The Effects of Dietary patterns on Hedonic Hunger in University Students

doi:10.21203/rs.3.rs-3224642/v1

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The Effects of Dietary patterns on Hedonic Hunger in University Students

https://doi.org/10.21203/rs.3.rs-3224642/v1

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This study was conducted to examine the effect of the Dietary patterns on hedonic hunger. This descriptive, cross-sectional study included 617 university students. The Study data was obtained through a web-based survey form. The survey form includes individuals’ socio-demographic characteristics, anthropometric measurements, Mediterranean Diet Quality Scale (KIDMED), Mediterranean Diet Adherence Scale (MEDAS), and Power of Food Scale (PFS). 503 women and 114 men have participated in the study. The sub-scale score average for food availability in Overweight/obese individuals was found to be significantly higher than that of underweight individuals (p < 0.05). A statistically significant negative correlation was observed at a low level between MEDAS scores and PFS total scores (r=-0.081, p = 0.045), as well as with food availability (r=-0.111, p = 0.006), and food presentation (r=-0.088, p = 0.028). However, no statistically significant relationship was found between food tasting sub-scale scores (p > 0.05). The results of this study reveal the existence of a low level of negative correlation between hedonic hunger and adherence to the Mediterranean diet. Further extensive research is needed concerning individuals residing in diverse geographic locations to gain deeper insights into this subject matter.

Health sciences/Diseases/Nutrition disorders/Obesity

Health sciences/Diseases/Nutrition disorders

Obesity is a growing problem worldwide and a significant risk factor for non-communicable diseases [1]. Obesity fundamentally arises as a manifestation of a positive energy balance, where in the caloric intake from food and beverages surpasses the energy expenditure [2]. Homeostatic and non-homeostatic mechanisms represent crucial processes responsible for initiating, regulating, and terminating eating behavior [3]. Homeostatic mechanisms are based on physiological processes that maintain energy balance in the absence of food consumption, These mechanisms achieve this by either reducing energy expenditure or augmenting nutrient intake. Non-homeostatic mechanisms, on the other hand, are processes that lead to food consumption due to reasons such as emotional comfort or the rewarding properties of food [4]. The main element capable of meeting an organism’s energy requirements is the intake of nutrients. But for some individuals, nutrition has evolved into much more than merely fulfilling metabolic needs [5,6]. Nowadays, nutrition is seen by many individuals as a coping mechanism for dealing with negative situations or emotions, or as a rewarding method [7]. The consumption of food driven by the desire or urge for pleasure, in the absence of physiological hunger, is referred to as “hedonic hunger” [8]. General thoughts about food, the individual’s desire for consumption of food they can directly access, and the evaluation of the pleasure derived from the first taste of food can determine a person’s susceptibility to hedonic hunger [9]. Hedonic eating motives are guided by the components of “liking,” which reflect the hedonic reaction to pleasure, and “wanting,” which represents the incentive motivation [8]. The components of “liking” and “wanting” for rewards are associated with distinct neuroanatomical and neurochemical brain reward systems [10,11]. The hedonic effect of processed foods, especially those high in fat and sugar content, is regulated by the µ-opioid system [12]. It has been reported that individuals at risk of hedonic hunger consume more fatty foods, sweets, and unhealthy snacks [13–15]. It is known that opioid µ-agonists increase food consumption by enhancing the hedonic properties of food [16]. While some studies could not find a relationship between hedonic hunger and body mass index (BMI) [17,18], Recent studies have reported that obese individuals are more at risk in terms of hedonic hunger compared to individuals with normal body weight [19–22].

