INFLUENCE OF DIETARY PATTERNS ON NUTRITIONAL STATUS

AMONG FEMALE STUDENTS IN MASENO UNIVERITY

BY

MOTURI MARK MOMANYI

PND/0007/2010

SHITOTE ALICE AKINYI

PND/0014/2010

A RESEARCH PROJECT REPORT IN PARTIAL FULFILLMENT OF REQUIREMENTS

FOR THE AWARD OF DEGREE IN BACHELOR OF SCIENCE IN NUTRITION AND

DIETETICS WITH IT OF MASENO UNIVERSITY

©2014

1

DECLARATION

I MOMANYI MARK MOTURI do declare that this project is my own and has never been

presented to any institution for any award.

Candidate

MOMANYI MARK MOTURI

PND/00007/2010

Signature: ……………………………… Date: ………………………………

I SHITOTE ALICE AKINYI do declare that this project is my own and has never been presented

to any institution for any award.

Candidate

SHITOTE ALICE AKINYI

PND/00014/2010

Signature: ……………………………… Date: ………………………………

Supervisor

DAVID OMONDI OKEYO (PhD)

School of Public Health and Community Development

Department of Nutrition and Health, Maseno University

Signature: ………………………………. Date: ……………………………….

2

Acknowledgement

We would like to thank the core technical advisor Dr. Okeyo David of Maseno University’s Head

of Department of Nutrition and Health for commendable hard work and technical expertise

towards the development of this report.

Finally we would like to express sincere gratitude towards all those who supported us all through

the research project to come up with this report.

3

MASENO UNIVERSITY

SCHOOL OF PUBLIC HEALTH AND COMMUNITY DEVELOPMENT

DEPARTMENT OF NUTRITION AND HEALTH

BACHELOR OF SCIENCE NUTRITION AND DIETETICS WITH INFORMATION TECHNOLOGY

INFLUENCE OF DIETARY PATTERNS ON NUTRITIONAL STATUS AMONG FEMALE STUDENTS IN

MASENO UNIVERITY

ABSTRACT

Life in the university involves both academic and social learning for students who are from different social,

economic and ethnical backgrounds hence a change of environment which can impact on personality,

attitudes and behavior of the students. This may be extended to the feeding habits and eventually to

nutritional status of the students Students may make poor choices which may affect their nutritional status

as they join university and this may continue throughout their campus life (Cruz, 2000; Isa & Masuri,

2011). University being a multicultural society, differences in foods habits is evident and this has been

influenced by factor like acculturation, students’ class schedules, peer pressure etc. In these situations, their

nutritional status can be impacted since one cannot tell if they are well nourished or not. Therefore the

purpose of this study was to establish the dietary patterns among female students and how it influences their

nutritional status in Maseno University. The study was conducted within Maseno University using a cross

sectional study design targeting female students residing within university hostels with a sample size of 74

female students using cluster random sampling procedure from a total estimate of 4600 female students.

Data collection tool was a self-structured questionnaire. Data analysis was done using descriptive and

inferential statistics. The results shows that 33.8% of respondents indicated that they took two meals per

day, 63.5% took three meals and 2.7% took four meals per day during the working day. While, during

weekends 1.4% took one meals per day, 23% took two meals, 62.2% took three meals, 12.2% took four

meals and 1.4% took five meals per day.Majority of respondents’ dietary intake were affected by lack of

money (47.3%), while lack of food items represented 35.1% while availability of fast foods had the least

effect with a representation of 17.6%. More than half of the respondents indicated that the foods available

do not meet their nutritional benefit.The established dietary patterns and nutritional status of female

students in Maseno university community was important as it can be used in designing and initiating

nutrition awareness programs to enlighten other students and entire community on nutrition, dietary patterns

and it influences on their nutrition status. Also it will be a base for further research on dietary patterns,

nutritional status or gaps of knowledge in this study in other universities within Kenya and entire world.

Candidate Signature Date

1. Moturi Mark Momanyi (PND/00007/2010) ------------------------- ---------------------------

2. Shitote Alice Akinyi (PND/00014/2010) ------------------------- ---------------------------

Supervisor Signature Date

Dr. Omondi David Okeyo (PhD) ------------------------- ---------------------------

School of Public Health and Community Development

Department of Nutrition and Health, Maseno University

4

Table of Contents ABSTRACT………………………………………………………………………………………………………………………………………………3

OPERATIONAL DEFINITION OF TERMS……………………………………………………………………………………………………6

ACRONYMS……………………………………………………………………………………………………………………………………………7

CHAPTER ONE: INTRODUCTION .......................................................................................................... 8

1.1 BACKGROUND STUDY .............................................................................................................. 8

1.2 PROBLEM STATEMENT ............................................................................................................. 9

1.3 STATEMENT OF OBJECTIVES ................................................................................................ 10

General objective ................................................................................................................................. 10

1.3.1 Specific objectives ................................................................................................................ 10

The specific objectives that guided the study were as follows; ............................................................. 10

1.4 RESEARCH QUESTIONS........................................................................................................... 10

1.5 SIGNIFICANCE OF THE STUDY .............................................................................................. 10

1.6 LIMITATIONS OF THE STUDY ................................................................................................ 11

1.7 ASSUMPTIONS OF THE STUDY .............................................................................................. 11

1.8 CONCEPTUAL FRAMEWORK ................................................................................................. 11

CHAPTER TWO: LITERATURE REVIEW ............................................................................................ 12

CHAPTER THREE: RESEARCH METHODOLOGY............................................................................. 17

3.0 INTRODUCTION ........................................................................................................................ 17

3.1 AREA OF STUDY ....................................................................................................................... 17

3.2 STUDY DESIGN .......................................................................................................................... 17

3.3 STUDY POPULATION ............................................................................................................... 17

3.3.1 Inclusion Criteria ................................................................................................................ 18

3.3.2 Exclusion Criteria ............................................................................................................... 18

3.4 SAMPLE SIZE DETERMINATION AND SAMPLING PROCEDURE ..................................... 18

3.5 DATA COLLECTION INSTRUMENTS .................................................................................... 19

3.5.1 Questionnaire ...................................................................................................................... 19

