TYPE Original Research

PUBLISHED 21 August 2024

DOI 10.3389/fpubh.2024.1409105

Factors associated with diet

OPEN ACCESS quality of adolescents in
Saudi Arabia
EDITED BY
Haleama Al Sabbah,
Abu Dhabi University, United Arab Emirates

REVIEWED BY
Nurul ‘Ain Azizan, Walaa Abdullah Mumena 1,2*
University of Nottingham Malaysia Campus, 1
Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Madinah,
Malaysia
Saudi Arabia, 2 Saudi Electronic University, Riyadh, Saudi Arabia
Aureliusz Kosendiak,
Wroclaw Medical University, Poland

*CORRESPONDENCE
Walaa Abdullah Mumena
[email protected] Introduction: Research exploring factors that may influence the diet quality of
RECEIVED 29 March 2024
adolescents in the Middle East are very limited. We aimed to investigate factors
ACCEPTED 12 August 2024 associated with diet quality and the weight status of adolescents in Saudi Arabia.
PUBLISHED 21 August 2024
Methods: A cross-sectional study that included 638 healthy adolescents aged
CITATION
between 11 and 18 years who were randomly recruited from 16 private and public
Mumena WA (2024) Factors associated with
diet quality of adolescents in Saudi Arabia. middle- and high-schools located in two Saudi cities (Jeddah and Madinah). All
Front. Public Health 12:1409105. participants were given an envelope for parents to collect socioeconomic data.
doi: 10.3389/fpubh.2024.1409105 Diet quality and anthropometric data of adolescents were evaluated at school.
COPYRIGHT
Results: Median diet quality score was higher among males compared to female
© 2024 Mumena. This is an open-access
article distributed under the terms of the adolescents (10.00 (8.00–11.00) vs. 9.00 (8.00–10.0), respectively, p = 0.018).
Creative Commons Attribution License Median diet quality score was significantly higher among adolescents residing
(CC BY). The use, distribution or reproduction
in Jeddah compared to adolescents residing in Madinah (10.00 (9.00–11.0) vs.
in other forums is permitted, provided the
original author(s) and the copyright owner(s) 9.00 (8.00–10.0), respectively, p = 0.002). Stepwise linear regression analysis
are credited and that the original publication indicated that city of residence (B = −0.53, SE = 0.16 [95% CI: −0.83 to −0.22]),
in this journal is cited, in accordance with
and child’s sex (B = −0.34, SE = 0.15 [95% CI: −0.64 to −0.05]) were associated
accepted academic practice. No use,
distribution or reproduction is permitted with diet quality scores of adolescents in Saudi Arabia.
which does not comply with these terms.
Discussion: Future longitudinal research should be directed to further investigate
other possible factors influencing the diet quality of adolescents and individuals
from other age groups in Saudi Arabia.

KEYWORDS

diet quality, factors, associations, adolescents, Saudi Arabia

Introduction
Diet quality is an indicator of the variety of the key food groups relative to the dietary guideline
recommendations. It involves the assessment of not only the variety of food but also the quality
of the diet. Diet quality allows the examination of the epidemiological associations between foods
and health (1–3). Diet quality is found to be inversely associated with the risk of several health
outcomes in children, adolescents, and adults (1, 3). For example, diet quality has been linked to
weight status, metabolic syndrome, blood pressure, cognitive performance, and quality of life (3).
Different methods have been used to assess the diet quality of individuals, each of which
use different scoring system that represent both quality and variety of diets. Indicators
mainly fall within one of the three categories: (1) Food/food group indicators; (2) Nutrient-
base indicators; (3) Combined indices (2, 3). The use of scoring system that consider both

