Diet Quality Associated with Risk of Non-communicable Diseases and Nutrient Inadequacy among Female University Students using the Global Diet Quality Score

Abstract

Background: Lebanon has been facing an increasing burden of non-communicable diseases (NCDs). Poor diet quality is a major driver of NCDs. The Global Diet Quality Score (GDQS) is a global measure of diet quality that is designed to be sensitive to diet-related outcomes associated with NCDs and nutrient inadequacy.

Objectives: This study aims to assess the diet quality of Lebanese female students at the American University of Beirut using the GDQS, determine the food groups that are driving a low GDQS score, explore drivers of consumption of these food groups, and assess changes in diet quality (GDQS) and food groups consumption that occurred over time.

Methods: This study was implemented in 2 phases. Phase 1 was a cross-sectional survey conducted among female students at the American University of Beirut (AUB). Three hundred Eighty-Four female students at AUB aged between 18-24 years were recruited. The sample size was determined using the World Health Organization (WHO) sample size calculator. Diet quality was assessed using the GDQS App, which is an electronic data collection tool developed by Intake to provide a standard, easy-to-use, low-cost, and time-relevant method for collecting data. A multi-component questionnaire which includes sociodemographic, lifestyle factors and drivers of consumption as well as self- reported anthropometric measurements was also collected from participants using face-to-face interviews. Phase 2 was a secondary analysis of dietary intake data stemming from the national nutrition survey carried out in Lebanon between 2008 and 2009. Data pertinent to Lebanese female adults aged 18-24 years were analyzed to determine the diet quality (GDQS) and investigate the changes in diet quality and food groups consumption overtime. The Statistical Package for the Social Sciences (SPSS; version 25) was used for all computations.

Results: In 2022, the mean total GDQS, GDQS+ and GDQS- scores of Lebanese AUB female students were 16.1±4.8, 7.0±3.7, and 9.1±2.9, respectively. Only 8.3% of the participants had a high GDQS score suggesting low risk of disease outcomes, whereas 48.4% had a moderate GDQS score suggesting moderate risk and 43.2% had a low GDQS score suggesting high risk for NCDs. Living at parental home, living in rural areas and high-intensity physical activity were associated with higher GDQS scores compared to living at student residence, living in urban areas and low and moderate-intensity physical activity. Low consumption of other fruits (fruits other than deep orange and citrus fruits), dark green leafy vegetables, legumes, deep orange tubers, nuts and seeds, whole grains, fish, and low-fat dairy and high consumption of processed meat, refined grains, sweets, sugar sweetened beverages, juice, white root tubers and purchased deep fried foods were shown as determinants of low GDQS score. Of the factors influencing consumption of the food groups taste was mostly reported as a predominant factor followed by past eating habits, availability, and cost. Compared to 2008/2009, the consumption of citrus fruits, dark green leafy vegetables and sugar sweetened beverages were lower in 2022 whereas the consumption of dairy, liquid oils, juice, cruciferous vegetables, poultry, white roots tubers and deep-fried foods were higher in 2022.

Conclusion: The study showed that in 2022, the majority of young Lebanese female AUB students have a low and moderate GDQS score suggesting high risk of NCDs. Low consumption of fruits, vegetables, legumes, deep orange tubers, nuts and seeds, whole grains, fish, low fat dairy and eggs and high consumption of processed meat, refined grains, sweets, sugar sweetened beverages, juice, white root tubers and purchased deep fried foods were major contributors to low GDQS score. This study also identified taste as most significant driver of consumption followed by past eating habits, availability and cost and showed that the diet quality among young Lebanese female adults has worsened over time. Interventions strategies to address such targeted poor dietary habits are needed to promote adherence of university students to healthy diets for mitigating the increase in NCDs in the country.