Anthropometric Assessment Tools ..................................................................................................... 19

3.6 DATA COLLECTION PROCESS ................................................................................................ 20

3.7 MEASUREMENT OF VARIABLES ............................................................................................ 20

Anthropometric measurements .......................................................................................................... 20

Dietary Pattern measurement ............................................................................................................. 20

3.8 DATA ANALYSIS ....................................................................................................................... 20

5

3.9 ETHICAL CONSIDERATION .................................................................................................... 20

3.10 Expected Outcomes ........................................................................................................................... 21

CHAPTER FOUR: RESULTS .......................................................................................................... 22

4.0 RESULTS ..................................................................................................................................... 22

CHAPTER FIVE: DISCUSSION ...................................................................................................... 26

CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS ..................................................... 28

REFERENCES .......................................................................................................................................... 29

APPENDIX I: RESEARCH CONSENT FORM ........................................................................... 31

APPENDIX II: STUDY QUESTIONNAIRE ................................................................................ 32

6

OPERATIONAL DEFINITION OF TERMS

Female student: An undergraduate student of age 18 years and above who reside within the

Maseno University institution hostels who consent to participate in the study.

Weight: weight will mean the weight of a female student in kilograms in Maseno University

during the period of study.

Age: Age of a female student in years in Maseno University during the period of study.

Height: Height of a female student in Centimeter in Maseno University during the period of study.

Nutritional status: Health status of a female student of age 18 years and above based on

underweight, overweight, normal weight or obese during the period of study.

Underweight: BMI (kg/m²) of a female student <18.5 during the period of study.

Normal weight: BMI (kg/m²) of a female student of between 18.5 and 24.9 during the period of

study.

Overweight: BMI (kg/m²) of a female student of >25.0 during the period of study.

Dietary pattern: This refers to the eating pattern, food preferences, food portion sizes and food

variety of female student in Maseno University during the period ofstudy.

Eating pattern: This refers to the number of meals taken per day and the spacing times of the

meals.

Food preferences: This refers tothe types of food the female student prefer in relation to the cost

or availability of food items.

Food portion sizes: This refers to the amount of food served in each of the food groups including

water intake as per the food guide pyramid.

Food variety: This refers to inclusion of different food groups at meal times.

7

ACRONYMS

WHO -World Health Organization

BMI - Body Mass Index

SPSS -Statistical package for social sciences

MUAC -Mid Upper Arm Circumference

Kg -Kilogram

cm -centimeter

m -meter

FIVIMS -Food Insecurity, Vulnerability Information and Mapping Systems Initiative

8

CHAPTER ONE: INTRODUCTION

1.1 BACKGROUND STUDY

Eating is vital in life and a major determinant of health hence important to study this subject from

its different perspectives. Most studies in eating and nutrition have focused on physiological

aspects, but if dissociated from their pertinent social environment, it is believed to produce only

limited knowledge and it is for this reason that cultural, psychological and social approach is

necessary. Different attitudes towards food may have an effect on overall health and contribute to

differences in non-communicable diseases (Rozin et al, 1991). Different dietary patterns can have

an effect on overall health since pleasure apparently acts as health promoters and worries can

adversely affect health. Social and psychological components of eating included in the concept of

eating attitude may be major health determinants. There is no difference associated to either race

or social condition among college students and the most important predictor is gender; women are

more concerned with eating, weight and health (Rozin et al, 1991.).

In some cases, a shift from a traditional eating pattern to a more Westernized diet has had some

undesirable effects on health status (Cruz 2000). Generally, there is a likelihood of an individual to

change his or her personality, attitude and behavior when introduced to a new environment. Food

habits which are shaped by culture, are dynamic and susceptible to changes brought about by

migration to a new environment. Dietary changes are related to length of exposure to a new

environment and extent of social contact with people of the new environment (Worthington-

Roberts & Wasiams 2000). The new environment has an impact on their personality, attitudes and

behavior hence their dietary habits (Papadaki et al 2007). From some of the studies conducted, the

causes of shift from the original food habits to adoption of the new food habits from their new

environment have not been taken to consideration.

In a case of a university in Zimbabwe, students make poor food choices due to lack of nutritional

knowledge and understanding of their dietary requirements. There was prevalence of physical

signs of malnutrition which indicated that the students were unhealthy and could impact negatively

on their academic performance (Manwa, 2013). In this study, it is also important to capture the

aspect of nutritional knowledge among students since it largely contributes to their dietary habits

9

and dietary requirements. Study conducted in Greece among university students to determine their

eating habits at or away from home, found that students living at home did not show major

changes in their eating habits since starting university. Students living away from family home had

made some negative changes. They decreased their weekly consumption of fresh fruits, cooked

and the raw vegetables, oily fish, sea foods, pulses and olive oil while they increased their sugar,

wine, alcohol and fast food intake. This implied that moving away from home and assuming

responsibility for food preparation and purchase for the first time affect dietary habits. (Manwa,

2013). However class schedules, food variety and physical activities for the students were not

looked into which can also influence dietary patterns.

Study on dietary intake and food pattern among university students in Spain found that the

university population consumed a diet with too much proteins and fats as compared to the Spanish

recommendations (Soriano et al, 2000). Therefore, more attention should focus on the energy and

nutrient intake for this population according to the recommended value.

Data on dietary patterns of university students is scant in Africa, especially Kenya. As a result, this

study was look into university students’ awareness of food choices, eating patterns and how they

influence students’ nutritional health. Due to various circumstances including change of

environment, cafeteria system, limited resources, busy class schedules, peer pressure and

availability of junk foods may compromise the diets of the female students. It is therefore

necessary to assess and evaluate their dietary patterns so as to establish if they are getting balanced

diet to meet their nutritional needs to reciprocate desirable health status.

1.2 PROBLEM STATEMENT

University life is a challenging period especially for students who have to leave their familiar

surroundings and settle in a new environment. The unfamiliar environment may have impact on

their personality, attitudes and behavior especially on their food choices which influences their

nutritional status. Dietary patterns of young adults has been widely studied and reported in the

literature as being associated with obesity, frequent snacking and meal skipping (Isa & Masuri

2011). Students may make poor choices which may affect their nutritional status as they begin

their university studies and this may continue throughout the university life. The issue of

continuity has been confirmed by previous researchers (Cruz, 2000; Isa & Masuri, 2011).