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food group and nutrient indicators has become more popular. Data collection
Recently, the Short-Form Food Frequency Questionnaire (SFFFQ)
has been used repeatedly used among healthy and ill One hundred twenty-five envelopes were distributed by a trained
individuals (4–6). data collection team members to students in each school with a total
Several factors may influence the diet quality of young of 2,000 envelopes (Figure 1). Each envelope included a consent form
individuals. Gender inequality has been shown to have an impact on to be signed by the student’s mother in addition to a questionnaire to
various nutrition-related aspects (7, 8). Socioeconomic factors, collect data on sociodemographic/socioeconomic status and height
including maternal education, occupation, and income, have been and weight of mothers. Mothers’ body mass index (BMI) was later
also found to influence the diet quality of adolescents (9, 10). Data calculated and categorized based on the World Health Organization
obtained from a large study conducted among children and (WHO) criteria (underweight, healthy weight, overweight, and
caregivers in Ireland suggest that household socioeconomic factors obesity) (27). The envelopes were distributed to students between
(e.g., maternal education level, household social class, household October and November 2021 in random classes in each school and
income) are important factors that can be associated with the dietary data collection team members collected all returned envelopes within
quality of children (11). Educated mothers are more likely to have a maximum of 1 week from the date of distribution. Dietary data and
healthy food options at home (e.g., fruits and vegetables) (12). anthropometrics of adolescents were then collected at school from
Additionally, it was found that the children of full-time working each student.
mothers had more unhealthy eating behaviors and food choices (13,
14). Family income is also a crucial factor that may affect the diet
quality of young individuals, as it reflects the availability and Assessment of diet quality
accessibility of nutritious food (12, 15, 16).
Negative dietary behaviors such as skipping meals and fast-food Diet quality was evaluated using the SFFFQ, which is a modified
consumption are linked to lower diet quality (17–21). In addition, version of the original tool that was developed by Cleghorn et al. (4).
data among young adults in Saudi Arabia have shown low Two nutritionists with expertise in dietary assessment validated items
consumption of fruits, vegetables, nuts, and fish, while high included in the SFFFQ to ensure the inclusion of all items consumed
consumption of processed foods and sugar-sweetened beverages by adolescents in Saudi Arabia. A hard copy of the SFFFQ was filled
have been reported (22). These unhealthy dietary behaviors are out by each student during the school day; Instructions concerning
common among adolescents in Saudi Arabia and in other the frequency of consumption and serving size were delivered by
populations (17, 18, 23–25). However, limited research has trained data collection personnel. The SFFFQ includes 20 food items
investigated factors associated with diet quality and the weight as follows: (1) “Fruits (tinned/fresh/frozen)”; (2) “Fruit juices (not
status of adolescents in Saudi Arabia. Thus, this study aimed to
explore factors associated with diet quality of adolescents in
Saudi Arabia. Such data are needed to plan effective interventions
that target improving the diet quality of adolescents in Saudi Arabia
and in other similar settings in the Middle East.

Materials and methods

Study population and sampling

For this cross-sectional study, adolescents aged between 11 and

18 years were recruited from 16 schools located in two major cities
in the Western region of Saudi Arabia, Jeddah and Madinah.
Schools were chosen at random from different areas in both cities
(North, South, East, West) which includes middle and high schools,
boys’ and girls’ schools, private and public schools, and schools
located at relatively wealthy neighborhoods and schools from lower
income communities. Exclusion criteria include chronic diseases,
allergies, diet restrictions, and use of medications that may affect
weight status. The minimum sample size needed for this was
estimated to be 235 adolescents based on beta = 0.10, alpha = 0.05
(two sided), mean dietary quality score of 11.4, a detectable
difference of 4% in mean value between male and female
adolescents, and a standard deviation of 1.6 (4, 26). Ethical
certificate for this study was granted from the ethical review board
in the College of Applied Medical Sciences, Taibah University FIGURE 1
(2021/104/201 CLN). Signed consent form was obtained from Flowchart of study sample.
caregivers of all adolescences before collecting the data.

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Mumena 10.3389/fpubh.2024.1409105

