© Borgis - New Medicine 1/2009, s. 13-18
Sylwia Merkiel, *Wojciech Chalcarz, Sylwia Chmielewska
FOOD BEHAVIOUR AND ATTITUDE TOWARDS NUTRITIONAL KNOWLEDGE IN PREMENOPAUSAL WOMEN
Food and Nutrition Department of the Eugeniusz Piasecki University School of Physical Education in Poznan
Head of the Department: Dr hab. Wojciech Chalcarz, prof. nadzw. AWF
Summary
Aim.The aim of this study was to assess food behaviour and attitude towards nutritional knowledge in premenopausal women.
Material and methods. Questionnaires on food behaviour and attitude towards nutritional knowledge were filled in by 60 women aged 44 to 50 years who lived in Dzierżoniów and worked as clerks in the Town Council and Internal Revenue. The questions concerned eating meals, food habits, frequency of eating selected foodstuffs, avoiding foodstuffs and dishes, as well as women´s opinions of their own diet and their attitude towards nutritional knowledge. Statistical analysis was carried out by means of the SPSS 12.0 PL for Windows computer program. The studied population was divided according to educational status.
Results. Educational status had a statistically significant influence on frequency of preparing meals on one´s own, frequency of consuming milk and dairy products, and on avoiding cereals and cereal products, poultry, eggs and alcohol.
Conclusions. Food habits of women with higher education were more favourable with respect to frequency of consuming milk and dairy products as well as avoiding eggs and alcohol in their diets, while food habits of women with secondary education were more desirable in terms of avoiding cereals and cereal products, and poultry. In most of the studied premenopausal women inadequate food habits were observed, including too long intervals between meals, too low frequency of eating wholemeal bread, vegetables, fruit, milk and dairy products, and fish, along with too high frequency of eating meat and poultry. A nutrition education programme for women of premenopausal age should be worked out and implemented.
INTRODUCTION
Premenopause is the period in a woman´s life which precedes the last menorrhoea, characterised by decreasing concentration and irregular secretion of reproductive hormones [1]. Changes in hormone concentrations in a woman´s body not only intensify the most troublesome in this period vasomotor symptoms but also bring about atrophic changes in oestrogen-dependent tissues and numerous metabolic disorders [2]. These physiological changes increase the risk of diet-related diseases such as obesity, atherosclerosis, hypertension, type 2 diabetes and osteoporosis [2, 3, 4, 5, 6]. Thus, premenopausal women should pay special attention to their own food behaviour in order to reduce the risk of the above-mentioned diseases.
AIM
The aim of this study was to assess food behaviour and attitude towards nutritional knowledge in premenopausal women.
MATERIAL AND METHODS
Questionnaires on food behaviour and attitude towards nutritional knowledge were filled in by all women aged 44 to 50 years who lived in Dzierżoniów, worked as clerks in the Town Council and Internal Revenue, and agreed to take part in the study. Thus, the studied population included 60 women whose mean age was 46.7±2.0 years. The questions concerned eating meals, food habits, frequency of eating selected foodstuffs, avoiding foodstuffs and dishes, as well as women´s opinions of their own diet and their attitude towards nutritional knowledge.
Statistical analysis was carried out by means of the SPSS 12.0 PL for Windows computer program. The studied population was divided according to educational status. Quantitative variables were first analysed using the Shapiro-Wilk statistic for testing normality. The level of significance was set at p=0.05. For all the analysed quantitative variables, means and standard deviations were calculated. The unpaired Student´s t test for normally distributed variables and the non-parametric Mann-Whitney U test for skewed variables were used to investigate statistically significant differences. Qualitative variables were presented in contingency tables. Statistical significance was determined using Pearson´s chi-square test. If for a certain variable the percentage of the population was lower than 20% for at least one subgroup and at least one answer, the Mann-Whitney U test was used. The level of significance was set at p=0.05.