10

Maseno University comprises students from different parts of the country hence a heterogeneous

socio-economic and multicultural society. These differences either influence food habits due to

acculturation. From observation on daily routine of students such as busy class schedules, peer

pressure, some female students tend to buy fast foods from different food joints around the

university while others eat from university cafeteria as other can afford to cook in their hostels. In

these foods outlets same kind of foods are prepared daily therefore students tend to consume same

diet repeatedly and these denies them variety of choices. Some female students have reported to

skip meals in order to achieve and maintain their desired body size. In these circumstances, these

routines can have an impact on nutritional status since one can’t tell whether students are well

nourished and healthy or not. Therefore it was necessary to investigate their dietary patterns, assess

their nutritional status and how dietary patterns influence nutritional status.

1.3 STATEMENT OF OBJECTIVES

General objective

To investigate the nutritional awareness of food choices and eating patterns and how it affects the

nutritional status of female students of Maseno University.

1.3.1 Specific objectives

The specific objectives that guided the study were as follows;

1. To assess dietary patterns of the female students.

2. To assess the nutritional status of the female students.

3. To establish the relationship between dietary patterns and nutritional status among female

students.

1.4 RESEARCH QUESTIONS

a.) What are the dietary patterns of the female students?

b.) What is the nutritional status of the female students?

c.) What is the relationship between the dietary patterns and nutritional status among the female

students?

1.5 SIGNIFICANCE OF THE STUDY

Generally a healthy body is important in order to maintain a healthy mind especially in an

academic environment. Hence, the outcome of the study was to establish the dietary patterns and

11

nutritional status of the female students; this was to help the students know their status in regard to

nutrition and health. Results obtained was to be handy to students and sedentary workers employed

in the university to observe correct nutritional practices. To the university administration, student

body organization, university catering systems, catering systems around the university and

personnel involved in student welfare; this study was be important in planning the meals and study

schedules in relation to students’ nutritional and health needs. In addition the findings was to be

important for the nutrition and health department, nutrition students of Maseno University and

other learning institutions in designing and initiating nutrition awareness programs to enlighten

other students and entire community on nutrition, dietary patterns and it influences on their

nutrition and health state. On the other hand the study was to be a base for further research on

dietary patterns, nutritional status or gaps of knowledge in this study in other universities within

Kenya and entire world.

1.6 LIMITATIONS OF THE STUDY

a.) Students were likely to give incorrect responses regarding their dietary patterns

1.7 ASSUMPTIONS OF THE STUDY

a.) The respondents provided correct information regarding dietary patterns.

1.8 CONCEPTUAL FRAMEWORK

This study focused on the relationship between the dietary patterns and the nutritional status

among female students. From the FIVIMS nutritional status conceptual framework, poor

nutritional status results from a complex set of elements. In this study the modified form of the

conceptual framework was developed in the context of the study.

BACKGROUND FACTORS

Religion

Culture

Socio-economic

factor

Food Accessibility

Food Availability

Physical Activity

PROXIMAL FACTORS

DIETARY PATTERNS

Eating patterns

Food

preferences

Food portion

sizes

Food variety

OUTCOME

NUTRITIONAL STATUS

Anthropometric

assessment

Dietary assessment

12

Figure 1. Conceptual l framework showing the relationship dietary patterns and nutritional status.

CHAPTER TWO: LITERATURE REVIEW

Eating is vital in life and a major determinant of health hence important to study this subject from

its different perspectives. Most studies in eating and nutrition have focused on physiological

aspects, but if dissociated from their pertinent social environment, it is believed to produce only

limited knowledge it is for this reason that cultural, psychological and social approach is

necessary. Different attitudes towards food may have an effect on overall health and contribute to

differences in non-communicable diseases (Rozin et al, 1991).

2.1. Dietary patterns of students in university

Different dietary patterns can have an effect on overall health since pleasure apparently act as

health promoters and worries can adversely affect health. Social and psychological components of

eating included in the concept of eating attitude may be major health determinants. There is no

difference associated to either race or social condition among college students and the most

important predictor is gender; women are more concerned with eating, weight and health (Rozin et

al, 1991.).

A nutrition transition has been noticed characterized by a change from traditional eating patterns to

those typical of Western lifestyle. In some cases, a shift from a traditional eating pattern to a more

Westernized diet has had some undesirable effects on health status (Cruz 2000). Generally, there is

a likelihood of an individual to change his or her personality, attitude and behavior when

introduced to a new environment. Food habits which are shaped by culture, are dynamic and

susceptible to changes brought about by migration to a new environment. Dietary changes are

related to length of exposure to a new environment and extent of social contact with people of the

new environment (Worthington-Roberts & Wasiams 2000). The new environment has an impact

on their personality, attitudes and behavior hence their dietary habits (Papadaki et al 2007).

Dietary patterns of adolescents and young adults has been studied widely and reported in the

literature as being associated with obesity, frequent snacking and meal skipping particularly

breakfast (Isa & Masuri, 2011). Students may make poor food choices which may affect their

13

nutritional health status at the beginning of college and continue throughout their tertiary life. This

has been studied and confirmed by previous studies (Cruz 2000; Soriano, Molto & Manes 2000;

Papadaki & Scot 2002; Isa & Masuri 2011).

In Tamale metropolis Ghana, determination of the effect of dietary patterns on nutritional status of

upper primary school children revealed that the prevalence of underweight was relatively low

among participants (10%), 7% were at risk of overweight while 4% were overweight compared to

other developing countries. They also found that food consumed was basically from local staples,

variability was however lacking in the diet with low consumption of animal protein. The study also

revealed that most meals were eaten at home and parents mostly determined what is to be eaten at

each meal time. Among the participants snacking was frequent on those who are overweight and

those at risk of overweight than the underweight. Nutritional knowledge was found to be poor

among the participants. From the study therefore it is concluded that snacking is more likely to

influence respondents’ nutritional status. On the other hand, sedentary lifestyle may be implicated

for the prevalence of risk of becoming overweight or being overweight (Adamu Abida et al

2012).Therefore, as much as the snacking and sedentary lifestyle was reported to have an

implication on the nutritional status; the gender differences, study schedules and change of

environment of students are not highlighted in this study.

