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Ceylan B, Kocoglu-Tanyer D, Sacikara Z, Sultan Dengiz K. The relationship between chronotype and food addiction: Serial mediation of social jetlag and psychological pain. Chronobiol Int 2024; 41:485-494. [PMID: 38353208 DOI: 10.1080/07420528.2024.2315220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/01/2024] [Indexed: 02/21/2024]
Abstract
This study evaluates how food addiction is related to chronotype, social jetlag, and psychological pain. Of the participants (n = 1,035 university students), 16.6% had a morning chronotype, 25.1% had an evening chronotype, and 25.1% were clinically addicted to eating. The mean sleep durations for participants were 7.41 ± 2.18 h and 8.95 ± 3.0 h on weekdays and weekends, respectively. The mean misalignment time for social jetlag was 1.45 ± 1.5 h. Food addiction, psychological pain, and social jetlag levels were high among participants with the evening chronotype. The risk factors for food addiction included being female, having an evening chronotype, and having high body mass index levels and psychological pain. The total indirect effect of psychological pain and social jetlag on the relationship between chronotype and food addiction was 20.6%. However, the social jetlag effect is relatively minor compared to psychological pain. The significant conclusions of this study are as follows. Clinical food addiction is prevalent among students, and a strong direct correlation between chronotype and food addiction was observed. The study emphasizes the importance of being aware of chronotype and mental status in establishing a healthy diet and lifestyle.
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Affiliation(s)
- Burcu Ceylan
- Faculty of Health Sciences, Nursing Department, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | | | - Zeynep Sacikara
- Faculty of Nursing, Public Health Department, Necmettin Erbakan University, Konya, Turkey
| | - Kubra Sultan Dengiz
- Faculty of Nursing, Public Health Department, Necmettin Erbakan University, Konya, Turkey
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Vélez-Alcázar AE, García-Roca JA, Vaquero-Cristóbal R. Adherence to the Mediterranean Diet and Its Influence on Anthropometric and Fitness Variables in High-Level Adolescent Athletes. Nutrients 2024; 16:624. [PMID: 38474752 DOI: 10.3390/nu16050624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
The objectives of the present research were to analyze adherence to the Mediterranean diet (AMD), to observe which variables most affect AMD, and to analyze whether AMD affects physical fitness and anthropometric parameters in high-level adolescent athletes. A total of 96 adolescent athletes in the under-16, under-18, and under-20 categories selected by the Athletics Federation of the Region of Murcia, of whom 47 were male (age = 18.31 ± 2.31 years old) and 49 female (age = 17.27 ± 1.44 years old), participated in this study. They completed the KIDMED questionnaire to discover their AMD, as well as an anthropometric and physical condition assessment. Results: The findings show that 61.45% had an excellent degree of AMD, 31.25% a moderate one, and 7.30% a poor one. The parameters that most conditioned AMD were the consumption of fruit, vegetables, nuts, legumes, fish, breakfast cereals, and dairy products (p = 0.011-0.000). AMD did not show significant differences in anthropometric characteristics and physical fitness (p = 0.057-0.996). Conclusions: The majority of high-level adolescent athletes have a moderate or excellent AMD. The degree of AMD seems to have no influence on physical fitness and anthropometric parameters in this population.