RESULTS
Table 1 shows general characteristics of the studied premenopausal women by educational status, and Tables 2 to 6 present answers of the studied women to questions concerning, respectively: number of meals, frequency of eating meals and the longest interval between meals; food habits; frequency of eating selected foodstuffs; avoiding foodstuffs and dishes; and women´s opinions of their own diets and their attitude towards nutritional knowledge.
Table 1. General characteristics of the studied population.
| No. | Variable | Education | All women
(n=60) |
Secondary
(n=30) | Higher
(n=30) |
| 1. | Age [years] | x ? sd | 46.9?2.1 | 46.5?2.1 | 46.7?2.0 |
| 2. | Weight [kg] | x ? sd | 68.1?10 | 64.1?8.5 | 66.1?9.4 |
| 3. | Height [cm] | x ? sd | 166.1?6.9 | 166.2?5.4 | 166.2?6.2 |
| 4. | Somatotype [%] | Endomorphic | 43.3 | 23.4 | 33.3 |
| Ectomorphic | 30.0 | 33.3 | 31.7 |
| Mesomorphic | 26.7 | 43.3 | 35.0 |
| 5. | Women´s opinion of their own economic status [%] | Very good | 3.3 | 10.0 | 6.7 |
| Good | 36.7 | 53.3 | 45.0 |
| Average | 56.7 | 36.7 | 46.6 |
| Bad | 3.3 | 0.0 | 1.7 |
| 6. | Marital status [%] | Married | 73.3 | 70.0 | 71.7 |
| Widow | 0.0 | 3.3 | 1.7 |
| Divorced | 20.0 | 16.7 | 18.3 |
| Unmarried | 6.7 | 10.0 | 8.3 |
Table 2. Number of meals, frequency of eating meals and the longest interval between meals [%].
| No. | Question | Answer | Education | All women
(n=60) |
Secondary
(n=30) | Higher
(n=30) |
| 1. | Number of meals a day | One | 3.3 | 0.0 | 1.7 |
| Two | 10.0 | 6.7 | 8.2 |
| Three | 33.3 | 50.0 | 41.7 |
| Four | 33.3 | 26.7 | 30.0 |
| Five | 20.1 | 13.3 | 16.6 |
| Six | 0.0 | 3.3 | 1.7 |
| 2. | Having breakfast | Every day | 83.4 | 80.0 | 81.7 |
| 3. | Having lunch | Every day | 33.3 | 46.7 | 40.0 |
| 4. | Having dinner | Every day | 86.7 | 80.0 | 83.3 |
| 5. | Having tea | Every day | 13.3 | 10.0 | 11.7 |
| 6. | Having supper | Every day | 33.3 | 36.6 | 35.0 |
| 7. | The longest interval between meals | Four hours or shorter | 50.0 | 50.0 | 50.0 |
| Longer than 4 hours | 50.0 | 50.0 | 50.0 |
Table 3. Food habits [%].
| No. | Variable | Education | All women
(n=60) |
Secondary
(n=30) | Higher
(n=30) |
| 1. | Time of being the most hungry | In the morning | 33.3 | 50.0 | 41.7 |
| In the afternoon | 30.0 | 6.7 | 18.4 |
| In the evening | 16.8 | 23.3 | 20.0 |
| At night | 3.3 | 3.3 | 3.3 |
| Before the main meal | 10.0 | 6.7 | 8.4 |
| Under stress | 3.3 | 3.3 | 3.3 |
| I never feel hungry | 3.3 | 6.7 | 5.0 |
| 2. | Foods most frequently eaten between the main meals1 | Cheese | 3.3 | 0.0 | 1.7 |
| Cold meats | 3.3 | 0.0 | 1.7 |
| Fruit | 43.3 | 43.3 | 43.3 |
| Instant soups | 3.3 | 0.0 | 1.7 |
| Sandwiches | 6.7 | 13.3 | 9.4 |
| Sweets | 23.3 | 36.7 | 30.0 |
| Vegetables | 10.0 | 3.3 | 6.7 |
| Yoghurt | 6.7 | 10.0 | 8.3 |
| 3. | Eating always until the feeling of satiety | 50.0 | 33.3 | 41.6 |
| 4. | Preparing meals always on one´s own | 93.3 | 66.6 | 80.0 |
| 5. | Eating between the main meals | 53.4 | 43.3 | 48.3 |
| 6. | Eating at night | 10.0 | 6.7 | 8.3 |
| 8. | Taking vitamins | 30.0 | 36.7 | 33.3 |
| 8. | Taking minerals | 20.0 | 30.0 | 25.0 |
1Some of the studied women chose more than one answer and so percentages in columns may not equal 100%.
