Next Article in Journal
The Southern European Atlantic Diet and Its Supplements: The Chemical Bases of Its Anticancer Properties
Previous Article in Journal
Standard Patient History Can Be Augmented Using Ethnographic Foodlife Questions
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Nutrients
Volume 15
Issue 19
10.3390/nu15194273
nutrients-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Association between Body Image Flexibility and Intermittent Fasting in Chinese Medical Students: A Cross-Sectional Study

by
Xinji Shi
1,†,
Yibo Wu
2,†,
Jie Yuan
3,
Xue Wang
1,
Chaowei Guo
1 and
Shuang Zang
1,*
1
Department of Community Nursing, School of Nursing, China Medical University, Shenyang 110122, China
2
School of Public Health, Peking University, Beijing 100191, China
3
Jitang College of North China University of Science and Technology, Tangshan 063000, China
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Nutrients 2023, 15(19), 4273; https://doi.org/10.3390/nu15194273
Submission received: 1 September 2023 / Revised: 26 September 2023 / Accepted: 1 October 2023 / Published: 6 October 2023
(This article belongs to the Section Nutrition and Public Health)
Browse Figure
Versions Notes

Abstract

:
Unhealthy dietary behaviors and body dissatisfaction are becoming increasingly common among college students. Understanding the association between body image flexibility and intermittent fasting is particularly meaningful, especially for medical college students. This study aimed to investigate the association between body image flexibility and intermittent fasting among medical students. We conducted a cross-sectional study with 5138 medical college students at Jitang College of North China University of Science and Technology. Univariate and multivariate logistic regression were used to evaluate the association between body image flexibility and intermittent fasting. Subgroup analysis and interaction tests were further used to examine the possible interaction between body image flexibility and intermittent fasting. In this study, 1329 (25.87%) students had intermittent fasting behavior. After adjustment for confounding factors, there was a negative association between body image flexibility and intermittent fasting (OR = 0.94, 95%CI = 0.93 to 0.95, p < 0.001). A significant interaction between body image flexibility and intermittent fasting was found in gender, academic year, major, and monthly living expenses (p for interaction < 0.05). E-value analysis suggested there was unlikely to be an unmeasured confounding. This association could contribute to the establishment of personalized health intervention strategies and provide recommendations for promoting the physical and mental health of medical students.

1. Introduction

In recent years, body image flexibility has received widespread attention [1,2]. The definition of body image flexibility is the capacity to experience and accept unwanted thoughts and feelings about one’s body, enabling individuals to engage in actions consistent with their values despite concerns about body size, weight, or shape [3]. Thus, individuals with greater body image flexibility generally have a more accepting attitude toward their body shape and size and are less likely to display distress or reactivity in response to changes in weight. Conversely, those with lower body image flexibility are typically more distressed and anxious about their body image. Several studies have indicated that individuals with higher levels of body image flexibility are more likely to engage in positive health behaviors [4,5]. Furthermore, body image flexibility is closely associated with positive body image cognition [6] and mental health [7].
Intermittent fasting is becoming increasingly popular as a dietary strategy for weight management and health benefits [8]. Currently, research on intermittent fasting primarily focuses on its effects on weight loss and overall physical health [9,10,11,12].
Studies have demonstrated a correlation between diminished body image flexibility and eating disorders [1,13]. Eating disorders include dieting, fasting, etc. [14]. Although intermittent fasting and body image flexibility have garnered increasing attention in the field of health [6,15], the relationship between intermittent fasting and body image flexibility has received limited research attention to date. Particularly, there exists a scarcity of research investigating the association between intermittent fasting and body image flexibility among medical students.
Understanding the association between body image flexibility and intermittent fasting is particularly interesting in the context of medical students. Medical students frequently encounter unique challenges, including high academic demands, rigorous coursework, and pressure related to clinical training [16,17]. Furthermore, medical education emphasizes the importance of understanding and promoting healthy lifestyles, such as professional nutrition education [18]. The characteristics of a medical students’ profession lead them to have a heightened focus on physical health and body image. As future healthcare practitioners, they need to interact with and care for patients, which requires them to possess a positive body image and health consciousness to effectively convey health information and set examples. Moreover, based on the different definitions of “body shape” and “beauty” in Chinese culture compared to the West [19], research on body image flexibility and intermittent fasting among Chinese medical students can help to better understand the manifestations of these phenomena. Therefore, studying the relationship between body image flexibility and intermittent fasting in medical students can offer insightful information about mental health and dietary behavior, serve as a foundation for creating individualized health interventions, and provide suggestions for future research.
The specific research questions (RQs) and hypotheses (Hs) in this study were as follows:
RQ1: 
Is there an association between body image flexibility and intermittent fasting among medical students?
H1: 
There is a significant association between body image flexibility and intermittent fasting among medical students.
RQ2: 
Are there other factors that influence the association between body image flexibility and intermittent fasting among medical students?
H2: 
There are additional factors that influence the association between body image flexibility and intermittent fasting among medical students.

2. Method

2.1. Study Design and Participants

The current cross-sectional study was conducted at Jitang College of North China University of Science and Technology (Tangshan, Hebei, China). This study used a single-centered cluster sampling method. The inclusion criteria were: (1) undergraduate students currently studying at the university; (2) volunteer to participate in this study; and (3) not in other similar studies. From November to December 2022, data were collected using a self-administered questionnaire. The questionnaire was distributed by trained investigators using WeChat (a social platform in China, with over one billion users) based on Questionnaire Star (a free online questionnaire survey program). In addition, the students were informed of the purpose of the study and related considerations. Informed consent was obtained from all participants, and all data were anonymized.
This study was conducted under the Declaration of Helsinki and the Measures for Ethical Review of Biomedical Research Involving Human Beings [20]. Ethical approval was obtained through the Ethics Review Committee of Jitang College of North China University of Science and Technology (JTXY-2022-002).
First, this study included 5154 medical students. Then, 16 participants were excluded due to the missing values of body image flexibility and intermittent fasting. Finally, a total of 5138 participants were included in this study.

2.2. Measures

2.2.1. Intermittent Fasting

In this study, intermittent fasting was defined in two ways: one as daily time-restricted fasting, with a shortened eating window of 6–8 h per day; the other as 5:2 fasting, which means that individuals only eat one medium-sized meal a day, and the calorie restriction is usually two days a week [21]. Participants were asked whether they had engaged in intermittent fasting behavior in the past year. Those who answered “yes” were identified as having intermittent fasting behavior, and those who answered “no” were considered not to have intermittent fasting behaviors.

