Exploring The Relationship Between High Dietary Sugars And Saturated Fat With Lower Back Pain Among University Students In Lebanon: A Cross Sectional Study

Exploring The Relationship Between High Dietary Sugars And Saturated Fat With Lower Back Pain Among University Students In Lebanon: A Cross Sectional Study | 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 Exploring The Relationship Between High Dietary Sugars And Saturated Fat With Lower Back Pain Among University Students In Lebanon: A Cross Sectional Study Georges Jarrouge, Clarita Zgheib, Rami Akiki, Christian El Chemaly, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9107940/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background: Lower back pain is recognized as a leading cause of disability and a major public health concern. Despite growing interest in lifestyle-related risk factors, the potential link between high intake of dietary sugars and saturated fats in relation to lower back pain remains poorly investigated, particularly among university students in Lebanon where westernized dietary habits are common. This study aims to examine the association between high dietary sugar and saturated fat intake and lower back pain, and to assess its prevalence and characteristics among Lebanese university students. Methods: A cross-sectional survey was carried out during the academic year 2025–2026 using a standardized, self-administered online questionnaire among Lebanese university students. Dietary intake of sugars and saturated fats was assessed using the Dietary Fat and Free Sugar Short Questionnaire (DFS), while lower back pain was evaluated using the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2). Statistical tests were performed using SPSS to examine associations, with significance set at p < 0.05. Results: A total of 361 participants were recruited. Findings show that the affective pain domain had the highest mean score among the SF-MPQ-2 pain subscales (2.44 ± 2.55). Moreover, males reported higher overall DFS scores than females (68.52 ± 19.59 vs 64.57 ± 15.80, p = 0.038), as well as higher sugar intake scores (15.48 ± 4.96 vs 14.03 ± 4.56, p = 0.004). However, pain scores did not differ significantly between sexes. Sugar intake shows the strongest correlation with lower back pain scores (r = 0.33, p < 0.001), followed by fat intake (r = 0.29, p < 0.001). These findings suggest a potential association between higher consumption of fat and sugar rich foods and greater lower back pain severity. Conclusions: This study brings attention to the potential link between high dietary sugar and saturated fat intake and lower back pain among Lebanese university students. These findings highlight the importance of considering dietary behaviors as potential contributors to lower back pain in young adults. Lower back pain Sugar intake Fat intake university students Lebanon Introduction Lower back pain will continue to impose a substantial global health burden, affecting approximately 619 million individuals worldwide and is expected to increase to nearly 843 million cases by 2050, largely due to population aging and lifestyle-related factors such as physical inactivity and obesity (Ferreira et al., 2023 ). Lower back pain is increasingly recognized as a major public health concern worldwide, representing one of the leading causes of disability among young and adult populations (Hartvigsen et al., 2018 ). Emerging evidence suggests that lifestyle factors, particularly unhealthy dietary patterns characterized by high intake of dietary sugars and saturated fats, are associated with increased musculoskeletal pain and functional limitations (Strath et al., 2021). Diets high in sugars and saturated fats have been shown to induce chronic low-grade inflammation through elevated production of pro-inflammatory cytokines and metabolic dysregulation (Ma et al., 2022 ), and this inflammatory state contributes to pain sensitization and degenerative changes in spinal structures involved in lower back pain (Fernandes et al., 2018 ). Moreover, recent findings indicate that pro-inflammatory dietary patterns, characterized by high intake of sugars and saturated fats, disrupt normal pain modulation mechanisms, leading to increased nociceptive sensitivity and greater perception of lower back pain (Elma et al., 2024 ). Recurrent or persistent lower back pain in adults is associated with an increased risk of chronic musculoskeletal disorders and long-term functional impairment, with early symptoms significantly predicting progression to chronic pain conditions (Hoy et al., 2014 ). A substantial proportion of lower back pain cases may be preventable through modification of lifestyle-related risk factors. A large prospective cohort study involving over 140,000 adults reported that modifiable behaviors, including elevated body mass index and prolonged sedentary time, were significantly associated with an increased risk of developing lower back pain, with risk estimates indicating increases of approximately 10% compared to individuals with healthier lifestyle profiles (Xiao et al., 2025 ). Abdominal obesity has been shown to be significantly associated with lower back pain among U.S. adults aged 18 years and older. A cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) found that individuals in the highest quartile of A Body Shape Index (ABSI) exhibited significantly greater odds of low back pain compared to those in lower quartiles (Xie et al., 2025 ). According to regional prevalence estimates derived from the Global Burden of Disease 2019 study, more than 43 million individuals across Middle Eastern and North African countries were affected by lower back pain in 2019, highlighting its widespread burden among adult populations. These findings underscore the urgency of addressing lower back pain as a major public health priority in the Arab region (Safiri et al., 2023 ). Unhealthy lifestyle behaviors have been identified as important contributors to lower back pain among young adults. Moreover, a cross-sectional study conducted among university students in Saudi Arabia reported a high prevalence of lower back pain, affecting 66.4% of participants, with significantly greater pain severity observed among students with poor sleep quality and prolonged sedentary behavior. The study further highlighted that lower levels of physical activity and poorer nutritional behaviors were associated with increased lower back pain severity (Alshehri et al., 2023 ). In Lebanon, it was reported in 2014 that 37.8% of participants followed a westernized dietary pattern characterized by high consumption of fast foods, fried foods, desserts, and sugar-sweetened beverages, and demonstrated significant associations between dietary patterns, body mass index, and physical inactivity. These findings highlight the presence of modifiable lifestyle behaviors among Lebanese university students that may predispose this population to adverse long-term health outcomes (Salameh et al., 2014 ). Furthermore, a cross-sectional study of office workers in Lebanon found that approximately 44.8% of participants experienced lower back pain, with females accounting for 68% of the affected cases and males accounting for 32% (Bawab et al., 2015 ). Despite the high prevalence of unhealthy dietary patterns among Lebanese university students and the substantial burden of lower back pain reported among Lebanese adults, no study to date has directly examined the relationship between dietary sugar and saturated fat consumption and lower back pain among the Lebanese university student population. The main objective of this study is to explore the relationship between high dietary sugar and saturated fat consumption and lower back pain among Lebanese university students. This study aims to assess the prevalence, severity, and frequency of lower back pain within this population, while examining the association between dietary patterns and pain outcomes. By identifying potential lifestyle-related contributors to lower back pain, this research seeks to provide evidence that may support future preventive strategies and health-promoting interventions targeting university students. Materials and Methods Participants and Study Design This cross-sectional study involved 361 university students from different universities in Lebanon during the 2025–2026 academic year. Data were collected using a self-administered online questionnaire. A convenience sampling method was employed, with participants recruited through university networks and social media platforms. The questionnaire was distributed electronically and completed voluntarily by students. The survey collected socio-demographic information including age and gender, as well as anthropometric and lifestyle-related data. In addition, dietary intake patterns and lower back pain characteristics were assessed using standardized questionnaires Ethical Considerations Ethical approval was obtained from the Human Research Protection Program (HRPP) and the Research Ethics Committee at the Holy Spirit University of Kaslik (USEK) (reference number: HRPP/202610/FT/044). The study was conducted in accordance with the principles outlined in the Declaration of Helsinki (World Medical Association, 2013 ). Participants were fully informed about the study’s objectives and procedures prior to participation. Electronic informed consent was obtained from all participants, and participation was entirely voluntary. Data confidentiality and anonymity were strictly maintained to ensure the protection of participants’ privacy. Survey Structure The questionnaire used in this study was designed with three main sections to assess participants’ demographic characteristics, lifestyle habits, dietary intake, and lower back pain. The first section collected baseline sociodemographic and lifestyle information, including gender, age, height, weight, and frequency of physical exercise. The second section assessed participants’ food consumption patterns using the Dietary Fat and Free Sugar Short Questionnaire (DFS), which evaluates habitual intake of foods rich in saturated fats and free sugars. The third section evaluated lower back pain using the Short-Form McGill Pain Questionnaire–2 (SF-MPQ-2), which measures different dimensions and intensities of pain experienced by participants. Assessment of dietary intake Participants’ dietary intake was assessed using the Dietary Fat and Free Sugar Short Questionnaire (DFS), a validated instrument designed to estimate habitual consumption of saturated fats and free sugars. The questionnaire evaluates dietary intake over the previous year and has demonstrated acceptable validity and test–retest reliability (Francis & Stevenson, 2012). The