|Year : 2015 | Volume
| Issue : 2 | Page : 71-77
Nutritional knowledge assessment of syrian university students
Department of Nutrition and Food Sciences, Faculty of Health Sciences, University of Kalamoon, Damascus, Syria
|Date of Web Publication||14-May-2015|
Department of Nutrition and Food Sciences, Faculty of Health Sciences, University of Kalamoon, P.O. Box 30440, Damascus
Source of Support: None, Conflict of Interest: None
Nutrition knowledge is one of the factors that affect nutritional status and nutritional habits of individuals, families, and societies. Nutrition knowledge is an important tool in assessing the nutritional status of an individual, group or community. Researchers have been trying to design and develop reliable and valid questionnaires that distinguish and measure nutrition knowledge and its impact on dietary behavior and diet-health awareness. Many studies have shown that nutrition knowledge can affect someone to follow dietary recommendations. The aim of this study was to assess the nutrition knowledge of Syrian university students and to find out if there was any relationship between anthropometric measurements, socioeconomic status, type of university and nutrition knowledge of the students. Nutritional knowledge was assessed using valid nutrition knowledge questionnaire, which covered six main sections. The questionnaire was designed for this study and was adapted from Parameter and Wardle. The number of students participated in the study was 998 students and were selected from four universities) in Syria. They were asked to complete the nutrition knowledge questionnaire under supervision of trained nutritionist. Anthropometric measurements were taken for all participants by trained professional. The results were statistically analyzed and P < 0.05 set to be significant. The total score of nutrition knowledge for all sections was 37.86 ± 0.26 (out of 110). Scores for nutrition knowledge was higher in females as compared with males (38.37 ± 0.35 and 37.29 ± 0.38, respectively). Students who enrolled in health related programs scored higher (41.23 ± 0.05) compared with those who were enrolled in nonhealth-related programs (36.86 ± 0.28). Students in private universities scored higher than students in public universities in total nutrition knowledge (TNK). Very good grade point average students scored the highest points in all sections. Surprisingly, students with body mass index (BMI) >30 had the highest points in TNK. Females had higher TNK score as compared with males. Furthermore, students enrolled in the private university and in health-related programs showed typically better TNK scores than those enrolled in public universities and in nonhealth-related programs. The highest TNK score based on BMI was found among students with BMI >30. The results support the likely value of including nutrition knowledge as a target for health education campaigns aimed at promoting healthy eating.
Keywords: Anthropometric measurement, assessment, body mass index, nutrition knowledge
|How to cite this article:|
Labban L. Nutritional knowledge assessment of syrian university students. J Sci Soc 2015;42:71-7
| Introduction|| |
Nutrition knowledge is one of the factors that affect nutritional status and nutritional habits of individuals, families, and societies. Nutritional knowledge in general has two types: First : d0 eclarative knowledge, with deal with awareness of things and processes; like saying lemon are good source of Vitamin C. Second : a0 nd procedural knowledge, which deal with how to do things; for example, how to chooses a low salt packet of soup, and nutritional knowledge mostly considered as declarative knowledge.  For successful health promotion of targeted audience, it's too important to take their current level of knowledge into consideration. In addition to their attitudes, and behavior patterns, setting a reliable and valid definition for nutrition knowledge is problematic, for that a true-false or multiple choice tests made up of items concerning such information such as what foods contain certain nutrients and what function and the nutrients play in human health, was used to address this subject. 
Study on children shows that nutritional awareness correlates with the quantity and quality of food and nutrition-related information delivered by the parents.  However, concepts such as "low-fat food" and "low-sodium food" are abstract expressions for most young children, suggesting that child-targeted nutrition education should probably combine theoretical information with real food and snack experiences to teach the children what to eat and what to avoid. 
Nutritional knowledge is gained from many sources. Some of these consciously try to present the current scientific view of nutritional knowledge. Questions about common nutritional problems were given to physicians, medical students, nurses, and theology students. All groups had a high level of "perceived knowledge," generally >80% for the questions asked, but the accuracy of the knowledge was alarmingly low. The highest level was in the physician, in whom 79% of the perceived knowledge was accurate. Two-thirds of the "knowledge" of nutrition held by theology students was, therefore, false by current scientific standards. These findings have implications for future education. 