Bold type denotes statistically significant results (p=0.05).
Table 4. Frequency of eating selected foodstuffs [%].
| No. | Foodstuff | Frequency | Education | All women
(n=60) |
Secondary
(n=30) | Higher
(n=30) |
| 1. | Wholemeal bread | Never | 30.0 | 23.4 | 26.6 |
| Once a day | 43.3 | 30.0 | 36.7 |
| Twice a day | 26.7 | 40.0 | 33.3 |
| Three times a day | 0.0 | 3.3 | 1.7 |
| Four times a day | 0.0 | 0.0 | 0.0 |
| Five times a day | 0.0 | 3.3 | 1.7 |
| 2. | Vegetables | Never | 3.3 | 0.0 | 1.7 |
| Once a day | 40.0 | 23.3 | 31.7 |
| Twice a day | 33.3 | 36.7 | 35.0 |
| Three times a day | 16.7 | 30.0 | 23.3 |
| Four times a day | 6.7 | 3.3 | 5.0 |
| Five times a day | 0.0 | 6.7 | 3.3 |
| 3. | Fruit | Never | 10.0 | 0.0 | 5.0 |
| Once a day | 23.3 | 30.0 | 26.6 |
| Twice a day | 36.7 | 36.7 | 36.7 |
| Three times a day | 16.7 | 23.3 | 20.0 |
| Four times a day | 13.3 | 10.0 | 11.6 |
| 4. | Milk and dairy products | Never | 16.7 | 6.7 | 11.7 |
| Once a day | 76.6 | 56.7 | 66.6 |
| Twice a day | 6.7 | 33.3 | 20.0 |
| Three times a day | 0.0 | 3.3 | 1.7 |
| 5. | Meat and meat products | Never | 0.0 | 6.7 | 3.3 |
| Once a day | 33.3 | 53.3 | 43.3 |
| Twice a day | 46.7 | 26.7 | 36.7 |
| Three times a day | 20.0 | 13.3 | 16.7 |
| 6. | Poultry | Never | 16.7 | 33.4 | 25.0 |
| Once a day | 63.3 | 63.3 | 63.3 |
| Twice a day | 13.3 | 3.3 | 8.4 |
| Three times a day | 6.7 | 0.0 | 3.3 |
| 7. | Fish | Never | 53.3 | 46.7 | 50.0 |
| Once a day | 46.7 | 46.7 | 46.7 |
| Twice a day | 0.0 | 6.6 | 3.3 |
Bold type denotes statistically significant results (p=0.05).
Table 5. Avoiding foodstuffs and dishes [%].