2.2.2. Body Image Flexibility

The Body Image-Acceptance and Action Questionnaire-5 (BI-AAQ-5) [22] was used to evaluate participants’ body image flexibility. The BI-AAQ-5 was an abbreviated version of the original version [3] with comparable performance [22,23]. It contained 5 items rated on a 7-point Likert-type scale (1 = never true to 7 = always true). All items (e.g., “Concern about weight makes it difficult for me to live a life that I consider worthwhile”) were reverse scored. A total score was calculated as the sum of all items (range: 5–35). Higher scores indicated higher levels of body image flexibility. In this study, Cronbach’s α for the BI-AAQ-5 was 0.94.

2.2.3. Covariates

Based on prior studies [24,25,26,27,28,29,30], we identified several potential confounding variables, including age, body mass index (BMI), social media usage, family health, gender (limited to gender variable, without collecting sex information), ethnicity, academic year, major, hukou, place of residence, monthly living expenses, and love experience.

Demographic Variables

Age, gender, academic year, and major were self-reported. The BMI was calculated based on self-reported height and weight. Ethnicity was classified into Han and minority. Hukou was divided into non-agricultural and agricultural. Place of residence was dichotomized into urban or rural. Monthly living expenses were a three-category variable: ≤800, 801–1500, and >1500 Chinese Yuan (CNY). Participants were asked, “What are your current monthly living expenses (for sophomores and seniors, choose the average for the past academic year; and for freshmen, choose the average for the past three months)?” Participants determined the variables of their love experience by answering the question “Are you in a relationship?”. And love experience was coded as a three-category variable: never been in love, have been in love, and are in love.

Social Media Usage

Social media usage was measured with the 9-item Identity Bubble Reinforcement Scale [31]. Responses ranged from 1 (does not describe me at all) to 10 (describes me completely). The total score was the sum of all 9 items (range: 9–90). Higher scores reflected higher involvement in social media usage. In this study, Cronbach’s α of the 9-item Identity Bubble Reinforcement Scale was 0.93.

Family Health

The Short Form of the Family Health Scale (FHS-SF) [32] was a 10-item scale to measure family health. Responses to each item were rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The sixth, ninth, and tenth items were scored in reverse (e.g., “In our family, we do not trust doctors and other health professionals”). A total score was the sum of all 10 items (range: 10–50). Higher scores reflected a higher family health degree. In this study, Cronbach’s α for the FHS-SF was 0.83.

2.3. Statistical Analysis

First, the data were assessed for normal distribution by the Kolmogorow–Smirnov test and Q-Q plots. Normally distributed continuous variables were presented as mean and standard deviation, and those that did not conform to a normal distribution were expressed as the median and interquartile range (IQR). Categorical variables were expressed as numbers and percentages. Participant characteristics were compared between groups using the t-test, Mann–Whitney U test, and Chi-square test. Second, a univariate logistic regression analysis was performed to identify factors associated with intermittent fasting. Multivariable binary logistic regression was used to explore the association between body image flexibility and intermittent fasting. Three models were used to adjust for potential confounders. Model I was unadjusted. Model II adjusted for age and gender. And Model III further adjusted variables with p < 0.05 in univariate analysis (i.e., age, BMI, social media usage, family health, gender, academic year, major, monthly living expenses, love experience). The results of the binary logistic regression models were shown as odds ratios (OR) with 95% confidence intervals (CI). Finally, we conducted a subgroup analysis and interaction test to explore the association between body image flexibility and intermittent fasting among different subgroups. To confirm the stability of the results, we calculated the E-value to assess potential unmeasured confounding [33].
Two-sided p < 0.05 was considered statistically significant. All statistical analyses were conducted using SPSS25.0 software (IBM Corp., New York, NY, USA) and R statistical package 4.2.0 (R Foundation for Statistical Computing, Vienna, Austria).

3. Result

3.1. Characteristics of Participants

A total of 5138 participants were included in this study. The age was 20.54 ± 1.62 years, and the median BMI was 22.23 kg/m2. The body image flexibility score was 25.24 ± 7.21, and 1329 (25.87%) participants had intermittent fasting behavior. The characteristics of participants divided by the median body imagery flexibility score were shown in Table 1. There were statistically significant differences in age, BMI, social media usage, family health, academic year, major, and intermittent fasting between the two groups (all p < 0.05). However, there were no statistically significant differences in gender, ethnicity, hukou, place of residence, monthly living expenses, and love experience (all p > 0.05).

3.2. Univariate Analysis Related to Intermittent Fasting

To screen potential risk factors related to intermittent fasting, we performed univariate binary logistic regression. Univariate analysis showed that body image flexibility, age, BMI, social media usage, family health, academic year, major, monthly living expenses, and love experience were associated with intermittent fasting (p < 0.05) (Table S1).

3.3. Association between Body Image Flexibility and Intermittent Fasting

Binary logistic regression was employed for multivariate analysis. Statistically significant factors in the univariate logistic regression analysis were included in the multivariate logistic regression analysis. In addition, based on previous studies [34], we also adjusted for gender as a potential confounding factor. In the unadjusted model, body image flexibility was negatively associated with intermittent fasting. For each unit increase in body imagery flexibility score, the likelihood of intermittent fasting decreased by 7.23% (OR = 0.93, 95%CI = 0.92 to 0.94, p < 0.001). After adjusting for age and gender, the association between body image flexibility and intermittent fasting remained robust. Further adjusting for BMI, social media usage, family health, academic year, major, monthly living expenses, and love experience, the result was still statistically significant. The probability of intermittent fasting decreased by 5.88% for every unit increase in body image flexibility scores (OR = 0.94, 95%CI = 0.93 to 0.95, p < 0.001) (Table 2).

