Eat Weight Disord DOI 10.1007/s40519-016-0261-0
ORIGINAL ARTICLE
Eating breakfast, fruit and vegetable intake and their relation with happiness in college students Azadeh Lesani1 • Asghar Mohammadpoorasl2,3 • Maryam Javadi1,4 Jabiz Modaresi Esfeh5 • Ali Fakhari6
•
Received: 27 December 2015 / Accepted: 9 February 2016 Ó Springer International Publishing Switzerland 2016
Abstract Purpose Nutrition plays a major role in physical and mental health. The aim of this study was to evaluate the relationships between happiness and fruit and vegetable intake as well as eating breakfast in students. Methods In this cross-sectional web-based study, all students of Qazvin University of Medical Sciences in Iran who attended course classes were invited to participate in the study. Five hundred forty-one students filled out the web-based questionnaire which included questions related to measurement of happiness, breakfast, fruit and & Asghar Mohammadpoorasl [email protected] Azadeh Lesani [email protected]
vegetable consumption and socio-economic and demographic information. Analysis of covariance was used to assess the relationship between happiness and breakfast, fruit and vegetable consumption by adjustments for covariates. Results Measure of happiness was positively associated with eating breakfast, number of meals eaten daily and the amount of fruit and vegetable consumption (P values were \0.001, 0.008, 0.02, and 0.045 respectively). Students who ate breakfast every day, more than 8 servings of fruit and vegetables daily, and had 3 meals in addition to 1–2 snacks per day had the highest happiness score. Conclusion Healthier behavior pattern was associated with higher happiness scores among medical students. Keywords Happiness Breakfast Fruit and vegetable Nutrition Life satisfaction Diet
Maryam Javadi [email protected] Jabiz Modaresi Esfeh [email protected]
Introduction
Ali Fakhari [email protected]
During the recent decades, happiness and psychological wellbeing have been among the most attractive issues for researchers in the fields of social sciences [1] and health [2]. It is widely acknowledged that psychological factors may play an important role in physical performance, and mental health positively affects physical wellbeing [3]. According to the World Health Organization (WHO), health is a state of general physical, psychological and social wellbeing [4]. Happiness can predict longevity among healthy people though this is not true for those who are sick. While happiness cannot treat severe disease, it may protect people against becoming sick. In other words, happiness strongly affects longevity in healthy population. The size of effect is comparable to being a smoker or not [3].
1
Department of Human Nutrition, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran
2
Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3
Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz 14711, Iran
4
Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
5
Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran
6
Clinical Psychiatry Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Happiness can improve the function of the immune system [5]. Several studies have shown that happiness might be affected by numerous factors such as: family and friend relationships, exercise, food quality (highly nutritious foods), recreational activities [2] religion [6], government [7], health, age, social status genetics [8, 9], employment, education [10] and the lack of stress in the last 6 months [11]. Nutrition plays a major role in physical [12] and mental health [13] and breakfast consumption is one of the key components of healthy nutrition. It is well associated with less body mass index (BMI) and skipping breakfast is a common behavior among overweight and obese people. Furthermore, breakfast consumption can positively affect cognitive function, particularly memory. In addition, breakfast eating is associated with less depression [14]. Several studies have reported that eating fruit and vegetables containing considerable amounts of antioxidants [15], can protect against acute illnesses such as coronary heart disease and cancer [16]. Some researchers have found a positive association between lower risks of depression and higher intake of antioxidants [17]. Previous research has shown that diet quality among Iranian young people [18, 19] has changed as they consume fewer amounts of some micro- nutrients and eat more carbohydrate or fat [20]. Additionally, thinness tendency is on rise as a body image style preferred by females. People who have positive body image perception will follow a healthier diet in competition with others [19]. Therefore nutrition education strategies may be required to promote diet quality especially among young [21] and adolescent [18]. In an international research Iranian happiness has been reported to be 5.3. This is lower than the highest score of happiness (8.2) which belongs to Danes [7]. Many studies have evaluated the state of happiness and its related factors, including cultural, economic, educational and social factors in different age groups in Iran; however, the association between breakfast, fruit and vegetable consumption and happiness has not been investigated yet. The aim of the present study was to evaluate the relationships between happiness and fruit and vegetable intake as well as eating breakfast in a group of students in Qazvin University of Medical Sciences.
