Nutritional Knowledge and its Association with Dietary Habits among Medical vs. Non-medical Students in Islamabad and Rawalpindi: A Cross-sectional Comparative Study

Nutritional Knowledge and its Association with Dietary Habits among Medical vs. Non-medical Students in Islamabad and Rawalpindi: A Cross-sectional Comparative 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 Nutritional Knowledge and its Association with Dietary Habits among Medical vs. Non-medical Students in Islamabad and Rawalpindi: A Cross-sectional Comparative Study Muhammad Talha Farrukh, Bakhtawar Mohsin Jami, Unaiza Iqbal, Sohaib Mushtaq, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6872420/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Mar, 2026 Read the published version in BMC Nutrition → Version 1 posted 13 You are reading this latest preprint version Abstract Introduction: Obesity and cardiovascular diseases have become the leading causes of mortality. Factors affecting dietary habits are crucial for preventing these diseases. However, there is limited knowledge regarding the correlation between nutritional knowledge and dietary habits. Objective: This study aimed to assess the association between nutritional knowledge and dietary practices among university students, and to compare the nutritional knowledge and dietary habits of medical and non-medical students. Methods : A quantitative cross-sectional study, ethically approved by the institution, was conducted among the undergraduate population. The sample size was calculated via OpenEpi software with a 95% confidence interval and a 5% margin of error. Data collection was performed through a validated questionnaire via a convenience sampling technique. All descriptive and inferential statistical tests were conducted with IBM SPSS 26 and a p-value of <0.05 was considered to indicate statistical significance for all applied measures. Results : The sample consisted of 382 participants (n=191 medical and n=191 non-medical), with a mean age of 21±2.39 years. When nutritional knowledge was assessed in terms of categories, 86 (22.5%) had unsatisfactory knowledge, 234 (61.2%) had good nutritional knowledge, and 62 (16.2%) had quite good nutritional knowledge. Among the participants, n=4 (1.04%) had inadequate eating habits, n=282 (73.82%) had good eating habits, while n=96 (25.1%) had quite good eating habits. Statistical tests revealed no significant correlation between nutritional knowledge and dietary habits (p>0.05). There was a significant difference (p0.05). A subgroup analysis of medical and non-medical students revealed no significant association (p>0.05) between nutritional knowledge and dietary habits. Conclusion: Nutritional knowledge does not affect dietary habits. Being a medical or non-medical student is associated with the level of nutrition knowledge but not with dietary habits. Figures Figure 1 Figure 2 Figure 3 Introduction Nutrition knowledge pertains to an individual's comprehension of food and nutrition, encompassing awareness of essential nutrients, the relationship between diet and health, and the ability to make informed food choices ( 1 ). In contemporary fast-paced, consumer-driven societies, such knowledge is increasingly vital for improving lifestyles. Students with greater awareness of nutrition exhibit lower obesity rates ( 2 ). The prevalence of processed and artificially manufactured food products compels individuals to make unhealthy dietary choices ( 3 ). This trend is particularly concerning among university students, who experience a significant lifestyle transition upon entering independence, managed schedules, and the first occasion of making autonomous food choices, frequently owing to a lack of experience and interest in the constituents of their diets. Dietary habits are defined as long-term patterns of food consumption influenced by cultural, environmental, and psychological factors ( 4 ). These behaviors significantly impact one’s health and risk of noncommunicable diseases. Obesity, which often results from unhealthy dietary patterns, is now acknowledged by the World Health Organization as a global epidemic affecting one in eight individuals ( 5 , 6 ). Obesity is linked to a wide array of chronic conditions, including type 2 diabetes, cardiovascular disease, hypertension, and certain cancers ( 7 ). On the basis of the literature, dietary behavior and quality may affect chronic conditions such as musculoskeletal pain disorders ( 8 ). It is also recognized as a leading cause of mortality ( 9 ) and contributes to a diminished quality of life and escalated healthcare costs ( 10 ). In Pakistan, rates of obesity are increasing, with national surveys indicating that 12.1% of males and 13.8% of females are classified as obese ( 11 ). Among youth demographics, a study conducted in Peshawar reported that 15.7% of undergraduates were obese ( 12 ), suggesting that detrimental dietary habits may begin during university years. Although unhealthy eating patterns contribute to obesity ( 13 , 14 ), the influence of nutritional knowledge on dietary behavior remains ambiguous. Studies indicate widespread misconceptions regarding healthy eating ( 15 ), and although education should theoretically enhance choices, the actual behavioral impact of nutritional knowledge is inconsistent ( 16 – 18 ). Owing to insufficient research, limited evidence suggests that dietary habits are influenced by nutritional knowledge ( 17 ). The current evidence regarding the relationship between nutritional knowledge and actual dietary behavior is inconclusive. For example, a study conducted in England identified only a weak positive correlation between nutrition knowledge and dietary practices, indicating that knowledge alone may not be sufficient to engender behavioral transformation ( 18 ). Comparable studies have been conducted in various countries ( 19 , 20 ), suggesting the influence of additional factors such as taste preferences, accessibility, time constraints, stress, peer influence, and socioeconomic status in molding eating habits. A separate study conducted in Thailand ( 21 ) evaluated the efficacy of a program aimed at reducing obesity through a comprehensive approach; the results indicated that substantial long-term investment in national programs is requisite for fostering societal involvement in enhancing knowledge and skills related to health, nutrition, and healthy food selections. Nevertheless, the importance of cultivating healthy dietary patterns during university years cannot be underestimated. These formative years often serve as a transitional phase wherein students establish routines and behaviors that may persist into adulthood, with profound effects on future health. Research has demonstrated that poor dietary habits established during this period tend to continue throughout life, thereby increasing the risk of early onset chronic health issues ( 22 ). Despite this fact, there is a dearth of literature examining the relationship between nutrition knowledge and dietary behaviors among university students, particularly concerning the South Asian context. Medical students are presumed to possess superior nutritional knowledge due to their educational background; however, this knowledge may not necessarily translate into healthier eating