3.4. Subgroup and Interaction Analyses

To explore the role of the covariables in the association between body image flexibility and intermittent fasting, the subgroup analysis was conducted after stratifying the participants by gender, academic year, major, monthly living expenses, and love experience. The results of the subgroup analysis were shown in Figure 1, and regardless of subgroup, body imagery flexibility was negatively associated with intermittent fasting. In addition, we found a significant interaction between body image flexibility and intermittent fasting in gender, academic year, major, and monthly living expenses (p for interaction <0.05). However, the interaction was not significant in the love experience group (p for interaction >0.05). The negative association between body image flexibility and intermittent fasting was stronger among females (OR = 0.92, 95%CI = 0.91 to 0.94, p < 0.001), first year of college (OR = 0.90, 95%CI = 0.88 to 0.93, p < 0.001), pharmacy major (OR = 0.91, 95%CI = 0.86 to 0.96, p < 0.001), nursing major (OR = 0.91, 95%CI = 0.89 to 0.94, p < 0.001), and those with monthly living expenses >1500 CNY (OR = 0.93, 95%CI = 0.92 to 0.95, p < 0.001).

3.5. Sensitivity Analyses

In sensitivity analyses, the E-value was used to assess the degree of unmeasured confounding. The E-value (1.32) indicated that there was unlikely to be an unmeasured confounding affecting the association between body image flexibility and intermittent fasting.

4. Discussion

In this study, we found a significant association between body image flexibility and intermittent fasting among Chinese medical students. This association was stronger in female students, those majoring in pharmacy and nursing, first-year students, and those with higher monthly living expenses.
There was a negative association between body image flexibility and intermittent fasting among Chinese medical students, and a higher level of body image flexibility was associated with a lower likelihood of engaging in intermittent fasting behaviors. In this study, the overall BMI level of medical students who experienced intermittent fasting behavior was at a healthy level according to the World Health Organization (WHO) standard [35]. To explain the observed negative association between body image flexibility and intermittent fasting, the role of psychosocial factors needs to be considered. For example, society’s emphasis on “thin beauty” standards may lead to increased dissatisfaction with one’s body image [36], causing individuals to attempt intermittent fasting even at a healthy body size to look more aesthetically pleasing. Within the university environment, academic stress, social pressures, and self-identity issues may play a role in shaping students’ body image and dietary behaviors [26,37]. In this contextual backdrop, body image flexibility may reflect individuals’ different ways of coping with these pressures and factors. On the other hand, the adoption of intermittent fasting behaviors may be motivated by a multitude of factors, including concerns regarding weight management and overall physical well-being [10]. These motivations may interact with individuals’ body image, further influencing their dietary choices. The findings of this study offered new insights into enhancing the well-being of college students. College life is often accompanied by multiple stress factors, and cultivating body image flexibility may serve as a protective factor in preventing the adoption of extreme dietary behaviors, which can entail health risks and psychological burdens [38,39]. A deeper understanding of the mechanisms and long-term impacts of this association is crucial for the development of targeted intervention measures and support strategies, such as implementing psychological health support, promoting the formation of positive body image cognition, healthy eating education, and social support, to assist students in establishing healthy body images and dietary habits, thereby improving the physical and mental health of college students. Future research should consider intervention measures and health education programs to reduce unhealthy eating habits and promote positive body image.
In this study, we found a stronger negative association between female body image flexibility and intermittent fasting among medical college students. This gender difference was consistent with previous studies [40,41]. Firstly, unlike males, females were significantly impacted by changes in hormone levels during the menstrual cycle, which regulated dietary consumption as well as metabolic and physiological conditions [42]. Studies have shown that changes in hormones could affect females’ food intake, binge eating, and emotional eating [43]. Secondly, females were more sensitive and concerned about their body image [44], thus exhibiting a propensity for weight management in their dietary behavior [45]. Finally, females were more vulnerable to external social and cultural pressures on their ideal body shape [37]. Many females engaged in social comparison regarding their bodies with peers, leading to potentially negative evaluations of their weight and physique [2]. Previous studies demonstrated that a high tendency towards appearance comparison was associated with eating disorders [46]. According to a Korean study, females may exert greater pressure on their appearance [47]. When they believe that their body does not meet social or cultural standards, they may try to change their body image by fasting. This finding emphasizes the importance of tailoring interventions specifically for female medical students to assist them in addressing the unique challenges associated with body image and intermittent fasting. Educational interventions should be designed to enhance medical students’ awareness of the risks related to extreme dietary habits. Students should be informed about the potential adverse physiological and psychological consequences of such behaviors. Workshops and seminars addressing body image issues and promoting balanced approaches to diet and exercise could be incorporated into the medical curriculum. The establishment of female-centered support groups and female advisors specializing in matters related to body image and dietary concerns should be prioritized to consider the overall well-being of students.