Nowadays, as a result of easy access to high-energy and highly delicious foods, individuals’ diets have shifted from the Mediterranean diet model to the Western-style diet. It is well known that university students, in particular, show lower adherence to the Mediterranean diet, characterized by high fat and sugar intake and low consumption of fruits, vegetables, and legumes [23]. The Mediterranean diet encourages the consumption of primarily unprocessed foods, including vegetables, fruits, whole grains, legumes, nuts, beans, fish, and olive oil, while limiting the intake of red meat and dairy products [24]. The Mediterranean diet, which plays a crucial role in preventing obesity and non-communicable chronic diseases, has been reported to reduce the risk of stress, anxiety, and depression [25–29]. It is argued that due to negative moods such as stress and anxiety, individuals with a lower adherence to the Mediterranean diet tend to have higher levels of food consumption [30–32]. It is known that emotions are significant factors affecting food choices. Individuals with depressive symptoms tend to consume foods that are particularly high in fat and sugar content [33]. The excessive consumption of such foods has been found to be associated with poor diet quality and increased body weight [34]. It is suggested that individuals with high hedonic hunger lose their eating control during the consumption of such foods [35]. It has been reported that there is a positive association between the consumption of unhealthy food and beverage intake and hedonic hunger [13,15,36]. In this regard, the aim of this study is to examine the impact of university students’ dietary patterns on hedonic hunger.

This descriptive, cross-sectional study was conducted with 617 individuals (18.5% male, 81.5% female, mean age 22.14 ± 4.31 years) who agreed to participate. The study data were collected from university students living in Erzurum between April 2023 and May 2023. The sample selection was made randomly. The study data were obtained through a web-based survey form. The participant was sent the URL of the study form, and after agreeing to participate, the study form was opened. In the survey form, individuals’ socio-demographic characteristics, anthropometric measurements, Mediterranean Diet Quality Scale (KIDMED), Mediterranean Diet Adherence Scale (MEDAS), and Power of Food Scale (PFS) are included. "Ethics Committee Approval" was received from Erzurum Technical University Ethics Committee (Meeting Number: 04, Decision Number: 05, 30 March 2023) in order to carry out this research. The research was carried out in accordance with the Declaration of Helsinki. Informed consent have been obtained from all participants.

Mediterranean Diet Quality Scale (KIDMED)

In this study, the Turkish version of the KIDMED (Mediterranean Diet Quality Index) was used to assess adherence to the Mediterranean diet in evaluating the Mediterranean-type dietary pattern. The Mediterranean diet quality scale was developed by Serra-Majem et al [37]. The validity and reliability study in Turkey was conducted by Şahingöz et al [38]. The scale consists of 16 questions. In the original scale scoring, items 6, 12, 14, and 16 are scored as -1 when completed, while the remaining 12 items are scored as + 1. Based on this, the evaluation of scores from the control list results in obtaining a low level of 3 or below, a moderate level between 4 and 7, and a high level at 8 points or above. It is reported that as the score increases, there will be a higher adherence to the optimal Mediterranean diet [38].

Mediterranean Diet Adherence Scale (MEDAS)

In the PREDIMED study, Martínez-González MA et al. used the 14-item Mediterranean Diet Adaptation Scale to assess adherence to Mediterranean dietary habits for primary prevention of cardiovascular disease. [40]. The validity of the questionnaire form was later assessed by Schröder H et al [41]. The Mediterranean Diet Adherence Scale includes questions related to individuals’ daily consumption of olive oil, their primary fat source, consumption of red meat and margarine/butter, portions of fruits and vegetables, preference for white meat over red meat, and weekly intake of olive oil-based tomato sauce, pasta, snacks, fish-seafood, nuts, legumes, and wine. The total score is calculated by assigning 0 or 1 point for each question based on the consumption level. A total score of 9 and above indicates a strict adherence to the Mediterranean diet, and an acceptable degree of adherence to the Mediterranean diet is 7 and above [42]. This scale is utilized to ascertain whether an individual possesses a Mediterranean-style dietary pattern.

