Nutrition Journal BioMed Central
Research Open Access
Nutritional knowledge, food habits and health attitude of Chinese
university students –a cross sectional study–
Ruka Sakamaki*1,2, Kenji Toyama2, Rie Amamoto2, Chuan-Jun Liu3 and
Naotaka Shinfuku1
Address: 1International Center for Medical Research. Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan, 2Seinan Jo Gakuin
University Faculty of Health and Welfare, Department of Nutritional Sciences, Kitakyusyu, 803-0835, Japan and 3Department of Plastic Surgery,
Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
Email: Ruka Sakamaki* - sakamaki@seinan-jo.ac.jp; Kenji Toyama - toyama@seinan-jo.ac.jp; Rie Amamoto - tanaka_r@seinan-jo.ac.jp; Chuan-
Jun J Liu - liu_jim@yahoo.com; Naotaka Shinfuku - shinfuku@kobe-u.ac.jp
* Corresponding author
Published: 09 February 2005 Received: 02 November 2004
Accepted: 09 February 2005
Nutrition Journal 2005, 4:4 doi:10.1186/1475-2891-4-4
This article is available from: http://www.nutritionj.com/content/4/1/4
© 2005 Sakamaki et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Background transition in the structure of the diet of Chinese [1]. The
The increasing problem of obesity has been observed in composition of the Chinese diet has been shifting towards
many lower-income countries during the last decades. a diet higher in fat and meat, and lower in carbohydrates
China has adopted an open-market policy and experi- and fiber [2]. Additionally, decreased levels of physical
enced explosive economic growth, which has led to less activity and leisure are linked to increases in the
food scarcity at the national level and to a remarkable
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Table 1: Characteristics of Participants software package SPSS 10.0 was used for the analysis of
data [5]. In this study, parametric variables were analyzed
Total Male Female
Variable n = 512 n = 212 n = 300 using the Student's t-test. Chi-square analyses were con-
ducted for non-parametric variables. All analyses were
Age (y) 20.4 ± 1.9 20.3 ± 1.7 20.4 ± 2.0 two-tailed, and a 'p' value less than 0.05 was considered
weight (kg) 56.9 ± 9.2 63.7 ± 8.8 52.1 ± 5.9 statistically significant.
height (cm) 165.8 ± 7.8 172.3 ± 5.5 161.2 ± 5.6
BMI (kg/m2) 20.6 ± 2.2 21.4 ± 2.5 20.0 ± 1.8 Results
Characteristics of the sample and BMI categories
Gender distribution in the sampled population. BMI is based on self- The response rate was 96% (512 / 540). The characteristics
reported height and weight. BMI = weight [kg] / height [m]2
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, par-
ticipated in this study. The average height was 165.8 ± 7.8
cm, while the average weight was 56.9 ± 9.2 kg. Mean BMI
prevalence of an overweight condition, obesity and diet- was 20.6 ± 2.2. To analyze the distribution of BMI and
related non-communicable diseases [3]. health-related behavior, BMI was categorized into 4
groups according to mean BMI of ± 1 standard deviation
In previous reports, we examined eating habits and die- (SD) (Figure 1). The average BMI for male students was
tary knowledge of female students in Japan. Our results 21.4 ± 2.5 and was highest in the categories
showed that irregular lifestyle was significantly related to 18.9≤BMI<21.4 (37.7%) and 21.4≤BMI<23.9 (32.5%).
indefinite complaint, with the majority of students having The average BMI for female students was 20.0 ± 1.8, with
a desire to be thinner although the prevalence of students the categories 18.2≤BMI<20.0 (37.5%) and
who were overweight was very low in this study sample 20.0≤BMI<21.8 (31.4%) displaying high values. Accord-
[4]. Universities and colleges are potentially important ing to WHO BMI classifications [6], 97.1% of students
targets for the promotion of healthy lifestyles of the adult were classified into the underweight or normal weight cat-
population. However, little is known concerning the body egories. 2.5% (13/512) students were overweight
mass index (BMI) distribution and nutritional and health- (BMI>25) and 0.4% (2/512) of students were obese
related behavior of Chinese university students. The pur- (BMI>30). BMI values of deviations from the average sam-
pose of this study was to obtain a preliminary understand- ple show the presence of few extreme values.
