Introduction
Nutrition is a crucial aspect of human life, so much so that the World Health Organization (WHO) considers it a significant component of health and development [
1]. A well-balanced diet and good nutrition can enhance students’ cognitive performance, intellectual growth, and memory [
2]. Research indicates that poor dietary habits during education, particularly at the undergraduate level, can increase students’ risk of chronic diseases [
3]. Nursing students, frequently present in clinical settings, are vital in providing nutritional guidance to hospitalized patients and educating them about proper eating behavior [
4‐
6].
Nutrition literacy, which is derived from health literacy, plays a crucial role in determining eating behavior [
7]. It refers to understanding and applying healthy nutrition practices [
8]. There are various definitions and concepts of nutrition literacy. Still, a comprehensive report describes an individual’s capacity to receive, process, and comprehend essential nutrition information, vital for preventing and managing nutrition-related diseases [
9]. Nutrition literacy encompasses six dimensions: knowledge, understanding, obtaining skills, applying skills, interactive skills, and critical skills [
10]. Individuals with high levels of nutrition literacy adhere to dietary guidelines to make healthy food choices [
11].
Conversely, those with low levels of nutrition literacy may need help with proper nutrition and consequently have poor dietary quality [
11]. According to a study conducted by Mengi Çelik & Semerci., which examined the level of nutrition knowledge among nursing students in Turkey, the findings revealed that 91.6% possessed adequate nutrition literacy [
4]. Furthermore, another study by Bahramfard et al., which investigated the nutrition literacy status and influencing factors among medical science students in Iran, found that nursing students had sufficient nutrition knowledge but struggled with determining their dietary regimen [
12].
Nursing students are regarded as this profession’s young population and future generation [
4]. Therefore, they may face challenges such as heavy workloads, long shifts, and intense practical training, which can affect their ability to maintain a proper diet and make them susceptible to various diseases [
5]. One necessary solution to address this issue is to enhance the nutrition knowledge of the community, particularly among nursing students [
4]. Understanding the factors contributing to a healthy diet and prioritizing nutrition literacy within this group [
12]. By increasing nutrition literacy through education, nursing students can gain more control over their dietary choices and opt for healthier options [
13].
Nurses have the most interaction and care responsibilities for patients among healthcare professionals, so they spend a significant amount of time promoting health. Compared to other healthcare providers, nurses have higher rates of sedentary behavior, unhealthy diet, overweight, and obesity [
14]. The health and well-being of nurses are crucial for healthcare organizations because they directly impact the quality of care [
15], patient safety [
16,
17], as well as performance and productivity [
18]. It is essential for healthcare organizations [
19]. The university years are crucial for transforming one’s lifestyle and developing healthy habits, including dietary choices [
20]. Therefore, improving healthy eating behavior has been recognized as a critical approach to decreasing the occurrence of non-communicable diseases in both developed and developing countries [
21].
Healthy eating behavior is a crucial aspect of life that can have long-term effects on health outcomes [
22]. Eating behaviors encompass a range of physiological, psychological, social, and genetic factors that influence meal timing, food intake quantity, food preferences, and food choices [
23]. In Iran, a country with an average income, common unhealthy eating behaviors among young people include consuming fast foods and unhealthy snacks, skipping breakfast, and low consumption of fruits, vegetables, whole grains, and dairy products [
24]. Among the many factors that affect eating behaviors, nutritional literacy has recently been recognized as a crucial element in enhancing the quality, health, and overall well-being of one’s eating patterns [
25]. Consequently, research indicates that different factors, such as eating behaviors, can influence an individual’s level of nutritional literacy [
26‐
29].
Consequently, nursing students must have nutrition-focused courses included in their curriculum. This will help them better understand nutrition, adopt healthier eating behaviors, and prevent diseases [
4]. Moreover, promoting healthy eating behaviors among nursing students should also prioritize maintaining physical health, enhancing learning abilities, and supporting academic advancement [
25].
The relationship between nutrition literacy and eating behaviors among nursing students in Iran has yet to be extensively studied. However, it is crucial to understand this relationship to encourage healthy eating habits among nursing students and improve their overall health outcomes. Therefore, this study assessed the relationship between nutrition literacy and eating behaviors among nursing students.
