Abstract
Purpose
The aim of this study was to assess the consumption frequency of sugar sweetened beverages, physical activity, BMI values and their relationships among university students.
Material/Methods
The data collection has been carried out with the help of questionnaires. The target population were students between the ages of 18 and 30, who study at the Faculty of Health Sciences (67 students) or at the Faculty of Humanities (64 students). The frequency of beverage consumption was assessed with a Food Frequency Questionnaire (FFQ) designed for sugar sweetened beverages and physical activity with the short form of the International Physical Activity Questionnaire.
Results
The most frequently consumed sugar sweetened beverage was freshly squeezed or 100% fruit juice in both faculties. The difference between the average BMI of the two groups was statistically significant (P = 0.035). A non-significant relationship was found between BMI and sugar sweetened beverages consumption.
Conclusions
The most consumed sugar sweetened beverage was freshly squeezed or 100% fruit juice, but it contains a lot of added sugar that contributes to developing overweight. Health education programmes are needed to teach the students of every faculty about healthy drink consumption.
Introduction
The prevalence of overweight and obesity has increased rapidly worldwide [1]. Among 20 European countries, the highest prevalence of this nutritional status occurs in Hungary, with 61.6% of the population [2]. According to the Hungarian Diet and Nutritional Status Survey in 2014 (OTÁP), the prevalence of overweight and obesity among young adults was 32.5% for women and 32.4% for men. The average BMI in this age group was 24.1 kg/m2 for men and 24.0 kg/m2 for women [3].
During the university years, the average increase in body weight can reach 2.1 ± 4.7 kg in three years. Above this, the study found that only 15% of the students were overweight or obese at the beginning of the freshman year that increased to 24% by the end of the university [4].
One of the main contributors to the development of overweight and obesity is the consumption of a high amount of added sugars. According to the recommendation of the World Health Organisation (WHO) the intake of free sugar has to reduce to less than 10% of total energy intake [5]. The Hungarian Diet and Nutritional Status Survey in 2014 has assessed the free sugar intake among Hungarian adults. The results show us that the average added sugar consumption does not reach the recommendation of the WHO but comparing the Hungarian Diet and Nutritional Status Survey of 2009–2014, it shows an increasing tendency, and the main sources are sugar sweetened beverages. Among female young adults (between the ages of 18 and 34) the consumption is much higher with the result of 11.3 energy %. One of the main sources of added sugars in this age group is sugar sweetened beverages (SSBs) as well, with 21% for women and 29% for men [6]. The consumption of sugar sweetened beverages could be an important health factor because one of the biggest meta-analyses has found a clear association between weight gain and SSBs [7].
The definition of sugar sweetened beverages according to the United States Department of Agriculture (USDA) is the following: drinks that contain added sugar such as sweetened mineral water, fruit juice, sports drinks, sweetened teas, sweetened coffees, flavoured milk and sweetened energy drinks. For sweetening saccharose or high fructose corn syrup (HFCS) are commonly used [8]. According to this definition the freshly squeezed or 100% fruit juice is distinguished from the SSBs category, but these types of beverages contain a similar amount of simple sugars as a natural source that can increase sugar consumption [9].
In 2016 the New Hungarian Dietary Guideline, the so-called ‘Okostányér’ (Smart Plate) was released, which makes a recommendation for the type of the preferred beverages and the consumption volume as well. In summary, this Hungarian guideline recommends the consumption of SSBs in a small portion and only to diversify the fluid consumption [10].
There is a great variety among the preferred drinks that are consumed by university students according to different studies. Bawadi et al. found that the most frequently consumed sugary drinks are the hot drinks with a frequency of four servings/day [11]. In contrast, in a Polish study the most frequently consumed drink was the 100% fruit juice, which contains sugar in a natural form [12].
In Hungary, few studies have been published about the physical activity of adults, especially of the young age group. The Hungarian Diet and Nutritional Status Survey in 2014 was complemented with the assessment of the physical activity of the Hungarian population. As the survey found, Hungarian adults are moderately active with 7,022 daily average steps [3].
The main purpose of this present study is to investigate the key differences between the students of the Faculty of Humanities and the students of the Faculty of Health Sciences regarding their consumption frequency of SSBs, their consumption volume of SSBs at one time, their BMI values, and their physical activity. The reason for comparing these two groups is that all the students of the Faculty of Health Sciences build some knowledge about healthy nutritional choices.
As overweight and/or obesity is one of the main health problems among the Hungarian population and we do not have much information about the consumption frequency of sugar sweetened beverages and about the physical activity of Hungarian university students, it is important to examine these factors and their relationships to improve a good functional prevention program.
