Adolescent Nutrition and Eating Behaviors in Türkiye (ANEB-TR)

Regional Nutritional Inequalities and Eating Behaviors Among Turkish Adolescents: A Cross-Regional Analysis

This study examines differences in nutrition and eating behaviors among adolescents living in two regions of Türkiye with contrasting socioeconomic and cultural conditions. A total of 100 adolescents aged 14-18 years were recruited from high schools in Ağrı (Eastern Türkiye) and Kırklareli (Western Türkiye). Participants completed dietary recalls, the Healthy Nutrition Behavior Scale, and the Eating Attitudes Test (EAT-26). The study aims to understand how regional inequalities influence nutrient intake and eating behaviors. Findings may help guide future public health strategies to improve adolescent nutrition across different regions of Türkiye.

Study Overview

• Status: Completed
• Conditions: Eating Behaviors; Adolescent Nutrition; Nutritional Inequalities; Eating Attitudes

Detailed Description

Adolescence is a critical developmental stage where nutritional habits are formed and often persist into adulthood. Nutritional inequalities in Türkiye are shaped by socioeconomic and cultural disparities between regions. This cross-sectional observational study was conducted between April and June 2025 in two provinces representing distinct socioeconomic contexts: Ağrı in Eastern Türkiye and Kırklareli in Western Türkiye.

A total of 100 adolescents (50 from each province) aged 14-18 years participated voluntarily. Dietary intake was assessed using 24-hour dietary recalls, and nutrient composition was analyzed with the BeBiS v9.0 software. Healthy eating behaviors were measured with the Healthy Nutrition Behavior Scale (HNBS), and disordered eating attitudes were evaluated with the Eating Attitudes Test (EAT-26).

The primary objective was to compare nutrient intake, healthy eating behaviors, and eating attitudes between the two provinces. Secondary analyses examined whether dietary patterns predicted psychosocial outcomes. Statistical methods included linear mixed-effects models, multivariate analysis of covariance, and principal component regression, adjusting for demographic and socioeconomic covariates.

Ethical approval was obtained from the Ağrı İbrahim Çeçen University Scientific Research and Publication Ethics Committee (Decision No: 112, March 27, 2025). All participants and their guardians provided informed consent.

This study is expected to generate evidence on regional nutritional disparities among adolescents in Türkiye. Results may inform dual public health strategies: (i) improving access to nutrient-dense foods in disadvantaged regions and (ii) addressing over-nutrition and processed food consumption in more affluent regions.

• Study Type: Observational
• Enrollment (Actual): 100

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ağrı, Turkey (Türkiye)
    • Agri Ibrahim Cecen University, Faculty of Health Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Adolescents aged 14-18 years attending secondary and high schools in Ağrı (Eastern Türkiye) and Kırklareli (Western Türkiye). Participants were recruited using a two-stage stratified cluster sampling design to reflect urban/rural and school-type diversity.

Description

Inclusion Criteria:

Adolescents aged 14-18 years

Residing in the study province (Ağrı or Kırklareli) for at least 5 years

Enrolled in selected secondary or high schools

Provided written informed consent (self and parent/guardian)

Exclusion Criteria:

Presence of chronic disease affecting diet (e.g., diabetes, celiac disease)

Currently receiving medical nutrition therapy or weight management interventions

Incomplete dietary recall or questionnaire data

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Kırklareli Cohort; Adolescents selected from secondary and high schools in Kırklareli, Türkiye. Observational data collection included 24-hour dietary recall, Healthy Nutrition Behavior Scale (HNBS), and Eating Attitudes Test (EAT-26). No intervention was applied
Ağrı Cohort; Adolescents selected from secondary and high schools in Ağrı, Türkiye. Observational data collection included 24-hour dietary recall, Healthy Nutrition Behavior Scale (HNBS), and Eating Attitudes Test (EAT-26). No intervention was applied

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Eating Attitudes (EAT-26)	Scores on the Eating Attitudes Test-26 (EAT-26), a validated screening tool for disordered eating attitudes in adolescents	Cross-sectional, single assessment (April-June 2025).
Healthy Nutrition Behavior Score (HNBS)	Scores on the Healthy Nutrition Behavior Scale (HNBS), a validated 20-item instrument for adolescents. Each item is rated on a 5-point Likert scale (1=never to 5=always). Higher total scores indicate healthier nutrition behaviors.	Single cross-sectional assessment at baseline (April-June 2025).
Nutrient Intake (24-hour recall)	Energy and nutrient intake (e.g., protein, fat, carbohydrates, vitamins, minerals) based on a 24-hour dietary recall and analyzed using BeBiS v9.0 software.	Cross-sectional, single assessment (April-June 2025).

Collaborators and Investigators

• Sponsor: Dursun Alper YILMAZ

Publications and helpful links

General Publications

• Sezer FE, Alpat Yavas I, Saleki N, Bakirhan H, Pehlivan M. Diet quality and snack preferences of Turkish adolescents in private and public schools. Front Public Health. 2024 Mar 1;12:1365355. doi: 10.3389/fpubh.2024.1365355. eCollection 2024.
• Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev. 2022 Jan;23(1):e13366. doi: 10.1111/obr.13366. Epub 2021 Oct 10.
• Neumark-Sztainer D, Wall M, Story M, Fulkerson JA. Are family meal patterns associated with disordered eating behaviors among adolescents? J Adolesc Health. 2004 Nov;35(5):350-9. doi: 10.1016/j.jadohealth.2004.01.004.
• Mates E, Lelijveld N, Ali Z, Sadler K, Yarparvar A, Walters T, Brown R, Rodriques B. Nutrition of School-Aged Children and Adolescents in Europe and Central Asia Region: A Literature and Survey Review. Food Nutr Bull. 2023 Mar;44(1):51-61. doi: 10.1177/03795721231163021. Epub 2023 Apr 5.
• Aounallah-Skhiri H, Traissac P, El Ati J, Eymard-Duvernay S, Landais E, Achour N, Delpeuch F, Ben Romdhane H, Maire B. Nutrition transition among adolescents of a south-Mediterranean country: dietary patterns, association with socio-economic factors, overweight and blood pressure. A cross-sectional study in Tunisia. Nutr J. 2011 Apr 24;10:38. doi: 10.1186/1475-2891-10-38.

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2025
• Primary Completion (Actual): June 1, 2025
• Study Completion (Actual): June 30, 2025

Study Registration Dates

• First Submitted: September 19, 2025
• First Submitted That Met QC Criteria: September 19, 2025
• First Posted (Estimated): September 26, 2025

Study Record Updates

• Last Update Posted (Estimated): September 26, 2025
• Last Update Submitted That Met QC Criteria: September 19, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: Adolescents; Nutrition; Dietary Intake; Eating Attitudes Test (EAT-26); Healthy Nutrition Behavior Scale (HNBS)
• Additional Relevant MeSH Terms: Behavior; Behavior, Animal; Feeding Behavior
• Other Study ID Numbers: AICU-2025-NUTR01; 112-2025 (Other Identifier: Agri Ibrahim Cecen University Ethics Committee)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared because the study involved a small sample of adolescents, and data include sensitive information on dietary habits and eating attitudes. To protect participant confidentiality, only aggregated results will be published.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No