nutritive value of meals, dietary habits and nutritive status in croatian university students...

International Journul of Food Sciences und Nutrition,

Volume 54, Number 6 (November 2003) 473-484 j Taylor&Francis

healthsciences

Nutritive value of meals, dietary habits and nutritive status in Croatian university students according to gender

Irena Colic BariC, Zvonimir ~a t a l ik and ~ e l j k a LukeSii-

Laboratory for Food Chemistry and Nutrition, Faculty of Food Technology und Bioteclznology, University of Zagreb, Pierottijeva 6, 10000 Zagreb, Croatia

The aim of this study was to evaluate daily menus at students' restaurants and to report dietary habits and other health-related behaviour of Croatian university students (n = 2075) according to gender. A specially designed self- administered questionnaire was used. One hundred and twenty daily menus were chosen by random sampling, and the nutritive value was calculated using food composition tables. Daily menus on average provide an adequate amount of energy, protein and most micronutrients: 88.2% of daily menus provide a balanced intake of protein, fat and carbohydrates, 22.5% of daily menus provide more than 300 mg of cholesterol, and 58.8% have more than 25 g dietary fibre. On average, students had 2.4 meals and 1.3 snacks per day. Breakfast was the most often skipped meal. Red meat, cereals and fast food were consumed more often by males (P < 0.05). Low-fat dairy products, whole grain products and breakfast cereals were consumed more often by females (P < 0.05). The most common choice for snacks was fruit. Males exercised more than females (4.4 hlweek versus 1.6 hlweek; P <0.05). A higher percentage of females (29.8%) than males (17.2%) smoked cigarettes. For alcohol consumption it was vice versa: 88.9 and 84.8% of males and females, respectively. A total of 80.4% of students were well nourished. This study showed that meals offered at students' restaurants are adequate. Dietary and other health-related behaviour differed according to gender. Clustering of some behaviours was observed.

Introduction

Because starting university in Croatia often represents the first time when students assume primary responsibility for their meals, dietary habits of students are particularly relevant. Nutritional concerns are of less relevance to most people than taste and cost, and it was shown that, for students,

Correspondence to: Irena Colic Bark. E-mail: [email protected]

importance of nutrition disappears as a perception while convenience emerges (Betts et a1 ., 1997; Glanz et a1 ., 1998; Lappalainen et al., 1998).

Health experts recommend merging a healthy diet and adequate physical activity into one behaviour. Physical wellness, includ-

ISSN 0963-7486 printedl1SSN 1465-3478 online 0 2003 Taylor & Francis Ltd DOI: 10.1080109637480310001622332

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474 I. ColiC BariC et al.

ing behaviours such as exercise, dietary habits, smoking and alcohol use, is important to address during the years of education, as this time period is critical in the development of a healthy lifestyle. Johnson et al . (1998) reported clustering of health behaviours among university students. Steptoe et al. (2002) observed a trend of unfavourable change of health behaviours among university students in 13 European counties during the past decade.

The aim of this study was to evaluate the nutritive value of meals offered to students at students' restaurants. The Ministry of Science and Technology of Republic Croatia is participating 74% in the price of those meals, and a student is paying the remaining 26% of the full price. Dietary habits and other health-related behaviour were also assessed to provide data to fill the current literature gap about the examined population that has existed for at least the past 12 years. Data was shown with regard to gender.

Subjects and Methods

Subjects In Croatia in the school year 2000-2001 there were 89,606 university students at all four Croatian universities, 47.5% of them male and 52.5% female (Croatian Bureau of Statistics, 200 1). Of the Croatian university students, 60.894, 9.1%, 13.7% and 16.4% were from the universities of Zagreb, Osijek, Rijeka and Split, respectively (Croatian Bu- reau of Statistics, 2001).

The examined subjects were 2075 university students, aged 21.7 f 2.0 years (x + standard deviation), from all four universities, which is 2.3% of all university students in Croatia (Table 1). Forty-eight per cent of subjects were males and 52.0% were females.