Methods In this cross-sectional web-based study, a questionnaire was created to assess the relationship between happiness and breakfast, fruit and vegetable consumption among the students. All of the questions were based on scientific literature and expert opinions which have been used in other studies previously. In order to assess the content validity of
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the questionnaire, it was sent to 5 content experts, 6 experts in methodology and development of the questionnaire and 10 lay experts (nutrition advisors and students) with a response form to comment on clarity and relevancy of questions. After receiving responses and revising the questionnaire the final questionnaire was designed in Google Drive. Then a few students (n = 26) were asked to fill out the web-based questionnaire for feasibility approving. The Institutional Review Board (IRB) at the Qazvin University of Medical Sciences (QUMS) approved the study protocol and the related questionnaire. All students of Qazvin University of Medical Sciences in Iran who had course class were invited to participate in the study. The total number of invited students was 1086. Participation was voluntary and anonymous. After preparing the class list the researchers had a meeting with each class in order to explain the purposes of the study. An informed consent was received from all of the interested participants. Then, the students’ email addresses were obtained and papers containing the link address of the questionnaire were delivered to them. The link address was also emailed to the students on the same day and a reminder was sent to the students for the following 3 weeks. The questionnaire consisted from the following parts: demographic characteristics, health status, stress experience in the past 6 months, weight, height, breakfast intake, food pattern, fruit consumption, vegetable consumption, physical activity (RAPA: The Rapid Assessment of Physical Activity), socio-economic questions (household income and assets) and Oxford Happiness Questionnaire (OHQ). It took 15–20 min to complete the questionnaires. All participants were encouraged to provide honest responses [22]. Happiness was measured by Oxford Happiness Questionnaire (OHQ), which contains 29 statements to be ranged from 1 ‘‘strongly disagree’’ to 6 ‘‘strongly agree’’. A few examples of these items are ‘‘Life is good,’’ and ‘‘I am well satisfied about everything in my life’’. Happiness score ranges from 29 to 174, where higher scores indicate a higher level of happiness. The reliability and validity of this questionnaire among university students in Iran have been confirmed by Liaghatdar [23]. Breakfast eating was assessed by a breakfast survey for students which included 10 questions. In this self-report questionnaire the participants were asked about their frequency of breakfast consumption per week, the reasons for skipping breakfast and the consequences they faced when they didn’t have breakfast. In addition, it was inquired whether the students had any snack in the morning and, if the answer was positive they were asked about its content. Food habits were assessed by two questions. The first question was ‘how many meals and snacks do you usually eat in a day?’ responses were categorized as ‘3 meals ?2
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snacks’,’ 3 meals ?one snack’, ‘3 meals’, ‘2 meals (including breakfast)’, ‘2 meals (but not breakfast) and ‘one meal’. The second question was a multiple choice one: ’which of following meals and snacks are your usual food habits?’’ Responses were categorized as breakfast, morning snack, lunch, afternoon snack, evening snack, dinner, late night snack. Fruit consumption was measured by two questions: ‘How many days of week do you usually eat fruit? Answers were scored from 0 (never eat fruit) to 7 days a week. Then a serving of fresh, canned fruit and juice fruit were explained and the participants were asked ‘in a day that you consume fruit, how many servings of fruit do you usually eat?’ and the responses were categorized as ‘less than 1 serving’, ‘1–2 serving’, ‘2–3 serving’, ‘3–4 serving’ and’ more than 5 servings’. Vegetable consumption was measured by two questions. The first question was: ‘How many days of week do you usually eat vegetable?’’ The answers were scored from 0 (don’t eat any vegetable in a usual week) to 7 days a week. Then after explaining a serving of fresh, canned vegetable and juice vegetable, the second question was asked as follows: ‘On a day when you eat vegetables, how many serves of vegetables do you usually eat?’ and the responses were categorized as ‘less than 1 serving’, ‘1–2 serving’, ‘2–3 serving’, ‘3–4 serving’,’ more than 5 servings’. Physical activity was measured by RAPA [22]. This is a 9-item, self-administered questionnaire regarding current levels of physical activity. RAPA evaluates a wide range of physical activity levels, from sedentary to vigorous activity and assesses the number of reported days of moderate activity (for at least 30 min) and vigorous activity (for at least 20 min), as well as strength and flexibility training. Each question has a ‘Yes’ or ‘No’ option. The total score of the first seven items are out of 7; participants choose the question corresponding to their activity level. Any score less than 6 is considered suboptimal. Strength training and flexibility are scored separately (strength training = 1, flexibility = 2, both = 3). A principal component analysis (PCA) was employed to measure socioeconomic status of the students based on the information collected about the household income and assets. Based on the PCA results, the students were classified into three SES groups being high, middle, and low socioeconomic status. Analysis of covariance was used to assess the relationship between happiness and breakfast, fruit and vegetables consumption and adjustments were made for BMI, marital status, socio-economic status, physical activity, experience of stress in the last 6 months and having a defined disease. SPSS 22 software was used for statistical analyses.
Results Out of a total of 1086 students, 541 participated in the study and filled out the web-based questionnaire (49.82 % response rate). The mean and standard deviation of the participants’ age were 24.14 ± 4.88 (the range was 18–46 years old). Four hundred and three students (75.4 %) were female and 138 (25.5 %) were male. The mean of happiness score was 114.59 ± 18.31 (min 44, max 157). Table 1 shows frequency of demographic characteristics and key variables of the students. Table 2 shows the adjusted mean of the happiness score by breakfast, fruit and vegetables consumption. As it is depicted in this table, after adjustment for BMI, marital status, socio-economic status, physical activity, experience of stress in the last 6 months and having a defined disease, happiness scores were statistically different in various categories including the number of meals eaten daily, breakfast eating, fruit consumption and vegetable consumption.