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Affiliation(s)
| | - Juan Alfonso García-Roca
- Facultad de Deporte, UCAM Universidad Católica de Murcia, 30310 Cartagena, Spain
- Olympics Studies Center, UCAM Universidad Católica de Murcia, 30310 Cartagena, Spain
| | - Raquel Vaquero-Cristóbal
- Department of Physical Activity and Sport, Faculty of Sport Sciences, University of Murcia, 30720 Murcia, Spain
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Borisenkov MF, Tserne TA, Popov SV, Smirnov VV, Dorogina OI, Pecherkina AA, Symaniuk EE. Association of Chrononutrition Indices with Anthropometric Parameters, Academic Performance, and Psychoemotional State of Adolescents: A Cross-Sectional Study. Nutrients 2023; 15:4521. [PMID: 37960174 PMCID: PMC10647400 DOI: 10.3390/nu15214521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Adolescents are an at-risk group for circadian misalignment. The contribution of sleep-wake rhythm instability to the psychoemotional, cognitive, and weight disorders of adolescents has been studied in sufficient detail. At the same time, there is insufficient information about the association between chrononutrition indices and the well-being of adolescents. The aim of this study is to investigate the relationship between chrononutrition indices and academic achievement, psychoemotional state, and anthropometric indicators in adolescents. The study involved 12,759 students in grades 6-11 of secondary schools, aged 14.2 ± 1.7 years old; 57.2% of whom were girls. Participants provided personal data, frequency and time of meals during the day and at night, on weekdays and weekends, and completed the Zung Self-Rating Depression Scale and the Yale Food Addiction Scale. There is a U-shaped association between eating mid-phase (EPFc), eating jetlag (EJL), and eating window (EW) with GPA, ZSDSI, and FA. At the same time, the frequency of night eating (NE) is linearly associated with the studied parameters. NE is the strongest predictor of ZSDSI (β = 0.24), FA (β = 0.04), and GPA (β = -0.22). EPFc, EJL, and EW practically do not differ in the strength of their association with the studied indicators. ZSDSI is most closely associated with the chrononutrition indices. There is a weak negative association between BMI and EW (β = -0.03) and NE (β = -0.04). Thus, circadian eating disorders are more often observed in adolescents with poor academic performance, high levels of depression, and food addiction.
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Affiliation(s)
- Mikhail F. Borisenkov
- Department of Molecular Immunology and Biotechnology, Institute of Physiology of Federal Research Centre “Komi Science Centre of the Urals Branch of the Russian Academy of Sciences”, 167982 Syktyvkar, Russia; (T.A.T.); (S.V.P.); (V.V.S.)
| | - Tatyana A. Tserne
- Department of Molecular Immunology and Biotechnology, Institute of Physiology of Federal Research Centre “Komi Science Centre of the Urals Branch of the Russian Academy of Sciences”, 167982 Syktyvkar, Russia; (T.A.T.); (S.V.P.); (V.V.S.)
| | - Sergey V. Popov
- Department of Molecular Immunology and Biotechnology, Institute of Physiology of Federal Research Centre “Komi Science Centre of the Urals Branch of the Russian Academy of Sciences”, 167982 Syktyvkar, Russia; (T.A.T.); (S.V.P.); (V.V.S.)
| | - Vasily V. Smirnov
- Department of Molecular Immunology and Biotechnology, Institute of Physiology of Federal Research Centre “Komi Science Centre of the Urals Branch of the Russian Academy of Sciences”, 167982 Syktyvkar, Russia; (T.A.T.); (S.V.P.); (V.V.S.)
| | - Olga I. Dorogina
- Ural Institute of Humanities, Ural Federal University, 620000 Yekaterinburg, Russia; (O.I.D.); (E.E.S.)
| | - Anna A. Pecherkina
- Ural Institute of Humanities, Ural Federal University, 620000 Yekaterinburg, Russia; (O.I.D.); (E.E.S.)
| | - Elvira E. Symaniuk
- Ural Institute of Humanities, Ural Federal University, 620000 Yekaterinburg, Russia; (O.I.D.); (E.E.S.)