Results
Two hundred twenty-four nursing students (98 males, 126 females) participated in the study. The mean age of participants was 22.8 ± 3.16 years, and the mean BMI was 22.70 ± 3.22 kg/m
2. 89.7% of the students were single. The majority of participants (58%) reported moderate physical activity levels. Most participants resided in urban areas and described their health status as good. 33.9% of students had never been exposed to nutritional information, while 46.9% used outside food sources 1–3 times per week. Only 25.4% had a history of smoking. Demographic characteristics of nursing students are presented in Table
1.
Table 1
Demographic characteristics of the participants (N = 224)
Age | 22.08 | 3.163 |
BMI | 22.70 | 3.228 |
| n | % |
Semester |
First semester | 12 | 5.4 |
Second semester | 38 | 17.0 |
Third semester | 31 | 13.8 |
Fourth semester | 48 | 21.4 |
Fifth semester | 62 | 27.7 |
Sixth semester | 33 | 14.7 |
Gender |
Male | 98 | 43.8 |
Female | 126 | 56.3 |
Marital status |
Single | 201 | 89.7 |
Married | 23 | 10.3 |
Physical activity level |
Physical inactive | 39 | 17.4 |
Moderate activity level | 130 | 58.0 |
Regular activity level | 42 | 18.8 |
Regular extensive activity | 13 | 5.8 |
Residence | | |
village | 15 | 6.7 |
countryside | 24 | 10.7 |
City center | 185 | 82.6 |
Frequency of exposer to Nutrition-related information at university |
Never | 76 | 33.9 |
seldom | 57 | 25.4 |
sometimes | 72 | 32.1 |
often | 3 | 1.3 |
always | 16 | 7.1 |
The level of perception of your health |
Poor | 15 | 6.7 |
moderate | 76 | 33.9 |
Good | 129 | 57.6 |
I do not know | 4 | 1.8 |
Frequency of eating out |
Seldom | 60 | 26.8 |
1–3 meals per weeks | 105 | 46.9 |
4–6 meals per weeks | 33 | 14.7 |
1–2 meals daily | 19 | 8.5 |
3 or more meals daily | 7 | 3.1 |
Smoking history |
Yes | 57 | 25.4 |
No | 167 | 74.6 |
The name of the nursing faculty |
Ardabil | 141 | 62.9 |
Germi | 38 | 17.0 |
Meshginshahr | 45 | 20.1 |
The level of nutrition literacy among nursing students is presented in Table
2. The mean score on the nutrition literacy questionnaire was 3.37 (95% CI: 3.28 to 3.46). Among the dimensions of nutrition literacy, the highest score was related to knowledge, 3.60 (95% CI: 3.43 to 3.77) and interactive skills, 3.50 (95% CI: 3.36 to 3.62). In contrast, the lowest score was related to applying skills 2.90 (95% CI: 2.85 to 3.13) and obtaining skills 3.25 (95% CI: 3.13 to 3.37).
