1

The National Ribat University

Faculty of Graduate Studies and Scientific Research

Assessment of Knowledge, Attitude and Practices (KAP) of Medical

Student Regarding the use of Carbonated Drinks at The National Ribat

University 2016

A Thesis Submitted in Partial Fulfillment of the Requirements of the

master Degree in Human Nutrition and Dietetics

By: Razan Abdul Monem Mohamed Ali

Supervised by: Dr. Mofida Yousif Elkhalifa

January 2017

II

ــةاآلي

ٹ ٹ

ڃ ڃ ڃ چ چ ى ى ىې ې ې ېۋ ۋ ۅ ۅ ۉ ۉ ٴۇۇ ۇ ۆ ۆ ۈ ۈچ

ى ى ىى ى ى ى ى ى ى ى ى ى ى ىى

ى ى ى ى ى ىى ى ى ى ى ىىی ی ي ی ى

چ ى ى

صدق هللا العظيم

٢٨٦سورةالبقرة:

DEDICATION

Every challenging work needs self-efforts as well as guidance of elders especially

those who were very close to our heart.

My humble effort I dedicate to my sweet and loving

Mother& Father, Whose affection, love, encouragement and prays of days and night

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make me able to get such success and honor.

My Mother

A strong and gentle soul who taught me to trust in Allah, believe in hard work and

that so much could be done with little.

My Father

For earning an honest living for us and for supporting and encouraging me to believe

in myself.

My Brothers:

For thinking of me and for always walking beside me for each day and night.

My Friends

For being who you are and for helping me be me and for making me smile always.

ACKNOWLEDGMENTS

In The Name of Allah, the Most Gracious, the Most Merciful

Foremost, I would like to express my special appreciation and thanks to my

advisor Dr.Mofida Yousif Al-Khalifa

Have been a tremendous

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Mentor for me. I would like to thank her for her patience, motivation,

enthusiasm, and

Immense knowledge.Her guidance helped me in my research, allowing me to

grow as a research scientist. her advice on both research as well as on

my career have been

Priceless. Her influence on my life will continue through my entire life, as

one of my role models.

ABSTRACT

Excess consumption of carbonated drink has been associated with many

adverse health effects.

This research conduct to assess the knowledge, attitudes and practices of students

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regarding carbonated drinks, a cross sectional study was conducted at National Ribat

University – Faculty of Medicine. A total of 300 students were selected randomly

and included in the study. Self-structured pretested questionnaire was used for

collection of data. Out of all students, 77% of the students reported that they had

started taking carbonated drinks when they were less than 16 years of age. Most of

the medical students thought that carbonated drinks are associated with ill effects

that included: osteoporosis (50%), and obesity (30%). Up to (30%) among these

students were not aware of the ill-effects of carbonated drinks.

Finally, to encounter the problems which are caused by consumption of

carbonated drinks, focus on various aspects of primary prevention like Health

education has to be done.

البحث ملخص

لتقییم أجري هذا البحث ارتبط االستهالك الزائد من المشروبات الغازية بالعديد من اآلثار السلبیة على الصحة.

جامعة كلیة الطب سلوك وممارسة الطالب بخصوص المشروبات الغازية، أجريت دراسة مقطعیة فيومعرفة

طالب تم اختیارهم بشكل عشوائي. تم جمع البیانات عن طريق استبیان 300 مل هذا البحث الرباط الوطني . ش

. يعتقد معظم ةسن 16لغازية قبل عمر تناول المشروبات ا بدءوا% من الطالب 77 موجه يمأل بواسطة الطالب.

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%( 30%( ، والسمنة )50: هشاشة العظام ) بأضرار صحیة منهاالمشروبات الغازية مرتبطة إنطالب الطب

غیر مضرة بالصحة . المشروبات الغازية بأن %( من الطالب30) يعتقد . بینما

والرعاية الصحیة األولیة التركیز على الوقاية و المشروبات الغازيةلتناول المصاحبة اإلشكالیات،تحديد ختاما