In a case of a university in Zimbabwe, students make poor food choices due to lack of nutritional

knowledge and understanding of their dietary requirements. There was prevalence of physical

signs of malnutrition which indicated that the students were unhealthy and could impact negatively

on their academic performance (Manwa ,2013). Study conducted in Greece among university

students to determine their eating habits at or away from home, found that students living at home

did not show major changes in their eating habits since starting university. Students living away

from family home had made some negative changes. They decreased their weekly consumption of

fresh fruits, cooked and the raw vegetables, oily fish, sea foods, pulses and olive oil while they

increased their sugar, wine, alcohol and fast food intake. This implied that moving away from

home and assuming responsibility for food preparation and purchase for the first time affect

dietary habits. (Manwa, 2013). However class schedules, food variety and physical activities for

the students were not looked into which also influence dietary patterns.

14

In differentiating between the effects of rapid dietary acculturation and the effect of living away

from home for the first time on the diets of Greek students in Glasgow revealed that they faced

difficulties in maintaining a traditional Mediterranean diet after leaving home especially for those

who moved to northern European environment (Kremmyda L.S et al 2007). This study focused

more on the shift from traditional Mediterranean diet rather than causes that led to the shift among

the students. In a study on the association of breakfast consumption habits, snacking behavior and

BMI among university students revealed that majority of the students reported a BMI in the health

range with overall 24% of the students reported to have not taken breakfast on the day of data

collection. These findings suggest that sex and healthy food frequency were significant associated

factors of BMI status (Isa & Masuri, 2011). There is need to carryout research to understand this

relationship in detail.

A study on social and psychological factors affecting eating habits among university students in a

Malaysian medical school found that more than half of the students had regular meals and

breakfast, majority of them consumed fruits less than three time a week while 51.5% had fried

foods twice or more a week and 59.8% drank water less than 2 litres daily. Eating habit score was

significantly low among younger students (18-22 years), smokers and alcohol drinkers. Most of the

students in this study had health eating habits. Therefore, social and psychological factors are

important determinants of eating habits among medical students (Kurubarun et al 2012).

Dietary intakes and eating patterns of students are of special interest because young adulthood is a

critical age of child bearing and sets the stage for lifestyles that influence later health. Dietary

patterns being based on food habits and beliefs is generally known that ethnic, religious, regional

and cultural factors influence the way people eat. Murcot (1998) posits that psychologists have

long been interested in dietary pattern and their determinants. The following factors were cited as

influencing dietary patterns; socio-economic factors, physical factors, psychological factors and

physiological factors.

2.2 Nutritional status of female students

To assess weight status, eating practices and nutritional knowledge amongst nursing students at the

University of Fort Hare, Eastern Cape a cross-sectional descriptive survey was conducted on 161

undergraduate (51 male and 110 female) students of the Department of Nursing Sciences at the

University of Fort Hare. Body mass index, waist and hip circumferences and waist hip ratio were

15

determined. Nutritional knowledge and eating practices were investigated by structured

interviewer-administered questionnaires. The study revealed statically that, 49.7% were

overweight or obese (58.2% of the females; 31.4% of the males) and 65.2% had waist

circumferences putting them at risk for non-communicable diseases. Most did not meet the

recommendations for intakes from the vegetable group (97.5% ate <3 servings per day), the fruit

group (42.2% ate <2 servings per day), and the dairy group (92.6% ate <2 servings per day); whilst

78.3% ate ≥4 serving per day of sugar or sweets. Most consumed margarine, oil or fat (68.3%),

sugar (59.0%) and bread (55.9%) daily, but few reported daily intakes of vegetables (12.4%), fruit

(23.6%), fruit juice (21.2%) and milk (15.6%). Fewer than 50% knew the recommended intakes

for vegetables, fruit, dairy, starchy foods and meat or meat alternatives. Hence, nursing students

had a high prevalence of overweight and obesity, poor eating habits and inadequate knowledge on

key nutrition issues, which may impact negatively on their efficacy as future health ambassadors to

the public ( Van den Berg VL, Okeyo AP, Dannhauser A,Nel M, 2012). However the environment

of study which impacts students live by acculturation, different study schedules, gender

differences, active lifestyle of students and factors that influence variety of food choices needs to

be addressed since they are likely to influence dietary patterns which can later have an impact of

nutritional status.

Recent evidence suggests that examining dietary patterns rather than specific nutrients may better

allow public health professionals to translate national dietary goals into practical dietary

recommendations that are culturally relevant and sex-specific (Delores CS James 2009).

According to Susan B Racette, Phd et al (2005), weight gain and behavioral patterns during college

may likely contribute to obesity in adulthood. This is revealed by the study where the aims were to

assess weight, exercise and dietary patterns of 764 college students (53% women, 47% men)

during their first year in college and during their sophomore year where by 29% of the students

reported not exercising, 70 % eating fewer than 5 fruits and vegetables daily while more than 50%

ate fried or high-fat fast foods at least thrice during the previous week of their first year of study.

Although 70% of the 290 students who were reassessed at the end of the sophomore year had

gained weight but with no apparent association with exercise or dietary patterns. Therefore the use

of BMI to classify college students as overweight does not prove to be appropriate, because BMI

does not differentiate between fat and fat-free masses. Hence, a likelihood that some of the

students in the sample whose BMI was in the overweight range were lean athletes with increased

16

muscle mass. Since body composition was not assessed, it is impossible to determine whether the

observed increases in body weight and BMI were a result of growth, muscular development, or

increases in adiposity. Also diet and exercise questionnaires used were not sensitive to small

increases in exercise or vegetable consumption by amounts that still do not meet the defined

criteria but that may be meaningful for health. Furthermore, the diet questionnaire asked about

behaviors during the previous week only, which may not have represented participants’ dietary

patterns throughout their life in college. Self-selection bias may have affected the outcome in the

study above. There is a possibility that students with very low or high body weights did not

volunteer, or that students who returned for follow-up assessments were those whose weight

increased the least, which may have biased the toward smaller weight gains. Therefore, this gaps

was require consideration in this study.