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de Melo Barros L, da Silva Júnior AE, Praxedes DRS, Monteiro MBL, de Lima Macena M, Bueno NB. Prevalence of food addiction determined by the Yale Food Addiction Scale in Latin America: A systematic review with meta-analysis. Int J Eat Disord 2023; 56:677-690. [PMID: 36722629 DOI: 10.1002/eat.23909] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Food addiction (FA) has been extensively investigated worldwide; however, the prevalence of FA in the Latin American population has yet to be established and past work has largely neglected the specificities of this region, that includes the most significant economic disparities in the world. Thus, the objective of this study was to assess the prevalence of FA measured by the Yale Food Addiction Scale in Latin America. METHOD The search was performed on MEDLINE, ScienceDirect, LILACS, IBECS, SciELO, PsycArticles, CENTRAL, and the gray literature. FA prevalence data were collected, and random effects meta-analyses were performed to calculate the overall weighted prevalence, the prevalence by country, and by clinical and non-clinical samples. RESULTS A total of 10,082 occurrences were identified through database searches, and 23 studies were included (Mexico = 9; Brazil = 7; Chile = 4; Argentina = 1; Peru = 1; Uruguay = 1). The prevalence of FA found in clinical samples was 38% (95% CI: 16%-63%; I2 = 98.67%; 8 studies), while in non-clinical samples, it was 15% (95% CI: 10%-21%; I2 = 98.51%; 15 studies). DISCUSSION The average prevalence of FA in the Latin American countries included here was in accordance with that reported in other regions worldwide. It is noteworthy that the studies were conducted only in six countries, which are among those with the highest income in the region and do not represent the situation in native populations or those with lower purchasing power. This gap in the data also reflects the effects of economic disparities on the availability of empirical data in the region. PUBLIC SIGNIFICANCE The prevalence of food addiction in Latin America was similar to that reported in other regions. It was higher among individuals with overweight, whether or not undergoing bariatric surgery, than in non-clinical samples. These findings contribute to aggregate information about this condition that has drawn the attention of clinicians and researchers.
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Affiliation(s)
- Ludmila de Melo Barros
- Laboratório de Nutrição e Metabolismo (LANUM), Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas, Maceió, Brazil
| | - André Eduardo da Silva Júnior
- Postgraduate Program in Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Maíra Barbosa Lobo Monteiro
- Laboratório de Nutrição e Metabolismo (LANUM), Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas, Maceió, Brazil
| | - Mateus de Lima Macena
- Postgraduate Program in Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Nassib Bezerra Bueno
- Laboratório de Nutrição e Metabolismo (LANUM), Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas, Maceió, Brazil.,Postgraduate Program in Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Cai HT, Zhang HW, Zheng H, Xu T, Liu L, Ban XY, Di JZ, Yuan TF, Han XD. Development of Chinese food picture library for inducing food cravings. Front Psychol 2023; 14:1143831. [PMID: 37063557 PMCID: PMC10098199 DOI: 10.3389/fpsyg.2023.1143831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023] Open
Abstract
Cue-induced food cravings are strong desires directed toward specific foods, usually ones with high caloric content, and can lead to overeating. However, although food cravings vary according to individual preferences for specific high-calorie food subtypes, a structured library of food craving-inducing pictures including multiple categories of high-calorie foods does not yet exist. Here, we developed and validated a picture library of Chinese foods (PLCF) consisting of five subtypes of high-calorie foods (i.e., sweets, starches, salty foods, fatty foods, and sugary drinks) to allow for more nuanced future investigations in food craving research, particularly in Chinese cultural contexts. We collected 100 food images representing these five subtypes, with four food items per subtype depicted in five high-resolution photographs each. We recruited 241 individuals with overweight or obesity to rate the food pictures based on craving, familiarity, valence, and arousal dimensions. Of these participants, 213 reported the severity of problematic eating behaviors as a clinical characteristic. Under the condition of mixing multiple subtypes of high-calorie foods, we did not observe significant differences in craving ratings for high- and low-calorie food images (p tukey > 0.05). Then, we compared each subtype of high-calorie food images to low-calorie ones, and found craving ratings were greater for the images of salty foods and sugary drinks (ps < 0.05). Furthermore, we conducted a subgroup analysis of individuals according to whether they did or did not meet the criteria for food addiction (FA) and found that greater cravings induced by the images of high-calorie food subtypes (i.e., salty foods and sugary drinks) only appeared in the subgroup that met the FA criteria. The results show that the PLCF is practical for investigating food cravings.