Materials and methods
Study participants
The target population of this study were students between the ages of 18 and 30, who study at the Faculty of Health Sciences or the Faculty of Humanities. in total 131 students completed our questionnaire, 67 students from the Faculty of Health Sciences and 64 students from the Faculty of Humanities. All participants were informed about the purpose of the study and were assured that their data will not be used for any other purposes.
Questionnaire
In this study, we used a self-administered questionnaire. The questionnaire that was completed by the participants could be divided into three parts. In the first part sociodemographic data were collected to inform us about the age, height, and weight of the students. The second part was a sugar sweetened beverages (SSBs) consumption frequency questionnaire, and the last part was an International Physical Activity Questionnaire (IPAQ) that was aimed to assess the physical activity of the participants.
Anthropometric measurement
Weight and height data were self-administered in the questionnaire. With these data body mass index (BMI) was calculated, and we categorised them into the BMI groups based on the WHO guidelines.
Assessment of SSB consumption
Sugar sweetened beverages included in the study were: sweetened mineral water, 100% or freshly squeezed fruit juice, fruit juice with <50% fruit content, fruit juice with <12% fruit content, sweetened vegetable juice, carbonated soft drink, sweetened tea, sweetened fruit tea, flavoured milk, sweetened espresso coffee, sweetened cappuccino, and sweetened energy drink. For home-prepared SSBs like sweetened tea, sweetened fruit tea, flavoured milk, and hot coffee drinks the participants were asked to give the used amount of teaspoon of sugar. For these data, we calculated the average sugar content of homemade sweetened beverages. For defining the sugar content of the other types of drinks, we used the average sugar content of the drinks available on the market.
For these types of SSBs, we provided six options to indicate consumption frequency. These were “many times a day”, “daily”, “1–3 times a week”, “1–3 times a month”, “less than once a month” and “never”. We inferred the daily added sugar intake from SSBs from frequency data and the sugar content of the drink. Participants were also allowed to give information about the consumption volume together with the BBS type, with the possible answers of ‘0.5 dl’, ‘2 dl’, ‘2.5 dl’, ‘5 dl’, and ‘other’.
Assessment of physical activity
We assessed physical activity using the short form of IPAQ that is a set of seven questions pertaining to the examination of vigorous activity, moderate activity, walking and sitting during the last seven days. The data were analysed using the IPAQ scoring protocol. To characterise the physical activity metabolic equivalent (MET) of each type of activity was used. According to the scoring protocol MET score of walking is 3.3 METS, moderate physical activity is 4 METS, and vigorous activity is 8 METS. According to this scoring protocol, vigorous activity means that the participants achieve a minimum activity level of 1500 MET-minutes three times a week or with the combination of walking, moderate activity or vigorous activity means achieving a minimum activity level of 3000 MET-minutes seven or more times a week. We speak about moderate activity if the participant does vigorous activity at least three times a week and/or walks at least 30 min per day. Moderate activity means if the participant does vigorous activity five or more times a week and/or walks at least 30 min or more, or the participant does the combination of the walking and moderate and vigorous activity and achieves a minimum total activity level of 600 MET-minutes a week. If the participant does not meet any of the above-mentioned criteria, it means a low level of physical activity [13].
Statistical analysis
The data about the frequency of the SSB consumption were transformed into daily consumption measures. To define the most frequently consumed sugary beverages, each frequency got an index number. These were the following, ‘many times a day’ got the index of 0, ‘daily’ got 1, ‘1–3 times a week’ got 2, ‘1–3 times a month’ got 3, ‘less than a month’ got 4, and ‘never’ got 5. According to these index numbers, the most frequently consumed SSB has the lowest index number. Descriptive statistics were conducted to investigate the BMI values and the physical activity of the university students from both faculties. The difference in the mean BMI of the two groups (students from the two faculties) was examined using independent samples t-test. Spearman’s rank-order correlation was conducted to examine the relationship between BMI scores and consumption frequency of SSBs as well as the relationship between physical activity according to the MET values and consumption frequency of SSBs. We used Mann-Whitney U test to examine the difference between the consumption volumes of SSBs at one time in the two groups. The data were analysed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp. Released 2017. Armonk, NY: IBM Corp.) and Excel 2016 (v16.0). The statistical significance for all tests was P < 0.05.
