Effect of a Nutrition Education Intervention on Ultra-Processed Food Awareness and Consumption Among University Students

Overview

Ultra-processed foods are industrially formulated products that often contain high amounts of salt, sugar, and saturated fat, as well as additives. Higher consumption of these foods has been associated with several chronic diseases. Medical students may be at increased risk of unhealthy dietary behaviors and food insecurity. This study aims to evaluate the effects of a low-cost nutrition education program on medical students' knowledge and attitudes about ultra-processed foods, ultra-processed food consumption, nutrition label literacy, and nutrition self-efficacy. A total of 74 sixth-year medical students at Eskisehir Osmangazi University Faculty of Medicine will be assigned by clusters to either an intervention group or a control group. The intervention group will participate in an educational program about ultra-processed foods, food labels, and healthier food choices. The control group will not receive this educational program during the study period. Data will be collected at baseline, immediately after the intervention, and at the one-month follow-up. The study will assess food security, knowledge and attitudes regarding ultra-processed foods, ultra-processed food consumption, nutrition label literacy, nutrition self-efficacy, and dietary intake based on three-day food records.

This study is designed as a cluster-randomized controlled intervention study with pre-intervention, post-intervention, and one-month follow-up measurements. The study will be conducted among sixth-year medical students at Eskisehir Osmangazi University Faculty of Medicine. Students aged 18 years or older who understand Turkish, agree to participate, and provide informed consent will be eligible. Internship groups will be assigned as clusters to either the intervention group or the control group. All eligible students in the selected internship groups will be invited to participate. The sample size calculation indicated that at least 34 participants per group are required. To account for possible losses during follow-up, the target sample size was increased by 10%. The final number of participants may vary depending on the number of eligible and consenting students in the selected clusters. The intervention group will receive a structured nutrition education program, while the control group will not receive this program during the study period. The education program is based on the Health Belief Model and Social Cognitive Theory. It focuses on ultra-processed foods, the NOVA food classification system, associations between ultra-processed food consumption and chronic diseases, nutrition label literacy, food security, nutrition self-efficacy, and healthier food choices. The program includes lectures, small-group discussions, interactive quizzes, case-based learning, role-playing, food-label exercises, analysis of dietary records, low-cost meal planning, and practical cooking activities. Participants will learn to distinguish ultra-processed foods from minimally processed and processed foods, interpret ingredient lists and nutrition information, evaluate the contribution of ultra-processed foods to dietary energy and nutrient intake, and establish achievable personal goals for reducing ultra-processed food consumption. Data will be collected at baseline before the intervention (T0), immediately after the intervention (T1), and at the one-month follow-up (T2). The assessment includes sociodemographic characteristics and health behaviors, food security, knowledge and attitudes concerning ultra-processed foods, food-processing knowledge, ultra-processed food consumption, nutrition label literacy, nutrition self-efficacy, and three-day dietary records. Changes in outcomes over time will be compared between the intervention and control groups to determine whether the education program improves knowledge, attitudes, nutrition label literacy, and nutrition self-efficacy and reduces ultra-processed food consumption.