A study investigates the relationship between knowledge and body mass index (BMI) was carried out in Ireland. Results demonstrated that there was no significant correlation between levels of nutrition knowledge and BMI; however, a high level of nutrition was found among the sample. This suggests that a knowledge deficit may not be the most significant factor preventing overweight individuals from adopting a healthier diet and questions the utility of purely educational approaches to dietary behavior change. 
Nutritional knowledge at least has two different scale items, one; those deal with issues concerning popular health food beliefs, and those deal with realistic nutritional information unrelated to popular health food beliefs.  Researchers' try to design and develop reliable and valid questionnaires that distinguish and measure general health-related nutrition knowledge and its impact on dietary behavior and diet-health awareness. , As well as, they work to improve these tests and questioner to be specific to measure nutrition knowledge in different cultures, age, or group of people or single nutrient knowledge effect.  Because, these variables affecting the designing and evaluating of nutrition education programs and monitoring the progress of it toward dietary goals in the different population and groups. , Moreover, nutrition knowledge showed positively related to the food label use, leading to a healthier food intake pattern, as well as more intakes, vegetables, and meats.  In general it influences the food behaviors to adopt habits and encourage the combustion of functional food.  This lead to help in manage and improve many health problems related to nutrition such as obesity, diabetes, and others.
Klohe-Lehman et al., established that increase nutrition knowledge among obese mothers with young children encourage weight control especially in low-income mothers. On other hand, studies show that nutrition knowledge has no effect on obesity prevalence, and the obese adolescence have more nutrition knowledge than nonobese one, indicating that there are environmental factors involved in the development of obesity. , Another study, find that the nutrition knowledge within diabetes individuals are greater among those who tend to a registered dietitian or a diabetes educator although there was no significant difference compared with nondiabetics individuals. ,
What is more, there was strong evidence that as maternal nutrition knowledge and health increased the better diet quality for preschoolers, and directly contributes to the child micronutrient. 
Researchers also concern on nutrition knowledge among students. Study to evaluate nutrition knowledge and attitudes of medical students in medical schools shows that preclinical teaching reduces students' sense of relevance of nutrition to medicine and suggests that nutrition knowledge can be increased through preclinical coursework and that the knowledge level can be maintained through the clinical years.  In another study on nutritional knowledge effect on food habits of Chinese university students and college is the final opportunity for the health and nutritional education of a large number of students.  Since data about nutritional knowledge in the Arab world are very limited. The aim of this study was to assess the nutritional knowledge among Syrian university students and investigate whether there is a significant correlation between levels of nutrition knowledge and BMI, waist circumference (WC), gender, grade point average (GPA), study major, university being attended, and fat percentage (FP) among university students.
| Materials and methods|| |
Developing the questionnaire item pool
In this study, nutrition knowledge was assessed using valid nutrition knowledge questionnaire. The purpose of this questionnaire was to provide a comprehensive measure of nutritional knowledge of university students in Syria.
The questionnaire was adapted from.  The questionnaire was divided into six main sections.
Total nutrition knowledge (TNK) is expressed as the sum of the 4 previous sections (110 points). The questionnaire was adapted from parameter 1990 and was tried on small sample to check the time required completing it which has been around 20 min in the average and we made sure that participants understood every technical word in it.
- Socioeconomic and demographic background.
- Anthropometric measurements and body composition : s0 uch as height, weight (BMI), WC, and body FP.
- Understanding of dietary recommendations (11 points).
- Knowledge of nutrients sources and its' content in food (69 points).
- Using nutrition information to make dietary choices (10 points).
- Understanding of diet-disease inter-relationship (20 points).
Subjects and methods of distribution for the preliminary questionnaire
One thousand and thirty students volunteered to participate in this study which was approved by the Department's Council and the students gave a written consent to participate in this study. The students were recruited from four different universities in Syria including public universities such as; Aleppo University, Teshreen University, Al-Baath University as well as one private university which was Kalamoon University. Questionnaire forms were distributed to the students and were asked to complete the questionnaire under the supervision of professional workers trained by the author. Only 998 participants were selected, and 32 participants were excluded from this study. This study was carried out between April and July 2011. The author made several visits to these universities in order to distribute forms and help in completing them.