Power of Food Scale (PFS)

In this study, the Turkish version of the Power of Food Scale (PFS) was used to assess hedonic hunger and measure appetite status. The Power of Food Scale was developed by Lowe et al. [44], validity and reliability study was also conducted in Turkey [9]. The scale consists of 13 questions. Four scores are obtained, including three subscale scores and one total scale score. The evaluation of PFS consists of a total score and three sub-evaluations: food availability, food presentation, and food tasting. The first one is the food availability scale, which evaluates general thoughts about foods (items 1, 2, 9, 10). The second one is the food presentation subscale, which consists of items (3, 4, 5, and 6) assessing attraction to food that the individual has direct access to. The third subscale is the food tasting subscale, consisting of items (7, 8, 11, 12, and 13) that evaluate the desire/pleasure obtained from foods when tasted for the first time. The total and subscale scores of PFS are obtained by summing the item scores and dividing by the number of items. It is reported that as the score increases, there will be a higher tendency towards hedonic hunger [44].

Statistical Evaluation of Data

The statistical evaluation of the data obtained from the study was performed using SPSS version 22 software. The normal distribution suitability of the variables was examined through visual (histograms and probability plots) and analytical methods (Kolmogorov-Smirnov/Shapiro-Wilk tests). Qualitative variables were summarized as number (n) and percentage (%), while quantitative variables were summarized as mean and standard deviation (X̅±SD). The pairwise group comparisons for quantitative variables were evaluated using the t-test in independent groups, and one-way analysis of variance for more than 2 group comparisons (Tukey HSD post hoc test was used to determine the source of differences when the analysis was significant). The comparison of group distributions for categorical variables was analyzed using Pearson’s chi-square test and Fisher’s exact test. Pearson correlation analysis was used in relational inferences. Statistical significance was evaluated as p < 0.05.

The study was completed with a total of 617 students, and the general characteristics of the individuals are provided in Table 1. The mean age of individuals is 22.14 ± 4.31 years, with 18.5% being male and 81.5% being female. Moreover, 92.7% of them are single. Among the participants, 20.9% of individuals are cigarette smokers, and 11.8% consume alcohol. According to BMI classification, 10.5% of individuals are underweight, 69.5% are normal weight, and 19.9% are Overweight/obese. The mean scores of the individuals’ KIDMED, MEDAS, PFS total scores, and sub-scales of food availability, food presentation, and food tasting, respectively, are 4.17 ± 2.47, 4.98 ± 1.48, 2.97 ± 1.11, 2.81 ± 1.19, 2.95 ± 1.16, and 3.11 ± 1.22. According to the KIDMED classification, 49.3% of individuals have low Adherence, 50.7% have moderate Adherence; according to the MEDAS classification, 86.5% of individuals are in the low adherence group, 11.7% are in the moderate adherence group, and 1.8% are in the high adherence group.

Table 1

General Characteristics of Participants (n: 617)
Sex, n(%)
Women	503 (81.5)
Men	114 (18.5)
marital status, n(%)
Single	572 (92.7)
Married	45 (7.3)
Smoking Status, n(%)
Consumption	129 (20.9)
No consumption	488 (79.1)
Alcohol Consumption Status, n(%)
Consumption	73 (11.8)
No consumption	544 (88.2)
Age (year), X̅±SS	22.14 ± 4.31
Body mass index (BMI) (kg/m²), X̅±SS	22.46 ± 4.27
Number of Meals, X̅±SS	3.18 ± 1.16
Body Mass Index (BMI) Groups, n(%)
Underweight (< 18.5)	65 (10.5)
Normal weight (18.5–24.9)	429 (69.5)
Overweight/Obese (≥ 25.0)	123 (19.9)
Mediterranean Diet Quality Scale (KIDMED)
Total Score, X̅±SS	4.17 ± 2.47
Low adherence, n(%)	304 (49.3)
Moderate adherence, n(%)	313 (50.7)
Mediterranean Diet Adherence Scale (MEDAS)
Total Score, X̅±SS	4.98 ± 1.48
low adherence, n(%)	534 (86.5)
Moderate adherence, n(%)	72 (11.7)
High adherence, n(%)	11 (1.8)
Power of Food Scale (PFS)
Total Score, X̅±SS	2.97 ± 1.11
Food available, X̅±SS	2.81 ± 1.19
Food present, X̅±SS	2.95 ± 1.16
Food tasted, X̅±SS	3.11 ± 1.22