التثقیف الصحي .و

TABLE OF CONTENTS

List of content Page

I إستهالل

Dedication II

VII

Acknowledgment III

Abstract in English IV

Abstract in Arabic )الملخص( V

List of Contents VI

List of Tables VIII

List of Abbreviations X

Carbonated Drinks Definition xi

CHAPTER ONE

Introduction

Introduction 1

1-1-Backgranoud 1

1-2- Problem Statement 2

1-3-Justification

1-4-objectives 2

A-general objective 2

B-specific objectives 2

CHAPTER TWO

Literature Review

2.1.Carbonated Drinks Ingredients 3

2.2.TheMain Types 4

2.3. Nutritional Value 4

VIII

2.4. Carbonated Drink Damage on The Body 5

2.5. Carbonated Drink Risks 10

CHAPTER THREE

Methodology

3.1. Study Design 15

3.2. Study Population 15

3.3. Sample Method 15

3.4. Sample Size 15

3.5. Study Duration 15

3.6. Study Tools 15

3.7. Statistical Analysis 16

3.8. Ethical Consideration 16

CHAPTERFOUR

Result, discussion, Conclusion & Recommendation

4.1.Result 17

4.2. Discussion 30

4.3. Conclusion 33

4.4. Recommendation 34

4.5. References 35

LIST OF TABLES

Table No Title Page No

Table(1) Gender Distribution of Study Population 17

Table(2) Recurring Age Distribution of Study Population 17

Table(3) Class Level of Study Population 18

Table(4) Distribution of Study Population By Family Income 18

Table(5) Mother Education of Study Population 18

IX

Table(6) Father Education of Study Population 19

Table(7) Student Expenditure Per Day 19

Table(8) Daily Financial Family Supported Distribution of Study

population

19

Table(9) Place of Residence of Study Population 20

Table(10) Way of Transportation of Study Population 20

Table(11) Disease Conditions among Distribution of Study Population 20

Table(12) Student Knowledge of Carbonated Drinks 21

Table(13) Knowledge of Components of Carbonated Drinks among Study

Population

21

Table(14) Student Knowledge of Calories Contents of Carbonated Drinks

(500ml) 21

Table(15) Student Knowledge about the Ill Effects of Carbonated Drinks 22

Table(16) Student Knowledge about the Ill Effects Associated with

Carbonated Drinks 22

Table(17) Student Knowledge about the Prolonged Effect of Consumption

and Health 22

Table(18) Student Knowledge about Using Pepsi for digestion of Foods 23

Table(19) Student Knowledge about Using Seven Up for relieving

abdominal pain 23

Table(20) Student Knowledge about Bread and Pepsi Calories 23

Table(21) Student Feeling Regarding Drink Pepsi carbonated Drink 24

Table(22) Student Feeling Regarding Others People When They Are

Drinks Pepsi 24

Table(23) Preferring of student Regarding Soft Drinks 25

Table(24) Students age when they are starting taking Carbonated Drinks

(Years) 25

Table(25) Consumption of Carbonated Drinks Per Litter 26

Table(26) Student Consumption of Carbonated Drink Per Day 27

Table(27) Preferable Consumed Carbonated Drinks 27

Table(28) Reason behind Consuming Carbonated Drinks 28

Table(29) Students Daily Coffee Consumption 28

Table(30) Sleep Disturbance at Night 28

Table(31) BMI 29

Table(32) Height 29

X

LIST OF ABBREVITIONS

NRU: National Ribat University

KAP: Knowledge, Attitude and Practices.

SPSS: Statistical Package for the Social Sciences.

BMI: Body Mass Index.

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HTN: Hypertension (HTN or HT), also known as high blood pressure (HBP).

DM: Diabetes mellitus.

SDG: Sudanese pound.

XII

The term Carbonated Drinks in this report refers to

carbonated beverages. If no adjective is used, then the term

refers to regular or sugar-sweetened carbonated drinks’. In

Sudan, the sugar added is sucrose.

However, some of the literature uses the term

carbonated drinks rinks to include artificially sweetened or

diet carbonated beverages. Where this is the case, we have

clarified meaning in the surrounding text. Other

terminology includes sugary drinks or sugar-containing

drinks — terms which encompass carbonated sugar-

sweetened carbonated drinks as well as fruit juices, fruit

drinks, cordials, sports drinks, energy drinks and iced teas.

Throughout this report, amounts of soft drinks are

expressed in milliliters (1mL = approximately 1 gram)

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Chapter One

Introduction

1.1. Background:

The soft drinks have been consumed since hundred years, but many

of their deleterious health effects have not been well studied or known.

There is a growing concern about the harmful effects associated with

carbonated soft drinks.Many academic studies have shown that there is

nothing healthy about carbonated drinks or soda. The term soft drink refers

to non-alcoholic water based flavoring agents that are optionally

sweetenedcoloring compounds, acidifiers, preservatives, caffeine might be

added. Carbonated drinks may contain fruit juice or pulp, salts; and their

flavor may be derived from vegetable extracts or other aromatic

substances. Carbonated drinks was invented in the 18th century and widely

used in recent decades.

The increasing consumption of carbonated drinks and carbonated water all

over the world and in market, as well as the growing diversity of carbonated drinks,

show the importance of evaluating the overall impact of carbonated drinks to

consumers’ health. When one consumes carbonated beverages instead of milk, juice

and water, body will not get some of the nourishment as per the needs.

Most people view soft drink consumption as fairly innocuous and its consumption

is not as harmless as generally believed; however, there are a number of serious

health issues associated with regular consumption of soft drinks .Scientific studies

have shown how as few as one or two soft drinks per day can increase one’s risk for

numerous health problems such as obesity, tooth decay, osteoporosis, heart disease,

diabetes, many neurological disorders and nutritional deficiencies.

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1.2. Problem Statement:

Althoughmultiplestudieshavebeen carried out globally relatedto soft

drinkconsumption, researchonthisbehalfinSudanseriouslylacking

.Anexhaustiveevaluation of the issue is fundamental to disentangle the more

profound complexities of the issue. At exactly that point, can any intercessions be

relied upon to fruitful this study undertaken in order to determine the level of soft

drink consumption and the level of knowledge about health impact of drink of soft

drinks among the medical students of (NRU).

1.3. Justification:

To suggest satiable recommendation for the health permeation andraising the

awareness of the sugar content of various carbonated drinks and potential health

problem associated with their consumption was considered important for achieving

better health for all individuals.

1.4. Objectives:

a. General Objectives:

To asses Knowledge, Attitude and Practices (KAP) regarding

Carbonated Drinks of faculty Medical students in National Ribat University.

b. Specific Objectives:

(1) To identify the Knowledge of Medical students regarding carbonated drinks.

(2) To identify the attitudes of students towards consumption of carbonated

drinks.

(3) To determine the practices of students regarding consumption of carbonated

drinks.

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Chapter Two

Literature Review

2.1. Carbonated Drinks Ingredients:

Water constitutes about 85% of the carbonated drinks. Sugar, and it is one

of the most important carbonated drinks components because it gives them

the desired taste, can add sucrose by two methods, the first in the form of a

concentrated solution, and the second through a solid condition. Usually a

percentage of sugar in carbonated drinks about 8% - 13%, Acids, many types

of acids are added in the preparation of carbonated drinks, among them

phosphoric acid, citric acid, tartaric acid. Smell and taste materials, uses many

of the characteristic taste of material to give a carbonated drink taste

distinctive, and different bait materials from drink to drink, and the reason that

each drink contains a taste of a particular feature, and there are several types

of bait, among them natural materials such as citrus peel, or fruit pulp, or by

using the full fruits taking care to remove the seeds, and industrial materials

are very similar to the taste of natural fruit extent, but the price is inexpensive

compared to natural flavors, as well as mixtures of natural blends industrial

mixtures gathered, used in the preparation of several types of carbonated

drinks. Color materials, which are used to impart color to carbonated drinks,

caramel and is widely used in the coloring, and must ensure that the materials

used does not affect the taste and smell drinks, in addition to the non-use of

harmful chemicals. Carbon dioxide, and is one of the most important materials

used in carbonated drinks, is named carbonated drinks that name because they

contain a large proportion of carbon dioxide, and is second compressed carbon

dioxide pumped into the final carbonated drink after cool completely on the

temperature of 1-2 degrees Selicizah by devices called carbonation devices,

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and there are several reasons to add carbon dioxide to carbonated drinks. The

reason that it gives a taste distinctive drink, it also prevents mold in carbonated

drinks, as well as it increases the acidity that prevent microorganisms from

growing. Caffeine, Which is made from kola nut material that gives a

distinctive flavor for carbonated drinks, caffeine and vary the proportion of

drink to another.(Mansho, 2006)