Table 2
The status of nutrition literacy among nursing students (N = 224)
Knowledge | 3.60 | 1.304 | 3.43 | 3.77 |
1. Balanced diet and reasonable nutrition are important measures to prevent and control chronic diseases such as diabetes and hypertension. | 3.59 | 1.469 | | |
2. Steaming and boiling are healthier ways of cooking than frying and grilling. | 3.61 | 1.354 |
Understanding | 3.40 | 0.903 | 3.27 | 3.51 |
3. I can easily understand the nutritional information delivered by new and traditional media. | 3.37 | 1.076 | | |
4. I have a good understanding of expert consensus regarding nutrition or dietary information. | 3.43 | 1.056 |
Obtaining skills | 3.25 | 0.941 | 3.13 | 3.37 |
5. I know where to find healthy diet information. | 3.34 | 1.097 | | |
6. I often read nutrition information transmitted through new media (e.g., WeChat and microblogging) or watch nutrition-related program | 3.16 | 1.208 |
Applying skills | 2.99 | 1.041 | 2.85 | 3.13 |
7. I drink milk or dairy products every day. | 3.02 | 1.287 | | |
8. I often buy foods based on nutrition facts on food packages. | 2.95 | 1.320 |
Interactive skills | 3.50 | 1.005 | 3.36 | 3.62 |
9. I am open to reasonable nutrition and health advice from family or friends. | 3.52 | 1.182 | | |
10. If my family members or friends are overweight and enjoy eating high-fat foods, I will encourage them to make dietary changes. | 3.47 | 1.298 |
Critical skills | 3.48 | 0.984 | 3.36 | 3.60 |
11. I can easily tell whether my daily diet is reasonable. | 3.50 | 1.171 | | |
12. I can estimate the suitable food intake for maintaining a healthy body weight. | 3.45 | 1.178 |
Total | 3.37 | 0.735 | 3.28 | 3.46 |
The mean score on the eating behavior questionnaire was 3.18 (95% CI: 3.12 to 3.23) (Table
3). Among the dimensions of the “food approach” scales, the highest score was related to the enjoyment of food, 3.84 (95% CI: 3.72 to 3.94), and the lowest score was related to emotional over-eating 2.82 (95% CI: 2.72 to 2.92). Among the dimensions of the “food avoidance” scale, the highest score was related to food fussiness, 3.48 (95%CI: 3.41 to 3.56), and the lowest score was related to slowness in eating, 3.08 (95% CI: 2.99 to 3.17).
Table 3
The status of eating behaviors among nursing students (N = 242)
Enjoyment Food | 3.84 | 0.846 | 3.72 | 3.94 |
EF 1 | I love food | 4.01 | 1.024 | | |
EF 3 | I enjoy eating | 4.12 | 0.930 | | |
EF 4 | I look forward to mealtimes | 3.38 | 1.134 | | |
Emotional Over-Eating | 2.82 | 0.819 | 2.72 | 2.92 |
EOE 5 | I eat more When I’m annoyed | 2.70 | 1.360 | | |
EOE 8 | I eat more When I’m worried | 3.38 | 1.317 | | |
EOE 10 | I eat more When I’m upset | 2.64 | 1.354 | | |
EOE 16 | I eat more When I’m anxious | 2.66 | 1.291 | | |
EOE 21 | I eat more When I’m angry | 2.73 | 1.287 | | |
Emotional Under-Eating | 3.18 | 0.666 | 3.10 | 3.27 |
EUE 15 | I eat less When I’m worried | 3.33 | 1.223 | | |
EUE 18 | I eat less When I’m angry | 3.28 | 1.279 | | |
EUE 20 | I eat less When I’m upset | 3.41 | 1.242 | | |
EUE 27 | I eat less When I’m annoyed | 3.35 | 1.222 | | |
EUE 35 | I eat less When I’m anxious | 2.56 | 1.240 | | |
Food Fussiness | 3.48 | 0.591 | 3.41 | 3.56 |
FF 7 | I refuse new foods at first | 2.74 | 1.257 | | |
FF 12 | I enjoy tasting new foods | 3.71 | 1.062 | | |
FF 19 | I am interested in tasting new food I haven’t tasted before | 3.75 | 0.988 | | |
FF 24 | I enjoy a wide variety of foods | 3.74 | 1.084 | | |
Food Responsiveness | 2.87 | 0.849 | 2.76 | 2.99 |
FR 13 | I often feel hungry when I’m with someone who is eating | 3.28 | 1.170 | | |
FR 17 | Given the choice, I would eat most if the time | 2.65 | 1.117 | | |
FR 22 | I am always thinking about food | 2.69 | 1.189 | | |
Hunger | 3.13 | 0.832 | 3.02 | 3.23 |
H 9 | If I miss a meal, I get irritable | 3.21 | 1.245 | | |
H 28 | I often feel so hungry that I have to eat something right away | 3.09 | 1.130 | | |
H 32 | I often feel hungry | 2.95 | 1.029 | | |
H 34 | If my meals are delayed, I get light-headed | 3.26 | 1.170 | | |
Slowness In Eating | 3.08 | 0.654 | 2.99 | 3.17 |
SE 14 | I often finish my meals quickly | 3.19 | 1.306 | | |
SE 25 | I am often last at finishing a meal | 3.02 | 1.350 | | |
SE 26 | I eat more and more slowly during the course of a meal | 3.08 | 1.297 | | |
SE 29 | I eat slowly | 3.04 | 1.290 | | |
Satiety Responsiveness | 3.02 | 0.825 | 2.91 | 3.13 |
SR 23 | I often get full before my meal is finished | 2.79 | 1.213 | | |
SR 30 | I cannot eat a meal if I have had a snack just before | 3.2009 | 1.075 | | |
SR 31 | I get full up easily | 3.06 | 1.002 | | |
Food Approach | 3.17 | 0.612 | 3.09 | 3.24 |
Food Avoidance | 3.19 | 0.001 | 3.14 | 3.25 |
Total | 3.18 | 0.398 | 3.12 | 3.23 |
The level of nutrition literacy and eating behavior of individuals based on demographic characteristics are presented in Table
4. Nutrition literacy significantly correlated with the frequency of exposure to nutrition-related information at the university and college. Additionally, the status of eating behavior had a significant negative correlation with BMI and a significant positive correlation with physical activity level (
p < 0.05).
