|Year : 2021 | Volume
| Issue : 2 | Page : 95-101
Association between women's level of education and family daily nutrient intake and obesity status in Iraq
Hamdia Mirkhan Ahmed1, Amani Layth Hameed2
1 Department of Physiotherapy, College of Health Sciences, Hawler Medical University, Erbil, Kurdistan Region, Iraq
2 Clinical Biochemistry, College of Health Sciences, Hawler Medical University, Erbil, Kurdistan Region, Iraq
|Date of Submission||23-Dec-2020|
|Date of Acceptance||04-Feb-2021|
|Date of Web Publication||26-Jun-2021|
Amani Layth Hameed
College of Health Sciences, Hawler Medical University, Erbil, Kurdistan Region
Source of Support: None, Conflict of Interest: None
Background: Mothers play an important role in controlling family eating habits as well as the type of food consumed. Obesity is one of the causing factors for many diseases. Objectives: This study was designed to determine whether a woman's level of education is associated with the family's daily dietary intake and mother weight status or not. Materials and Methods: A web survey study designed through Google Forms was sent online to the entire Iraqi population from August 26 to September 20, 2020. The survey was distributed through institutional and private social networks (University E-mail, Facebook, Instagram, Viber, and WhatsApp). This method was entirely effective for the research hypothesis. A face-to-face interview was also conducted with illiterate women in public hospitals and medical centers. Results: The study result by 376 participating women showed a significant relationship between the level of education and body mass index (BMI) (P = 0.001). No significant relationship was shown between the level of daily dietary intake and BMI. The results also showed a significant association between education and family level of dietary intake (P = 0.003). The study showed a better daily dietary intake with those who do not have a high education level. Conclusions: The study concluded that healthy dietary choices and daily food intake are not related to education level but the mother's nutritional knowledge level.
Keywords: Body mass index, dietary intake, level of education, mothers
|How to cite this article:|
Ahmed HM, Hameed AL. Association between women's level of education and family daily nutrient intake and obesity status in Iraq. Med J Babylon 2021;18:95-101
|How to cite this URL:|
Ahmed HM, Hameed AL. Association between women's level of education and family daily nutrient intake and obesity status in Iraq. Med J Babylon [serial online] 2021 [cited 2021 Jul 30];18:95-101. Available from: https://www.medjbabylon.org/text.asp?2021/18/2/95/319500
| Introduction|| |
Food is vital for the human body to function properly. The best approach for minimizing cellular stress and promoting optimal cellular function and health is to consume nutrients that are low in energy density and high in a variety of contents. The metabolism of nutrients plays an essential role in regulating gene expression and cellular function through different mechanisms. Studies have shown that the disruption of nutrient metabolism and/or energy homeostasis causes cell stress, leading to metabolic dysregulation and tissue damage, and ultimately to the development of metabolic syndromes, where obesity is one of its risk factors. Dietary intake plays a vital role in individual health and obesity levels. Eating high dense energy diets can cause health problems and conversely can cause malnutrition if eaten in small amounts. Eating a healthy balanced diet that contains all necessary nutrients is the way for a healthy body and weight.,, Snacking is considered an important factor in meal avoidance. The kind of foods usually consumed as snacks are often high in fats or sugars (e.g., potato chips and cookies). This may contribute to a person's daily total energy ingestion. Food choice matters if a person wants to have a healthy body and weight. Researchers have found that consumption of sugar-sweetened beverages and fructose contents can increase the risk of obesity, especially in increasing the childhood obesity epidemic. Obesity and overweight define as abnormal or excessive fat accumulation that present a risk to health. A body mass index (BMI), which is individual weight indicator, over 25 is considered overweight and over 30 is obese. Obesity is the fifth cause of death worldwide. It has grown to epidemic proportion. According to the global affiliation of disease in 2017, over four million people are dying every year because of obesity. Many factors play a role in the obesity epidemic; these factors include dietary intake, physical activity, smoking, alcohol consumption, unhealthy snacking, parenting style and children's food intake, as well as the mother's level of education and nutrition knowledge., Childhood obesity is a growing problem in many developing countries. Overweight and obesity during childhood and youth can be a danger alert later in life, causing severe health risks such as heart problems, sleeping problems, diabetes, and even cancer., Parents' food choices can impact children's food choices and eating-related behaviors by swaying their dietary beliefs and habits, which can be affected by the family's social and behavioral conditions. As a social example, many researchers have measured the impact of parents' work on food-choice behaviors such as skipping breakfast, family meals, and takeout food.,,,,,,, The mother's education, in particular the knowledge concerning food choices and benefits, is considered as one of the most critical elements affecting the family, especially the children's weight and health status.,,, Most studies have found a strong association between a mother's education level and child nutrition outcomes.,
In Middle Eastern countries, for example, Iraq, the woman is the one who is responsible for preparing meals, where three meals usually consumed plus a snack between lunch and dinner. In the north of Iraq, particularly Erbil city, where this study is conducted, Kurdish people two decades ago depended more on homemade food by their mom and consumed more fresh and local products such as dairy and groceries, than food from restaurants. Nowadays, women are working outside home, which causes her inability to cook and prepare healthy food choices. As a result, more fast food and unhealthy snacks are providing and less focus is on physical activity and family nutrition needs. Instead, women may tend to care more about their own weight status than their family's. This phenomenon raised the following question: Does a mother's nutrition-related knowledge substitute for a mother's education or complement to create better child nutrition and health outcomes. This study hypothesized that some women who hold a degree in medicine, law, education, etc., are less focused on their family's healthy dietary intake; on the other hand, some women who have intermediate or even no education may be more focused on their family's healthy dietary intake.
