|Year : 2020 | Volume
| Issue : 4 | Page : 175-180
Knowledge of nutrition among students in a dental teaching institution in Kerala
Rohan Yatindra Vaidya, Vibha M R. Shivani, Sachi Santosh, Priyanka Tiruchirapalli Gaupiysunder, Aiswarya Anil, Venkitachalam Ramanarayanan
Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
|Date of Submission||23-Jul-2020|
|Date of Decision||25-Jul-2020|
|Date of Acceptance||04-Aug-2020|
|Date of Web Publication||23-Dec-2020|
Dr. Venkitachalam Ramanarayanan
Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, AIMS, Ponekkara P.O., Kochi - 682 041, Kerala
Source of Support: None, Conflict of Interest: None
Introduction: Basic education about nutrition can be extremely beneficial for medical and dental professionals. It is very important that, dental students are taught about nutrition during their course of study as this will help in developing a holistic approach in treating patients. As limited literature is available regarding the nutritional knowledge among dental students, the present study was done to assess the same among students in a dental teaching institution. Materials and Methods: The awareness of dietary recommendations, knowledge of food sources and nutrients and diet–disease relationship was assessed among clinical students of a dental teaching institute in Kerala, through a 13-point self-administered questionnaire. Analysis was done based on two groups (undergraduate [UG] students and post-graduate [PG] students). Results: A total number of 140 responses were obtained. UG students comprised 31.4% while PG students comprised 68.6% of the study population. Majority (>75%) of the participants in both groups (UG and PG) felt that there is a need to consume more vegetables and fibers and less amounts of sugary and fatty foods. Among the PG students, most respondents (36%) opined that sugar contained more calories for the same weight while 34% of PG students and 44% of UG students reported that starchy food contained more calories. While more than 95% of participants associated diabetes to sugar consumption, there was a mixed response for kidney disease (47.7% in PG and 53.1% in UG; P < 0.026) and heart diseases (40.9% in PG and 38.5% in UG), respectively. Conclusion: The knowledge among dental students about dietary recommendations, knowledge of food sources and nutrients and diet–disease relationship was found to be satisfactory.
Keywords: Diet, nutrition, oral health
|How to cite this article:|
Vaidya RY, R. Shivani VM, Santosh S, Gaupiysunder PT, Anil A, Ramanarayanan V. Knowledge of nutrition among students in a dental teaching institution in Kerala. Amrita J Med 2020;16:175-80
|How to cite this URL:|
Vaidya RY, R. Shivani VM, Santosh S, Gaupiysunder PT, Anil A, Ramanarayanan V. Knowledge of nutrition among students in a dental teaching institution in Kerala. Amrita J Med [serial online] 2020 [cited 2022 Sep 27];16:175-80. Available from: https://ajmonline.org.in/text.asp?2020/16/4/175/304580
| Introduction|| |
Nutrition plays a vital role in human growth and development and is an integral part of oral health. By definition, nutrition is the study of nutrients in the food, how the body uses them and the relationship between diet, health and disease. The World Health Organization estimates that over 80% of the world's current chronic disease burden is linked to dietary and lifestyle factors., The quality of diet plays a vital role in the health of people and a balanced diet is essential for healthy living and disease prevention., Health-care professionals are not only responsible for a patient's treatment, but also for their health and safety, including disease prevention. Basic education about nutrition imparted by medical or dental professionals constitutes a simple activity with high potential benefit. Despite acknowledging that nutritional risk assessment and counseling are important components of comprehensive dental care, most practitioners do not integrate the same into practice. It is however necessary that dental health-care professionals develop skills to identify those at nutritional risk and give them appropriate guidance, either personally or by involving the services of a nutritionist. The American Dental Association's Preventive Health Statement on Nutrition and Oral Health encouraged dentists to maintain current knowledge of nutritional recommendations such as Dietary Guidelines, as they related to general and oral health and disease. Needless to say, it is imperative for dental health-care professionals to have basic knowledge about nutrition.