DFS consists of 26 items, of which most food and beverage items are rated using a five-point frequency scale ranging from “less than once per month” to “five or more times per week.” One item assesses added sugar intake using categorical response options based on the estimated number of teaspoons of sugar consumed per week. Mean dietary intake scores were calculated based on participants’ responses, with higher scores indicating greater consumption of saturated fats and free sugars. Assessment of lower back pain Lower back pain was assessed using the English version of the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2), a validated multidimensional instrument used to evaluate pain intensity and quality (Dworkin et al., 2009 ). The questionnaire includes 22 pain descriptors covering four domains: neuropathic, intermittent, continuous, and affective pain. Participants rated the intensity of each pain descriptor experienced during the previous week using a numeric rating scale ranging from 0 (no pain) to 10 (worst possible pain). Mean scores were calculated for each pain subscale as well as an overall mean SF-MPQ-2 score across all 22 items, with higher scores indicating greater lower back pain severity. Data Collection and Storage The survey was web-based, and data were collected via a secure digital platform. All participants provided electronic informed consent prior to their enrollment in the study, and participation was completely voluntary. No identifiable information was collected, and all responses remained confidential, accessible only to the research team. All data were stored in password-protected files. The datasets generated and analyzed during the study are available from the corresponding author upon reasonable request. Data Analysis The survey was distributed electronically among university students across Lebanon to obtain a diverse sample of the student population. Participation was voluntary; therefore, the sample represents a convenience sample and may not be fully representative of all Lebanese university students. Data collected through the questionnaires were anonymized and securely stored prior to analysis. Statistical analyses were conducted using IBM SPSS Statistics (version 27). Descriptive statistics were used to summarize socio-demographic, anthropometric, dietary, and pain-related variables. Continuous variables were presented as means and standard deviations, while categorical variables were expressed as frequencies and percentages. Associations between dietary intake scores and lower back pain measures were examined using correlation analyses. Statistical significance was set at p < 0.05. Results Table 1 Characteristics of participants (N = 361) Variable Category / Statistic N % Age (years) Mean (± SD) 19.52 ± 1.58 – Gender Female 196 54.3 Male 165 45.7 BMI (kg/m²) Mean (± SD) 24.05 ± 10.09 – Frequency of physical exercise Never 43 11.9 Rarely (once a month) 89 24.7 Occasionally (1–2 times/week) 116 32.1 Regularly (3–5 times/week) 90 24.9 Daily 23 6.4 A total of 361 participants were included in the analysis. The mean age of the sample was 19.52 ± 1.58 years. Females comprised slightly more than half of the study population (196 participants, 54.3%), while males accounted for 165 participants (45.7%). The mean body mass index (BMI) was 24.05 ± 10.09 kg/m². Regarding physical activity, the largest proportion of participants reported engaging in exercise occasionally, defined as 1–2 times per week (32.1%). Approximately one quarter of participants reported exercising rarely (once a month; 24.7%) or regularly (3–5 times per week; 24.9%). Smaller proportions reported never exercising (11.9%) or exercising daily (6.4%). Table 2 Dietary habits frequency over the past year using the DFS questionnaire (N = 361) Variable Less than 1 per month 2–3 per month 1–2 per week 3–4 per week 5 + per week 1. Mince, beef or lamb 47 (13%) 83 (23%) 131 (36.3%) 80 (22.2%) 20 (5.5%) 2. Beef or pork 83 (23%) 93 (25.8%) 121 (33.5%) 42 (11.6%) 22 (6.1%) 3. Fried chicken / chicken burgers 51 (14.1%) 101 (28%) 136 (37.7%) 54 (15%) 19 (5.3%) 4. Sausages / frankfurts / salami 192 (53.2%) 72 (19.9%) 56 (15.5%) 31 (8.6%) 10 (2.8%) 5. Bacon 224 (62%) 61 (16.9%) 37 (10.2%) 26 (7.2%) 13 (3.6%) 6. Salad dressings (not low fat) 55 (15.2%) 88 (24.4%) 130 (36%) 65 (18%) 23 (6.4%) 7. Margarine / butter / oil in cooking 46 (12.7%) 51 (14.1%) 125 (34.6%) 88 (24.4%) 51 (14.1%) 8. Eggs (not egg whites alone) 47 (13%) 88 (24.4%) 128 (35.5%) 63 (17.5%) 35 (9.7%) 9. Pizza 80 (22.2%) 143 (39.6%) 92 (25.5%) 37 (10.2%) 9 (2.5%) 10. Cheese / cheese spread (not low fat) 35 (9.7%) 84 (23.3%) 105 (29.1%) 86 (23.8%) 51 (14.1%) 11. French fries / fried potatoes 28 (7.8%) 99 (27.4%) 134 (37.1%) 75 (20.8%) 25 (6.9%) 12. Corn chips / potato chips / popcorn with butter 79 (21.9%) 115 (31.9%) 107 (29.6%) 47 (13%) 13 (3.6%) 13. Doughnuts / pastries / croissants 87 (24.1%) 126 (34.9%) 95 (26.3%) 40 (11.1%) 13 (3.6%) 14. Cakes / cookies 79 (21.9%) 122 (33.8%) 104 (28.8%) 37 (10.2%) 19 (5.3%) 15. Ice cream (not sorbet or low fat) 89 (24.7%) 118 (32.7%) 93 (25.8%) 48 (13.3%) 13 (3.6%) 16. Chocolate 30 (8.3%) 60 (16.6%) 121 (33.5%) 95 (26.3%) 55 (15.2%) 17. Lollies 193 (53.5%) 66 (18.3%) 58 (16.1%) 31 (8.6%) 13 (3.6%) 18. Spreads (peanut butter / jam / honey) 112 (31%) 102 (28.3%) 85 (23.5%) 44 (12.2%) 18 (5%) 19. Pancakes / french toast 154 (42.7%) 94 (26%) 70 (19.4%) 31 (8.6%) 12 (3.3%) 20. Sports drinks / energy drinks 186 (51.5%) 56 (15.5%) 68 (18.8%) 37 (10.2%) 14 (3.9%) 21. Soft drinks (not diet) 91 (25.2%) 72 (19.9%) 101 (28%) 53 (14.7%) 44 (12.2%) 22. Full-fat milk 64 (17.7%) 71 (19.7%) 113 (31.3%) 71 (19.7%) 42 (11.6%) 23. Other sweetened beverages 89 (24.7%) 92 (25.5%) 104 (28.8%) 51 (14.1%) 25 (6.9%) 24. White bread 50 (13.9%) 47 (13%) 97 (26.9%) 83 (23%) 84 (23.3%) 25. Takeaway / fast food 44 (12.2%) 107 (29.6%) 107 (29.6%) 65 (18%) 38 (10.5%) None 1–2 3–4 5–6 7+ 26. Teaspoons of sugar added to beverage, cereal or food 121 (33.5%) 105(29.1%) 76(21.1%) 29(8.0%) 30(8.3%) Participants reported moderate consumption frequencies for most food items over the past year, with intake generally occurring on a weekly rather than daily basis (Table 2 ). Mince, beef, or lamb were most commonly consumed 1–2 times per week (36.3%), with similar patterns for beef or pork (33.5%) and fried chicken products (37.7%). Processed meats were infrequently consumed, with 53.2% reporting intake less than once per month. High-fat spreads and cooking fats were commonly used, most often 1–2 times per week (34.6%), and non-low-fat salad dressings showed similar consumption (36.0%). Eggs were also typically consumed 1–2 times per week (35.5%). Snack foods and desserts, including fried potatoes, chips, pastries, cakes, and ice cream, were generally consumed weekly or a few times per month. Chocolate intake was relatively frequent, with 26.3% consuming it 3–4 times per week and 15.2% five or more times per week. Soft drink consumption was moderate, with 28.0% reporting intake 1–2 times per week, while sports and energy drinks were rarely consumed (51.5% less than once per month). White bread and takeaway foods were most commonly consumed weekly to monthly. One third of participants (33.5%) reported adding no sugar to foods or beverages, while 29.1% added 1–2 teaspoons. Table 3 Distribution of SF-MPQ-2 pain descriptor scores across pain subscales (N = 361) Item Domain Pain type Mean SD 1 Neuropathic Hot burning pain 1.99 2.84 2 Neuropathic Cold-freezing pain 1.92 2.76 3 Neuropathic Pain caused by light touch 1.65 2.66 4 Neuropathic Itching 2.09 2.80 5 Neuropathic Tingling or “pins and needles” 2.32 3.12 6 Neuropathic Numbness 2.85 3.31 7 Affective Tiring-exhausting 3.69 3.21 8 Affective Sickening 2.57 2.97 9 Affective Fearful 1.81 2.69 10 Affective Punishing-cruel 1.68 2.78 11 Continuous Throbbing pain 2.15 2.94 12 Continuous Cramping pain 2.98 3.10 13 Continuous Gnawing pain 2.29 2.85 14 Continuous Aching pain 2.49 2.97 15 Continuous Heavy pain 2.31 3.07 16 Continuous Tender 2.23 2.94 17 Intermittent Shooting pain 2.37 2.95 18 Intermittent Stabbing pain 2.36 2.95 19 Intermittent Sharp pain 2.31 2.97 20 Intermittent Splitting pain 2.01 2.84 21 Intermittent Electric-shock pain 1.93 3.02 22 Intermittent Piercing 1.89 2.89 Pain characteristics assessed using the SF-MPQ-2 are presented in Table 3 . Overall, mean scores for individual pain descriptors were generally low to moderate, with variability observed across pain domains. Within the neuropathic pain subscale, numbness had the highest mean score (2.85 ± 3.31), followed by tingling or “pins and needles” (2.32 ± 3.12) and itching (2.09 ± 2.80). Other neuropathic symptoms, including hot burning pain, cold-freezing pain, and pain caused by light touch, demonstrated lower mean scores. For the affective pain subscale, tiring-exhausting pain showed the highest mean score among all affective descriptors (3.69 ± 3.21), followed by sickening pain (2.57 ± 2.97). Fearful and punishing-cruel pain had comparatively lower mean scores. Within the continuous pain subscale, cramping pain demonstrated the highest mean score (2.98 ± 3.10), followed by aching pain (2.49 ± 2.97) and gnawing pain (2.29 ± 2.85). Other continuous pain descriptors, including throbbing, heavy, and tender pain, showed similar moderate mean values. In the intermittent pain subscale, shooting pain (2.37 ± 2.95) and stabbing pain (2.36 ± 2.95) had the highest mean scores, while piercing pain (1.89 ± 2.89) and electric-shock pain (1.93 ± 3.02) were reported less frequently. Table 4 Mean SF-MPQ-2 subscale scores (N = 361) (N = 361) Subscale Number of items Item numbers Mean ± SD Neuropathic 6 1–6 2.14 ± 2.57 Affective 4 7–10 2.44 ± 2.55 Continuous 6 11–16 2.41 ± 2.73 Intermittent 6 17–22 2.14 ± 2.74 Total 22 1–22 2.27 ± 2.47 Mean SF-MPQ-2 subscale scores are presented in Table 4 . Overall, pain scores across domains were low to moderate in severity. The affective pain subscale demonstrated the highest mean score (2.44 ± 2.55), followed by the continuous pain subscale (2.41 ± 2.73). Mean scores for neuropathic pain (2.14 ± 2.57) and intermittent pain (2.14 ± 2.74) were comparable and slightly lower than those observed for affective and continuous pain domains. The overall SF-MPQ-2 total mean score, calculated across all 22 items, was 2.27 ± 2.47. Table 5 Comparison of dietary fat and sugar intake and SF-MPQ pain scores between males and females Variable Female (n = 196) Mean ± SD Male (n = 165) Mean ± SD p-value Dietary fat and sugar intake Total DFS score 64.57 ± 15.80 68.52 ± 19.59 0.038 Fat subscale 30.49 ± 7.48 32.02 ± 9.27 0.091 Sugar subscale 14.03 ± 4.56 15.48 ± 4.96 0.004 SF-MPQ pain scores Mean SF-MPQ 2.25 ± 2.32 2.28 ± 2.64 0.922 