| Materials and Methods|| |
A web survey was created to obtain data from different Iraqi regions. The survey included female demography, lifestyle, and eating habits. The survey was conducted from August 26 to September 20. The questionnaire was distributed among the entire Iraqi population, by creating Google Forms, accessible through any device with an Internet connection. The survey was sent through institutional and private social networks (University E-mail, Facebook, Instagram, Viber, and WhatsApp). This method was completely effective for the research hypothesis. A face-to-face interview was also conducted with illiterate women in public hospitals and medical centers.
The questionnaire was made using Google Forms with 48 questions divided into three sections. The first section consisted of the consent question asking if the participants agreed to participate or not. The second section included female demography (10 questions: age, weight, height, gender, city, level of education, current employment, economic situation, marital status, and number of children).The third section was about female lifestyle (14 questions included cooking style, children eating habits, physical activity level, smoking, sleeping habits and dietary intake information). The anonymous nature of the web survey does not allow any sensitive personal data to be traced. All information was private, and once completed, each questionnaire was transmitted to the Google platform. The final database was downloaded as a Microsoft Excel sheet. Then, it was transferred to Statistical Package of Social Sciences (Version 22) which is a software platform offers advanced statistical analysis, a vast library of machine learning algorithms, text analysis, open-source extensibility, integration with big data, and seamless deployment into applications. Frequency and percentage and Chi-square test were used for analyzing of data. For mother information regarding nutrition, they were asked how extended they estimate their level of knowing. For intake level, the food categories of deep-fried and proceed foods, sweets, and beverage were considered bad nutritional habits and the related responses were scored vice versa. Then, total scores were obtained (minimum 47, maximum 80) and categorized as following: poor intake (47–55), fair intake (56–63), good intake (64–71), and very good intake (72–80).
The study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki. It was carried out with subjects' verbal approval before conducting this study. The study protocol and the subject information and consent form were reviewed and approved by a local ethics committee at Hawler Medical University, College of Health Sciences.
| Results|| |
Out of the 376 participating women, the sociodemographic characteristics [Table 1] showed that the age range was between 15 and 50 years. The highest percentage was in the age range of 30–39 years, which was 35.2%. The majority of the population were from the north of Iraq 295 (77%), where the majority were Kurd 253 (66.1%), and the highest number of our sample were Muslims 366 (96.6%). Regarding the level of education, the highest percentage (55.6%) held diplomas and BSc. For specialty, the highest number were found in a different specialty than what was included in the questionnaire 172 (44.9%), followed by medical specialty 107 (27.9%). The results showed that the majority of the women were married 276 (72.1%), followed by single 94 (24.5%). For the income status, it was found that the range between one and two million Iraqi dinar 150 (39.2%) was represented by <1 million Iraqi dinar 101 (26.4%). Finally, the results showed that the majority of the participating women had an average body weight of 154 (40.2%), followed by overweight of 143 (37.3%), as shown in [Figure 1].
[Figure 1] shows the BMI category for the study sample; the majority of the sample were between normal and overweight.
Based on self-evaluation of nutrition knowledge level for our participants, the results showed that the majority believed they have a good nutrition information level 188 (49.1%), followed by a very good knowledge 101 (26.4%) [Figure 2].