habits due to academic stress, irregular routines, and limited access to healthy food options ( 23 ). Therefore, this study sought to investigate whether enhanced nutritional knowledge among medical students corresponds to better dietary habits than their non-medical peers do. In light of the increasing prevalence of obesity among young people, it is essential to identify the risk factors and the role of nutritional knowledge in mitigating those factors. This study endeavors to address this gap by evaluating and comparing the dietary knowledge and habits of medical and nonmedical students. Through the analysis of the correlation between knowledge and behavior, this research aims to provide insights into whether increased awareness results in healthier choices and consequently, whether targeted nutrition education could serve as an effective strategy to promote healthier lifestyles among university students. This comparative analysis aims to underscore the potential role of nutrition education in shaping healthier eating patterns, inform future health promotion strategies on university campuses, and contribute to initiatives aimed at reducing obesity and enhancing long-term public health outcomes. Methods Aims: - The specific aims of the study were as follows: ( 1 ) to assess and compare nutritional knowledge and dietary habits among medical and nonmedical students, and ( 2 ) to assess the association between nutritional knowledge and dietary habits. Sampling: - This cross-sectional study was conducted from July 2024 to January 2025. Data were collected from 382 undergraduate students via a non-random convenience sampling approach. The sample size was calculated to be 379 via the OpenEpi web tool from the total undergraduate population of 27000 with a confidence level of 95%. Half of the sample (n = 191) was reserved for the medical student group which also included students from other health related fields, and the other half was reserved for non-medical students in unrelated fields. The participants were informed about the study, and informed written consent was obtained before participation. The research protocols were approved by the ethical review board of the institution. A standardized questionnaire was used for the assessment of dietary habits and nutritional knowledge ( 24 ). Exclusion/ Inclusion Criteria: - Undergraduate students aged 17–25 years from Islamabad and Rawalpindi were included. Those with postgraduate status, enrollment in nutrition-related programs, dietary restrictions due to medical conditions or special diets were excluded. Questionnaire: - The questionnaire and scoring method used in this study were developed and validated by Italian researcher Giovanni Turconi ( 24 ), used with her permission, and have been applied in previous studies ( 25 , 26 , 27 ). The questionnaire was used because it had separate sections for both nutritional knowledge and dietary habits and had validated scoring and grouping of variables. The questionnaire included three sections: demographic information, dietary habits (14 items; score range: 0–42), and nutritional knowledge (7 items; score range: 0–7). The scores were categorized into knowledge and behavior groups (Table 1 ). Table 1 NUTRITIONAL KNOWLEDGE (score 0–11) 0–4 Insufficient Nutrition Knowledge 5–8 Good Nutritional Knowledge 9–11 Quite Good Nutritional Knowledge EATING HABITS (0–42) 0–14 Unsatisfactory Eating Habits 15–28 Partially Satisfactory Eating Habits 29–42 Satisfactory Eating Habits Demographics Section: - The demographics section assessed the field of study, age, sex, and special diet. Descriptive statistics were run to determine the results. Dietary Habits Section: - The score for the dietary habits section ranged from 0–42. The section had 14 questions, with scores for each question ranging from 0 to 3. Nutritional Knowledge Section: This section consisted of 7 questions related to nutritional knowledge concerning healthy foods and diet and diet-related diseases. The score for each correct answer was equal to one. Thus, the range was between 0 and 7. The scores were grouped into categories for dietary habits and nutritional knowledge. The scoring range for each category is described in Table 1 . Statistical Analysis: All descriptive statistics, such as frequencies and percentages, were calculated. Inferential statistical tests such as chi-square tests, were applied to find any significant associations among categorical variables. To find correlations between continuous variables Spearman’s rank correlation test was performed for nonnormally distributed data, and Pearson’s correlation test was performed for normally distributed data. In addition, the Mann‒Whitney U test was also used to compare the quantitative data and assess the statistical significance of the differences in the mean values between the 2 groups (to determine the significance of the differences in nutritional knowledge or dietary habits between the medical and nonmedical subgroups). For tests of significance, p-values of < 0.05 were considered statistically significant. All the statistical analyses were performed with SPSS 26. Results General Characteristics A total of 382 students participated (mean age: 21 ± 2.39 years). Female participants represented 57.9% of the total sample. Table 2 shows participant demographics stratified by academic field. Table 2 Characteristics Medical Students N = 191 Mean (SD) Non-medical Students N = 191 Mean (S.D) Total N = 382 Mean (S.D) Age in years 20.8 (2.12) 21.6 (2.64) 21 (2.39) n (%) n (%) n (%) Gender Female 129 (67.5) 92 (48.2) 221 (57.9) Male 62 (32.5) 99 (51.8) 161 (42.1) Nutritional Knowledge and Dietary Habits Among non-medical students, 67 (39 males, 28 females) had insufficient nutrition knowledge , whereas only 21 medical students (9 males, 12 females) fell into this category. A greater proportion of medical students achieved 'good ' or 'quite good' knowledge scores (n = 170) compared to non-medical students (n = 126). Among non-medical students, only 11 participants scored quite good nutritional knowledge , in contrast to the 51 medical students in the same category. In all categories, there were more females than males in both the medical and non-medical subgroups who scored good and quite good nutritional knowledge . The details of the distribution of the population in the various categories for both subgroups are described in Figure 1. (Figure 1 will come here (NUTRITION KNOWLEDGE)) Statistical analysis (Mann–Whitney test) revealed significantly greater nutritional knowledge in medical students (p < 0.0001), but the sex differences were not significant. Most participants in both groups fell into the somewhat satisfactory and satisfactory dietary habits category, with 50 medical students and 46 non-medical students scoring satisfactory nutritional knowledge . Most of the students (73% medical and 74% non-medical) scored in the partially satisfactory nutritional knowledge category . The scores of students in the inadequate eating habits category for the medical and non-medical groups were 1 and 3 respectively. Figure 2 shows the distribution of the samples in the different categories of eating habits. (Figure 2 will come here (DIETARY HABITS)) Statistical analysis, comparing both subgroups, revealed no