In recent years, there has been an increased prevalence of food neophobia in young adults, such as university students. Understanding food neophobia in this demographic is especially important as, overall, their eating habits are considered unhealthy because they consume too much fat, sugar, and salt and too little fruit, vegetables, and fiber. Despite the fact that there are numerous studies on food neophobia in children, there is little data available for university students [17]. There is not any study that is about food neophobia, mediterranean diet adherence and eating disorders. That’s why, this study is the first to evaluate the relationship between food neophobia, mediterranean diet adherence and eating disorders.
The studies conducted so far on gender differences are still quite inconclusive [18]: Some authors have found that women are more neophobic than men [19–21] and this is in line with our study significantly, some authors described instead the contrary [22]. Whilst some others failed to find any differences at all [23–27]. The fact that food neophobia can be inherited as well as acquired through environmental conditioning can account for these variations in the results [19, 28]. These discrepancies suggest that further research is needed in order to clarify the relationship between gender and food neophobia.
Based on the mean FNS scores and their standard deviation, the participants were divided into three groups as follows: food neophobic (scores higher than 49.99), neutral (scores between 30.23–49.99), and food neophilic (scores lower than 30.23). The number of participants in the food neophobic, neutral and food neophilic groups was 182 (14.3%), 888 (69.5%) and 208 (16.3%), respectively. Jezewska-Zychowicz et al. found that food neophobic, neutral, and food neophilic groups was 146 (14.4%), 747 (73.4%),and 124 (12.2%), respectively [25]. This results showed that most of the participants are in the neutral group.
The average score of food neophobia varies from society to society. For example, Lebanon 36.4 ± 9.8 [29]; Southern India 37.7 ± 8.8 (vegetarian), 38.9 ± 8.3 (ovo-vegetarian), 37.3 ± 8.6 (nonvegetarian) [30]; China 36.27 ± 7.61 [17] higher than that reported in developed countries, such as United Kingdom 29.51 (26.67–30.30) [31]; The United States 29.80 ± 11.70 [29]; Spain 31.74 ± 10.98 [32]; Finnish youth 32.3 ± 10.5 [22]; South Korea 33.50 ± 9.0 [33]; highest score that reported in Turkiye 41,3 ± 10,93 [34] and in this study was a mean ± SD of 40.1 ± 9.9. In summary, the food neophobia score decreases as the development level of the country increases. Higher degrees of food neophobia are thought to be associated with lower annual household income.
The study participants, who had varying degrees of food neophobia, showed differently to the groups that had previously been studied. Even some authors have found that food neophobics were shown to had a higher BMI compared to neophilics [19, 25], these results are not parallel with our study. The correlation between food neophobia score and BMI is negative insignificantly in our study. Individuals would like to consume high energy content foods due to food neophobia. However, BMI is affected by various factors such as physical activity, room temperature, and body muscle mass. So, it may not be correct to attribute this difference to just only one cause.
The mediterranean diet is a dietary pattern that describes the eating patterns of people living in the Mediterranean region [35]. The mediterranean diet is characterized by a number of characteristics, including the consumption of whole grains, a wide variety of regional and seasonal fruits and vegetables, moderate dairy product consumption, plant-based sources of protein, and reduced consumption of saturated fats, with olive oil and olives serving as the main sources of fat. Reduced red meat consumption, moderate red wine consumption, and the use of herbs and spices as a salt alternative are also recommended [36]. One of the tools to assess the adherence to the mediterranean diet is the KIDMED. Adherence to the mediterranean diet among university students has been studied and it was found that 32.7% of Lebanon university students [35] compared to 21.8% of Cypriot university students [37]. 37.5% of Turkish university students had low adherence to the mediterranean diet [38] results were very similar with this study regards of 37.4% low adherence to the mediterranean diet.
In this study, the mean total KIDMED score of male students were 4.3 ± 2.87, and female students were 4.4 ± 2.72. There was no significant difference between the total KIDMED scores of male and female students. In another study from Turkey, the mean total KIDMED score of male students were 3.78 ± 0.14, and female students were 4.10 ± 0.14. There was no significant difference between the total KIDMED scores of male and female students, as well [39]. When compared to students’ BMI and KIDMED scores, there is a positive correlation between the two parameters even if it is not significant. Study results of Hajj and Julien are not consistent with this one. Students with lower average BMI was found higher adherence to the mediterranean diet [35]. BMI is an important indicator of the importance of nutrition awareness, especially when it comes highlighting the importance of the mediterranean diet and its various health benefits among university students.
Our results confirm the hypothesis that food neophobia is associated with poorer diet quality, less balanced diets and eating disorders. Even though the relationship between FNS score and KIDMED is not significant, there is a positive correlation between them. There is a negative and significantly correlation between EDE-Q scores and KIDMED.
Eating disorders are quite common among university students and left untreated, physical, psychological, social, and academic consequences can be severe. Early diagnosis and treatment of eating disorders are very important, but it is difficult to determine the prevalence in university students [40, 41]. The EDE-Q is a well-established assessment instrument of eating disorder psychopathology, and is used for both research and clinical purposes [42]. Women have eating disorders 20 times more frequently than men have. The physical and physiological changes that women go in during adolescence are thought to be the cause of this [43]. In the literature, there are numerous studies that show that women are more likely than men to suffer from eating disorders [43–45]. This is in line with our study significantly; women EDE-Q score was 4.4 ± 4.05 and men EDE-Q score was 3.5 ± 3.32. There are studies reporting that BMI is a risk factor for the development of eating disorders [45, 46]. According to the research, people with a BMI of 25 or more are twice as likely to experience eating disorders [46]. According to the results of another study conducted on a total of 610 university students, 338 of whom were men and 272 of whom were women, aged between 17–23 years, it was stated that there was a positive correlation between BMI and the risk of eating disorders [45]. In this study, it is seen that as the BMI increases, EDE-Q increases significantly. There are four subcomponent of EDE-Q: restrictive eating, eating anxiety, form anxiety, weight anxiety. There was a positive and significant correlation between these subcomponents and BMI. There was a negative and significant correlation between eating anxiety and FNS scores. There were a positive and significant correlation between eating anxiety, form anxiety, weight anxiety and KIDMED.
This study emphasizes the necessity of not only detecting food neophobia among university students, but also promoting healthy eating behaviors by raising awareness of adolescents' adaptation to the mediterranean diet and eating behavior disorders.
Strengths and limits
The strength of our study is the relatively large representative sample of Turkish adults. The selection of the study group was carried out by trained interviewers, and our study is based on data from different regions of Turkey. However, there are some limitations to our study. Firstly, the study include the large population of self-reported data and the cross-sectional design, which did not allow assessing the causality of the relationship between the variables. Second, the data were collected using an online questionnaire which has some limitations (internet access, non-using smart phone or computer, eductaion level etc.). The fact that the participants were selected from university students between the ages of 18–24 utilizing the internet more actively reduced the limitation of this situation. Lastly, the data in our research are prone to social desirability errors. Participants may have reported the situation they wanted instead of the situation experienced. Nevertheless, we believe that this study may inform future studies as it is the first time that investigated the relationship between food neophoia and mediterranean diet adherence-eating disorders.