Neuropathic pain 2.12 ± 2.40 2.16 ± 2.76 0.892 Intermittent pain 2.07 ± 2.52 2.24 ± 2.99 0.57 Continuous pain 2.39 ± 2.60 2.42 ± 2.89 0.93 Affective pain 2.53 ± 2.45 2.33 ± 2.66 0.454 In Table 5 , females (n = 196) and males (n = 165) differed significantly in overall dietary fat and sugar intake. Males (68.52 ± 19.59) had higher Total DFS scores compared with females (64.57 ± 15.80), and this difference was statistically significant (p = 0.038). When examining DFS subscales, males (15.48 ± 4.96, p = 0.004) also reported significantly higher sugar intake scores than females (14.03 ± 4.56, p = 0.004). Although males (32.02 ± 9.27) had higher fat subscale scores than females (30.49 ± 7.48 for females), this difference did not reach statistical significance (p = 0.091).No significant sex differences were observed in pain outcomes. Mean SF-MPQ scores were comparable between females (2.25 ± 2.32) and males (2.28 ± 2.64, p = 0.922). Similarly, there were no statistically significant differences between sexes for neuropathic, intermittent, continuous, or affective pain subscale scores (all p > 0.05). Table 6 Pearson correlations (r) between dietary scores and pain outcomes (N = 361) Variable 1 2 3 4 5 6 7 8 1. Total DFS score — 2. Fat subscale 0.934* — 3. Sugar subscale 0.864* 0.703* — 4. Mean SF-MPQ-2 score 0.321* 0.290* 0.332* — 5. Neuropathic pain 0.305* 0.271* 0.309* 0.929* — 6. Intermittent pain 0.299* 0.272* 0.328* 0.949* 0.861* — 7. Continuous pain 0.298* 0.273* 0.299* 0.950* 0.824* 0.863* — 8. Affective pain 0.287* 0.255* 0.291* 0.866* 0.722* 0.751* 0.814* — *p < 0.001 Pearson product-moment correlation analyses were conducted to examine associations between food intake, assessed using the Dietary Fat and Free Sugar Short Questionnaire (DFS), and pain outcomes measured by the Short Form McGill Pain Questionnaire-2 (SF-MPQ-2) (Table 5 ). Total DFS score was positively correlated with overall pain severity, as indexed by the SF-MPQ-2 mean score (r = .321, p < .001). Total DFS was also positively associated with all SF-MPQ-2 pain subscales, including neuropathic pain (r = .305, p < .001), intermittent pain (r = .299, p < .001), continuous pain (r = .298, p < .001), and affective pain (r = .287, p < .001), indicating small to moderate associations between discretionary food intake and pain across multiple domains. Analyses of the DFS subscales demonstrated similar patterns. The fat subscale was positively correlated with the SF-MPQ-2 mean score (r = .290, p < .001) and with neuropathic pain (r = .271, p < .001), intermittent pain (r = .272, p < .001), continuous pain (r = .273, p < .001), and affective pain (r = .255, p < .001). Likewise, the sugar subscale showed positive associations with the SF-MPQ-2 mean score (r = .332, p < .001) and with neuropathic pain (r = .309, p < .001), intermittent pain (r = .328, p < .001), continuous pain (r = .299, p < .001), and affective pain (r = .291, p < .001). Discussion Dietary intake patterns in this study indicate that several foods high in saturated fat and added sugars were commonly consumed among students. Fried potatoes were most frequently consumed 1–2 times per week by 37.1% of participants. Similarly, 28.8% consumed cakes or cookies 1–2 times per week, and 25.8% reported eating ice cream at the same frequency. Consumption of animal products was also common, with 36.3% of participants consuming minced beef or lamb 1–2 times per week. Chocolate intake was particularly notable, with 33.5% consuming chocolate 1–2 times per week, indicating relatively frequent intake compared with other discretionary foods. Soft drink consumption was moderate, with 28.0% reporting intake 1–2 times per week. Regarding added sugar, 29.1% of students reported adding 1–2 teaspoons of sugar to foods or beverages. These findings are consistent with previous research conducted among Lebanese university students, which reported that 37.8% of participants followed a Westernized dietary pattern characterized by a higher consumption of fast foods, desserts, and sugar-sweetened beverages (Salameh et al., 2014 ). Additionally, studies from other countries have similarly shown that university students often exhibit poor dietary quality marked by high intake of snacks, fried foods, sweets, and sugar-sweetened beverages, accompanied by lower consumption of healthier foods such as fruits and vegetables (Alomari et al., 2024). Moreover, research has also indicated that university students are particularly vulnerable to adopting unhealthy dietary behaviors due to factors such as academic stress, lifestyle changes, and food environments that promote higher intake of foods rich in fat, salt, and added sugars (Deliens et al., 2022 ). Lower back pain symptoms were reported across all SF-MPQ-2 pain domains in the present study. The affective pain domain showed the highest mean score (2.44 ± 2.55), with tiring–exhausting pain (3.69 ± 3.21) being the most frequently reported symptom across all descriptors. The continuous pain domain ranked second (2.41 ± 2.73), including symptoms such as cramping pain (2.98 ± 3.10), aching pain (2.49 ± 2.97), and gnawing pain (2.29 ± 2.85). Neuropathic symptoms were also present (2.14 ± 2.57), particularly numbness (2.85 ± 3.31) and tingling or “pins and needles” (2.32 ± 3.12). These findings highlight the multidimensional nature of lower back pain, which involves sensory, emotional, and neurological components. These findings are consistent with previous research which highlighted that diets high in saturated fats and added sugars have been associated with an increased risk of pain and inflammation compared with healthier dietary patterns (Strath et al., 2018). Similarly, pro-inflammatory diets have been linked to increased pain sensitivity in individuals with nonspecific lower back pain (Elma et al., 2020). Excessive intake of added sugars has been associated with chronic low-grade inflammation through metabolic dysregulation and increased production of inflammatory mediators (Ma et al., 2022 ). Diets rich in saturated fatty acids may also promote inflammatory responses by activating immune signaling pathways and increasing the release of pro-inflammatory cytokines (Rocha et al., 2018 ). Inflammation has been identified as an important mechanism in the development and persistence of low back pain, as increased levels of pro-inflammatory cytokines associated with excess adipose tissue may contribute to pain and musculoskeletal dysfunction (da Cruz Fernandes et al., 2018 ) From a public health perspective, these findings are particularly important given the global burden of low back pain. Low back pain has been identified as the leading cause of years lived with disability worldwide (Hartvigsen et al., 2018 ). Recent projections suggest that the burden of low back pain will continue to increase due to population growth, aging, and lifestyle-related factors such as poor diet and physical inactivity (GBD 2021 Low Back Pain Collaboration, 2023). In the Middle East and North Africa (MENA) region, low back pain also represents a significant public health concern. Although the burden attributable to low back pain showed a slight decline between 1990 and 2019, the prevalence remains high. In 2019, the age-standardized point prevalence and incidence rates per 100,000 population were 7668.2 (95% UI: 6798.0–8363.3) and 3215.9 (95% CI: 2838.8–3638.3), respectively, representing reductions of 5.8% and 4.4% compared with 1990 (Safiri et al., 2023 ). Sex-based analyses showed that male students reported higher consumption of sugars and saturated fats than female students, whereas no significant differences were observed between sexes across the SF-MPQ-2 pain domains. Similar patterns of dietary behavior have been reported in previous studies, where male university students demonstrated higher intake of added sugars and sugar-sweetened beverages compared with females (Bawadi et al., 2019 ). Despite these dietary differences, pain symptoms were distributed similarly between sexes in the present study. This finding differs from studies conducted among Lebanese adults, where women accounted for a greater proportion of low back pain cases than men (Bawab et al., 2015 ). This cross-sectional study highlights the relationship between high dietary sugars and saturated fat intake with lower back pain among university students in Lebanon. The findings indicated generally low to moderate lower back pain symptoms across several pain domains (neuropathic, affective, continuous, and intermittent) in the studied population and specified a positive correlation between a higher consumption of sugar and fat rich food and overall pain severity. The results obtained prove to be consistent with national and international studies that suggest that unhealthy lifestyle and pro-inflammatory diet patterns contribute to musculoskeletal pain and limitations. This consistency with the previously reported findings emphasizes the role and influence of dietary behaviors on musculoskeletal health. Strengths To our knowledge, this is the first study to be conducted in Lebanon to evaluate the relationship between high dietary sugars and saturated fat intake with lower back pain among university students in Lebanon, using validated questionnaires (DFS and SF-MPQ-2). Limitations This study was a convenient cross-sectional survey sample of Lebanese university students, which findings cannot be inferred, and findings may be influenced by selection bias. The study was based on anonymous self-reported information which may result in issues with social desirability bias and recall bias, and the online administration of the questionnaire may have introduced response bias and excluded students with limited digital engagement or access. Conclusion Given the increasing prevalence of lower back pain and westernized dietary patterns among university students, this research emphasizes the importance of dietary behaviors and lifestyle habits as contributing factors in musculoskeletal health in young adults. Preventive strategies and health initiatives within universities should be set to increase awareness about balanced nutrition, encourage healthier food choices, and promote more active lifestyles among university students to help reduce the risk of developing lower back pain and other musculoskeletal disorders. Future studies, involving larger and more diverse populations, should assess the long-term effects of dietary habits and lifestyle choices on young adults’ musculoskeletal health and concentrate on the intrinsic mechanisms connecting dietary patterns and lower back pain. Declarations Ethical Approval In Lebanon, this research received an approval from the Research Ethics Committee (REC) and the Human Research Protection Program (HRPP) at the Holy Spirit University of Kaslik (Reference Number: HRPP/202610/FT/044). Informed Consent All participants provided electronic informed consent prior to enrollment in the study and participation was entirely voluntary. No personally identifiable information was collected, and all responses were treated with strict confidentiality and were accessible only to members of the research team. All study data are securely stored in password-protected files to ensure the protection of participant privacy and data security. Conflict of Interest All the authors declare no competing interests. Clinical trial number not applicable. Funding Declaration This research is not funded. Author Contribution All authors have contributed equally to this manuscript. The corresponding author is: Georges Jarrouge, his email is: [email protected] , and his number is: +96181485813 Acknowledgement Holy Spirit University of Kaslik (USEK) Data Availability The datasets generated and analyzed during this study are available from the corresponding author upon reasonable request. References Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M, Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet (London England). 