Abstract
Background
Obesity and cardiovascular diseases have become the leading causes of mortality. Factors affecting dietary habits are crucial for preventing these diseases. However, there is limited understanding of the relationship between nutritional knowledge and dietary habits.
Objective
To assess and compare the nutritional knowledge and dietary practices among university students, and to determine the quality of nutritional knowledge and dietary habits among medical and non-medical students.
Methods
A quantitative cross-sectional study, ethically approved by the institution, was conducted among the undergraduate population. The sample size was calculated via OpenEpi software with a 95% confidence interval and a 5% margin of error. Data collection was performed through a validated questionnaire via a convenience sampling technique. All descriptive and inferential statistical tests were conducted with IBM SPSS 26, and a p-value of < 0.05 was considered to indicate statistical significance for all applied measures.
Results
The sample consisted of 382 participants (n = 191 medical and n = 191 non-medical), with a mean age of 21 ± 2.39 years. When nutritional knowledge was assessed in terms of categories, 86 (22.5%) had unsatisfactory knowledge, 234 (61.2%) had good nutritional knowledge, and 62 (16.2%) had quite good nutritional knowledge. Among the participants, n = 4 (1.04%) had inadequate eating habits, n = 282 (73.82%) had good eating habits, while n = 96 (25.1%) had quite good eating habits. Statistical tests revealed no significant correlation between nutritional knowledge and dietary habits (p = 0.106). There was a significant difference (p < 0.0001) in the nutritional knowledge of medical and non-medical students, but the same was not true for dietary habits (p = 0.576). A subgroup analysis of medical and non-medical students revealed no significant association (p > 0.05) between nutritional knowledge and dietary habits. There was no significant difference in findings between males and females.
Conclusion
Nutritional knowledge is not associated with dietary habits and is higher in medical students, whereas dietary habits are similar in both medical and non-medical students. Therefore, future research should be more focused on other predictors of dietary habits, along with nutrition knowledge, and should implement a larger study that incorporates stratified random sampling. Also, nutrition education departments should make their courses more focused on behavioral change rather than the dissemination of knowledge.
Keywords: dietary habits, nutritional knowledge, medical students, nutrition, cross-sectional study, food, awareness, lifestyle
Introduction
Nutritional knowledge pertains to an individual’s comprehension of food and nutrition, encompassing awareness of essential nutrients, the relationship between diet and health, and the ability to make informed food choices. In contemporary, fast-paced, consumer-driven societies, such knowledge is increasingly vital for improving lifestyles. Students with greater awareness of nutrition exhibit lower obesity rates [1]. The widespread availability of processed and artificially manufactured food products compels individuals to make unhealthy dietary choices [2]. This trend is particularly concerning among university students, who experience a significant lifestyle transition upon entering independence, managing schedules, and making autonomous food choices, frequently owing to a lack of experience and interest in the constituents of their diets.
Dietary habits are defined as long-term patterns of food consumption influenced by cultural, environmental, and psychological factors [3]. In urban settings, unhealthy dietary habits have led to the rise of obesity, which is recognized by the World Health Organization as a global epidemic [4, 5] and a leading cause of mortality [6, 7]. Additionally, unhealthy diets lead to diabetes, cardiovascular diseases, hypertension, certain cancers, and chronic musculoskeletal pain [8, 9]. In Pakistan, national surveys estimate 12.1% of the male and 13.8% of the female population to be obese [10]. Studies on undergraduates of Islamabad indicated a 17% prevalence of obesity, suggesting the importance of finding predictors of unhealthy dietary habits in university life [11], as habits picked up during this time can persist into adulthood.
Globally, the evidence linking nutritional knowledge with dietary habits remains inconclusive. Recent studies in the United States and Europe reveal a complex and often contradictory relationship between the two variables. A study conducted in Granada in 2021 showed that university students highlighted a gap between knowing what constitutes a healthy diet and adhering to healthy dietary habits [12]. A study in Ireland found a positive relationship between nutritional knowledge and dietary practices [13]. Another study on Italians found a similar positive association [14], whereas evidence from Nigeria suggested no association [15]. Regionally, studies are just as contradictory in their conclusions. A study in Kuwait found nutritional knowledge to be a weak predictor of dietary habits [16]. However, a study in Morocco concluded that nutritional knowledge is a leading cause of dietary behavior [17]. On the other hand, a study from Nepal found no association [18].
