Investigating eating patterns and risk factors of weight status among undergraduate students in a multinational cross-sectional study across 15 countries with 8,482 participants

BACKGROUND: Underweight and overweight are significant public health issues worldwide, contributing to impaired physical and cognitive development, weakened immunity, and increased morbidity and mortality. This study investigated dietary patterns and sociodemographic risk factors influencing weight status among undergraduate students. METHODS: A multicenter cross-sectional survey was conducted from November 2022 to February 2023 across 15 countries using a self-reported questionnaire (Google Forms) in English and Arabic. In total, 8,482 participants were included. Data were analyzed in R (version 4.1.1), and multivariable regression was used to identify predictors of underweight and overweight/obesity. RESULTS: Only 58.8% of respondents maintained a healthy weight. Overweight/obesity was more common among individuals aged 21-25 (aOR = 1.22, p < 0.001) or 26-30 (aOR = 1.64, p < 0.001) than 16-20, those not taking supplements (aOR = 1.16, p = 0.007), and frequent consumers of white meat (5-7 times/week; aOR = 1.24, p = 0.009). Regular fruit consumption (2-4 times/week; aOR = 0.89, p = 0.048) and eating three meals/day (aOR = 0.70, p = 0.011) were protective. Interestingly, the absence of diabetes (aOR = 0.58, p = 0.003) and dyslipidemia (aOR = 0.14, p < 0.001) correlated with higher overweight/obesity risk. Underweight was less likely among females (aOR = 0.62, p = 0.043) and participants aged 21-25 (aOR = 0.82, p = 0.004). Living with a family (aOR = 1.33, p = 0.018) increased underweight risk, while higher intakes of white meat (aOR = 0.73, p = 0.006) and fruit (aOR = 0.75, p = 0.008) reduced it. Frequent dairy (aOR = 1.25, p = 0.025), cereal (aOR = 1.43, p = 0.001), and tuber consumption (aOR = 1.54, p < 0.001) raised underweight odds. The absence of depression and greater sports practice were linked to lower underweight risk. CONCLUSIONS: Substantial weight imbalances exist among undergraduate students. Low fruit and vegetable intake, frequent sugary food consumption, and high screen time during meals were notable concerns. These findings underscore the need for targeted nutrition education and lifestyle interventions to promote healthier eating and weight management in this population.