Table 1 Demographic and key variables of students Variable
n
%
Male
138
25.6
Female
403
74.4
Gender
Marital status Single
456
84.3
85
15.7
Low
134
24.8
Medium
271
50.2
High
135
25.0
Married Socio-economic status
Body mass index Low weight Normal Over weight Obesity
56
10.4
387
71.5
83 15
15.3 2.8
Physical activity Sedentary
39
7.2
Light and regular activity
128
23.7
Insufficient activity
151
27.9
Sufficient activity
223
41.2
Yes
368
68.0
No
173
32.0
No
505
93.3
Yes
36
6.7
Stress experience in the last 6 months
Having a defined disease
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Eat Weight Disord Table 2 Adjusted means of happiness score by number of meals eaten daily, breakfast eating, fruits consumption and vegetable consumption
n
%
Meana
Standard error
3 Meals and 1–2 snakes
149
27.5
118.33
1.41
3 Meals
1.60
Variable
P value
Number of meals eaten daily 115
21.3
115.74
2 Meals involve breakfast
52
9.6
113.33
2.37
2 Meals except breakfast
71
13.1
110.97
2.03
154
28.5
112.22
1.38
39
7.2
103.76
2.71
1 Meal
0.008b
Breakfast eating Never Sometimes
57
10.5
110.86
2.26
Often
139
25.7
113.81
1.44
Always
306
56.6
117.01
0.96
\1 Serving
35
6.5
112.00
2.99
1 Serving
339
62.7
113.12
0.94
76 91
14.0 16.8
116.99 119.03
1.99 1.84
\1 Serving
123
22.7
113.52
1.59
1 Serving
279
51.6
113.52
1.03
2–3 Serving
114
21.1
116.52
1.63
[3 Serving
25
4.6
122.96
3.54
\0.001c
Fruits consumption (per day)
2–3 Serving [3 serving
0.020d
Vegetables consumption (per day) 0.045e
a
Mean adjusted for BMI, marital status, socio-economic status, physical activity, experience of stress in the last 6 months and having a defined disease b Bonferroni test showed that 3 meals and 1–2 snakes had significant difference with 2 meals except breakfast and 1 meal (P \ 0.05) c
Bonferroni test showed that had Never eater significant difference with often and always eater (P \ 0.05)
d
Bonferroni test showed that 1 serving consumption per day had significant difference with more than 3 serving (P \ 0.05)
e
Bonferroni test showed that 1 serving consumption per day had significant difference with more than 3serving (P \ 0.05)
Discussion This study revealed a significant association between happiness and breakfast, fruit and vegetable consumption. Many studies have examined the association between negative emotions and food intake. Furthermore, a number of laboratory studies have shown that negative emotions may result in increased consumption of high fat and high sugar snacks as well as a tendency for consuming snacks rather than meals [24] and a decreased consumption of fruit and vegetables [25]. Similar results have been reported in cross-sectional surveys [26].However, few studies have examined the relationship between positive affect and food consumption [27] or the possibility of bidirectionality of this relationship. Biochemical studies have suggested that foods high in carbohydrate cause a raise in brain serotonin level which contributes to feeling well and happy [28]. Certain micronutrients found in fruit and vegetables might ameliorate symptoms of depression in less than 10 weeks when used in conjunction with antidepressant drugs [29]. It
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has been reported that flavonols present in fruit and vegetables [30] and docosahexaenoic acid (an omega-3 fatty acid) [31] can improve cognitive function which may improve mood. In the present study happiness was associated with eating breakfast in students. Those who used to eat breakfast constantly (7 days a week) were the happiest, while those who never had breakfast gained the lowest scores for happiness. These findings are in harmony with those reported among Chilean students [32] though these students were divided into two groups while in our study the subjects had been put into 4 different groups regarding their frequency of eating breakfast (never, sometimes, often or always). Smith et al. have shown that consumption of three different types of breakfast with coffee can cause increased heart rate, better mood and improved cognitive memory and recall [33]. Breakfast is defined as the first meal eaten before 10 am or 2 h after waking up and it should contain about 20–35 percent of daily calorie expenditure. According to nutritionist it is a critical energy
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supply for the brain as the brain relies mainly on glucose [14, 34] Studies have shown that breakfast omission will cause fatigue and disturbance in concentration required for daily tasks, as well as a negative impact on learning and memory [14]. Better physical health, doing daily activities more energetically, better academic performance, improved learning and getting higher scores are factors which result from breakfast consumption all of which may affect the students’ happiness. On the other hand, some surveys have shown that in the majority of people happiness causes healthier eating behaviors. Thus, the relationship might be bidirectional. Our findings clarifies that there is a significant relationship between the numbers of daily meals and happiness. Those who had 3 meals and 1–2 snacks per day were the happiest while a decrease in the number of meal and snack intake would lead to lower happiness scores. In addition, students who had skipped their breakfast, having only 2 main meals per day, and those who had only one meal a day, had the lowest level of happiness. Among those who had only consumed 2 meals a day, those who had skipped breakfast had lower scores of happiness than those who had eaten breakfast and had skipped another meal and this association was statistically significant. This shows a correlation between the two variables yet, it does not clarify whether positive emotions promote a healthier diet or healthy eating patterns leads to more positive feelings. Piqueras’s study in Chile has revealed that daily