Table 1. Subjects defined by age, gender and place of study

A total of 57.9% subjects were from the University of Zagreb, 15.4% from the Uni- versity of Osijek, 13.3% from the University of Rijeka and 13.4% from the University of Split.

Methods Daily menus provided by the Ministry of Science and Technology that are used in Croatian universities' centres were chosen by random sampling. They were meant to provide at least 80% of students' daily energy requirements. Thirty daily menus for each season were analysed (n = 120; i.e. 30 for each season). The analysed daily menu con- tains lunch and dinner. Breakfast was not taken into account because it is served only in Zagreb, is consumed by less than 3% of students from the University of Zagreb and is provided only for residents of students' dormitories (personal communication and internal statistics).

Macronutrient and micronutrient contents were calculated separately for lunches and dinners, and also as total values of the daily menus, using food composition tables and data from food labels, and they were compared with recommended dietary allowances (RDA) and dietary reference intakes (DRI) according to age and gender (Kulier, 1990; Food and Nutrition Board of the Institute of Medicine, 1998; National Academy of Sciences, 2002). RDA have been in use in Croatia since 1994 (National Academy of Science, 1989; The Ministry of Health, 1994). According to the National Academy of Sciences (2002) well-balanced diet should provide 10-324 of energy from protein, 20-35% from fat and 45-65% from carbohydrates. Dietary fibre intake should be 25 g and 38 g for adult males and females, respectively (National Academy of Sciences,

N umbcr (n ) Age (years) (x *standard deviation) University of Zagreb ( n ) University of Osijek ( n ) University of Rijeka (n) University of Split ( n )

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Dietary habits and nutrition in Croatia 475

2002). It is widely accepted that cholesterol intake should be under 300 mg and saturated fatty acid intake less than 10% kJ/day.

The energy fraction of food groups was calculated and foods were grouped according to the Eurocode Food Coding System (ver- sion 9912) (Poortvliet et al., 1991; http:// www.vfd2.dk/eurocode/).

To detect dietary habits during previous years, a specially designed self-administered food frequency questionnaire (FFQ) was used. Self-reports of food intake may be considered a fairly accurate method, although disadvantages do exist (Stunkard & Waxman, 1981; Macdonald, 1991). The questionnaire provided information on a number of daily meals and snacks and the weekly consumption frequency of foods, meals and snacks.

Reproducibility of the food frequency questionnaire was tested by second administration of the questionnaire to 83 students (4% of the examined population) 5 weeks after the first administration. Pearson's correlation coefficients ranged from 0.3 (P < 0.001) for consumption frequency of fish to 0.8 (P < 0.001) for consumption frequency of whole grain products. On average, the correlation coefficient for the consumption frequency of 19 foods listed in the questionnaire was 0.6. Block & Hartman (1989) consider it preferable to administer the second questionnaire within 4-8 weeks, which is a long enough gap to ensure the respondent is not simply remembering what helshe said before and a short enough gap to minimize real dietary changes in the interim.

During the year 2001, the questionnaire was offered to students at students' restaurants in four university towns. This setting was chosen because students from all facul- ties eat there. We also assume that the sample studied is representative of Croatian university students since a very high percentage (60%) of Croatian university students do use students' restaurants (personal communication and internal statistics).

From 3840 given questionnaires, 2075 (54.0%) were returned completed. Responses to the questionnaire were voluntary and the questionnaires were completed anonymously.

Completion required approximately 10-20 min.

The additional questions about physical activity, cigarette smoking and alcohol consumption were also included, as well as self- reports of body weight and body height. Subjects were asked if they follow any alter- native diet or are on a special diet because of some metabolic disease. Students were also asked to rate the quality and quantity of meals in students' restaurants on a scale from 1 to 5.

The self-reported weight and height were used to calculate the body mass index (BMI). According to guidelines proposed by the National Institutes of Health, overweight in adults aged 18 years and older is defined as 25.0 kg/m2 5 BMI < 30.0 kg/m2, obesity as BMI 2 30.0 kg/m2, and underweight as BMI < 18.5 kg/m2 (National Institutes of Health, National Heart, Lung, and Blood Institute, 1998). These cut-off points were used to define nutritive status.