There was a stronger negative association between body image flexibility and intermittent fasting in first-year medical students. Firstly, first-year students may experience greater adaptation pressure from graduating from high school to entering university, which means adapting to new educational environments and social challenges [39]. Studies have shown that the adaptation process may harm the physical and mental health of college freshmen [48,49]. During this adaptation process, more and more scrutiny of their appearance may make them pay more attention to their body image, leading to a reduction in their dietary intake [50]. Secondly, for freshmen, the transition from high school to university is also a new stage of self-exploration and identity building [51,52]. They typically begin to contemplate their identity, interests, and values. Therefore, some first-year students may attempt to enhance their self-confidence and shape their image by improving their physical appearance, establishing social connections, and finding their place within the university [53]. Furthermore, first-year students may lack efficient stress and emotion management methods, resulting in an inability to properly alleviate stress and emotions during the transition period to university, raising the likelihood of intermittent fasting [54]. This finding serves as a reminder of the importance of prioritizing the physical and mental well-being of first-year college students to ensure a smooth transition during this period. Targeted interventions aimed at promoting the welfare of first-year students should be devised, encompassing strategies to address adaptation stress, enhance self-confidence, and cultivate effective stress management techniques. Further research should explore these facets in greater detail to formulate more comprehensive interventions tailored to accommodate the unique challenges faced by first-year medical college students.
We found that college students majoring in nursing and pharmacy had a stronger negative association with body image flexibility and intermittent fasting. This may be related to the characteristics of the different majors. Compared to doctors, nurses usually start to contact patients at the early stage of their training [55] and have more extensive and intimate interactions with patients during the whole nursing process [56,57]. Research indicated that possessing a healthy shape may enhance individuals’ body image and physical attractiveness [53]. Patients also exhibit a greater inclination to trust and respect nurses who present themselves with a tidy, healthy, and self-assured appearance [58]. Meanwhile, research suggested a strong association between self-esteem and body image [59]. Possessing a positive body image can enhance nurses’ self-esteem and self-confidence [60]. Such self-esteem and self-confidence may convey their dedication and professional competence, establish a sense of trust with patients, and facilitate effective communication and patient satisfaction. Similar to the nursing major, graduates of pharmacy programs often enter an industry that necessitates extensive interpersonal engagement. For instance, pharmacists are required to communicate extensively with physicians, nurses, and patients to enhance medication adherence and provide medication dispensing and counseling services [61]. A favorable professional image may contribute to their career advancement. This finding highlights the necessity for tailored interventions to cater to the unique requirements of students pursuing different academic majors within medical education institutions. However, research on different medical majors remains relatively restricted. Hence, this result encourages further research to delve more comprehensively into the potential mechanisms underpinning the identified correlations and to explore potential intervention strategies. By conducting broader investigations into the body image and dietary behaviors of medical school students, a wealth of information can be gathered to better inform the development of comprehensive well-being programs, ultimately leading to enhanced overall physical and mental health among future medical college students.
There was a stronger negative association between body image flexibility and intermittent fasting in medical students with high monthly living expenses. Students with higher living expenses usually come from affluent families. Studies have shown that family income is significantly related to nutritional intake [62]. Affluent individuals were more likely to adopt a high-quality diet and realize the importance of balanced nutrition to maintain health [63]. Therefore, students with high monthly living expenses have more economic resources at their disposal to obtain a healthy diet and exercise regularly and are naturally more inclined to maintain a healthy weight and body shape [64]. Furthermore, students with high monthly living expenses may be more likely to have access to good family education and mental health education [65], which can help them develop a positive body image and ultimately reduce the occurrence of intermittent fasting. Understanding the affluent socioeconomic background of students with high monthly living expenses can facilitate the development of health promotion strategies that are tailored to their specific needs and characteristics, enhance their physical image flexibility, and reduce unhealthy dietary behaviors. This finding emphasizes the potential role of socioeconomic factors in shaping medical students’ body image flexibility and dietary behavior. It also advocates for the development of strategic approaches aimed at mitigating socioeconomic disparities among medical students. By actively pursuing equitable resource allocation and equal opportunities, medical education institutions can work towards providing comprehensive physical and mental health education to all students, regardless of their economic backgrounds [66]. These strategies may encompass targeted educational initiatives, counseling services, and interventions designed to foster a positive body image. By recognizing the influence of social and economic background on students’ health-related choices, we can strive to create an inclusive environment that promotes physical and mental health and ensures students’ physical and mental well-being.
However, there were also limitations to our study. First, although the sample size of this study was 5138, it only represented all the medical students from one college in China. Therefore, the generalizability and extrapolation of our results to college students require further verification. Future research should consider employing more extensive multicenter samples that encompass medical students from varied geographical regions and cultural backgrounds to enhance the representativeness of the study results. Second, we only investigated whether there was intermittent fasting in the past year, but did not involve the duration and frequency of intermittent fasting. Future research could delve into the temporal aspects, encompassing both the duration and frequency of intermittent fasting behaviors to attain a more nuanced comprehension of this phenomenon. Third, this study relied on self-reported data to assess the association between intermittent fasting and body image flexibility, which might suffer from recall bias and desirability bias. Future research should contemplate the utilization of objective measurement tools to validate research findings, thereby promoting result precision. Fourthly, although we calculated E-values to evaluate unmeasured confounding, the potential presence of other unmeasured confounding variables cannot be entirely discounted. Future research should consider these unmeasured confounding variables for more robust results regarding the association between body image flexibility and intermittent fasting. Finally, we were unable to draw causal associations between body image flexibility and intermittent fasting from the cross-sectional study. Therefore, future research should prioritize longitudinal studies to enhance the understanding of the causal association between body image flexibility and intermittent fasting.