significant differences in eating habits between medical and non-medical students (p>0.05). Furthermore, the difference between the eating habits of males and females was not statistically significant. The findings of the present study revealed that the associations between eating habits and nutritional knowledge were not statistically significant for either group (p>0.05). The non-association between nutritional knowledge and eating habits is shown in Figure 3 for the individual scores of the 382 samples plotted between nutritional knowledge and eating habits. (Figure 3 will come here (INDIVIDUAL SCORES ) The scatterplot revealed no significant linear correlation between nutritional knowledge and eating habits (mean knowledge score = 6.18; mean eating habits score = 25.38). Discussion This study examined the relationship between nutrition knowledge and dietary habits among medical and non-medical undergraduate students in Islamabad and Rawalpindi. While medical students demonstrated better nutritional knowledge, their dietary habits were similar to those of non-medical students, who had significantly less nutritional knowledge. Inferential statistics showed that there was no significant association between nutritional knowledge and dietary habits. This suggests that knowledge alone may be insufficient to drive behavior change, echoing findings from similar studies ( 18 , 23 ). Thus, having better nutritional knowledge did not translate into having better dietary standards. This could indicate that nutritional knowledge does not necessarily lead to better dietary habits. The lack of association between dietary habits and nutritional knowledge might be explained by other factors that come into play during a person’s university life. The finding of similar dietary habits in both medical and non-medical students might be explained by the fact that both groups share relatively similar living environments, consisting mainly of academics and few extracurricular activities. University students, both medical and non-medical, have been shown to suffer from anxiety and stress ( 28 , 29 ). Non-medical students are not exposed to much health education. Enrolled mostly in professional universities, they receive education primarily related to their respective fields of study and professions. This results in a lack of essential concepts needed to maintain a healthy lifestyle. Their only understanding of nutrition seems to stem from biology classes in their higher secondary education. On the other hand, medical students excel in their understanding of nutrition and a healthy diet because they undergo rigorous courses in biochemistry and physiology in their early years, where subjects pertaining to nutrition are taught along with their clinical aspects. The sample shows a 15.8% difference between the number of males and females in the combined sample. This difference was more pronounced in the medical sample, with a percentage difference of 36%. This disparity, especially in the medical subgroup, reflects the larger population of female medical students in most medical and health profession colleges. Although there were more female responses than male responses in both subgroups, there were no significant differences between them in terms of nutritional knowledge or dietary habits. The mean age of the sample was 21 years, with the non-medical sample being slightly older, although this difference was not significant. The findings of the present study highlight the gap in essential education regarding nutrition among non-medical students. Educational interventions, including short nutrition courses, have been shown to improve knowledge and awareness among university students ( 30 ). Future efforts should explore how external factors, such as food marketing ( 31 ), affordability, and campus access, influence student behavior. Identifying such factors is crucial for promoting better dietary habits among university students. This study is the first to assess the association between nutritional knowledge and dietary habits in Islamabad and Rawalpindi. The results align with the findings of a Karachi-based study on nutritional knowledge among medical and non-medical students. This suggests that the lack of nutrition education among non-medical students is consistent across universities in Pakistan. Owing to the abundance of studies assessing anthropometric variables in university students in the region ( 32 , 33 ), these variables were not assessed in this study. The limitations regarding confounders arise from the cross-sectional design of the study, which makes dealing with confounding factors difficult. However, obvious confounders such as special diets and diseases were considered in the exclusion criteria. Therefore, this study does not indicate the presence or absence of a causal relationship between nutritional knowledge and dietary habits. This study was also limited to the cities of Rawalpindi and Islamabad, and the mode of data collection was convenience sampling due to feasibility and resource constraints. However, the study results can be generalized to most urban populations in the country, as university students in these areas have similar sociodemographic characteristics and food choices. Another limitation is that convenience sampling, a non-random sampling technique, was used because of its feasibility. Conclusion Although medical students had significantly greater nutritional knowledge, no significant difference in dietary habits was observed between medical and non-medical students. This underscores the need for targeted interventions that go beyond knowledge alone to influence eating behaviors. Declarations Grant Support/Funding: None Disclosure: No potential conflicts of interest. Consent for Publication: Not applicable Writing Assistance: none Ethical Approval and Consent: Consent was taken after apprising the participants of the details of the study and the type of data required from them, according to the Declaration of Helsinki. The study was ethically approved by the Ethical Review Committee, Foundation University Medical College after evaluation of the study protocol. Approval Number: FF/FUMC/215-489/Phy/24 Data Availability The datasets created and analyzed during the course of the study are not available to the public, but are available from the corresponding author on reasonable request. Acknowledgments : Significant guidance and help were taken from Ahmad Ali Khan president Student Research Society at Foundation University Medical College for which we are immensely grateful. We are also thankful to all participants who took the time to fill in the questionnaire forms. Lastly, we acknowledge the support of our peers and faculty for their encouragement throughout the course of the study. Author Contributions: MTF conceptualized and designed the study, collected and analyzed the data, prepared the figures and tables, and wrote the discussion and methodology sections of the manuscript, as well as the abstract, involved in writing the study protocol for ethical approval. BMJ collected data and wrote the introduction section of the manuscript, and was involved in writing the study protocol for ethical approval. UI made a Google Forms version of the questionnaire, collected data and revised the introduction section of the manuscript SM collected data and wrote the results section of the manuscript. DAA reviewed the design of the study and edited the manuscript. Author Information Contact: [email protected] (corresponding author) References Axelson ML, Brinberg D. The measurement and conceptualization of nutrition knowledge. Journal of Nutrition Education. 