ing of the relative level of BMI distribution of Chinese
university students and to determine the nutritional Eating habit
knowledge and body-shape perceptions. The life style practices were compared by gender (see addi-
tional file 1). The majority of students (83.6 %) reported
Material and Methods taking meals regularly, with 79.0% eating meals 3 times
This study was carried out between February 2001 and per day; there were no gender differences. However, a sig-
April 2002. Medical students from Beijing University (135 nificant gender difference was found in the response relat-
men and 150 women) in Northern China and Kunming ing to breakfast intake, with 66.8% of males and 82.3% of
Medical College in southern China (95 men and 160 females reporting eating breakfast regularly (p < 0.0006).
women) participated in this study. A sample of 540 stu- The frequency of snacking rate was significantly higher in
dents aged 19 – 24 years were administered a self-reported females (31.1%) than in males (11.5%; p < 0.0001). The
questionnaire. The questionnaire consisted of 21 ques- present sample demonstrated high consumption of vege-
tions regarding eating, drinking and smoking habits (19 table and fruits. A total of 47.9% of students reported the
questions), with 2 questions related to dieting (trying to consumption of colored vegetables such as spinach and
lose weight). Self-reported height and weight were used to carrots, and 32.5% of subjects reported eating fruit daily.
calculate BMI (kg/m2). The questionnaire was designed by Female students tend to eat more fruit than males (p <
the authors and based on a national dietary survey held by 0.0001). In addition, female students tend to eat with
the Health and Labor Ministry of Japan. Some of the friends and family more frequently than males (p < 0.01).
authors also traveled to China to investigate the dietary Few subjects smoke or drink alcohol. When the students
life of Chinese to facilitate questionnaire design. The eat out, female students are more likely to consider the
questionnaire was first written in Japanese and then trans- calorie content of the menu than males (data not shown).
lated to Chinese utilizing fluent bilingual linguistic serv- Although 85.6% of students are aware of the concept of
ices. The translated Chinese version was back-translated to nutritionally balanced food, only a small number of stu-
insure the original meaning was not lost. Informed con- dents (7%) apply this concept when selecting food from a
sent was obtained from all participants of this study menu. Moreover, only 51% of students showed a desire to
according to the Declaration of Helsinki. The statistical learn about healthy diets.
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100 120
100
80
Number of female subjects
Number of male subjects
80
60
60
40
40
20
20
0 0
BMI<18.9 18.9҅ BMI<21.4 21.4҅ BMI<23.9 23.9҅ BMI BMI<18.2 18.2҅ BMI<20.0 20.0҅ BMI<21.8 21.8҅ BMI
Male Female
Figure
BMI distribution
1 of Chinese university students
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).
Body image and health consciousness obese (BMI≥25) [7]. According to the WHO definition of
When subjects were asked about their history of dieting, obesity, BMI>30 is the cut-off point [6]. The definition is
22.7% of respondents reported that they had dieted (see based on research of Caucasian populations. Asian popu-
additional file 2). The proportion of female students hav- lations are reported to have a higher body fat (%) at a
ing a dieting experience (29.8%) was more than twice as lower BMI compared to Caucasians [8]. The WHO expert
great as that of male subjects (12.7%; p < 0.0006). In total, consultation reported that BMI in Asian populations is
56% of the students selected 'thin or slim is beautiful'. The related to disease at a lower level [9]. In order to compare
percentage by gender was, 47.4% for male and 62.0% for obesity prevalence between ethnic groups, BMI cut-off
female students. Female students have a significantly points for Asians need to be considered by well con-
greater desire to be thinner than males (p < 0.001). More structed and standardized body composition studies. It is
than half of the respondents reported a desire to adopt notable that in China, the prevalence of overweight indi-
healthier dietary habits. Moreover, a question regarding viduals increased from 1991 to 1997, with the increasing
the degree of consciousness pertaining to health and diet rate changing from 6.4 to 7.7 [10]. The proportion of
was asked; 45.2% of male students and 48.3% of female energy derived from the fat of both vegetable and animal
students wish to learn about health and diet. Among sources increased each year. A recent study revealed that
female subjects, BMI<18.2 strongly showed their con- energy derived from dietary fat accounted for more than
sciousness of health and diet (p < 0.03). 30% of the total energy [11]. Changes in dietary composi-
tion, which correspond to socioeconomic growth, may
Discussion accelerate the prevalence of obesity in China.