2.2. The Main Types:

One canister containing the equivalent of 10 teaspoons of sugar sufficient

to destroy vitamin B deficiency, which leads to poor digestion and poor

infrastructure nervousness, headaches, insomnia, depression, muscle spasms and

disorders. Carbonated drinks also vary depending on the flavor added to the

original components which is a drink, sugar, preservatives and gases, and these

flavors are

A. It Cola flavor additives for Pepsi and Coca-Cola.

B. Lemon and add to the ships in Seven Up and Sprit.

C. Orange and add to Miranda and Fanta.(Warner, 2007)

2.3. Nutritional Value:

All carbonated drinks are of low nutritional value, contains no protein or

fat, or vitamins and minerals, but is a means of containing large amounts of empty

sugars (i.e. non-nutritional value).A very small amount of salt, As for the

carbonated drinks for diabetes and diet (diet), similar to regular drinks is the

sugar substitute aspartame compound is a two welding aspartic acid and vinyl,

which generate the sweet taste when their union. This compound is not fit for a

class of people (who suffer from the disease vinyl ketene urea).(Mansho, 2006)

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2.4. Carbonated Drink Damage on The Body:

2.4.1. Drought:

Water constitutes about 60% of body weight. According to the Mayo

Clinic reports that the drink is lost in different shapes and images, including

sweat, urination, breathing, so that the body continues to work properly, as it

should compensate the amount of fluids that are lost constantly. Some may

resort to other alternatives solutions such as drink and other wet liquids,

carbonated drink. But many of the carbonated drinks contain a high content

of caffeine which acts as a diuretic, and leads to increased urination and rid

the body of existing inside the fluid and the absence of the amount of fluid in

order to lead the body and its functions properly and healthy. In addition, some

Diet carbonated drinks contain a high content of sodium, which is based,

according to the drink from the cells and enhances the drought. (Warner, 2007)

2.4.2. High sugar content:

Many carbonated drinks contain large amounts of sugar. For example,

the, about 12 ounces of carbonated drinks contain 39 grams, the equivalent of

about 3.3 tablespoons sugar and consumption of these large quantities of sugar

leads to raise the sugar levels in the blood and increases the risk of heart

disease and blood vessels. In addition, many carbonated drinks containing

high fructose corn syrup and sugar longer is the primary ingredient. And thus

lead to damage to the pancreas and fluctuating blood sugar levels. It can when

the consumption of sugary carbonated drinks regularly, lead to diabetes type

II. (Patel, 2016)

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2.4.3. Overweight:

Studies have shown that weight gain caused by the consumption of too

many calories and not burning the body. About 12 ounces of carbonated

drinks contain 140 calories, often called "empty calories because they do not

provide the body with no nutritional value. When you drink one can of cola a

day for four weeks, the equivalent of taking nearly 3920 calories and increase

one kilo in weight in the absence of the ability to burn calories. And when you

walk on the feet for 27 minutes about 3.5 miles per hour can burn calories in

one can of cola. According to report in May Kellnek about calories analysis

that if you do not burn calories, leads to an increase of 12 kg per year. In

addition, the carbonated drinks sweet disrupt signals of appetite and increased

cravings for sugary foods. (MaichlXorafe, 2005)

2.4.4. Obesity:

Obesity is a serious public health problem world over, which is

associated with high mortality and a major risk factor for cardiovascular

diseases, diabetes mellitus, osteoarthritis and cancers.Changes in lifestyle,

dietary habits, physical activity, and the socio cultural environment play an

important role in obesity.Changes in socioeconomic status have had a

significant effect on physical activity with the availability of easy transport,

the increase in electrical home appliances and more involvement in office

work, long periods in watching television and using the internet. (Kishore, 2009)

Now days, schools of affluent societies generally provide mostly fast

foods and beverages which are dense in calories. Children who eat fast food,

compared with those who do not, consume more total energy (calories), more

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energy per gram of food, more total fat, more total carbohydrate, more added

sugar, more sugar sweetened beverages, less fiber, more milk and few fruits

and non-starchy vegetable, are vulnerable to develop obesity problem.Obesity

and associated diabetes rates are rising worldwide.1-3 More than 1.5 billion

people worldwide are now overweight, and at least1in 20 adults now have

diabetes.2,3 Globally, obesity has doubled since1980, such that most of the

world’s population now lives in countries where there are more deaths

attributable to being overweight than to being underweight.(Patel, 2016)

2.4.5. Osteoporosis:

Calcium from the base metals, which helps you get the teeth and bones

strong and consumption of high amounts of phosphoric acid, one of the

common elements in the carbonated drinks could lead to the absorption of

calcium from the body .lead to cases of osteoporosis and weak bones,

especially in women.

Osteoporosis is a systematic metabolic disease resulting in low bone

mass, and deteriorates of bone structure, which increases the risk of fracture

called “silent killer.(Oloyede, EO, 2009)

The impact of carbonateddrinks on calcium absorption showed that

consumption of carbonated drinks with food negatively affect the calcium from the

intestinal absorption due to the presence of phosphoric and citric acid who unite with

the calcium content in food in one man, and this can cause a decrease in the amount

of calcium that link to blood and thus to the bones, it is known the importance of

calcium in building bone and growth, especially in childhood and adolescence age,

or later age of forty when they start osteoporosis problems.(Doglas, 2003)

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2.4.6. Heart disease:

Excessive weight gain to increase the operating risk of heart disease,

due to the ingredients found in soda drink. The Dr. Mary said that

McLaughlin, medical director of the Center for American heart health that the

sodium and caffeine in soda drink with dangers on the heart. That so health

because sodium leads to fluid retention, caffeine works to increase heart rate

and blood pressure. As stated in the analysis it was published in 2012 that

more than 42,000 men ate a single package of sugary carbonated drinks every

day. They had an increased risk of heart attack, compared with those who did

not take carbonated drinks at all.(Yancy CW, et al. 2013).