The total and subscale scores of the PFS for individuals participating in the study, based on their BMI Groups, are presented in Table 2. When comparing the PFS total and subscale mean scores among different BMI groups, there were no statistically significant differences in terms of PFS total, food presentation, and food tasting subscale scores (p > 0.05). However, there was a statistically significant difference in the food availability subscale score (p < 0.05) among the groups. The mean score of the food availability scale of Overweight/Obese individuals (2.99 ± 1.26) was approximately 0.49 points higher than the mean score of Underweight individuals (2.50 ± 1.11) (p = 0.018).

Table 2

PFS scores according to participants’ BMI groups
	BMI groups
	Underweight X̅ ±SS	Normal weight X̅ ±SS	Overweight/Obese X̅ ±SS	p
PFS Total	2.80 ± 1.06	2.97 ± 1.11	3.07 ± 1.14	0.304
food available	2.50 ± 1.11^α	2.80 ± 1.16	2.99 ± 1.26 ^β	0.025^*
food present	2.78 ± 1.08	2.94 ± 1.16	3.11 ± 1.20	0.157
food tasted	3.07 ± 1.29	3.12 ± 1.22	3.10 ± 1.18	0.951

*p < 0.05, Data were evaluated by One-Way Analysis of Variance.

^αβ Values shown with different letters on the same row are statistically different from each other (Tukey HSD test was applied).

There was no statistically significant difference between underweight, normal weight and Overweight/Obese individuals based on BMI classification in terms of adherence to the Mediterranean diet according to KIDMED and MEDAS (p > 0.05) (Table 3).

Table 3

The distribution of participants according to BMI groups for KIDMED and MEDAS groups.
	BMI groups
	Underweight n (%)		Normal weight n (%)		Overweight/Obese n (%)			p
KIDMED
Low adherence	33 (50.8)			209 (48.7)			62 (50.4)			0.917^α
Moderate adherence	32 (49.2)			220 (51.3)			61 (49.6)
MEDAS
Low adherence	54 (83.1)	371 (86.5)				109 (88.6)			0.232^β
Moderate adherence	11 (16.9)	51 (11.9)				10 (8.1)
High adherence	0 (0,0)	7 (1.6)				4 (3.3)

^α Pearson’s chi-square test, ^βFisher’s exact test were applied.

The scores of KIDMED, MEDAS, and the total and subscale scores of PFS based on individuals' sex are provided in Table 4. There was no statistically significant difference between women and men in terms of the mean KIDMED and MEDAS scores, as well as the total and subscale mean scores of PFS (p > 0.05).

Tablo 4. The scores of KIDMED, MEDAS, and PFS according to sex.

	Sex
	Woman X̅ ±SS	Man X̅ ±SS	p
KIDMED	4.22 ± 2.47	3.93 ± 2.47	0.260
MEDAS	4.98 ± 1.53	4.96 ± 1.28	0.876
PFS total	2.98 ± 1.13	2.90 ± 1.04	0.493
Food available	2.83 ± 1.19	2.72 ± 1.13	0.381
Food present	2.96 ± 1.18	2.92 ± 1.08	0.756
Food tasted	3.13 ± 1.24	3.04 ± 1.12	0.479

The t-test was applied to independent groups.

PFS total and subscale scores in the Mediterranean diet adherence groups according to KIDMED are given in Table 5. There was no statistically significant difference in terms of the mean total and subscale scores of PFS between the groups with low and moderate adherence to the Mediterranean diet (p > 0.05).