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Affiliation(s)
- Hui-Ting Cai
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong-Wei Zhang
- Department of Metabolic and Bariatric Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Hui Zheng
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Xu
- Department of Metabolic and Bariatric Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Lin Liu
- Department of Metabolic and Bariatric Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xu-Yan Ban
- Department of Metabolic and Bariatric Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jian-Zhong Di
- Department of Metabolic and Bariatric Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Jian-Zhong Di,
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
- Ti-Fei Yuan,
| | - Xiao-Dong Han
- Department of Metabolic and Bariatric Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Xiao-Dong Han,
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Kong L, Cui Y, Gong Q. Duration of Keeping an Exercise Habit and Mental Illness and Life Attitude among University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811669. [PMID: 36141940 PMCID: PMC9517129 DOI: 10.3390/ijerph191811669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 05/12/2023]
Abstract
Physical exercise has beneficial effects on human health, and several studies have examined the association between exercise and mental health. However, most of these studies focused on exercise intensity, duration, or frequency. Evidence for the association between the duration of maintaining an exercise habit and mental illness is lacking, especially in young adulthood-a crucial period that bridges adolescence and adulthood. This study investigated the association between the duration of keeping an exercise habit and mental illness and life attitude among Chinese university students. A total of 11,392 university students participated in this study (6866 men and 4526 women). The duration of keeping an exercise habit was evaluated using a questionnaire with relevant questions. Exercise habit was defined as exercising for longer than 30 min per session and more than twice a week. Mental illness consisted of two elements: depressive symptoms-assessed using the Zung Self-rating Depression Scale, and anxiety symptoms-assessed using the seven-item Generalized Anxiety Disorder scale. Life attitude was assessed using a questionnaire with relevant questions. Multivariate logistic regression analysis examined the adjusted association between the duration of keeping an exercise habit and mental illness and life attitude. In the final adjusted model, compared to the no exercise category, the odds ratios and 95% confidence intervals (CIs) of depressive symptoms were 0.80 (0.70, 0.91) for those with an exercise habit of 1-4 months, and 0.72 (0.63, 0.83) for those with one of >4 months (p for trend <0.001). Additionally, when compared to participants with no exercise habit, the adjusted odds ratios (95% CIs) for anxiety symptoms were 1.01 (0.90, 1.14) for those with a habit of 1-4 months and 0.78 (0.69, 0.88) for those with one of >4 months (p for trend =0.001). A longer duration of keeping an exercise habit was also significantly associated with positive life attitudes. Our results showed that a long duration of keeping an exercise habit was significantly associated with a lower prevalence of mental illness among university students. Further, maintaining a more prolonged exercise habit may benefit individuals' mental health in young adulthood.
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Affiliation(s)
- Lingfeng Kong
- Department of Physical Education, Hohai University, 1 Xikang Road, Nanjing 210098, China
| | - Yufei Cui
- Department of Physical Education, Huaiyin Institute of Technology, Huaian 223003, China
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Qiang Gong
- Department of Physical Education, Huaiyin Institute of Technology, Huaian 223003, China
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Kaya Cebioğlu İ, Dumlu Bilgin G, Kavsara HK, Gül A, Sarioğlu A, Aydin S, Keküllüoğlu M. Food addiction among university students: The effect of mindful eating. Appetite 2022; 177:106133. [PMID: 35753440 DOI: 10.1016/j.appet.2022.106133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/13/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
Recent evidence indicated that lifestyle modifications, especially mindful eating, might be effective interventions for treating food addiction (FA). Mindful eating practices have been considered to regulate emotional eating, which is one predictor of FA along with automatic eating behaviors, including emotional, impulsive, and habitual eating. Thus, this cross-sectional study aimed to determine the effect of mindful eating on FA of university students. The research team collected the data with 2133 undergraduate students. The Mindful Eating Questionnaire examined the mindfulness status of the students, and the FA diagnosed by using the YALE Food Addiction Scale. 56.9% of participants were women, with a mean age of 21.5 ± 2.2 and a mean body mass index (BMI) of 22.5 ± 3.8 kg/m2. Although no significant differences were observed regarding sex (p > .05), the FA prevalence among men (16.1%) was higher than women. The overall prevalence of FA was 15.3%, which was 1.5 units higher among those with BMI ≥25 kg/m2. Also, FA diagnosis was significantly more prevalent among smokers and ex-smokers (p < .01). In addition, participants diagnosed with FA had a significantly lower mean mindful eating score (p < .001). Furthermore, those with lower mindfulness levels had a 4.96 higher risk of being food addicted (p < .000). Those with FA diagnosis had significantly lower scores regarding subscales of "disinhibition," "emotional eating," "control of eating," "mindfulness," and "interference" (p < .001). Consequently, it should be highlighted that determining the level of individuals' mindful eating may have remarkable and cumulative impacts on both obesity and FA in the long term. Thus, increasing mindful eating may be suggested as an essential strategy to control FA among young individuals.