2.4.7. Diabetes:

Most individuals may find it difficult when you eat one cookie a day

for fear of sugar addiction. If you're dealing with carbonated drinks, you will

suffer from high blood sugar and the body's inability to produce insulin. High

blood sugar make you are looking for more material sugar and soda to

compensate. With the passage of time to become the body's resistance to

insulin is weak and is unable to metabolize sugar, resulting diabetes. Oivkr

doctor or disseminating that India dealt with 1:59 carbonated drinks a day

increases the risk of diabetes 2 by 26%, according to a report published in the

in 2010 in the Journal of diabetes care.(Warner, 2007)

2.4.8. Dental problems:

The Children prefer cola to milk and fruit juice. The excess

consumption on of these carbonated beverages is playing havoc in teenage

population on as it contains no essential al nutrients and harms their general

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and oral health. If you prefer not to go to the dentist, try to limit the

consumption of carbonated drinks. This is because the bacteria found in the

mouth grow with sugar and feed it. And lead to the production of acids that

damage tooth enamel and leads to tooth decay. (Attin, 2004)

2.4.9. Gout:

Gout is a medical condition afflicting the body of increased uric acid,

which leads to swelling and inflammation of the joints. According to data

published in 2012 in the Journal of the American Medical that there was a

study done on about 80,000 women for 22 years caused eat one package a day

from cola to a significant increase in the risk of developing gout when

compared with those who rarely drank sugary drinks.(Roubenoff R. 2008)

2.4.10. Cause headaches:

Drink carbonated drinks may increase the risk of a headache because

of the artificial sweeteners because aspartame cause headaches and still

unknown effects on the body. The most patients who complain of migraines

may be to see that they consume carbonated drinks regularly.(Malik-

Kotru,G2004).

2.4.11. Bulge:

Carbonated drink can cause air bubbles in the stomach and cause

accumulation of air, can lead to loudly and sometimes cannot control it. Leads

to the accumulation of air bloated abdomen. In the case of carbonated drink

intake will constantly suffer from chronic bloating. The pain may lead resulting

from the Bulge.(R., Grasso, R., 2002)

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2.5. Carbonated Drink Risks:

The danger of taking carbonated drinks is the low nutritional value of not

contain protein or fat, or vitamins and minerals, but it is a liquid containing large

amounts of free nutritional value sugars. Warning that carbonated drinks have

spread dramatically because of several key factors, in which the ad is playing a

major role in promoting this .As that carbonated drinks began to replace milk and

natural juices which represents a threat to the extent of damage to persons as a

result of drink such beverages, particularly young people category, also note that

all the meals eaten by children not devoid of carbonated drinks.(Doglas, 2003)

2.5.1. Iron Absorption:

The effect of carbonated drinks on the absorption of iron containing

carbonated drinks caffeine that negatively affect the absorption of iron,

thereby causing anemia, which is one of the health problems among children,

adolescents and cause them years vulnerable to health and the lack of activity

and lack of appetite. Caffeine also leads to increased heart rate and high blood

pressure and increase the acidity in stomach and increase the hormones in the

blood, which may cause inflammation and ulceration of the stomach, is also

working to weaken the pressure valve lower esophagus, which in turn leads

to reflux of food and acid from inside the stomach into the esophagus, causing

pain and inflammation.(Bukhari H, 2014)

2.5.2. Digestion:

For the argument that the carbonated drinks and help digestion made it

clear that it is erroneous beliefs are widespread among people that carbonated

beverages help digestion and this is not true, and can be explained by the

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feeling that he feels his mustache and gases that leads them out after drinking

because of the gases contained in the drink itself and not as a result of the

digestion of food in your stomach, and carbonated drinks cause indigestion

because they contain a substance bicarbonate which is an alkaline substance,

so if you have been taken after meals cause reduced stomach acid, which plays

an important role in the process of digestion, as the carbonated drinks affect

the center of stomach acid as it interacts with all its sodium bicarbonate with

stomach acid, is produced by the reaction gases stomach opens doors to

forcibly push the food into the intestines before completing digest.(Mohamed, 2009)

2.5.3. Second gas and carbon dioxide

The containof carbon dioxide, which leads to the stomach of important

yeasts salivary deprived in the process of digestion gas and that when ingested

with food or after and lead to a reduction of the role of digestive enzymes

secreted by the stomach and thus impede the process of digestion and reduce

the advantage of the food.(Nelson, 2011)

2.5.4. Acidity rate:

The rate of acidity in carbonated drinks: for example, Pepsi-Cola or Coca-

Cola has a pH rate is 3.4 i.e. it is very acidic. PH by this strong can dissolve teeth

and bones! The human body stops building bone remodeling at the age of thirty.

After this age, depending on the amount of acidity in the food so that they affect

the overall functions and lead to be stones in them. (The proportions of these acids

are not dependent on the taste of our food, but depend on the proportion of each of

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potassium, chlorine, manganese, and others to salts of phosphorous).Curzon,M.E.J.

(2004).

2.5.5. Protection

The best solution is to stay away from carbonated beverages and replace them

with natural juices, fresh fruit, and that had to be used, there are some tips for people

addicted to drink, namely:

Avoid carbonated drinks with food so as to prevent a bad influence on important

minerals such as calcium and iron absorption.

If you would like very much to drink, you can drink a glass at the most a week does

not harm you staying away from it completely.(Maichl, 2009)

2.5.6. Previous studies

A study by (Hattersley-2009), aiming at exploring the knowledge,

attitudes and behaviors regarding caloric soft drinks in a group of young

adults attending university and to identify opportunities for a health

promotion intervention aimed at reducing consumption. This study was

carried out in Sydney, Australia. They found that the social and

environmental cues, intrinsic qualities of beverages and personal health

beliefs were identified as important influences on consumption. Social cues

included settings in which drinks are usually consumed, socializing with

friends, and family influences. Environmental cues included purchasing of

fast foods, and ready availability, preferential pricing and promotion of

caloric beverages. Reinforcing intrinsic qualities of caloric soft drinks

included taste, sugar and caffeine content, and their association with treats

and rewards. Major gender differences as well as variations in individual

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readiness for behavior change were observed. Raising awareness of the

sugar content of various beverages and the potential health impacts

associated with their consumption was considered important.