including syrup), fruit drink (e.g., Vimto) or powder juice (e.g., distribution was evaluated using the Shapiro–Wilk test. Mann–
Tang)”; (3) “Salad (not including garnish added to sandwiches)”; (4) Whitney U test or Kruskal-Wallis H test were used to compare the
“Cooked vegetables (not including potatoes)”; (5) “Fried potatoes/ median of diet quality score across the different groups. Pairwise
chips”; (6) “Beans or legumes (baked beans, chickpeas, lentils)”; (7) comparison was performed to explore the significance across the
“Fiber-rich breakfast cereal (e.g., Fit-ness)”; (8) “Whole wheat bread different income groups. Bonferroni adjustments were used to correct
(all kinds including rusks)”; (9) “Cheese/yogurt”; (10) “Crisps/savory for multiple testing in the bivariate analysis. Stepwise regression
snacks”; (11) “Sweet biscuits, cookies, cakes, chocolates, and sweets)”; analysis was performed to explore factors (independent variables)
(12) “Ice cream/cream (cooking cream or whipped cream or cream)”; associated with diet quality score (dependent variable) among the
(13) “Soft drinks/pop/iced tea/energy drinks/beer (not sugar free or study participants. All tests were two-tailed with alpha = 0.05.
diet/light)”; (14) “Beef or lamb (steak, mince, cube)”; (15) “Chicken
or turkey (steak, mince, cube) does not include those in batter or with
added breadcrumbs”; (16) “Processed meats/meat product (sausage, Results
bacon, meat samosa, corned beef, meat pies/pastries, meat burgers)”;
(17) “Processed chicken/turkey (chicken nuggets/burgers, chicken Sample characteristics
pies in batter or bread-crumbs)”; (18) “White fish in batter or
breadcrumbs (fish fingers and fried fish)”; (19) “White fish (does not A total of 741 envelopes were returned. Data of 638 adolescents
include fish in batter or breadcrumbs)”; (20) “Oily fish (salmon, were included in this study after excluding 6.48% (n = 48) of the
sardines, fresh tuna-not tinned tuna.” The frequency of consumption adolescents due to missing dietary or anthropometric data, 4.59%
for items 1–13 were: “rarely or never” (coded as 0); “less than once a (n = 34) for food allergy, 2.16% (n = 16) for chronic diseases, 0.40%
week” (coded as 1); “once a week” (coded as 2); “2–3 times a week” (n = 3) of the adolescents were excluded as they were on a diet regimen,
(coded as 3); “4–6 times a week” (coded as 4); “1–2 times a day” and 0.27% (n = 2) of the adolescents were excluded as they were older
(coded as 5); “3–4 times a day” (coded as 6); “≥ 5 a day” (coded as 7). than 18 years. Fifty-three percent (n = 339) of adolescents aged
For items 14–20, the frequencies of consumption were: “rarely or between 15 and 18 years and 52.8% of the adolescents were female
never” (coded as 0); “less than once a week” (coded as 1); “once a (n = 337). Most of the adolescents were Saudis (82.4%, n = 526), and
week” (coded as 2); “2–3 times a week” (coded as 3); “4–6 times a 64.6% of participants (n = 412) were from Madinah. Fifty-six percent
week” (coded as 4); “≥7 times a week” (coded as 5). The excel sheet (n = 359) of adolescents were enrolled in public schools, while 46.1%
provided by Nutritools (https://www.nutritools.org) was used to (n = 294) of adolescents were the middle children. The prevalence of
calculate the total score of diet quality which ranges between 5 and 15. underweight (<5th percentile) among adolescents included in the
study was 9.25% (n = 59), whereas the prevalence of overweight and
obesity (≥85% percentile) was 36.5% (n = 233). About half of the
Assessment of anthropometrics mothers included in this study aged 41–50 years (44.7%, n = 285), and
91.2% (n = 582) were married. Over half of the mothers (53.4%,
After each student handed in the completed SFFFQ, students were n = 310) were experiencing overweight or obesity (≥25 km/m2), and
directed to move to the anthropometric data collection station. The 61.0% (n = 389) reported holding a Bachelor or Postgraduate degree.
data collection personnel measured the height and weight of all Over two-thirds of the mothers (34.6%, n = 221) were employed of
students following a standardized procedure (28). Height was which 55.2% (n = 122) mothers were working 7–8 h per day.
measured in centimeters by a measuring tape that was assembled on Twenty-two percent of the mothers (n = 140) reported family monthly
a flat wall. Students were requested to take off their shoes and look income of < SR 6,000 (see Table 1).
straight forward to assess their height and recoded the number after
rounding it to the nearest 0.5 centimeter. An electronic scale (OMRON
BF508, Japan) was used to assess weight of students in kilograms, and Association between diet quality and
the measurement was rounded to the nearest 0.1 kilogram. characteristics of adolescents
Measurements of height and weight were collected twice and average
for each student was calculated using Excel. Third measurement was Diet quality score reported among the study sample ranged
collected if the height and weight recorded in the first two times have between 5 and 14. Median diet quality score was significantly higher
difference of more than 0.5 centimeter and 0.01 kilogram. Height, among the adolescents residing in Jeddah compared to the adolescents
weight, and date of birth were used to determine the weight status of residing in Madinah (10.00 (9.00–11.0) vs. 9.00 (8.00–10.0),
students using body mass index percentile according to the criteria of respectively, p = 0.002). Additionally, median diet quality score was
the Center for Disease Control and Prevention (CDC) (29). significantly higher among male compared to female adolescents
(10.00 (8.00–11.00) vs. 9.00 (8.00–10.0), respectively, p = 0.018). Diet
quality score was significantly linked to family monthly income but
Statistical analysis results of the pairwise comparison indicated no differences in median
diet quality score across the different family income groups after
Data were analyzed using the Statistical Package for the Social Bonferroni adjustment (p > 0.005 for all tests). The median diet quality
Sciences (SPSS 20, SPSS Inc., Chicago, IL). Data of categorical score was similar among all other characteristics of adolescents and
variables are presented as frequency (percentage), while data of their mothers included in this study (see Table 2).
continuous variables are presented as mean ± standard deviation and Stepwise linear regression analysis indicated that sex city of
median (interquartile range). Normality of the diet quality score residence (B = −0.53, SE = 0.16 [95% CI: −0.83 to −0.22], p = 0.001),

