This article reports food consumption habits in young people attending universities in four countries. University students are usually better educated and younger than a population-based sample, and comprise a suitable sample for examining food consumption habits, as the variability of ill health and education is minimal.
Regarding the first aim of the study, students’ nutrition showed some unfavourable practices across all studied sites. E.g. less than 50% of students reported frequent consumption of fruits. High consumption of foods that are “away” from the Mediterranean diet [where standard dessert is fresh fruit with sweets consumed only on special occasions ] was significantly associated with 10-year coronary risk of >10% for 40% of adults . Other studies among students confirmed a low intake of fruits and vegetables [29–31]. However, students’ food consumption patterns differed also across the sites. For instance, Bulgarian female and male students reported most often a frequent consumption of sweets and cakes. Bulgarian students also had highest frequencies of snacks, including chips (40%), and fast food (52%). This could indicate a need for specific public health action at this site.
Women’s food consumption differed significantly from men’s. For snacks, across all 4 countries, men had reported more often a frequent consumption of snacks than women, supporting similar findings from France that male university students had a higher mean number of daily snacks than women . For fruits, Lee  found that female students had better nutritional habits than men (were more likely to report eating fruit/vegetables), providing support that women behaved ‘healthier’ than men in terms of fruit consumption . Earlier reports also found that female university students ate more fruits than males . However a point is that although females might consume more fruits than men, such consumption levels could still fall short of recommended daily recommendations . We are in agreement with these authors, where across our sample, women exhibited more fruit, salads and vegetable consumption than men. Regardless of country, more males regularly consumed meat than females, in agreement with Turkish males who reported significantly more meat serving per day compared to female adolescents . Our findings also support results of Swedish university students where females had healthier habits related to nutrition .
Regarding the second aim of the study, across the four countries, 59% to 91% of students were not living at home with their parents during their studies, similar to France where at least 65% of university students lived away from the family home during the week . Our findings suggested that students living at home with their parents consumed more fruits and cooked/raw vegetables than those who resided outside of their family home. This parallels Papadaki’s  conclusions that students living away from the family home decreased their weekly consumption of fresh fruit and cooked/raw vegetables. This might suggest parents’ potential influence on their children’s diets, in agreement with studies which found associations between intakes of parents and their adolescent children for fruit, vegetables and dairy foods [35, 36]. Indeed parents can possibly inspire their children’s food intake positively through role modeling and the food environment they provide at home [37, 38]. Furthermore, home accessibility to fruits and vegetables was found to increase preference for these foods in a 6-month follow-up study .
Students living away from the family home might develop more unfavourable eating habits than those living at the family home. This might be due to the fact that those living at home do not have to pay for food and therefore do not suffer from financial limitations in this respect. In addition, meals containing vegetables and other healthy food items might be prepared for them and thus more healthy food is available to them. As college students leave home and adjust to independent living, good dietary habits decline . The living situation is further compounded, where studies have reported that students living on campus reported significantly less frequent food preparation . Frequency of preparing food was related to more healthful food choices in terms of lower intakes of fat and fried foods and higher intakes of fruits and vegetables . These factors affect students when they move to a different city within their own country , or translocate to attend university in countries other than their own with new eating patterns and food choices in their new environment [9, 44]. This might be particularly relevant for the consumption of fast foods. In our sample, living away from parental home was not associated with higher consumption of fast food, snacks or sweets. Fast foods consumption, a frequently used indicator of unhealthy eating , might mirror the degree of the shift away from traditional cooking towards meals that are made outside the home . Indeed the consumption of nutritious foods (e.g. fruit, vegetables) is inversely related to the frequency of visits to fast food outlets [47, 48]. Although we found a lower consumption in healthy food items like fruits and vegetable in students who have moved out from parental home this was not accompanied by a significant increase in fast food, snacks or sweet consumption in our samples.
Our study has several limitations. Data were self-reported (no validation undertaken) and cross-sectional (does not infer causal relationships). Food consumption was estimated with 9 food frequency questions. Although similar (or shorter) questionnaires have been alleged to underestimate fruit and vegetable or high-fat foods intake when compared to multiple 24-hour dietary recalls , for fruit and vegetable, they produced estimates similar to those produced by other brief food frequency surveys . We did not undertake formal tests of validity on the questionnaire but it was very similar to other food frequency questionnaires: e.g. Osler & Heitmann’s  for which validity was demonstrated that it correctly quantified food intakes when compared with diet history interview; and to Roddam et al’s  who reported that the short food group questionnaire functioned reasonably well for the assessment of dietary nutrients. In Bulgaria, the frequency of consumption for all studied food items was higher than in other countries, suggesting a specific tendency of responses. While the translation very strongly focussed on the equivalence of meaning, there are some cultural aspects of translation which cannot be overcome. Possibly this was here the case, but we were not able to assess this issue formally. Another limitation is that we were not able to further differentiate living conditions with respect to opportunities for food preparation. Residence halls are not common in the studied countries, but still the conditions for food preparation can differ across different living arrangements. In fact, we were only able to make a meaningful separation between those living at parental home and those not, while we were not able to compare different living arrangements among those not living at home. We did not assess whether the students were eating at the university’s refectories or were preparing their own food. We also did not assess if differences between those living at parental home or not were possibly resulting from pre-existing choices in food consumption rather than introduced by change in living arrangements. Furthermore, we examined only one university per country, differences between countries could be in fact just differences between particular universities. Theoretically, students with particular nutrition patterns could be also more prone to choose universities which require that they leave parental home.