In Pakistan, evidence on this subject is limited. A study in Lahore aimed to assess nutritional knowledge and its application to dietary habits among nutrition students. They found that most of the participants practiced adequate dietary behaviors, although some were unable to do so due to their living circumstances, such as living in hostels and having limited access to healthy foods [19]. Another study on both medical and non-medical students found that although students had good knowledge of food healthiness good diet is often neglected in times of academic stress [20].
This study endeavors to address this gap by evaluating and comparing the dietary knowledge and habits of medical and non-medical students. As medical students take rigorous courses in basic sciences such as anatomy, physiology, and biochemistry, they are expected to have better nutritional knowledge. Whereas non-medical students generally are not exposed to the same rigor in such courses. However, whether this expected difference in nutritional knowledge might be related to differences in dietary habits remains unknown. Through the analysis of the association between knowledge and dietary behavior, this research aims to provide insights into whether increased awareness results in healthier choices and, consequently, healthier dietary practices.
This comparative analysis aims to underscore the potential role of nutrition education in shaping healthier eating patterns, inform future health promotion strategies on university campuses, and contribute to initiatives aimed at reducing obesity and enhancing long-term public health outcomes.
Methods
Aims
The specific aims of the study were as follows: (1) to evaluate the quality of nutritional knowledge and dietary habits among medical and nonmedical students, and (2) to assess the association between nutritional knowledge and dietary habits.
Sampling
This cross-sectional study was conducted from July 2024 to January 2025. Data were collected from 382 undergraduate students via a non-random convenience sampling approach. While this sampling method limits the generalizability of the findings and does not provide a fully representative sample of the population, with some groups possibly being overrepresented than others due to selection bias, it was selected due to its feasibility and the unavailability of comprehensive population lists. The sample size was calculated to be 379 via the OpenEpi web tool from the total undergraduate population of 27,000, with a confidence level of 95%, and a proportion of 50% owing to inadequate data. Half of the sample (n = 191) was reserved for the medical student group, which also included students from other health-related fields, and the other half was reserved for non-medical students in unrelated fields. Three medical and three non-medical colleges were chosen for data collection: Foundation University Islamabad, Shifa International Medical College, and Riphah International University for medical students, and National University of Science and Technology, FAST University, and COMSATS University for non-medical students. These intuitions were chosen because of their approachability and feasibility.
The participants were informed about the study, and informed written consent was obtained before participation. The research protocols were approved by the ethical review board of the institution. A standardized questionnaire was used for the assessment of dietary habits and nutritional knowledge.
Exclusion/ Inclusion criteria
Undergraduate students aged 17–25 years from Islamabad and Rawalpindi were included. Those enrolled in nutrition-related programs, dietary restrictions due to medical conditions, or special diets were excluded. Those in nutrition-related programs have high-intensity learning that inflates their nutritional knowledge and, because of the nature of their studies, makes them unrepresentative of either medical or non-medical students. Those with dietary restrictions or special diets were excluded because of diseases or special nutrition requirements that lead them to change their diet rather than nutritional knowledge.
Questionnaire
The questionnaire comprised three sections: demographic information, dietary habits (14 items; score range: 0–42), and nutritional knowledge (7 items; score range: 0–7). The scores were categorized into knowledge and behavior groups (Table 1). The sections on dietary habits and nutritional knowledge were taken from a questionnaire used in several studies [13, 18] and originally developed and validated by Turconi et al. (2005). According to Turconi et al., the Food Habits section demonstrates good internal consistency (Cronbach’s α = 0.75), while the Nutrition Knowledge section shows moderate internal consistency (Cronbach’s α = 0.56) [21].
Table 1.
Categorization of nutritional knowledge and dietary habits scores
| NUTRITIONALKNOWLEDGE(score 0-11) | 0-4 | 5-8 | 9-11 |
| Insufficient Nutrition Knowledge | Good Nutritional Knowledge | Quite Good Nutritional Knowledge | |
| EATING HABITS(0-42) | 0-14 | 15-28 | 29-42 |
| Unsatisfactory Eating Habits | Partially Satisfactory Eating Habits | Satisfactory Eating Habits |
Demographics section
The demographics section assessed the field of study, age, sex, and special diet. Descriptive statistics were run to determine the results.