5. Conclusions

In this study, we found an association between body image flexibility and intermittent fasting among Chinese medical students. Individuals with higher levels of body image flexibility were less inclined to engage in intermittent fasting behaviors, particularly among female students, those majoring in pharmacy and nursing, first-year students, and those with higher living expenses. This study provides valuable insights and directions for the development of specific health intervention strategies aimed at enhancing the overall well-being of medical students. Firstly, personalized health intervention plans should be devised, offering tailored psychological support and health guidance based on students’ body image flexibility, thereby assisting them in cultivating healthier lifestyles. Secondly, a particular focus should be directed toward the female medical student population, implementing gender-specific intervention measures to mitigate unhealthy dietary habits. Furthermore, students in pharmacy and nursing majors appear to be more susceptible to engaging in intermittent fasting behaviors, indicating the need for specialized health education and support for students in these professions to ensure their physical and mental well-being. Lastly, consideration should be given to providing financial assistance to alleviate the negative impact of economic stressors on body image. These recommendations serve as a foundation for the formulation of targeted health interventions in the context of medical education, with the ultimate goal of improving the holistic health of medical students.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/nu15194273/s1, Table S1: Factors associated with intermittent fasting.

Author Contributions

X.S.: Conceptualization, Methodology, Formal analysis, Software, Visualization, Writing—original draft. Y.W.: Conceptualization, Formal analysis, Investigation, Writing—review and editing. J.Y.: Investigation, Supervision. X.W.: Writing—review and editing. C.G.: Writing—review and editing. S.Z.: Conceptualization, Resources, Writing—original draft, Supervision. All authors have read and agreed to the published version of the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Review Committee of Jitang College of North China University of Science and Technology (JTXY-2022-002).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data in this study can be obtained from the corresponding author on reasonable request.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Pellizzer, M.L.; Waller, G.; Wade, T.D. Body image flexibility: A predictor and moderator of outcome in transdiagnostic outpatient eating disorder treatment. Int. J. Eat. Disord. 2018, 51, 368–372. [Google Scholar] [CrossRef]
  2. Perey, I.; Koenigstorfer, J. Appearance Comparisons and Eating Pathology: A Moderated Serial Mediation Analysis Exploring Body Image Flexibility and Body Appreciation as Mediators and Self-Compassion as Moderator. Body Image 2020, 35, 255–264. [Google Scholar] [CrossRef] [PubMed]
  3. Sandoz, E.K.; Wilson, K.G.; Merwin, R.M.; Kate Kellum, K. Assessment of body image flexibility: The Body Image-Acceptance and Action Questionnaire. J. Context. Behav. Sci. 2013, 2, 39–48. [Google Scholar] [CrossRef]
  4. El Ansari, W.; Berg-Beckhoff, G. Association of Health Status and Health Behaviors with Weight Satisfaction vs. Body Image Concern: Analysis of 5888 Undergraduates in Egypt, Palestine, and Finland. Nutrients 2019, 11, 2860. [Google Scholar] [CrossRef]
  5. Gomes, M.L.B.; Tornquist, L.; Tornquist, D.; Caputo, E.L. Body image is associated with leisure-time physical activity and sedentary behavior in adolescents: Data from the Brazilian National School-based Health Survey (PeNSE 2015). Rev. Bras. De Psiquiatr. 2021, 43, 584–589. [Google Scholar] [CrossRef] [PubMed]
  6. Webb, J.B.; Butler-Ajibade, P.; Robinson, S.A. Considering an affect regulation framework for examining the association between body dissatisfaction and positive body image in Black older adolescent females: Does body mass index matter? Body Image 2014, 11, 426–437. [Google Scholar] [CrossRef] [PubMed]
  7. Ren, Y.; Lu, C.; Yang, H.; Ma, Q.; Barnhart, W.R.; Zhou, J.; He, J. Using machine learning to explore core risk factors associated with the risk of eating disorders among non-clinical young women in China: A decision-tree classification analysis. J. Eat. Disord. 2022, 10, 19. [Google Scholar] [CrossRef]
  8. Catenacci, V.A.; Pan, Z.; Ostendorf, D.; Brannon, S.; Gozansky, W.S.; Mattson, M.P.; Martin, B.; MacLean, P.S.; Melanson, E.L.; Troy Donahoo, W. A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity. Obesity 2016, 24, 1874–1883. [Google Scholar] [CrossRef]
  9. Washburn, R.L.; Cox, J.E.; Muhlestein, J.B.; May, H.T.; Carlquist, J.F.; Le, V.T.; Anderson, J.L.; Horne, B.D. Pilot Study of Novel Intermittent Fasting Effects on Metabolomic and Trimethylamine N-oxide Changes During 24-hour Water-Only Fasting in the FEELGOOD Trial. Nutrients 2019, 11, 246. [Google Scholar] [CrossRef]
  10. Wu, D.; Bang, I.H.; Park, B.H.; Bae, E.J. Loss of Sirt6 in adipocytes impairs the ability of adipose tissue to adapt to intermittent fasting. Exp. Mol. Med. 2021, 53, 1298–1306. [Google Scholar] [CrossRef]
  11. Duszka, K.; Gregor, A.; Guillou, H.; König, J.; Wahli, W. Peroxisome Proliferator-Activated Receptors and Caloric Restriction-Common Pathways Affecting Metabolism, Health, and Longevity. Cells 2020, 9, 1708. [Google Scholar] [CrossRef]
  12. Chen, S.; Han, R.; Liu, H. A Bibliometric and Visualization Analysis of Intermittent Fasting. Front. Public Health 2022, 10, 946795. [Google Scholar] [CrossRef]
  13. Rogers, C.B.; Webb, J.B.; Jafari, N. A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science (2011–2018). Body Image 2018, 27, 43–60. [Google Scholar] [CrossRef]