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TABLE 1 Characteristics of the study sample (n = 638). TABLE 1 (Continued)

n % n %
Adolescents ≤High school/Diploma 249 39.0

School level Bachelor degree 324 50.8

Middle school 318 49.8 Postgraduate degree 65 10.2

High-school 320 50.2 Employment status

Age group Unemployed//Retired 417 65.4

11–14 years 299 46.9 Employed 221 34.6

15–18 years 339 53.1 Working hours per day

Sex <4 h 5 0.78

Males 301 47.2 4–6 h 72 11.3

Females 337 52.8 7–8 h 122 19.1

Nationality >8 h 22 3.45

Saudi 526 82.4 N/A 417 65.4

Non-Saudi 112 17.6 Family monthly income in SR 2

City of residence <SR 6,000 140 21.9

Madinah 412 64.6 SR 6,000–10,999 154 24.1

Jeddah 226 35.4 SR 11,000–15,999 120 18.8

School type SR 16,000–20,999 110 17.2

Private 279 43.7 ≥SR 21,000 114 17.9

Public 359 56.3

1
Data concerning weight status for mother were provided by 580 mothers.
2
SR: Saudi Riyal ($1 = SR 3.75).
Order of child among siblings

Older child 177 27.7

Middle child 294 46.1 and child’s sex (B = −0.34, SE = 0.15 [95% CI: −0.64 to −0.05],
p = 0.023) were associated with diet quality scores of adolescents in
Youngest child 154 24.1
Saudi Arabia. School level, age group, nationality, school type, order
Only child 13 2.04 of child among siblings, weight status of adolescents as well as age
Weight status group of mothers, marital status of mothers, weight status of mothers,
Underweight (<5th percentile) 59 9.25 education level of mothers, employment status of mothers, working
hours per day, and family monthly income were not associated with
Healthy weight (5th to <85th percentile) 346 54.2
the diet quality of adolescents (see Table 3).
Overweight (85th to <95th percentile) 102 16.0