Results
Out of a total of 131 university students, 64 attend the Faculty of Humanities and 67 attend the Faculty of Health Sciences. The mean age of humanities students was 21.67 (SD = 2.34), and of health sciences students was 22.79 (SD = 2.84). The mean BMI of the humanities students was 21.5 kg/m2 (SD = 4.14), and of health science students was 22.39 kg/m2 (SD = 3.48). Both values were in the normal category, so probably most of the students had a normal weight (Table 1). The difference in the mean BMI values of the two faculties was statistically significant (P = 0.035).
Sociodemographic data
| Variables | Faculty of Humanities | Faculty of Health Sciences |
| n | 64 | 67 |
| Age (M±SD) | 21.67 ± 2.34 | 22.79 ± 2.84 |
| BMI (kg/m2) (M±SD) | 21.5 ± 4.14 | 22.39 ± 3.48 |
| Underweight (%)* | 15.6 | 7.5 |
| Normal Weight (%)* | 70.3 | 74.6 |
| Overweight (%)* | 10.9 | 13.4 |
| Obese (%)* | 3.1 | 4.5 |
Note. *According to the Body Mass Index (BMI) category of the Word Health Organisation (WHO).
The most frequently consumed sugar sweetened beverage was the freshly squeezed and/or 100% fruit juice among the students of both faculties. However, there is a different order for the other sugar sweetened drinks in the two faculties (Table 2).
Most frequently consumed SSBs by faculties
| Faculty of Humanities | Faculty of Health Sciences | |
| 1. | freshly squeezed or 100% fruit juice | freshly squeezed or 100% fruit content |
| 2. | carbonated soft drink | fruit juice <50% fruit content |
| 3. | sweetened fruit tea | fruit juice <12% fruit content |
| 4. | fruit juice <50% fruit content | carbonated soft drink |
| 5. | sweetened tea | sweetened fruit tea |
| 6. | fruit juice <12% fruit content | sweetened cappuccino |
| 7. | sweetened cappuccino | flavoured milk |
| 8. | flavoured milk | sweetened tea |
| 9. | sweetened energy drink | sweetened presso coffee |
| 10. | sweetened mineral water | sweetened mineral water |
| 11. | sweetened presso coffee | sweetened energy drink |
| 12. | sweetened vegetable juice | sweetened vegetable juice |
The students of the Faculty of Humanities consumed more at one time in the case of eight sugar sweetened beverages than students of the Faculty of Health Sciences. These are freshly squeezed or 100% fruit juice, fruit juice <50% fruit content, fruit juice <12% fruit content, sweetened tea, sweetened fruit tea, flavoured milk, sweetened cappuccino, sweetened presso coffee, and sweetened energy drink. Between the consumption volumes of the two faculties, there was a statistically significant difference in the case of sweetened tea (P = 0.010) and flavoured milk (P = 0.035).
Consumption frequency of none of the SSBs was in a statistically significant relationship with the students’ BMI values (Table 3).
The relationships between the consumption frequency of SSBs and the students' BMI values
| SSBs | P-value |
| freshly squeezed or 100% fruit juice | 0.098 |
| fruit juice <50% fruit content | 0.397 |
| fruit juice <12% fruit content | 0.179 |
| carbonated soft drink | 0.060 |
| sweetened tea | 0.404 |
| sweetened fruit tea | 0.572 |
| sweetened mineral water | 0.545 |
| sweetened presso coffee | 0.211 |
| sweetened cappuccino | 0.344 |
| flavoured milk | 0.933 |
| sweetened energy drink | 0.677 |
| sweetened vegetable juice | 0.966 |
The third part of the questionnaire aiming to examine the physical activity of the students was not obligatory to fill, so here we can see a decrease in the number of the participants. The distribution of the students’ physical activity is different in the two faculties. At the Faculty of Humanities 13.6% of the total number of students shows a high level of physical activity, compared to the 9.1% of the total number of students of the Faculty of Health Sciences. Between students of both faculties, the distribution of the medium level of physical activity was the highest, with 54.2% of the students of the Faculty of Humanities and 65.2% of the students of the Faculty of Health Sciences. The distribution of low level of physical activity could be observed in both faculties, as among the students of the Faculty of Humanities, the distribution is 32.2%, while among students of the Faculty of Health Sciences it is lower with the result of 25.7% (Fig. 1).
Distribution of physical activity among students of the Faculty of Humanities (n = 59) and the Faculty of Health Sciences (n = 66)
Citation: Developments in Health Sciences 3, 4; 10.1556/2066.2021.00038
The relationship between physical activity and consumption frequency of SSBs is statistically significant only in one case. A positive significant straight proportional relationship was found between physical activity and consumption frequency of fruit juice with a maximum fruit content of 12%. Table 4 shows the values of the other SSBs.
