Prevalence and Correlates of Food Addiction among University Students in the United Arab Emirates: The Role of Stress and Body Mass Index

Prevalence and Correlates of Food Addiction among University Students in the United Arab Emirates: The Role of Stress and Body Mass Index | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Correlates of Food Addiction among University Students in the United Arab Emirates: The Role of Stress and Body Mass Index Israa Moetaz, Taima Qudah, Suhad Abumweis, Lana Bustanji, Shaimaa Higazay, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7879760/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Aim: Food addiction (FA) is increasingly recognized as a possible cause of obesity and disordered eating, especially in young adults. In the UAE, rapid shifts in food culture and the elevated stress levels among college students may influence FA prevalence. The aim of this study is to assess the prevalence of FA among 392 UAE university students and its relationships to stress, age, gender and BMI. Methods: A cross-sectional study was conducted among 392 university students in the UAE between September 2024 and January 2025. Participants completed a validated online questionnaire that included the Modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) and the Perceived Stress Scale (PSS-10). Data were analyzed using chi-square tests and Pearson correlation coefficients. Results: The overall prevalence of FA was 9.9%. No significant associations were found between FA and age, gender, or marital status. Although not statistically significant, FA was more common among obese students (16.2%). Students with severe stress (25%) had a significantly higher prevalence of FA than those with mild stress (3.6%) or moderate stress (9.2%) (p = 0.014). Food addiction scores were significantly positively correlated with age (r = 0.101, p = 0.047), stress levels (r = 0.229, p < 0.001), and BMI (r = 0.258, p < 0.001). Conclusion: FA affects a considerable percentage of UAE university students and is strongly correlated with stress and BMI. Results highlight the necessity of focused programs addressing young adults' eating habits and mental health. Food addiction Perceived Stress Scale UAE Cross-sectional Introduction In recent years, the prevalence of obesity and overweight is raising in the UAE. It was estimated that 43% of the total population is overweight, 32.3% is obese, and 37.7% of university students classified obese based on body mass index (BMI) cut-off points [1]. There are multiple factors that lead to obesity and overweight, including; an imbalance between energy intake and energy expenditure, such as large portion sizes of meals, excessive energy intake, physical inactivity, high consumption of empty calories that are high in saturated fat and simple sugar and lack of vitamins and minerals, pharmacological factors, vitamin D deficiency, thyroid gland diseases, and eating disorders[2]. Eating disorders encompass various types of addiction, food restriction addiction and food consumption addiction (FA) [3]which is the point of interest of this study. The food addiction model proposes that the excessive intake of palatable and tasty food may involve neurobiological mechanisms similar to those associated with drug addiction. This concept is widely accepted in the neuroscientific literature and has been “operationalized” using criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). People experiencing FA are expected to have symptoms comparable to those of substance abuse disorders, including “loss of control, withdrawal, and cravings for problem foods” [4]. The term food addiction was used first by Theron Randolph in 1956 and he described it as “a specific adaptation to one or more regularly consumed foods to which a person is highly sensitive [which] produces a common pattern of symptoms descriptively similar to those of other addictive processes like consumption of various foods, such as corn, milk, eggs, and potatoes”[5]. By 1980, studies began to indicate that eating disorders such as anorexia nervosa and bulimia nervosa might be seen as types of addiction. Anorexia was perceived as an addiction to food deprivation, but bulimia nervosa was linked to addictive personality characteristics, especially in obese persons. Around 2010, there was a noticeable increase in interest in food addiction, rather than classifying binge eating disorder (BED) under conventional substance use frameworks, researchers created a structured interview based on the drug dependency criteria from the fourth edition of the DSM-IV.)” and they found that 92% of “participants with BED met the full criteria for substance dependence”. Additionally, the Yale Food Addiction Scale (YFAS) was developed as a self-report tool to assess symptoms of food addiction based on the diagnostic criteria used in DSM-IV [5] . Several factors contribute to the development of BEDs, including genetics, substance abuse, alteration in gut microbiome, perfectionism personality, childhood obesity, family weight concerns, environment and culture, as well as psychological factors such as depression, anxiety, and stress. These factors are regarded as high-risk, especially for young adults [6–8] The Perceived Stress Scale (PSS), a well-known psychological tool created by Cohen et al. in[7] 1983, is frequently used to measure stress levels. There were seven negative and seven positive items in the original edition (PSS-14). Later, researchers refined the scale by removing the four items with the lowest factor loadings, resulting in the more commonly used 10-item version (PSS-10) [9]. The PSS designed to assess how people view and react to stress in diverse contexts. Previous studies that measure the correlation between food addiction among people with overweight or mental health disorders found a clear relationship between food addiction and obesity, anxiety, depression, and eating disorders (anorexia nervosa, bulimia nervosa, and BED). Furthermore, the frequency of food addiction is anticipated to be higher in the 18–29 age range than in older populations due to the fact that this age group is more vulnerable to environmental factors[2]. Even in the absence of physical hunger, the consumption of some foods has increased in modern UAE society due to a number of factors, including the accessibility of a wide variety of food presentations, the rise of new restaurants and recipes, social media food trends, rising wealth, and the ease of food delivery services. Consequently, it is anticipated that a significant frequency of food addiction will exist within the population. Additionally, significant levels of stress and depression among UAE students have been documented in a number of studies [10–12]. It has been demonstrated that stress levels differ according to age, gender, and academic year[13]. The prevalence of food addiction among university students in UAE was not previously investigated. Therefore, this study aims to determine the prevalence of food addiction among university students in UAE. It also examines the relationships between food addiction and variables including perceived stress, age, weight status, academic specialty, and academic level. Method 2.1. Ethics Approval and Consent to Participate: The study protocol was approved by the Ethics Committee of Al Ain University (Reference No. COP/AREC/AD/14). Informed consent was obtained from all participants prior to their participation in the study. 2.2. Study Design, Sampling and participants : A validated cross-sectional online survey was created and circulated to UAE university students from September 2024 to January 2025 . To collect data, the questionnaire was uploaded to Google Forms, an online survey platform. Snowball sampling recruitment techniques were used to distribute the invitation to interested participants online. The online survey was first made available to university students via WhatsApp and other social media channels in order to begin the recruitment process. A short overview of the study and a link to the survey were included in the invitation. Participants were made aware that the survey was anonymous—that is, that no geolocation or personally identifiable information was gathered—and that the answers would be kept private. Participant withdrawal from the questionnaire was permitted, and completion of it was voluntary. A minimum sample size of 385 participants was recommended, according to the RaoSoft® calculator, based on a margin of error of 5%, confidence level of 95%, population size of 10 million people living in the UAE and a response distribution of 50%. The first section collected socio-demographic data, including age, gender, weight, height, marital status, education level, college affiliation, and year of study. Body Mass Index was calculated by dividing weight in kilograms by height in meters squared. The subsequent sections consisted of self-administered, internationally validated, and reliable questionnaires: the Modified Yale Food Addiction Scale (mYFAS 2.0, 13 items)[14] and the Perceived Stress Scale (PSS)[15] . 2.3: Questionnaires 2.3.1. Food addiction: The modified Yale Food Addiction Scale (mYFAS) is a tool that has been developed to identify those who are most likely to exhibit markers of food substance dependence especially the consumption of high fat /high-sugar foods [16]. There are two versions of YFAS, the early version of YFAS is YFAS 1.0 contains 25 items , and the most recent modified version is m YFAS 2.0 which has 13 items [14]. The m YFAS 2.0 aimed to enhance reliability and validity while making it easier for respondents to answer. The latter was used in our study. The mYFAS2 itself contains 13 questions with answers given on 8-point Likert scale (0 = Never; 1 = Less than monthly; 2 = Once a month; 3 = 2–3 times a month; 4 = Once a week; 5 = 2–3 times a week; 6 = 4–6 times a week; 7 = Every Day). As shown in Table 1, 11 questions of the mYFAS 2.0 assess the 11 substance-use disorder (SUD) criteria that are adapted from the Diagnostic and Statistical Manual of Mental Disorders 5th edition Text Revision (DSM-5-TR; American Psychiatric Association, and 2 questions assess the clinical impairment criterion. Each question has a different threshold: 0 = threshold not met, 1 = threshold is met After computing the threshold for each question, if the score for the symptom criterion is > 1, then the criterion has been met and is scored as 1. If the score = 0, then the symptom criterion has not been met and is scored as 0. There are two ways to score the measure. The first is a continuous scoring system that summarizes the number of the 11 SUD criteria that a person endorsed in relation to eating extremely appetizing items. Second, if a person endorses two or more symptoms in addition to disability or distress, they may meet the "diagnostic" threshold, which can be determined by scoring the measure. Severity criteria are established for those who meet the requirements for a mYFAS 2.0 'diagnosis' of food addiction: mild = two to three symptoms plus impairment or distress, moderate = four to five symptoms plus impairment or distress, and severe = six or more symptoms plus impairment [14]. The mYFAS 2.0, used in this study, showed a Cronbach's alpha of 0.759 in the previous study [17]. 