Participants were defined as regular smokers if they reported smoking more than one cigarette per day. A category of light smokers was defined according to classification of Subar et al. (1990) (one to 14 cigarettes per day).

Statistical analyses included the F-test and calculation of Pearson's product moment correlation coefficients. Statistical signifi- cance was accepted at P < 0.05.

Results

Daily menus on average provide an adequate amount of energy and protein (Table 2). A total of 83.3% and 100.0% of daily menus provide more than 80% of the RDA of energy for males and females, respectively. The average protein content of both lunches and dinners is very high (Table 2). All 120 daily menus provide more than 100% of the RDA for protein for both genders. A total of 8l.4%, 83.3% and 88.2% of lunches, dinners and daily menus, respectively, provide a balanced intake of protein, fat and carbohydrates. Of daily menus, 22.5% provide more than 300 mg cholesterol and 45.1% have more than 100 mgl4187 kJ; and 58.8% of daily menus have more than 25 g dietary fibre

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Table 2. Energy and macronutrient content of lunches and dinners (xks tandard deviation)

Parurnrfrr Lunch Dinner Daill: menu

Energy (kJ) kJ1100 g food

Energy ( % I RDA) Male Female

Protein (g)

Protein ('XI RDA) Male Female

Protein ('Ih kJ/day) Fat (g) Fat ('XI kJ/day) Carbohydrates (g) Carbohydrates (%I kJ/day) Cholesterol (mg) Cholesterol (mgl4 187 kJ) Saturated fatty acids (g) Saturated fatty acids (%I kJ/day) Mono-unsaturated fatty acids (g) Mono-unsaturated fatty acids ('I%] kJ/day) Polyunsaturated fatty acids (g) Polyunsaturated fatty acids ('XI kJ/day) Dietary fibre (g) Dietary fibre (&I4187 kJ)

RDA, recommended dietary allowances

and 2.9% have more than 38 g. Grains and of some winter menus. When compared, grain products, followed by meat and meat lunch and dinner showed significant differ- products, give the most energy (Table 3). The ences in quantities of vitamins A, C and BI2, micronutrient content ranged from 37.1% of and the minerals phosphorus, magnesium, the DRI for vitamin E to 489.8% of the DRI zinc, iodine and selenium. A total of 25.5% for vitamin K (Table 4). Such high vitamin K of daily menus had the recommended con- content was because sour cabbage was part tent of energy, protein, fat, carbohydrates,

Table 3. Energy fraction of food groups in lunches and dinners (xks tandard deviation)

Dinnrr

Milk and milk products (en'%) Egg and egg products (en%) Meat and meat products (en%) Fish and fish products (en%) Fats and oils (en%) Grains and grain products (en%) Pulses, seeds, kernels, nuts and products (en%) Vegetables and vegetable products (en%) Fruits and fruit products (en1%) Sugar, sugar products, chocolate products and confectionary (en%) Beverages (non-milk) (en%) Miscellaneous, soups, sauces, snacks and products (en%,) Products for special nutritional use (en%)

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Table 4. Micronutrient content of lunches and dinners (xf standard deviation)

Pururnrter Lunch Dinner Daily nzenu

Vitamin A (pg RE)

Vitamin A (% DRI) Male Female

Vitamin D (pg) Vitamin D (% DRI)

Vitamin E (mg a-TE) Vitamin E (%I DRI)

Male Female

Vitamin K (pg) Vitamin K ('XI DRI)

Male Female

Vitamin C (mg) Vitamin C ('Xi DRI)

Thiamin (mg) Thiamin (%I DRI)

Male Female

Riboflavin (mg) Riboflavin ('%I DRI)

Male Female

Niacin (mg NE) Niacin ('%I DRI)

Male Female

Vitamin B6 (mg) Vitamin B6 ('XI DRI) Folate (pg) Folate ('%, DRI) Vitamin B12 (pg) Vitamin B12 ( 'XI DRI) Calcium (mg) Calcium (% DRI) Phosphorus (mg) Phosphorus ((51 DRI)

Magnesium (mg) Magnesium ('%I DRI)

Male Female

Iron (mg) Iron ('% DRI)

Male Female

Zinc (mg)

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478 I. ColiC BariC et al.