Regarding their source of nutrition information, the one used most was other than what was mentioned in the questionnaire 119 (31.1%), followed by Facebook 65 (17.0%). There was high priority regarding family nutrition status 114 (29.8%), followed by 89 (23.2%) with the least priority for the family nutrition status [Table 2].
|Table 2: Level of information regarding nutrition and source of knowledge variables|
Click here to view
The results revealed that the highest amount of daily intake was found in dairy products, nuts, fruits, vegetables, poultry, and grains (228 [59.5%], 224 [58.5%], 193 [50.4%], and 186 [48.6%], respectively). The nutrients consumed twice a day were fruit, grains, vegetables, and dairy products (107 [27.9%], 100 [26.1%], 99 [25.8%], and 78 [20.4%], respectively). The results also showed that vegetables and fruits and grains were the highest nutrients taken three times a day: 55 (14.4%) and 48 (12.5%) correspondingly. It was also shown that the highest weekly nutrients' intakes were among seafood, deep-fried food, starchy food, and legumes (154 [40.2%], 150 [39.2%], 139 [36.3%], and 139 [36.3%], respectively). For monthly nutrient intake, it was shown that seafood, sweets, and beverages were the highest among all nutrients (97 [25.3%], 50 [13.1%], and 46 [12%], respectively). The results have shown the highest nonconsumed nutrients were processed food, beverages, and sweets (136 [35.5%], 62 [16.2%], and 24 [6.3%] respectively) [Table 3].
The results showed that nutrient intake was adequate in healthy nutrient intake 346 (90.3%) [Figure 3].
The results showed a significant association between the level of education and religion with the family level of dietary intake (P = 0.026 and 0.003, respectively). No significant relationship was found between city, ethnicity, and marital status with the level of dietary intake [Table 4].
|Table 4: Association of sociodemographic characteristics of the sample with dietary intake|
Click here to view
[Table 5] shows a significant relationship between level of education and BMI (P = 0.001); no significant relationship was shown between level of daily dietary intake and BMI.
|Table 5: Association between level of intake and level of education with body mass index|
Click here to view
[Table 6] reveals no significant relationship between level of nutrition knowledge and level of daily dietary intake.
|Table 6: Association between level of information regarding nutrition and intake|
Click here to view
[Table 7] reveals a significant association between age, religion, and marital status with BMI (P = 0.001, P = 0.013, and P = 0.001, respectively).
|Table 7: Association between sociodemographic characteristics and body mass index|
Click here to view
| Discussion|| |
The present study examined the association between women's level of education with their BMI and daily dietary intake of their families. The results indicate a significant association between the level of education of the mothers and the level of intake. Although the highest percentage of good intake was observed in those who had the highest level of education (MSc and PhD), interestingly the percentage of very good intake was allocated to those who had a basic level of education. This may be because those mothers who have less educational level are mostly homemakers, which means that they spend more time preparing foods in the home. Or they may interact more with social media, whereas those with Master's and PhD may have less time to interact with social media and receive better knowledge about dietary intake. The BMI of mothers has a significant association with their level of education but not their level of intake. The good level of intake was higher among those mothers who mentioned that they have a high level of information about nutrition. Other sociodemographic characteristics such as residency, ethnicity, marital status, and level of income have no association with level of intake except religion.
Results of a study done on 130 secondary school students and their parents in the south of Italy which aimed to identify the relationships between parental sociodemographic characteristics, diet awareness, lifestyle, and children's food habits, revealed a positive effect of parental sociodemographic characteristics (i.e., education and occupation), diet, awareness, and lifestyle on children's food habits and lifestyle. In a study conducted on 1010 subjects aged 25 ± 74 years (500 men and 510 women) to examine the influence of education and marital status on dietary intake and BMI in Hong Kong, results indicated that higher education level is associated with a healthier diet and a lower prevalence of overweight. These results are similar to our study results regarding the level of education but are inconsistent with BMI. In the present study, religion has a significant association with the level of intake, in which the percentage of Christians who had very good intake was higher than Muslims. The results are the opposite of a study by Ansari (2017) on 410 women, which indicates no association between religiosity and diet.
The majority of the study sample in the present study estimated that their knowledge and nutrition ranged from good to high. Interestingly, those who had estimated high information regarding nutrition were overweight or obese, and those who claimed to have very little information were mostly average weight. This may reflect that mothers do not know about BMI or do not have adequate knowledge to apply it, possibly due to their income status. Findings of the systematic review, which examined the relationship between nutrition knowledge and dietary intake in adults, support our findings, which concluded a weak, positive association between nutrition knowledge and dietary intake. However, the quality of the evidence is limited, and future studies require the use of well-designed and well-validated instruments to assess nutrition knowledge and dietary intake.
| Conclusions|| |
The educational level of mothers, who are the primary food intake providers in the Iraqi family, is an essential factor in the food intake quality. A high level of education does not necessarily mean more information about food. It is recommended to impart nutritional education programs for mothers in Iraqi families through mass media and in schools/colleges.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gómez-Pinilla F. Brain foods: the effects of nutrients on brain function. Nature reviews neuroscience 2008;9:568-78.