lunch and breakfast consumption is significantly associated with happiness [32]. Moreover, some studies have shown that skipping meals, especially breakfast, is associated with the risk of overweight and obesity in children [35] and adults [14]. This can also cause accumulation of fat in the abdominal area which increases the risk of metabolic syndrome [36]. Finally, skipping meals has been reported to be associated with increased appetite [34]. There is some evidence that a direct relationship exists between depression and missing breakfast [37]. Glucose is the main energy supply for the brain. Thus, more frequent meal intake provides the brain with a more constant energy source which will affect a person’s physical and mental health. Previous studies support a significant relationship between physical and mental health with happiness. Our results showed a significant association between daily fruit and vegetable consumption and happiness. Students who consumed 4 servings or more from each group gained the highest scores for happiness. A 30 day online survey showed that more daily fruit and vegetable intake could improve positive emotions which led to a better mood [38]. The results from a study performed in Chili are in agreement with our findings apart from the fact that in that study, consuming more than 5 servings of each
of these food groups a day was accompanied by more happiness [32]. Similar results have been reported by Blanch flower [39]. In another study which has been carried out among Iranian youth, significant relationship between happiness and daily fruit and vegetable consumption was observed [40]. Eating more fruit and vegetables (more than usual amounts) leads to feeling calmer, happier and more energetic and these positive emotions will last until the next day. The daily recommended intake for fruit and vegetables is about 7–8 servings. It has been approved that fruit and vegetables are rich in fiber, various types of vitamins, polyphenols and antioxidants. As a result, these food items may play a role in food-mood relationship [41]. Another study has shown that people who eat more fruit and vegetables are happier, more satisfied with their lives and less depressed [42]. There is some evidence that more consumption of fruit and vegetables is associated with increased curiosity, more creativity and feeling more prosperous which can improve the quality of life among youth [43]. A higher blood antioxidant level is associated with significantly more optimism [44]. Fruit and vegetables contain some beneficial nutrients and an association has been reported to exist between lack of some of these items, such as group B vitamins, especially folic acid, and depression which is caused by a reduction in access to s-adenosine methionine. S-adenosine methionine is required for reduction of methyl a critical component in production of myelin, neurotransmitters and phospholipid membrane [45]. Various surveys have found a relationship between fruit and vegetable consumption and physical health. This is because consuming these healthy food items may result in weight maintenance or weight loss in overweight or obese people and a better regulation of blood sugar, blood lipids and blood pressure all of which can reduce the risk of various diseases and deaths caused by them [46]. Thus, physical and mental health of individuals who eat more fruit and vegetables may be protected. Previous studies have confirmed that not only there is a relationship between these two variables but also happiness can strengthen positive behavioral patterns such as healthy eating. There are several limitations to be noted regarding this study. This has been a web-based study. Students should have had access to the internet in order to read and complete the questionnaire and also net speed played an important role in successfully saving the data. A great number of student complained that they had completed the form but had failed to send the completed questionnaire due to a limited internet speed. Moreover, 50 percent of the student community did not participate in this study and its possible impact on the results of the study shouldn’t be overlooked. Moreover, this study was a cross-sectional one which is another limitation of this research.
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Conclusions Happiness was positively correlated with having breakfast on most days of the week, consuming more daily meals (3 meals and snacks) and eating more fruit and vegetables (a total of 8 serving or more). Although a considerable number of researchers have studied the relationship between happiness and fruit and vegetable intake among adolescents, young people and adults in different countries few studies have examined the relationship between happiness and the number of meals eaten daily. Previous studies have emphasized that people with higher happiness scores or more positive feelings tend to follow a healthier lifestyle. It is also probable that healthier food choices promote positive emotions and happiness through providing essential micronutrients for the body. Similarly, nutrition education programs may lead to improvement in mental and physical health. Acknowledgments This article is a main part of M.Sc thesis supported by Qazvin University of Medical Sciences. We would like to thank Deputy of Research and Technology of Qazvin University of Medical Sciences. We also wish to thank all of the students for their valuable collaboration with this study. Compliance with ethical standards Conflict of interest of interests.
The authors declare that there are no conflicts
Ethical approval The Institutional Review Board (IRB) at the Qazvin University of Medical Sciences (QUMS) approved the study protocol and the related questionnaire. Informed consent Informed consent was obtained from all participants in the study.