Another study of carried out by (ElSawy-2014), about the relationship

between carbonated drinks and osteoporosis. They reported that in several

observational studies, intake of carbonated drink was associated with reduced

bone mass, decreased calcium level in the blood, and increased fracture risk.

Carbonated drinks consumption has exploded over the past three decades,

demonstrating a per capita availability increase from 22 gallons to 52 gallons. In

the USA, carbonated soft drinks and milk are the two most popular non-alcoholic

beverages, accounting for 39.1% of total beverage consumption.

A recent study in Saudi Arabia in 5033 boys and 4400 girls aged

10 to 19 years on dietary intake and obesity showed that Sugar sweetened

carbonated drink consumption varied from 5.93 to 9.04 servings a week by age,

and was significantly higher than consumption of non-caloric sweetened "Diet"

carbonated drink, which varied between 0.92 and 1.52 servings per week. Thus,

obesity combined with poor dietary habits can increase osteoporosis”.

A study carried out by (Tahmassebi-2004) in the USA showed a positive

relationship between cumulative caries scores and the frequency of mealtime and

between-meal use of carbonated beverages. However, the strength of this

conclusion was weakened by the use of only a one-day diet analysis to represent

the foods and drinks used over the period of up to 20 years during which the

observed caries developed”.

Another study by (Kharde-2013) found that the consumption of high sugar contained

carbonated drinks is more prevalent among youngsters. The excess consumption of

carbonated drink has been associated with many adverse health effects.

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Thus, out of all students 52 (48%) reported that they had started to drink carbonated drink

at the age less than 10 years. The majority of students consider obesity (28.2%) as side

effect associated with consumption of carbonated drink followed by bone decay (11%)

and dental caries (9%). They concluded that the health education and primordial

prevention would be the best way to adopt healthy life style and combat the problems

associated with the consumption of carbonated drinks.

A study by (Kishore -2009) investigating the knowledge, attitude and

practices of students regarding carbonated drinks,the study subjects comprised of

medical and nursing students at HIMS. Maximum of the medical students

responded gastritis (27.14%) specifically as the important ill-effects associated

with the consumption of the carbonated drinks for long period of time followed by

teeth and bone diseases (22.85%) and about 28.57% of the them were not aware of

the ill-effects of the same at all. About 39.65% of the nursing students responded.

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Chapter Three

Methodology

The field study aims to get the parameters and indicators on the Knowledge,

Attitude and Practices (KAP) regarding carbonated drinks among students of

medical college of the national Ribat University from 15th October to 30th October

2016.

3.1. Study design:

This is a descriptive cross sectional study.

3.2. Study population:

Thestudy population was the students of the Faculty of Medicine of the

National University of Rabat.

3.3. Sample Method:

The sample of student was scientific selectionrandomly from the faculty of

Medicine.300 Questionnaires were distributed 300 students of the sampling

group.The researcher retrieved all the questionnaires (100%).

3.4. Study Duration:

This study started from Period of 15Oct to 15MAR.

3.5. StudyTools:

Self-administer questionnaire as a tool for data collection from the study

sample. It included questions about

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1) The socio-demographic characteristics of the students (age, sex, residence,

parent’s education and occupation…etc.).

2) The practices of students towards carbonated drinks (how many cups they

daily consume, why, which types were preferred.

3) Knowledge of students towards the health effect of carbonated drinks, the

nutrient contents as well as other contents.

4) The attitudes of the students towards drinking of carbonated drinks.

3.6. Statistical Analysis:

Data was entered and analyzed using SPSS program. Descriptive statistics

was used including percentages and frequencies. Data was presented in the form

of tables.

3.7. Ethical Consideration:

The Main indicator of ethical Consideration that is a good conformation &

grantees for student of NUR that all information it be in highly secured and not

use for other purposes.

- 29 -

Chapter Four

Result and Conclusion

4.1. Result:

A. Socio Demographic Data:

Table(1) Gender Distribution of Study population:

gender Number Percentage%

Male 141 47%

Female 159 53%

Total 300 100%

Table(2) Age Distribution of Study population:

Percentage% Number Age

30% 90 16 – 20 years

59% 177 21 – 24 years

17% 51 > 24 years

100% 300 Total

- 30 -

Table(3) Class Level of Study population:

Percentage% Number Class

29% 87 Class One

23% 69 Class Two

19% 57 Class Three

15% 45 Class Four

14% 42 Class Five

100% 300 Total

Table(4) Distribution of Study Population By Family Income :

Percentage% Number Family Income

12% 36 less than2000SDG

48% 144 2000-5000 SDG

22% 66 5000-7000 SDG

18% 54 more than7000SDG

100% 300 Total

Table(5) Mother Education of Study population:

Percentage% Number Mother Education

44% 132 secondary school

56% 168 University

100% 300 Total

- 31 -

Table(6) Father Education of Study population:

Percentage% Number Father Education

22% 66 secondary school

88% 234 University

100% 300 Total

Table(7) Student Expenditure Per Day:

Percentage% Number Pocket

21% 63 less than25 SDG

49% 147 25-50SDG

30% 90 More than 50 SDG

100% 300 Total

Table(8) Daily Financial Family Supported Distribution of Study

population:

Percentage% Number The phrase

45% 135 Father

6% 18 Mother

41% 123 Both

5% 15 student him/herself

3% 9 Relatives

100% 300 Total

- 32 -

Table(9) Place of Residence of Study Population:

Percentage% Number Living

84% 252 Family

8% 24 Relative

9% 27 Boarding Houses

100% 300 Total

Table(10) Way of Transportation of Study Population:

Percentage% Number

Method

Transportation

64% 192 public Transportation

17% 51 Joint Transportation

18.33% 55 Vehicles

0.67% 2 Walking

100% 300 Total

Table(11) Disease Conditions among Distribution of Study

population:

Percentage% Number Disease

4% 12 Asthma

0.67% 2 HTN

0.33% 1 DM

95% 285 Free from Illness

100% 300 Total

- 33 -

B. Knowledge :

Table(12) Student Knowledge of Carbonated Drinks:

Percentage% Number Knowledge

93% 279 Knows

7% 21 Doesn’t knows

100% 300 Total

Table(13) Knowledge of Components of Carbonated Drinks Among

Study Population:

Percentage% Number Knowledge

51% 153 Knows

49% 147 Doesn’t knows

100% 300 Total

Table(14) Student Knowledge of Calories Contents of Carbonated

Drinks (500ml):

Percentage% Number Knowledge

80% 240 Knows

20% 60 Doesn’t knows

100% 300 Total

- 34 -

Table(15) Student Knowledge about the Ill Effects of Carbonated

Drinks:

Percentage% Number Knowledge

71% 213 Knows

29% 87 Doesn’t knows

100% 300 Total

Table(16) Student Knowledge about the Ill Effects Associated with

Carbonated Drinks:

Illness Number Percentage%

Obesity 90 30%

Bone decay 150 50%

Dental caries 21 7%

Other (DM, Hyperacidity) 39 13%

Total 300 100%

Table(17) Student Knowledge about the Prolonged Effect of

Consumption and Health:

Percentage% Number Effects

10% 30 Healthy

90% 270 Not Healthy

100% 300 Total

- 35 -

Table(18) Student Knowledge about Using Pepsi for digestionof

Foods:

Percentage% Number Case

84% 252 Believe

16% 48 Don’t Believe

100% 300 Total

Table(19) Student Knowledge about Using Seven Up for relieving

abdominal pain:

Percentage% Number Case

85% 255 Believe

15% 45 Don’t Believe

100% 300 Total

Table(20) Student Knowledge about Bread and Pepsi Calories:

Percentage% Number Case

69% 207 Pepsi 500ml> bread100gm

18% 54 bread 100> Pepsi 500ml

13% 39 Pepsi 500 ml= bread 100g

100% 300 Total

- 36 -

C. Attitude:

Table(21) Student Feeling Regarding Drink Pepsi carbonated Drink:

Percentage% Number Feeling

42% 126 Good

44% 132 Bad

14% 42 Unspecific

100% 300 Total

Table(22) Student Feeling Regarding Others People When They Are

Drinks Pepsi:

Percentage% Number Feeling

38% 114 Good

46% 138 Bad

16% 48 Unspecific

100% 300 Total

- 37 -

D. Practice:

Table(23) Preferring of student Regarding Soft Drinks:

Percentage% Number Drinks Type

79% 237 Natural Fruit Juice

21% 63 Carbonated Drinks

100% 300 Total

Table(24) Studentsage when they are starting taking Carbonated

Drinks (Years):

Percentage% Number Years

77% 231 ≥ 16 Years

23% 69 < 16 Years

100% 300 Total

- 38 -

Table(25) Consumption of Carbonated Drinks Per Litter :

Percentage% Number Average Group

26% 78 Less than 200ml

24% 72 200-350ml

33% 99 350-500ml

17% 51 More than 500ml

100% 300 Total

Table(26) Student Consumption of Carbonated Drink Per Day:

Percentage% Number Frequency

50% 150 Once

24% 72 twice

15% 45 3 Times

11% 33 more than 3 Times

100% 300 Total

- 39 -

Table(27) Preferable Consumed Carbonated Drinks:

Percentage% Number Carbonated Drink

51.67% 155 Pepsi

3% 9 Sprite

16% 48 Coca Cola

14% 42 Seven UP

5.33% 16 Miranda

2% 6 Stim

8% 24 Similar

100% 300 Total

Table(28) Reason behind Consuming Carbonated Drinks:

Percentage% Number Reason

39% 117 Satisfy Thirst

18% 54 To Gain Energy

43% 129 Habit

100% 300 Total

- 40 -

E. Lifestyle:

Table(29) Students Daily Coffee Consumption :

Percentage% Number Coffee Consumption

51% 153 Drinking Coffee

49% 147 Don’t Drinking Coffee

100% 300 Total

Table(30) Sleep Disturbanceat night :

Percentage% Number Sleep Disturbance

42% 126 Sleep Disturbance

58% 174 No Sleep Disturbance

100% 300 Total

F. Anthropometric Measures:

Table(31) BMI

Percentage% Number BMI

66% 198 ≥ 25

34% 102 < 25

100% 300 Total

- 41 -

Table(32) Height:

Percentage% Number Height

10% 30 ≥ 150cm

60% 180 151cm-160cm

18% 54 161cm-180cm

12% 36 More than 180cm

100% 300 Total

- 42 -

4.2. Discussion

In this study the majority of the students studied were females (53%). Most of

them (59%) belong to the age group from 21-24 years. Their families' income is

considered generally to be mordent, as (48%) have monthly incomesbetween2000

to 5000SDG. The majority of the students’ parents completed high levels of

education (university). Up to 49% of the students have dailyexpanses money

between 25 to 50 SDG. Which mainly come from the students'parents.The majority

of these students live with their parents (84%). The present study revealed that 93%

of the study sample had heard about carbonated drinks, and7% have never heard

about the term “carbonated drinks”. This is disagrees with Patel et al., (2016),

results that, 100% had heard about carbonated drink and 0% hadn’t heard about

carbonated drinks.

From the result we found that 51% knew the components of carbonated drinks,

and 49% didn’t know. This disagreed with Khardeet al., (2013), result that, 5.5%

knew about carbonated drinks, and 94.5% didn’t know.

In this study majority of students 80% knew the amount of calories in carbonated

drinks, and 20% didn’t know it. This disagreed with Khardeet al., (2013), result

that, most of the students didn’t know the amount of calories. That might be referred

to that not all students care about reading the ingredients that in label of bottle. Also

the participants of this study were medical school students who were probably

familiar with calories.

In the present study it was found that 71% knew about the bad effects of

carbonated drinks, and 29% didn’t know. This is close to the results reported by

Khardeet al., (2013), who showed that, 72.7% knew the bad effects and 27.3% didn’t

know it. This might be due to that these students prefer the taste of carbonated drinks

over the nutritional value and didn’t care about the consequences.

In the present study the opinions of the students associated with the ill effects of

carbonated drinks, was highest for bone decay 50%, obesity was 30%.This disagreed

with Patel et al., (2016) result that 11% had reported bone decay and agreed with

Khardeet al., (2013) that 28% of subjects in their study mentioned obesity.