Table 4
Relationship between nursing students’ general characteristics with nutrition literacy and eating behavior (N = 224)
Age | 3.37 | 0.735 | r = -0.035 p = 0.598 | 3.1835 | 0.39816 | r = − 0.062 p = 0.356 |
BMI | 3.37 | 0.735 | r = -0.062 p = 0 0.356 | 3.1835 | 0.39816 | r = -0.163 p = 0.015 |
Semester | F = 1.610 p = 0.159 | | F = 0.505 p = 0.772 |
First Semester | 2.84 | 0.768 | | 3.12 | 0.215 | |
Second Semester | 3.33 | 0.755 | 3.21 | 0.550 |
Third Semester | 3.44 | 0.792 | 3.17 | 0.403 |
Fourth Semester | 3.34 | 0.717 | 3.17 | 0.325 |
Fifth Semester | 3.46 | 0.687 | 3.22 | 0.405 |
Sixth Semester | 3.41 | 0.723 | 3.10 | 0.324 |
Gender | t = -0.239 p = 0.811 | | t = 3.459 p = 0.107 |
Male | 3.36 | 0.719 | | 3.13 | 0.449 | |
Female | 3.38 | 0.749 | 3.22 | 0.350 |
Marital status | t = 1.279 p = 0.202 | | t = 1.207 p = 0.229 |
Single | 3.39 | 0.722 | | 3.19 | 0.403 | |
Married | 3.18 | 0.836 | 3.08 | 0.345 |
Physical activity level | | F = 2.001 p = 0.115 | | F = 3.633 p = 0.014 |
Physical inactive | 3.21 | 0.723 | | 3.01 | 0.310 | |
Moderate activity level | 3.36 | 0.729 | 3.20 | 0.373 |
Regular activity level | 3.42 | 0.754 | 3.20 | 0.387 |
Regular extensive activity | 3.77 | 0.677 | 3.38 | 0.701 |
Residence | F = 1.048 p = 0.352 | | F = 0.595 p = 0.552 |
village | 3.55 | 0.801 | | 3.17 | 0.452 | |
countryside | 3.21 | 0.818 | 3.10 | 0.295 |
City center | 3.38 | 0.718 | 3.19 | 0.405 |
Frequency of exposer to Nutrition-related information at university | F = 2.382 p = 0.050 | | F = 0.629 p = 0.643 |
Never | 3.27 | 0.797 | | 3.14 | 0.397 | |
seldom | 3.57 | 0.629 | 3.22 | 0.433 |
sometimes | 3.36 | 0.741 | 3.20 | 0.377 |
often | 3.91 | 0.901 | 3.30 | 0.246 |
always | 3.10 | 0.576 | 3.10 | 0.394 |
The level of perception of your health | F = 2.195 p = 0.090 | | F = 0.924 p = 0.430 |
Poor | 3.02 | 0.583 | | 3.06 | 0.245 | |
moderate | 3.28 | 0.704 | | 3.21 | 0.334 | |
Good | 3.46 | 0.760 | | 3.18 | 0.431 | |
I do not know | 3.50 | 0.619 | | 2.99 | 0.778 | |
Frequency of eating out | F = 0.873 p = 0.481 | | F = 1.572 p = 0.183 |
Seldom | 3.41 | 0.732 | | 3.17 | 0.412 | |
1–3 meals per weeks | 3.31 | 0.719 | 3.14 | 0.357 |
4–6 meals per weeks | 3.34 | 0.744 | 3.17 | 0.441 |
1–2 meals daily | 3.45 | 0.875 | 3.31 | 0.495 |
3 or more meals daily | 3.80 | 0.519 | 3.45 | 0.258 |
Smoking history | t = -0.447 p = 0.656 | | t = -0.983 p = 0.327 |
Yes | 3.33 | 0.718 | | 3.13 | 0.371 | |
No | 3.38 | 0.742 | 3.19 | 0.406 |
The name of the nursing faculty | F = 3.080 p = 0.048 | | F = 0.257 p = 0.773 |
Ardabil | 3.46 | 0.700 | | 3.16 | 0.405 | |
Germi | 3.27 | 0.752 | 3.21 | 0.422 |
Meshginshahr | 3.17 | 0.792 | 3.20 | 0.357 |
This study used nutritional literacy to predict eating behavior and its subscales. Our results showed that the final stage of the hierarchical regression model for eating behavior was significant, F (13.066),