  14. Solmi, F.; Bentivegna, F.; Bould, H.; Mandy, W.; Kothari, R.; Rai, D.; Skuse, D.; Lewis, G. Trajectories of autistic social traits in childhood and adolescence and disordered eating behaviours at age 14 years: A UK general population cohort study. J. Child Psychol. Psychiatry Allied Discip. 2021, 62, 75–85. [Google Scholar] [CrossRef] [PubMed]
  15. Allaf, M.; Elghazaly, H.; Mohamed, O.G.; Fareen, M.F.K.; Zaman, S.; Salmasi, A.M.; Tsilidis, K.; Dehghan, A. Intermittent fasting for the prevention of cardiovascular disease. Cochrane Database Syst. Rev. 2021, 1, CD013496. [Google Scholar] [CrossRef] [PubMed]
  16. Olum, R.; Nakwagala, F.N.; Odokonyero, R. Prevalence and Factors Associated with Depression among Medical Students at Makerere University, Uganda. Adv. Med. Educ. Pract. 2020, 11, 853–860. [Google Scholar] [CrossRef] [PubMed]
  17. Mat Nor, Z.M.; Yusoff, S.B.M.; Abdul Rahim, F.A. Characteristics of mentoring programmes in the early phase of medical training at the Universiti Sains, Malaysia. J. Taibah Univ. Med. Sci. 2017, 12, 343–348. [Google Scholar] [CrossRef]
  18. DiMaria-Ghalili, R.A.; Mirtallo, J.M.; Tobin, B.W.; Hark, L.; Van Horn, L.; Palmer, C.A. Challenges and opportunities for nutrition education and training in the health care professions: Intraprofessional and interprofessional call to action. Am. J. Clin. Nutr. 2014, 99, 1184S–1193S. [Google Scholar] [CrossRef]
  19. Fan, H.; Gan, Y.; Wang, R.; Chen, S.; Lipowska, M.; Li, J.; Li, K.; Krokosz, D.; Yang, Y.; Lipowski, M. The Relationship between Obligatory Exercise and Eating Attitudes, and the Mediating Role of Sociocultural Attitudes towards Appearance during the COVID-19 Pandemic. Nutrients 2021, 13, 4286. [Google Scholar] [CrossRef]
  20. Measures for Ethical Review of Biomedical Research Involving Human Beings. National Health and Family Planning Commission of the People’s Republic of China. (In Chinese). Available online: http://www.gov.cn/gongbao/content/2017/content_5227817.htm (accessed on 31 August 2023).
  21. Varady, K.A.; Cienfuegos, S.; Ezpeleta, M.; Gabel, K. Clinical application of intermittent fasting for weight loss: Progress and future directions. Nat. Rev. Endocrinol. 2022, 18, 309–321. [Google Scholar] [CrossRef]
  22. Basarkod, G.; Sahdra, B.; Ciarrochi, J. Body Image-Acceptance and Action Questionnaire-5: An Abbreviation Using Genetic Algorithms. Behav. Ther. 2018, 49, 388–402. [Google Scholar] [CrossRef] [PubMed]
  23. Linardon, J.; Messer, M.; Lee, S.; Fuller-Tyszkiewicz, M. Testing the measurement invariance of the Body Image Acceptance and Action Questionnaire between women with and without binge-eating disorder symptomatology: Further evidence for an abbreviated five-item version. Psychol. Assess. 2019, 31, 1368–1376. [Google Scholar] [CrossRef] [PubMed]
  24. Dairi, G.; Alafghani, R.; Ghafouri, K.; Noorwali, E. Effect of Intermittent Fasting on Body Image Satisfaction and Appreciation Among Saudi Adults. Cureus 2023, 15, e33468. [Google Scholar] [CrossRef]
  25. He, J.; Sun, S.; Lin, Z.; Fan, X. The association between body appreciation and body mass index among males and females: A meta-analysis. Body Image 2020, 34, 10–26. [Google Scholar] [CrossRef] [PubMed]
  26. Lonergan, A.R.; Bussey, K.; Mond, J.; Brown, O.; Griffiths, S.; Murray, S.B.; Mitchison, D. Me, my selfie, and I: The relationship between editing and posting selfies and body dissatisfaction in men and women. Body Image 2019, 28, 39–43. [Google Scholar] [CrossRef]
  27. Min, J.; Fang Yan, A.; Wang, Y. Mismatch in Children’s Weight Assessment, Ideal Body Image, and Rapidly Increased Obesity Prevalence in China: A 10-Year, Nationwide, Longitudinal Study. Obesity 2018, 26, 1777–1784. [Google Scholar] [CrossRef]
  28. Yu, Z.; Tan, M. Disordered Eating Behaviors and Food Addiction among Nutrition Major College Students. Nutrients 2016, 8, 673. [Google Scholar] [CrossRef]
  29. Soulliard, Z.A.; Layland, E.K.; Smith, J.C.; Kipke, M.D.; Bray, B.C. Body Image Concerns, Correlates, and Community Connection Among Black and Latinx Sexual Minority Cisgender Men and Transgender/Gender Nonconforming Young Adults. LGBT Health 2022, 9, 122–130. [Google Scholar] [CrossRef]
  30. Kuo, J.H.; Albaladejo Carrera, R.; Cendra Mulyani, L.; Strong, C.; Lin, Y.C.; Hsieh, Y.P.; Tsai, M.C.; Lin, C.Y. Exploring the Interaction Effects of Gender Contentedness and Pubertal Timing on Adolescent Longitudinal Psychological and Behavioral Health Outcomes. Front. Psychiatry 2021, 12, 660746. [Google Scholar] [CrossRef]
  31. Kaakinen, M.; Sirola, A.; Savolainen, I.; Oksanen, A. Shared identity and shared information in social media: Development and validation of the identity bubble reinforcement scale. Media Psychol. 2020, 23, 25–51. [Google Scholar] [CrossRef]
  32. Crandall, A.; Weiss-Laxer, N.S.; Broadbent, E.; Holmes, E.K.; Magnusson, B.M.; Okano, L.; Berge, J.M.; Barnes, M.D.; Hanson, C.L.; Jones, B.L.; et al. The Family Health Scale: Reliability and Validity of a Short-and Long-Form. Front. Public Health 2020, 8, 587125. [Google Scholar] [CrossRef]
  33. Haneuse, S.; VanderWeele, T.J.; Arterburn, D. Using the E-Value to Assess the Potential Effect of Unmeasured Confounding in Observational Studies. JAMA 2019, 321, 602–603. [Google Scholar] [CrossRef]
  34. Treasure, J.; Duarte, T.A.; Schmidt, U. Eating disorders. Lancet 2020, 395, 899–911. [Google Scholar] [CrossRef]
  35. Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ. Tech. Rep. Ser. 1995, 854, 1–452. [Google Scholar]
  36. Stice, E.; Van Ryzin, M.J. A prospective test of the temporal sequencing of risk factor emergence in the dual pathway model of eating disorders. J. Abnorm. Psychol. 2019, 128, 119–128. [Google Scholar] [CrossRef] [PubMed]
  37. Jackson, T.; Jiang, C.; Chen, H. Associations between Chinese/Asian versus Western mass media influences and body image disturbances of young Chinese women. Body Image 2016, 17, 175–183. [Google Scholar] [CrossRef] [PubMed]
