INTRODUCTION

The Mediterranean diet, considered by UNESCO as belonging to the world’s Intangible Cultural Heritage, provides sufficient energy and nutrition to protect the human organism from important illnesses as well as enhancing life expectancy^1,2,3

In recent decades, eating patterns in Mediterranean countries have become more Westernized, with particular effect on the young^1,4.

The period of transition from adolescence to adulthood is characterized by the increased risk of acquiring unhealthy habits such as poor diet and sedentary lifestyles^1,2,6,7,8.

Students attending university can experience a deterioration in their lifestyles, giving rise to the potential consolidation of risky behaviours which, if not controlled, could increase the chances of morbidity-mortality later in life^3,4,5,6.

Factors associated to students turning away from the Mediterranean diet are: their newly acquired sense of independence, responsibility for taking care of themselves, the greater availability of pre-cooked food and fast food restaurants, lack of nutritional knowledge and experience in cooking, or a question of taste and preference^2,3,4,5,6,7.

There are innumerable studies on the extent of student adherence to the Mediterranean diet, which conclude that they tend to follow a narrow, low-calorie diet. Students do not eat enough meals a day and take them at irregular times; they are more likely to snack between meals and skip breakfast mainly due to lack of time or to not feeling hungry first thing in the morning, and when they do, it tends to be insufficient^{1,2,3,4,5,6,7,9,10}. It is important to go beyond this and examine the roots of the problem in order to develop intervention strategies. As is known, university is a strategic target for promoting healthy lifestyles⁸, which is the aim of the Spanish Network of Healthy Universities (REUS in Spanish) which unites institutions committed to this end by leading and supporting processes to bring about social change⁹.

The aim of this work is to know the dietary habits, preferences and cooking skills of first-year students attending the University of Huelva, in order to carry out effective interventions to improve their culinary competence.

MATERIAL AND METHOD

Design and sample

This is a descriptive transversal study performed in academic year 2015-2016. The study population consisted of 2,330 students in their first year at the University of Huelva. A random group sampling was made, and stratified according to the university’s nine faculties. The information was extracted from the university’s academic management service database. A final sample of 756 students was obtained with +3% error and 95.5% NC.

Variables and data gathering

The information gathered on different aspects of student eating habits included:

Data on adherence to the Mediterranean diet was gathered from responses to the KIDMED questionnaire¹¹. The information on the other variables was collected by ad hoc questionnaire that was tested by experts and piloted in a group of 15 university students who had already completed their first year. Assessment of the influence of factors on eating habits was measured on a 0-5 Likert scale. Socio-demographic data on age, gender, civil status, degree course undertaken and type of residence during the course were also taken.

The data were gathered in the second four-month period of the 2015-2016 academic year, following a process in which information was facilitated by faculty heads and permission sought from teaching staff for the students to complete the questionnaire; informed consent was received from the students for their voluntary participation in the study, and they were given a guarantee of confidentiality.

Data analysis

Data analysis was organized and processed using the PSPP software statistical package, which calculated means, standard deviations and percentages for the descriptive analysis; the chi-squared test and ANOVA were used for the relational analysis.

RESULTS

The sample consisted of 62.7% women (474) and 37.3% men (282), with an average age of 20.95 ± 4.090 (age range: 17-56).

For civil status, 92.6% were single and 4.5% married, 2.1% described themselves as common-law partners, and 0.8% were DR/DK. Data on type of residence and faculty attended are shown in Table 1.

Table 1. Sample distribution for the Faculty and Type of Residence variables during the academic year 

Adherence to the Mediterranean diet

According to the KIDMED test, only 20.4% of students stuck closely to the Mediterranean diet, against 79.6% whose adherence was middling and 14.3% whose adherence was low.

In relation to each item in the KIDMED test, the most positive aspects were: the use of olive oil in cooking (95.5%), non-consumption of factory-baked foods for breakfast (90.2%), students who breakfasted (87.9%), students who did not snack on sweets and/or cakes several times a day (84.5%) students who ate cereals or derivatives for breakfast (75.7%). On the downside, the least healthy responses in the survey were: consumption of fruit or cooked vegetables more than once day (12.3%), students who consumed two pieces of fruit a day (25.7%), those who ate pasta or rice almost daily (32%) and consumed two yoghurts and/or 40 grams of cheese a day (38%) (Figure 1).

Figure 1. Distribution of responses for KIDMED test items 

The scoring in the KIDMED test showed significant differences for the variables of age (p<0.000), civil status (p<0.01), type of residence during the academic year (p<0.001) and self-assessment of food intake (p<0.000) (Table 2).

Table 2. Distribution of total KIDMED test scores for the socio-demographic variables 

Distribution of meals throughout the day

The results for distribution of meals throughout the day appear in Figure 2. One relevant finding is that 70.4% of students stated that they always made themselves breakfast, 58.3% consumed the five recommended meals a day and 57.6% admitted to snacking between meals. There were no significant differences between the socio-demographic variables and the type of meals consumed during the day.