1992 Sep;24(5):239–46. ul Haq I, Mariyam Z, Li M, Huang X, Jiang P, Zeb F, et al. 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Cite Share Download PDF Status: Published Journal Publication published 27 Mar, 2026 Read the published version in BMC Nutrition → Version 1 posted Editorial decision: Revision requested 16 Jul, 2025 Reviews received at journal 29 Jun, 2025 Reviewers agreed at journal 29 Jun, 2025 Reviews received at journal 29 Jun, 2025 Reviews received at journal 29 Jun, 2025 Reviewers agreed at journal 29 Jun, 2025 Reviewers agreed at journal 29 Jun, 2025 Reviewers agreed at journal 27 Jun, 2025 Reviewers invited by journal 27 Jun, 2025 Editor invited by journal 18 Jun, 2025 Editor assigned by journal 15 Jun, 2025 Submission checks completed at journal 15 Jun, 2025 First submitted to journal 11 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6872420","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":478441836,"identity":"34e996e9-57c7-4406-8668-2171e75b1363","order_by":0,"name":"Muhammad Talha Farrukh","email":"data:image/png;base64,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","orcid":"","institution":"Foundation University Medical College","correspondingAuthor":true,"prefix":"","firstName":"Muhammad","middleName":"Talha","lastName":"Farrukh","suffix":""},{"id":478441839,"identity":"1d635186-9bf6-481d-90fd-4153ae9a38b4","order_by":1,"name":"Bakhtawar Mohsin Jami","email":"","orcid":"","institution":"Foundation University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Bakhtawar","middleName":"Mohsin","lastName":"Jami","suffix":""},{"id":478441841,"identity":"a6b02aa6-ea35-4ab9-9063-bfcaf11c1d61","order_by":2,"name":"Unaiza Iqbal","email":"","orcid":"","institution":"Foundation University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Unaiza","middleName":"","lastName":"Iqbal","suffix":""},{"id":478441847,"identity":"efd828a2-032d-4f31-bd8b-21c70d6f7e7c","order_by":3,"name":"Sohaib Mushtaq","email":"","orcid":"","institution":"Foundation University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Sohaib","middleName":"","lastName":"Mushtaq","suffix":""},{"id":478441848,"identity":"5ef126c1-356b-438c-a2a1-ba7ec7cadc31","order_by":4,"name":"Danish A. Ashraf","email":"","orcid":"","institution":"TruGift Health LLC","correspondingAuthor":false,"prefix":"","firstName":"Danish","middleName":"A.","lastName":"Ashraf","suffix":""}],"badges":[],"createdAt":"2025-06-11 13:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6872420/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6872420/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40795-026-01306-3","type":"published","date":"2026-03-27T16:12:39+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85825901,"identity":"fe2e5c4c-ddc3-4abc-a57a-36e4bd021104","added_by":"auto","created_at":"2025-07-02 07:11:15","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":69793,"visible":true,"origin":"","legend":"\u003cp\u003eNUTRITION KNOWLEDGE\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6872420/v1/9facd4a5738e77a80b131993.jpg"},{"id":85825902,"identity":"c7da26ab-3b29-4122-a4ec-3352a5f9510c","added_by":"auto","created_at":"2025-07-02 07:11:15","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":60200,"visible":true,"origin":"","legend":"\u003cp\u003eDIETARY HABITS\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6872420/v1/c395340578bb41733ac6037d.jpg"},{"id":85825904,"identity":"90fc1669-fc47-41b8-84a6-523f685c0cf2","added_by":"auto","created_at":"2025-07-02 07:11:15","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":71942,"visible":true,"origin":"","legend":"\u003cp\u003eINDIVIDUAL SCORES\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6872420/v1/3f1b5d00c35e38bf0167c0c2.jpg"},{"id":105756066,"identity":"9289b294-6d6a-4286-b0ec-5230f956b193","added_by":"auto","created_at":"2026-03-30 16:35:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":863948,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6872420/v1/cce5c44b-4a57-4dbe-a622-f99ee776914d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nutritional Knowledge and its Association with Dietary Habits among Medical vs. Non-medical Students in Islamabad and Rawalpindi: A Cross-sectional Comparative Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNutrition knowledge pertains to an individual's comprehension of food and nutrition, encompassing awareness of essential nutrients, the relationship between diet and health, and the ability to make informed food choices (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In contemporary fast-paced, consumer-driven societies, such knowledge is increasingly vital for improving lifestyles. Students with greater awareness of nutrition exhibit lower obesity rates (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The prevalence of processed and artificially manufactured food products compels individuals to make unhealthy dietary choices (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This trend is particularly concerning among university students, who experience a significant lifestyle transition upon entering independence, managed schedules, and the first occasion of making autonomous food choices, frequently owing to a lack of experience and interest in the constituents of their diets.\u003c/p\u003e \u003cp\u003eDietary habits are defined as long-term patterns of food consumption influenced by cultural, environmental, and psychological factors (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These behaviors significantly impact one’s health and risk of noncommunicable diseases. Obesity, which often results from unhealthy dietary patterns, is now acknowledged by the World Health Organization as a global epidemic affecting one in eight individuals (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Obesity is linked to a wide array of chronic conditions, including type 2 diabetes, cardiovascular disease, hypertension, and certain cancers (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). On the basis of the literature, dietary behavior and quality may affect chronic conditions such as musculoskeletal pain disorders (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). It is also recognized as a leading cause of mortality (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and contributes to a diminished quality of life and escalated healthcare costs (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Pakistan, rates of obesity are increasing, with national surveys indicating that 12.1% of males and 13.8% of females are classified as obese (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Among youth demographics, a study conducted in Peshawar reported that 15.7% of undergraduates were obese (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), suggesting that detrimental dietary habits may begin during university years.