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Affiliation(s)
- İrem Kaya Cebioğlu
- Yeditepe University, Faculty of Health Sciences, Department of Nutrition and Dietetics, İnönü Mah, Kayışdağı Cad, 34755, İstanbul, Turkey.
| | - Gözde Dumlu Bilgin
- Yeditepe University, Faculty of Health Sciences, Department of Nutrition and Dietetics, İnönü Mah, Kayışdağı Cad, 34755, İstanbul, Turkey.
| | - Hasan Kaan Kavsara
- Yeditepe University, Faculty of Health Sciences, Department of Nutrition and Dietetics, İnönü Mah, Kayışdağı Cad, 34755, İstanbul, Turkey.
| | - Açelya Gül
- Yeditepe University, Faculty of Health Sciences, Department of Nutrition and Dietetics, İnönü Mah, Kayışdağı Cad, 34755, İstanbul, Turkey.
| | - Aybüke Sarioğlu
- Yeditepe University, Faculty of Health Sciences, Department of Nutrition and Dietetics, İnönü Mah, Kayışdağı Cad, 34755, İstanbul, Turkey.
| | - Sema Aydin
- Yeditepe University, Faculty of Health Sciences, Department of Nutrition and Dietetics, İnönü Mah, Kayışdağı Cad, 34755, İstanbul, Turkey.
| | - Melis Keküllüoğlu
- Yeditepe University, Institute of Health Sciences, Physiology, İnönü Mah, Kayışdağı Cad, 34755, İstanbul, Turkey.
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Romero-Blanco C, Hernández-Martínez A, Parra-Fernández ML, Onieva-Zafra MD, Prado-Laguna MDC, Rodríguez-Almagro J. Food Preferences in Undergraduate Nursing Students and Its Relationship with Food Addiction and Physical Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073858. [PMID: 35409543 PMCID: PMC8998007 DOI: 10.3390/ijerph19073858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 12/10/2022]
Abstract
The transition to college is a decisive stage for the acquisition of eating habits that continue into adulthood. The aim of this study is to assess the consumption of healthy elements of the Mediterranean diet in a group of university students and to evaluate whether the consumption pattern was related to sex, Body Mass Index (BMI), food addiction or the amount of physical activity performed. A total of 515 nursing students participated. The Mediterranean diet adherence questionnaire (PREDIMED), the food addiction scale (YFAS 2.0) and the International Physical Activity Questionnaire (IPAQ) were completed. For data analysis, multivariate analysis was performed with multiple linear regression and adjusted for sex, age, and BMI. The results showed that females consumed various types of meats (white/red, processed) in a healthier proportion (p < 0.05). Students that consumed more than one per day (unhealthy) of red/processed meats (mean difference (MD) = −0.49; 95% CI: −0.83; −0.15), soft drinks (MD = −0.82; 95% CI: 82−1.36; −0.27) and pastries (MD = −0.63; 95% CI: −0.97; −0.30) displayed higher food addiction scores. In addition, students who skipped breakfast also scored higher on food addiction (MD = 0.75; 95% CI: 0.31−1.19). Higher values of physical activity were observed in those who presented a healthy consumption of vegetables (MD = 140.86; 95% CI: 72.71−209.02), fruit (MD = 145.78; 95% CI: 69.35−222.21), legumes (MD = 136.46; 95% CI: 60.43−212.50) and nuts (MD = 74.36; 95% CI: 14.23−134.49). Students who consumed more red or processed meats, more pastries and more soft drinks had higher values of food addiction, while those who consumed more vegetables, fruits, legumes, and nuts had more minutes of physical activity per week. These findings invite us to insist on expanding knowledge regarding the health benefits of consuming a Mediterranean-type diet as a whole. The healthy consumption of fish, fruit and legumes should also be emphasized, especially among university students.
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