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ORIGINAL ARTICLE
Eating breakfast, fruit and vegetable intake and their relation with happiness in college students Azadeh Lesani1 • Asghar Mohammadpoorasl2,3 • Maryam Javadi1,4 Jabiz Modaresi Esfeh5 • Ali Fakhari6
•
Received: 27 December 2015 / Accepted: 9 February 2016 Ó Springer International Publishing Switzerland 2016
Abstract Purpose Nutrition plays a major role in physical and mental health. The aim of this study was to evaluate the relationships between happiness and fruit and vegetable intake as well as eating breakfast in students. Methods In this cross-sectional web-based study, all students of Qazvin University of Medical Sciences in Iran who attended course classes were invited to participate in the study. Five hundred forty-one students filled out the web-based questionnaire which included questions related to measurement of happiness, breakfast, fruit and & Asghar Mohammadpoorasl [email protected] Azadeh Lesani [email protected]
vegetable consumption and socio-economic and demographic information. Analysis of covariance was used to assess the relationship between happiness and breakfast, fruit and vegetable consumption by adjustments for covariates. Results Measure of happiness was positively associated with eating breakfast, number of meals eaten daily and the amount of fruit and vegetable consumption (P values were \0.001, 0.008, 0.02, and 0.045 respectively). Students who ate breakfast every day, more than 8 servings of fruit and vegetables daily, and had 3 meals in addition to 1–2 snacks per day had the highest happiness score. Conclusion Healthier behavior pattern was associated with higher happiness scores among medical students. Keywords Happiness Breakfast Fruit and vegetable Nutrition Life satisfaction Diet
Maryam Javadi [email protected] Jabiz Modaresi Esfeh [email protected]
Introduction
Ali Fakhari [email protected]
During the recent decades, happiness and psychological wellbeing have been among the most attractive issues for researchers in the fields of social sciences [1] and health [2]. It is widely acknowledged that psychological factors may play an important role in physical performance, and mental health positively affects physical wellbeing [3]. According to the World Health Organization (WHO), health is a state of general physical, psychological and social wellbeing [4]. Happiness can predict longevity among healthy people though this is not true for those who are sick. While happiness cannot treat severe disease, it may protect people against becoming sick. In other words, happiness strongly affects longevity in healthy population. The size of effect is comparable to being a smoker or not [3].
1
Department of Human Nutrition, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran
2
Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3
Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz 14711, Iran
4
Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
5
Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran
6
Clinical Psychiatry Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Happiness can improve the function of the immune system [5]. Several studies have shown that happiness might be affected by numerous factors such as: family and friend relationships, exercise, food quality (highly nutritious foods), recreational activities [2] religion [6], government [7], health, age, social status genetics [8, 9], employment, education [10] and the lack of stress in the last 6 months [11]. Nutrition plays a major role in physical [12] and mental health [13] and breakfast consumption is one of the key components of healthy nutrition. It is well associated with less body mass index (BMI) and skipping breakfast is a common behavior among overweight and obese people. Furthermore, breakfast consumption can positively affect cognitive function, particularly memory. In addition, breakfast eating is associated with less depression [14]. Several studies have reported that eating fruit and vegetables containing considerable amounts of antioxidants [15], can protect against acute illnesses such as coronary heart disease and cancer [16]. Some researchers have found a positive association between lower risks of depression and higher intake of antioxidants [17]. Previous research has shown that diet quality among Iranian young people [18, 19] has changed as they consume fewer amounts of some micro- nutrients and eat more carbohydrate or fat [20]. Additionally, thinness tendency is on rise as a body image style preferred by females. People who have positive body image perception will follow a healthier diet in competition with others [19]. Therefore nutrition education strategies may be required to promote diet quality especially among young [21] and adolescent [18]. In an international research Iranian happiness has been reported to be 5.3. This is lower than the highest score of happiness (8.2) which belongs to Danes [7]. Many studies have evaluated the state of happiness and its related factors, including cultural, economic, educational and social factors in different age groups in Iran; however, the association between breakfast, fruit and vegetable consumption and happiness has not been investigated yet. The aim of the present study was to evaluate the relationships between happiness and fruit and vegetable intake as well as eating breakfast in a group of students in Qazvin University of Medical Sciences.