\u003c/p\u003e \u003cp\u003eAlthough unhealthy eating patterns contribute to obesity (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), the influence of nutritional knowledge on dietary behavior remains ambiguous. Studies indicate widespread misconceptions regarding healthy eating (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and although education should theoretically enhance choices, the actual behavioral impact of nutritional knowledge is inconsistent (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e–\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOwing to insufficient research, limited evidence suggests that dietary habits are influenced by nutritional knowledge (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The current evidence regarding the relationship between nutritional knowledge and actual dietary behavior is inconclusive. For example, a study conducted in England identified only a weak positive correlation between nutrition knowledge and dietary practices, indicating that knowledge alone may not be sufficient to engender behavioral transformation (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Comparable studies have been conducted in various countries (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), suggesting the influence of additional factors such as taste preferences, accessibility, time constraints, stress, peer influence, and socioeconomic status in molding eating habits. A separate study conducted in Thailand (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) evaluated the efficacy of a program aimed at reducing obesity through a comprehensive approach; the results indicated that substantial long-term investment in national programs is requisite for fostering societal involvement in enhancing knowledge and skills related to health, nutrition, and healthy food selections.\u003c/p\u003e \u003cp\u003eNevertheless, the importance of cultivating healthy dietary patterns during university years cannot be underestimated. These formative years often serve as a transitional phase wherein students establish routines and behaviors that may persist into adulthood, with profound effects on future health. Research has demonstrated that poor dietary habits established during this period tend to continue throughout life, thereby increasing the risk of early onset chronic health issues (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Despite this fact, there is a dearth of literature examining the relationship between nutrition knowledge and dietary behaviors among university students, particularly concerning the South Asian context.\u003c/p\u003e \u003cp\u003eMedical students are presumed to possess superior nutritional knowledge due to their educational background; however, this knowledge may not necessarily translate into healthier eating habits due to academic stress, irregular routines, and limited access to healthy food options (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Therefore, this study sought to investigate whether enhanced nutritional knowledge among medical students corresponds to better dietary habits than their non-medical peers do.\u003c/p\u003e \u003cp\u003eIn light of the increasing prevalence of obesity among young people, it is essential to identify the risk factors and the role of nutritional knowledge in mitigating those factors. This study endeavors to address this gap by evaluating and comparing the dietary knowledge and habits of medical and nonmedical students. Through the analysis of the correlation between knowledge and behavior, this research aims to provide insights into whether increased awareness results in healthier choices and consequently, whether targeted nutrition education could serve as an effective strategy to promote healthier lifestyles among university students.\u003c/p\u003e \u003cp\u003eThis comparative analysis aims to underscore the potential role of nutrition education in shaping healthier eating patterns, inform future health promotion strategies on university campuses, and contribute to initiatives aimed at reducing obesity and enhancing long-term public health outcomes.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eAims: -\u003c/p\u003e\u003cp\u003eThe specific aims of the study were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) to assess and compare nutritional knowledge and dietary habits among medical and nonmedical students, and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) to assess the association between nutritional knowledge and dietary habits.\u003c/p\u003e\u003cp\u003eSampling: -\u003c/p\u003e\u003cp\u003eThis cross-sectional study was conducted from July 2024 to January 2025. Data were collected from 382 undergraduate students via a non-random convenience sampling approach. The sample size was calculated to be 379 via the OpenEpi web tool from the total undergraduate population of 27000 with a confidence level of 95%. Half of the sample (n = 191) was reserved for the medical student group which also included students from other health related fields, and the other half was reserved for non-medical students in unrelated fields.\u003c/p\u003e\u003cp\u003e The participants were informed about the study, and informed written consent was obtained before participation. The research protocols were approved by the ethical review board of the institution. A standardized questionnaire was used for the assessment of dietary habits and nutritional knowledge (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eExclusion/ Inclusion Criteria: -\u003c/p\u003e\u003cp\u003eUndergraduate students aged 17–25 years from Islamabad and Rawalpindi were included. Those with postgraduate status, enrollment in nutrition-related programs, dietary restrictions due to medical conditions or special diets were excluded.\u003c/p\u003e\u003cp\u003eQuestionnaire: -\u003c/p\u003e\u003cp\u003eThe questionnaire and scoring method used in this study were developed and validated by Italian researcher Giovanni Turconi (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), used with her permission, and have been applied in previous studies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The questionnaire was used because it had separate sections for both nutritional knowledge and dietary habits and had validated scoring and grouping of variables. The questionnaire included three sections: demographic information, dietary habits (14 items; score range: 0–42), and nutritional knowledge (7 items; score range: 0–7). The scores were categorized into knowledge and behavior groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\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\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNUTRITIONAL\u003c/p\u003e \u003cp\u003eKNOWLEDGE\u003c/p\u003e \u003cp\u003e(score 0–11)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0–4\u003c/p\u003e \u003cp\u003eInsufficient Nutrition Knowledge\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5–8\u003c/p\u003e \u003cp\u003eGood Nutritional Knowledge\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9–11\u003c/p\u003e \u003cp\u003eQuite Good Nutritional Knowledge\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEATING HABITS\u003c/p\u003e \u003cp\u003e(0–42)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0–14\u003c/p\u003e \u003cp\u003eUnsatisfactory Eating Habits\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15–28\u003c/p\u003e \u003cp\u003ePartially Satisfactory Eating Habits\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29–42\u003c/p\u003e \u003cp\u003eSatisfactory Eating Habits\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eDemographics Section: -\u003c/p\u003e\u003cp\u003eThe demographics section assessed the field of study, age, sex, and special diet. Descriptive statistics were run to determine the results.