p < 0.001, adjusted R
2 = 0.41 (Table
5). Based on the results, nutritional literacy explained 44% of the variance in eating behavior and demonstrated significant explanatory power in two eating behavior subscales. The adjusted R
2 values for the food approach and food avoidance subscales were 0.27 (
p < 0.001) and 0.33 (
p < 0.001), respectively.
Table 5
Hierarchical regression model for eating behavior explained by nutrition literacy (Model 2)
Β | 0.62*** | 0.56*** | 0.33*** |
∆ R2 | 0.44 | 0.37 | 0.31 |
∆F | 134.095*** | 97.757*** | 31.783*** |
Adjusted R2 (Final) | 0.41 | 0.33 | 0.27 |
F (Final) | 13.066*** | 9.520*** | 7.562*** |
Df1, Df2 | 1,210 | 1,210 | 1,210 |
Discussion
According to our knowledge, this was the first study to examine the relationship between nutrition literacy and eating behaviors in college students, including eating approach and avoidance behaviors. Li and colleagues found a positive correlation between nutrition literacy scores and healthy eating behaviors in nursing students, with nutrition literacy being a strong predictor of eating approach and avoidance behaviors [
28]. Siow et al. also found a relationship between nutrition literacy and adult eating behaviours. Additionally, students with a plan for healthy eating had higher nutrition literacy scores and healthier eating behaviors than their peers [
8]. This suggests that individuals who prioritize a healthy lifestyle can improve and maintain their eating behaviors. Therefore, nutrition literacy interventions that include developing a healthy eating plan can improve eating behaviors [
8]. Studies have also reported that individuals’ eating behavior is influenced by their nutrition literacy levels [
27], and healthy eating behaviors are positively associated with NL skills [
36,
37]. Prioritizing personal health has a positive impact on eating habits. By increasing one’s nutrition knowledge and creating healthy meal plans, individuals can effectively influence their eating behavior and improve their overall health and well-being. Nutrition education plays a significant role in promoting healthy eating habits; therefore, it is crucial to prioritize nutrition literacy.
In our study, there was a relationship between eating behavior and physical activity level. According to Farahani’s study, unhealthy behaviors such as eating behaviors are associated with insufficient physical activity and increased sedentary behavior [
38]. Another survey on adolescents showed a significant relationship between their friends’ eating behavior and their BMI because they usually have similar eating behaviors, making them somewhat identical in weight status [
38].