In contrast to other health professionals who usually examine more ill patients, a dentist typically sees relatively more healthy patients on a regular/periodic basis. The emphasis on regular/periodic dental checkups puts the dentist in a unique position when compared with other health care professionals. He/she has the opportunity to clinically observe apparently healthy patients for nutritional deficiencies and give appropriate guidance. Taking a dietary history in the patients first dental visit will not only help in diagnosis but will also tell us about the prognosis of a dental procedure. This may also give us an idea about the patients eating habits which may be harmful to him/her in the longer run (e.g., malnutrition/too much junk food/type of diet). In a patient already undergoing nutritional therapy, a dentist's advice will reinforce the importance of a good diet and will help in inculcating healthier habits.
Conventionally, dietary counseling in dentistry involved advising the patient to reduce consumption of sweets and reduce the frequency of consuming snacks. However, this is not sufficient as nutrients not only have an impact on the oral cavity but also have an impact on the general health. In fact, the first signs of poor nutrition often show-up in oral health. Nutritionists, clinicians, and dentists should be up to date with all the recent understanding in relation to diet and nutrition to provide proper advice to their patients.
A study done by Chalmuri et al. in a dental institution in India reported poor knowledge of nutrition among undergraduate (UG) students. It is essential to guide the approach of students right from the beginning in their learning phase. Understanding the importance of nutrition in oral health and disease prevention during practice will help in inculcating a holistic approach. This process of learning by doing will help dental students to adapt and learn these concepts and this knowledge in turn will translate into their dental practice in future. As limited literature is available regarding the nutritional knowledge among dental students, the present study was done to assess the same among students in a dental teaching institution.
| Materials and Methods|| |
A cross-sectional questionnaire study was conducted among clinical students of a dental teaching institution in Kerala. The students comprised two groups, UG students (which included 3rd-year students, final-year students, and house surgeons) and postgraduates (PG) students.
We handed out a 13-point self-administered questionnaire, which was adapted from the study conducted by Labban and Chalmuri et al. It was designed to assess the awareness of dietary recommendations, knowledge of food sources and nutrients and diet–disease relationship. The study was reviewed by the Institutional Review Board and ethical approval was obtained. A participant information sheet was given and informed consent was obtained from the willing participants. Total duration of the study was 6 months.
The data obtained was coded, tabulated, and analyzed with IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp for statistical analysis. Chi-square test was applied to find out associations between nutritional knowledge and study groups (UG students and PG students). A “P” < 0.05 was considered statistically significant.
| Results|| |
A total number of 140 responses were obtained. Mean age of the participants in the study was 22.11 ± 2.18 years with 14 men and 126 women. UG students comprised 31.4% (n = 44) while PG students comprised 68.6% (n = 96) of the study population.
Responses of participants in the study on knowledge of dietary recommendation are given in [Table 1]. Majority (>75%) of the participants in both the groups (UG and PG) felt that there is a need to consume more vegetables and fibers and less amounts of sugary and fatty foods. Most participants (40%) in either group felt that the amount of salt intake per day should not exceed one tablespoon. The difference between the two groups with regard to knowledge on dietary recommendations was not statistically significant.
Knowledge among participants regarding various food sources for nutrition is elucidated in [Table 2]. Participants in both groups (>85%) felt that ice cream had high amounts of added sugar, while almost an equal number of respondents in both groups felt that tomato ketchup had high and low amounts of added sugar, respectively. More than 75% of respondents were of the opinion that there was a high content of fat in pasta/noodles and low amounts of fat in honey. About 75% and 60% of respondents felt that soyabean was a rich source and fruits were a low source of proteins respectively. About 68% of participants in the PG group and 72% of participants in the UG group felt that among the given options, whole grain bread contains more vitamins and minerals. Among the PG students, 36% respondents opined that sugar contained more calories for the same weight while, 34% of PG students and 44% of UG students reported that starchy foods contained more calories. There was no statistically significant difference between the two groups, for all questions on sources of food.
Participants' knowledge on diet–disease relationship is shown in [Table 3]. Majority of participants identified constipation and stomach diseases as a consequence of low intake of fruit and vegetables. While more than 95% of participants associated diabetes to sugar consumption, there was a mixed response for kidney disease (47.7% in PG and 53.1% in UG; P < 0.026) and heart diseases (40.9% in PG and 38.5% in UG). Similarly, more than 90% of the participants felt hypertension was linked to high salt intake. There was no statistically significant difference among the study groups with regard to diet-disease relationship also.
|Table 3: Knowledge on diet-disease relationship among study participants|
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| Discussion|| |
Poor nutrition affects the entire immune system degrading the immunity of individuals making them susceptible to a number of systemic and oral diseases. Dental caries and periodontal diseases, the most common dental diseases are closely linked to diet. Dentists thus have a major role in diet counseling and inadequate knowledge and misconceptions about nutrition can have a serious impact on the nutritional status of the dentist as well as the patient.