- 43 -

In the present study subjects also viewed out the consequences of prolonged

consumption of carbonated drinks was found to be: bad for health (90%). This agrees

with (Kharde-2013) result who reported that 99% thought carbonated drinks were

bad for health. Also agrees with (Patel-2016) who found that 94% of subjects

thought carbonated drinks were bad for health.

This study also showed that 84% of the medical students thought that drinking of

Pepsi is good for food digestion. And 85% of subjects think that drinking Seven Up

is good for relievingabdominal pain. These were wrong believes. Thus, Soda, also

contain carbon dioxide which might generate more abdominal gases when they

break down during digestion and cause the belching and discomfort. There was also

wrong belief about carbonated drinks and their caloric contents. Thus, it was found

that up to 69% of the studied participants thought that Pepsi has more calories

compared to a whole piece of bread. These thought might encourage students to

substitute bread with drinking of Pepsi believing that they have taken the needed

amount of calories

The present study showed that up to 46% of the students felt badly for students

who drink one cup every day of carbonated drinks. And 42% felt good when they

drink it. This study also showed that most students prefer natural juices (79%) and

the carbonated drinks was preferred by 21%, these results were in line of the findings

of (Patel-2016), and they concluded that, preference for natural juices was reported

by 89.5% and the carbonated drinks by 10.4%. However, the natural juices aren’t

available and affordable as carbonated drinks especially in Sudan.

The majority of the medical students in this study started drinking carbonated

drinks since they were 16 years old or younger for up to 77%, and over 16 years old

for 23%. This disagrees with the results stated by (Kharde-2013), they reported that,

the age the students started to take carbonated drinks younger than the age of 16

years old was 84%, and over 16 years old was 16%. This might be due to the better

awareness of parents towards carbonated drinks as when student gain some sort of

independence as they grew up freedom for such choices is enhanced.

The results showed that the most common reason that encourage students to start

taking carbonated drinks was good taste by 49%, this agrees with the result stated

- 44 -

by (Patel-2016), who reported that among 45% and also (Kharde-2013), who

reported this among 30%..

In the present study it was found that Pepsi was the commonest carbonated drinks

students prefer to consume (51%) compared to other carbonated drinks. In That line

of findings of (Kishore-2009), they reported that higher intake of carbonated drinks

was a Pepsi by 49%. And with (Kharde-2013), who concluded that higher intake of

carbonated drinks was a Pepsi by 27%. This might be because Pepsi is the oldest

carbonated drinks and the most permanent produced one. The results show the body

mass indices of the studied students were equal or under 25 for 66%, and over 25 for

34%.That in agreement with the results reported by (Kharde-2013) that.The body

mass index of students fewer than 25 was 77%, and over 25 were 23%. From this

result we concluded the carbonated although for the students at the time of the study

are not a major cause of obesity probably if they continue in consuming it they will

probably suffer from obesity and its associated health associated disease.

- 45 -

4.3. Conclusion:

1. The knowledge of the students regarding the ill-effects of the consumption of

carbonated drinks is not convincing one. The attitudes of the students are

relatively better but their practices are neither preventive nor health

promoting.

2. A high number of university students take carbonated drinks on daily basis as

a refreshing preferable drink to get rid of thirst and dehydration, and the

majority of them knew that carbonated drinks leads to many health problems

including obesity, osteoporosis and diabetes.

3. The field study has shown that there is sufficient knowledge of the dangers of

carbonated drink intake by males and females, and in spite of that is addressed

in abundance.

4. Some of the study population believes that some carbonated drinks contribute

to the digestion of food, or as a treatment for abdominal pain.

5. 93% of study population knows about carbonated drinks while 77% started

drink carbonated drinks when they were less than 16 years of age.

- 46 -

4.4. Recommendations:

Based on previous results researcher recommends the following:

1. It is recommended that a holistic approach should be incorporated to combat the

problems associated with the consumption of carbonated drinks. There is a need of

Behavioral Change (BCC) for youngsters.

2. To develop nutritional education and designing more nutritional intervention

programs for the university students in general, specially focusing on the drink fresh

fruit juice and their benefits to the body, the consequences of high sugar

consumption from carbonated drink.

3. The need for awareness through seminars in schools and universities of the

harmful effects of carbonated drinks.

4. The importance of putting health warnings included the adverse effects of these

beverages in newspapers, radio and television bulletins and various social media, as

well as increased advertising of these drinks fees and attach a health warning is

mandatory.

5. Further studies on the short and long term dangers of drinking carbonated drink

on health are urgently needed.

6. Research on alternative nutritious, appealing and affordable drinks must be carried

out as to replace carbonated drinks.

7. Health education section for student regarding health effect of carbonated drink.

- 47 -

4.5. Reference:

1. Adults. Public Health Nutrition, 12(10): 1816–1822.

2. Attin T, Siegel S, Buchalla W, Lennon AM, Hannig C, Becker K. Brushing

abrasion of softened and remineralized dentin: an in situ study. Caries Res.

2004;38(1):62–66. doi: 10.1159/000073922.

3. Bamise, CT.; Kolawol, KA.; and Oloyede, EO. (2009).The Determinants And

Control Of Soft Drinks-Incited Dental Erosion. Rev ClínPesqOdontol, 5(2):141-

154

4. Carbonated water and bone health, Nelson, J.K., RD, MAYO CLINIC:

HEALTHY LIFESTYLE, 2011. http://www.mayoclinic.org/healthy-

living/nutrition-and-healthy-eating/expert-blog/carbonated-water/bgp-20056174

5. Doglas, S. Laboratory experiments on carbonated drink effects on osteoporosis,

United Kingdom.2003.

6. Effects of carbonated water on functional dyspepsia and constipation, Cuomo,

R., Grasso, R., et. al., EUROPEAN JOURNAL OF

GASTROENTEROLOGY& HEPATOLOGY 14: 1-9, 2002

7. ElSawy,N,; Bukhari,H.; Nada,I.;andAHeader,E. (2014). Obesity and

Osteoporosis among Students in Umm Al-Qura University Makkah, KSA.VRI

Bio Med Chem, 2(2):29-35.

8. James,J.; Thomas,P.; Cavan.;D And Kerr.;D.(2004).Preventing childhood

obesity by reducing consumption of carbonated drinks. Diabetes Primary Care

,4(3):9-75.