2018;391(10137):2356–67. https://doi.org/10.1016/S0140-6736(18)30480-X . Strath LJ, Brooks MS, Sorge RE, Judd SE. Relationship between diet and relative risk of pain in a cross-sectional analysis of the REGARDS longitudinal study. Pain Manage. 2022;12(2):168–79. https://doi.org/10.2217/pmt-2021-0048 . Ma X, Nan F, Liang H, Shu P, Fan X, Song X, Hou Y, Zhang D. Excessive intake of sugar: An accomplice of inflammation. Front Immunol. 2022;13:988481. https://doi.org/10.3389/fimmu.2022.988481 . da Fernandes C, Pinto IM, Ferreira RZ, P., Lira FS. Low back pain, obesity, and inflammatory markers: exercise as potential treatment. J Exerc rehabilitation. 2018;14(2):168–74. https://doi.org/10.12965/jer.1836070.035 . Elma Ö, Tümkaya Yılmaz S, Nijs J, Clarys P, Coppieters I, Mertens E, Deliens T, Malfliet A. Proinflammatory Dietary Intake Relates to Pain Sensitivity in Chronic Nonspecific Low Back Pain: A Case-Control Study. J pain. 2024;25(2):350–61. https://doi.org/10.1016/j.jpain.2023.08.015 . Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74. https://doi.org/10.1136/annrheumdis-2013-204428 . Ferreira ML, De Luca K, Haile LM, Steinmetz JD, Culbreth GT, Cross M, Kopec JA, Ferreira PH, Blyth FM, Buchbinder R, Hartvigsen J, Wu A, Safiri S, Woolf AD, Collins GS, Ong KL, Vollset SE, Smith AE, Cruz JA, March LM. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316–29. https://doi.org/10.1016/s2665-9913(23)00098-x . Xiao Z, Luo L, Xu R, Zheng J, Weng W, Jiang Y, Wang Y, Liang R, Pan X, Wang R. Unhealthy lifestyles and low Life’s Essential 8 scores are associated with a higher risk of new-onset low back pain: A prospective cohort study. Spine J. 2025. https://doi.org/10.1016/j.spinee.2025.11.002 . Xie S, Xiao H, Li G, Zheng J, Zhang F, Lan Y, Luo M. Association between a body shape index and low back pain: a cross-sectional study highlighting gender-specific differences in NHANES data. BMC Public Health. 2025;25(1):753. https://doi.org/10.1186/s12889-025-21904-3 . Safiri S, Nejadghaderi SA, Noori M, Sullman MJM, Collins GS, Kaufman JS, Hill CL, Kolahi AA. The burden of low back pain and its association with socio-demographic variables in the Middle East and North Africa region, 1990–2019. BMC Musculoskelet Disord. 2023;24(1):59. https://doi.org/10.1186/s12891-023-06178-3 . Alshehri MM, Alqhtani AM, Gharawi SH, Sharahily RA, Fathi WA, Alnamy SG, Alothman SA, Alshehri YS, Alhowimel AS, Alqahtani BA, Alenazi AM. Prevalence of lower back pain and its associations with lifestyle behaviors among college students in Saudi Arabia. BMC Musculoskelet Disord. 2023;24(1):646. https://doi.org/10.1186/s12891-023-06683-5 . Salameh P, Jomaa L, Issa C, Farhat G, Salamé J, Zeidan N, Baldi I, Lebanese National Conference for Health in University Research Group. & (2014). Assessment of Dietary Intake Patterns and Their Correlates among University Students in Lebanon. Frontiers in public health , 2 , 185. https://doi.org/10.3389/fpubh.2014.00185 Bawab W, Ismail K, Awada S, Rachidi S, Hajje AA, Salameh P. (2015). Prevalence and Risk Factors of Low Back Pain among Office Workers in Lebanon. SHILAP Revista De Lepidopterología. https://doaj.org/article/f2e22a58f2604c628ceb8e98e8cbc559 Francis H, Stevenson RJ. Validity and test–retest reliability of a short dietary questionnaire to assess intake of saturated fat and free sugars: A preliminary study. J Hum Nutr Dietetics. 2013;26(3):234–42. https://doi.org/10.1111/jhn.12008 . Dworkin RH, Turk DC, Revicki DA, Harding G, Coyne KS, Peirce-Sandner S, Bhagwat D, Everton D, Burke LB, Cowan P, Farrar JT, Hertz S, Max MB, Rappaport BA, Melzack R. Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). Pain. 2009;144(1–2):35–42. https://doi.org/10.1016/j.pain.2009.02.007 . World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310(20):2191–4. https://doi.org/10.1001/jama.2013.281053 . Alomari M, Al-Amoudi R. Dietary habits and lifestyle behaviors among university students: A cross-sectional study. Nutrients. 2024;16(2):312. https://doi.org/10.3390/nu16020312 . Deliens T, Clarys P, De Bourdeaudhuij I, Deforche B. Determinants of eating behaviour in university students: A narrative review. Front Nutr. 2022;9:840818. https://doi.org/10.3389/fnut.2022.840818 . Ma X, Nan F, Liang H, Shu P, Fan X, Song X, Hou Y, Zhang D. Excessive intake of sugar: An accomplice of inflammation. Front Immunol. 2022;13:988481. https://doi.org/10.3389/fimmu.2022.988481 . Rocha DMUP, Caldas APS, Oliveira LL, Bressan J, Hermsdorff HHM. Saturated fatty acids trigger TLR4-mediated inflammatory response. Front Immunol. 2018;9:259. https://doi.org/10.3389/fimmu.2018.00259 . Bawadi H, Khataybeh T, Obeidat B, Kerkadi A, Tayyem R, Banks A, Subih H. Sugar-Sweetened beverages contribute significantly to college students’ daily caloric intake in Jordan: soft drinks are not the major contributor. Nutrients. 2019;11(5):1058. https://doi.org/10.3390/nu11051058 . Additional Declarations No competing interests reported. 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Lower back pain is increasingly recognized as a major public health concern worldwide, representing one of the leading causes of disability among young and adult populations (Hartvigsen et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Emerging evidence suggests that lifestyle factors, particularly unhealthy dietary patterns characterized by high intake of dietary sugars and saturated fats, are associated with increased musculoskeletal pain and functional limitations (Strath et al., 2021). Diets high in sugars and saturated fats have been shown to induce chronic low-grade inflammation through elevated production of pro-inflammatory cytokines and metabolic dysregulation (Ma et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and this inflammatory state contributes to pain sensitization and degenerative changes in spinal structures involved in lower back pain (Fernandes et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Moreover, recent findings indicate that pro-inflammatory dietary patterns, characterized by high intake of sugars and saturated fats, disrupt normal pain modulation mechanisms, leading to increased nociceptive sensitivity and greater perception of lower back pain (Elma et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Recurrent or persistent lower back pain in adults is associated with an increased risk of chronic musculoskeletal disorders and long-term functional impairment, with early symptoms significantly predicting progression to chronic pain conditions (Hoy et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA substantial proportion of lower back pain cases may be preventable through modification of lifestyle-related risk factors. A large prospective cohort study involving over 140,000 adults reported that modifiable behaviors, including elevated body mass index and prolonged sedentary time, were significantly associated with an increased risk of developing lower back pain, with risk estimates indicating increases of approximately 10% compared to individuals with healthier lifestyle profiles (Xiao et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAbdominal obesity has been shown to be significantly associated with lower back pain among U.S. adults aged 18 years and older. A cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) found that individuals in the highest quartile of A Body Shape Index (ABSI) exhibited significantly greater odds of low back pain compared to those in lower quartiles (Xie et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to regional prevalence estimates derived from the Global Burden of Disease 2019 study, more than 43\u0026nbsp;million individuals across Middle Eastern and North African countries were affected by lower back pain in 2019, highlighting its widespread burden among adult populations. These findings underscore the urgency of addressing lower back pain as a major public health priority in the Arab region (Safiri et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Unhealthy lifestyle behaviors have been identified as important contributors to lower back pain among young adults. Moreover, a cross-sectional study conducted among university students in Saudi Arabia reported a high prevalence of lower back pain, affecting 66.4% of participants, with significantly greater pain severity observed among students with poor sleep quality and prolonged sedentary behavior. The study further highlighted that lower levels of physical activity and poorer nutritional behaviors were associated with increased lower back pain severity (Alshehri et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Lebanon, it was reported in 2014 that 37.8% of participants followed a westernized dietary pattern characterized by high consumption of fast foods, fried foods, desserts, and sugar-sweetened beverages, and demonstrated significant associations between dietary patterns, body mass index, and physical inactivity. These findings highlight the presence of modifiable lifestyle behaviors among Lebanese university students that may predispose this population to adverse long-term health outcomes (Salameh et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Furthermore, a cross-sectional study of office workers in Lebanon found that approximately 44.8% of participants experienced lower back pain, with females accounting for 68% of the affected cases and males accounting for 32% (Bawab et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the high prevalence of unhealthy dietary patterns among Lebanese university students and the substantial burden of lower back pain reported among Lebanese adults, no study to date has directly examined the relationship between dietary sugar and saturated fat consumption and lower back pain among the Lebanese university student population. The main objective of this study is to explore the relationship between high dietary sugar and saturated fat consumption and lower back pain among Lebanese university students. This study aims to assess the prevalence, severity, and frequency of lower back pain within this population, while examining the association between dietary patterns and pain outcomes. By identifying potential lifestyle-related contributors to lower back pain, this research seeks to provide evidence that may support future preventive strategies and health-promoting interventions targeting university students.