2.3.2. Stress: The Perceived Stress Scale is the most widely used psychological instrument for measuring the perception of stress [15]. It is a measure of how stressful one considers certain circumstances in their life to be. The purpose of the items was to assess the degree of unpredictability, uncontrollability, and overload in the respondents' lives. A number of direct questions regarding present stress levels are also included in the scale. The PSS was designed for use with community samples who have completed at least junior high school. Both the items and the response options are easy to understand. Furthermore, because the questions are general in nature, they do not contain information specific to any particular subpopulation. The questions in the PSS ask about feelings and thoughts during the last month. In each case, respondents are asked how often they felt a certain way. Although there are versions of 5, 10, and 14 questions, the version with 10-questions is the most significant and widely used. In our research, the 10-item version was used. The answers to questions 1, 2, 3, 6, 9, and 10 are added together to determine the cumulative score. The scores for questions 4, 5, 7, and 8 are inverted. A higher score indicates greater stress. The scale demonstrated a Cronbach's alpha of 0.817 in a previous study [17] Data Analysis: The statistical analyses were carried out using SPSS software for Windows (version 26.0, Chicago, IL, USA). The significance level was set at 0.05. The prevalence of FA was calculated and reported as percentage. Chi-square test was used to find if the prevalence of FA differed between participants according to variables including the age group, gender, residency Emirate, education level, marital status, BMI categories, college, studying year and stress level. Pearson correlation coefficient was also used to evaluate the association between continuous variables. Results A total of 392 university students were included in this study. Among them 334 (85.2%) were younger than 25 years old and 58 (14.7%) were older than 25 years. About 206 (52.5%) were female and 186 (47.5%) were male students. Most of the respondents were from Abu Dhabi 236 (60%), and rest of them came from other emirates in UAE. Majority of the 364 (92.8%) reported they are single. Most of the students (58.6%) were in the healthy weight range and the rest either overweight (31.8%) or obese (9.6%) according to BMI categories (Table2). The prevalence of food addiction was nearly the same across age, gender, and marital status groups with no statistical difference. Among students, those younger than 25 years have a prevalence of 34/334 (10.1%), compared to 5/58 (10.1%) in students older than 25 years. In terms of gender, females report a prevalence of 20/206 (9.9%), which is similar to the 19/186 (9.7%) reported by males. For marital status, the prevalence among single respondents was 36/364 (9.9%), which is comparable to the 3/28(10.7%) seen in married respondents. Although the prevalence of food addiction was highest in the BMI ≥ 30 category 6/37 (16.2%), followed by overweight individuals14/125 (11.2%), the difference between these weight groups was not statistically significant (Table2). The prevalence of food addiction was highest among students studying in Pharmacy and Health Sciences colleges (14.0%), followed by Education, Business, Media, and Law (7.7%) and Engineering (5.8%). Although the p-value of 0.053 does not reach the conventional level of statistical significance (p < 0.05), it indicates a borderline trend that may warrant further investigation. (Table 2). As showing in Table 2 the prevalence of food addiction was only reported to be significantly higher in individuals with severe stress (25%) compared to those with mild stress (3.6%) or moderate stress (9.2%), with a p-value of 0.014. Table 3 presents the frequencies of the symptoms associated with food addiction as measured by mYFAS 2.0. In total, the prevalence of food addiction was 9.9% among the university students according to the mYFAS 2.0. The most common symptoms or behaviors of food addiction among university students were reported in four diagnostic criteria related to reducing in recreation activities (23.2%), the continue use despite social or interpersonal problems (27.6%), failure to fulfil daily obligation (26.5%), and the use in physically hazardous situations (23.7%). The least four criteria reported presence of food addiction are much time/ activity to obtain, use, recover; persistent desire or repeated unsuccessful attempts at quitting; substance taken in larger amount and for longer period than intended; and use causes clinically significant impairment or distress in frequencies of between 6.9%and 9.9% . Table 4 represents the correlation observed between the different study questionnaire scores, as well as between the participants’ socio-demographic quantitative variables and the questionnaire scores. Positive and significant correlation was found between the total continuous mYFAS 2.0 score and age (r=0.101, p-value=0.047), BMI (r=0.258, p-value=0.000) and the total continuous PSS score (r=0.229, p-value= 0.000). In addition, PSS scores were positively and significantly correlated to the BMI (r=0.128, p-value=0.011). There are no significant correlations between age and BMI, or age and PSS. Discussion To the best of our knowledge, this is the first study in UAE that investigate the prevalence of food addiction as well as its association with stress among university students. In this sample, the prevalence of food addiction was 9.9% among university students in UAE according to the mYFAS 2.0. Among different participants characteristics, the symptoms score of food addiction was found to be associated with age, stress status score, and BMI as measured by PSS. Our results are in agreement with previous studies on the prevalence of food addiction and factors associated with it. In Germany, the prevalence of food addiction among the population was 7.9% measured using YFAS 2.0 [18]. Similarly, A cross-sectional study conducted among 644 Lebanese university students found that the prevalence of food addiction was 10.1% using YFAS [17]. Another cross-sectional study aimed to measures the prevalence of food addiction in United State , they found that 15% of participants met the YFAS 2.0 criteria [19] . An additional study conducted in Malaysian university students with total participants of 295 reported a 15.9% prevalence of food addiction [20] . In our study, the four most frequent endorsed mYFAS 2.0 symptoms by the participants were : continue use despite social problems, failure to fulfil the daily obligations, use in physically hazardous situations, and the reduction or abandonment of important social, occupational, or recreational activities. This symptom may be directly caused by unfavourable encounters with other people and is frequently connected to traumatic childhood experiences. It has been linked to more severe symptoms of posttraumatic stress disorder (PTSD), especially in young adults and adolescents (18–24 years old). According to research, the association between interpersonal trauma and PTSD symptoms is significantly influenced by interpersonal issues, including hostility, immature or dependent conduct, and social difficulties[21]. The first commonly reported food addiction symptom in this study was continued use despite interpersonal problems. This symptom may be directly caused by unfavourable encounters with other people and is frequently connected to traumatic childhood experiences. It has been linked to more severe symptoms of PTSD, especially in young adults and adolescents (18–24 years old). According to research, the association between interpersonal trauma and PTSD symptoms is significantly influenced by interpersonal issues, including hostility, immature or dependent conduct, and social difficulties[21]. The second prevalent symptom is impaired daily function, which indicates a failure to adequately manage or accept responsibility for daily tasks. For example, the knowledge of the assignment, how to do it, and when to do it, doing tasks alone, the ability to evaluate if the task is performed well, and solving problems and identifying solutions if there is any problem[22]. The third most common symptom among students is activities giving up, which is “giving up important social, occupational, or recreational activities because of eating”. People who experience food addiction-like behaviour may avoid any social interactions when food is freely available (10). Finally, the fourth most frequent symptom was use in physically hazardous situations, which describes eating in situations when one's safety may be jeopardized, such as eating while operating a motor vehicle or taking part in dangerous activities[18]. The least frequently reported symptoms among participants were: unsuccessful attempts to cut down on certain foods, tolerance, and excessive time spent on food-related activities . Despite being conscious of their eating habits, several participants found it difficult to regulate them because of their addictive tendencies. The requirement to consume greater amounts of particular meals in order to experience the same emotional relief—such as lowering depressive moods—was indicative of tolerance. Further illustrating the complexity and difficulty of attempting to reduce, some participants reported spending a significant amount of time acquiring, consuming, or recovering after eating particular items. Age and food addiction correlations were reported in some studies. In US, a cross-sectional study aimed to measure the prevalence of food addiction and the correlations with demographics factors and obesity. They found that younger participants (add mean or age category) have greater prevalence of food addictions compared to other participants [19] . In order to determine the incidence of food addiction and its correlation with age, another study was conducted in Germany. They found that those who met the YFAS 2.0 criteria were younger, mean of 41.3 years old, than those who did not [18]. Similar to the findings of this study, previous studies have reported an association between food addiction and stress. For instance, a cross-sectional survey conducted among 362 university