The Diet Quality of Medical Students in the United States During the Early COVID-19 Pandemic
Keywords:Medical students, Diet, Body mass index, COVID-19 pandemic, Diet surveys
Background: Medical students report lacking the knowledge to conduct nutrition counseling for patients and practice good dietary quality in their personal life. This cross-sectional study describes the dietary quality of medical students at one Midwestern College of medicine during the early COVID-19 pandemic in the United States of America.
Methods: Cross-sectional study based on a survey applied to medical students (n=102) during spring 2020. We used the Rapid Eating Assessment for Participants–Shortened (REAP-S) to assess dietary quality during the COVID-19 pandemic. The response rate was 27%. The primary outcome was to obtain total mean REAP-S scores and identify variables related to poor diet quality.
Results: A mean REAP-S score of 30.5, SD=3.9 (range 13-39) was obtained (67% of ideal dietary quality). Body weight remained the same for 54.9% of students, 25.7% gained weight, and 18.8% lost weight during the late spring of 2020. Students with BMI < 24.9 kg/m2 (mean REAP-S score of 31.6±3.6) had a significantly better dietary quality (p < 0.001) compared to students with BMI > 25 kg/m2 (mean REAP-S score of 28.9±3.9). Students with a self-reported “less healthy” diet (mean REAP-S=28.2±3.3) had significantly worse dietary quality (p < 0.001) compared to those who either maintained a healthy diet (mean REAP-S=31.1±3.8) or improved diet (mean REAP-s=31.9±3.6). Of note, 89.2% of students indicated that they want to improve their diet.
Conclusion: The dietary quality of participants was found to be sub-optimal during the early COVID-19 pandemic, potentially impacting our future medical workforce's long-term health adversely.
Cresci G, Beidelschies M, Tebo J, Hull A. Educating Future Physicians in Nutritional Science and Practice: The Time Is Now. J Am Coll Nutr. 2019;38(5):387–94.
Global Health Risks: Mortality and burden of disease attributable to selected major risks [Internet]. Vol. 87, Bulletin of the World Health Organization. Web site. https://www.who.int/publications/i/item/97892415638713. Updated 2009. Accessed November 30, 2020.
Matthews JI, Doerr L, Dworatzek PD. University students intend to eat better but lack coping self-efficacy and knowledge of dietary recommendations. J Nutr Educ Behav. 2016;48(1):12-9.e1.
Gramlich LM, Olstad DL, Nasser R, et al. Medical students’ perceptions of nutrition education in canadian universities. Appl Physiol Nutr Metab. 2010;35(3):336-43.
Perlstein R, McCoombe S, Macfarlane S, Bell C, Nowson C. Nutrition practice and knowledge of first-year medical students. J Biomed Educ. 2017;2017:1-10.
Crowley J, Ball L, Hiddink GJ. Nutrition in medical education: A systematic review. Lancet Planetary Heal. 2019;3(9):e379-89.
Finkelstein EA, Khavjou OA, Thompson H, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med. 2012;42(6):563-70.
Healthy eating index (HEI). USDA Food and Nutrition Service Web site. https://www.fns.usda.gov/resource/healthy-eating-index-hei. Updated 2020. Accessed November 30, 2020.
Johnston CS, Bliss C, Knurick JR, Scholtz C. Rapid eating assessment for participants [shortened version] scores are associated with healthy eating index-2010 scores and other indices of diet quality in healthy adult omnivores and vegetarians. Nutr J. 2018;17(1):89.
Mayra S, Ugarte N, Johnston CS. Health biomarkers in adults are more closely linked to diet quality attributes than to plant-based diet categorization. Nutrients. 2019;11(6):1427.
Segal-Isaacson CJ, Wylie-Rosett J, Gans KM. Validation of a short dietary assessment questionnaire: The rapid eating and activity assessment for participants short version (REAP-S). Diabetes Educ. 2004;30(5):774-81.