Chen Y, Michalak M, Agellon LB. Focus: Nutrition and food science: Importance of nutrients and nutrient metabolism on human health. Yale J Biol Med 2018;91:95.
Markwald RR, Melanson EL, Smith MR, Higgins J, Perreault L, Eckel RH, et al
. Impact of insufficient sleep on total daily energy expenditure, food intake, and weight gain. Proc Natl Acad Sci USA 2013;110:5695-700.
Bass J, Takahashi JS. Circadian integration of metabolism and energetics. Science 2010;330:1349-54.
Grossklaus H, Marvicsin D. Parenting efficacy and its relationship to the prevention of childhood obesity. Pediatr Nurs 2014;40:69-86.
Pérez-Morales E, Bacardí-Gascón M, Jiménez-Cruz A. Sugar-sweetened beverage intake before 6 years of age and weight or BMI status among older children; systematic review of prospective studies. Nutr Hosp 2013;28:47-51.
Gutiérrez Valverde JM, Guevara Valtier MC, Enríquez Reyna MC, Morales P, de los Ángeles M, del Ángel H, et al
. Study of families: Environmental and cultural factors associated with overweight and obesity. Enferm Glob 2017;16:1-10.
Nazareno N, Benavente A, Alicto M, Arceo J, Charfauros A, Dizon C, et al
. Smoking, Nutrition, Alcohol, Physical Activity, and Obesity (SNAPO) health indicators among college students in guam. Hawaii J Health Soc Welf 2020;79:24-9.
Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: Systematic review. Int J Obes (Lond) 2011;35:891-8.
Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: Causes and consequences. J Family Med Prim Care 2015;4:187-92.
] [Full text]
Kral TV, Rauh EM. Eating behaviors of children in the context of their family environment. Physiol Behav 2010;100:567-73.
Blake CE, Wethington E, Farrell TJ, Bisogni CA, Devine CM. Behavioral contexts, food-choice coping strategies, and dietary quality of a multiethnic sample of employed parents. J Am Diet Assoc 2011;111:401-7.
Al-Ayed IH. Mothers' knowledge of child health matters: Are we doing enough? J Family Community Med 2010;17:22-8.
Kuzma J. Knowledge, attitude and practice related to infant feeding among women in rural Papua New Guinea: A descriptive, mixed method study. Int Breastfeed J 2013;8:1-5.
Karnawat D, Karnawat BS, Joshi A, Kohli GK. Knowledge, attitude & practices about infant feeding among mothers of urban & rural areas of Ajmer district. J Med Res 2015;1:90-4.
Ekwochi U, Ndu IK, Osuorah CD, Amadi OF, Okeke IB, Obuoha E, et al
. Knowledge of danger signs in newborns and health seeking practices of mothers and care givers in Enugu state, South-East Nigeria. Ital J Pediatr 2015;41:18.
Fadare O, Amare M, Mavrotas G, Akerele D, Ogunniyi A. Mother's nutrition-related knowledge and child nutrition outcomes: Empirical evidence from Nigeria. PloS One 2019;14:e0212775.
Headey D, Hoddinott J, Ali D, Tesfaye R, Dereje M. The other Asian enigma: Explaining the rapid reduction of undernutrition in Bangladesh. World Dev 2015;66:749-61.
Nazzaro C, Lerro M, Marotta G. Assessing parental traits affecting children's food habits: An analysis of the determinants of responsible consumption. Agric Food Econ 2018;6:23.
Woo J, Leung SS, Ho SC, Sham A, Lam TH, Janus ED. Influence of educational level and marital status on dietary intake, obesity and other cardiovascular risk factors in a Hong Kong Chinese population. Eur J Clin Nutr 1999;53:461-7.
Ansari S, Soltero EG, Lorenzo E, Lee RE. The impact of religiosity on dietary habits and physical activity in minority women participating in the Health is Power (HIP) study. Prev Med Rep 2017;5:210-3.
Spronk I, Kullen C, Burdon C, O'Connor H. Relationship between nutrition knowledge and dietary intake. Br J Nutr 2014;111:1713-26.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]