Dietary patterns in a group of medical students Maria Niţescu, Florentina Ligia Furtunescu, A. Streinu-Cercel, Marina Oţelea, Bucharest, Romania The 39th National Congress of the Romanian Society of Diabetes, Nutrition and Metabolic Diseases

OBJECTIVES To evaluate the dietary patterns and the metabolic syndrome prevalence in a population of medical students To assess the need of intervention in this population.

STUDY DESIGN 235 students, grade I to V, of the Faculty of Medicine in Bucharest were investigated during 2010-2011 Cross sectional study Enrollment criteria: subjects without known or treated diabetes and never treated with antihypertensive therapy Anthropometric and biological measurements were performed FFQ - Block Fat/Sugar/Fruit/Vegetable Screener self-administrated on-line Quantitative intake of nutrients was estimated based on the methodology developed by Nutrition Quest Statistical analysis were performed with the SPSS 17.0.

QUESTIONNAIRE DESCRIPTION The questionnaire included 40 questions regarding eating habits over the past year. For each type of food, subjects were asked to answer at 2 questions: “how many days/week on average do you eat that food” “how much on those days do you usually eat” Supplemental 15 questions investigated the preferred types of food such as: soft drinks, pastry, milk, sweets, processed meet, snacks (e.g. chips), margarine, cereal, bread in relation with their content in sugar, salt, fat or trans-fat E.g.” If you drink soft drinks, is it usually: Diet or sugar free Regular I don´t drink soft drinks”

RESULTS DEMOGRAPHIC DATA Age of subjects ranged from 19-30 years average of 21.82 years (standard deviation = 2.32, variation coefficient = 10.6%). Distribution by gender: There were 165 (70.2%) women and 70 men (29.8%).

RESULTS ANTROPOMETRIC PARAMETERS   Weight (kg) Height (cm) BMI (kg/m2) Waist circumference W M Average 57.61 72.46 165.44 179.51 21.04 22.46 83.58 86.30 St deviation 9.24 11.07 5.708 7.287 3.179 3.085 8.611 8.713 Maximum 98 120 183 197 37 38 117 130 Minimum 40 53 152 164 15 17 65 73

FREQUENCY OF DIAGNOSIS CRITERIA FOR METABOLIC SYNDROME BY GENDER

RESULTS SIGNIFICANT DIFFERENCES BETWEEN WOMEN AND MEN Distribution of waist circumference by gender

VALUES OF THE METABOLIC SYNDROME PARAMETERS IN WOMEN, depending on the value of waist circumference Measured parameter WC< 80 cm WC>80 cm average standard deviation BMI* (kg/m2) 19.12 1.94 22.12 3.24 Systolic blood pressure (mmHg) 108.88 10.64 108.35 9.03 Diastolic blood pressure (mmHg) 67.24 9.96 66.96 7.81 Fasting plasma glucose (mg/dl) 79.67 8.88 81.31 9 Triglycerides (mg/dl) 71.66 29.77 77.25 40.28 HDL* (mg/dl) 71.16 11.79 63.4 14.87

VALUES OF THE METABOLIC SYNDROME PARAMETERS IN MEN, depending on the value of waist circumference Measured parameter WC< 94 cm WC>94 cm average standard deviation BMI* (kg/m2) 21,7 2,248 26,37 4,075 Systolic blood pressure (mmHg) 117,2 10,686 119,6 10,113 Diastolic blood pressure (mmHg) 72,84 8,383 75,91 7,355 Fasting plasma glucose (mg/dl) 81,71 8,146 83,09 6,472 Triglycerides (mg/dl) 76,9 38,179 76,18 25,459 HDL* (mg/dl) 54,81 11,166 48,36 11,526