In a study determining the nutritional status of undergraduates in Nigerian university, 100

undergraduates aged 15-40 years were evaluated on their eating habits using a 7- day dietary recall

questionnaire, general information and anthropometric data. Also venous blood samples were

collected for biochemical tests of vitamin A and C, creatinine, zinc, iron and different blood

counts. The study revealed that number of meals and milk intake had no effect on the status of the

subjects. However, fruit intake positively affected neutrophil count; vegetable intake positively

affected Fe concentration and intake of nutritional supplements positively affected serum Zn

concentration. Also vitamin A concentration in both male and female students was low (O.B Adu

et al, 2009).

Study on dietary intake and food pattern among university students in Spain found that the

university population consumed a diet with too much proteins and fats as compared to the Spanish

recommendations (Soriano et al, 2000). Therefore, more attention should focus on the energy and

nutrient intake for this population according to the recommended value.

Data on dietary patterns of university students is scant in Africa, especially Kenya. As a result, this

study was to look into university students’ awareness of food choices, eating patterns and how they

influence students’ nutritional health. Due to various circumstances including change of

environment, cafeteria system, limited resources, busy schedules, peer pressure and availability of

junk foods may compromise the diets of the female students. It is therefore necessary to assess and

evaluate their dietary patterns so as to establish if they are getting balanced diet to meet their

nutritional needs and to ensure good health.

17

CHAPTER THREE: RESEARCH METHODOLOGY

3.0 INTRODUCTION

This section consists of the methods that were used in the research to accomplish the study

objectives. Included in this section are study area, study design, study population, sample size

and sampling procedures, data collection instruments, data collection procedures, measurements

of variables, data analysis, pilot study, and ethical consideration.

3.1 AREA OF STUDY

Maseno University is found in the Western Kenya region with its position coordinates at 0° 10' 0"

South, 34° 36' 0" East. The area has an Equatorial climate with fairly well distributed rainfall throughout

the year. Rainfall occurs mainly twice a year, that is, March to June (Long rains) and October to

November (short rains). The area precipitation ranges between 1750mm and 2000mm. The

temperature ranges between 14̊ C and 32̊ C with mean temperature of 23̊ C. The area has a good

road network with one major road passing within the area, that is, Kisumu-Busia road. The

university is divided into two sections, that is, Siriba Campus and College Campus. The main

market areas are Luanda and Maseno market with Emabungo and Nyawita shopping centres.

Maseno University has quite a large number of institutions around it including primary and

secondary schools, colleges, churches, mosques and health centre, court, police post among others.

This study was carried out in Maseno University because it consists of students from diverse

social, cultural, economic, religious and ethnic groups as well as being a population made of the

young generation who are highly susceptible to changes that are current in dietary patterns and

nutrition related conditions.

3.2 STUDY DESIGN

This study adopted cross-sectional design which included questionnaire development, quantitative

data collection and analysis.

3.3 STUDY POPULATION

This study had a study population consisting of female students whose place of residence are

within the Siriba and Main Campuses. The students were of different religious backgrounds with

the significant number being Christians followed by the Muslims. The students have their financial

sources from HELB loans, parents and/or guardians, sponsoring institutions and other minor

18

personal businesses conducted by some of the students. They were from the following ethnic

groups; Luhya, Luo, Gusii, Gikuyu, Aembu, and Akamba. The female students were

approximately 4590 students. They were from two main faculties which were the Arts and Science

Faculties.

3.3.1 Inclusion Criteria

The study population included female undergraduate students who reside within the Maseno

University female hostels, take different courses offered by the university, from different religious,

cultural, social and economic groups.

3.3.2 Exclusion Criteria

The study excluded all female undergraduate staying outside Maseno University hostels.

3.4 SAMPLE SIZE DETERMINATION AND SAMPLING PROCEDURE

A sample size was determined as follows from a listing of members from specified hostels. To

determine the sample size the following formulae was used:

n = Z2P(1-P) ÷ (D)2

Where:

n= the required sample size

Z = 1.645(for 90% level of confidence)

P = 50% (so as to get the highest sample size)

D = Level of confidence Limit (10%).

Therefore the sample size was be:

n= (1.645) 2*0.5*(1-0.5) ÷ (0.1) 2

= 67. 65 ͌ 68

Ss/ {1+ (ss-1)/population}

68/ {1+ (68-1)/4600} = 67

10% of 67 to cater for non-respondents =6.7= 7

Sample for the study was be 67+7= 74 female students

19

Cluster random sampling technique was be used in the sample selection. Hitchcock and Hunges

(1995) suggest that cluster random sampling is more convenient when the population is very large

hence fair distribution of the subjects.

On selection of the respondents, the clusters were equivalent to hostels and all legible respondents

randomly selected proportionate to population size of a hostel using the following formula;

N= n/ {1+ (n-1)/ hostel population}

Where N= sample from each hostel

3.5 DATA COLLECTION INSTRUMENTS

3.5.1 Questionnaire

Demographic and Dietary Pattern Questionnaire

It consisted of three sections, that is: demographic characteristics information; eating pattern, food

choice and preference section. Demographic information having age, faculty, religion, hostel of

residence and ethnic group information taken within this section. Dietary pattern information

sections had aspects of food availability, meal patterns, planning meals and food groups consumed

was captured.

3.5.2 Nutritional status assessment tools

Anthropometric Assessment Tools

This was done at the anthropometric assessment section of the questionnaire which included

measurement of students’ height, Mid-Upper Arm circumference as well as taking weight

measures.

Calibrated Weighing Scalewas used to measure the weight of the students in kilograms.

Calibrated Height rod was used to measure the height of the students to the nearest centimeter.

MUAC Tape was a non-stretchable tape that was used to measure the mid upper arm

circumference (to the nearest centimeter) of the students on their left upper arms(for right handed

students and vice-versa).