Dietary habits section
The score for the dietary habits section ranged from 0 to 42. The section had 14 questions, with scores for each question ranging from 0 to 3.
Nutritional knowledge section
This section consisted of 7 questions related to nutritional knowledge concerning healthy foods and diet and diet-related diseases. The score for each correct answer was equal to one. Thus, the range was between 0 and 7.
The scores were grouped into categories for dietary habits and nutritional knowledge. The scoring range for each category is described in Table 1.
Statistical analysis
All descriptive statistics, such as frequencies and percentages, were calculated. Inferential statistical tests, such as chi-square tests, were applied to find any significant associations among categorical variables. The choice of correlation test was based on the distribution of the variables: normality was assessed using the Shapiro–Wilk test and visual inspection of histograms/Q-Q plots. Spearman’s rank correlation was used to assess the correlation between two non-normally distributed variables (nutritional knowledge and dietary habits). Group comparisons were performed using the Mann-Whitney U test, a non-parametric alternative to the independent samples t-test, as the relevant quantitative variables (nutritional knowledge and dietary habits scores) were not normally distributed. This test compares the distribution of ranks and is ideal for ordinal or skewed data and allows for the comparison of medians between two independent groups. For tests of significance, p-values of < 0.05 were considered statistically significant. All the statistical analyses were performed with SPSS 26.
Results
General characteristics
A total of 382 students participated (mean age: 21 ± 2.39 years). Female participants represented 57.9% of the total sample. Table 2 shows participant demographics stratified by academic field.
Table 2.
Sample characteristics compared by academic field
| Characteristics | Medical StudentsN=191Mean (SD) | Non-medical StudentsN=191Mean (S.D) | TotalN= 382Mean (S.D) |
|---|---|---|---|
| Age in years | 20.8 (2.12) | 21.6 (2.64) | 21 (2.39) |
| n(%) | n(%) | n(%) | |
| Gender | |||
| Female | 129 (67.5) | 92 (48.2) | 221 (57.9) |
| Male | 62 (32.5) | 99 (51.8) | 161 (42.1) |
Among non-medical students, 67 (39 males, 28 females) had insufficient nutrition knowledge, whereas only 21 medical students (9 males, 12 females) fell into this category. A greater proportion of medical students achieved good or quite good knowledge scores (n = 170) compared to non-medical students (n = 126). Among non-medical students, only 11 participants scored quite good nutritional knowledge, in contrast to the 51 medical students in the same category.
In all categories, there were more females than males in both the medical and non-medical subgroups who scored good and quite good nutritional knowledge.
The details of the distribution of the population in the various categories for both subgroups are described in Fig. 1.
Fig. 1.
Nutrition knowledge
Mann-Whitney’s U test for non-normally distributed data revealed significantly greater nutritional knowledge in medical students (p < 0.0001) (see Table 3), but the sex differences were not significant (see Table 4).
Table 3.
Comparison of dietary habits and nutritional knowledge among medical and non-medical students
| Questionnaire Section | Scores | Medical | Non-Medical | p-value |
|---|---|---|---|---|
| Dietary Habits |
Lowest Score Mean (SD) |
12 25.15 (4.86) |
14 25.58 (4.77) |
0.576 |
| Highest Score | 41 | 39 | ||
|
Nutritional Knowledge |
Lowest Score Mean (SD) |
1 6.99 (2.12) |
0 5.37 (2.20) |
0.000* |
| Highest Score | 11 | 10 |
Comparisons between medical and non-medical students were performed using the Mann–Whitney U test
*p-value < 0.05
Table 4.
Comparison of dietary habits and nutritional knowledge between males and females
| Questionnaire Section | Scores | Male | Female | p-value |
|---|---|---|---|---|
| Dietary Habits |
Lowest Score Mean (SD) |
6 10.741 (1.92) |
6 11.23 (1.75) |
0.146 |
| Highest Score | 15 | 15 | ||
|
Nutritional Knowledge |
Lowest Score Mean (SD) |
3 9.07 (2.42) |
4 9.61 (2.25) |
0.118 |
| Highest Score | 15 | 16 |
Most participants in both groups fell into the somewhat satisfactory and satisfactory dietary habits category, with 50 medical students and 46 non-medical students scoring satisfactory nutritional knowledge. Most of the students (73% medical and 74% non-medical) scored in the partially satisfactory nutritional knowledge category. The scores of students in the inadequate eating habits category for the medical and non-medical groups were 1 and 3, respectively. Figure 2 shows the distribution of the samples in the different categories of eating habits.