students looked at the relationship between food addiction using YFAS 2.0, and stress, anxiety, and depression symptoms, as measured by the Depression, Anxiety, and Stress Scale (DASS-21). They found that the rates of DAS in students with food addiction were higher compared to those in students without food addiction [23]. Furthermore, A cross-sectional study done in Malasia assessing the prevalence of food addiction among university students, sample size of 295, and factors that expected to be correlated with food addiction. Total of 15.9% were at risk of having food addiction and factors such as binge eating, anxiety, and high carbohydrate intake are significantly correlated to food addiction symptoms[20]. Another cross-sectional survey studying the prevalence and indicators of food addiction among women of low socioeconomic status and multiethnic, sample size of 1,067. Total of 2.8% of participants experience food addiction and significant correlations founded with level of depression, race and ethnicity with food addiction, black women scores was higher than Hispanic women, but low prevalence of food addiction among low-income women [24]. Stress can lead to food addiction as reported by Felix S. [25]. A cohort study conducted in German aim to analyse of chronic stress with different domains are related to food addiction using Life Adult Study with sample size of 1172. They found that there was a positive, significant association between social overload, excessive demands from work, and chronic worrying with food addiction. To understand how stress can lead to food addiction, a study done in China investigated the effect of stress application to mice for a month, sample size of 24 mice. They found that chronic stress was clearly increase the food addiction scores. Moreover, they found that chronic stress increase expression of Dopamine receptor 2 (DR2), mu-opioid receptor (MOR), and corticotropin-releasing factor receptor 1(CRFR1)[26]. A cross-sectional study conducted in Egypt studying the prevalence of food addiction and symptoms prevalence among medical students of Minia University. They found that most food addiction indicators positively associated with stress and depression, and other factors, such as low socioeconomic level, and smoking[27]. In this study, PSS shows a positive correlation with BMI. In cross-sectional study conducted among 2116 university students in Greek found that students with moderate or high perceived stress levels had a higher prevalence of overweight/obesity compared to those with low stress[28]. In another study conducted in Bangladesh among adolescent students measuring the prevalence and correlated risks of overweight/obesity and perceived stress using eating behaviours and physical activity. They found that BMI and eating behaviours are positively and significantly correlated with perceived stress, whereas physical activity is significantly correlated with the prevalence of overweight/obesity and high stress[29]. In our study, BMI was associated with both stress and food addiction scores. This suggests that increased energy consumption, which may be impacted by the various challenges students face while attending university, could significantly worsen weight gain and the potential development of eating disorders. Comparing this finding with other studies, a cross-sectional survey done among adult with total participants of 172 reported that 22.7% of participants with overweight and obesity had met the criteria of food addiction according to YFAS 2.0. Also, food addiction symptoms were higher in participants with high BMI, mean 32.0 kg/m2, body fat mass, diastolic blood pressure, and sedentary lifestyle [30]. Study strengths and limitations To the best of our knowledge, this is the first study in the UAE to investigate the prevalence of food addiction and its association with stress among university students. However, several limitations should be acknowledged. The use of self-reported questionnaires may introduce response bias, and the use of a convenience sampling technique to collect data from various universities across the UAE may limit the generalizability of the findings and introduce selection bias. Furthermore, information on students' dietary consumption, usual food types, eating habits, frequency of snacking, meal skipping, and nutrient intake was not included in the study. Additionally, no data on past medical history, ongoing medical conditions, or current medication use was gathered, which might have affected the outcomes. Despite these limitations, this study is the first of its type in the United Arab Emirates to investigate the relationship between stress and food addiction using validated tools, the PSS and the modified mYFAS 2.0. It offers insightful information about the psychological and behavioural aspects of food addiction in college students. Conclusion and Recommendation This study reveals that food addiction affects a considerable percentage of university students in the UAE and is significantly associated with stress, BMI, and age. These findings highlight the importance of addressing both mental health and dietary behaviors among young adults in academic settings. The findings indicate that stress reduction and the encouragement of better eating practices should be the primary focuses of successful prevention and intervention programs. By providing organized activities like educational workshops, mental health support, nutrition counselling, and awareness campaigns, universities can play a significant role. The danger of food addiction in students can be reduced by giving them access to trained professionals such as dietitians and psychiatrists, as well as by providing them with guidance on stress management techniques and how to plan nutritious meals. Declarations Human Ethics and Consent to Participate The study protocol was approved by the Ethics Committee of Al Ain University (Reference No. COP/AREC/AD/14). Informed consent was obtained from all participants prior to their participation in the study. 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Overweight and Obesity Is Associated with Higher Risk of Perceived Stress and Poor Sleep Quality in Young Adults. Medicina (Kaunas). 2024 Jun 14;60(6). Roy SK, Jahan K, Alam N, Rois R, Ferdaus A, Israt S, Karim MR. Perceived stress, eating behavior, and overweight and obesity among urban adolescents. J Health Popul Nutr. 2021 Dec 17;40(1):54. Zielińska M, Łuszczki E, Szymańska A, Dereń K. Food addiction and the physical and mental health status of adults with overweight and obesity. PeerJ. 2024;12:e17639. Tables Table 1: Mapping DSM-5 Substance Use Disorder Criteria to Modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) Questions and Scoring Thresholds. DSM-5 SUD criteria mYFAS 2.0 question Question Threshold to score 1 1) Substance taken in larger amount and for longer period than intended I ate to the point where I felt physically ill Once a week (=>4) 2) Persistent desire or repeated unsuccessful attempts to quit I tried and failed to cut down on or stop eating certain foods. Two to three times a week (=>5) 3) Much time/activity to obtain, use, recover I spent more time feeling sluggish or tired from overeating. Two to three times a week (=>5) 4) Important social, occupational, or recreational activities given up or reduced I avoided work, school or social activities because I was afraid, I would overeat there. Once a month (=>2): 5) Use continues despite knowledge of adverse consequences (e.g., emotional problems, physical problems) I kept eating in the same way even though my eating caused emotional problems. Once a week (=>4) 6) Tolerance (marked increase in amount; marked decrease in effect) Eating the same amount of food did not give me as much enjoyment as it used to. Two to three times a week (=>5) 7) Characteristic withdrawal symptoms; substance taken to relieve withdrawal If I had emotional problems because I had not eaten certain foods, I would eat those foods to feel better. Once a week (=>4) 8) Continued use despite social or interpersonal problems My friends or family were worried about how much I overate. Once a month (=>2). 9) Failure to fulfill major role obligation (e.g., work, school, home) My overeating got in the way of me taking care of my family or doing household chores. Once a month (=>2). 10) Use in physically hazardous situations I was so distracted by eating that I could have been hurt (e.g. when driving a car, crossing the street and operating machinery). Once a month (=>2). 11) Craving, or a strong desire or urge to use I had such strong urges to eat certain foods that I could not think of anything else. Once a week (=>4). 12) Use causes clinically significant impairment or distress I had significant problems in my life because of food and eating. These may have been problems with my daily routine, work, school, friends, family or health. My eating behaviour caused me much distress. Two to three times a week (=>5). Table2: Prevalence of Food Addiction Measured by the Yale Food Addiction Scale Among University students. Characteristics Total Prevalence of food addiction P Age (years), n (%) <25 ≥25 392 334 58 39 (9.9) 34 (10.1) 5 (8.6) 0.714 Gender, n (%) female male 392 206 186 39 (9.9) 20 (9.7) 19 (10.2) 0.867 Emirates, n (%) Abu Dhabi Ajman Alain Dubai Ras Al Khaimah Sharjah Umm Al Quwain 392 236 7 86 26 1 35 1 39 (9.9) 27 (11.4) 1 (14.2) 4 (4.7) 3 (11.5) 0 (0) 4 (11.4) 0 (0) 0.703 Marital status, n (%) Single Married 392 364 28 39 (9.9) 36 (9.9) 3 (10.7) 0.888 BMI a , n (%) < 25.0 25.0- 29.9 ≥ 30.0 392 230 125 37 39 (9.9) 19 (8.2) 14 (11.2) 6 (16.2) 0.276 College, n (%) Pharmacy and health sciences Engineering Education, business, Media and Law 392 171 104 117 39 (9.9) 24 (14.0) 6 (5.8) 9 (7.7) 0.053 Studying year, n (%) Year 1 Year 2 Year 3 Year 4 Year 5 Postgraduate 392 38 80 112 91 24 47 39 (9.9) 7 (18.4) 7 (8.8) 9 (8.0) 8 (8.8) 3 (12.5) 5 (10.6) 0.554 Stress status, n (%) Mild Moderate Severe 392 28 336 28 39 (9.9) 1 (3.6) 31 (9.2) 7 (25) 0.014* a Body mass index (BMI) < 25.0 kg/m 2 , underweight or normal weight; BMI 25.0-29.9 kg/m 2 , overweight, (BMI) ≥ 30.0 kg/m 2, obese. *p<0.05 considered statistically significant using chi-square test Table 3: Frequencies of the symptoms associated with food addiction as measured by mYFAS 2.0 N = 392 Percentage Food Addiction diagnosis (Total YFAS) Yes No 39 353 9.9 90.1 Substance taken in larger amount and for longer period than intended Yes No 39 353 9.9 90.1 Persistent desire or repeated unsuccessful attempts at quitting Yes No 33 359 8.4 91.6 Much time/ activity to obtain, use, recover Yes No 27 365 6.9 93.1 Important social, occupational or recreational activities given up or reduced Yes No 91 301 23.2 76.8 Use continues despite knowledge of adverse consequences (e.g. failure to fulfil role obligation, use when physically hazardous Yes No 54 338 13.8 86.2 Tolerance (marked increase in amount, marked decrease in effect Yes No 38 354 9.7 90.3 Characteristic withdrawal symptoms, substance taken to relieve withdrawal yes No 51 341 13 87 Continued use despite social or interpersonal problems Yes No 108 284 27.6 72.4 Failure to fulfil major role obligation ( e.g work , school, home ) Yes No 104 288 26.5 73.5 Use in physically hazardous situations Yes No 93 299 23.7 76.3 Craving, or a strong desire or urge to use Yes No 57 335 14.5 85.5 Use causes clinically significant impairment or distress Yes No 39 353 9.9 90.1 Table 4: Pearson’s correlations observed between the different questionnaire scores and the participants socio-demographic quantitative variables and the questionnaire scores. Age BMI PSS mYFAS 2.0 mYFAS 2.0 Pearson’s Correlation 0.101 * 0.258 ** 0.229 ** 1 P value .047 .000 .000 . N 392 392 392 392 PSS Pearson Correlation -.028 .128 * 1 .229 ** P value .582 .011 . .000 N 392 392 392 392 BMI Pearson Correlation .032 1 .128 * .258 ** P value .531 . .011 .000 N 392 392 392 392 Age Pearson Correlation 1 .032 -.028 .101 * P value . .531 .582 .047 N 392 392 392 392 BMI, body mass index; mYFAS 2.0, modified Yale Food Addiction Scale 2.0 (based on the DSM-5 criteria for substance-related and addictive disorders; 13 items). PSS; *p<0.05 considered statistically significant. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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23:39:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":910225,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7879760/v1/ceeceb51-6e5c-4ccf-9dde-9ecf8afafadd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Correlates of Food Addiction among University Students in the United Arab Emirates: The Role of Stress and Body Mass Index","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent years, the prevalence of obesity and overweight is raising in the UAE. It was estimated that 43% of the total population is overweight, 32.3% is obese, and 37.7% of university students classified obese based on body mass index (BMI) cut-off points [1]. There are multiple factors that lead to obesity and overweight, including; an imbalance between energy intake and energy expenditure, such as large portion sizes of meals, excessive energy intake, physical inactivity, high consumption of empty calories that are high in saturated fat and simple sugar and lack of vitamins and minerals, pharmacological factors, vitamin D deficiency, thyroid gland diseases, and eating disorders[2]. Eating disorders encompass various types of addiction, food restriction addiction and food consumption addiction (FA) [3]which is the point of interest of this study.\u003c/p\u003e\u003cp\u003eThe food addiction model proposes that the excessive intake of palatable and tasty food may involve neurobiological mechanisms similar to those associated with drug addiction. This concept is widely accepted in the neuroscientific literature and has been \u0026ldquo;operationalized\u0026rdquo; using criteria from the \u003cem\u003eDiagnostic and Statistical Manual of Mental Disorders\u003c/em\u003e (DSM-IV). People experiencing FA are expected to have symptoms comparable to those of substance abuse disorders, including \u0026ldquo;loss of control, withdrawal, and cravings for problem foods\u0026rdquo; [4].\u003c/p\u003e\u003cp\u003eThe term food addiction was used first by Theron Randolph in 1956 and he described it as \u0026ldquo;a specific adaptation to one or more regularly consumed foods to which a person is highly sensitive [which] produces a common pattern of symptoms descriptively similar to those of other addictive processes like consumption of various foods, such as corn, milk, eggs, and potatoes\u0026rdquo;[5].\u003c/p\u003e\u003cp\u003eBy 1980, studies began to indicate that eating disorders such as anorexia nervosa and bulimia nervosa might be seen as types of addiction. Anorexia was perceived as an addiction to food deprivation, but bulimia nervosa was linked to addictive personality characteristics, especially in obese persons. Around 2010, there was a noticeable increase in interest in food addiction, rather than classifying binge eating disorder (BED) under conventional substance use frameworks, researchers created a structured interview based on the drug dependency criteria from the fourth edition of the DSM-IV.)\u0026rdquo; and they found that 92% of \u0026ldquo;participants with BED met the full criteria for substance dependence\u0026rdquo;. Additionally, the Yale Food Addiction Scale (YFAS) was developed as a self-report tool to assess symptoms of food addiction based on the diagnostic criteria used in DSM-IV [5] .\u003c/p\u003e\u003cp\u003eSeveral factors contribute to the development of BEDs, including genetics, substance abuse, alteration in gut microbiome, perfectionism personality, childhood obesity, family weight concerns, environment and culture, as well as psychological factors such as depression, anxiety, and stress. These factors are regarded as high-risk, especially for young adults [6\u0026ndash;8]\u003c/p\u003e\u003cp\u003eThe Perceived Stress Scale (PSS), a well-known psychological tool created by Cohen et al. in[7] 1983, is frequently used to measure stress levels. There were seven negative and seven positive items in the original edition (PSS-14). Later, researchers refined the scale by removing the four items with the lowest factor loadings, resulting in the more commonly used 10-item version (PSS-10) [9]. The PSS designed to assess how people view and react to stress in diverse contexts.\u003c/p\u003e\u003cp\u003ePrevious studies that measure the correlation between food addiction among people with overweight or mental health disorders found a clear relationship between food addiction and obesity, anxiety, depression, and eating disorders (anorexia nervosa, bulimia nervosa, and BED). Furthermore, the frequency of food addiction is anticipated to be higher in the 18\u0026ndash;29 age range than in older populations due to the fact that this age group is more vulnerable to environmental factors[2].\u003c/p\u003e\u003cp\u003eEven in the absence of physical hunger, the consumption of some foods has increased in modern UAE society due to a number of factors, including the accessibility of a wide variety of food presentations, the rise of new restaurants and recipes, social media food trends, rising wealth, and the ease of food delivery services. Consequently, it is anticipated that a significant frequency of food addiction will exist within the population.\u003c/p\u003e\u003cp\u003eAdditionally, significant levels of stress and depression among UAE students have been documented in a number of studies [10\u0026ndash;12]. It has been demonstrated that stress levels differ according to age, gender, and academic year[13].\u003c/p\u003e\u003cp\u003eThe prevalence of food addiction among university students in UAE was not previously investigated. Therefore, this study aims to determine the prevalence of food addiction among university students in UAE. It also examines the relationships between food addiction and variables including perceived stress, age, weight status, academic specialty, and academic level.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.1. Ethics Approval and Consent to Participate:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The study protocol was approved by the Ethics Committee of Al Ain University (Reference No. COP/AREC/AD/14). Informed consent was obtained from all participants prior to their participation in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.2. Study Design, Sampling and participants\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA validated cross-sectional online survey was created and circulated to UAE university students from September 2024 to January 2025\u003cem\u003e.\u0026nbsp;\u003c/em\u003eTo collect data, the questionnaire was uploaded to Google Forms, an online survey platform. Snowball sampling recruitment techniques were used to distribute the invitation to interested participants online. The online survey was first made available to university students via WhatsApp and other social media channels in order to begin the recruitment process. A short overview of the study and a link to the survey were included in the invitation. Participants were made aware that the survey was anonymous—that is, that no geolocation or personally identifiable information was gathered—and that the answers would be kept private. Participant withdrawal from the questionnaire was permitted, and completion of it was voluntary. A minimum sample size of 385 participants was recommended, according to the RaoSoft® calculator, based on a margin of error of 5%, confidence level of 95%, population size of 10 million people living in the UAE and a response distribution of 50%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe first section collected socio-demographic data, including age, gender, weight, height, marital status, education level, college affiliation, and year of study. Body Mass Index was calculated by dividing weight in kilograms by height in meters squared. The subsequent sections consisted of self-administered, internationally validated, and reliable questionnaires: the Modified Yale Food Addiction Scale (mYFAS 2.0, 13 items)[14]\u0026nbsp;and the Perceived Stress Scale (PSS)[15] .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3: Questionnaires\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;2.3.1. Food addiction:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe modified Yale Food Addiction Scale (mYFAS) is a tool that has been developed to identify those who are most likely to exhibit markers of food substance dependence especially the consumption of high fat /high-sugar foods [16]. There are two versions of YFAS, the early version of YFAS is \u003cstrong\u003eYFAS 1.0\u003c/strong\u003e contains 25 items\u003cstrong\u003e,\u003c/strong\u003e and the most recent modified version is m\u003cstrong\u003eYFAS 2.0\u003c/strong\u003e which has 13 items [14]. The m\u003cstrong\u003eYFAS 2.0\u0026nbsp;\u003c/strong\u003eaimed to enhance reliability and validity while making it easier for respondents to answer. The latter was used in our study. The mYFAS2 itself contains 13 questions with answers given on 8-point Likert scale (0 = Never; 1 = Less than monthly; 2 = Once a month; 3 = 2–3 times a month; 4 = Once a week; 5 = 2–3 times a week; 6 = 4–6 times a week; 7 = Every Day). As shown in Table 1, 11 questions of the mYFAS 2.0 assess the 11 substance-use disorder (SUD) criteria that are adapted from the Diagnostic and Statistical Manual of Mental Disorders 5th edition Text Revision (DSM-5-TR; American Psychiatric Association, and 2 questions assess the clinical impairment criterion. Each question has a different threshold: 0 = threshold not met, 1 = threshold is met\u003c/p\u003e\n\u003cp\u003eAfter computing the threshold for each question, if the score for the symptom criterion is \u0026gt; 1, then the criterion has been met and is scored as 1. If the score = 0, then the symptom criterion has not been met and is scored as 0.