Gallo LA, Gallo TF, Young SL, Moritz KM, Akison LK. The impact of isolation measures due to COVID-19 on energy intake and physical activity levels in australian university students. Nutrients. 2020;12(6):1865.
Pellegrini M, Ponzo V, Rosato R, et al. Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency. Nutrients. 2020;12(7):2016.
Novel coronavirus: Events, public gatherings, and schools guidance (march 16-31, 2020). Department of Health and Human Services. Web Site. https://cdn.education.ne.gov/wp-content/uploads/2020/03/COVID-19-Events-Public-Gatherings-Schools-Guidance.pdf. Updated 2020. Accessed November 30, 2020.
Fulgoni III VL, Keast DR, Drewnowski A. Development and validation of the nutrient-rich foods index: A tool to measure nutritional quality of foods. J Nutr. 2009;139(8):1549-54.
Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc. 1995;95(7):791-7.
Welch AA, Mulligan A, Bingham SA, Khaw K. Urine pH is an indicator of dietary acid–base load, fruit and vegetables and meat intakes: Results from the european prospective investigation into cancer and nutrition (EPIC)-norfolk population study. Br J Nutr. 2008;99(6):1335-43.
Neuhouser ML, Patterson RE, King IB, Horner NK, Lampe JW. Selected nutritional biomarkers predict diet quality. Public Health Nutr. 2003;6(7):703-9.
Weinstein SJ, Vogt TM, Gerrior SA. Healthy eating index scores are associated with blood nutrient concentrations in the third national health and nutrition examination survey. J Am Diet Assoc. 2004;104(4):576-84.
Hall KD, Kahan S. Maintenance of lost weight and long-term management of obesity. Med Clin North Am. 2018;102(1):183-97.
Dragun R, Ve?ek NN, Marendi? M, et al. Have lifestyle habits and psychological well-being changed among adolescents and medical students due to COVID-19 lockdown in croatia? Nutrients. 2021;13(1):97.
Naska A, Lagiou A, Lagiou P. Dietary assessment methods in epidemiological research: Current state of the art and future prospects. F1000Res. 2017;6.
Ruiz-Roso MB, Knott-Torcal C, Matilla-Escalante DC, et al. COVID-19 lockdown and changes of the dietary pattern and physical activity habits in a cohort of patients with type 2 diabetes mellitus. Nutrients. 2020;12(8):2327.
Ammar A, Brach M, Trabelsi K, et al. Effects of COVID-19 home confinement on eating behaviour and physical activity: Results of the ECLB-COVID19 international online survey. Nutrients. 2020;12(6):1583.
Naja F, Hamadeh R. Nutrition amid the COVID-19 pandemic: A multi-level framework for action. Eur J Clin Nutr. 2020;74(8):1117-21.
Evidence-based clinical nutrition education for medical students, residents, fellows, and other physicians. Nutrition in Medicine Web site. https://www.nutritioninmedicine.org/. Updated 2014. Accessed February 22, 2021.
Healthy kitchens healthy lives. Healthy Kitchens Healthy Lives Web site. https://www.healthykitchens.org/. Updated 2021. Accessed February 22, 2021.
Health meets food. the culinary medicine curriculum. Health meets Food. The Culinary Medicine.org Web site. https://culinarymedicine.org/. Accessed February 22, 2021.
Evans Susan, Khandalavala Birgit., O'Malley Brian, Geske Jenenne, Lydiatt Maxwell. Impact of an interprofessional mediterranean culinary course on medical student nutrition skills. STFM Medical Student Conference. 2020.
#HealthyAtHome: Healthy diet. World Health Organization Web site. https://www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---healthy-diet. Updated 2021. Accessed 3 March 2021.
- 2022-07-12 (3)
- 2022-06-30 (2)
How to Cite
Copyright (c) 2022 Mira Yousef, Birgit Khandalavala
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to email@example.com
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to firstname.lastname@example.org