Fig. 2.
Dietary habits
Statistical analysis, comparing both subgroups, revealed no significant differences in eating habits between medical and non-medical students (p = 0.106) (Table 3). Furthermore, the difference between the eating habits of males and females was not statistically significant.
A subgroup analysis revealed that the associations between eating habits and nutritional knowledge were not statistically significant for either group (p = 0.296 in medical students and p = 0.764 in non-medical students) (Table 5). The non-association between nutritional knowledge and eating habits is shown in Fig. 3 for the individual scores of the 382 samples plotted between nutritional knowledge and eating habits.
Table 5.
Cross-tabulation of nutritional knowledge scores and eating habit categories
| Question | Nutritional Knowledge | Dietary Habits | |||
|---|---|---|---|---|---|
| Score | Good | Quite Good | Unsatisfactory | *p-value | |
| Which food contains carbohydrates? | 0 | 12 | 7 | 0 | |
| 1 | 93 | 81 | 1 | 0.683 | |
| Which food does not contain dietary fiber? | 0 | 62 | 55 | 0 | |
| 1 | 43 | 33 | 1 | 0.414 | |
| Which food is less rich in fat? | 0 | 68 | 49 | 0 | |
| 1 | 37 | 39 | 1 | 0.204 | |
| Which food is richest in protein? | 0 | 78 | 65 | 0 | |
| 1 | 27 | 23 | 1 | 0.244 | |
| Which food is the richest in calories? | 0 | 23 | 29 | 0 | |
| 1 | 82 | 59 | 1 | 0.188 | |
| Which substance contains more energy? | 0 | 80 | 65 | 1 | |
| 1 | 25 | 23 | 0 | 0.791 | |
| What are the functions of vitamins and minerals? | 0 | 38 | 32 | 0 | |
| 1 | 67 | 56 | 1 | 0.753 | |
| According to you, what is a “balanced diet”? | 0 | 16 | 5 | 0 | |
| 1 | 89 | 83 | 1 | 0.098 | |
| According to you, what is “daily energy expenditure”? | 0 | 41 | 31 | 0 | |
| 1 | 64 | 57 | 1 | 0.640 | |
| What are “biological foods”? | 0 | 65 | 52 | 0 | |
| 1 | 40 | 36 | 1 | 0.430 | |
| What are “transgenic foods”? | 0 | 28 | 26 | 0 | |
| 1 | 77 | 62 | 1 | 0.746 | |
*P values represent the significance of the Chi-Square test
Fig. 3.
Individual scores
The scatterplot revealed no significant linear association between nutritional knowledge and eating habits (mean knowledge score = 6.18; mean eating habits score = 25.38). No statistically significant correlation between the non-normally distributed continuous score variables was confirmed by Spearman’s correlation test (p = 0.112).
Discussion
The study examined the relationship between nutritional knowledge and dietary habits among medical and non-medical undergraduate students in Islamabad and Rawalpindi. While medical students demonstrated better nutritional knowledge, their dietary habits were similar to those of non-medical students, who had significantly less nutritional knowledge. Inferential statistics showed that there was no significant association between nutritional knowledge and dietary habits. This suggests that knowledge alone may be insufficient to drive behavior change, echoing findings from similar studies [15, 18].
The non-association between nutritional knowledge and dietary habits has been speculated to be due to multiple environmental and academic factors, as seen in many studies. Particularly highlighted is the impact of stress and negative emotions, which have been shown to alter dietary habits and lead to unhealthy practices such as binge eating [22]. A study conducted in Kuwait reached a similar conclusion, proposing academic stress and routine as the primary predictors of dietary habits. A scoping review highlighted increased stress levels, burnout, eating problems, and unstable sleep patterns among medical students as limiting factors in assessing the association [13]. As seen in this study, these may be some of the factors that also explain why, despite having better nutritional knowledge, medical students do not have significantly better dietary habits than non-medical students.