This study aimed to determine the health, nutritional
knowledge and dietary behavior of university students in The results of our study show that the majority of students
China. As a result, we recorded the distribution of BMI regularly eat three times per day, and almost 80% of stu-
among Chinese students and found a low prevalence of dents eat vegetables and fruit twice per day. These eating
obesity, a finding that is consistent with a study of Japa- habits ought to be encouraged. The traditional Chinese
nese female students (BMI≥25 overweight was 5.8%, diet contains plenty of vegetables and is rice-based. The
BMI>30 of obesity was 0%) [4]. In the United States, 35% present study reported a high proportion of Chinese stu-
of the college students are reported to be overweight or dents eat breakfast daily. In contrast, a dietary survey of
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young Japanese subjects revealed a low rate of individuals Authors' contributions
engaged in regular eating patterns [12]. The skipping of R.S carried out questionnaire design, manuscript drafting
breakfast has been associated with lower nutritional status and total coordination of the study. K.T has been involved
and the risk of cardiovascular diseases [13]. It has also in drafting and revision of the article. R.A contributed to
been reported that less adequate breakfast habits may the data entry and its analysis. L.CJ contributed to the
contribute to the appearance and further development of questionnaire design, data collection and language trans-
obesity [14]. Therefore the importance of regular eating lations. N.S contributed to final approval of the manu-
patterns cannot be overemphasized in nutritional script.
education.
Additional material
Our results showed that body figure perception was signif-
icantly different between female and male students. A
number of researchers have investigated the relationship
Additional File 1
Table 2 containing the results of questions related to lifestyle practices with
of body image and gender role. Women tend to desire a special reference to food habit. The meal patterns, consumption of fruits
thinner figure, express more anxiety about becoming fat, and vegetables, consumption of fried foods, consumption of alcohol were
and are more likely to diet than men [15,16]. In contrast, assessed in male and female students. The Chi-square analyses were
men have reported a desire for a heavier physique and employed to compare the behavioral differences by gender. The evaluations
muscularity [17]. In recent years, eating disorders have of statistical significance were made at the p < 0.05.
Click here for file
been increasing dramatically among young women. The
[http://www.biomedcentral.com/content/supplementary/1475-
results of our study did not confirm this suggestion to the 2891-4-4-S1.doc]
level of statistical significance; however, it is worth point-
ing out that 65.0% of female students with BMI<20, Additional File 2
which is under to normal weight range, indicated a desire Table 3 contains the results of body shape perception and health conscious-
to be thin. Dissatisfaction with body figure and eating dis- ness of male and female students. Male and female respondents were cat-
orders are closely related [18-20]. Being young, female, egorized in to 4 groups respectively, according to mean BMI of ± 1
and dieting are identified risk factors that have been relia- standard deviation (SD). Analyses were made between BMI groups using
Chi-square analysis. The evaluations of statistical significance were made
bly linked to the development of eating disorders [21]. It at the p < 0.05.
was speculated that some of the students who were preoc- Click here for file
cupied with a thin body may develop eating disturbances. [http://www.biomedcentral.com/content/supplementary/1475-
Thus, the promotion of healthy weight management prac- 2891-4-4-S2.doc]
tices should be considered when developing health educa-
tion programs.
Conclusions Acknowledgements
In conclusion, our findings reveal that the majority of stu- The authors express their appreciation for the invaluable partnership and
support of Dr. Wang of Beijing University, Dr Zhao of Kunming Medical
dents were classified into the normal BMI group, with the
College and all the study participants of both institutes. We also thank Dr.
prevalence of BMI >30 obesity being very low in this study
Shigeki Minakami for valuable comments on the manuscript.
sample. Young female students had a greater desire to be
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