  38. Wang, R.; Gan, Y.; Wang, X.; Li, J.; Lipowska, M.; Izydorczyk, B.; Guo, S.; Lipowski, M.; Yang, Y.; Fan, H. The Mediating Effect of Negative Appearance Evaluation on the Relationship Between Eating Attitudes and Sociocultural Attitudes Toward Appearance. Front. Psychiatry 2022, 13, 776842. [Google Scholar] [CrossRef]
  39. Guo, Y.; Li, S.; Zhang, L.; Xuan, Q.; He, L.; Ye, Q.; Ma, J.; Peng, L.; Xiong, Y.; Yang, J.; et al. Depression and anxiety of medical students at Kunming Medical University during COVID-19: A cross-sectional survey. Front. Public Health 2022, 10, 957597. [Google Scholar] [CrossRef] [PubMed]
  40. Hill, M.L.; Masuda, A.; Latzman, R.D. Body image flexibility as a protective factor against disordered eating behavior for women with lower body mass index. Eat. Behav. 2013, 14, 336–341. [Google Scholar] [CrossRef]
  41. Elias, M.C.; Gomes, D.L.; Paracampo, C.C.P. Associations between Orthorexia Nervosa, Body Self-Image, Nutritional Beliefs, and Behavioral Rigidity. Nutrients 2022, 14, 4578. [Google Scholar] [CrossRef]
  42. Doo, M.; Kim, Y. The Risk of Being Obese According to Short Sleep Duration Is Modulated after Menopause in Korean Women. Nutrients 2017, 9, 206. [Google Scholar] [CrossRef] [PubMed]
  43. Fowler, N.; Keel, P.K.; Burt, S.A.; Neale, M.; Boker, S.; Sisk, C.L.; Klump, K.L. Associations between ovarian hormones and emotional eating across the menstrual cycle: Do ovulatory shifts in hormones matter? Int. J. Eat. Disord. 2019, 52, 195–199. [Google Scholar] [CrossRef] [PubMed]
  44. Joh, H.K.; Oh, J.; Lee, H.J.; Kawachi, I. Gender and socioeconomic status in relation to weight perception and weight control behavior in Korean adults. Obes. Facts 2013, 6, 17–27. [Google Scholar] [CrossRef]
  45. Bénard, M.; Camilleri, G.M.; Etilé, F.; Méjean, C.; Bellisle, F.; Reach, G.; Hercberg, S.; Péneau, S. Association between Impulsivity and Weight Status in a General Population. Nutrients 2017, 9, 217. [Google Scholar] [CrossRef]
  46. Arigo, D.; Schumacher, L.; Martin, L.M. Upward appearance comparison and the development of eating pathology in college women. Int. J. Eat. Disord. 2014, 47, 467–470. [Google Scholar] [CrossRef]
  47. Choi, H.G.; Lim, H. Association between BMI for Obesity and Distress about Appearance in Korean Adolescents. J. Korean Med. Sci. 2018, 33, e150. [Google Scholar] [CrossRef] [PubMed]
  48. Bruffaerts, R.; Mortier, P.; Kiekens, G.; Auerbach, R.P.; Cuijpers, P.; Demyttenaere, K.; Green, J.G.; Nock, M.K.; Kessler, R.C. Mental health problems in college freshmen: Prevalence and academic functioning. J. Affect. Disord. 2018, 225, 97–103. [Google Scholar] [CrossRef] [PubMed]
  49. Hu, J.; Wang, J.; Li, D.; Huang, X.; Xue, Y.; Jia, L.; Zhang, Z.; Wan, Y.; Song, X.; Wang, R.; et al. Mediating Effect of Sleep Disorder Between Low Mental Health Literacy and Depressive Symptoms Among Medical Students: The Roles of Gender and Grade. Front. Psychiatry 2022, 13, 818295. [Google Scholar] [CrossRef]
  50. Rana, Z.H.; Frankenfeld, C.L.; de Jonge, L.; Kennedy, E.J.; Bertoldo, J.; Short, J.L.; Cheskin, L.J. Dietary Intake and Representativeness of a Diverse College-Attending Population Compared with an Age-Matched US Population. Nutrients 2021, 13, 3810. [Google Scholar] [CrossRef]
  51. Xu, Y.M.; Pu, S.S.; Li, Y.; Zhong, B.L. Possible Avoidant Personality Disorder Magnifies the Association Between Bullying Victimization and Depressive Symptoms Among Chinese University Freshmen. Front. Psychiatry 2022, 13, 822185. [Google Scholar] [CrossRef]
  52. Pfeifer, J.H.; Kahn, L.E.; Merchant, J.S.; Peake, S.J.; Veroude, K.; Masten, C.L.; Lieberman, M.D.; Mazziotta, J.C.; Dapretto, M. Longitudinal change in the neural bases of adolescent social self-evaluations: Effects of age and pubertal development. J. Neurosci. Off. J. Soc. Neurosci. 2013, 33, 7415–7419. [Google Scholar] [CrossRef]
  53. Bian, D.; Shi, Y.; Tang, W.; Li, D.; Han, K.; Shi, C.; Li, G.; Zhu, F. The Influencing Factors of Nutrition and Diet Health Knowledge Dissemination Using the WeChat Official Account in Health Promotion. Front Public Health 2021, 9, 775729. [Google Scholar] [CrossRef]
  54. Ul Haq, I.; Mariyam, Z.; Li, M.; Huang, X.; Jiang, P.; Zeb, F.; Wu, X.; Feng, Q.; Zhou, M. A Comparative Study of Nutritional Status, Knowledge Attitude and Practices (KAP) and Dietary Intake between International and Chinese Students in Nanjing, China. Int. J. Environ. Res. Public Health 2018, 15, 1910. [Google Scholar] [CrossRef]
  55. Ulmer, F.; Pallivathukal, S.; Bartenstein, A.; Bieri, R.; Studer, D.; Lava, S.A.G. Preparedness for Life-Threatening Situations in a Pediatric Tertiary-Care University Children’s Hospital: A Survey. Children 2022, 9, 271. [Google Scholar] [CrossRef]
  56. Karcz, E.; Zdun-Ryżewska, A.; Zimmermann, A. Loneliness, Complaining and Professional Burnout of Medical Personnel of Psychiatric Wards during COVID-19 Pandemic-Cross-Sectional Study. Healthcare 2022, 10, 145. [Google Scholar] [CrossRef]
  57. Zhang, C.; Yang, L.; Liu, S.; Ma, S.; Wang, Y.; Cai, Z.; Du, H.; Li, R.; Kang, L.; Su, M.; et al. Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak. Front. Psychiatry 2020, 11, 306. [Google Scholar] [CrossRef] [PubMed]
  58. Varley, A.; Warren, F.C.; Richards, S.H.; Calitri, R.; Chaplin, K.; Fletcher, E.; Holt, T.A.; Lattimer, V.; Murdoch, J.; Richards, D.A.; et al. The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial. Int. J. Nurs. Stud. 2016, 58, 12–20. [Google Scholar] [CrossRef] [PubMed]
  59. Moulier, V.; Guinet, H.; Kovacevic, Z.; Bel-Abbass, Z.; Benamara, Y.; Zile, N.; Ourrad, A.; Arcella-Giraux, P.; Meunier, E.; Thomas, F.; et al. Effects of a life-skills-based prevention program on self-esteem and risk behaviors in adolescents: A pilot study. BMC Psychol. 2019, 7, 82. [Google Scholar] [CrossRef]
  60. Ip, K.T.V.; Ho, W.Y. Healing Childhood Psychological Trauma and Improving Body Image Through Cosmetic Surgery. Front. Psychiatry 2019, 10, 540. [Google Scholar] [CrossRef] [PubMed]
