health Organization: Obesity: preventing and managing the global

epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser.
2000, 894: i-xii, 1-253.

o Google Scholar
7. 7.

Lowry R, Galuska DA, Fulton JE, Wechsler H, Kann L, Collins JL Jan : Physical
activity, food choice, and weight management goals and practices among US
college students. Am J Prev Med. 2000, 18: 18-27. 10.1016/S0749-
3797(99)00107-5.

o CAS
o Article
o PubMed
o Google Scholar
8. 8.

Wang J, Thornton JC, Russell M, Burastero S, Heymsfield S, Pierson RN: Asians

have lower body mass index (BMI) but higher percent body fat than do whites:
comparisons of anthropometric measurements. Am J Clin Nutr. 1994, 60: 23-8.

o CAS
o PubMed
o Google Scholar
9. 9.

WHO Expert Consultation: Appropriate body-mass index for Asian populations

and its implications for policy and intervention strategies. Lancet. 2004, 363:
157-63. 10.1016/S0140-6736(03)15268-3.
o Article
o Google Scholar
10. 10.

Wang Y, Monteiro C, Popkin BM: Trends of obesity and underweight in older

children and adolescents in the United States, Brazil, China, and Russia. Am J
Clin Nutr. 2002, 75: 971-7.

o CAS
o PubMed
o Google Scholar
11. 11.

Xiao-Shu Chen MD, Ke-You Ge: Nutrition transition in China: the growth of
affluent diseases with the alleviation of undernutrition. Asia Pacific Journal of
Clinical Nutrition. 1995, 4: 287-293.

o Google Scholar
12. 12.

Ministry of Health, Labour and Welfare, Japan: The National Nutrition Survey in
Japan, 2002. 2004, Daiichi publisher

o Google Scholar
13. 13.

Sakata K, Matumura Y, Yoshimura N, Tamaki J, Hashimoto T, Oguri S, Okayama

A, Yanagawa : Relationship between skipping breakfast and cardiovascular
disease risk factors in the national nutrition survey data. Nippon Koshu Eisei
Zasshi. 2001, 48: 837-41.

o CAS
o PubMed
o Google Scholar
14. 14.

Ortega RM, Redondo MR, Lopez-Sobaler AM, Quintas ME, Zamora MJ, Andres
P, Encinas-Sotillos A: Associations between obesity, breakfast-time food habits
 and intake of energy and nutrients in a group of elderly Madrid residents. J Am
Coll Nutr. 1996, 15: 65-72.

o CAS
o Article
o PubMed
o Google Scholar
15. 15.

Cash TF, Brown TA: Body image in anorexia nervosa and bulimia nervosa. Behav
Modif. 1987, 11: 487-521.

o CAS
o Article
o PubMed
o Google Scholar
16. 16.

Smith BL, Handley P, Eldredge DA: Sex differences in exercise motivation and
body-image satisfaction among college students. Percept Mot Skills. 1998, 86:
723-32.

o CAS
o Article
o PubMed
o Google Scholar
17. 17.

Pope HG, Gruber AJ, Mangweth B, Bureau B, deCol C, Jouvent R, Hudson JI:
Body image perception among men in three countries. Am J Psychiatry. 2000,
157: 1297-301. 10.1176/appi.ajp.157.8.1297.

o Article
o PubMed
o Google Scholar
18. 18.

Solenberger SE, Exercise and eating disorders: a 3-year inpatient hospital record
analysis. Eat Behav. 2001, 2: 151-68. 10.1016/S1471-0153(01)00026-5.
 o CAS
o Article
o PubMed
o Google Scholar
19. 19.

Williamson DA, Cubic BA, Gleaves DH: Equivalence of body image disturbances
in anorexia and bulimia nervosa. J Abnorm Psychol. 1993, 102: 177-80.
10.1037//0021-843X.102.1.173.

o CAS
o Article
o PubMed
o Google Scholar
20. 20.

Waller G, Hodgson S: Body image distortion in anorexia and bulimia nervosa: the
role of perceived and actual control. J Nerv Ment Dis. 1996, 184: 213-9.
10.1097/00005053-199604000-00003.

o CAS
o Article
o PubMed
o Google Scholar
21. 21.

Pratt BM, Woolfenden SR: Interventions for preventing eating disorders in

children and adolescents. Cochrane Database Syst Rev. 2002, CD002891-

o Google Scholar

Download references

Acknowledgements

The authors express their appreciation for the invaluable partnership and support of Dr.
Wang of Beijing University, Dr Zhao of Kunming Medical College and all the study
participants of both institutes. We also thank Dr. Shigeki Minakami for valuable
comments on the manuscript.
Author information

Affiliations
1. International Center for Medical Research, Kobe University Graduate School of
Medicine, Kobe, 650-0017, Japan
o Ruka Sakamaki
o & Naotaka Shinfuku
2. Department of Nutritional Sciences, Seinan Jo Gakuin University Faculty of
Health and Welfare, Kitakyusyu, 803-0835, Japan
o Ruka Sakamaki
o , Kenji Toyama
o & Rie Amamoto
3. Department of Plastic Surgery, Kobe University Graduate School of Medicine,
Kobe, 650-0017, Japan
o Chuan-Jun Liu

Corresponding author
Correspondence to Ruka Sakamaki.

Additional information

Authors' contributions
R.S carried out questionnaire design, manuscript drafting and total coordination of the
study. K.T has been involved in drafting and revision of the article. R.A contributed to
the data entry and its analysis. L.CJ contributed to the questionnaire design, data
collection and language translations. N.S contributed to final approval of the
manuscript.