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and Study Design\u003c/h2\u003e \u003cp\u003eThis cross-sectional study involved 361 university students from different universities in Lebanon during the 2025\u0026ndash;2026 academic year. Data were collected using a self-administered online questionnaire. A convenience sampling method was employed, with participants recruited through university networks and social media platforms. The questionnaire was distributed electronically and completed voluntarily by students. The survey collected socio-demographic information including age and gender, as well as anthropometric and lifestyle-related data. In addition, dietary intake patterns and lower back pain characteristics were assessed using standardized questionnaires\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the Human Research Protection Program (HRPP) and the Research Ethics Committee at the Holy Spirit University of Kaslik (USEK) (reference number: HRPP/202610/FT/044). The study was conducted in accordance with the principles outlined in the Declaration of Helsinki (World Medical Association, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Participants were fully informed about the study\u0026rsquo;s objectives and procedures prior to participation. Electronic informed consent was obtained from all participants, and participation was entirely voluntary. Data confidentiality and anonymity were strictly maintained to ensure the protection of participants\u0026rsquo; privacy.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eSurvey Structure\u003c/h3\u003e\n\u003cp\u003eThe questionnaire used in this study was designed with three main sections to assess participants\u0026rsquo; demographic characteristics, lifestyle habits, dietary intake, and lower back pain. The first section collected baseline sociodemographic and lifestyle information, including gender, age, height, weight, and frequency of physical exercise. The second section assessed participants\u0026rsquo; food consumption patterns using the Dietary Fat and Free Sugar Short Questionnaire (DFS), which evaluates habitual intake of foods rich in saturated fats and free sugars. The third section evaluated lower back pain using the Short-Form McGill Pain Questionnaire\u0026ndash;2 (SF-MPQ-2), which measures different dimensions and intensities of pain experienced by participants.\u003c/p\u003e\n\u003ch3\u003eAssessment of dietary intake\u003c/h3\u003e\n\u003cp\u003eParticipants\u0026rsquo; dietary intake was assessed using the Dietary Fat and Free Sugar Short Questionnaire (DFS), a validated instrument designed to estimate habitual consumption of saturated fats and free sugars. The questionnaire evaluates dietary intake over the previous year and has demonstrated acceptable validity and test\u0026ndash;retest reliability (Francis \u0026amp; Stevenson, 2012). The DFS consists of 26 items, of which most food and beverage items are rated using a five-point frequency scale ranging from \u0026ldquo;less than once per month\u0026rdquo; to \u0026ldquo;five or more times per week.\u0026rdquo; One item assesses added sugar intake using categorical response options based on the estimated number of teaspoons of sugar consumed per week. Mean dietary intake scores were calculated based on participants\u0026rsquo; responses, with higher scores indicating greater consumption of saturated fats and free sugars.\u003c/p\u003e\n\u003ch3\u003eAssessment of lower back pain\u003c/h3\u003e\n\u003cp\u003eLower back pain was assessed using the English version of the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2), a validated multidimensional instrument used to evaluate pain intensity and quality (Dworkin et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). The questionnaire includes 22 pain descriptors covering four domains: neuropathic, intermittent, continuous, and affective pain. Participants rated the intensity of each pain descriptor experienced during the previous week using a numeric rating scale ranging from 0 (no pain) to 10 (worst possible pain). Mean scores were calculated for each pain subscale as well as an overall mean SF-MPQ-2 score across all 22 items, with higher scores indicating greater lower back pain severity.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Collection and Storage\u003c/h2\u003e \u003cp\u003eThe survey was web-based, and data were collected via a secure digital platform. All participants provided electronic informed consent prior to their enrollment in the study, and participation was completely voluntary. No identifiable information was collected, and all responses remained confidential, accessible only to the research team. All data were stored in password-protected files. The datasets generated and analyzed during the study are available from the corresponding author upon reasonable request.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe survey was distributed electronically among university students across Lebanon to obtain a diverse sample of the student population. Participation was voluntary; therefore, the sample represents a convenience sample and may not be fully representative of all Lebanese university students. Data collected through the questionnaires were anonymized and securely stored prior to analysis. Statistical analyses were conducted using IBM SPSS Statistics (version 27). Descriptive statistics were used to summarize socio-demographic, anthropometric, dietary, and pain-related variables. Continuous variables were presented as means and standard deviations, while categorical variables were expressed as frequencies and percentages. Associations between dietary intake scores and lower back pain measures were examined using correlation analyses. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of participants (N\u0026thinsp;=\u0026thinsp;361)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory / Statistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u0026sup2;)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.05\u0026thinsp;\u0026plusmn;\u0026thinsp;10.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eFrequency of physical exercise\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRarely (once a month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccasionally (1\u0026ndash;2 times/week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegularly (3\u0026ndash;5 times/week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA total of 361 participants were included in the analysis. The mean age of the sample was 19.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58 years. Females comprised slightly more than half of the study population (196 participants, 54.3%), while males accounted for 165 participants (45.7%). The mean body mass index (BMI) was 24.05\u0026thinsp;\u0026plusmn;\u0026thinsp;10.09 kg/m\u0026sup2;. Regarding physical activity, the largest proportion of participants reported engaging in exercise occasionally, defined as 1\u0026ndash;2 times per week (32.1%). Approximately one quarter of participants reported exercising rarely (once a month; 24.7%) or regularly (3\u0026ndash;5 times per week; 24.9%). Smaller proportions reported never exercising (11.9%) or exercising daily (6.4%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDietary habits frequency over the past year using the DFS questionnaire (N\u0026thinsp;=\u0026thinsp;361)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 1 per month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u0026ndash;3 per month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u0026ndash;2 per week\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u0026ndash;4 per week\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u0026thinsp;+\u0026thinsp;per week\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Mince, beef or lamb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131 (36.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (5.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Beef or pork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121 (33.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Fried chicken / chicken burgers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136 (37.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Sausages / frankfurts / salami\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e192 (53.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Bacon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e224 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (16.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (10.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (7.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Salad dressings (not low fat)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e130 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Margarine / butter / oil in cooking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125 (34.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Eggs (not egg whites alone)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Pizza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 (39.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92 (25.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (10.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Cheese / cheese spread (not low fat)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. French fries / fried potatoes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134 (37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. Corn chips / potato chips / popcorn with butter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115 (31.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. Doughnuts / pastries / croissants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126 (34.