20

3.6 DATA COLLECTION PROCESS

Data from respondents collected using a questionnaire. The respondents were well briefed on

how to answer the questionnaires and fill them after which their anthropometric measurements

were obtained.

3.7 MEASUREMENT OF VARIABLES

Anthropometric measurements

The data collection instrument used was a self-structured questionnaire.

The variables that were measured included nutritional status which was measured as weight-for-

height (BMI) as well as the MUAC. The anthropometric measurements was computed and

recorded for each respondent in relation to the WHO BMI and MUAC standards for adults (2006).

Dietary Pattern measurement

The main questionnaire obtained data on meal pattern, food choices and preferences. The

demographic factors was also obtained using the same questionnaire.

3.8 DATA ANALYSIS

Data was collected, arranged, and analyzed as quantitative. The quantitative data was coded and

entered in the Statistical Package for Social Sciences (SPSS) and analyzed using descriptive

statistics, mainly measures of central tendency. Inferential statistics, which tries to make deduction

on population parameters based on the available sampled population was used to compute the

degree of association between dietary patterns and nutritional status.

Data presentation was done by use of tables, charts and graphs.

3.9 ETHICAL CONSIDERATION

Permission was sought from the Maseno University Nutrition and Health Department. Ethical

clearance was sought from Maseno University Ethical Review Committee. Informed verbal and

written consent was obtained from the female students who were involved in the study before

21

proceeding with the interview. Confidentiality was maintained in all the aspects of the research and

participation in the research was voluntary with participants allowed to drop from the study

without explanation whatsoever. Data quality was maintained.

3.10 Expected Outcomes

The dietary patterns and nutritional status of female students in Maseno University was identified.

The nutritional status of female students was also measured and the relationship between the

dietary patterns and nutritional status wasdetermined.

22

CHAPTER FOUR: RESULTS

4.0 RESULTS

Demographic characteristics of respondents

Of the 74 respondents, twenty-three (23) were second years, twenty- two (22) were third years and

twenty-nine(29) were fourth years, thus comprising 31%, 29.7% and 39.2% respectively. This

indicated there was a good representation as per students’ year of study.. Majority of the

respondents of age twenty-one (21 years) representing a 32.4% of all the female respondents.

Twenty-eight point four(28.4%) of the respondents represented the school of education which had

the highest number while school of computing and informatics and school of mathematics and

applied statistics had the least number with bothbeing represented by 2.7% of the respondents. In

all of the respondents majority were identified to be Christians a representation of 97.3 % while the

Muslims and traditional religion both had a representation of 1.4 % in all the female respondents

interviewed. On the ethnic groups of respondents the Luo community had the highest number

followed by Luhya community represented by 39.2% and 16.2%respectively.

Eating pattern and food choice

33.8% of respondents indicated that they took two meals per day, 63.5% took three meals and

2.7% took four meals per day during the working day. While, during weekends 1.4% took one

meals per day, 23% took two meals, 62.2% took three meals, 12.2% took four meals and 1.4%

took five meals per day. The results show that a larger number of respondents took three meals per

day during the week and during weekends. These findings indicate that most female students did

not get the recommended daily meals. The data shows that most female students have time to eat

during the evening (85.1% ) and they also try to have something in the morning represented by

more than have of respondents taking breakfast before classes (58.1%). Most of the respondents

indicated to be taking 1-3 glasses of water representing 54.1% of the female students thus

indicating inadequate consumption, as the ideal of 6-8 glasses had only 18.9% of respondents

represented. Only 35.1% of the respondents had access to their favorite meals of which 23.0%

favoured traditional foods, 16.2% fast foods, 1.4% snacks and 6.8% exotic foods. The findings

indicate that 64.9% of the respondents could not access their favourite meals frequently. On their

opinion towards the price of their favourite meals a larger percentage of respondents (74.3%)

23

indicated that the foods are relatively expensive, while very expensive, cheap represented by 23%

and 2.7% respectively. The results show that only 21.6% of the respondents planned their meals in

advance. While, the majority did not plan their meals in advance represented by 78.4%.

The results indicate that a very large number of female students consider balanced diet when

making food choices represented by 33.8%. However, cost of food (24.3%), favorite (23.0%) and

foods available for purchase (18.9%) are other factor which are considered by the respondents as

shown in fig.1

The results shows that majority of respondents’ dietary intake were affected by lack of money

(47.3%), while lack of food items represented 35.1% while availability of fast foods had the least

effect with a representation of 17.6% as shown in fig 2. Morethan half of the respondents indicated

that the foods available do not meet their nutritional benefit

Fig.1. Factors considered in making food choices

1817

25

14

0

5

10

15

20

25

30

cost of food fovorite meals balanced diet foods available forpurchase

24

Fig 2. What affects food intake

The relationship between dietary pattern and nutritional status.

Inference of nutritional status based on BMI * Number of meals taken a day during the working day (Monday-Friday) * Took breakfast before

daily classes

Cross tabulation

Count

Took breakfast before daily classes

Number of meals takenin a day during the working

day(Monday-Friday)

Total two three four

yes Inference of nutritional status based

on BMI

Underweight 1 2 0 3

Normal weight 12 18 0 30

overweight 2 7 1 10

Total 15 27 1 43

no Inference of nutritional status based

on BMI

Underweight 1 1 0 2

Normal weight 7 15 1 23

overweight 2 4 0 6

Total 10 20 1 31

Total Inference of nutritional status based

on BMI

Underweight 2 3 0 5

Normal weight 19 33 1 53

overweight 4 11 1 16

Total 25 47 2 74

47%

35%

18%

WHAT MAINLY AFFECTS YOUR FOOD INTAKE?

lack of money lack of food items availability of fast foods

25

Chi-Square Tests

Do you take breakfast before your

daily classes? Value df Asymp. Sig. (2-sided)

yes Pearson Chi-Square 4.289a 4 .368

Likelihood Ratio 4.010 4 .405

N of Valid Cases 43

no Pearson Chi-Square .640b 4 .958

Likelihood Ratio .867 4 .929

N of Valid Cases 31

Total Pearson Chi-Square 1.592c 4 .810

Likelihood Ratio 1.570 4 .814

N of Valid Cases 74

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .07.

b. 7 cells (77.8%) have expected count less than 5. The minimum expected count is .06.

c. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .14.