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;There are two ways to score the measure.\u0026nbsp;\u003cbr\u003eThe first is a continuous scoring system that summarizes the number of the 11 SUD criteria that a person endorsed in relation to eating extremely appetizing items. Second, if a person endorses two or more symptoms in addition to disability or distress, they may meet the \"diagnostic\" threshold, which can be determined by scoring the measure. Severity criteria are established for those who meet the requirements for a mYFAS 2.0 'diagnosis' of food addiction: mild = two to three symptoms plus impairment or distress, moderate = four to five symptoms plus impairment or distress, and severe = six or more symptoms plus impairment [14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe mYFAS 2.0, used in this study, showed a Cronbach's alpha of 0.759 in the previous study [17].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;2.3.2. Stress:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The Perceived Stress Scale is the most widely used psychological instrument for measuring the perception of stress [15]. It is a measure of how stressful one considers certain circumstances in their life to be. The purpose of the items was to assess the degree of unpredictability, uncontrollability, and overload in the respondents' lives. A number of direct questions regarding present stress levels are also included in the scale. The PSS was designed for use with community samples who have completed at least junior high school. Both the items and the response options are easy to understand. Furthermore, because the questions are general in nature, they do not contain information specific to any particular subpopulation. The questions in the PSS ask about feelings and thoughts during the last month. In each case, respondents are asked how often they felt a certain way. Although there are versions of 5, 10, and 14 questions, the version with 10-questions is the most significant and widely used. In our research, the 10-item version was used. The answers to questions 1, 2, 3, 6, 9, and 10 are added together to determine the cumulative score. The scores for questions 4, 5, 7, and 8 are inverted. A higher score indicates greater stress. The scale demonstrated a Cronbach's alpha of 0.817 in a previous study [17]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eData Analysis:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe statistical analyses were carried out using SPSS software for Windows (version 26.0, Chicago, IL, USA). The significance level was set at 0.05. The prevalence of FA was calculated and reported as percentage. Chi-square test was used to find if the prevalence of FA differed between participants according to variables including the age group, gender, residency Emirate, education level, marital status, BMI categories, college, studying year and stress level. Pearson correlation coefficient was also used to evaluate the association between continuous variables.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 392 university students were included in this study. \u0026nbsp;Among them 334 (85.2%) were younger than 25 years old and 58 (14.7%) were older than 25 years. About 206 (52.5%) were female and 186 (47.5%) were male students. Most of the respondents were from Abu Dhabi 236 (60%), and rest of them came from other emirates in UAE. Majority of the 364 (92.8%) reported they are single. Most of the students (58.6%) were in the healthy weight range and the rest either overweight (31.8%) or obese \u0026nbsp; (9.6%) according to BMI categories (Table2).\u003c/p\u003e\n\u003cp\u003eThe prevalence of food addiction was \u0026nbsp;nearly the same across age, gender, and marital status groups with no statistical difference. Among students, those younger than 25 years have a prevalence of 34/334 (10.1%), compared to 5/58 (10.1%) in students older than 25 years. In terms of gender, females report a prevalence of 20/206 (9.9%), which is similar to the 19/186 (9.7%) reported by males. For marital status, the prevalence among single respondents was 36/364 (9.9%), which is comparable to the 3/28(10.7%) seen in married respondents. Although the prevalence of food addiction was highest in the BMI \u0026ge; 30 category 6/37 (16.2%), followed by overweight individuals14/125 (11.2%), the difference between these weight groups was not statistically significant (Table2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe prevalence of food addiction was highest among students studying in Pharmacy and Health Sciences colleges (14.0%), followed by Education, Business, Media, and Law (7.7%) and Engineering (5.8%). Although the p-value of 0.053 does not reach the conventional level of statistical significance (p \u0026lt; 0.05), it indicates a borderline trend that may warrant further investigation. (Table 2).\u003c/p\u003e\n\u003cp\u003eAs showing in Table 2 the prevalence of food addiction was only reported to be significantly higher in individuals with severe stress (25%) compared to those with mild stress (3.6%) or moderate stress (9.2%), with a p-value of 0.014.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 3 presents the frequencies of the symptoms associated with food addiction as measured by mYFAS 2.0. In total, the prevalence of food addiction was 9.9% among the university students according to the mYFAS 2.0. The most common symptoms or behaviors of food addiction among university students were reported in four diagnostic criteria related to reducing in recreation activities \u0026nbsp; (23.2%), the continue use despite social or interpersonal problems (27.6%), failure to fulfil daily obligation \u0026nbsp;(26.5%), and the use in physically hazardous situations (23.7%). \u0026nbsp;The least four criteria reported presence of food addiction are much time/ activity to obtain, use, recover; persistent desire or repeated unsuccessful attempts at quitting; substance taken in larger amount and for longer period than intended; and use causes clinically significant impairment or distress in frequencies of between 6.9%and 9.9% .\u003c/p\u003e\n\u003cp\u003eTable 4 represents the correlation observed between the different study questionnaire scores, as well as between the participants\u0026rsquo; socio-demographic quantitative variables and the questionnaire scores. Positive and significant correlation was found between the total continuous mYFAS 2.0 score and age (r=0.101, p-value=0.047), BMI (r=0.258, p-value=0.000) and the total continuous PSS score (r=0.229, p-value= 0.000). In addition, PSS scores were positively and significantly correlated to the BMI (r=0.128, p-value=0.011). There are no significant correlations between age and BMI, or age and PSS.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this is the first study in UAE that investigate the prevalence of food addiction as well as its association with stress among university students. In this sample, the prevalence of food addiction was 9.9% among university students in UAE according to the mYFAS 2.0. Among different participants characteristics, the symptoms score of food addiction was found to be associated with age, stress status score, and BMI as measured by PSS. \u003c/p\u003e\n\n\u003cp\u003eOur results are in agreement with previous studies on the prevalence of food addiction and factors associated with it. In Germany, the prevalence of food addiction among the population was 7.9% measured using YFAS 2.0 [18]. Similarly, A cross-sectional study conducted among 644 Lebanese university students found that the prevalence of food addiction was 10.1% using YFAS [17]. Another cross-sectional study aimed to measures the prevalence of food addiction in United State , they found that 15% of participants met the YFAS 2.0 criteria \u003cspan lang=\"EN-US\"\u003e[19]\u003c/span\u003e. An additional study conducted in Malaysian university students with total participants of 295 reported a 15.9% prevalence of food addiction \u003cspan lang=\"EN-US\"\u003e[20]\u003c/span\u003e.\u003c/p\u003e\n\n\u003cp\u003eIn our study, the four most frequent endorsed mYFAS 2.0 symptoms by the participants were : continue use despite social problems, failure to fulfil the daily obligations, use in physically hazardous situations, and the reduction or abandonment of important social, occupational, or recreational activities.\u003c/p\u003e\n\n\u003cp\u003eThis symptom may be directly caused by unfavourable encounters with other people and is frequently connected to traumatic childhood experiences. It has been linked to more severe symptoms of posttraumatic stress disorder (PTSD), especially in young adults and adolescents (18\u0026ndash;24 years old). According to research, the association between interpersonal trauma and PTSD symptoms is significantly influenced by interpersonal issues, including hostility, immature or dependent conduct, and social difficulties[21]. \u003c/p\u003e\n\n\u003cp\u003eThe first commonly reported food addiction symptom in this study was continued use despite interpersonal problems. This symptom may be directly caused by unfavourable encounters with other people and is frequently connected to traumatic childhood experiences. It has been linked to more severe symptoms of PTSD, especially in young adults and adolescents (18\u0026ndash;24 years old). According to research, the association between interpersonal trauma and PTSD symptoms is significantly influenced by interpersonal issues, including hostility, immature or dependent conduct, and social difficulties[21]. The second prevalent symptom is impaired daily function, which indicates a failure to adequately manage or accept responsibility for daily tasks. For example, the knowledge of the assignment, how to do it, and when to do it, doing tasks alone, the ability to evaluate if the task is performed well, and solving problems and identifying solutions if there is any problem[22]. The third most common symptom among students is activities giving up, which is \u0026ldquo;giving up important social, occupational, or recreational activities because of eating\u0026rdquo;. People who experience food addiction-like behaviour may avoid any social interactions when food is freely available (10). Finally, the fourth most frequent symptom was use in physically hazardous situations, which describes eating in situations when one\u0026apos;s safety may be jeopardized, such as eating while operating a motor vehicle or taking part in dangerous activities[18].