The following anthropometric measurements were taken from the participant by professional workers trained by the author:
There was a difference in calculating GPA in public and private universities. GPA levels are illustrated in [Table 2].
- Weight: Was measured to the nearest 100 g using regular scale (Laica, Italy).
- Height: Was measured to the nearest 0.5 cm using regular stadiometer (Seca 217, UK).
- WC: Was measured using regular measuring tape. WC above 102 cm in men and above 88 cm in women was considered as a risk. WC below the mentioned criteria was considered as no-risk. 
- FP: Was measured using bioelectrical impedance device (Omron, USA). FP above 31% in women and above 25% in men was considered high fat. FP below 23% for women and 18% for men was considered as low-fat. FP of 23-31% for women and 18-25% for men was considered as normal fat content.
- BMI: Was calculated as weight in kg/height (m) 2 and was classified according to World Health Organization  as demonstrated in [Table 1].
The results were statistically analyzed using SPSS 17 (SPSS Inc. 2007). Mean ± standard error of the mean were calculated for each category. Statistical difference was set P < 0.05.
| Results|| |
Nine hundred and ninety students completed the questionnaire, and their compliance was considered as good. In this study, 531 (53.2%) were males and 467 (46.8%) of the students were females. The age of the students ranged from 18 to 34 years. 539 (54%) of the students were in the age group 18-24, whereas 459 students or (46%) wherein the age group 25-34 years. 267 students or (26.8%) enrolled in the private university and 731 students or (73.2%) enrolled in public universities. Students registered in health-related programs comprised of 227 students (22.7%) and 771 students (77.3%) registered in nonhealth-related programs such as engineering or economy. With regards to year of attendance, 253 students or (25.4%) where in the 1 st year of college, 291 students or (29.2%) in second, 229 students or (22.9%) in third, 151 students or (15.1%), 68 students or (6.8%), 5 students or (0.5%) and 1 student or (0.1%) were in the 4 th , 5 th , 6 th and 7 th year, respectively. 31 students or (3.1%) had excellent grades and 61 students or (6.1%) had very good grades, whereas 404 students or (40.5%) and 492 students or (49.2%) had good and passing grades, respectively. Only 10 students or (1.1%) had failing grades. The results are shown in [Table 3].
|Table 3: student distribution according to gender, age, type of university, study program, studying year and grades|
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Only 63 students or 6.3% were underweight (BMI <18.5) and 621 students or (62.2%) had normal BMI (18.5-24.9) whereas 261 students or (26.2%) and 53 students or (5.3%) were overweight and obese. 183 students or (18.3%) students had high WC, which is higher than 102 cm for men and over 88 cm for women, which are considered to be at risk for developing some chronic diseases such as cardiovascular disease, hypertension and diabetes. 815 students or (81.7%) had normal WC and they considered it at no risk for developing chronic diseases. With regard to percentage of body fat, 183 students or (18.3%) had low-fat content, 497 students or (49.8%) had normal fat levels, whereas 318 students or (31.9%) had high body fat content as demonstrated in [Table 4].
|Table 4: Distribution of students according to their BMI, WC and body FP|
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Totally, 314 students or (31.5%) were city residents whereas 684 students or (68.5%) were country side residents. Most of the students lived with their parents 591 students (59.2%) comparing with 407 students or (40.8%) lived at dorms in campuses. With regards to mothers educations level, 434 students or (43.5%) of participants, their mothers did not finish high school while 56.5% or 564 students their mothers finished high school or higher. The same thing applies to fathers' education levels, 313 students (31.4%) of the students, their fathers did not finish high school comparing with 685 students (68.6%) their fathers finished high school or higher. With regards to household income <5000 SP, 299 students or 30% had that income and 401 students or (40.2%) had an income between 5000 and 14,999 SP/month whereas 288 students or (28.8%) had income higher than 15,000 SP/month. The data are represented in [Table 5].
|Table 5: Distribution of students according to home location, residency, parents education level and household income|
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Regarding nutrition knowledge score, for section 1 (dietary recommendation), the students had 3.46 ± 0.04 points (out of 11). In section 2 (sources of nutrients), the students had 25.42 ± 0.18 points out of 69 points whereas in section 3 (dietary choices) and section 4 (diet-disease inter-relationship) the students had 2.68 ± 0.04 and 6.30 ± 0.10, respectively. For the TNK score, students had 37.86 ± 0.25 out of 110 points. The results are shown in [Table 6].