FIGURE 2: DR/DK, never, sometimes, alwaysSnacking between meals, before bedtime, dinner, teatime, lunch, mid-morning, breakfast, before breakfast

Figure 2. Distribution of meals throughout the day 

Frequency of meal taking

Table 3 presents the absolute and relative frequency of consumption of each food item in the survey. The food products consumed various times a day were water (93.9%), olive oil (33.9%), dairy products (33.2%) and cereals (31.9%).

Table 3. Frequency of consumption of food items in the survey 

On a daily basis, only 39.8% of respondents stated that they consumed dairy products, 39.4% cereals, 33.7% olive oil and 32.7% fruit.

About half the sample declared that several times a week they consumed red meat (50.3%), eggs (46%), legumes (41.7%), cold meats (34.3%), blue fish (32.1%) and white fish (31.2%). Only 36.1% of students consumed legumes once a week. An interesting finding was that 37.7% of students did not drink coffee.

Factors that influence eating habits

The results for the factors that influence eating habits show that a lack of experience in cooking healthy food (1.69 ± 1.6), lack of knowledge of the repercussions of a poor diet (1.77 ± 1.6) and the ease of not cooking (2.2 ± 1.7) all have a moderate effect. Whereas lack of time due to study commitments (2.5 ± 1.6) and the pleasure gained from eating what they like (3.4 ± 1.42) significantly influence students’ eating habits.

Students’ self-assessment of their diet

In the students’ self-assessment of their dietary intake, 63.8% (479) believed that they needed to improve their eating habits, 22.6% (170) said they were happy with their current diet as they considered it to be healthy, and 13.6% (102) admitted a radical change was needed in their food consumption.

Information on food and nutrition

Regarding information on food and nutrition, 48.2% (634) stated that they needed to know more, 40.9% (309) believed they were well informed and 9.7% (73) thought their knowledge on the subject was lacking; 1.2% (9) were DR/DK.

Favourite foods

In terms of food preferences (Table 4), we observe that food favourites included: chicken (62.2%), pasta (58.2%), pork (50.4%) and fried potato chips 45.9%). Least favourite choices were: tinned sardines (40.7 %), beans (35.3 %), green beans (34.6 %), fresh sardines (28.2 %) and tinned mackerel (27.4 %).

Table 4. Distribution of food preferences by gender 

The preference variable for foods showed hardly any variation for gender, but there were significant differences in women’s predilection for lettuce (p<0.001), tomato (p<0.002) and pastries (p<0.001) over men. The men were less liable to be turned off by beans (p<0.02), white bread (p<0.05), fresh sardines (p<0.001) tinned sardines (p<0.000), beef (p<0.000) and pork (p<0.000) (Table 4).

Eating habits

The students surveyed stated that their skills at preparing and cooking food extended to the following: pasta (93.8%), egg and chips (90.2 %), pre-cooked pizza (88.7 %), fruit juice (86.1%), grilled meat (85.8 %), salads (83.8 %), grilled fish (76.7%), potato omelette (74.8 %), fried fish (68.9%), scrambled eggs (64.9%) and chicken with rice (53.83%).

The students recognized that some common meals were beyond their culinary capabilities:gazpacho(cold tomato soup) (48.9%), rice with added ingredients (46.1%), baked fish (44%), sponge cake (43.2%), homemade pizza (41%),salmorejo(thick cold tomato soup) (40.5%), meat in tomato sauce (36.2%), ratatouille (28.4%), mixed vegetables (28.3%), meat stew (24.7%), lentils (24%), any type of rice (23.9%), French toast (23.1%), meat and vegetable stew (22.6 %), paella (18.9 %), beans (14.2 %),cocido (traditional Spanish stew) (13.8 %) tuna fish stew (10.6%).

The percentage of women who declared that they knew how to cook a variety of dishes was higher than for the men for all cooked meals, with a significant gender difference across most types of meals (Table 5). The distribution of cooking skills according to type of residence tended strongly towards those who lived in their own home and were fully independent. Table 5 shows that students who live in a hall of residence or in a shared flat had more cooking skills than those living at home with their parents, the differences being significant in only five dishes: chicken with rice (p<0.01),cocido(p<0.000), scrambled eggs (p<0.01), meat in tomato sauce (p<0.0000) and ratatouille (p<0.015).

Table 5. Distribution by gender and type of residence related to the variable of skills in preparing and/or cooking certain dishes 

LH: Living at Home with Parents; OH: Own House; HR: Hall of Residence; SF: Shared Flat; O: Other

DISCUSSION

The extent of adherence to the Mediterranean diet among the first-year students surveyed at the University of Huelva is very similar to that of other students whose eating habits have been studied^{1,2,3,4,5,6,7,10,13}. However, it should be stated that our study population was formed only of new students who had only recently arrived at university, as opposed to other studies that analysed students beyond the first year of their degree courses; thus the possible negative effects recorded in the literature^1,2,3,4,6,13 would not yet be obvious.