\u003c/p\u003e\u003cp\u003eDietary Habits Section: -\u003c/p\u003e\u003cp\u003eThe score for the dietary habits section ranged from 0–42. The section had 14 questions, with scores for each question ranging from 0 to 3.\u003c/p\u003e\u003cp\u003eNutritional Knowledge Section:\u003c/p\u003e\u003cp\u003eThis section consisted of 7 questions related to nutritional knowledge concerning healthy foods and diet and diet-related diseases. The score for each correct answer was equal to one. Thus, the range was between 0 and 7.\u003c/p\u003e\u003cp\u003eThe scores were grouped into categories for dietary habits and nutritional knowledge. The scoring range for each category is described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003ch2\u003eStatistical Analysis:\u003c/h2\u003e\u003cp\u003eAll descriptive statistics, such as frequencies and percentages, were calculated. Inferential statistical tests such as chi-square tests, were applied to find any significant associations among categorical variables. To find correlations between continuous variables Spearman’s rank correlation test was performed for nonnormally distributed data, and Pearson’s correlation test was performed for normally distributed data. In addition, the Mann‒Whitney U test was also used to compare the quantitative data and assess the statistical significance of the differences in the mean values between the 2 groups (to determine the significance of the differences in nutritional knowledge or dietary habits between the medical and nonmedical subgroups). For tests of significance, p-values of \u0026lt; 0.05 were considered \u003cem\u003estatistically significant.\u003c/em\u003e All the statistical analyses were performed with SPSS 26.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eGeneral Characteristics\u003c/h2\u003e\n \u003cp\u003eA total of 382 students participated (mean age: 21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39 years). Female participants represented 57.9% of the total sample. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows participant demographics stratified by academic field.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedical Students\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;191\u003c/p\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-medical Students\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;191\u003c/p\u003e\n \u003cp\u003eMean (S.D)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;382\u003c/p\u003e\n \u003cp\u003eMean (S.D)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.8 (2.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.6 (2.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (2.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129 (67.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92 (48.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e221 (57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99 (51.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e161 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003ch4\u003eNutritional Knowledge and Dietary Habits\u003c/h4\u003e\n \u003cp\u003eAmong non-medical students, 67 (39 males, 28 females) had \u003cem\u003einsufficient nutrition knowledge\u003c/em\u003e, whereas only 21 medical students (9 males, 12 females) fell into this category. A greater proportion of medical students achieved \u003cem\u003e\u0026apos;good\u003c/em\u003e\u0026apos; or \u003cem\u003e\u0026apos;quite good\u0026apos;\u003c/em\u003e knowledge scores (n = 170) compared to non-medical students (n = 126). Among non-medical students, only 11 participants scored \u003cem\u003equite good nutritional knowledge\u003c/em\u003e, in contrast to the 51 medical students in the same category.\u003c/p\u003e\n \u003cp\u003eIn all categories, there were more females than males in both the medical and non-medical subgroups who scored \u003cem\u003egood\u0026nbsp;\u003c/em\u003eand \u003cem\u003equite good nutritional knowledge\u003c/em\u003e.\u003c/p\u003e\n \u003cp\u003eThe details of the distribution of the population in the various categories for both subgroups are described in Figure 1.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Figure 1 will come here (NUTRITION KNOWLEDGE))\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eStatistical analysis (Mann\u0026ndash;Whitney test) revealed significantly greater nutritional knowledge in medical students (p \u0026lt; 0.0001), but the sex differences were not significant.\u003c/p\u003e\n \u003cp\u003eMost participants in both groups fell\u0026nbsp;\u003cem\u003einto the somewhat\u003c/em\u003e\u003cem\u003e\u0026nbsp;satisfactory\u003c/em\u003e and \u003cem\u003esatisfactory dietary habits\u0026nbsp;\u003c/em\u003ecategory, with 50 medical students and 46 non-medical students scoring \u003cem\u003esatisfactory nutritional knowledge\u003c/em\u003e. Most of the students (73% medical\u003cem\u003e\u0026nbsp;\u003c/em\u003eand 74% non-medical) scored in the \u003cem\u003epartially satisfactory nutritional knowledge\u0026nbsp;\u003c/em\u003ecategory\u003cem\u003e.\u0026nbsp;\u003c/em\u003eThe scores of students in the \u003cem\u003einadequate eating habits\u0026nbsp;\u003c/em\u003ecategory for the medical and non-medical groups were 1 and 3 respectively. Figure 2 shows the distribution of the samples in the different categories of eating habits.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Figure 2 will come here (DIETARY HABITS))\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eStatistical analysis, comparing both subgroups, revealed no significant differences in eating habits between medical and non-medical students (p\u0026gt;0.05). Furthermore, the difference between the eating habits of males and females was not statistically significant.\u003c/p\u003e\n \u003cp\u003eThe findings of the present study revealed that the associations between eating habits and nutritional knowledge were not statistically significant for either group (p\u0026gt;0.05). The non-association between nutritional knowledge and eating habits is shown in Figure 3 for the individual scores of the 382 samples plotted between nutritional knowledge and eating habits.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Figure 3 will come here (INDIVIDUAL SCORES\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe scatterplot revealed no significant linear correlation between nutritional knowledge and eating habits (mean knowledge score = 6.18; mean eating habits score = 25.38).