Gender played a role in determining nutritional knowledge among students. The TNK points based on student's gender showed that females scored slightly higher points in all sections of questionnaire than males counterparts. Females had 38.37 ± 0.34 points, whereas males had 37.29 ± 0.39 and the difference was significant (P < 0.05). There was no significant difference between males and females in all sections. When comparing health related programs and nonrelated programs and nutritional knowledge, student enrolled in health related program scored higher than students in nonhealth-related programs 41.23 ± 0.56 and 36.86 ± 0.28 and the difference was significant (P < 0.05). Also, students in health related programs scored higher than those in nonhealth-related programs in section 4, which about disease-nutrient inter-relationship and the difference was significant too (P < 0.05) whereas there was no significant difference between two programs in sections 1, 2 and 3. Students at private universities scored higher points in total score and in section 4 comparing with students in public universities. 40.16 ± 0.55 comparing to 37.05 ± 0.29 points and 8.09 ± 0.24 comparing to 5.68 ± 0.11 points and the difference was significant (P < 0.05), but his difference was not significant in sections 1, 2 and 3 as shown in [Table 7].
|Table 7: Nutrition knowledge scores based on students gender, program of study and type of university|
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With regard to GPA and nutritional knowledge, students who had very good GPA scored the highest points in all sections of the questionnaire and also in TNK points and the difference was significant (P < 0.05). There was a significant difference between students of very good GPA and student with excellent, good, passing and fail GPA with regard to section 1. In section 2, very good GPA student had significant difference with excellent and passing GPA, but there was no significant difference between them and good and fail GPA. Also, there was a significant difference between very good GPA students and all other GPA's in section 3 and section 4 as shown in [Table 8].
Body mass index did not impact the TNK. There was no significant difference in points scored for BMI except for BMI over 30 in section 4 and in TNK points and the difference was significant (P < 0.5). With regard to WC, there was a significant difference between students at risk and those at no risk. Their points were 38.18 ± 0.6 compared with 37.78 ± 0.2, but there was no significant difference between these groups in all sections. This also applies to FP; only the difference was significant between students with high fat content and other groups in all sections. These results are presented in [Table 9].
| Discussion|| |
There were no previous studies about nutritional knowledge assessment among Syrians in general and among universities students in particular and in the neighboring countries as well. This was the first study aiming to determine and assess the relationship between nutrition knowledge and dietary behavior in Syria. Moreover, the study aimed to investigate whether there was a significant correlation between levels of nutrition knowledge and BMI, WC and FP among students. This study showed that TNK was slightly higher in females than in males. Similar result was observed in a study carried out in England.  The highest TNK in our study was shown for the students with very good GPA. The results of this study have showed that students enrolled in health-related programs had higher TNK compared with those enrolled in nonhealth related programs (41.23 and 36.86 respectively). In another study carried out by Parameter and Wardle compared the TNK of the dietetic and computer science students and found a significant difference between the two groups. Dietetic students achieved a TNK of 98.8 (out of 110), while computer science scored only 60.1, which are very similar to results we obtained from this study. The questionnaire used in this study was the same one used by.  The TNK for all students achieved in this study was 37.86 (out of 110). The score is quite below the TNK observed by Parameter and Wardle for dietetic (98.8) and computer science (60.1) students. These results demonstrate the low nutrition knowledge available among Syrian students. The highest TNK was obtained among obese students (39.72), followed by underweight students. No significant difference in TNK was shown between normal and overweight students. O'Brien and Davies described similar observation in study carried out in Ireland; obese individuals achieved the highest TNK compared with normal, under, and overweight individuals.  The results of this study are parallel to the results demonstrated by Klohe-Lehman et al. 2006  which indicated highest TNK among students with high fat content. No significant difference was observed in the TNK among students with normal WC (no risk) and those with higher WC (no risk).
The results of this study provide a useful tool in research about nutrition knowledge and healthy food choice awareness. The study has also demonstrated the importance of nutrition education as an important measure to prevent diet-related diseases and to improve consciousness about healthy diet and health life-style. 
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]