Table 4 (Continued)

Pararneter Lunch Dinner Daily menu

Zinc ('A, DRI) Male Female

Iodine (pg) Iodine (YO DRI)

Selenium (pg) Selenium ('%, DRI)

Male Female

DRI, dietary reference intakes; RE, retinol equivalents.

cholesterol, saturated fatty acids and dietary fibre.

A total of 36.5% of subjects eat at students' restaurant more than once a day, and 37.1% once a day. Food for breakfast and snacks, besides lunch and dinner, from students' restaurant was consumed by 36.5%; 17.6% do not. Ninety-one per cent of subjects have lunch as the most common meal at a students' restaurant. Only 1.4% of students reported having breakfast at students' restaurant. A total of 77.7% students are satisfied with the quantity of meals offered, but recommend more variety.

The mode grade for quantity was 4 and 3 in females and males, respectively. The mode grade for diversity was 2. The mode grade for the main dish, side dishes, salad and dessert was 3.

Males had significantly more meals at students' restaurants than females (Table 5). On average, students had 2.4 meals and 1.3 snacks per day (Table 5). Males had a significantly higher number of meals per day than females (Table 5). The opposite was observed for number of snacks according

to gender (Table 5). Lunch is a meal that was least often skipped when compared with consumption frequencies of breakfast and dinner (Table 5) . Males had a significantly higher number of lunches and dinners per week, but the number of breakfasts per week did not significantly differ according to gender (Table 5). When examining the summed number of meals and snacks per day, results showed that males ate significantly more often than females (3.7 versus 3.6 times per day). A total of 43.4% and 36.1% of males and females, respectively, had three meals and at least one snack daily. Regular breakfast, defined as having breakfast six or seven times per week, was observed in 32.3% of females and 25.7% of males. The number of breakfasts per week significantly correlated with the number of lunches (r = 0.32) and dinners (r = 0.30) per week. Students who had regular breakfast, when compared with students that never had breakfast, had significantly lower BMI (21.7 kg/m2 versus 22.2 kg/m2), exercised significantly more (3.5 h versus 2.6 h of exercise per week) and had a significantly higher sum of

Table 5. Daily and weekly frequency of meals and snacks (xf standard deviation)

Parameter Total students Mules Females F-test

Meals per day 2.4 f 0.7 2.5 f0 .6 2.3 f0 .7 * Meals per day in students' restaurant 1.5k0.7 1.7f 0.8 1.3 f0 .6 * Snacks per day 1.3+0.8 1.3 f0 .8 1.4f0.8 * Breakfasts per week 3.4 +2.7 3.1 k2.7 3.6 f2 .7 I Lunches per week 6.0f 1.6 6.1 f 1.5 5.9 f 1.6 * Dinners per week 4.7 f 2.4 5.3 f 2.2 4.1 k2.5 *

* P < 0.05 according t o gender.

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daily meals and snacks (4.2 versus 3.2 eating occasions daily). Those who had three or more eating occasions daily, when compared with those who ate less than three times per day, exercised significantly more (3.1 h versus 2.0 h per week).

Red meat, cereals and fast food were consumed significantly more often by males than females (Table 6). Low-fat dairy products, whole grain products and breakfast cereals were consumed significantly more often by females than males (Table 6). Consumption frequencies of fruit and both fresh (r = 0.40) and cooked ( r = 0.36) vegetables significantly correlated. Consumption frequencies of low-fat dairy products and whole grain products significantly correlated (r = 0.38). Daily consumption of fruit was reported by 16.3% and 27.1% of males and females, respectively. Daily consumption of fresh or cooked vegetables was reported by 14.1% and 18.0% of males and females, respectively.

When choosing foods for snacks, the most common choices were fruit, milk and dairy products, and sweets or bars (Table 7). No significant correlation was observed between number of snacks on a daily or weekly bases, with consumption frequencies of milk, yoghurt, fruit or fruit juice. Significant correlation did occur for the number of daily snacks

Table 7. Food choices for snacks (%) subjects)

Purunirtc.r Total student^ Mulrs Femulrs

Fruit Vegetables Milk and dairy products Sweets or bars Meet products and eggs Pizza Fast food Low fat products

and consumption frequency of sweets and bars ( r = 0.20). According to gender, males preferred meat products and fast food, while females preferred high carbohydrate foods, low fat products, fruits and vegetables (Table 7). A total of 5.1% and 7.6% of males and females, respectively, consumed snacks only when they had some company. Consumption frequencies of fast food and carbonated soft drinks significantly correlated ( r = 0.32). Carbonated soft drinks were consumed significantly more often by males than females (2.7 versus 1.7 times per week).

A total of 41.6% of males and 63.5% of females reported no exercising at all (Table 8). Males exercised significantly more than females (4.4 hlweek versus 1.6 hlweek). When observing only those that do exercise, results also showed that males exercised significantly

Table 6. Food consumption frequency (n times per week) (xks tandard deviation)

Red meet Poultry Fish Eggs Milk Yoghurt Low fat dairy products Fresh fruit Fresh vegetables Cooked vegetables Legumes White bread Pasta, rice or potato Whole grain products Breakfast cereals SOY Fast food Sandwiches Fruit juice

*P < 0.05 according to gender.

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Table 8. Physical activity, alcohol consumption and cigarette smoking (0% subjects)

Parameter Total students Mciles Females

Hours per week of exercise 0 1-5 6-10 11 -20 > 20

Alcohol consumption Alcohol consumers Strong alcoholic beverages consumers Alcohol consumption only on weekends

Smoking Regular smokers (at least one cigarette per day) 23.8 17.2 29.8 Light smokers (one to 14 cigarettes per day) 10.8 7.4 13.9 More than 14 cigarettes per day 13.0 9.7 15.9

more than females (7.4 hlweek versus 4.5 h/ week). A higher level of males than females exercised for more than 5 h per week (Table 8). Students that did exercise had significantly higher number of daily meals when compared with students that did not exercise at all (2.5 versus 2.3 meals per day).

A higher percentage of males than females consumed alcohol (Table 8). Strong alcoholic beverages were more popular among males than females (Table 8). A total of 7.9 and 2.5% of males and females, respectively, reported daily consumption of at least one glass of beer or wine. Consumption of alcohol only on weekends was reported by a higher percentage of females than males (Table 8). Males reported to consume beer or wine significantly more often than females (2.0 versus 1.0 times per week). The same was observed for strong alcoholic beverages (1.1 versus 0.6 times per week). Significantly correlated consumption frequencies of fast food and beer or wine were reported ( r =

0.21). A higher percentage of females than males

were regular smokers (Table 8). More females than males were daily smokers in the category of light smokers (one to 14 cigarettes per day) according to classification of Subar et al. (1990) (Table 8). A total of 94.3% of regular smokers tried their first cigarette before the age of 20 years. The number of cigarettes smoked correlated with consumption frequency of beer or wine ( r = 0.23) a

negative correlation was observed between number of cigarettes smoked and age of smoking initiation ( r = -0.32), meaning that the number of cigarettes smoked in- creases with age.

Three per cent and 7.0% of males and females, respectively, followed a vegetarian or macrobiotic diet. A total of 23.2% and 50.1% of males and females, respectively, reported avoidance of beef consumption.

In total, 4.1% of students followed a special diet because of some health-related problem. Twenty-five students had gastritis, two students had a food allergy (soybean and strawberry allergy), three cases of diabetes were observed and one case of phenylketo- nuria.

The BMI calculated from self-reported body weight and body height was 23.5 kg/ m2 and 20.5 kg/m2 in males and females, respectively. In total, 80.4% of students were normally nourished (Table 9). A higher percentage of females than males were under- nourished (Table 9). Overweight and obese occurred in a higher percentage of males than females (Table 9). When comparing overweight and normally nourished, overweight students exercised significantly more (4.0 11 versus 2.9 h per week) and had significantly less numbers of eating occasions daily (3.4 versus 3.6). Overweight students consumed beer or wine significantly more often than normally nourished students (1.9 versus 1.4 times per week).

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Dietary habits and nutrition in Croafiu 48 1

Table 9. Body weight, body height and nutritive status with regard to body mass index (BMI)

Parameter Total students Mules

Body weight (kg) (xkstandard deviation) Body height (cm) (x $ standard deviation)

Nutritive status (% subjects) BMI > 18.5 18.5 < BMI < 25.0 25.0 < BMI < 30.0 BMI > 25.0 BMI > 30.0

Discussion

Meals offered to students at students' restaurants provide an adequate amount of energy, which is also seen when observing the grade for the quantity of foods offered. A high percentage of meals are well balanced. Eva- luation of meals offered to Croatian students at students' restaurants carried out in 1988 concluded that the meals were not adequate and unbalanced, meaning that improvement has occurred since then (ColiC & JurkoviC, 1988).

Many meals are high in protein and cholesterol and many meals contain little fruit and dairy products. That is because meals were planned to be of such a quality, since it is less convenient for students to ensure meals are high in protein, so such dishes were more emphasized. Fruit and dairy products were thought to be the most common choice for snacks so they were not on offer in high quantities, but a student can buy these foods in students' restaurants for 26% of the full price.

When comparing consumption frequencies of different foods according to gender, preferences toward high protein foods were observed in males and toward high carbohydrate foods (especially when choosing snack foods) in females. According to Fiirst (1994), the male identity is confirmed through what the man chooses to eat, whereas the female identity, to a larger extent, is defined by what she does not eat.

More frequent consumption of fast food and white bread among males and more frequent consumption of low-fat products and whole-grain products among females were also reported in US students (Huang

et al., 1994). A weight-control concern of young women is a possible explanation.

A question about beef consumption was included in the questionnaire because of high public interest in Bovine Spongiform Ence- phalopathy present in the period of data collection, although there were no reported cases in Croatia. In this study more females than males reported beef avoidance. Red meat avoidance has shown an increase, especially among young female consumers (Kubberard et al., 2002). More females than males followed a vegetarian or macrobiotic diet. A similar percentage of females but a lower percentage of males followed a vegetarian diet when compared with Spanish students (Soriano et al., 2000). More British female students than male students showed avoidance of meat (Santos & Booth, 1996). The consumption frequency of soy, which is usually viewed as a replacement for meat, differed significantly according to gender. One study showed that the sensory rate for soy nuts in female students was higher than in male students (Kandiah & Laird, 2002).

More females than males skipped meals. Skipping meals often results in missed nu- trients that are not made up at the next meal. The healthy habit of a regular breakfast was associated with a higher number of daily eating occasions and a higher number of hours of exercise. Skipping breakfast is more prevalent in Croatian students than in Croa- tian children and adolescents (ColiC BariC & SataliC, 2002). This decline could be ex- plained by the absence of parental monitoring.

Breakfast is the most frequently skipped meal by all age groups, and young adults are known skip this meal more often than other

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482 I. Colii. BaviC et al.

age groups, which was also observed in this study (Pao et a1 ., 1989).

A significantly higher number of meals in males and of snacks in females could mean a different perception of eating occasions among males and females, regarding meal size or actual difference in meal size as a consequence of higher energy needs in males.

It seems that consumption of foods that are regarded similarly (as healthy or as unhealthy) are clustered: fruit and vegetables, low-fat dairy products and whole grain products, fast food and carbonated soft drinks, fast food and beer or wine. This was also observed for smoking and alcohol consumption.

Daily consumers of fruit and vegetables were in a higher percentage of females than males. Among Spanish students, women were found to consume greater quantities of fruit and vegetables than men (Ortega et al., 1997).

The consumption frequency of the most common reported snack foods (fruit and milk and dairy products) did not correlate with the daily or weekly number of snacks, but significantly correlated with the number of daily snacks and consumption frequency of sweets and bars. This is probably because fruit or dairy foods are viewed as usual snack foods, but when actually choosing a snack food, sweets and bars have the advantage because of convenience and sweetness.

Exercisers compared with non-exercisers show better food attitudes and food choices (Georgiou et al., 1996). Associations among participation in physical activity and increased consumption of fruit and vegetables have been noted in research involving the general adult population (Simoes et al., 1995; Serdula et al., 1996). In this study, exercisers compared with non-exercisers en- joyed more regular meals.

The consumption frequencies of fruit and vegetables did not differ-significantly among exercisers and non-exercisers. The number of students engaged in exercise has increased when shown results that 36.1% of Croatian students exercised in 1990 (ColiC & JurkoviC, 1990). US female students are less likely than male students to participate in vigorous physical activity (Lowry et a1 ., 2000). Among

Eastern and Western European students, men are more likely to exercise regularly (Steptoe & Wardle, 2001). Similar results were observed in this study.

A total of 86.6% and 89.4% of Western Europe and Eastern Europe students, respectively, consume alcohol, and alcohol consumption is more prevalent among males than females, which is similar to findings from this study (Ortega et al., 1997; Steptoe & Wardle, 2001). Alcohol abuse in students is affected by social influences, which could explain the higher percentage of females than males who reported to consume alcohol only during weekends, which was the opposite to results that a higher percentage of males than females consumed alcohol (Sands et al., 1998).

A higher percentage of regular smokers was observed in this study when compared with Eastern European and Western Eur- opean students, and women were less likely to be regular smokers than men, which is opposite to this study's results (Steptoe & Wardle, 2001). Cigarette smoking is the most preventable cause of early death (US Depart- ment of Health and Human Services, 1989). Although smokers acknowledge the risk of the behaviour, they minimize the size of that risk and show a clear tendency to believe that the risk applies more to other smokers than to themselves (Weinstein, 1998). More than 90% of adult regular smokers in the US tried their first cigarette before the age of 20 years (US Department of Health and Human Services, 1994), which was also observed in this study.

While overweight and obesity appear to track from childhood into adulthood, overweight during late adolescence is most strongly associated with increased risk of overweight in adulthood (Guo et al., 1994). Persons consistently under-report their true weights by approximately 1 kg; however, correlations between reported weights and measured weights are typically quite high, ranging between r = 0.96 and r = 0.99 (Stun- kard & Albaum, 1981). Female students from this study had the same BMI (20.5 kg/ m2) when compared with results from study that included university students from 21 European countries, while Croatian male

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students had a higher BMI (23.5 kg/m2 versus 22.0 kg/m2) (Bellisle et al., 1995). The observation that a higher percentage of those underweight were female and a higher percentage of those overweight were males was also reported for Spanish students, and similar results were reported in the Croatian study from 1990 (ColiC & JurkoviC, 1990; Soriano et al., 2000). The percentage of overweight or obese students (BMI 2 25 kg/ m2) was lower when compared with US students (Lowry et al., 2000). Overweight students reported to exercise more than normal nourished students, which could be a consequence of intentional over-reporting because of social stigmatism of obesity, or a consequence of misclassification of non-obese persons as obese using only the BMI to determine the nutritional status.

This study showed some marked differences in dietary and other health-related behaviours among male and female univer-

sity students, and also clustering of some behaviours.

Corrections would be an increase in the consumption frequency of fruit and vegetables, and more regular consumption of breakfast. Education regarding benefits of regular physical activity, especially in females, and education regarding cigarette smoking health risks should be encouraged. Universities provide numerous opportunities to positively influence physical activity, nutrition, and weight management behaviours of large numbers of older adolescents and young adults in an educational setting. A nutrition education programme should be incorporated in the educational programme of students to improve their dietary habits.

Acknowledgements-This study was part of a project funded by the Ministry of Science and Technology, Republic of Croatia (number 068303).

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nutritive value of meals, dietary habits and nutritive status in croatian university students...

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