Methods In this cross-sectional web-based study, a questionnaire was created to assess the relationship between happiness and breakfast, fruit and vegetable consumption among the students. All of the questions were based on scientific literature and expert opinions which have been used in other studies previously. In order to assess the content validity of
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the questionnaire, it was sent to 5 content experts, 6 experts in methodology and development of the questionnaire and 10 lay experts (nutrition advisors and students) with a response form to comment on clarity and relevancy of questions. After receiving responses and revising the questionnaire the final questionnaire was designed in Google Drive. Then a few students (n = 26) were asked to fill out the web-based questionnaire for feasibility approving. The Institutional Review Board (IRB) at the Qazvin University of Medical Sciences (QUMS) approved the study protocol and the related questionnaire. All students of Qazvin University of Medical Sciences in Iran who had course class were invited to participate in the study. The total number of invited students was 1086. Participation was voluntary and anonymous. After preparing the class list the researchers had a meeting with each class in order to explain the purposes of the study. An informed consent was received from all of the interested participants. Then, the students’ email addresses were obtained and papers containing the link address of the questionnaire were delivered to them. The link address was also emailed to the students on the same day and a reminder was sent to the students for the following 3 weeks. The questionnaire consisted from the following parts: demographic characteristics, health status, stress experience in the past 6 months, weight, height, breakfast intake, food pattern, fruit consumption, vegetable consumption, physical activity (RAPA: The Rapid Assessment of Physical Activity), socio-economic questions (household income and assets) and Oxford Happiness Questionnaire (OHQ). It took 15–20 min to complete the questionnaires. All participants were encouraged to provide honest responses [22]. Happiness was measured by Oxford Happiness Questionnaire (OHQ), which contains 29 statements to be ranged from 1 ‘‘strongly disagree’’ to 6 ‘‘strongly agree’’. A few examples of these items are ‘‘Life is good,’’ and ‘‘I am well satisfied about everything in my life’’. Happiness score ranges from 29 to 174, where higher scores indicate a higher level of happiness. The reliability and validity of this questionnaire among university students in Iran have been confirmed by Liaghatdar [23]. Breakfast eating was assessed by a breakfast survey for students which included 10 questions. In this self-report questionnaire the participants were asked about their frequency of breakfast consumption per week, the reasons for skipping breakfast and the consequences they faced when they didn’t have breakfast. In addition, it was inquired whether the students had any snack in the morning and, if the answer was positive they were asked about its content. Food habits were assessed by two questions. The first question was ‘how many meals and snacks do you usually eat in a day?’ responses were categorized as ‘3 meals ?2
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snacks’,’ 3 meals ?one snack’, ‘3 meals’, ‘2 meals (including breakfast)’, ‘2 meals (but not breakfast) and ‘one meal’. The second question was a multiple choice one: ’which of following meals and snacks are your usual food habits?’’ Responses were categorized as breakfast, morning snack, lunch, afternoon snack, evening snack, dinner, late night snack. Fruit consumption was measured by two questions: ‘How many days of week do you usually eat fruit? Answers were scored from 0 (never eat fruit) to 7 days a week. Then a serving of fresh, canned fruit and juice fruit were explained and the participants were asked ‘in a day that you consume fruit, how many servings of fruit do you usually eat?’ and the responses were categorized as ‘less than 1 serving’, ‘1–2 serving’, ‘2–3 serving’, ‘3–4 serving’ and’ more than 5 servings’. Vegetable consumption was measured by two questions. The first question was: ‘How many days of week do you usually eat vegetable?’’ The answers were scored from 0 (don’t eat any vegetable in a usual week) to 7 days a week. Then after explaining a serving of fresh, canned vegetable and juice vegetable, the second question was asked as follows: ‘On a day when you eat vegetables, how many serves of vegetables do you usually eat?’ and the responses were categorized as ‘less than 1 serving’, ‘1–2 serving’, ‘2–3 serving’, ‘3–4 serving’,’ more than 5 servings’. Physical activity was measured by RAPA [22]. This is a 9-item, self-administered questionnaire regarding current levels of physical activity. RAPA evaluates a wide range of physical activity levels, from sedentary to vigorous activity and assesses the number of reported days of moderate activity (for at least 30 min) and vigorous activity (for at least 20 min), as well as strength and flexibility training. Each question has a ‘Yes’ or ‘No’ option. The total score of the first seven items are out of 7; participants choose the question corresponding to their activity level. Any score less than 6 is considered suboptimal. Strength training and flexibility are scored separately (strength training = 1, flexibility = 2, both = 3). A principal component analysis (PCA) was employed to measure socioeconomic status of the students based on the information collected about the household income and assets. Based on the PCA results, the students were classified into three SES groups being high, middle, and low socioeconomic status. Analysis of covariance was used to assess the relationship between happiness and breakfast, fruit and vegetables consumption and adjustments were made for BMI, marital status, socio-economic status, physical activity, experience of stress in the last 6 months and having a defined disease. SPSS 22 software was used for statistical analyses.
Results Out of a total of 1086 students, 541 participated in the study and filled out the web-based questionnaire (49.82 % response rate). The mean and standard deviation of the participants’ age were 24.14 ± 4.88 (the range was 18–46 years old). Four hundred and three students (75.4 %) were female and 138 (25.5 %) were male. The mean of happiness score was 114.59 ± 18.31 (min 44, max 157). Table 1 shows frequency of demographic characteristics and key variables of the students. Table 2 shows the adjusted mean of the happiness score by breakfast, fruit and vegetables consumption. As it is depicted in this table, after adjustment for BMI, marital status, socio-economic status, physical activity, experience of stress in the last 6 months and having a defined disease, happiness scores were statistically different in various categories including the number of meals eaten daily, breakfast eating, fruit consumption and vegetable consumption.