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003cbr\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the relationship between nutrition knowledge and dietary habits among medical and non-medical undergraduate students in Islamabad and Rawalpindi. While medical students demonstrated better nutritional knowledge, their dietary habits were similar to those of non-medical students, who had significantly less nutritional knowledge. Inferential statistics showed that there was no significant association between nutritional knowledge and dietary habits. This suggests that knowledge alone may be insufficient to drive behavior change, echoing findings from similar studies (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThus, having better nutritional knowledge did not translate into having better dietary standards. This could indicate that nutritional knowledge does not necessarily lead to better dietary habits. The lack of association between dietary habits and nutritional knowledge might be explained by other factors that come into play during a person\u0026rsquo;s university life. The finding of similar dietary habits in both medical and non-medical students might be explained by the fact that both groups share relatively similar living environments, consisting mainly of academics and few extracurricular activities. University students, both medical and non-medical, have been shown to suffer from anxiety and stress (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNon-medical students are not exposed to much health education. Enrolled mostly in professional universities, they receive education primarily related to their respective fields of study and professions. This results in a lack of essential concepts needed to maintain a healthy lifestyle. Their only understanding of nutrition seems to stem from biology classes in their higher secondary education. On the other hand, medical students excel in their understanding of nutrition and a healthy diet because they undergo rigorous courses in biochemistry and physiology in their early years, where subjects pertaining to nutrition are taught along with their clinical aspects.\u003c/p\u003e \u003cp\u003eThe sample shows a 15.8% difference between the number of males and females in the combined sample. This difference was more pronounced in the medical sample, with a percentage difference of 36%. This disparity, especially in the medical subgroup, reflects the larger population of female medical students in most medical and health profession colleges. Although there were more female responses than male responses in both subgroups, there were no significant differences between them in terms of nutritional knowledge or dietary habits. The mean age of the sample was 21 years, with the non-medical sample being slightly older, although this difference was not significant.\u003c/p\u003e \u003cp\u003eThe findings of the present study highlight the gap in essential education regarding nutrition among non-medical students. Educational interventions, including short nutrition courses, have been shown to improve knowledge and awareness among university students (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Future efforts should explore how external factors, such as food marketing (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), affordability, and campus access, influence student behavior. Identifying such factors is crucial for promoting better dietary habits among university students.\u003c/p\u003e \u003cp\u003eThis study is the first to assess the association between nutritional knowledge and dietary habits in Islamabad and Rawalpindi. The results align with the findings of a Karachi-based study on nutritional knowledge among medical and non-medical students. This suggests that the lack of nutrition education among non-medical students is consistent across universities in Pakistan.\u003c/p\u003e \u003cp\u003eOwing to the abundance of studies assessing anthropometric variables in university students in the region (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), these variables were not assessed in this study.\u003c/p\u003e \u003cp\u003eThe limitations regarding confounders arise from the cross-sectional design of the study, which makes dealing with confounding factors difficult. However, obvious confounders such as special diets and diseases were considered in the exclusion criteria. Therefore, this study does not indicate the presence or absence of a causal relationship between nutritional knowledge and dietary habits.\u003c/p\u003e \u003cp\u003eThis study was also limited to the cities of Rawalpindi and Islamabad, and the mode of data collection was convenience sampling due to feasibility and resource constraints. However, the study results can be generalized to most urban populations in the country, as university students in these areas have similar sociodemographic characteristics and food choices.\u003c/p\u003e \u003cp\u003eAnother limitation is that convenience sampling, a non-random sampling technique, was used because of its feasibility.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAlthough medical students had significantly greater nutritional knowledge, no significant difference in dietary habits was observed between medical and non-medical students. This underscores the need for targeted interventions that go beyond knowledge alone to influence eating behaviors.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eGrant Support/Funding:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure:\u0026nbsp;\u003c/strong\u003eNo potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting Assistance:\u0026nbsp;\u003c/strong\u003enone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent:\u0026nbsp;\u003c/strong\u003eConsent was taken after apprising the participants of the details of the study and the type of data required from them, according to the Declaration of Helsinki. The study was ethically approved by the Ethical Review Committee, Foundation University Medical College after evaluation of the study protocol. Approval Number: FF/FUMC/215-489/Phy/24\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets created and analyzed during the course of the study are not available to the public, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSignificant guidance and help were taken from Ahmad Ali Khan president Student Research Society at Foundation University Medical College for which we are immensely grateful. We are also thankful to all participants who took the time to fill in the questionnaire forms. Lastly, we acknowledge the support of our peers and faculty for their encouragement throughout the course of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMTF conceptualized and designed the study, collected and analyzed the data, prepared the figures and tables, and wrote the discussion and methodology sections of the manuscript, as well as the abstract, involved in writing the study protocol for ethical approval.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBMJ collected data and wrote the introduction section of the manuscript, and was involved in writing the study protocol for ethical approval.\u003c/p\u003e\n\u003cp\u003eUI made a Google Forms version of the questionnaire, collected data and revised the introduction section of the manuscript\u003c/p\u003e\n\u003cp\u003eSM collected data and wrote the results section of the manuscript.\u003c/p\u003e\n\u003cp\u003eDAA reviewed the design of the study and edited the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContact:\u0026nbsp;\u003c/strong\[email protected] (corresponding author)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAxelson ML, Brinberg D. 