Dietary habits, lifestyle and self-medication in an Italian and Spanish university population

BACKGROUND: Over the past 20 years there has been an increase in obesity rates among university students, therefore they should be seen as a group that requires special attention regarding health promotion. The interest in a healthy diet can lead to a psychological obsession known as orthorexia nervosa (ON), frequent among students in the biomedical field and in the sports context. The high levels of stress recorded in university students have been related to the use of drugs to enhance their cognitive abilities. However, a high adherence to the Mediterranean diet (MD) can bring cognitive benefits, with an improvement in depressive symptoms and anxiety, enabling a better academic outcome. AIM: The aim of this study was to evaluate self-medication, adherence to MD, and the relationship between lifestyle and biomarkers of metabolic status in a university population. METHODS: Students, doctoral students, post-docs and specialists have been recruited in Italy (N = 108) and Spain (N = 86). Data were collected through questionnaires in order to evaluate lifestyle, self-medication, alcohol consumption (AUDIT), eating habits, in particular adherence to MD and food neophobia (FN), level of physical activity (IPAQ), orthorexia (ORTO-15 and subscores), body concerns (MBSRQ and BUT), psychological distress (K10), eating attitude (EAT-26) and malnutrition (SSI). Participants have been evaluated with clinical parameters of metabolic status (glycaemia, cholesterol, triglycerides, and ketones). RESULTS: Italian females had higher MED-55 and FNS (Food Neophobia Scale) scores, and a lower AUDIT score than Spaniards (p < 0.01). Students who stayed with their family (resident) were more adherent to MD than those who moved away from home. Resident Italians consumed less beer, hard liquors, and cocktails than Spaniards on Saturday nights (p < 0.01). There were negative correlations between AUDIT and QueMD (R2: 0.137, p < 0.05), and AUDIT and non-typical MD foods score (ntMED) (R2: 0.201, p < 0.01) in Spaniards; however, there was no relationship between AUDIT and other MD scores. Most of the sample (72.8% of IT and 62.3% of SP) used medicines without medical prescription, with a higher tendency to self-medication among Italian females (IT-F) and Spanish males (SP-M). Moreover, 47.6% of IT and 31.1% of SP read the leaflet before taking a drug (p < 0.05). The ORTO-15 positive subjects, assessed with the originally proposed cut-off, were above 70% in both IT and SP students, with a higher prevalence in the Spanish sample (96-97%). According to ORTO-7, about 30% of Italian and 48% of Spanish students were positive to ON, with not significant gender differences. When excluding students underweight, overweight or obese, as well as those potentially at risk of eating disorders or presenting mild, moderate, and severe distress (K10neg-EAT-26neg subgroup), we did not find many correlations between ORTO scores and BUT, SSI, total MBSRQ and some of its components. ORTO-7 resulted the only ON score unrelated with body mass index, MBSRQ components and IPAQ-assessed intense activity, in the NW - K10neg -EAT-26neg subgroup. After this sort of “exclusion diagnosis”, the prevalence of ON of these students on the overall sample resulted of 16.9%, 12.2%, 15.2% and 25.9% for IT-F, IT-M, SP-F and SP-M, respectively. As regards the metabolic status, Spaniards had higher blood glucose levels than Italians (IT-F vs SP-F, p < 0.01; IT-M vs SP-M, p < 0.001), whereas a state of ketosis has been observed in SP-M. CONCLUSION: Results of this study suggest that non-typical MD foods and Saturday night consumptions, related to being far from home, have a great impact on alcohol consumption. In some university students ON could be a symptom of other conditions related to body image concerns and distress, as well as to high PA and appearance, fitness, health, or illness orientation. However, ORTO-7 became independent from these confounding, after the exclusion of underweight, overweight, obese and students positive to EAT-26 and K10, suggesting the possibility of identifying orthorexic subjects with this specific questionnaire.