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. Cakes / cookies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122 (33.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104 (28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (10.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Ice cream (not sorbet or low fat)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16. Chocolate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (16.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121 (33.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17. Lollies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e193 (53.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (18.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18. Spreads (peanut butter / jam / honey)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (28.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19. Pancakes / french toast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154 (42.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20. Sports drinks / energy drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e186 (51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (10.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21. Soft drinks (not diet)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (25.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53 (14.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22. Full-fat milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (17.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (19.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113 (31.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71 (19.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23. Other sweetened beverages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (25.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104 (28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24. White bread\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e84 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25. Takeaway / fast food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u0026ndash;2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3\u0026ndash;4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5\u0026ndash;6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e7+\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26. Teaspoons of sugar added to beverage, cereal or food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121 (33.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105(29.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76(21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29(8.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30(8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eParticipants reported moderate consumption frequencies for most food items over the past year, with intake generally occurring on a weekly rather than daily basis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Mince, beef, or lamb were most commonly consumed 1\u0026ndash;2 times per week (36.3%), with similar patterns for beef or pork (33.5%) and fried chicken products (37.7%). Processed meats were infrequently consumed, with 53.2% reporting intake less than once per month. High-fat spreads and cooking fats were commonly used, most often 1\u0026ndash;2 times per week (34.6%), and non-low-fat salad dressings showed similar consumption (36.0%). Eggs were also typically consumed 1\u0026ndash;2 times per week (35.5%). Snack foods and desserts, including fried potatoes, chips, pastries, cakes, and ice cream, were generally consumed weekly or a few times per month. Chocolate intake was relatively frequent, with 26.3% consuming it 3\u0026ndash;4 times per week and 15.2% five or more times per week. Soft drink consumption was moderate, with 28.0% reporting intake 1\u0026ndash;2 times per week, while sports and energy drinks were rarely consumed (51.5% less than once per month). White bread and takeaway foods were most commonly consumed weekly to monthly. One third of participants (33.5%) reported adding no sugar to foods or beverages, while 29.1% added 1\u0026ndash;2 teaspoons.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of SF-MPQ-2 pain descriptor scores across pain subscales (N\u0026thinsp;=\u0026thinsp;361)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePain type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuropathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHot burning pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuropathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCold-freezing pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuropathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePain caused by light touch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuropathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuropathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTingling or \u0026ldquo;pins and needles\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuropathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumbness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAffective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTiring-exhausting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAffective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSickening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAffective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFearful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAffective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePunishing-cruel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThrobbing pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCramping pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGnawing pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAching pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHeavy pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermittent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eShooting pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermittent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStabbing pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermittent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSharp pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermittent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSplitting pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermittent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eElectric-shock pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermittent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePiercing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePain characteristics assessed using the SF-MPQ-2 are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Overall, mean scores for individual pain descriptors were generally low to moderate, with variability observed across pain domains. Within the neuropathic pain subscale, numbness had the highest mean score (2.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31), followed by tingling or \u0026ldquo;pins and needles\u0026rdquo; (2.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12) and itching (2.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.80). Other neuropathic symptoms, including hot burning pain, cold-freezing pain, and pain caused by light touch, demonstrated lower mean scores. For the affective pain subscale, tiring-exhausting pain showed the highest mean score among all affective descriptors (3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21), followed by sickening pain (2.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97). Fearful and punishing-cruel pain had comparatively lower mean scores. Within the continuous pain subscale, cramping pain demonstrated the highest mean score (2.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.10), followed by aching pain (2.49\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97) and gnawing pain (2.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85). Other continuous pain descriptors, including throbbing, heavy, and tender pain, showed similar moderate mean values. In the intermittent pain subscale, shooting pain (2.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95) and stabbing pain (2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95) had the highest mean scores, while piercing pain (1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89) and electric-shock pain (1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02) were reported less frequently.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean SF-MPQ-2 subscale scores (N\u0026thinsp;=\u0026thinsp;361) (N\u0026thinsp;=\u0026thinsp;361)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubscale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItem numbers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeuropathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContinuous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u0026ndash;16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntermittent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u0026ndash;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026ndash;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMean SF-MPQ-2 subscale scores are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Overall, pain scores across domains were low to moderate in severity. The affective pain subscale demonstrated the highest mean score (2.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55), followed by the continuous pain subscale (2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73). Mean scores for neuropathic pain (2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57) and intermittent pain (2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74) were comparable and slightly lower than those observed for affective and continuous pain domains. The overall SF-MPQ-2 total mean score, calculated across all 22 items, was 2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of dietary fat and sugar intake and SF-MPQ pain scores between males and females\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;196) Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;165) Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDietary fat and sugar intake\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal DFS score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e64.57\u0026thinsp;\u0026plusmn;\u0026thinsp;15.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e68.52\u0026thinsp;\u0026plusmn;\u0026thinsp;19.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFat subscale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e30.49\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.02\u0026thinsp;\u0026plusmn;\u0026thinsp;9.