Obesity (≥95th percentile) 131 20.5

Mothers Discussion
Age group
This study aimed to investigate factors associated with diet
19–40 years 278 43.6 quality of adolescents in Saudi Arabia. Bivariate analysis shows that
41–50 years 285 44.7 median diet quality score was higher among males compared to
>50 years 75 11.8 female adolescents. Additionally, median diet quality score was
significantly higher among adolescents residing in Jeddah compared
Marital status
to adolescents residing in Madinah. Median diet quality score was
Married 582 91.2
similar across the different family income groups. Stepwise linear
Separated 38 5.96 regression analysis indicated that city of residence and child’s sex
Widow 18 2.82 were associated with diet quality scores of adolescents in
Weight status1
Saudi Arabia.
We found that male adolescents have significantly higher diet
Underweight (<18.5 km/m2) 16 2.76
quality scores compared to female adolescents. This finding was
Healthy weight (18.5–24.9 km/m )2
254 43.8 consistent with previous work conducted among Canadian and
Overweight (25.0–29.9 km/m2) 192 33.1 Brazilian adolescents (20, 30). However, other studies conducted
Obesity (≥30 km/m2) 118 20.3 among adolescents in the UK and Malaysia show significantly higher
diet quality scores among female adolescents compared to males (31,
Education level
32). In fact, this variation in findings could be due to differences in
(Continued) food preference among the studied populations. Studies that

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TABLE 2 Median diet quality score across the different groups (n = 638).

Mean ± SD Median (IQR) p-value

Adolescents
School level

Middle school 9.18 ± 1.78 9.00 (8.00–10.0)

0.201
High-school 9.33 ± 1.68 9.00 (9.00–10.0)

Age group

11–14 years 9.17 ± 1.76 9.00 (8.00–10.0)

0.116
15–18 years 9.33 ± 1.70 9.00 (9.00–11.0)

Sex

Males 9.43 ± 1.73 10.00 (8.00–11.00)

0.0181
Females 9.10 ± 1.71 9.00 (8.00–10.0)

Nationality

Saudi 9.21 ± 1.76 9.00 (8.00–10.0)

0.235
Non-Saudi 9.46 ± 1.54 9.50 (9.00–10.0)

City of residence

Madinah 9.08 ± 1.75 9.00 (8.00–10.0) 0.0021

Jeddah 9.56 ± 1.65 10.00 (9.00–11.0)

School type

Private 9.29 ± 1.77 9.00 (8.00–11.0)

0.795
Public 9.23 ± 1.70 9.00 (8.00–10.0)

Order of child among siblings

Older child 9.45 ± 1.80 10.00 (8.00–11.0)

Middle child 9.13 ± 1.78 9.00 (8.00–10.0)

0.370
Youngest child 9.27 ± 1.55 9.00 (8.00–10.0)

Only child 9.23 ± 1.48 10.00 (7.50–10.0)

Weight status

Underweight (<5th percentile) 9.05 ± 1.80 9.00 (8.00–10.0)

Healthy weight (5th to <85th percentile) 9.21 ± 1.73 9.00 (8.00–10.0)

0.546
Overweight (85th to <95th percentile) 9.35 ± 1.82 9.50 (8.00–11.0)

Obesity (≥95th percentile) 9.38 ± 1.63 9.00 (9.00–10.0)

Mothers
Age group

19–40 years 9.22 ± 1.81 9.00 (8.00–11.0)

41–50 years 9.26 ± 1.70 9.00 (8.00–10.0) 0.888

>50 years 9.33 ± 1.53 9.00 (9.00–11.0)

Marital status

Married 9.23 ± 1.72 9.00 (8.00–10.0)

Separated 9.58 ± 1.70 10.00 (9.00–10.25) 0.286

Widow 9.44 ± 1.98 10.00 (9.00–11.0)

Weight status2

Underweight (BMI <18.5 kg/m2) 9.38 ± 1.67 9.00 (8.25–10.0)

Healthy weight (BMI 18.5 to 24.9 kg/m ) 2

9.26 ± 1.77 9.00 (8.00–10.25)
0.800
Overweight (BMI 25.0 to 29.9 kg/m2) 9.13 ± 1.83 9.00 (8.00–10.00)

Obesity (≥30.0 kg/m2) 9.34 ± 1.58 9.00 (9.00–10.0)

Education level

(Continued)

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TABLE 2 (Continued)

Mean ± SD Median (IQR) p-value

≤High school/Diploma 9.22 ± 1.77 9.00 (8.00–10.0)

Bachelor’s degree 9.18 ± 1.72 9.00 (8.00–10.0) 0.051

Postgraduate degree 9.74 ± 1.59 10.00 (9.00–11.0)

