The aim of the study was to evaluate the effectiveness of implementing multimodal nutrition education intervention (NEI) to improve dietary intake among university students. The design of study used was cluster randomised controlled design at four public universities in East Coast of Malaysia. A total of 417 university students participated in the study. They were randomly selected and assigned into two arms, that is, intervention group (IG) or control group (CG) according to their cluster. The IG received 10-week multimodal intervention using three modes (conventional lecture, brochures, and text messages) while CG did not receive any intervention. Dietary intake was assessed before and after intervention and outcomes reported as nutrient intakes as well as average daily servings of food intake. Analysis of covariance (ANCOVA) and adjusted effect size were used to determine difference in dietary changes between groups and time. Results showed that, compared to CG, participants in IG significantly improved their dietary intake by increasing their energy intake, carbohydrate, calcium, vitamin C and thiamine, fruits and 100% fruit juice, fish, egg, milk, and dairy products while at the same time significantly decreased their processed food intake. In conclusion, multimodal NEI focusing on healthy eating promotion is an effective approach to improve dietary intakes among university students. 1. Introduction The transition from adolescence to young adulthood which is mostly spent at colleges or universities is gaining recognition as an important time for health promotion and disease prevention [1]. This is the critical time during which young people establish independence and adopt lasting health behaviour patterns. Although once considered to be an age of optimal health and well-being, it is well documented that university students nowadays have poor dietary habits [2, 3]. University students often fail to meet recommended target for fruits and vegetables (FV) [4, 5], whole grain, milk, and dairy products [6, 7] compared to their adolescence years. They also tend to skip meals especially breakfast [8, 9] and have higher consumption of fast food, snacks, and soft drinks [10–12]. Poor eating habits in earlier stage of life have been directly linked to serious health consequences later in life such as osteoporosis, obesity, hyperlipidemia, and diabetes [13, 14]. Therefore early interventions are needed to improve health behaviours in this age group [15]. Currently only a few nutrition education interventions (NEI) have targeted college or university students
References
[1]
M. C. Nelson, M. Story, N. I. Larson, D. Neumark-Sztainer, and L. A. Lytle, “Emerging adulthood and college-aged youth: an overlooked age for weight-related behavior change,” Obesity, vol. 16, no. 10, pp. 2205–2211, 2008.
[2]
A. Papadaki, G. Hondros, J. A. Scott, and M. Kapsokefalou, “Eating habits of university students living at, or away from home in Greece,” Appetite, vol. 49, no. 1, pp. 169–176, 2007.
[3]
J. Kolodinsky, J. R. Harvey-Berino, L. Berlin, R. K. Johnson, and T. W. Reynolds, “Knowledge of current dietary guidelines and food choice by college students: better eaters have higher knowledge of dietary guidance,” Journal of the American Dietetic Association, vol. 107, no. 8, pp. 1409–1413, 2007.
[4]
N. I. Larson, D. Neumark-Sztainer, P. J. Hannan, and M. Story, “Trends in adolescent fruit and vegetable consumption, 1999–2004. Project EAT,” American Journal of Preventive Medicine, vol. 32, no. 2, pp. 147–150, 2007.
[5]
A. Richards, K. K. Kattelmann, and C. Ren, “Motivating 18- to 24-year-olds to increase their fruit and vegetable consumption,” Journal of the American Dietetic Association, vol. 106, no. 9, pp. 1405–1411, 2006.
[6]
N. I. Larson, D. Neumark-Sztainer, L. Harnack, M. Wall, M. Story, and M. E. Eisenberg, “Calcium and dairy intake: longitudinal trends during the transition to young adulthood and correlates of calcium intake,” Journal of Nutrition Education and Behavior, vol. 41, no. 4, pp. 254–260, 2009.
[7]
K. H. Poddar, K. W. Hosig, S. M. Nickols-Richardson, E. S. Anderson, W. G. Herbert, and S. E. Duncan, “Low-fat dairy intake and body weight and composition changes in college students,” Journal of the American Dietetic Association, vol. 109, no. 8, pp. 1433–1438, 2009.
[8]
W. Y. Gan, M. T. Mohd Nasir, M. S. Zalilah, and A. S. Hazizi, “Differences in eating behaviours, dietary intake and body weight status between male and female Malaysian university students,” Malaysian Journal of Nutrition, vol. 17, no. 2, pp. 213–228, 2011.
[9]
N. H. Abdull Hakim, N. D. Muniandy, and A. Danish, “Nutritional status and eating practices among university students in selected universities in Selangor, Malaysia,” Asian Journal of Clinical Nutrition, vol. 4, no. 3, pp. 77–87, 2012.
[10]
N. I. Larson, D. R. Neumark-Sztainer, M. T. Story, M. M. Wall, L. J. Harnack, and M. E. Eisenberg, “Fast food intake: longitudinal trends during the transition to young adulthood and correlates of intake,” Journal of Adolescent Health, vol. 43, no. 1, pp. 79–86, 2008.
[11]
M. Alizadeh and K. Ghabilii, “Health related life style among Iranian medical students,” Research Journal of Biological Sciences, vol. 3, no. 1, pp. 4–9, 2008.
[12]
K. Ganasegeran, S. A. Al-Dubai, A. M. Qureshi, A. A. Al-abed, A. Rizal, and S. M. Aljunid, “Social and psychological factors affecting eating habits among university students in a Malaysian medical school: a cross-sectional study,” Nutrition Journal, vol. 11, no. 1, article 48, 2012.
[13]
L. A. Bazzano, “The high cost of not consuming fruits and vegetables,” Journal of the American Dietetic Association, vol. 106, no. 9, pp. 1364–1368, 2006.