The main aim of teaching medical and dental students about nutrition should be health promotion, disease prevention and comprehensive care rather than just disease management. Basic knowledge and skills regarding nutritional counseling should be inculcated during the days of training in dental schools. As discovered by Paulo et al. in his study, majority of the surgeons (80%) were not up-to-date with nutritional facts and thus were not confident in providing nutritional therapy. Whereas, in Faine and Oberg work on women, infants, and children nutritionists and dental hygienists, it was seen that they had much more dental nutritional knowledge. This may be because of the dental hygienists' course. Similarly, in a study done by Labban, it was seen that students in health related programs had more knowledge about diet– disease relationship than those in nonhealth-related programs. The dental students' nutritional knowledge and attitudes are shaped on the basis of the curriculum followed by dental schools, of which nutritional counseling is not a major component. In a study done by Sivakumar et al. on dental house surgeons, it was seen that 75% agreed that nutrition was a vital component of total health care. However, only 42% of them felt that they had received adequate training in diet counseling. Most of the subjects agreed that diet counseling needed to be emphasized in dental education.
Among vegetables, sugars, fatty foods, and high fiber foods, more than 80% of the participants were aware that consumption of vegetables and high fiber foods needs to be more and there was a need to cut down on sugar and fatty foods. In the present study, majority of the UGs (90.6%) agreed with the experts view on eating more amount of vegetables and less amount of sugar (82.3%) as compared to the PG students. Majority of the UGs also agreed on less fatty food (88.5%) and more amount of high fiber food (82.3%). UGs (44.8%) also possessed better knowledge about the type of fat which needed to be decreased (i.e., unsaturated fats) when compared to the PGs. However, these results were not statistically significant and did not correlate with the study done by Chalmuri et al. who found the PGs to have more knowledge compared to the UGs.
Different kinds of foodstuffs are rich in different nutrients. To find a dietary cause of disease, if any, it is important for students to know which type of food is rich in which nutrient. Tallying the data, it was found that the PG students had more knowledge about which type of food was rich in sugars, fats, proteins, vitamins, and minerals as compared to the UGs. In assessing the knowledge about sugar content, the PGs felt that ice creams 95.5%, and fruit juices 72.7% were rich in sugar whereas 45.5% thought fruit yoghurt, and tomato ketchup had high sugar content. Regarding the fat content, majority of them thought pasta/noodles, and nuts to be rich sources of fats. Throwing light on a few protein rich foods, 81.8% of PGs voted for chicken while 65.9% opted cheese, and 75% opted for soya bean to have high protein content. Nutritional knowledge about bread, a common food consumed by many, was encouraging, with both groups considering whole grain bread to be healthier. This was in accordance with the study done by Chalmuri et al.
When we consider fats in particular, there are different types of fats namely monounsaturated and polyunsaturated. All these do have some role to play in one of the global health diseases, i.e., obesity. In the present study, 44.8% of the UGs felt that it is the unsaturated fats which are harmful and must be reduced. This was not in accordance to the study done by Chalmuri et al., where the number of PGs were more than the number of UGs.
About the number of calories provided by the same quantity of different foodstuffs, it was observed that 43.8% of the UGs felt it to be starchy foods while 36.4% of the PGs thought sugars to be rich in calories. This was in contrast with the study done by Chalmuri et al., where both groups considered fats to be a major source of calories.
In the relationship between diet and disease, it is known that improper nutrition is one of the main etiological factors for occurrence of disease. Both the student groups, i.e., UGs and PGs had a similar opinion and felt that diet had a role to play in constipation and abdominal disease whereas allergy and rheumatism were not much affected by diet.
Majority of the UGs (96.9%) and PGs (95.5%) thought diabetes to have an association with sugar intake whereas 65.9% of the PGs and 56.2% of the UGs were sure that anemia had no link with sugar intake. This was in accordance with the study conducted by Perlstein et al. on medical PG students' perceptions regarding the importance of nutritional knowledge and their confidence in providing competent nutrition practice. However, the opinions were mixed about heart disease and kidney disease. There were also a few students, around 15%–35% in both the groups who were not sure if the consumption of sugar would predispose them to certain diseases.