Monitoring the eating habits of this student population throughout the entirety of their degree courses will demonstrate this influence. One strength of our study is that it covers students across all faculties at the University of Huelva without focusing on a particular degree course group, as well as including student eating preferences and culinary habits, factors that have received less attention in other descriptive investigations. Our research has similar limitations to studies that seek to assess student food intake.

The results of this study show that Huelva University students have deficient eating habits that need to change and draw closer to the typical healthy Mediterranean diet. Most students’ scores were in the middle segment of the KIDMED questionnaire, with the stand-out feature being the proportion of students who scored high on adherence to the Mediterranean diet and the small percentage of those who scored low. The results are similar to those in other studies of university students and their eating habits¹². The eating habits that stand out most among students in Huelva relates to taking the time to have breakfast, in contrast to results from studies in Murcia and Ourense^1,3in which this meal was skipped more frequently; another point to emphasise is the high use of olive oil in cooking. A negative point is the low daily consumption of fruit and vegetables among Huelva students, an important aspect that needs to be reversed in future intervention strategies.

In our study, a clear determining factor was age, although civil status and type of residence also had an effect. It was observed that students who are married and have their own homes, which indicates students of mature age, had higher mean scores than the rest. It could be that greater independence in their daily lives, maturity, experience and a heightened sense of responsibility for taking care of themselves, together with greater concern about their future health and awareness or knowledge of the impact on their health of bad eating habits, as well as traditional family eating habits that depend less on the consumption of precooked foods, could all be reasons that explain the main differences between younger and older students. In terms of gender, as in other research^12,13 no significant differences were noted. However, we did find discrepancies in the effect of type of residence. Students who scored highest in our survey were those who lived in their own home, followed by those who lived at home with their parents, whereas other studies have shown that students scoring highest were those who reside away from home¹. Maybe the fact that the students in our survey were still in the first year could explain the difference.

Regarding the distribution of meals throughout the day, three points in particular need to be improved in any future process to promote healthy eating. The first refers to the high number of students who systematically skip breakfast, although this is not necessarily every single day. Secondly, reducing food intake to just three meals a day, although most students stated that they occasionally have five. The third point is the high number of students who snack between meals, often unplanned and unhealthily. In terms of the frequency of consumption of certain types of food, the results show a clear daily deficit in fruit and vegetables, and a high weekly intake of red meat and sugary and/or refined food, and low consumption of dried fruit and nuts. These results are only comparable to those of Chacón et al.¹², with similar low consumption of fruit, vegetables in general, green vegetables and dried fruit and nuts, together with high consumption of meat, factory baked foods, cakes, snacks and fizzy drinks.

Another important result is the relation established in students’ self-assessment of their eating habits and the KIDMED test scores. The students with the lowest scores were those who considered their eating habits to be the poorest, indicating that they were aware that they do not eat well. This awareness of the need to eat better does not necessarily mean that all students demand information on nutrition, which suggests that future research should focus not only on improving nutritional knowledge but also on how to inculcate healthy eating practices.

There is a similarity between the factors that influence Huelva students’ eating habits and those of students in other research^2,3,4,5,6,7. Factors exercising the biggest influence are food preferences and elements related to the organization of academic work, followed by the more moderate effect of lack of experience in cooking healthy food, the ease of not cooking and lack of awareness of the negative effects of bad diet on health. These data fit those found in students’ self-assessment of their own eating habits, with the awareness that their eating habits need to improve, somewhat or substantially.

On food preferences, there are more studies that analyse the influence of food preferences on making eating decisions¹⁴ than research that explores students preferred choices. Our study found a high percentage of students who preferred meat and carbohydrate-rich foods to fruit and vegetables, as in similar study populations^2,6,13,15.

The scientific literature has little to say on culinary skills but more on students’ self-perception of their own cooking capabilities and the factors that influence them^16,17,18,19. Our study adopts a new approach in that it describes students’ favourite foods and cooking skills as determining factors in good culinary practice. The lack of cooking expertise among Huelva university students could partly explain the deterioration in their eating habits; gender differences might have shifted the balance towards closer adherence to the Mediterranean diet, but this was not observed in our survey. With this in mind, future interventions should promote healthy eating habits that enable students to acquire skills to prepare healthier food in the kitchen.

CONCLUSIONS

The results from the survey of first-year students attending the University of Huelva reveal poor eating habits that need to be improved and redirected towards greater adherence to the Mediterranean diet. The eating habits that most clearly stand out are related to having breakfast and the use of olive oil in cooking. The least healthy dietary features were low consumption of fruit and vegetables, mirrored by the students’ inclusion of these among their least favourite foods.

The results for adherence to the Mediterranean diet, the relation established to self-assessment of eating habits, the factors that influence their habits and food preferences all have important implications for future research. We believe that investigators should focus on the creation of healthy environments that enable students to rest and have access to healthy food, as well as programmes to develop cooking skills.

Future research should evaluate the efficacy of community interventions at university that aim to improve eating habits and students’ cooking capabilities in order to strengthen scientific evidence in the promotion of healthy lifestyles and the prevention of the type of public health problems that are most prevalent in developed countries.