RESULTS Nutrient Content of the Diet – MEN Parameter Mean 95% CI for mean Median SD Min lower bound upper bound Saturated fat* 24.27 21.53 27.01 21.68 11.48 5 Trans fat* 6.4 5.41 7.4 5.83 4.158 1 Sugar* 112.2 98.8 125.58 113.89 56.16 27 Free sugar 78.46 65.4 91.51 66.37 54.77 Fruits 1.44 1.17 1.7 1.131 Veggies 1.33 1.12 1.54 1.24 0.876 Fruits and veggies 2.77 2.35 3.19 2.43 1.762 kcalories* 1828 1653.3 2002.2 1749.7 731.7 621 Proteins* 72.82 64.67 80.97 67.35 34.18 22 Total fat* 71.07 63.5 78.63 66.01 31.71 21 Carbohidrates* 223.2 202.05 244.32 214.3 88.64 68 Fibers 11.28 10.16 12.4 10.87 4.701 4

RESULTS Nutrient Content of the Diet – WOMEN Parameter Mean 95% CI for mean Median SD Min Max lower bound upper bound Saturated fat* 18.89 17.43 20.35 16.7 9.519 3 50 Trans fat* 5.42 4.74 6.11 4.27 4.437 23 Sugar* 93.55 84.69 102.4 77.98 57.61 15 362 Free sugar 66.21 56.84 73.59 49.56 54.48 4 355 Fruits 1.36 1.21 1.51 1 0.972 Veggies 1.35 1.2 1.5 1.09 0.969 5 Fruits and veggies 2.71 2.46 2.96 2.48 1.649 9 kcalories* 1442 1345 1540.2 1336.9 636.4 284 3504 Proteins* 54.82 50.93 58.71 50.23 25.3 11 158 Total fat* 55.77 51.62 59.93 49.27 27.03 149 Carbohidrates* 186 172.8 199.15 162.71 85.74 42 459 Fibers 10.42 9.64 11.2 9.21 5.057 34

RESULTS Analysis of nutrients related to chronic disease risk Gender Intake within the recommended limit Intake beyond the recommended limit No. of subjects % SFA Men 3 4% 67 96%   Women 5 3% 159 97% Trans fat 4 6% 66 94% 16 10% 148 90% Free sugar 21 30% 49 70% 115 Fruit and veggies 9 13% 61 87% 19 12% 146 88% Fibers 7% 65 93% 5% 155 95%

RESULTS SATURATED AND TRANS FAT INTAKE saturated fats represents: 12% of the total caloric contribution in our study. 97% of women and 96% of men have saturated fat intake above the threshold recommended by WHO. trans fats represents: 3% of the total caloric contribution of both genders 6% for men and 10% for women consume trans fat within the limits recommended by WHO.

RESULTS SUGAR INTAKE Free sugar represents: 17.22 % (women ) and 16.43% (men) respectively, from the total caloric contribution. 70% of the subjects have an intake of free sugar above the limit recommended by WHO

RESULTS FRUITS AND VEGETABLES INTAKE The average number of portions of vegetables and fruit consumed daily was: 2.71 for women 2.77 for men. Only 12.8% of the men and 11.5% of the women, consumed daily at least 5 portions of fruit and vegetables. Intake of fruit and vegetables < 5 portions /day was declared as regular dietary habit by: 77.2% of men 88.5% of women.

RESULTS FIBERS The average intake of fibers was: 11.28g/day for men 10.42 g/day for women. Only 7% of the men and 5% of the women consumed fibers in a sufficient quantity.

CONCLUSION Prevalence of diagnosis criteria for metabolic syndrome was relatively low in this group, except for waist circumference. Prevalence of metabolic syndrome was 1.28% (1.2% in women and 1.4% in men). Although the average caloric intake is in the normal range for age, sex and type of activity, more than 90% of medical students in this study have an unhealthy diet, with: high intake of saturated fat, trans fat, free sugar and low intake of fruits, vegetables and fibers.

CONCLUSIONS We conclude that young age of subjects from our study contribute to the low prevalence of metabolic syndrome, despite this unhealthy diet. The level of information and healthy diet behavior are expected to be lower in the general population. Doctors with healthy diet are more effective in promoting healthy diet to their patients. So, based on our results, we consider that the level of awareness, knowledge and behavior regarding nutrition inside the medical students community has to be improved. Our study highlights the need of a public health program in the nutrition field.