Along with sugar, another important ingredient of our daily food is salt. High salt intake is considered as an important etiological factor for hypertension. Around 90.9% of the PGs and 92.7% of the UGs had a similar view point. However, they were uncertain whether salt consumption had any effect on urticaria and night blindness. Similar opinions were seen with night blindness with majority of them, i.e., 70% PGs and 60.4% UGs opined that there was no relation while the rest were not aware of the link. When they were asked about the daily amount of salt consumption, both the groups equally thought that one table spoon of salt per day was adequate. This was not the case in the study done by Chalmuri et al. where the PGs had more knowledge than the UGs.
About dietary modification to prevent heart disease, PGs were more aware than the UGs, though the difference was not statistically significant. There was sufficient knowledge among both the groups on the link between heart disease and consumption of sugar, salt, saturated fats, vegetables and fruits. Both the groups agreed that eating less of sugar, salt and saturated fats, with an increase in the amount of fruit and vegetables would help in prevention of heart disease.
This study was intended as an exploratory study and thus had its inherent limitations. The study was conducted in a single dental teaching institution. We recommend similar studies to be conducted across different institutes and also among practicing dentists to gain insights into nutritional advice provided during dental consultation. We strongly recommend a brief dietary analysis and basic nutrition counseling to be done while attending patients' dental needs.
| Conclusion|| |
Information obtained from the present study regarding the knowledge of nutrition among dental students showed that both the groups of students (UG and PG) had adequate knowledge about nutrition. Our study showed that the UG students had more general knowledge about nutrition, but the PG students fared better regarding knowledge of specific nutrients.
The authors would like to thank the contribution of Vindhya Ampili, Murugan Monisha, Sisira Sivan, Sruthi PB, Sukanya NR and Richie Prince to this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rosales FJ, Reznick JS, Zeisel SH. Understanding the role of nutrition in the brain and behavioral development of toddlers and preschool children: Identifying and addressing methodological barriers. Nutr Neurosci 2009;12:190-202.
World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva, Switzerland: World Health Organization; 2009. Available from: https://apps.who.int/iris/handle/10665/44203
. [Last accessed on 2020 Jul 09].
Chalmuri Y, Padma TM, Vineela P, Varma LS, Vidyasagar Y. Do the dental students have enough nutritional knowledge? A survey among students of a dental college in Telangana State. J Indian Assoc Public Health Dent 2018;16:38-43. [Full text]
Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z. Nutritional risk screening and assessment. J Clin Med 2019;8:1065.
Sivakumar V, Jain J, Tikare S, Palliyal S, Kulangara S, Patil P. Perception of diet counseling among dental students in India. Saudi J Oral Sci 2016;3:36-41. [Full text]
Sheetal A, Hiremath VK, Patil AG, Sajjansetty S, Kumar SR. Malnutrition and its oral outcome – A review. J Clin Diagn Res 2013;7:178-80.
Labban L. Nutritional knowledge assessment of Syrian university students. J Sci Soc 2015;42:71. [Full text]
Wu D, Lewis ED, Pae M, Meydani SN. Nutritional modulation of immune function: Analysis of evidence, mechanisms, and clinical relevance. Front Immunol 2018;9:3160.
Paulo DA, de Oliveira BM, Wang DW, Guimarães MP, Cukier C, Lopes Filho Gde J. Surgeons' knowledge and attitude regarding concepts of nutritional therapy. Rev Col Bras Cir 2013;40:409-19.
Faine MP, Oberg D. Survey of dental nutrition knowledge of WIC nutritionists and public health dental hygienists. J Am Diet Assoc 1995;95:190-4.
Urek R, Crncević-Urek M, Cubrilo-Turek M. Obesity – A global public health problem. Acta Medica Croat Cas Hravatske Akad Med Znan 2007;61:161-4.
Abraham S, Noriega BR, Shin JY. College students eating habits and knowledge of nutritional requirements. J Nutr Hum Health 2018;2:13-7.
Perlstein R, McCoombe S, Shaw C, Nowson C. Medical students' perceptions regarding the importance of nutritional knowledge and their confidence in providing competent nutrition practice. Public Health 2016;140:27-34.
[Table 1], [Table 2], [Table 3]