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSugar subscale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.48\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSF-MPQ pain scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean SF-MPQ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeuropathic pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntermittent pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContinuous pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAffective pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.454\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, females (n\u0026thinsp;=\u0026thinsp;196) and males (n\u0026thinsp;=\u0026thinsp;165) differed significantly in overall dietary fat and sugar intake. Males (68.52\u0026thinsp;\u0026plusmn;\u0026thinsp;19.59) had higher Total DFS scores compared with females (64.57\u0026thinsp;\u0026plusmn;\u0026thinsp;15.80), and this difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.038). When examining DFS subscales, males (15.48\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96, p\u0026thinsp;=\u0026thinsp;0.004) also reported significantly higher sugar intake scores than females (14.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.56, p\u0026thinsp;=\u0026thinsp;0.004). Although males (32.02\u0026thinsp;\u0026plusmn;\u0026thinsp;9.27) had higher fat subscale scores than females (30.49\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48 for females), this difference did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.091).No significant sex differences were observed in pain outcomes. Mean SF-MPQ scores were comparable between females (2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.32) and males (2.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64, p\u0026thinsp;=\u0026thinsp;0.922). Similarly, there were no statistically significant differences between sexes for neuropathic, intermittent, continuous, or affective pain subscale scores (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson correlations (r) between dietary scores and pain outcomes (N\u0026thinsp;=\u0026thinsp;361)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Total DFS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Fat subscale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.934*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Sugar subscale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.864*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.703*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Mean SF-MPQ-2 score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.321*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.290*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.332*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Neuropathic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.305*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.271*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.309*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.929*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Intermittent pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.299*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.272*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.328*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.949*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.861*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Continuous pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.298*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.273*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.299*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.950*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.824*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.863*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Affective pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.287*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.255*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.291*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.866*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.722*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.751*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.814*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/h2\u003e \u003cp\u003ePearson product-moment correlation analyses were conducted to examine associations between food intake, assessed using the Dietary Fat and Free Sugar Short Questionnaire (DFS), and pain outcomes measured by the Short Form McGill Pain Questionnaire-2 (SF-MPQ-2) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Total DFS score was positively correlated with overall pain severity, as indexed by the SF-MPQ-2 mean score (r = .321, p \u0026lt; .001). Total DFS was also positively associated with all SF-MPQ-2 pain subscales, including neuropathic pain (r = .305, p \u0026lt; .001), intermittent pain (r = .299, p \u0026lt; .001), continuous pain (r = .298, p \u0026lt; .001), and affective pain (r = .287, p \u0026lt; .001), indicating small to moderate associations between discretionary food intake and pain across multiple domains. Analyses of the DFS subscales demonstrated similar patterns. The fat subscale was positively correlated with the SF-MPQ-2 mean score (r = .290, p \u0026lt; .001) and with neuropathic pain (r = .271, p \u0026lt; .001), intermittent pain (r = .272, p \u0026lt; .001), continuous pain (r = .273, p \u0026lt; .001), and affective pain (r = .255, p \u0026lt; .001). Likewise, the sugar subscale showed positive associations with the SF-MPQ-2 mean score (r = .332, p \u0026lt; .001) and with neuropathic pain (r = .309, p \u0026lt; .001), intermittent pain (r = .328, p \u0026lt; .001), continuous pain (r = .299, p \u0026lt; .001), and affective pain (r = .291, p \u0026lt; .001).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDietary intake patterns in this study indicate that several foods high in saturated fat and added sugars were commonly consumed among students. Fried potatoes were most frequently consumed 1\u0026ndash;2 times per week by 37.1% of participants. Similarly, 28.8% consumed cakes or cookies 1\u0026ndash;2 times per week, and 25.8% reported eating ice cream at the same frequency. Consumption of animal products was also common, with 36.3% of participants consuming minced beef or lamb 1\u0026ndash;2 times per week. Chocolate intake was particularly notable, with 33.5% consuming chocolate 1\u0026ndash;2 times per week, indicating relatively frequent intake compared with other discretionary foods. Soft drink consumption was moderate, with 28.0% reporting intake 1\u0026ndash;2 times per week. Regarding added sugar, 29.1% of students reported adding 1\u0026ndash;2 teaspoons of sugar to foods or beverages. These findings are consistent with previous research conducted among Lebanese university students, which reported that 37.8% of participants followed a Westernized dietary pattern characterized by a higher consumption of fast foods, desserts, and sugar-sweetened beverages (Salameh et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Additionally, studies from other countries have similarly shown that university students often exhibit poor dietary quality marked by high intake of snacks, fried foods, sweets, and sugar-sweetened beverages, accompanied by lower consumption of healthier foods such as fruits and vegetables (Alomari et al., 2024). Moreover, research has also indicated that university students are particularly vulnerable to adopting unhealthy dietary behaviors due to factors such as academic stress, lifestyle changes, and food environments that promote higher intake of foods rich in fat, salt, and added sugars (Deliens et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLower back pain symptoms were reported across all SF-MPQ-2 pain domains in the present study. The affective pain domain showed the highest mean score (2.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55), with tiring\u0026ndash;exhausting pain (3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21) being the most frequently reported symptom across all descriptors. The continuous pain domain ranked second (2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73), including symptoms such as cramping pain (2.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.10), aching pain (2.49\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97), and gnawing pain (2.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85). Neuropathic symptoms were also present (2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57), particularly numbness (2.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31) and tingling or \u0026ldquo;pins and needles\u0026rdquo; (2.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12). These findings highlight the multidimensional nature of lower back pain, which involves sensory, emotional, and neurological components. These findings are consistent with previous research which highlighted that diets high in saturated fats and added sugars have been associated with an increased risk of pain and inflammation compared with healthier dietary patterns (Strath et al., 2018). Similarly, pro-inflammatory diets have been linked to increased pain sensitivity in individuals with nonspecific lower back pain (Elma et al., 2020).