\u003c/p\u003e\n\n\u003cp\u003eThe least frequently reported symptoms among participants were: unsuccessful attempts to cut down on certain foods, tolerance, and excessive time spent on food-related activities\u003cstrong\u003e.\u003c/strong\u003e Despite being conscious of their eating habits, several participants found it difficult to regulate them because of their addictive tendencies. The requirement to consume greater amounts of particular meals in order to experience the same emotional relief\u0026mdash;such as lowering depressive moods\u0026mdash;was indicative of tolerance. Further illustrating the complexity and difficulty of attempting to reduce, some participants reported spending a significant amount of time acquiring, consuming, or recovering after eating particular items.\u003c/p\u003e\n\n\u003cp\u003eAge and food addiction correlations were reported in some studies. In US, a cross-sectional study aimed to measure the prevalence of food addiction and the correlations with demographics factors and obesity. They found that younger participants (add mean or age category) have greater prevalence of food addictions compared to other participants \u003cspan lang=\"EN-US\"\u003e[19]\u003c/span\u003e. In order to determine the incidence of food addiction and its correlation with age, another study was conducted in Germany. They found that those who met the YFAS 2.0 criteria were younger, mean of 41.3 years old, than those who did not [18]. \u003c/p\u003e\n\n\n\n\n\u003cp\u003eSimilar to the findings of this study, previous studies have reported an association between food addiction and stress. For instance, a cross-sectional survey conducted among 362 university students looked at the relationship between food addiction using YFAS 2.0, and stress, anxiety, and depression symptoms, as measured by the Depression, Anxiety, and Stress Scale (DASS-21). They found that the rates of DAS in students with food addiction were higher compared to those in students without food addiction [23].\u003c/p\u003e\n\n\u003cp\u003eFurthermore, A cross-sectional study done in Malasia assessing the prevalence of food addiction among university students, sample size of 295, and factors that expected to be correlated with food addiction. Total of 15.9% were at risk of having food addiction and factors such as binge eating, anxiety, and high carbohydrate intake are significantly correlated to food addiction symptoms[20]. Another cross-sectional survey studying the prevalence and indicators of food addiction among women of low socioeconomic status and multiethnic, sample size of 1,067. Total of 2.8% of participants experience food addiction and significant correlations founded with level of depression, race and ethnicity with food addiction, black women scores was higher than Hispanic women, but low prevalence of food addiction among low-income women [24]. \u003c/p\u003e\n\n\u003cp\u003eStress can lead to food addiction as reported by Felix S. [25]. A cohort study conducted in German aim to analyse of chronic stress with different domains are related to food addiction using Life Adult Study with sample size of 1172. They found that there was a positive, significant association between social overload, excessive demands from work, and chronic worrying with food addiction. To understand how stress can lead to food addiction, a study done in China investigated the effect of stress application to mice for a month, sample size of 24 mice. They found that chronic stress was clearly increase the food addiction scores. Moreover, they found that chronic stress increase expression of Dopamine receptor 2 (DR2), mu-opioid receptor (MOR), and corticotropin-releasing factor receptor 1(CRFR1)[26]. A cross-sectional study conducted in Egypt studying the prevalence of food addiction and symptoms prevalence among medical students of Minia University. They found that most food addiction indicators positively associated with stress and depression, and other factors, such as low socioeconomic level, and smoking[27].\u003c/p\u003e\n\n\u003cp\u003eIn this study, PSS shows a positive correlation with BMI. In cross-sectional study conducted among 2116 university students in Greek found that students with moderate or high perceived stress levels had a higher prevalence of overweight/obesity compared to those with low stress[28]. In another study conducted in Bangladesh among adolescent students measuring the prevalence and correlated risks of overweight/obesity and perceived stress using eating behaviours and physical activity. They found that BMI and eating behaviours are positively and significantly correlated with perceived stress, whereas physical activity is significantly correlated with the prevalence of overweight/obesity and high stress[29]. \u003c/p\u003e\n\n\u003cp\u003eIn our study, BMI was associated with both stress and food addiction scores. This suggests that increased energy consumption, which may be impacted by the various challenges students face while attending university, could significantly worsen weight gain and the potential development of eating disorders. Comparing this finding with other studies, a cross-sectional survey done among adult with total participants of 172 reported that 22.7% of participants with overweight and obesity had met the criteria of food addiction according to YFAS 2.0. Also, food addiction symptoms were higher in participants with high BMI, mean 32.0 kg/m2, body fat mass, diastolic blood pressure, and sedentary lifestyle [30]. \u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eStudy strengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo the best of our knowledge, this is the first study in the UAE to investigate the prevalence of food addiction and its association with stress among university students. However, several limitations should be acknowledged. The use of self-reported questionnaires may introduce response bias, and the use of a convenience sampling technique to collect data from various universities across the UAE may limit the generalizability of the findings and introduce selection bias.\u003c/p\u003e\n\u003cp\u003eFurthermore, information on students\u0026apos; dietary consumption, usual food types, eating habits, frequency of snacking, meal skipping, and nutrient intake was not included in the study. Additionally, no data on past medical history, ongoing medical conditions, or current medication use was gathered, which might have affected the outcomes.\u003c/p\u003e\n\u003cp\u003eDespite these limitations, this study is the first of its type in the United Arab Emirates to investigate the relationship between stress and food addiction using validated tools, the PSS and the modified mYFAS 2.0. It offers insightful information about the psychological and behavioural aspects of food addiction in college students.\u003c/p\u003e"},{"header":"Conclusion and Recommendation","content":"\u003cp\u003eThis study reveals that food addiction affects a considerable percentage of university students in the UAE and is significantly associated with stress, BMI, and age. These findings highlight the importance of addressing both mental health and dietary behaviors among young adults in academic settings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe findings indicate that stress reduction and the encouragement of better eating practices should be the primary focuses of successful prevention and intervention programs. By providing organized activities like educational workshops, mental health support, nutrition counselling, and awareness campaigns, universities can play a significant role. The danger of food addiction in students can be reduced by giving them access to trained professionals such as dietitians and psychiatrists, as well as by providing them with guidance on stress management techniques and how to plan nutritious meals.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committee of Al Ain University (Reference No. COP/AREC/AD/14). Informed consent was obtained from all participants prior to their participation in the study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthor Declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All authors declare that they have no competing interests related to this study. Additionally, all authors have contributed to the study design, data analysis, and manuscript preparation. \u0026nbsp;There are no conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailable on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNo fund received.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSulaiman N, Elbadawi S, Hussein A, Abusnana S, Madani A, Mairghani M, Alawadi F, Sulaiman A, Zimmet P, Huse O, Shaw J, Peeters A. Prevalence of overweight and obesity in United Arab Emirates Expatriates: the UAE National Diabetes and Lifestyle Study. Diabetol Metab Syndr. 2017 Dec 2;9(1):88. \u003c/li\u003e\n\u003cli\u003eRomero-Blanco C, Hern\u0026aacute;ndez-Mart\u0026iacute;nez A, Parra-Fern\u0026aacute;ndez ML, Onieva-Zafra MD, Prado-Laguna MDC, Rodr\u0026iacute;guez-Almagro J. Food Addiction and Lifestyle Habits among University Students. Nutrients. 2021 Apr 18;13(4). \u003c/li\u003e\n\u003cli\u003eHauck C, Cook B, Ellrott T. Food addiction, eating addiction and eating disorders. Proceedings of the Nutrition Society. 2020;79(1):103\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eWestwater ML, Fletcher PC, Ziauddeen H. Sugar addiction: the state of the science. Eur J Nutr. 2016 Nov 2;55(S2):55\u0026ndash;69. \u003c/li\u003e\n\u003cli\u003eMeule A. Back by Popular Demand: A Narrative Review on the History of Food Addiction Research. Yale J Biol Med. 2015 Sep;88(3):295\u0026ndash;302. \u003c/li\u003e\n\u003cli\u003eLim MC, Parsons S, Goglio A, Fox E. Anxiety, stress, and binge eating tendencies in adolescence: a prospective approach. J Eat Disord. 2021 Aug 3;9(1):94. \u003c/li\u003e\n\u003cli\u003eMars JA, Iqbal A, Rehman A. Binge Eating Disorder. 2025. \u003c/li\u003e\n\u003cli\u003eMathes WF, Brownley KA, Mo X, Bulik CM. The biology of binge eating. Appetite. 2009 Jun;52(3):545\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eShe Z, Li D, Zhang W, Zhou N, Xi J, Ju K. Three Versions of the Perceived Stress Scale: Psychometric Evaluation in a Nationally Representative Sample of Chinese Adults during the COVID-19 Pandemic. Int J Environ Res Public Health. 2021 Aug 5;18(16):8312. \u003c/li\u003e\n\u003cli\u003eRazzak HA, Harbi A, Ahli S. Depression: Prevalence and associated risk factors in the United Arab Emirates. Vol. 34, Oman Medical Journal. Oman Medical Specialty Board; 2019. p. 274\u0026ndash;83. \u003c/li\u003e\n\u003cli\u003eAl Marzouqi AM, Otim ME, Alblooshi A, Al Marzooqi S, Talal M, Wassim F. State of Emotional Health Disorders of Undergraduate Students in the United Arab Emirates: A Cross-Sectional Survey. Psychol Res Behav Manag. 