Differences in Behaviour Related to Dietary Habit, Self-medication and Nutraceuticals Use Among Italian and Spanish University Students: Relationship With Cardiovascular Risk Factors.

Young people are considered a population at risk of nutritional deficiencies due to bad eating habits, found especially among university students. In fact, the latter tend to change their eating habits when they begin their university studies, with adherence to a typically western diet that includes low consumption of fish, fruit and vegetables, monounsaturated and polyunsaturated fatty acids, and an increase in consumption of sugars, alcohol and "fast food", with the consequent increase in this population class of the risk of malnutrition and/or obesity, metabolic and cardiovascular diseases. These changes are due to the lack of experience in meal planning, with a consequent increase in the frequency of meals away from home, to the increase in the number of snacks or meals skipped to respect the timetable of the lessons, to the easier access to the fast food and limited economic resources. Among the unhealthy behaviors adopted by the students, in addition to the wrong eating habits, there are also reduced physical activity, increased sedentariness, alcohol consumption and smoking.

Over the past 20 years there has been an increase in obesity rates among university students who, especially for medical students, are closely related to specific habits such as: skipping breakfast, attending fast food, low fruit and vegetables consumption, and easy access to unhealthy foods from the machines. Among the freshmen, especially those who live far from families and find themselves independent for the first time in their lives, higher rates of weight gain and higher levels of stress have been reported, responsible for changes in food choices. In fact, to control stress levels, individuals are encouraged to prefer foods that are high in fat. Therefore, university students should be seen as a group that requires special attention regarding health promotion, especially food.

However, the interest in a healthy diet can lead to a psychological obsession known as orthorexia (ortho = just, oreksis = appetite), which consists in the persistent concern of maintaining the self-imposed diet to improve one's health. Nutritionists/dieticians and students are the categories of population most affected by orthorexia, with a prevalence in Italian nutrition science students of 35.9%. The typical behaviors of orthorexia can be associated with a negative image of one's own body, despite the subject's strong interest in appropriate and healthy food choices. However, as a result of extreme restriction/concern over one's diet, orthorhexics would tend to eliminate whole groups of foods with consequent nutritional deficiencies, malnutrition and weight loss. Furthermore, the typical eating behavior of orthoressia is associated with intense physical activity, suggesting that students who practice sports have a greater tendency to develop this disorder.

The high levels of stress recorded in university students were also related to the use of smart drugs and "smart nutrients", which university students, especially those in medicine (74.7%), use to enhance their cognitive abilities. The phenomenon of self-medication is one of the main problems for public health, with only 48% of the population of the European Union using prescribed drugs. Among the students of health professions high levels of self-medication with antibiotics are recorded in the absence of indication. Another trend that is of particular concern is the increase in the use of antidepressants among young people, which many of them take after disappointments in academic performance and which have negative side effects such as weight gain , altered lipid profile and risk of diabetes. Another category of substances that young people abuse or otherwise misuse are amphetamines, and the co-intake of stimulants, alcohol or other drugs is also of concern. Indeed, a recent study carried out on Italian and Spanish pharmacy students showed that Spaniards have a high percentage of drug use and that 38.4% of subjects take them in conjunction with alcohol; instead, Italian students have revealed that they rarely turn to the pharmacist and rely more on the advice of family or friends.

The university years therefore represent a period marked not only by food problems but also by stress, anxiety, depression and other psychological problems. However, it emerged that a high adherence to the Mediterranean diet would bring benefits at the cognitive level, with an improvement in the states of depression and anxiety and a better academic result. In addition to a healthy diet, even moderate and regular physical activity (90 minutes a week) has been shown to reduce levels of anxiety and depression with improved well-being and self-esteem. For this reason it is essential to promote this lifestyle among university students.