Employment status

Unemployed/Retired 9.27 ± 1.71 9.00 (8.00–10.0)

0.611
Employed 9.22 ± 1.76 9.00 (8.00–10.0)

Working hours per day

<4 h 9.00 ± 1.00 9.00 (8.00–10.0)

4–6 h 9.25 ± 1.79 9.00 (8.00–10.0)

7–8 h 9.16 ± 1.76 9.00 (8.00–10.0) 0.797

>8 h 9.55 ± 1.68 10.00 (9.00–11.0)

N/A 9.27 ± 1.72 9.00 (8.00–10.0)

Family monthly income in SR 3

<SR 6,000 9.41 ± 1.56 10.00 (9.00–10.0)

SR 6,000–10,999 9.01 ± 1.71 9.00 (8.00–10.0)

SR 11,000–15,999 9.03 ± 1.65 9.00 (8.00–10.0) 0.0251

SR 16,000–20,999 9.29 ± 1.93 10.00 (8.00–11.0)

≥SR 21,000 9.58 ± 1.78 10.00 (9.00–11.0)

1
Alpha = 0.05.
2
Data concerning weight status for mothers were provided by 582 participants.
3
SR: Saudi Riyal ($1 = SR 3.75).

TABLE 3 Stepwise regression analysis of association between diet quality and characteristics of the study sample (n = 638).

Variables Beta Standard error 95% confidence p-value R-square

interval
Model 1

City of residence −0.58 0.16 −0.89 to −0.28 <0.0011 0.03

Model 2

City of residence −0.53 0.16 −0.83 to −0.22 0.0011 0.04

Child’s sex −0.34 0.15 −0.64 to −0.05 0.0231

1
Alpha = 0.05.

reported better diet quality among males compared to female likely to stay home, which may lead to higher media use, lower
adolescents also reported higher intake of fats and lower intake of dietary practices, and a lower diet quality compared to
grain products, fruits and vegetables, milk products, and meats male adolescents.
among female adolescents (20), while in Saudi Arabia higher intake Several factors related to the environment may influence the
of fruits was observed among males than female adolescents (33). diet quality of individuals. In this study, the diet quality score was
Additionally, female adolescents are more likely to skip meals significantly higher among adolescents residing in Jeddah compared
compared to male adolescents, where male adolescents reported to adolescents residing in Madinah. Access to food retails, types,
regularity in the consumption of breakfast, lunch, and dinner and prices of food offered in these outlets can affect food choices of
compared to female adolescents (34). Data suggest a link between adolescents (37). It is possible that individuals living in bigger cities,
skipping meals and snacking behaviors, which are also found to such as Jeddah, tend to consume more fruits, vegetables, and
be different between male and female adolescents (35). A study healthy food items as bigger cities have several large food retails in
conducted in 2016 found a high correlation between adolescents and most, if not all, main neighborhoods that offer variety of fresh local
snacking while watch television. This study also found a positive and imported food products throughout the year, whereas
association between snacking and energy intake, consumption of individuals residing in relevantly smaller cities, like Madinah, may
sugar-sweetened beverage, and frequent fast-food intake. Negative have limited access to these type of food retails. In addition, more
association was reported between snacking and fruit and vegetable job opportunities with higher income might be more available in
consumption (36). In Saudi Arabia, female adolescents are more larger cities compared to smaller cities. More research should