| No. | Foodstuff/dish avoided | Education | All women
(n=60) |
Secondary
(n=30) | Higher
(n=30) |
| 1. | Cereals and cereal products | 0.0 | 13.3 | 6.7 |
| 2. | Refined bread | 36.7 | 46.7 | 41.7 |
| 3. | Vegetables | 3.3 | 0.0 | 1.7 |
| 4. | Fruit | 6.7 | 0.0 | 3.3 |
| 5. | Milk and dairy products | 26.7 | 13.3 | 20.0 |
| 6. | Meat | 3.3 | 13.3 | 8.3 |
| 7. | Poultry | 0.0 | 16.7 | 8.3 |
| 8. | Fish | 3.3 | 13.3 | 8.3 |
| 9. | Eggs | 3.3 | 20.0 | 11.7 |
| 10. | Butter | 26.7 | 40.0 | 33.3 |
| 11. | Margarine | 43.3 | 60.0 | 51.7 |
| 12. | Animal fat | 46.7 | 50.0 | 48.3 |
| 13. | Vegetable fat | 3.3 | 3.3 | 3.3 |
| 14. | Sugar | 40.0 | 60.0 | 50.0 |
| 15. | Sweets | 33.3 | 43.3 | 38.3 |
| 16. | Alcohol | 23.3 | 50.0 | 36.7 |
| 17. | Fried dishes | 16.7 | 23.3 | 20.0 |
| 18. | Baked/roasted dishes | 10.0 | 10.0 | 10.0 |
| 19. | Boiled dishes | 6.7 | 3.3 | 5.0 |
| 20. | Stewed dishes | 0.0 | 10.0 | 5.0 |
Bold type denotes statistically significant results (p=0.05).
Table 6. Women´s opinions of their own diets and their attitude towards nutritional knowledge [%].
| No. | Women´s opinions | Education | All women
(n=60) |
Secondary
(n=30) | Higher
(n=30) |
| 1. | My diet is adequate | 20.0 | 26.7 | 23.3 |
| 2. | My nutritional knowledge is sufficient | 46.7 | 66.7 | 56.7 |
| 3. | I broaden my knowledge about nutrition | 50.0 | 56.7 | 53.3 |
Educational status had a statistically significant influence on frequency of preparing meals on one´s own, frequency of consuming milk and dairy products, and on avoiding cereals and cereal products, poultry, eggs and alcohol. More women with secondary education, 93.3%, compared to their peers with secondary education, 66.6%, always prepared meals on their own. A higher percentage of women with higher education, compared to women with secondary education, consumed milk and dairy products more frequently and avoided cereals and cereal products, poultry, eggs and alcohol.
DISCUSSION
Food behaviour in women with higher education, compared to their peers with secondary education, were more favourable first of all because of the higher frequency of consuming milk and dairy products which – as a source of calcium and vitamin D – are particularly important components of diet in premenopausal women due to increased risk of osteoporosis. Moreover, more women with higher education avoided eggs and alcohol in their diets. Eggs are rich in cholesterol, which raises cholesterol concentration in serum, and excessive amounts of alcohol increase blood pressure; therefore these products should be avoided in premenopausal age due to increased risk of cardiovascular diseases. On the other hand, none of the women with secondary education avoided cereals and cereal products, which are recommended to be included in every meal, or poultry, whose protein is less atherogenic than protein of red meat.
It was highly favourable that more than 90% of the studied premenopausal women ate three or more meals a day, that every second woman avoided animal fat and sugar, and that every third woman avoided butter, sweets and alcohol in their diets. A good habit was also avoiding refined bread, observed in 40% of the studied women. However, it was unfavourable that not even a half of the premenopausal women had lunch, tea and supper every day and that in only every second woman was the longest interval between meals shorter than four hours. An undesirable behaviour was also low frequency of eating wholemeal bread, vegetables, fruit, milk and dairy products, and fish, along with high frequency of eating meat and poultry.
In the literature there is a lack of articles on food behaviour in premenopausal women. We found only one paper on dietary habits of 50-year-old men and women from Wrocław [7]. The women from Wrocław [7] had lower body height but higher body weight compared to the studied women. A higher percentage of women from Wrocław [7] ate less than three meals a day and a lower percentage of them had breakfast, lunch, dinner and tea every day compared to the studied premenopausal women.
