| Abstract | CILJ: Cilj ovog istraživanja je bio istražiti učestalost mediteranske prehrane te procijeniti
pouzdanost i valjanost hrvatske inačice kratkog Indeksa konzumiranja mediteranske
prehrane u uzorku studenata zdravstvenih usmjerenja sa Sveučilišta u Splitu.
METODE: Presječno istraživanje je provedeno u razdoblju od prosinca 2018. do
prosinca 2019. godine. Studenti Medicinskog fakulteta Sveučilišta u Splitu (N = 360) su
predstavljali inicijalni uzorak koji se koristio u svrhu procjene pouzdanosti te kriterijske
i konstruktivne valjanosti kratke inačice Indeksa konzumiranja mediteranske prehrane
(engl. Mediterranean Diet Serving Score; MDSS), a kao referentna metoda se koristio
Upitnik za pridržavanje mediteranske prehrane (engl. Mediterranean Diet Adherence
Screener; MEDAS). Studenti Sveučilišnog odjela zdravstvenih studija (N = 299) su
predstavljali potvrdni uzorak koji se koristio u svrhu procjene prediktivne valjanosti
hrvatske inačice MDSS upitnika. U oba uzorka se naposljetku utvrđivala učestalost
mediteranske prehrane. Nadalje, percepcija stresa je procijenjena pomoću Ljestvice
doživljenog stresa (engl. Perceived Stress Scale – 10; PSS-10), a mentalno blagostanje je
procijenjeno korištenjem Warwick-Edinburgh ljestvice mentalnog blagostanja (engl.
Warwick-Edinburgh Mental Well-being Scale; WEMWBS). Životne navike studenata su
ispitane pomoću upitnika koji je sadržavao pitanja o dobi, spolu, ITM-u, vremenu
proteklom od posljednjeg vaganje tjelesne mase, pušenju, navikama spavanja,
prehrambenim navikama (samostalnost u pripremi obroka, broju obroka u danu/tjednu,
učestalosti doručkovanja), tjelesnoj aktivnosti (uključenost u sport i korištenje teretane),
zadovoljstvo izgledom, kvaliteti života te razini tjeskobe, sreće i optimizma. Za procjenu
pouzdanosti za MDSS i MEDAS upitnik korišten je koeficijent korelacije unutar klase
(ICC) i Spearmanov koeficijent korelacije (ρ), a za slaganje između pojedinih skupina
namirnica unutar MDSS i MEDAS upitnika korišten je Cohenov koeficijent (κ).
Multivarijatnom linearnom regresijom je ispitana povezanost između mediteranske
prehrane i doživljenog stresa te blagostanja.
REZULTATI: Analiza podataka na uzorku studenata medicine je ukazala na dobru
pouzdanost MDSS upitnika kad je rezultat izražen kao ukupni zbroj bodova (ICC = 0,881,
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95% CI 0,843-0,909; ρ = 0,627; P < 0,001) i umjerenu razinu pouzdanosti kada je rezultat
izražen kao binarna varijabla (κ = 0,584). U analizi valjanosti MDSS upitnika naprema
MEDAS upitniku, valjanost je također bila bolja kada je korištena brojčana varijabla, tj.
ukupan zbroj bodova (ICC = 0,544; 95% CI 0,439–0,629; P < 0,001), dok je korištenjem
binarne varijable dobiveno slabo slaganje (κ = 0,223). Sličan rezultat je dobiven i u
potvrdnom uzorku studenata zdravstvenih studija (ICC = 0,510; 95% CI 0,384–0,610; κ
= 0,216). Nažalost, samo se 13,6% studenata medicine i 9,4% studenata zdravstvenih
studija pridržavalo preporuka mediteranske prehrane prema MDSS upitniku (11,7%
studenata u ukupnom uzorku). Studenti koji su se pridržavali mediteranske prehrane su
imali prosječnu vrijednost od 20 bodova (IKR 10,5) od maksimalnih 40 bodova na
ljestvici stresa, dok su studenti koji se nisu pridržavali mediteranske prehrane postigli
prosječnu vrijednost od 21 boda (IKR 10,8), što nije bila značajna razlika. Prosječni zbroj
bodova na ljestvici blagostanja je iznosio 56 bodova (IKR 17) u studenata koji su se
pridržavali i 53 boda (IKR10) u studenata koji se nisu pridržavali mediteranske prehrane
(P = 0,048), što ukazuje na umjerenu razinu mentalnog blagostanja u oba poduzorka
studenata. Pridržavanje mediteranske prehrane prema MDSS upitniku je bilo u pozitivnoj
korelaciji s dobi (ρ = 0,179: P = 0,003), samo-procijenjenom percepcijom zdravlja (ρ =
0,123; P = 0,047) i mentalnim blagostanjem (ρ = 0,139; P = 0,022). Međutim,
pridržavanje mediteranske prehrane nije bilo povezano s percepcijom stresa i mentalnim
blagostanjem u regresijskoj analizi. Studentice su imale veću vjerojatnost za višu
percepciju psihološkog stresa u odnosu na studente (β = 2,29; 95% CI 0,55-4,03; P =
0,010) te je utvrđena negativna povezanost između stresa i mentalnog blagostanja (β = -
0,42; 95% CI -0,49 – -0,36; P < 0,001). Pozitivna povezanost je identificirana između
razine mentalnog blagostanja i dobi studenata (β = 0,17; 95% CI 0,05-0,028; P = 0,006),
kao i trajanja spavanja radnim danom (β = 0,84; 95% CI 0,11-1,58; P = 0,025).