Table 1 Demographic and key variables of students Variable
n
%
Male
138
25.6
Female
403
74.4
Gender
Marital status Single
456
84.3
85
15.7
Low
134
24.8
Medium
271
50.2
High
135
25.0
Married Socio-economic status
Body mass index Low weight Normal Over weight Obesity
56
10.4
387
71.5
83 15
15.3 2.8
Physical activity Sedentary
39
7.2
Light and regular activity
128
23.7
Insufficient activity
151
27.9
Sufficient activity
223
41.2
Yes
368
68.0
No
173
32.0
No
505
93.3
Yes
36
6.7
Stress experience in the last 6 months
Having a defined disease
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Eat Weight Disord Table 2 Adjusted means of happiness score by number of meals eaten daily, breakfast eating, fruits consumption and vegetable consumption
n
%
Meana
Standard error
3 Meals and 1–2 snakes
149
27.5
118.33
1.41
3 Meals
1.60
Variable
P value
Number of meals eaten daily 115
21.3
115.74
2 Meals involve breakfast
52
9.6
113.33
2.37
2 Meals except breakfast
71
13.1
110.97
2.03
154
28.5
112.22
1.38
39
7.2
103.76
2.71
1 Meal
0.008b
Breakfast eating Never Sometimes
57
10.5
110.86
2.26
Often
139
25.7
113.81
1.44
Always
306
56.6
117.01
0.96
\1 Serving
35
6.5
112.00
2.99
1 Serving
339
62.7
113.12
0.94
76 91
14.0 16.8
116.99 119.03
1.99 1.84
\1 Serving
123
22.7
113.52
1.59
1 Serving
279
51.6
113.52
1.03
2–3 Serving
114
21.1
116.52
1.63
[3 Serving
25
4.6
122.96
3.54
\0.001c
Fruits consumption (per day)
2–3 Serving [3 serving
0.020d
Vegetables consumption (per day) 0.045e
a
Mean adjusted for BMI, marital status, socio-economic status, physical activity, experience of stress in the last 6 months and having a defined disease b Bonferroni test showed that 3 meals and 1–2 snakes had significant difference with 2 meals except breakfast and 1 meal (P \ 0.05) c
Bonferroni test showed that had Never eater significant difference with often and always eater (P \ 0.05)
d
Bonferroni test showed that 1 serving consumption per day had significant difference with more than 3 serving (P \ 0.05)
e
Bonferroni test showed that 1 serving consumption per day had significant difference with more than 3serving (P \ 0.05)
Discussion This study revealed a significant association between happiness and breakfast, fruit and vegetable consumption. Many studies have examined the association between negative emotions and food intake. Furthermore, a number of laboratory studies have shown that negative emotions may result in increased consumption of high fat and high sugar snacks as well as a tendency for consuming snacks rather than meals [24] and a decreased consumption of fruit and vegetables [25]. Similar results have been reported in cross-sectional surveys [26].However, few studies have examined the relationship between positive affect and food consumption [27] or the possibility of bidirectionality of this relationship. Biochemical studies have suggested that foods high in carbohydrate cause a raise in brain serotonin level which contributes to feeling well and happy [28]. Certain micronutrients found in fruit and vegetables might ameliorate symptoms of depression in less than 10 weeks when used in conjunction with antidepressant drugs [29]. It
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has been reported that flavonols present in fruit and vegetables [30] and docosahexaenoic acid (an omega-3 fatty acid) [31] can improve cognitive function which may improve mood. In the present study happiness was associated with eating breakfast in students. Those who used to eat breakfast constantly (7 days a week) were the happiest, while those who never had breakfast gained the lowest scores for happiness. These findings are in harmony with those reported among Chilean students [32] though these students were divided into two groups while in our study the subjects had been put into 4 different groups regarding their frequency of eating breakfast (never, sometimes, often or always). Smith et al. have shown that consumption of three different types of breakfast with coffee can cause increased heart rate, better mood and improved cognitive memory and recall [33]. Breakfast is defined as the first meal eaten before 10 am or 2 h after waking up and it should contain about 20–35 percent of daily calorie expenditure. According to nutritionist it is a critical energy
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supply for the brain as the brain relies mainly on glucose [14, 34] Studies have shown that breakfast omission will cause fatigue and disturbance in concentration required for daily tasks, as well as a negative impact on learning and memory [14]. Better physical health, doing daily activities more energetically, better academic performance, improved learning and getting higher scores are factors which result from breakfast consumption all of which may affect the students’ happiness. On the other hand, some surveys have shown that in the majority of people happiness causes healthier eating behaviors. Thus, the relationship might be bidirectional. Our findings clarifies that there is a significant relationship between the numbers of daily meals and happiness. Those who had 3 meals and 1–2 snacks per day were the happiest while a decrease in the number of meal and snack intake would lead to lower happiness scores. In addition, students who had skipped their breakfast, having only 2 main meals per day, and those who had only one meal a day, had the lowest level of happiness. Among those who had only consumed 2 meals a day, those who had skipped breakfast had lower scores of happiness than those who had eaten breakfast and had skipped another meal and this association was statistically significant. This shows a correlation between the two variables yet, it does not clarify whether positive emotions promote a healthier diet or healthy eating patterns leads to more positive feelings. Piqueras’s study in Chile has revealed that daily lunch and breakfast consumption