\u003c/p\u003e \u003cp\u003eExcessive intake of added sugars has been associated with chronic low-grade inflammation through metabolic dysregulation and increased production of inflammatory mediators (Ma et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Diets rich in saturated fatty acids may also promote inflammatory responses by activating immune signaling pathways and increasing the release of pro-inflammatory cytokines (Rocha et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Inflammation has been identified as an important mechanism in the development and persistence of low back pain, as increased levels of pro-inflammatory cytokines associated with excess adipose tissue may contribute to pain and musculoskeletal dysfunction (da Cruz Fernandes et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFrom a public health perspective, these findings are particularly important given the global burden of low back pain. Low back pain has been identified as the leading cause of years lived with disability worldwide (Hartvigsen et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Recent projections suggest that the burden of low back pain will continue to increase due to population growth, aging, and lifestyle-related factors such as poor diet and physical inactivity (GBD 2021 Low Back Pain Collaboration, 2023). In the Middle East and North Africa (MENA) region, low back pain also represents a significant public health concern. Although the burden attributable to low back pain showed a slight decline between 1990 and 2019, the prevalence remains high. In 2019, the age-standardized point prevalence and incidence rates per 100,000 population were 7668.2 (95% UI: 6798.0\u0026ndash;8363.3) and 3215.9 (95% CI: 2838.8\u0026ndash;3638.3), respectively, representing reductions of 5.8% and 4.4% compared with 1990 (Safiri et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSex-based analyses showed that male students reported higher consumption of sugars and saturated fats than female students, whereas no significant differences were observed between sexes across the SF-MPQ-2 pain domains. Similar patterns of dietary behavior have been reported in previous studies, where male university students demonstrated higher intake of added sugars and sugar-sweetened beverages compared with females (Bawadi et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Despite these dietary differences, pain symptoms were distributed similarly between sexes in the present study. This finding differs from studies conducted among Lebanese adults, where women accounted for a greater proportion of low back pain cases than men (Bawab et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis cross-sectional study highlights the relationship between high dietary sugars and saturated fat intake with lower back pain among university students in Lebanon. The findings indicated generally low to moderate lower back pain symptoms across several pain domains (neuropathic, affective, continuous, and intermittent) in the studied population and specified a positive correlation between a higher consumption of sugar and fat rich food and overall pain severity. The results obtained prove to be consistent with national and international studies that suggest that unhealthy lifestyle and pro-inflammatory diet patterns contribute to musculoskeletal pain and limitations. This consistency with the previously reported findings emphasizes the role and influence of dietary behaviors on musculoskeletal health.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStrengths\u003c/h2\u003e \u003cp\u003eTo our knowledge, this is the first study to be conducted in Lebanon to evaluate the relationship between high dietary sugars and saturated fat intake with lower back pain among university students in Lebanon, using validated questionnaires (DFS and SF-MPQ-2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study was a convenient cross-sectional survey sample of Lebanese university students, which findings cannot be inferred, and findings may be influenced by selection bias. The study was based on anonymous self-reported information which may result in issues with social desirability bias and recall bias, and the online administration of the questionnaire may have introduced response bias and excluded students with limited digital engagement or access.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGiven the increasing prevalence of lower back pain and westernized dietary patterns among university students, this research emphasizes the importance of dietary behaviors and lifestyle habits as contributing factors in musculoskeletal health in young adults. Preventive strategies and health initiatives within universities should be set to increase awareness about balanced nutrition, encourage healthier food choices, and promote more active lifestyles among university students to help reduce the risk of developing lower back pain and other musculoskeletal disorders.\u003c/p\u003e \u003cp\u003eFuture studies, involving larger and more diverse populations, should assess the long-term effects of dietary habits and lifestyle choices on young adults\u0026rsquo; musculoskeletal health and concentrate on the intrinsic mechanisms connecting dietary patterns and lower back pain.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthical Approval\u003c/h2\u003e\n\u003cp\u003eIn Lebanon, this research received an approval from the Research Ethics Committee (REC) and the Human Research Protection Program (HRPP) at the Holy Spirit University of Kaslik (Reference Number: HRPP/202610/FT/044).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided electronic informed consent prior to enrollment in the study and participation was entirely voluntary. No personally identifiable information was collected, and all responses were treated with strict confidentiality and were accessible only to members of the research team. All study data are securely stored in password-protected files to ensure the protection of participant privacy and data security.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eClinical trial number\u003c/h2\u003e\n\u003cp\u003enot applicable.\u003c/p\u003e\n\u003ch2\u003eFunding Declaration\u003c/h2\u003e\n\u003cp\u003eThis research is not funded.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAll authors have contributed equally to this manuscript. The corresponding author is: Georges Jarrouge, his email is: [email protected], and his number is: +96181485813\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eHoly Spirit University of Kaslik (USEK)\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and analyzed during this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M, Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. 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Sugar-Sweetened beverages contribute significantly to college students\u0026rsquo; daily caloric intake in Jordan: soft drinks are not the major contributor. Nutrients. 2019;11(5):1058. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/nu11051058\u003c/span\u003e\u003cspan address=\"10.3390/nu11051058\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"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":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lower back pain, Sugar intake, Fat intake, university students, Lebanon","lastPublishedDoi":"10.21203/rs.3.rs-9107940/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9107940/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eLower back pain is recognized as a leading cause of disability and a major public health concern. Despite growing interest in lifestyle-related risk factors, the potential link between high intake of dietary sugars and saturated fats in relation to lower back pain remains poorly investigated, particularly among university students in Lebanon where westernized dietary habits are common. This study aims to examine the association between high dietary sugar and saturated fat intake and lower back pain, and to assess its prevalence and characteristics among Lebanese university students.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was carried out during the academic year 2025\u0026ndash;2026 using a standardized, self-administered online questionnaire among Lebanese university students. Dietary intake of sugars and saturated fats was assessed using the Dietary Fat and Free Sugar Short Questionnaire (DFS), while lower back pain was evaluated using the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2). Statistical tests were performed using SPSS to examine associations, with significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eA total of 361 participants were recruited. Findings show that the affective pain domain had the highest mean score among the SF-MPQ-2 pain subscales (2.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55). Moreover, males reported higher overall DFS scores than females (68.52\u0026thinsp;\u0026plusmn;\u0026thinsp;19.59 vs 64.57\u0026thinsp;\u0026plusmn;\u0026thinsp;15.80, p\u0026thinsp;=\u0026thinsp;0.038), as well as higher sugar intake scores (15.48\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96 vs 14.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.56, p\u0026thinsp;=\u0026thinsp;0.004). However, pain scores did not differ significantly between sexes. Sugar intake shows the strongest correlation with lower back pain scores (r\u0026thinsp;=\u0026thinsp;0.33, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), followed by fat intake (r\u0026thinsp;=\u0026thinsp;0.29, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings suggest a potential association between higher consumption of fat and sugar rich foods and greater lower back pain severity.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eThis study brings attention to the potential link between high dietary sugar and saturated fat intake and lower back pain among Lebanese university students. These findings highlight the importance of considering dietary behaviors as potential contributors to lower back pain in young adults.\u003c/p\u003e","manuscriptTitle":"Exploring The Relationship Between High Dietary Sugars And Saturated Fat With Lower Back Pain Among University Students In Lebanon: A Cross Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-16 07:13:44","doi":"10.21203/rs.3.rs-9107940/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-27T04:17:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T06:51:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T19:48:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"38629606481543333680489049595648662763","date":"2026-04-17T15:09:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243395031275278120159681556023927453313","date":"2026-04-17T01:19:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-15T10:25:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303206924597157252070480760515881562607","date":"2026-04-15T09:44:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-15T07:49:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81322819866443416101655356552939450406","date":"2026-04-14T17:01:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15059021919127674806302438437949635164","date":"2026-04-14T16:21:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T11:51:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-17T06:24:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-16T08:05:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-16T08:04:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-03-12T19:28:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b53068d4-e249-4e7b-b72d-32e429d22244","owner":[],"postedDate":"March 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T11:55:42+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-16 07:13:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9107940","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9107940","identity":"rs-9107940","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}