  61. Svensberg, K.; Björnsdottir, I.; Wallman, A.; Sporrong, S.K. Nordic Pharmacy Schools’ Experience in Communication Skills Training. Am. J. Pharm. Educ. 2017, 81, 6005. [Google Scholar] [CrossRef] [PubMed]
  62. Oh, H.; Kim, J.; Huh, Y.; Kim, S.H.; Jang, S.I. Association of Household Income Level with Vitamin and Mineral Intake. Nutrients 2021, 14, 38. [Google Scholar] [CrossRef] [PubMed]
  63. Hiza, H.A.; Casavale, K.O.; Guenther, P.M.; Davis, C.A. Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level. J. Acad. Nutr. Diet. 2013, 113, 297–306. [Google Scholar] [CrossRef]
  64. Pereira, B.; Silva, C.; Núñez, J.C.; Rosário, P.; Magalhães, P. "More Than Buying Extra Fruits and Veggies, Please Hide the Fats and Sugars": Children’s Diet Latent Profiles and Family-Related Factors. Nutrients 2021, 13, 2403. [Google Scholar] [CrossRef] [PubMed]
  65. Brotman, L.M.; Dawson-McClure, S.; Kamboukos, D.; Huang, K.Y.; Calzada, E.J.; Goldfeld, K.; Petkova, E. Effects of ParentCorps in Prekindergarten on Child Mental Health and Academic Performance: Follow-up of a Randomized Clinical Trial through 8 Years of Age. JAMA Pediatr. 2016, 170, 1149–1155. [Google Scholar] [CrossRef]
  66. Xia, X. Research on Mental Health Education Model of College Students under the Background of Internet. J. Healthc. Eng. 2022, 2022, 9979891. [Google Scholar] [CrossRef] [PubMed]
Nutrients 15 04273 g001
Figure 1. Association between body image flexibility and intermittent fasting in different subgroups. Note: The confounding variables (age, BMI, social media usage, family health, gender, academic year, major, monthly living expenses, and love experience) were adjusted for each stratification, except the stratification factor itself. BMI indicates body mass index. CNY indicates the Chinese Yuan. OR: odds ratio. 95%CI: 95% confidence interval.
Figure 1. Association between body image flexibility and intermittent fasting in different subgroups. Note: The confounding variables (age, BMI, social media usage, family health, gender, academic year, major, monthly living expenses, and love experience) were adjusted for each stratification, except the stratification factor itself. BMI indicates body mass index. CNY indicates the Chinese Yuan. OR: odds ratio. 95%CI: 95% confidence interval.
Nutrients 15 04273 g001
Table 1. Characteristics of participants according to the median body image flexibility (n = 5138).
Table 1. Characteristics of participants according to the median body image flexibility (n = 5138).
VariableTotalBody Image Flexibilityt/Z/χ2p-Value
≤25.24
(n = 2852)		>25.24
(n = 2286)
Age (years)20.54 ± 1.6220.58 ± 1.5720.48 ± 1.692.180.030
BMI (kg/m2)22.23 (19.23, 23.88)21.97 (19.82, 24.69)20.40 (18.68, 22.64)−15.24<0.001
Social media usage48.91 ± 18.9748.21 ± 18.3349.80 ± 19.71−2.990.003
Family health38.00 ± 6.8236.51 ± 6.0939.86 ± 7.23−17.99<0.001
Gender, n (%) 0.050.829
Male2119 (41.24)1180 (41.37)939 (41.08)
Female3019 (58.76)1672 (58.63)1347 (58.92)
Ethnicity, n (%) 0.010.909
Han4886 (95.10)2713 (95.13)2173 (95.06)
Minority252 (4.90)139 (4.87)113 (4.94)
Academic year, n (%) 49.80<0.001
Fifth830 (16.15)460 (16.13)370 (16.19)
Fourth1249 (24.31)745 (26.12)504 (22.05)
Third1244 (24.21)709 (24.86)535 (23.40)
Second907 (17.65)526 (18.44)381 (16.67)
First908 (17.67)412 (14.45)496 (21.70)
Major, n (%) 28.72<0.001
Clinical medicine862 (16.78)1312 (46.00)1108 (48.47)
Oral medicine625 (12.16)350 (12.27)275 (12.03)
Medical imaging2420 (47.10)133 (4.66)100 (4.37)
Traditional Chinese medicine289 (5.62)378 (13.25)331 (14.48)
Pharmacy233 (4.53)138 (4.84)151 (6.61)
Nursing709 (13.80)541 (18.97)321 (14.04)
Hukou, n (%) 1.800.180
Non-agricultural2031 (39.53)1104 (38.71)927 (40.55)
Agricultural3107 (60.47)1748 (61.29)1359 (59.45)
Place of residence, n (%) 1.630.201
Urban2781 (54.13)1521 (53.33)1260 (55.12)
Rural2357 (45.87)1331 (46.67)1026 (44.88)
Monthly living expenses (CNY), n (%) 1.020.600
≤800557 (10.84)307 (10.76)250 (10.94)
801–15002981 (58.02)1672 (58.63)1309 (57.26)
>15001600(31.14)873 (30.61)727 (31.80)
Love experience, n (%) 5.110.078
Never been in love2374 (46.20)1280 (44.88)1094 (47.86)
Have been in love1454 (28.30)837 (29.35)617 (26.99)
Are in love1310 (25.50)735 (25.77)575 (25.15)
Intermittent fasting, n (%) 212.33<0.001
No3809(74.13)1887 (66.16)1922 (84.08)
Yes1329(25.87)965 (33.84)364 (15.92)
Note: Continuous variables were presented as means ± standard deviations or the median and interquartile range, and categorical variables were presented as numbers and percentages. Percentages might not add up to 100% due to rounding. BMI indicates body mass index. CNY indicates the Chinese Yuan.
Table 2. Association between body image flexibility and intermittent fasting.
Table 2. Association between body image flexibility and intermittent fasting.
ModelOR (95%CI)p
Model Ⅰ0.93 (0.92, 0.94)<0.001
Model Ⅱ0.93 (0.92, 0.94)<0.001
Model Ⅲ0.94 (0.93, 0.95)<0.001
Note: Model I was unadjusted. Model II adjusted for age and gender. Model III adjusted for age, BMI, social media usage, family health, gender, academic year, major, monthly living expenses, and love experience. OR: odds ratio. 95%CI: 95% confidence interval.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Shi, X.; Wu, Y.; Yuan, J.; Wang, X.; Guo, C.; Zang, S. Association between Body Image Flexibility and Intermittent Fasting in Chinese Medical Students: A Cross-Sectional Study. Nutrients 2023, 15, 4273. https://doi.org/10.3390/nu15194273

AMA Style

Shi X, Wu Y, Yuan J, Wang X, Guo C, Zang S. Association between Body Image Flexibility and Intermittent Fasting in Chinese Medical Students: A Cross-Sectional Study. Nutrients. 2023; 15(19):4273. https://doi.org/10.3390/nu15194273

Chicago/Turabian Style

Shi, Xinji, Yibo Wu, Jie Yuan, Xue Wang, Chaowei Guo, and Shuang Zang. 2023. "Association between Body Image Flexibility and Intermittent Fasting in Chinese Medical Students: A Cross-Sectional Study" Nutrients 15, no. 19: 4273. https://doi.org/10.3390/nu15194273

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop