Association between Eating Behavior and Academic

Journal of the American College of Nutrition

ISSN: 0731-5724 (Print) 1541-1087 (Online) Journal homepage: http://www.tandfonline.com/loi/uacn20

Association between Eating Behavior and Academic Performance in University Students Macarena Valladares PhD, Elizabeth Durán, Alexis Matheus, Samuel DuránAgüero PhD, Ana María Obregón PhD & Rodrigo Ramírez-Tagle PhD To cite this article: Macarena Valladares PhD, Elizabeth Durán, Alexis Matheus, Samuel Durán-Agüero PhD, Ana María Obregón PhD & Rodrigo Ramírez-Tagle PhD (2016): Association between Eating Behavior and Academic Performance in University Students, Journal of the American College of Nutrition, DOI: 10.1080/07315724.2016.1157526 To link to this article: http://dx.doi.org/10.1080/07315724.2016.1157526

Published online: 13 Oct 2016.

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Date: 14 October 2016, At: 06:35

Original Research

Association between Eating Behavior and Academic Performance in University Students Macarena Valladares, PhD, Elizabeth Dur
an, Alexis Matheus, Samuel Dur
an-Ag€ uero, PhD, Ana Mar
ıa Obreg
on, PhD, Rodrigo Ram
ırez-Tagle, PhD Unidad de Salud del Observatorio Regional de Paz y Seguridad (ORPAS) (M.V.), and Programa de Mag
ıster en Ciencias Qu
ımicas y Biol
ogicas (E.D.), Departamento de Ciencias Pedag
ogicas (A.M.), Direcci
on de Investigaci
on (R.R.-T.), Universidad Bernardo O’Higgins, Santiago, CHILE; Carrera de Nutrici
on y Diet
etica, Facultad de Ciencias de la Salud, Universidad San Sebastian, CHILE (A.M., S.D.-A.) Key words: eating behavior, university students, academic performance, healthy nutritional habits Objective: To determine the association between academic performance and eating behavior in university students in Chile. Methods: A total of 680 college students, 409 (60%) women and 271 (40%) men, were randomly recruited and the mean age of the entire sample was 26. The Three-Factor Eating Questionnaire (TFEQ), which evaluates 3 dimensions of eating behavior—cognitive restriction (limiting own intake), uncontrolled eating (inclination to eat), and emotional eating (control of food intake in the context of negative emotions)—was used. Academic performance was measured by the grade point average (GPA) and was associated with eating behavior. Results: Women had significantly higher scores in the “emotional eating” dimension than men (p D 0.002). The eating behavior analysis showed that female students with higher GPAs (above 5.5) had statistically significantly lower uncontrolled eating scores (p D 0.03) and higher cognitive restriction scores (p D 0.05) than women with lower academic performance (below 5.5). There were no significant associations between eating behavior and academic performance in men. Conclusions: A positive association between eating behavior and academic performance was observed in female university students in Chile. Further studies are needed to explore the causes of this association and determine how to improve the nutritional habits of this population.

INTRODUCTION

adjusting for sociodemographic characteristics and negative health behaviors [4–7]. During this university stage, students are exposed to many unhealthy food options, including foods high in saturated fat and refined sugar, which may be detrimental to cognitive processing [8,9]. The main factors affecting whether individuals adopt healthy or unhealthy nutritional habits include their opinions and perceptions of their own bodies, as well as genetic factors, lifestyle choices, environmental factors, and other habits, all of which have known interdependent effects [10]. Within the category of nutritional habits, one influential variable is eating behavior, a set of actions establishing the relationship of humans with food [11], which includes drinking habits, selection of food consumed, culinary preparations, and quantity of food consumed. Eating behavior is affected by food

University is a time when students experience lifestyle changes and a stressful transition that may influence academic performance, which is related to professional success and even influences future educational attainment and income [1]. Many factors are associated with cognitive processes and effective study habits and, therefore, with academic performance among university students, such as stress, social distractions, and psychological state (e.g., the presence of anxiety and depression) [2,3]. Within this context, subjects’ health, especially nutritional habits, seems to function as significant predictors of cognitive processes and academic performance. Thus, university students who adhere to public health nutritional recommendations have modestly higher grade point averages (GPAs) after

Address correspondence to: Macarena Vallardes, Unidad de Salud del Observatorio Regional de Paz y Seguridad (ORPAS), Universidad Bernardo O’Higgins, General Gana 1702, Santiago, CHILE. E-mail: [email protected]

Journal of the American College of Nutrition, Vol. 0, No. 0, 1–5 (2016) Ó American College of Nutrition Published by Taylor & Francis Group, LLC 1

Eating Behavior and Academic Performance availability, food preferences, portion size, cultural values, family beliefs, and food styles, which are factors that are strongly conditioned by learned experiences [12]. Eating behavior is grouped into sets of behaviors called dimensions, wherein each dimension characterizes a specific feature related to food [12]. The dependence of eating behavior on environmental factors is quite important. For example, a positive correlation between problematic Internet use and eating attitudes in university students has recently been observed [10]. Despite the importance of nutritional habits and academic performance, as well as easy access to unhealthy foods during this stage, few studies have evaluated the relationship between academic performance and eating behavior in university students. Based on the evidence presented, the objective of this work is to examine the association between academic performance and eating behavior in Chilean university students.

circumstances and the difficulty of stopping this intake; higher scores indicate constant food intake during the day. Finally, EE evaluates the inability to control food intake in the context of negative emotions; higher scores indicate that persons in difficult emotional situations tend to eat more food. Higher CR scores and lower UE and EE scores indicate healthy eating behaviors [13,14]. A standardized score was calculated for each dimension as the average of the summed individual raw scores divided by the number of items in each subscale. The scores are presented as the average § SD. The TFEQ showed acceptable reliability, with an internal consistency higher than 0.6, measured by Cronbach’s alpha. The following values were obtained for to each dimension: CR: 0.71, UE: 0.83, and EE: 0.76. These scores indicate moderate to strong reliability of the instrument, according to reports by Bland and Altman [15].

Analysis of Academic Performance

METHODS Participants and Study Design The study sample included 680 students, 409 (60%) women and 271 (40%) men, enrolled at the Bernardo O’Higgins University in Chile. In this cross-sectional study with voluntary participation, eating behavior was evaluated through a questionnaire that was randomly distributed to students and administered by the authors. The responses were associated with GPA. Before starting the study, students were informed about the aim of the study and the questionnaire. This research was conducted in accordance with the Declaration of Helsinki, and the Ethics Committee of the University of Bernardo O’Higgins approved the study protocol.

Eating Behavior The Three-Factor Eating Questionnaire (TFEQ) is a psychometric questionnaire used to determine eating behavior. The 18-question TFEQ [13] was adapted for use in this study; it includes 19 questions, has been validated for use in the Chilean population [14], and has been used by our group in various studies. The TFEQ evaluates 3 dimensions of eating behavior: cognitive restriction (CR, 6 questions), uncontrolled eating (UE, 10 questions), and emotional eating (EE, 3 questions). The responses are measured on a Likert scale ranging from 1 (completely true) to 4 (completely false). CR measures the tendency to limit one’s own intake (either the quantity or the type of food) to control body weight; higher scores indicate greater restriction of food consumption. UE measures both the inclination to eat with exposure to external stimuli in different

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Academic performance was determined by the students’ GPA at the time the questionnaire was fielded (January 2015). In Chile, grades are assigned on a scale from 1.0 to 7.0. To analyze their association with eating behavior, GPAs were divided into 2 groups using 5.5 as the cutoff; that is, the lower GPA group ranged from 1.0 to 5.4, and the higher GPA group ranged from 5.5 to 7.0. This cutoff was selected because at the Bernardo O’Higgins University, a GPA of 5.5 exempts a student from final exams and qualifies a student to participate as a class assistant and to apply for academic scholarships. Therefore, this cutoff is considered a marker of good academic performance.

Data Collection The authors reviewed each questionnaire, and the scores were added to a database organized by dimension. These data were subsequently analyzed. Additionally, grades were obtained from a university database for all students.

Statistical Analysis The students’ ages, GPAs, and 3 eating behavior dimension scores are expressed as mean § SD. Because eating behavior scores are abnormally distributed, a nonparametric MannWhitney test was used to compare eating behavior between groups. Differences by sex (women vs men) and GPA (below 5.5 vs above 5.5) were examined. A significance level of 0.05 was used; therefore, p values less than 0.05 were considered statistically significant. All statistical analyses were performed using STATA 13.0.

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Eating Behavior and Academic Performance Table 1. General Characteristics of Study Sample

Age Faculty GPA Uncontrolled eating Cognitive restriction Emotional eating

Table 3. GPA According to the Eating Behavior Dimensions in Men

Women (n D 409)

Men (n D 271)

Mean § SD

Mean § SD

24.8 § 4.9 67.24% assist to Health Faculty 4.98 § 0.68 2.34 § 0.47 2.52 § 0.51 2.21 § 0.86*

26.8 § 6.4 49.08% assist to Health Faculty 5.07 § 0.63 2.37 § 0.53 2.47 § 0.48 1.99 § 0.93

GPA D grade point average. *p D 0.002.

RESULTS Eating Behavior Scores for Women and Men The main characteristics of the sample are presented in Table 1, which shows that the average participant age is 24 and 26 for women and men, respectively, although one subject is 58 years old. Women had significantly higher scores on the EE dimension (p D 0.002) than men; however, significant difference between women and men were not observed by age or GPA or along the UE and CR dimensions.

Association between Eating Behavior Scores and Academic Performance The association between eating behavior scores and academic performance was evaluated by classifying each student’s GPA as high (above 5.5) or low (below 5.5). The associations between the GPA category and each of the 3 eating behavior dimensions were then evaluated by gender. Women with higher GPAs (above 5.5) have lower UE scores than women with GPAs below 5.5 (p D 0.03; Table 2), indicating that women with better academic performance exhibit greater ability to control their food intake. Regarding the other 2 dimensions of eating behavior, the analysis showed that women with higher GPAs (above 5.5) had higher CR scores than women with lower academic performance (p D 0.05; Table 2), showing, in accordance Table 2. GPA According to the Eating Behavior Dimensions in Women

Uncontrolled eating Cognitive restriction Emotional eating

Below 5.5

Above 5.5

Mean § SD

Mean § SD

p Value

2.37 2.43 2.24

2.26 2.55 2.14

0.03* 0.05* 0.32

GPA D grade point average. *Significant difference.

JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION

Uncontrolled eating Cognitive restriction Emotional eating

Below 5.5

Above 5.5

Mean § SD

Mean § SD

P Value

2.38 2.45 2.01

2.35 2.52 1.92

0.52 0.32 0.41

GPA D grade point average.

with the preceding result, that women with better academic performance exhibit greater ability to control their food intake. Finally, we found no significant differences in the third eating behavior, EE, by academic performance, as measured through GPA. Among men, higher CR score were observed in the group with higher GPAs (Table 3), which is consistent with the findings for women. Students with better academic performance exhibit eating behaviors relating to control over the amount and type of food consumed. However, the difference was not statistically significant (p D 0.3) in men.

DISCUSSION The main objective of this study was to determine the association between eating behavior and academic performance. To the best of our knowledge, this is the first study to evaluate the association between eating behavior and academic performance in any student population, including university students, because most studies published on healthy dietary habits have examined the effects of breakfast on academic performance mainly in children and adolescents [16,17]. In this study, we found that women had higher EE scores than men; this finding aligns with those of Horstmann et al., which suggested that a central nervous system mechanism might explain this difference, independent of age and body mass index (BMI) but dependent on genetics [18]. We did not measure the genetic component, a variable that may influence eating behavior and thus the results of this study; this component would be interesting to consider in future studies. Though some studies have found that women have higher GPAs [4,8,19], we found no gender differences in GPA, probably because those studies considered other variables associated with academic performance in university students, such as compromise and self-esteem, that we did not examine. In relation to the objective of the study, we found that women with higher GPAs (above 5.5) had lower UE scores. This dimension captures the inclination to eat due to external stimuli in various circumstances and difficulties with stopping eating and is related to disinhibition behavior [11]. Several studies have shown that higher UE scores are strongly associated with

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Eating Behavior and Academic Performance higher BMI when obese persons present with memory impairment and are therefore more vulnerable to problems with executive function than persons of normal weight [20,21], which is concordant with our results. Additionally, our results are related to those of Maayan et al. [22] wherein obese adolescents exhibited higher disinhibition scores, lower performance on cognitive tests, and lower orbitofrontal cortex volume. Therefore, behavioral disinhibition may be related to BMI, which then causes a decline in academic performance. This study also shows that women with higher GPAs are associated with higher CR scores, suggesting that students with higher grades have healthier nutritional habits, because this dimension captures the tendency to limit their food intake (in terms of either quantity or type) to control body weight [11]. This dimension is also related to the disinhibition domain of eating behavior [23]; therefore, it is consistent with the previously established fact that higher UE and lower CR show disinhibition related to food and may generate an unhealthy intake of food [20]. This pattern relates directly to our study because higher disinhibition scores are associated with higher BMIs and, therefore, with disturbances in cognitive processes [20,24] that may be reflected in academic performance. These results are also aligned with previous studies that have shown a direct association between healthy diets and better academic performance in school-aged and university students [8,23,25,26]. Considering the dimensions of eating behavior measured in this study, it is possible that the association with academic performance may occur through the regulation of certain psychological factors that are associated with academic performance. For example, self-esteem directly influences BMI, and other anthropometric variables are conditioned by eating behavior [24,27]. It is also possible that the association between eating behavior and low academic performance reflects differences in the brain that increase behavioral disinhibition. Despite our observations in women, we observed no statistically significant relation between the eating behavior dimensions evaluated and academic performance in men. Eating behavior is heterogeneous and determined by genetic, sociocultural, psychological, and socioeconomic factors, among other [28] variables that were not measured in this study, which could be important in this group. Other studies have also found differences in eating behavior by sex, some of which also used the TFEQ, indicating that the eating behaviors of women and men may be regulated differently in some aspects [29–31]. Likewise, this study shows a relation in women but not in men. In future studies, it would be interesting to relate obesity parameters, such as BMI or fat percentage, with academic performance in our sample. It would also be interesting to associate the variables measured in this study (eating behaviors and academic performance) with genetic parameters and sociocultural factors.

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CONCLUSION This study showed a negative association between the UE dimension and higher GPAs in women, as well as a positive association between CR dimension and the same GPA variable in university students in Chile. However, further studies are needed to explore the causes of this association. It would be interesting to investigate genetic and sociocultural causes that link academic performance (cognitive factors), eating behavior, and BMI using a larger sample. This is especially relevant considering the high prevalence of obesity and related pathologies in our society; universities could be important places for generating knowledge about this issue.

ACKNOWLEDGMENT The authors are grateful to the Director of Information Technology at the Bernardo O’Higgins University for collaborating in the process of selecting and contacting students.

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