ZAKLJUČAK: MDSS upitnik je kratak, pouzdan i valjan mjerni instrument za procjenu
pridržavanja mediteranske prehrane u Hrvatskoj. Osim toga, ovo je istraživanje ukazalo
na nisku učestalost mediteranske prehrane u studenata zdravstvenih usmjerenja, umjerenu
razinu percepcije stresa i umjerenu razinu mentalnog blagostanja. Stoga je potrebno
uložiti napore u provedbu intervencije s ciljem poboljšanja prehrambenih navika studenata u smjeru promicanja i poticanja mediteranske prehrane, što će rezultirati
zaštitom njihova zdravlja i zdravlja njihovih budućih pacijenata. |
| Abstract (english) | AIM: The aim of this study was to investigate the prevalence of the Mediterranean diet
and to evaluate the reliability and validity of the Croatian version of the short
Mediterranean Diet Serving Score (MDSS) questionnaire in a sample of health sciences
students from the University of Split.
METHODS: The cross-sectional study was conducted from December 2018 to
December 2019. Students from the University of Split School of medicine (N = 360)
constituted the initial sample used to assess the reliability and criterion and construct
validity of the short version of the Mediterranean Diet Serving Score (MDSS), while the
Mediterranean Diet Adherence Questionnaire (MEDAS) was used as the reference
method. Students from the University Department of Health Studies (N = 299) presented
a confirmatory sample used to assess the predictive validity of the Croatian version of the
MDSS questionnaire. The prevalence of the Mediterranean diet was assessed in both
samples. In addition, stress perception was assessed with the Perceived Stress Scale (PSS10), and psychological well-being was assessed using the Warwick-Edinburgh Mental
Well-being Scale (WEMWBS). Students' lifestyle habits were assessed using a
questionnaire that included questions on age, gender, BMI, time since last weighing,
smoking, sleeping habits, eating habits (independence in preparing meals, number of
meals per day/week, frequency of breakfast), physical activity (involvement in sports and
gym use), satisfaction with physical appearance, quality of life, and levels of anxiety,
happiness, and optimism. The intraclass correlation coefficient (ICC) and Spearman
correlation coefficient (ρ) were used to assess the reliability of the MDSS and MEDAS
questionnaires, and the Cohen coefficient (κ) was used to assess the agreement between
food groups within the MDSS and MEDAS questionnaires. Multivariate linear regression
was used to examine the association between the Mediterranean diet and perceived stress
and well-being.
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RESULTS: Data analysis on a sample of medical students revealed good reliability of
the MDSS questionnaire when the result was expressed as a total score (ICC = 0.881,
95% CI 0.843-0.909; ρ = 0.627; P < 0.001), and a moderate reliability when the result
was expressed as a binary variable (κ = 0.584). When analyzing the validity of the MDSS
questionnaire versus the MEDAS questionnaire, validity was also better when the
numeric variable was used, ie, the total score (ICC = 0.544; 95% CI 0.439-0.629; P <
0.001), whereas fair agreement was obtained when the binary variable was used (κ =
0.223). A similar result was obtained in the confirmatory sample of health studies students
(ICC = 0.510; 95% CI 0.384-0.610; κ = 0.216). Unfortunately, only 13.6% of medical
students and 9.4% of health studies students adhered to the Mediterranean diet
recommendations according to the MDSS questionnaire (11.7% of students in the total
sample). Students who adhered to the Mediterranean diet scored an average of 20 points
(IKR 10.5) out of a maximum of 40 points on the perceived stress scale, while students
who did not adhere to the Mediterranean diet scored an average of 21 points (IQR 10.8),
which was not a significant difference. The mean score of the well-being scale was 56
points (IQR 17) in students who adhered to the Mediterranean diet and 53 points (IQR
10) in students who did not adhere to the Mediterranean diet (P = 0.048), indicating
moderate levels of psychological well-being in both subgroups of students. Adherence to
the Mediterranean diet according to the MDSS questionnaire was positively correlated
with age (ρ = 0.179; P = 0.003), self-rated perception of health (ρ = 0.123; P = 0.047),
and psychological well-being (ρ = 0.129; P = 0.022). However, adherence to the
Mediterranean diet was not associated with perceived stress and psychological well-being
in the regression analysis. Female students were more likely to perceive psychological
stress compared to male students (β = 2.29; 95% CI 0.55-4.03; P = 0.010), and a negative
association was found between stress and psychological well-being (β = -0.42, 95% CI -
0.49 - -0.36, P < 0.001). A positive association was found between the level of
psychological well-being and the age of the students (β = 0.17; 95% CI 0.05-0.028; P =
0.006), as well as between well-being and the duration of sleep on weekdays (β = 0.84;
95% CI 0, 11-1.58; P = 0.025).
CONCLUSION: The MDSS questionnaire is a brief, reliable, and valid measurement
tool to assess adherence to the Mediterranean diet in Croatia. In addition, this study found
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a low prevalence of the Mediterranean diet among health sciences students, a moderate
level of stress, and a moderate level of psychological well-being. Therefore, it is
necessary to initiate an intervention aimed at improving the dietary habits of students in
the direction of promoting and supporting the Mediterranean diet, which will lead to the
protection of their health and the health of their future patients. |