2022;15:1423\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eBayram N, Bilgel N. The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Soc Psychiatry Psychiatr Epidemiol. 2008 Apr;43(8):667\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eAlalalmeh SO, Hegazi OE, Shahwan M, Hassan N, Humaid Alnuaimi GR, Alaila RF, Jairoun A, Tariq Hamdi Y, Abdullah MT, Abdullah RM, Zyoud SH. Assessing mental health among students in the UAE: A cross-sectional study utilizing the DASS-21 scale. Saudi Pharmaceutical Journal. 2024 Apr;32(4):101987. \u003c/li\u003e\n\u003cli\u003eSchulte EM, Gearhardt AN. Development of the Modified Yale Food Addiction Scale Version 2.0. European Eating Disorders Review. 2017 Jul 1;25(4):302\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eCohen S, Kamarck T, Mermelstein R. A Global Measure of Perceived Stress. Vol. 24, Source: Journal of Health and Social Behavior. 1983. \u003c/li\u003e\n\u003cli\u003eGearhardt AN, Corbin WR, Brownell KD. Preliminary validation of the Yale Food Addiction Scale. Appetite. 2009 Apr;52(2):430\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eNajem J, Saber M, Aoun C, El Osta N, Papazian T, Rabbaa Khabbaz L. Prevalence of food addiction and association with stress, sleep quality and chronotype: A cross-sectional survey among university students. Clinical Nutrition. 2020 Feb 1;39(2):533\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eHauck C, Wei\u0026szlig; A, Schulte EM, Meule A, Ellrott T. Prevalence of \u0026ldquo;Food Addiction\u0026rdquo; as Measured with the Yale Food Addiction Scale 2.0 in a Representative German Sample and Its Association with Sex, Age and Weight Categories. Obes Facts. 2017;10(1):12\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eSchulte EM, Gearhardt AN. 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Evaluation of the relationship between food addiction and depression, anxiety, and stress in university students: A cross-sectional survey. J Child Adolesc Psychiatr Nurs. 2023 Aug;36(3):256\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eBerenson AB, Laz TH, Pohlmeier AM, Rahman M, Cunningham KA. Prevalence of Food Addiction Among Low-Income Reproductive-Aged Women. J Womens Health (Larchmt). 2015 Sep;24(9):740\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eHussenoeder FS, Conrad I, L\u0026ouml;bner M, Engel C, Reyes N, Yahiaoui-Doktor M, Glaesmer H, Hinz A, Witte V, Schroeter ML, Medawar E, Wichmann G, Kirsten T, L\u0026ouml;ffler M, Villringer A, Riedel-Heller SG. The different areas of chronic stress and food addiction: Results from the LIFE-Adult-Study. Stress Health. 2024 Jun;40(3):e3348. \u003c/li\u003e\n\u003cli\u003eWei NL, Quan ZF, Zhao T, Yu XD, Xie Q, Zeng J, Ma FK, Wang F, Tang QS, Wu H, Zhu JH. Chronic stress increases susceptibility to food addiction by increasing the levels of DR2 and MOR in the nucleus accumbens. Neuropsychiatr Dis Treat. 2019;15:1211\u0026ndash;29. \u003c/li\u003e\n\u003cli\u003eMarwa Abdelrehim. Indicators and Determinants of Food Addiction among Fourth-grade Medical Students of Minia University in Egypt. The Egyptian Journal of Community Medicine. 2021 Oct 1;39(4):33\u0026ndash;41. \u003c/li\u003e\n\u003cli\u003eDakanalis A, Voulgaridou G, Alexatou O, Papadopoulou SK, Jacovides C, Pritsa A, Chrysafi M, Papacosta E, Kapetanou MG, Tsourouflis G, Antonopoulou M, Mitsiou M, Antasouras G, Giaginis C. Overweight and Obesity Is Associated with Higher Risk of Perceived Stress and Poor Sleep Quality in Young Adults. Medicina (Kaunas). 2024 Jun 14;60(6). \u003c/li\u003e\n\u003cli\u003eRoy SK, Jahan K, Alam N, Rois R, Ferdaus A, Israt S, Karim MR. Perceived stress, eating behavior, and overweight and obesity among urban adolescents. J Health Popul Nutr. 2021 Dec 17;40(1):54. \u003c/li\u003e\n\u003cli\u003eZielińska M, Łuszczki E, Szymańska A, Dereń K. Food addiction and the physical and mental health status of adults with overweight and obesity. PeerJ. 2024;12:e17639. \u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Mapping DSM-5 Substance Use Disorder Criteria to Modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) Questions and Scoring Thresholds.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDSM-5 SUD criteria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003emYFAS 2.0 question\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Threshold to score 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1) Substance taken in larger amount and for longer period than intended\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI ate to the point where I felt physically ill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOnce a week (=\u0026gt;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2) Persistent desire or repeated unsuccessful attempts to quit\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI tried and failed to cut down on or stop eating certain foods.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTwo to three times a week (=\u0026gt;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3) Much time/activity to obtain, use, recover\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI spent more time feeling sluggish or tired from overeating.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTwo to three times a week (=\u0026gt;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4) Important social, occupational, or recreational activities given up or reduced\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI avoided work, school or social activities because I was afraid, I would overeat there.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOnce a month (=\u0026gt;2):\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5) Use continues despite knowledge of adverse consequences (e.g., emotional problems, physical problems)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI kept eating in the same way even though my eating caused emotional problems.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOnce a week (=\u0026gt;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6) Tolerance (marked increase in amount; marked decrease in effect)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEating the same amount of food did not give me as much enjoyment as it used to.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTwo to three times a week (=\u0026gt;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7) Characteristic withdrawal symptoms; substance taken to relieve withdrawal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIf I had emotional problems because I had not eaten certain foods, I would eat those foods to feel better.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOnce a week (=\u0026gt;4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8) Continued use despite social or interpersonal problems\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMy friends or family were worried about how much I overate.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOnce a month (=\u0026gt;2).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9) Failure to fulfill major role obligation (e.g., work, school, home)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMy overeating got in the way of me taking care of my family or doing household chores.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOnce a month (=\u0026gt;2).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10) Use in physically hazardous situations\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI was so distracted by eating that I could have been hurt (e.g. when driving a car, crossing the street and operating machinery).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOnce a month (=\u0026gt;2).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11) Craving, or a strong desire or urge to use\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI had such strong urges to eat certain foods that I could not think of anything else.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOnce a week (=\u0026gt;4).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12) Use causes clinically significant impairment or distress\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI had significant problems in my life because of food and eating. These may have been problems with my daily routine, work, school, friends, family or health.\u003c/p\u003e\n \u003cp\u003eMy eating behaviour caused me much distress.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Two to three times a week (=\u0026gt;5).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable2: Prevalence of Food Addiction Measured by the Yale Food Addiction Scale Among University students.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"590\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrevalence of food addiction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (years), \u003cem\u003en\u0026nbsp;\u003c/em\u003e(%) \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026lt;25\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;≥25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003cp\u003e334\u003c/p\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (9.9)\u003c/p\u003e\n \u003cp\u003e34 (10.1)\u003c/p\u003e\n \u003cp\u003e5 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender, \u003cem\u003en\u0026nbsp;\u003c/em\u003e(%) \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;female\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003cp\u003e206\u003c/p\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (9.9)\u003c/p\u003e\n \u003cp\u003e20 (9.7)\u003c/p\u003e\n \u003cp\u003e19 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmirates, \u003cem\u003en\u0026nbsp;\u003c/em\u003e(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Abu Dhabi\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Ajman\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Alain\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Dubai\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Ras Al Khaimah\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Sharjah\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Umm Al Quwain\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (9.9)\u003c/p\u003e\n \u003cp\u003e27 (11.4)\u003c/p\u003e\n \u003cp\u003e1 (14.2)\u003c/p\u003e\n \u003cp\u003e4 (4.7)\u003c/p\u003e\n \u003cp\u003e3 (11.5)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e4 (11.4)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.703\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarital status, \u003cem\u003en\u0026nbsp;\u003c/em\u003e(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Single\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Married\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003cp\u003e364\u003c/p\u003e\n \u003cp\u003e28\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (9.9)\u003c/p\u003e\n \u003cp\u003e36 (9.9)\u003c/p\u003e\n \u003cp\u003e3 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.888\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBMI\u003csup\u003ea\u0026nbsp;\u003c/sup\u003e, \u003cem\u003e\u0026nbsp;n\u0026nbsp;\u003c/em\u003e(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026lt; 25.