Evidence shows positive progress in eating behavior accompanied by increased physical activity. Individuals who were engaged in sports showed healthier eating behaviors. This study observed physical activity as a determinant of eating behavior. Students who did not engage in physical activity lacked motivation to consume a balanced diet [
37]. This analysis is consistent with a study by Downes et al., which stated that physical activity is a strong motivator for healthy eating behaviors among students [
39]. Shinde et al.‘s study on Indian healthcare professionals showed a significant positive correlation between the eating behavior scale and BMI. This study showed that eating behavior was associated with obesity, daily physical activity, or sedentary lifestyle [
40].
Based on the findings of this study, the mean score for nutritional literacy among nursing students was 3.37 out of 5, indicating that they had sufficient nutritional literacy. In Bahramfard et al. study on medical students in Iran who used the Adult Nutrition Literacy Assessment (EINLA) tool, the total score for nutritional literacy was reported as 24.92 out of 35 [
12]. In Lai et al. study on Taiwanese students who used the Nutrition Literacy Scale (NL scale), the total score for nutritional literacy was 4.32 out of 6 [
20]. However, in a study conducted by Siow et al., on adults in Malaysia who used the self-rated nutrition literacy scale, the mean nutrition literacy score was reported as 17.66 out of 30. Additionally, 80% of participants in this study were found to have poor nutrition literacy [
41]. In Ashoori et al., on Iranian youth who used our original questionnaire form, the average nutritional literacy score was 52.1 out of 100, indicating low levels of nutritional literacy among Iranian youth and highlighting the need to improve their nutritional literacy skills [
24]. The difference in nutrition literacy levels may be due to limited exposure to nutrition information among certain population groups, differences in individuals’ education levels, societal pressures and norms, or socio-economic status.
Among the dimensions of nutrition literacy, the highest score was related to the knowledge dimension, which was consistent with the findings of Liao et al. This study showed that because most students have access to the internet and can search for and obtain nutrition information on social media platforms, they have acquired a high level of knowledge about nutrition [
28]. Nowadays, social media platforms are becoming one of the sources of nutrition and health information for students. However, in our study, students obtained the lowest score in nutrition literacy skill application dimension [
37]. This result may be due to the ease of access to a large volume of health and nutrition-related content today, causing students to need clarification when selecting accurate and precise information and applying it effectively [
24,
41].
The study results showed that the mean overall score of students’ eating behavior was 3.18 out of 5. This result was consistent with Lee C-K et al. and Liday DM et al. studies [
8,
42]. but did not match Liao and colleagues’ findings. In Lee et al.‘s study, the mean overall score of students’ eating behavior was 39.97 out of 65 [
24], while in the Liday DM study, it was reported as 2.62 out of 4 [
42]. Mamun et al. considered good eating behavior to result from high awareness about health status, extensive knowledge about nutrition, and a positive attitude towards healthy food [
43]. Liao et al.‘s findings indicated that students’ eating behavior was unsatisfactory [
28]. Additionally, Siow et al.‘s study on adults found that the mean overall score of eating behavior was 88.26 out of 52, indicating that most respondents (74.5%) had poor eating behavior due to the prevalence of low-quality diets, increased frequency of eating outside the home, and consumption of low-quality and harmful food [
41].
Food enjoyment received the highest score among the dimensions of the scale (food approach). This finding was consistent with Hunot-Alexander et al. [
44] and He J et al. [
45] studies. Nowadays, due to the availability of restaurants, fast foods, and other food-related stores along with media influence, encouraging students to consume food as a form of recreation and enjoyment [
46]. Emotional Over-Eating received the lowest score among the scale dimensions (food approach). Previous studies conducted by Zickgraf et al. on candidates for bariatric surgery in America [
47] and Dubois et al. study [
48] also found that emotional over-eating received the highest score. Due to various psychological workshops for students, such as communication skills and prevention of emotional relationship damage, nursing students learn how to manage their emotions and feelings well in crises, which is why they are less prone to emotional overeating.