From the cross tabulation above it is observed majority of those who took breakfast and managed

to achieve three meals in a day had a normal weight. However on doing a chi-square test to check

for the significance of breakfast in affecting nutritional status, the significance value of the test was

more than 0.05 hence not conclusive evidence of a relationship between taking breakfast and

nutritional status.

26

CHAPTER FIVE: DISCUSSION

5.0 DISCUSSION OF FINDINGS

Demographic Characteristics of Respondents

Findings indicate that Majority of the respondents of age twenty-one (21 years) representing a

32.4% of all the female respondents. . In all of the respondents majority were identified to be

Christians a representation of 97.3 % while the Muslims and traditional religion both had a

representation of 1.4 % in all the female respondents interviewed. On the ethnic groups of

respondents the Luo community had the highest number followed by Luhya community

represented by 39.2% and 16.2%respectively.Findings from the respondents profile also indicated

that some were affected by religious and ethnical beliefs on their food choices.

Eating Pattern and Food choice

The results indicate that a larger number of respondents took two meals per day during the week

and three meals per day during weekends. These findings indicate that most students did not get

their daily nutrient requirements as it is recommended to take at least three meals a day so as to get

adequate nutrients. Wardlow and Insel (2000) affirm that it is difficult to meet daily nutrient needs

in two meals only.

The findings regarding favourite meals indicate that more than half of the respondents could not

get their favourite meals frequently. Austin et al (2004) and Hegarty (1995) state that lack of

favourite meals means non-enjoyment of meals which may compromise nutrient intake. Those

who got their favourite meals were those who favoured traditional meals, which they could get

easily and these meals were cheaper but lacked variety and most of the dishes do not supply

adequate nutrients. On the question of planning meals in advance, the findings indicate that the

majority of the students did not plan their meals in advance. Worthington-Roberts and Williams

(2000) and Bennion (1994) state that it is very important to plan meals in advance so as to take

note of the dietary needs and the recommended daily allowances. The results indicate that a very

large number of students consider the cost of food and almost three quarters, also, consider their

favourite foods. This may mean those with less money may have compromised nutrient intake

while those with a lot of money to spent on food may resort to fast foods. Papadaki et al (2007) in

their research found out that most students who have a lot to spend on food, take junk meals and

snack on junk snacks leading to obesity. Results also showed that slightly more than half of them

27

did not consider having a balanced diet or nutritional value of foods so they just took what was

available thus indicating poor nutritional practices. Findings regarding what students considered

when deciding what to eat revealed that more than half did not consider to take balanced meals

again indicating that they may lack some nutrients in their daily intakes specially the

micronutrients which are mostly provided in the fruits and vegetables.(Papadaki et al, 2007;

Murcott, 1998 and Cruz, 2000). The results show that the majority of respondents were affected by

lack of money and more than half were affected by lack of food items. Lack of money may lead to

missed meals and intake of low nutritional value foods. The findings also established that most

students had their diets restricted by scarcity which may be an indication of poor nutrient intakes.

Three–quarters of them were not affected by the availability of fast food meaning they did not

know the problems they may face due to taking fast food (Kinton et al, 2000 and Papadaki et al,

2007).

The data shows that most students had time to eat during the evening and they also tried to have

something in the morning. This means that most students may not meet their daily nutrient

requirement as it is argued by Papadaki et al, (2007) and Kremmyda, Papadaki, Hondrus,

Kapsokefalou and Scott (2007) that it is very difficult to meet daily nutrient needs in one or two

meals. Most nutritionists recommend five to six meals per day to ensure adequate nutrient intake

(American Dietetic Association, 2004; Cruz, 2000).

Most students had something to eat nearly every meal but most of the meals were not nutritionally

adequate. The breakfasts were particularly very poor, which indicates that most of the students do

not get enough daily nutrients. This is supported by Bennion (1994) who concludes that if

someone misses a breakfast, lunch and supper could not meet their daily calories.

The results indicate that students lacked some nutrients as their diets had limited variety.

Kinton et al (2000) and Wardlow and Insel (2000) posit that having limited food choices may lead

to lack of some essential nutrients.

28

CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS

6.1 CONCLUSION

Nutrition education is also an aspect that is lacking among the students as evidenced by the meal

skipping especially breakfast, ensuring nutrient adequacy to meet their daily energy requirements.

The findings indicate that most students do not get their daily nutrient requirements as it is

recommended to take at least three meals a day nutrient adequacy.Most of the students did not

consider having a balanced diet or nutritional value of foods so they just took what was available

thus indicating poor nutritional practices.From the results and discussion, it is evident that the

female students are not keen on their meal intake as much as their class schedules are also

important. From the results, it can be concluded that the dietary patterns have an attributes on the

nutritional status.

6.2 RECOMMENDATIONS

1. Nutrition education on appropriate nutritional practices should be provided to the students

and the institution administration in order for required nutrition practices in the institution

to be implemented.

2. Primary Health care workers in educational institutions should educate students on their

nutritional needs and how it affects their nutritional status.

3. Asurvey should be carried out on the same topic and include the use of 24 hour recall or

food frequency questionnaire tools for diet intake data collection in assessing dietary

patterns.

4. Catering departments in the institution should ensure variety in their daily food supplies to

meet nutritional needs of their clients.

5. The administration should plan the class schedules in consideration to meal times as it will

help in ensuring adequate time during meals for adequate meal intake among students.

29

REFERENCES

1. Cruz Amorim, J. (2000). Dietary habits and Nutritional Status of Adolescents over Europe-

Southern Europe. Eur. J. Clin. Nutr., 54: (Suppl 1) S29-S35. MEDLINE

2. Food and Nutrition Bulletin Vol. 05:02, www.un.edu/

3. Food and Nutrition Bulletin Vol. 16:05, www.un.edu/

4. Hitchock, G. & Hughes, D. (1995). 2nd Edition. Research and the Teacher: A Qualitative

Introduction to School Based Research. Great Britain: Routledge.