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 25.0- 29.9\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;≥ 30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003cp\u003e230\u003c/p\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (9.9)\u003c/p\u003e\n \u003cp\u003e19 (8.2)\u003c/p\u003e\n \u003cp\u003e14 (11.2)\u003c/p\u003e\n \u003cp\u003e6 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCollege, \u003cem\u003en\u0026nbsp;\u003c/em\u003e(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Pharmacy and health sciences\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Engineering \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Education, business, Media and Law\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (9.9)\u003c/p\u003e\n \u003cp\u003e24 (14.0)\u003c/p\u003e\n \u003cp\u003e6 (5.8)\u003c/p\u003e\n \u003cp\u003e9 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStudying year, \u003cem\u003en\u0026nbsp;\u003c/em\u003e(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Year 1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Year 2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Year 3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Year 4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Year 5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Postgraduate\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (9.9)\u003c/p\u003e\n \u003cp\u003e7 (18.4)\u003c/p\u003e\n \u003cp\u003e7 (8.8)\u003c/p\u003e\n \u003cp\u003e9 (8.0)\u003c/p\u003e\n \u003cp\u003e8 (8.8)\u003c/p\u003e\n \u003cp\u003e3 (12.5)\u003c/p\u003e\n \u003cp\u003e5 (10.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStress status,\u003cem\u003e\u0026nbsp;n\u0026nbsp;\u003c/em\u003e(%)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Mild\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Moderate\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Severe\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e336\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (9.9)\u003c/p\u003e\n \u003cp\u003e1 (3.6)\u003c/p\u003e\n \u003cp\u003e31 (9.2)\u003c/p\u003e\n \u003cp\u003e7 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.014*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eBody mass index (BMI) \u0026lt; 25.0 kg/m\u003csup\u003e2\u003c/sup\u003e,\u003csup\u003e\u0026nbsp;\u003c/sup\u003eunderweight or normal weight; BMI 25.0-29.9 kg/m\u003csup\u003e2\u003c/sup\u003e, overweight, (BMI) ≥ 30.0 kg/m\u003csup\u003e2,\u003c/sup\u003e obese.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e*p\u0026lt;0.05 considered statistically significant using chi-square test\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Frequencies of the symptoms associated with food addiction as measured by mYFAS 2.0\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"591\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 392\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFood Addiction diagnosis (Total YFAS)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003cp\u003e353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003cp\u003e90.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubstance taken in larger amount and for longer period than intended\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003cp\u003e353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003cp\u003e90.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePersistent desire or repeated unsuccessful attempts at quitting\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003cp\u003e359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003cp\u003e91.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMuch time/ activity to obtain, use, recover\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003cp\u003e93.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eImportant social, occupational or recreational activities given up or reduced\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e91\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003cp\u003e76.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUse continues despite knowledge of adverse consequences (e.g. failure to fulfil role obligation, use when physically hazardous\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003cp\u003e338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003cp\u003e86.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTolerance (marked increase in amount, marked decrease in effect\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003cp\u003e354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003cp\u003e90.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCharacteristic withdrawal symptoms, substance taken to relieve withdrawal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eyes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003cp\u003e341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eContinued use despite social or interpersonal problems\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003cp\u003e284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27.6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e72.4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFailure to fulfil major role obligation ( e.g work , school, home )\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26.5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e73.5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUse in physically hazardous situations\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23.7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCraving, or a strong desire or urge to use\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003cp\u003e335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14.5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e85.5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUse causes clinically significant impairment or distress\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003cp\u003e90.1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Pearson’s correlations observed between the different questionnaire scores and the participants socio-demographic quantitative variables and the questionnaire scores.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003emYFAS 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003emYFAS 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePearson’s Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.101\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.258\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.229\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePSS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePearson Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.128\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.229\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eBMI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePearson Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.128\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.258\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePearson Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.101\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI, body mass index; mYFAS 2.0, modified Yale Food Addiction Scale 2.0 (based on the DSM-5 criteria for substance-related and addictive disorders; 13 items). PSS; *p\u0026lt;0.05 considered statistically significant.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Food addiction, Perceived Stress Scale, UAE, Cross-sectional","lastPublishedDoi":"10.21203/rs.3.rs-7879760/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7879760/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and Aim:\u003c/h2\u003e\u003cp\u003eFood addiction (FA) is increasingly recognized as a possible cause of obesity and disordered eating, especially in young adults. In the UAE, rapid shifts in food culture and the elevated stress levels among college students may influence FA prevalence. The aim of this study is to assess the prevalence of FA among 392 UAE university students and its relationships to stress, age, gender and BMI.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted among 392 university students in the UAE between September 2024 and January 2025. Participants completed a validated online questionnaire that included the Modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) and the Perceived Stress Scale (PSS-10). Data were analyzed using chi-square tests and Pearson correlation coefficients.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eThe overall prevalence of FA was 9.9%. No significant associations were found between FA and age, gender, or marital status. Although not statistically significant, FA was more common among obese students (16.2%). Students with severe stress (25%) had a significantly higher prevalence of FA than those with mild stress (3.6%) or moderate stress (9.2%) (p\u0026thinsp;=\u0026thinsp;0.014). Food addiction scores were significantly positively correlated with age (r\u0026thinsp;=\u0026thinsp;0.101, p\u0026thinsp;=\u0026thinsp;0.047), stress levels (r\u0026thinsp;=\u0026thinsp;0.229, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and BMI (r\u0026thinsp;=\u0026thinsp;0.258, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eFA affects a considerable percentage of UAE university students and is strongly correlated with stress and BMI. Results highlight the necessity of focused programs addressing young adults' eating habits and mental health.\u003c/p\u003e","manuscriptTitle":"Prevalence and Correlates of Food Addiction among University Students in the United Arab Emirates: The Role of Stress and Body Mass Index","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-13 10:14:28","doi":"10.21203/rs.3.rs-7879760/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a95298c4-2403-4e0a-88f1-b30ca34a8580","owner":[],"postedDate":"November 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-26T23:39:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-13 10:14:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7879760","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7879760","identity":"rs-7879760","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}