The relationship between physical activity and the frequency consumption of SSBs
| SSBs | P-value |
| sweetened mineral water | 0.937 |
| freshly squeezed or 100% fruit juice | 0.819 |
| fruit juice <50% fruit content | 0.684 |
| fruit juice <12% fruit content | 0.025 |
| sweetened vegetable juice | 0.069 |
| carbonated soft drinks | 0.638 |
| sweetened tea | 0.215 |
| sweetened fruit tea | 0.310 |
| flavoured milk | 0.534 |
| sweetened presso coffee | 0.076 |
| sweetened cappuccino | 0.061 |
| sweetened energy drink | 0.616 |
Discussion
The consumption of the freshly squeezed or 100% fruit juice was found to be the highest among the students of both faculties, while there were differences between the faculties in the ranking of other beverages. Although freshly squeezed or 100% fruit juice contains valuable nutrients, it is important to emphasise their high level of sugar content, which increases the prevalence of overweight. Fruit juice was found on the second place among students of the Faculty of Health Sciences and carbonated soft drinks among students of the Faculty of Humanities. The consumption frequency of sweetened energy drinks was found in the last third of the listed beverages. Similar findings were obtained in the study of Bawa et al. [12].
A larger amount of sugar sweetened beverages was consumed by the students of the Faculty of Humanities in the case of eight types of beverages. By sweetened tea and flavoured milk consumption we found a statistically significant difference. This difference can be explained by the students’ knowledge about healthy eating and drinking patterns at the Faculty of Health Sciences.
We observed a higher average BMI value among the students of Faculty of Health Sciences and this difference was statistically significant. The average BMI values of both faculties’ students were classified into the normal category according to the WHO classification [14]. The results of the average BMI values were lower than the results of the Hungarian Diet and Nutritional Status Survey in 2014, age and gender-adjusted [3]. The prevalence of overweight and obesity was also lower in both faculties than in the above-mentioned study [3]. This can be explained by the education level of the participants in this study, which positively influences the nutritional status [15], although in this study the results were lower compared to a Canadian college students’ BMI values [16].
In this study, no association was found between SSBs consumption frequency and BMI values, but Malik et al. found in their meta-analysis a clear relationship between SSBs consumption and weight gain [7].
A great part of the participants had a moderate level of physical activity while the distribution of the high level of physical activity was the lowest in both faculties. According to the Hungarian Diet and Nutritional Status Survey in 2014, the daily average steps were 7,022 by adults which means a moderate activity [3]. Findings of a Bosnia and Herzegovina study show that more than half of the participating students (53.7%) had a high level of physical activity [17], while in Italy, according to the study of Belingheri et al., 35% of the participating students of the Faculty of Health Sciences did no physical activity at all [18].
We found a statistically significant relationship only between consumption frequency of fruit juice with the maximum fruit content of 12% and physical activity. This relationship was positively significant and straight proportional, which may be influenced by an unknown third factor.
Conclusions
Our study does not show a positive relationship between the consumption frequency of these SSBs, but in the scientific literature many are to be found. The most frequently consumed SSB was the freshly squeezed or 100% fruit juice although thanks to its sugar content, it may lead to weight gain. A moderate level of physical activity may not be sufficient to maintain a healthy body weight among university students.
We recommend that in the future all university students should take part in a health education programme, where they can improve their physical activity level and according to the New Hungarian Dietary Guideline “Okostányér” (Smart Plate) enhance their knowledge about SSBs consumption frequency and volumes.
The findings of this study may be limited due to the self-reporting data by the participants. Another limitation is the use of a single FFQ, it would have been more accurate to use a 24 h recall to validate the results. However, asking the consumption volume together with the given type of SSBs strengthens the quality of the study.
Authors’ contribution
BBCs came up with the research topic, reviewed the scientific literature, coordinated the data collection, carried out the statistical analyses, and summarised the results. LA designed the data collection, critically reviewed the manuscript, and approved the final manuscript.
Ethical approval
This study was conducted in accordance with the 2008 revision of the 1975 Declaration of Helsinki.
Conflicts of interest/funding
The authors declare no conflicts of interest, and no financial support was received for this study.
References
- 1.↑
Obesity and overweight [Internet]. Geneva: World Health Organisation; [cited 2020 March 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
- 2.↑
Marques A, Peralta M, Naia A, Loureiro N, de Matos MG. Prevalence of adult overweight and obesity in 20 European countries, 2014. Eur J Public Health 2018;28:295–300. https://doi.org/10.1093/eurpub/ckx143.