9. Hattersley,L.; Irwin1,M.; King,L.; and Allman-Farinelli,M.(2009). Determinants

and patterns of soft drink consumption in young.

10. Kharde,ADeshpande,J.; and Phalke,D.(2013).

- 48 -

11. Kishore, S.; Aggarwal, P.; and Muzammil, K. (2009). KAP Study

AboutCarbonated Drinks Among Medical and Nursing Students at Teaching

Hospital. J K Science, 11(4):196-199.

12. Knowledge, attitude and practice (KAP) regarding carbonated drinks among

medical students. International Journal of Medical Science and Public Health,

6(1).

13. Knowledge, Attitude and Practices (KAP) Regarding Carbonated Drinks Among

Student Of Medical College Of Western Maharashtra. International Journal

ofMedical Science and Public Health, 2(4):912-915.

14. Kumar P, Clark M, Clinical Medicine; 5th Edition.

15. MaichlXorafe, Gaseous material components through a medical perspective,

the National Library, New York, 2005.

16. Mansho, F. (2006) Carbonated drink experiments on Public Health,

University of Manchester,Manchester.

17. Mohamed Abu Eez, The effect of caffeine in organic materials for

carbonated drinks, Michigan University, 2009.

18. Patel,N.; Joshi,K.; Kumar,P.; Purani,S.; and Kartha,G.(2016).

19. Roubenoff R, Klag MJ, Mead LA, Liang KY, Seidler AJ, Hochberg MC.

Incidence and risk factors for gout in white men. JAMA 1991;266:3004-7.

20. Tahmassebi,J.F.; Duggal,M.S.; Malik-Kotru,G.; and Curzon,M.E.J.

(2004).Soft drinks and dental health. Journal of Dentistry, 0300-5712

Warner, D. (2007) Carbonated drinks manufacturing, the United States.

21. Yancy CW, et al. (2013). 2013 ACCF/AHA Guideline for the management

of heart failure: A report of the American College of Cardiology

Foundation/American Heart Association Task Force on Practice Guidelines.

Journal of the American College of Cardiology, 62(16): e147-e239.

- 49 -

The National Ribat University

Faculty of Post Graduate Studies & Scientific Research

Faculty of Medicine

Knowledge, Attitude And Practices (KAP) Regarding Carbonated Drinks

Among Students Of Medical College Of The National Ribat University from

15th October to 30th October 2016

Questionnaire

Please mark (√) on the corresponding item:

Serial No: ………………… Date ……………………

A.Socio Demographic data :

1) Gender:

Male ( ) Female ( )

2) Age:

16-20 ( ) 21-24 ( ) ≥24 ( )

3) Grade:.......

4) Family monthly income:

Less than 2000SDG ( ) 2000-5000SDG ( ) 5000-7000SDG ( ) More than

7000SDG ( )

5) How much is your pocket money /day?

<15 SDG ( ) 16-25 SDG ( ) 26-50 SDG ( )

6) Source of income

Father ) ( Mother ( ) Both ) (

Student him/herself ( ) Relative ) (

Other: specify…………………………………

7) Type of accommodation:

With family ) ( with relative ) (

Boarding Houses ( ) other: specify: ……………………….

8) Usually you get to university by:

- 50 -

Public transportation ( ) Joint Transportation ( ) Vehicles ( )

Walking ( )

9) Mother education level:

Illiterate ( ) Secondary school ( ) University ) (

10) Father education level:

Illiterate ( ) Secondary school ( ) University ) (

11) Do you have any chronic illness?

Yes ( ) No ( )

if yes: specify.........................

B.Knowledge :

1) Have You Heard about Carbonated Drinks?

Yes ( ) No ( )

2) Do you know the Ingredients of Carbonate Drink?

Yes ( ) No ( )

3) Do you Know how much calories of 500ml carbonate drink contains?

Yes ( ) No ( )

If yes how many calories? ml

4) Do you know about the Ill Effects?

Yes ( ) No ( )

5) Is carbonated drink associated with Ill Effects?

Obesity ( ) Bone decay ( ) Dental caries ( ) Belching ( )

Hyperacidity ( ) Diabetes type II ( ) Sleep Disturbance ( )

6) Prolonged Consumption and health?

Bad for health ( ) Good for health ( )

7) Do you think people may drink Pepsi because it helps in digesting the food?

Yes ( ) No ( )

8) Do you think people may drink seven up because it relieves abdominal

pain?

Yes ( ) No ( )

9) Which one of the following have more calories?

Pepsi 500ml> bread100gm ( ) bread 100> Pepsi 500ml ( ) Pepsi 500 ml=

bread 100gm ( )

C. Attitude:

- 51 -

1) What do you feel or think (feel good or feel bad or no specific feeling) about

yourself when you drink carbonated drinks?

a. One cup Every day ( )

2) What do you feel or think (feel good or feel bad or no specific feeling) about

the people who drink carbonated drinks?

a. One cup Every day ( )

D. Practice regarding carbonated drinks:

1) What would you prefer?

Natural Fruit Juice ( ) Carbonated Drinks ( ) other ( )

2) At which Age you started to take carbonated drinks (Years)?

≤16 ( ) >16 ( )

3) What encouraged you to start taking it?

Good taste ( ) Media Advertisement ( ) Easy access ( )

Appeal of drink ( ) Family influence ( )

Courtesy friends ( ) other ( )

4) What is Average Amount you usually consume?

<200ml ( ) 200-350ml ( ) 350-500ml ( ) >500ml ( )

5) How many times per day you drink carbonated drink?

Once ( ) twice ( ) third ( ) more than 3 ( )

6) What is the commonest carbonates drink you prefer to consume?

Pepsi ( ) Sprite ( ) coca cola ( ) seven UP ( )

Miranda ( ) steem ( ) Similar ( )

7) Why do you drink it?

Satisfy thirst ( ) To Gain energies ( ) habit ( )

E. Lifestyle:

1) Do you drink coffee on daily basis? Yes ( ) No ( )

2) Do you stay awake till late times at night?

Yes ( ) No ( )

F. Anthropometrics measures:

Weight ( ) kg Height ( ) cm