is significantly associated with happiness [32]. Moreover, some studies have shown that skipping meals, especially breakfast, is associated with the risk of overweight and obesity in children [35] and adults [14]. This can also cause accumulation of fat in the abdominal area which increases the risk of metabolic syndrome [36]. Finally, skipping meals has been reported to be associated with increased appetite [34]. There is some evidence that a direct relationship exists between depression and missing breakfast [37]. Glucose is the main energy supply for the brain. Thus, more frequent meal intake provides the brain with a more constant energy source which will affect a person’s physical and mental health. Previous studies support a significant relationship between physical and mental health with happiness. Our results showed a significant association between daily fruit and vegetable consumption and happiness. Students who consumed 4 servings or more from each group gained the highest scores for happiness. A 30 day online survey showed that more daily fruit and vegetable intake could improve positive emotions which led to a better mood [38]. The results from a study performed in Chili are in agreement with our findings apart from the fact that in that study, consuming more than 5 servings of each
of these food groups a day was accompanied by more happiness [32]. Similar results have been reported by Blanch flower [39]. In another study which has been carried out among Iranian youth, significant relationship between happiness and daily fruit and vegetable consumption was observed [40]. Eating more fruit and vegetables (more than usual amounts) leads to feeling calmer, happier and more energetic and these positive emotions will last until the next day. The daily recommended intake for fruit and vegetables is about 7–8 servings. It has been approved that fruit and vegetables are rich in fiber, various types of vitamins, polyphenols and antioxidants. As a result, these food items may play a role in food-mood relationship [41]. Another study has shown that people who eat more fruit and vegetables are happier, more satisfied with their lives and less depressed [42]. There is some evidence that more consumption of fruit and vegetables is associated with increased curiosity, more creativity and feeling more prosperous which can improve the quality of life among youth [43]. A higher blood antioxidant level is associated with significantly more optimism [44]. Fruit and vegetables contain some beneficial nutrients and an association has been reported to exist between lack of some of these items, such as group B vitamins, especially folic acid, and depression which is caused by a reduction in access to s-adenosine methionine. S-adenosine methionine is required for reduction of methyl a critical component in production of myelin, neurotransmitters and phospholipid membrane [45]. Various surveys have found a relationship between fruit and vegetable consumption and physical health. This is because consuming these healthy food items may result in weight maintenance or weight loss in overweight or obese people and a better regulation of blood sugar, blood lipids and blood pressure all of which can reduce the risk of various diseases and deaths caused by them [46]. Thus, physical and mental health of individuals who eat more fruit and vegetables may be protected. Previous studies have confirmed that not only there is a relationship between these two variables but also happiness can strengthen positive behavioral patterns such as healthy eating. There are several limitations to be noted regarding this study. This has been a web-based study. Students should have had access to the internet in order to read and complete the questionnaire and also net speed played an important role in successfully saving the data. A great number of student complained that they had completed the form but had failed to send the completed questionnaire due to a limited internet speed. Moreover, 50 percent of the student community did not participate in this study and its possible impact on the results of the study shouldn’t be overlooked. Moreover, this study was a cross-sectional one which is another limitation of this research.
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Conclusions Happiness was positively correlated with having breakfast on most days of the week, consuming more daily meals (3 meals and snacks) and eating more fruit and vegetables (a total of 8 serving or more). Although a considerable number of researchers have studied the relationship between happiness and fruit and vegetable intake among adolescents, young people and adults in different countries few studies have examined the relationship between happiness and the number of meals eaten daily. Previous studies have emphasized that people with higher happiness scores or more positive feelings tend to follow a healthier lifestyle. It is also probable that healthier food choices promote positive emotions and happiness through providing essential micronutrients for the body. Similarly, nutrition education programs may lead to improvement in mental and physical health. Acknowledgments This article is a main part of M.Sc thesis supported by Qazvin University of Medical Sciences. We would like to thank Deputy of Research and Technology of Qazvin University of Medical Sciences. We also wish to thank all of the students for their valuable collaboration with this study. Compliance with ethical standards Conflict of interest of interests.
The authors declare that there are no conflicts
Ethical approval The Institutional Review Board (IRB) at the Qazvin University of Medical Sciences (QUMS) approved the study protocol and the related questionnaire. Informed consent Informed consent was obtained from all participants in the study.
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