Among the dimensions of the scale (food avoidance), the highest score was related to the dimension of food fussiness, consistent with a study conducted by Shamsalinia on epileptic patients [
35]. Considering that the type of food is rooted in the culture of that geographical region and the available food ingredients and that most students are non-native and live independently away from their families, they may experience food confusion. Bookari et al. showed that parental eating habits and nutrition strategies are the most influential factors in determining eating behavior and food choices. Parents actively choose what their family eats, act as role models for food choices and patterns, and use eating practices to reinforce preferred eating patterns and behaviors [
49]. Another study on adolescents reported that regular family meals might promote healthy eating behaviors and serve as models for healthy food choices. Family structure and socioeconomic status have also been identified as determinants of nutritional status [
24,
50]. However, given that in Iran, non-native students are mostly accepted in universities located in cities similar in terms of food culture, they are open to trying new foods from that region and show a willingness to do so.
The results showed that the lowest score among the scale dimensions (food avoidance) was related to the slowness in the eating dimension, which is consistent with the results of a study conducted by Alruwaitaa et al. on adults [
51]. It can be said that due to the heavy workload of university, students may have limited time or interest in developing their food and nutrition-related skills, such as eating, shopping, preparing and cooking food (performance skills) or interacting with others about food and nutrition (interactive skills) [
24]. According to previous studies, it can be interpreted that nursing students may need more time to eat due to heavy university curricula and hospital internships, which is why they are less likely to experience difficulties in eating.
This study showed a significant relationship between nutrition literacy and students’ exposure to nutrition-related information in universities and places of study. This finding is consistent with previous studies [
52,
53] and suggests that individuals who receive nutrition information in universities and have completed relevant nutrition courses have better nutrition literacy [
52]. Additionally, using food and nutrition information obtained through various media channels may be challenging for university students due to the university’s unique environment [
30]. Insufficient nutrition literacy among students who do not attend central provincial universities may be due to underdeveloped economic conditions, low income, poor quality of life, limited access to nutrition information, and low awareness of eating behaviors [
54,
55]. Therefore, an inappropriate learning environment affects the nutrition literacy of students and leads to unhealthy eating behaviors [
49,
55]. Alotaibi et al., who examined the geographical impact on nutrition literacy levels and eating behaviors in the United States, found that nutrition literacy and eating behaviors vary depending on individuals’ residential areas [
50].
One of the findings of the present study was that there was a significant relationship between eating behavior and BMI. Herle et al. also found similar results to ours, stating that there is a significant correlation between BMI and eating behaviors [
55]. Individuals with unhealthy eating behaviors are likely to have a higher BMI. Therefore, individuals with a healthy diet believe it helps them maintain their body weight within a healthy range as much as possible [
56]. However, Natour et al.‘s results contradicted ours, stating that individuals with higher BMI are more likely to engage in healthier behaviors. In comparison, those with lower BMI are less likely to engage in healthy behaviors [
55].
Our study differed from previous ones in two ways. Firstly, we assessed the correlation between nutritional literacy and eating behaviors, in nursing students rather than the general population. Secondly, we explored the relationship between healthy behavior and physical activity levels in nursing students. We used standardized instruments to measure nutritional awareness and behaviors, which can lead to a better understanding of dietary behaviors in nursing students.
Nursing students often experience changes in their eating behaviors due to their entry into independent lifestyles, and can easily exhibit unhealthy eating behaviors. Unhealthy eating behaviors can lead to illness and consequently reduce students’ daily and academic quality of life. Nutritional literacy is an essential factor in determining eating behavior and plays a crucial role in improving the health and well-being of students. According to our knowledge, this is the first study to examine the relationship between nutritional literacy and eating behaviors among nursing students in Iran, which can reflect the weaknesses of current nursing curricula in improving nutritional literacy and nutrition among students.
Limitations
This study was subject to the following limitations: firstly, the cross-sectional nature of this study does not allow for causal interpretations. Secondly, this study was conducted only in nursing faculties of Ardabil University of Medical Sciences and had a small sample size, therefore the findings cannot be generalized across the country. Thirdly, since the tools used in this research were self-report questionnaires, personal mental feelings may have been inconsistent with actual behaviors and may have caused errors in data collection. Finally, our aim was to investigate the relationship between nutritional behaviors and nutritional literacy among nursing students. Therefore, we did not add factors affecting nutritional knowledge to the questionnaire. It is recommended that future studies examine factors affecting the level of nutritional knowledge among nursing students.
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