- 3.↑
Erdei G, Kovács AV, Bakacs M, Martos É. Országos Táplálkozás és Tápláltsági Állapot Vizsgálat 2014. I. A magyar felnőtt lakosság tápláltsági állapota. [Hungarian Diet and Nutritional Status Survey 2014. I. Nutritional status of the Hungarian adult population]. Orv Hetil 2017;158:533–40. https://doi.org/10.1556/650.2017.30700[Article in Hungarian].
- 4.↑
Gropper SS, Simmons KP, Connell JL, Ulrich PV. Weight and body composition changes during the first three years of college. J Obes 2012:634048. https://doi.org/10.1155/2012/634048.
- 5.↑
Guideline: Sugars intake for adults and children [Internet]. Geneva: World Health Organisation; [cited 2020 March 17]. Available from: https://www.who.int/publications/i/item/9789241549028.
- 6.↑
Sarkadi Nagy E, Bakacs M, Illés É, et al. Országos Táplálkozás és Tápláltsági Állapot Vizsgálat–OTÁP2014. II. A magyar lakosság energia- és makrotápanyag-bevitele. [Hungarian Diet and Nutritional Status Survey – OTÁP2014. II. Energy and macronutrient intake of the Hungarian population]. Orv Hetil 2017;158(15):587–97. https://doi.org/10.1556/650.2017.30718[Article in Hungarian].
- 7.↑
Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr 2013;98:1084–102. https://doi.org/10.3945/ajcn.113.058362.
- 8.↑
U.S. Department of Agriculture & U.S. Department of Health and Human Services. Dietary guidelines for Americans 2010 [Internet]. Washington DC: U.S. Government Printing Office Fund; [cited 2020 March 19]. Available from: https://health.gov/sites/default/files/2020-01/DietaryGuidelines2010.pdf.
- 9.↑
Popkin BM, Hawkes C. Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses. Lancet Diabetes Endocrinol 2016;4(2):174–86. https://doi.org/10.1016/S2213-8587(15)00419-2.
- 10.↑
OKOSTÁNYÉR® - Új magyar táplálkozási ajánlás [Internet]. Magyar Dietetikusok Országos Szövetsége: Budapest, Hungary; [cited 2020 March 24]. Available from: https://mdosz.hu/uj-taplalkozasi-ajanlasok-okos-tanyer/. [Web Site in Hungarian].
- 11.↑
Bawadi H, Khataybeh T, Obeidat B, et al.. Sugar-sweetened beverages contribute significantly to college students’ daily caloric intake in Jordan: soft drinks are not the major contributor. Nutrients 2019;11:1058. https://doi.org/10.3390/nu11051058.
- 12.↑
Bawa SH, Rupert N, Webb M. The link between the consumption of sweetened beverages and the development of overweight and obesity among students of the University of the West Indies, St. Augustine campus in Trinidad and Tobago. Rocz Panstw Zakl Hig 2018;69:251–5.
- 13.↑
Forde C. Scoring the international physical activity questionnaire (IPAQ) [Internet]. Dublin: Trinity College Dublin, The University of Dublin; 2020 [cited 2019 Nov 16]. Available from: https://ugc.futurelearn.com/uploads/files/bc/c5/bcc53b14-ec1e-4d90-88e3-1568682f32ae/IPAQ_PDF.pdf.
- 14.↑
Body Mass Index – BMI [Internet]. Geneva: World health organisation; [cited 2020 March 17]. Available from: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi.
- 15.↑
Kim TJ, Roesler NM, von dem Knesebeck O. Causation or selection – examining the relation between education and overweight/obesity in prospective observational studies: a meta-analysis. Obes Rev 2017;18:660–72. https://doi.org/10.1111/obr.12537.
- 16.↑
Busque A, Yao PL, Miquelon P, Lachance É, Rivard MC. Lifestyle and health habits of a Canadian university community. J Phys Act Res 2017;2:107–11. https://doi.org/10.12691/jpar-2-2-7.
- 17.↑
Ćosić Mulahasanović I, Nožinović Mujanović A, Mujanović E, Atiković A. Level of physical activity of the students at the university of Tuzla according to IPAQ. Cent Eur J Sport Sci Med 2018;21:23–30. https://doi.org/10.18276/cej.2018.1-03.
- 18.↑
Belingheri M, Facchetti R, Scordo F, Butturini F, Turato M, De Vito G, et al. Risk behaviors among Italian healthcare students: a cross-sectional study for health promotion of future healthcare workers. Med Lav 2019;110:155–62. https://doi.org/10.23749/mdl.v110i2.7573.