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Impact of nutritional knowledge on dietary behaviors of students in Kuwait University. Acta Biomed. 2020 Nov 10;91(4):e2020183. doi: 10.23750/abm.v91i4.8716. PMID: 33525277; PMCID: PMC7927513.\u003c/li\u003e\n \u003cli\u003eArrigoni C, Grugnetti AM, Caruso R, Dellafiore F, Borelli P, Cenzi M, Gallotti L, Signorelli C. Describing the health behaviours of future nurses: a cross-sectional study among Italian nursing students. Acta Biomed. 2020 Sep 7;91(3):e2020068. doi: 10.23750/abm.v91i3.8338. PMID: 32921763; PMCID: PMC7717033.\u003c/li\u003e\n \u003cli\u003eShaikh B, Kahloon A, Kazmi M, Khalid H, Nawaz K, Khan N, et al. Students, Stress and Coping Strategies: A Case of Pakistani Medical School. Education for Health: Change in Learning \u0026amp; Practice [Internet]. 2004;17(3):346\u0026ndash;53. Available from: https://www.researchgate.net/profile/Babar_Shaikh/publication/7888674_Students_Stress_and_Coping_Strategies_\u003cbr/\u003eA_Case_of_Pakistani_Medical_School/links/02bfe50ff750d1b06c000000.pdf\u003c/li\u003e\n \u003cli\u003eAsif S, Muddassar A, Shahzad TZ, Raouf M, Pervaiz T. Frequency of depression, anxiety and stress among university students. Pakistan Journal of Medical Sciences [Internet]. 2020 Jul;36(5):971\u0026ndash;6. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7372668/\u003c/li\u003e\n \u003cli\u003eNani M, Gordon K, Caine-Bish N. P45 Impact of a College Nutrition Course on Nutrition Knowledge and Dietary Intake of Undergraduate Students. Journal of Nutrition Education and Behavior. 2019 Jul;51(7):S52.\u003c/li\u003e\n \u003cli\u003eArrona-Cardoza P, Labont\u0026eacute; K, Cisneros-Franco JM, Nielsen DE. The effects of food advertisements on food intake and neural activity: a systematic review and meta-analysis of recent experimental studies. Advances in Nutrition [Internet]. 2022 Dec 31;14(2). Available from: https://www.sciencedirect.com/science/article/pii/S2161831322013187\u003c/li\u003e\n \u003cli\u003eKhalid M, Khan SA, Awan M, Asif K, Waseem M, Tariq MI. Correlation between body mass index, body perception and physical activity among university students. Foundation University Journal of Rehabilitation Sciences. 2023 Jul 31;3(2):38\u0026ndash;43.\u003c/li\u003e\n \u003cli\u003eAsif M, Aslam M, Qasim M, Altaf S, Ismail A, Ali H. A dataset about anthropometric measurements of the Pakistani children and adolescents using a cross-sectional multi-ethnic anthropometric survey. Data in Brief. 2021 Feb;34:106642\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6872420/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6872420/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eObesity\u003cstrong\u003e \u003c/strong\u003eand cardiovascular diseases have become the leading causes of mortality. Factors affecting dietary habits are crucial for preventing these diseases. However, there is limited knowledge regarding the correlation between nutritional knowledge and dietary habits.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aimed to assess the association between nutritional knowledge and dietary practices among university students, and to compare the nutritional knowledge and dietary habits of medical and non-medical students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A quantitative cross-sectional study, ethically approved by the institution, was conducted among the undergraduate population. The sample size was calculated via OpenEpi software with a 95% confidence interval and a 5% margin of error. Data collection was performed through a validated questionnaire via a convenience sampling technique. All descriptive and inferential statistical tests were conducted with IBM SPSS 26 and a p-value of \u0026lt;0.05 was considered to indicate statistical significance for all applied measures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The sample consisted of 382 participants (n=191 medical and n=191 non-medical), with a mean age of 21±2.39 years. When nutritional knowledge was assessed in terms of categories, 86 (22.5%) had unsatisfactory knowledge, 234 (61.2%) had good nutritional knowledge, and 62 (16.2%) had quite good nutritional knowledge. Among the participants, n=4 (1.04%) had inadequate eating habits, n=282 (73.82%) had good eating habits, while n=96 (25.1%) had quite good eating habits. Statistical tests revealed no significant correlation between nutritional knowledge and dietary habits (p\u0026gt;0.05). There was a significant difference (p\u0026lt;0.001) in the nutritional knowledge of medical and non-medical students, but the same was not true for eating habits (p\u0026gt;0.05). A subgroup analysis of medical and non-medical students revealed no significant association (p\u0026gt;0.05) between nutritional knowledge and dietary habits.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eNutritional knowledge does not affect dietary habits. Being a medical or non-medical student is associated with the level of nutrition knowledge but not with dietary habits.\u003c/p\u003e","manuscriptTitle":"Nutritional Knowledge and its Association with Dietary Habits among Medical vs. Non-medical Students in Islamabad and Rawalpindi: A Cross-sectional Comparative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-02 07:11:10","doi":"10.21203/rs.3.rs-6872420/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-16T04:49:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-30T03:34:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328246453819925816935379232948217583249","date":"2025-06-30T03:04:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-29T12:55:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-29T10:08:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255357710367268562308733086709532357178","date":"2025-06-29T05:06:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"45890683890973432521139415015448276","date":"2025-06-29T04:54:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295302053765916732321958567438415498364","date":"2025-06-27T06:52:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-27T04:52:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-18T06:43:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-16T01:32:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-16T01:32:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nutrition","date":"2025-06-11T13:28:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1744b299-1ece-4a8f-a662-007004f4d631","owner":[],"postedDate":"July 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:33:39+00:00","versionOfRecord":{"articleIdentity":"rs-6872420","link":"https://doi.org/10.1186/s40795-026-01306-3","journal":{"identity":"bmc-nutrition","isVorOnly":false,"title":"BMC Nutrition"},"publishedOn":"2026-03-27 16:12:39","publishedOnDateReadable":"March 27th, 2026"},"versionCreatedAt":"2025-07-02 07:11:10","video":"","vorDoi":"10.1186/s40795-026-01306-3","vorDoiUrl":"https://doi.org/10.1186/s40795-026-01306-3","workflowStages":[]},"version":"v1","identity":"rs-6872420","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6872420","identity":"rs-6872420","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}