[14]
P. C. Hallal, L. B. Andersen, F. C. Bull, R. Guthold, W. Haskell, and U. Ekelund, “Global physical activity levels: surveillance progress, pitfalls, and prospects,” Lancet, vol. 380, no. 9838, pp. 247–257, 2012.
[15]
M. Sovyanhadi and M. Cort, “Effectiveness of various nutrition education teaching methods for high school students: a case study in Alabama, United States,” Malaysian Journal of Nutrition, vol. 10, no. 1, pp. 31–37, 2004.
[16]
L. P. Lin and W. P. E. W. Dali, “The impact of nutrition education interventions on the dietary habits of college students in developed nations: a brief review,” Malaysian Journal of Medical Sciences, vol. 19, no. 1, pp. 4–14, 2012.
[17]
E. J. Ha and N. Caine-Bish, “Effect of nutrition intervention using a general nutrition course for promoting fruit and vegetable consumption among college students,” Journal of Nutrition Education and Behavior, vol. 41, no. 2, pp. 103–109, 2009.
[18]
S. E. Shive and M. N. Morris, “Evaluation of the Energize Your Life! Social marketing campaign pilot study to increase fruit intake among community college students,” Journal of American College Health, vol. 55, no. 1, pp. 33–39, 2006.
[19]
H. Cole-Lewis and T. Kershaw, “Text messaging as a tool for behavior change in disease prevention and management,” Epidemiologic Reviews, vol. 32, no. 1, pp. 56–69, 2010.
[20]
B. S. Fjeldsoe, A. L. Marshall, and Y. D. Miller, “Behavior change interventions delivered by mobile telephone short-message service,” American Journal of Preventive Medicine, vol. 36, no. 2, pp. 165–173, 2009.
[21]
J. S. Ahluwalia, N. Nollen, H. Kaur, A. S. James, M. S. Mayo, and K. Resnicow, “Pathway to health: cluster-randomized trail to increase fruit and vegetable consumption among smokers in public housing,” Health Psychology, vol. 26, no. 2, pp. 214–221, 2007.
[22]
I. Ikram Shah, W. B. Wan Mohamed, N. Mohd Ismail, et al., Clinical Practice Guidelines on Management of Obesity 2004, Ministry of Health, Malaysia, 2004.
[23]
R. Lee and D. Nieman, Nutritional Assessment, McGraw-Hill Science, New York, NY, USA, 6th edition, 2012.
[24]
NCCFN, Malaysian Dietary Guidelines, Ministry of Health, Putrajaya, Malaysia, 2010.
[25]
P. L. Lua, W. Wan Dali, and M. Shahril, “Malaysian dietary guidelines 2010 in practice: acceptability and applicability of nutrition education delivery tools among university students in Terengganu, Malaysia,” International Journal of Current Research and Review, vol. 4, no. 15, pp. 126–140, 2012.
[26]
J. Cohen, Statistical Power Analysis for the Behavioral Sciences, Routledge, New Jersey, NJ, USA, 2nd edition, 1988.
[27]
E. J. Ha and N. Caine-Bish, “Interactive introductory nutrition course focusing on disease prevention increased whole-grain consumption by college students,” Journal of Nutrition Education and Behavior, vol. 43, no. 4, pp. 263–267, 2011.
[28]
J. Pomerleau, K. Lock, C. Knai, and M. McKee, “Interventions designed to increased adult fruit and vegetable intake can be effective: a systematic review of the literature,” Journal of Nutrition, vol. 135, no. 10, pp. 2486–2495, 2005.
[29]
I. R. Contento, P. A. Koch, H. Lee, and A. Calabrese-Barton, “Adolescents demonstrate improvement in obesity risk behaviors after completion of choice, control & change, a curriculum addressing personal agency and autonomous motivation,” Journal of the American Dietetic Association, vol. 110, no. 12, pp. 1830–1839, 2010.
[30]
E. J. Ha, N. Caine-Bish, C. Holloman, and K. Lowry-Gordon, “Evaluation of effectiveness of class-based nutrition intervention on changes in soft drink and milk consumption among young adults,” Nutrition Journal, vol. 8, no. 1, article 50, 2009.
[31]
W. J. Wan Arfah Nadiah, A. Mohd Ezane, and L. H. Foo, “Knowledge, attitude and dietary and lifestyle practices on bone health status among undergraduate university students in Health Campus, Universiti Sains Malaysia, Kelantan,” Health and the Environment Journal, vol. 1, no. 1, pp. 34–40, 2010.
[32]
A. K. Norimah, M. Safiah, K. Jamal et al., “Food consumption patterns: findings from the Malaysian Adult Nutrition Survey (MANS),” Malaysian Journal of Nutrition, vol. 14, no. 1, pp. 25–39, 2008.
[33]
K. H. Poddar, K. W. Hosig, E. S. Anderson, S. M. Nickols-Richardson, and S. E. Duncan, “Web-based nutrition education intervention improves self-efficacy and self-regulation related to increased dairy intake in college students,” Journal of the American Dietetic Association, vol. 110, no. 11, pp. 1723–1727, 2010.
[34]
E. S. Tee, “Development and promotion of Malaysian dietary guidelines,” Asia Pacific Journal of Clinical Nutrition, vol. 20, no. 3, pp. 455–461, 2011.
[35]
Malaysian Communications and Multimedia Commission, “Statistical brief number eleven: hand phone users survey 2010,” Cyberjaya, article 36, 2012.
[36]
C. Kapoor and E. Au, “University gender gap,” The New Straits Times, vol. 1, article 12, 2011.
[37]
C. Goldin, L. F. Katz, and I. Kuziemko, “The homecoming of American college women: the reversal of the college gender gap,” Journal of Economic Perspectives, vol. 20, no. 4, pp. 133–156, 2006.