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be directed to explore association between diet quality and city of included local food items as examples of the 20 food items presented
residence considering the number of food retails and type and in the original tool. Additionally, the SFFFQ provides total score of
prices of food offered. diet quality and data concerning the score of each component of the
It has been recognized that lower income households are diet is not available.
purchasing less healthful food items, including fruits, vegetables, In conclusion, the diet quality of adolescents was found to
and dairy products, compared with higher income households (38, be linked to city of residence and child’s sex. Nutrition education
39). Thus, young individuals living in lower income households programs targeting female adolescents and adolescents residing
tend to consume diets that are of lower quality (11, 40). However, in smaller cities are needed to improve the diet quality of
our findings indicate similar median diet quality score across the adolescents. By better understanding how sex and setting affect
different family income groups. Generally, the population of the quality of diets, effective interventions can be designed to
Saudi Arabia, including young adults, are consuming diets that are improve the diet quality of adolescents in Saudi Arabia specifically
low in nutritious food items including nuts, fruits, vegetables, fish, and more generally in the Middle East. Future longitudinal
and high quantitates of sugary drinks and processed meats, which research should be directed to further investigate other possible
indicate limited quality of diet (22). Inconsistent findings reported factors influencing the diet quality of adolescents and individuals
in this study can be explained by the low variation in diet quality from other age groups in order to design effective interventions
among adolescents included in this study. Additionally, a number that aim to improve the quality of diets among the population of
of factors can influence the quality of diet of low-income individuals Saudi Arabia.
including knowledge related coping strategies and availability of
assistant programs for low-income families (39, 41–43). Several
assistant programs are offered to low-income families and Data availability statement
individuals in Saudi Arabia, including the financial support
provided via the Human Resources Development Fund, citizen The raw data supporting the conclusions of this article will
account, Ehsan, charities, and Food Preservation Societies (Hefz Al be made available by the authors, without undue reservation.
Nema) and many other formal and informal forms of support (41–
43). These assistant programs could help in improving the quality
of diet of low-income families. Improving the income of families Ethics statement
with children is important; however, educating mothers on how to
improve the diet quality of children and how to cope with food The studies involving humans were approved by the ethical review
insecurity is more important to achieve optimal nutritional health board in the College of Applied Medical Sciences, Taibah University.
on the long-term (44). The studies were conducted in accordance with the local legislation
It is important to conduct interventions that focuses on improving and institutional requirements. Written informed consent for
the quality of diet from a young age in order to enhance the overall participation in this study was provided by the participants’ legal
health status of individuals. A review published in 2023 reported guardians/next of kin.
differences in motivational factors influencing food habits among
male and female adolescents. Female adolescents were found to
be more externally motivated (e.g., change dietary habits to lose Author contributions
weight to fit traditional norms), whereas male adolescents were found
to be more internally motivated (e.g., eat for enjoyment). Thus, using WM: Conceptualization, Data curation, Formal analysis,
sex-specific motivation approaches to improve food habits of Investigation, Methodology, Project administration, Resources,
adolescents can result in more effective interventions (45). Despite the Software, Supervision, Validation, Visualization, Writing – original
significantly higher diet quality score reported in male adolescents draft, Writing – review & editing.
compared to female adolescents included in our study (10.00 vs. 9.00,
respectively), the diet quality score is considered limited for both sexes
(maximum diet quality score is 15), which indicates the need for Funding
tailored intervention that aims to improve the diet quality of
adolescents in Saudi Arabia. The author(s) declare that no financial support was received for
To our knowledge, this is the first study to investigate factors the research, authorship, and/or publication of this article.
associated with the diet quality among adolescents in Saudi Arabia
and in the Middle East. In addition, recruitment in this study was
performed randomly, which increases the generalizability of Acknowledgments
findings. However, the study is limited by its design, as causal
relationship cannot be determined from cross-sectional studies. In This work was conducted using the Short Form FFQ tool
addition, findings of this study might be limited to adolescents developed by Cleghorn as reported in https://doi.org/10.1017/
residing in main cities in the Western region of Saudi Arabia and S1368980016001099 and listed in the Nutritools (www.nutritools.org)
results could be different in other regions in Saudi Arabia. The library. We thank Amal Alhejaili, Fai Al-Mutairi, Jenan Mahabbat,
SFFFQ used was developed and validated among population of the Seba Lamfoon, Shahad Al-mughathawi, Yara Sadeq, and Yousor
UK; however, the modified version of the tool used in this study Qarani for their collaboration during data collection.

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Mumena 10.3389/fpubh.2024.1409105

Conflict of interest organizations, or those of the publisher, the editors and the
reviewers. Any product that may be evaluated in this article, or
The author declares that the research was conducted in the claim that may be made by its manufacturer, is not guaranteed or
absence of any commercial or financial relationships that could endorsed by the publisher.
be construed as a potential conflict of interest.

Supplementary material
Publisher’s note
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All claims expressed in this article are solely those of the authors at: https://www.frontiersin.org/articles/10.3389/fpubh.2024.1409105/
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