5. Isa, K. A. M. & Masuri, M. G. (2011). The Association of Breakfast Consumption Habit,

Snacking Behaviour and body mass Index among University Students. American Journal of

Food and Nutrition. 1 (2) pp55-60

6. Kremmyda, L. S., Papadaki, A., Hondrus, G., Kapsokefalou, M. and Scott, J. A. (2007).

Differentiating Between the Effect of Rapid Dietary Acculturation and the Effects of Living

Away from Home for the First Time, on the Diets of Greek Students Studying in Glasgrow.

Appetite 49 (1) pp 169-176.

7. Leedy, P.D. (1989). Practical Research Planning and Design. New York: McMillan. Murcott,

A. (1998). The Nation’s Diet: The Social Science of Food Choice U.K.: Addison Wesley

Longman Ltd.

8. Papadaki, A and Scott, J A (2002).The impact on eating habits of temporary translocation

from a Mediterranean to a Northern European environment European Journal of Clinical

Nutrition 56, 455-461.

9. Papadaki, A., Hondros, G., Scott, J. A. and Kapsokefalou, M. (2007). Eating habits of

University students living at, or away from home in Greece Appetite Volume 49, Issue 1 pp

169-176

10. Schickednaz, J.A. Schickednaz, D. I. Hansen, K. &Forsyth, P.D. (1993) Understanding

Children. 2nd Ed London: Mayfield Publishing Company.

11. Soriano, J. M., Moltó, J. C. & Mañes, J. 2000, Dietary Intake and Food Pattern Among

University Students Nutrition Research, Volume 20, Issue 9, Pages 1249-1258., The

American Ditetic Association.

12. The Manual of Clinical Dietetics (1992). The American Dietetic Association 4th Edition.

30

13. Lokadhia Manwa (2013). University Students’ Dietary Patterns: A Case of auniverity in

Zimbabwe: Journal of Emerging Trends in Educational Research and Policy Studies

(JETERAPS) 4(1):191-197 (ISSN:2141-6990)

14. Rozin, P., Fischler, C., Imada, S. & Wrzesniewski, A. 1999. Attitudes to food and the role

of food in life in the U.S.A, Japan, Flemish, Belgium and France: Possible implications for

the diet-health debate. Appetite. 33:163-180

31

APPENDIX I: RESEARCH CONSENT FORM

Name of Researcher(s)

MOTURI MARK MOMANYI( PND/00007/010) AND SHITOTE ALICE AKINYI

(PND/00014/010)

Title of study

INFLUENCE OF DIETARY PATTERNS ON NUTRITIONAL STATUS AMONG

FEMALE STUDENTS IN MASENO UNIVERITY

Please read and complete this form carefully. If you are willing to participate in this study,

ring the appropriate responses and sign and date the declaration at the end. If you do not

understand anything and would like more information, please ask.

I have had the research satisfactorily explained to me in verbal and / or written form by the

researcher.

I understand that the research was involve: giving information about dietary patterns using

questionnaire(s) and oral interview on food intake as well as physical body measures.

I understand that I may withdraw from this study at any time without having to give an

explanation.

I understand that all information about me was be treated as confidential and that I was not

be named in any written work arising from this study.

I understand that I was not be compensated for giving information in this study.

I understand that you was be discussing the progress of your research with others at Maseno

University.

I therefore freely give my consent to participate in this research study.

RESEACHER

Signature: …………………………………………………………………….………….

Date: ………………………………………………………………………………………

RESPONDENT

Signature: …………………………………………………………………….………….

Date: ………………………………………………………………………………………

32

APPENDIX II: STUDY QUESTIONNAIRE

SEC

TIO

N I:

DE

MOGRAPHIC INFORMATION

Age: ______ years.

Religion: 1) Christian 2) Muslim 3) Traditional 4) Other (specify)______

Hostel of residence:

Ethnic community:

SECTION II: ANTHROPOMETRIC DATA

Weight_____ kg Height _____ cm BMI______ (Kg/m2

Inference of nutritional status based on BMI (Kg/m²)

a) Normal weight BMI=18.5-24.9 (b) underweight BMI<18.5 (c) overweight. BMI>25

MUAC____ cm

SECTION III: DIETARY PATTERN

1) Eating pattern

a.) Averagely, how many meals do you take on a day during the working days (Monday to

Friday)?

1) One 2) Two 3) Three 4) Four 5) Five 6) Six

b.) Averagely, how many meals do you take on a day during the weekends (Saturday and

Sunday)?

1) One 2) Two 3) Three 4) Four 5) Five 6) Six

c.) At what time do you have adequate time for eating on a day?

1) Morning 2) Mid-day 4) Evening 5) All of the above

d.) Do you take breakfast before your daily classes?

TITLE OF STUDY INFLUENCE OF DIETARY PATTERN ON NUTRITIONAL

STATUS OF FEMALE STUDENTS

AREA OF STUDY MASENO UNIVERSITY (MAIN CAMPUS)

RESPONDENT’S NAME

YEAR OF STUDY

FACULTY

DATE

INTERVIEWER

33

1) Yes 2) No

e) What is your average daily water intake?

1) 1-3 glasses 2) 4-6 glasses 3) 6-8 glasses 4) More than 8 glasses

2) Food choice pattern

a) Do you access your favorite meals frequently?

1`) Yes 2) No

b) If yes what do your favorite meal consist of?

1) Traditional foods 2) fast foods 3) Snacks 4) Exotic foods

c) What can you comment about the prices of your favorite meals?

1) Cheap 2) Relatively expensive) 3) Very expensive

d) In your daily diet, how often do you consume foods from this food groups?

1-daily, 2- weekly, 3- occasionally, 4- never

Indicate 1, 2, 3 or 4 against the foods below

1) Cereals & whole grains 2) Vegetables

3) Fruits 4) Proteins

5) Fats

e) What do you consider when making food choices?

1) Cost of food 2) Favorite meals 3) Balanced diet 4) Foods available for purchase

f) What mainly affects your food intake?

1) Lack of money 2) Lack of food items 3) Availability of fast foods

g) Do you plan your meals in advance?

1) Yes 2) No

h) Do you feel that variety of foods provided are for your nutritional benefit

1) Yes 2) No