We found only a few articles focused on various facets of diets in women of perimenopausal age. Duda et al. [8] studied women of perimenopausal age and reported low intake of fruit, vegetables and pulses. Wajszczyk et al. [9] assessed intake of energy and selected nutrients in perimenopausal and postmenopausal women and observed excessive intake of energy from fat as well as excessive intake of sodium and phosphorus along with deficient intake of other minerals and vitamins, particularly calcium and vitamin D. A study by Piórecka et al. [10] on energy and macronutrient intake in premenopausal and postmenopausal women found excessive intake of saturated fatty acids and deficient intake of plant protein and dietary fibre.
Our results showed that some undesirable food habits in the studied premenopausal women were the same as in women of similar age studied by Ilow et al. [7] and Duda et al. [8]. However, although Wajszczyk et al. [9] and Piórecka et al. [10] analysed intake of energy and selected nutrients, their results imply similar inadequacies in food habits as in the studied population.
The undesirable food habits observed in the studied women are typical of the Polish population. In order to avoid them, educational programmes focused on nutrition in premenopausal age should be worked out and implemented. Such programmes are expected to be effective since only every fourth woman considered her diet to be adequate and more than half of the studied population broadened their knowledge on nutrition. A study by Friedrich [11] on a group of obese menopausal women showed that nutritional education resulted in better food habits, weight loss and reduced body fat.
CONCLUSIONS
1. Food habits of women with higher education were more favourable with respect to frequency of consuming milk and dairy products as well as avoiding eggs and alcohol in their diets, while food habits of women with secondary education were more desirable in terms of avoiding cereals and cereal products, and poultry.
2. In most of the studied premenopausal women inadequate food habits were observed, including too long intervals between meals, too low frequency of eating wholemeal bread, vegetables, fruit, milk and dairy products, and fish, along with too high frequency of eating meat and poultry.
3. A nutrition education programme for women of premenopausal age should be worked out and implemented.
Piśmiennictwo
1. Warenik-Szymankiewicz A., Słopień R.: Premenopauza - problemy diagnostyczne i terapeutyczne. Od kiedy hormonalna terapia zastępcza, do kiedy antykoncepcja? Ginekol Położ 2008; 3(4): 19-28. 2. Grycewicz J, Cypryk K: Wpływ hormonów płciowych na występowanie zaburzeń metabolicznych u kobiet w okresie menopauzy. Prz Menopauz 2008; 7(1): 29-37. 3. Stachowiak G et al.: Nadciśnienie tętnicze u kobiet w okresie menopauzy. Prz Menopauz 2008; 7(2): 96-101. 4. Szlendak-Sauer K: Profilaktyka osteoporozy u kobiet w okresie okołomenopauzalnym. Essent Med 2006; 2: 28-32. 5. Milewicz A et al.: Metaboliczne następstwa okresu przekwitania kobiet. Pol Med Rodz 2003; 5(3): 413-417. 6. Brożyna E, Bernas M: Menopauza jest istotnym czynnikiem ryzyka cukrzycy typu 2. Med Metab 2001; 5(4): 35-40. 7. Ilow R et al.: Ocena zwyczajów żywieniowych 50-letnich mieszkańców Wrocławia. Bromat Chem Toksykol 2007; 40(2): 121-129. 8. Duda G, Thiem B, Masiak M: Fitoestrogeny w żywieniu kobiet w wieku menopauzalnym. Żyw Człow Metab 2007; 34(1/2): 783-787. 9. Wajszczyk B et al.: Sposób żywienia kobiet w wieku okołomenopauzalnym i pomenopauzalnym. Żyw Człow Metab 2003; 30(1/2): 372-376. 10. Piórecka B et al.: Wpływ żywienia na występowanie wybranych metabolicznych czynników ryzyka chorób układu krążenia wśród mieszkanek Krakowa. Roczn PZH 2007; 58(1): 119-127. 11. Friedrich M: Żywieniowa modyfikacja składu ciała i lokalizacji tkanki tłuszczowej u otyłych kobiet w okresie menopauzalnym. Prz Lek 2007; 64(Supl 4): 19-23.