Table 5

The PFS scores according to KIDMED groups
	Mediterranean Diet Quality Scale
	low adherence X̅ ±SS	moderate adherence X̅ ±SS	p
PFS total	2.98 ± 1.13	2.96 ± 1.10	0.832
Food available	2.80 ± 1.20	2.82 ± 1.16	0.733
Food present	2.98 ± 1.16	2.93 ± 1.17	0.651
Food tasted	3.13 ± 1.25	3.09 ± 1.19	0.673

The t-test was applied to independent groups.

The relationship between individuals' KIDMED and MEDAS scores with PFS total and subscale scores is provided in Table 6. There is no statistically significant relationship between individuals' KIDMED scores and PFS total and subscale scores (p > 0.05). There is a low-level statistically significant negative correlation between MEDAS scores and PFS total (r=-0.081, p = 0.045), food available (r=-0.111, p = 0.006), and food present (r=-0.088, p = 0.028) subscale scores. However, there is no statistically significant relationship between MEDAS scores and the subscale score for food tasted (p > 0.05).

Table 6. The relationship between KIDMED and MEDAS scores with PFS scores

	Mediterranean Diet Quality Scale		Mediterranean Diet Adherence Scale
PFS total	r	-0.051	r	-0.081*
	p	0.202	p	0.045
Food available	r	-0.057	r	-0.111**
	p	0.158	p	0.006
Food present	r	-0.070	r	-0.088*
	p	0.081	p	0.028
Food tasted	r	-0.024	r	-0.038
	p	0.549	p	0.340
p < 0.05 *p < 0.01, r: Correlation coefficient, Pearson correlation analysis was applied

This study is the first evaluation of the relationship between hedonic hunger status and adherence to the Mediterranean diet among university students. As a result of the study, it was observed that the sub-scale scores of the food availability, in which general thoughts about food were evaluated, were higher in overweight/obese individuals than in underweight individuals. A low-level negative correlation was found between individuals' hedonic hunger status and adherence to the Mediterranean diet.

It is stated that appetite and eating behavior are not solely controlled by energy needs, but also hedonic/reward brain systems play a significant role in obesity. In today's modern environment, which is filled with high-energy, high-sugar, and high-fat foods, especially young people are prompted to consume such foods for reasons like reducing negative emotions and thoughts, seeking pleasure, and feeling better. (35). Although there is no homeostatic need, the increased consumption of these foods can lead to significant changes in energy intake and give rise to hedonic hunger. This situation provides a partial explanation for the increase in obesity prevalence by disrupting body weight balance in the long term (45). However, studies investigating the relationship between hedonic hunger and BMI show inconsistent results (35). While some studies show a positive relationship between hedonic hunger and BMI (19, 22, 46), Another cross-sectional study with adolescents as the sample showed that higher BMI values were associated with lower hedonic hunger (14). Furthermore, some studies have reported no correlation between hedonic hunger and BMI (17, 18). Besides studies that have correlated the total score of the power of food scale with BMI, there are also studies showing associations between some of the subscales of the scale and BMI. In this study, it was found that the food availability subscale score was higher in overweight/obese individuals compared to underweight individuals, and this result supported the findings of the study conducted by Lipsky et al. with young adults (18). Similarly, Ribeiro et al. Reported that a one-unit increase in the food availability scale score doubled the likelihood of being obese (47). Chmurzynska et al. Showed that the food presentation subscale score had a positive correlation with BMI, while the food tasting subscale score had a negative correlation with BMI, and this finding could explain the inconsistent results regarding the correlations between BMI and hedonic hunger (20). The evaluation of the relationship between hedonic hunger and sex is based on several foundations. It is stated that brain signals and hormones, which are effective in regulating energy intake and body weight, may vary according to sex. Neurological analyzes have shown that women have more sensitive neural responses than men to visual perceptions of delicious foods that stimulate hedonic hunger (48). In this regard, In a study aimed at determining the factors influencing hedonic hunger in adults, it was found that hedonic hunger levels were higher in women than in men (6). In another study, only the food presentation subscale score was found to be higher in women than in men (22). In this study, no difference was found between men and women in terms of power of food scale scores.

The relationship between the Mediterranean diet, which is an effective dietary pattern for reducing the risk of obesity and other non-communicable diseases, has been studied in numerous researches. A recent meta-analysis of cohort studies examined the relationship between adherence to the Mediterranean diet and the risk of overweight or obesity. The analysis showed that higher adherence to the Mediterranean diet was significantly associated with a 9% reduction in the risk of overweight and/or obesity. (49). However, similar to another study conducted with university students, a significant relationship between BMI and adherence to the Mediterranean diet was not found in this study. (30). This situation can be attributed to various factors other than nutrition in the etiology of obesity, such as genetics, physical activity habits, and more. An intervention study aimed at assessing the effectiveness of a two-year intervention based on the Mediterranean diet for the treatment of overweight and obesity on psychological health showed that the experimental group received educational sessions, personalized diet therapy based on the Mediterranean diet, and a physical activity program, while the control group received written instructions on the Mediterranean diet. The study results indicated that the experimental group exhibited significant reductions in body weight, fat mass, BMI, and waist circumference. Additionally, it was observed that depression levels decreased in the experimental group at the end of the intervention (50). In studies conducted with university students, it was found that a lower adherence to the Mediterranean diet was associated with higher levels of negative emotions such as stress and anxiety, and higher adherence to the Mediterranean diet reduced the risk of depression by approximately 50% (29, 51). It is stated that hedonic food consumption in university students arises as a response to various emotional states or as a way to suppress these emotional states. Additionally, it is mentioned that unlike the Mediterranean dietary model, there is an increasing prevalence of the Western-style diet, which involves consuming foods with low nutritional value and high energy, fat, and sugar content. (22, 23). In line with this, in this study examining the relationship between adherence to the Mediterranean diet and hedonic hunger, a low-level negative correlation was found between adherence to the Mediterranean diet and hedonic hunger status. Similarly, in some studies conducted with adolescents, it has been shown that there is a positive relationship between hedonic hunger and consumption of unhealthy foods such as fast food and processed foods rich in added sugars and saturated fats, which do not reflect the Mediterranean dietary pattern (13, 15, 36).

This study does have some limitations. Firstly, the fact that all participants included in the research were university students studying in Erzurum province may have led to the lack of a strong relationship between adherence to the Mediterranean diet and hedonic hunger, as they might have similar dietary habits. Secondly, height and body weight data were obtained based on the individuals' self-reports. This situation could be the reason for the lack of a relationship between BMI and hedonic hunger and adherence to the Mediterranean diet, due to potential inaccuracies in individuals' self-reports. Despite all these limitations, the significance of this study is heightened by being the first research into the relationship between hedonic hunger and the Mediterranean dietary pattern.

Consumption of energy-dense, high-fat, and high-sugar unhealthy foods is common among university students. In contrast to the Mediterranean dietary pattern, this type of Western-style diet containing such foods can result in hedonic hunger in the long term. According to the results obtained from this study, the power of food scale's subscale for food availability is higher in overweight/obese individuals compared to underweight individuals. There is a low level of negative correlation between hedonic hunger and adherence to the Mediterranean diet. In future studies examining the relationship between dietary patterns and hedonic hunger, it is recommended to increase the sample size by including individuals from different regions.

Author Contributions: IU: Design, Statistical analysis, writing, proofreading; AC: Statistical analysis, writing, proofreading; EF: data colection, writing; ZA: data colection, writing.

Competing interests: The author(s) declare no competing interests.

Funding: This research received no external funding.

Data availability: Data is available from the corresponding author upon reasonable request

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No competing interests reported.

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The Effects of Dietary patterns on Hedonic Hunger in University Students

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Abstract

INTRODUCTION

MATERİALS AND METHODS

Mediterranean Diet Quality Scale (KIDMED)

Mediterranean Diet Adherence Scale (MEDAS)

Power of Food Scale (PFS)

Statistical Evaluation of Data

RESULTS

DISCUSSION

CONCLUSION

Declarations

References

Additional Declarations

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