This sample of Saudi mothers was young and highly educated with almost 60 % having a high household income and over 70 % were married. The knowledge and awareness of MyPlate was low with only 29.1 % saying they were definitely aware of MyPlate and a further 41.7 responding that they were “maybe” aware of MyPlate. Only 11.2 and 39.8 % of the women said that MyPlate always or mostly affected their eating choices respectively. The number of women correctly identifying food groups on the plate and correctly identifying serving sizes was also low-under 50% for most of the food groups. These finding are in line with the literature [2, 10] including the findings of Scwartz et al who found only 29.6 % of the population in the US was using MyPlate [3]. These finding are also in line with the finding that only a very small percentage of Saudi people follow dietary guidelines [7].
Education was not associated with knowledge of Myplate, this may be because overall the Saudi population is not familiar with the MyPlate image. However, educated mothers were much more likely to say that dietary guidelines influenced their choices and a significantly greater percentage of those with a postgraduate education were accurate about the correct servings of fruit, vegetables and grains compared to those without a postgraduate education. Our finding indicate that education is an important factor and merits further exploration. It is well known that education and other socio demographic factors affect health outcomes though less is known about specific nutrition education versus general education level. One study has found that nutrition knowledge was important for healthy food intake independently of education level [19] and some studies have found educated people to have healthier dietary behaviors [20, 21, 22].
Married women were much more likely to know what MyPlate was and for it to affect their eating choices. There was a significant association between being married and correctly identifying the food group vegetables on the MyPlate image and a significantly greater number of married women also had correct knowledge of the serving size for fruit and milk compared to unmarried women. This is consistent with studies that show that being married is linked to eating more fruit and vegetables [22, 23]. It has been shown that marriage positively affects health outcomes over the life course [24, 25]. The protective effects of marriage include availability of partner’s support; better regulation of health-related behaviors, which may be particularly important for men; and economic benefits, such as partner’s resources support, which may be particularly important for women or pooling of resource [26, 27]. It is inconclusive how diet changes with marriage and what effect marriage and having children has on diet and how diet may mediate the protective effects of being married [28, 29]. As a high proportion of this sample was married (72%) and the percentage of women married in in Saudi Arabia is not known our findings cannot be generalized to the general population; however further research should include marital status, marital history and changes in marital status and investigate how this impact dietary intake and health so that educational programs can be designed effectively.
Having a high income was significantly associated with MyPlate influencing food choices but otherwise was not associated with any other of the knowledge questions. Some studies have found higher income to be associated with healthier diets [30] and healthier diets cost more. Being able to afford a healthier diet has been shown to be an independent predictor of eating a healthier diet, [21] this may be one reason why those with a higher income were more likely to say MyPlate influenced their food choices; they may have healthier diets and their dietary voices reflect the guidelines presented in MyPlate. It has also been shown that those on welfare in the US would find it hard to afford the diet recommended by MyPlate [31].
Being employed was also significantly associated with Myplate influencing their eating choices compared to unemployed people.; it was also significantly associated with correctly identifying the serving size for the food groups Protein Meat. This may be a chance finding and needs to be replicated in future studies. Employment is associated with income and also with socioeconomic class therefore our findings regarding food choices is consistent with the literature. It has been shown that unemployed people, people on benefits/welfare and those of a lower socioeconomic class have a lower intake of fruit and vegetables [23] and less healthy diets overall and worse health related behaviors [32, 33, 34]. Furthermore, it has been shown that maternal employments is linked to better infant and young child feeding [35].
One limitation of this study is the low sample size, future studies with a larger sample size can provide greater statistical power and reduce likelihood of type 2 error. Another weakness is the narrow age range and over 70 percent of the women were married so these findings cannot be generalized to the whole Saudi population. Future studies should have a sample that is nationally representative and include different population groups, with diverse sociodemographic characteristics. Another limitation is the use of the American MyPlate logo which Saudi nationals may not be familiar with therefore the assessment of their knowledge of food groups may not be accurate; although using the Saudi written guidelines may have yielded the same results as these are not widely disseminated. A major strength of this study is that is the first study investigating nutrition knowledge in the Saudi population and therefore is highly original research.