The difference in nutritional knowledge between non-medical students and medical students can be explained by the fact that non-medical students are not exposed to much health education. Enrolled mostly in professional universities, they receive education primarily related to their respective fields of study and professions. This results in a lack of essential concepts needed to maintain a healthy lifestyle. They’re only understanding of nutrition stems from biology classes taken in higher secondary education. On the other hand, medical students excel in their understanding of nutrition and a healthy diet because they undergo rigorous courses in biochemistry and physiology in their early years, where subjects pertaining to nutrition are taught along with their clinical aspects.
The sample shows a 15.8% difference between the number of males and females in the combined sample. This difference was more pronounced in the medical sample, with a percentage difference of 36%. This disparity, especially in the medical subgroup, reflects the larger proportion of female medical students in most medical and health profession colleges. Although there were more female respondents than male respondents in both subgroups, there were no significant differences between them in terms of nutritional knowledge or dietary habits. The mean age of the sample was 21 years, with the non-medical sample being slightly older, although this difference was not significant.
The findings of the present study highlight the gap in essential education regarding nutrition among non-medical students. Educational interventions, including short nutrition courses, have been shown to improve knowledge and awareness among university students [23, 24]. Rather than courses that merely disseminate information about the healthiness of food, nutrition education that is more focused on behavior and provides opportunities for learning and experience has been shown to positively impact dietary habits, obesity, and even physical activity [25].
Future efforts should explore how external factors, such as food marketing [26], affordability, and campus access, influence student behavior. Identifying such factors is crucial for promoting better dietary habits among university students. In addition, measures must be taken to mitigate factors such as academic stress, anxiety, and peer pressure, which are known to worsen dietary habits.
The limitations regarding confounders arise from the cross-sectional design of the study, which makes dealing with confounding factors difficult. However, obvious confounders, such as special diets and diseases, were excluded. Therefore, this study does not indicate the presence or absence of a causal relationship between nutritional knowledge and dietary habits. Convenience sampling, chosen for its feasibility and resource constraints, limits the generalizability of the study and poses risks of over-representing some groups within the population. Nevertheless, the findings of this study can inform the public health sector of the need to further assess these findings and derive achievable goals for improving nutrition-related programs for university students. This study was also limited to the cities of Rawalpindi and Islamabad. However, these populations are similar to most urban centers of Pakistan, as university students in these areas have comparable sociodemographic characteristics and food choices. Owing to the abundance of studies assessing anthropometric variables in university students in the region [27, 28], these variables were not assessed in this study.
Conclusion
Although medical students had significantly greater nutritional knowledge, no significant difference in dietary habits was observed between medical and non-medical students. This underscores the need for targeted interventions that go beyond knowledge alone to influence eating behaviors—specifically, nutrition education programs that employ methods directed toward changing dietary behaviors and inculcating a sense of voluntary choice for healthier diets. Future studies dealing with this research question should seek to employ randomization and experimental designs that make findings generalizable for the studied population. They should also assess other predictors of dietary habits, such as marketing programs, mental well-being of students, and the availability of inexpensive but healthier foods, to inform them of decisions to better impact healthy practices among university students.
Acknowledgements
Significant guidance and help were taken from Ahmad Ali Khan, president of the Student Research Society at Foundation University Medical College, for which we are immensely grateful. We are also thankful to all participants who took the time to fill the questionnaire forms. Lastly, we acknowledge the support of our peers and faculty for their encouragement throughout the course of the study.
Authors' contributions
MTF conceptualized and designed the study, collected and analyzed the data, prepared the figures and tables, and wrote the discussion and methodology sections of the manuscript, as well as the abstract, involved in writing the study protocol for ethical approval. BMJ collected data and wrote the introduction section of the manuscript and was involved in writing the study protocol for ethical approval. UI made a Google Forms version of the questionnaire, collected data, and revised the introduction section of the manuscript. SM collected data and wrote the results section of the manuscript. DAA reviewed the design of the study and edited the manuscript. INH reviewed the manuscript and made writing changes.
Funding
None.
Data availability
The datasets created and analyzed during the course of the study are not available to the public but are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Informed consent was taken after apprising the participants of the details of the study and the type of data required from them, according to the Declaration of Helsinki. The study was ethically approved by the Ethical Review Committee, Foundation University Medical College, after evaluation of the study protocol. Approval Number: FF/FUMC/215–489/Phy/24.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets created and analyzed during the course of the study are not available to the public but are available from the corresponding author on reasonable request.