# Association between external eating and dietary patterns among middle school students in Chongqing, China

## TL;DR

This study explores how external eating behaviors relate to different dietary patterns among middle school students in Chongqing, China.

## Contribution

The study identifies specific dietary patterns and their associations with external eating in a large sample of Chinese middle school students.

## Key findings

- External eating is positively linked to fast-food and balanced dietary patterns.
- External eating is negatively linked to modern dietary patterns.
- Three distinct dietary patterns were identified: modern, fast-food, and balanced.

## Abstract

The dietary pattern, serving as a comprehensive indicator of the nutritional intake of middle school students, plays a crucial role in guiding their health. External eating, the behavior of eating based on external cues associated with food (e.g., the sight and smell of food), is a key factor influencing the choice of dietary patterns.

To investigate the dietary patterns of middle school students in Chongqing and analyze the association between external eating and dietary patterns.

A cross-sectional study was conducted among 6,590 middle school students from 17 districts and counties in Chongqing, selected by stratified cluster sampling. The questionnaire included basic information about the participants, external eating score [based on the Dutch Eating Behaviour Questionnaire (DEBQ)] and dietary frequency, and data were collected via online self-report. Exploratory factor analysis was employed to extract dietary patterns, and multiple linear regression analysis was used to analyze the association between external eating and dietary patterns among middle school students.

The total score for external eating among middle school students in Chongqing ranges from 19 to 27. Three dietary patterns were identified among middle school students: modern dietary pattern, fast-food dietary pattern, and balanced dietary pattern. The results of multiple linear regression analysis showed that, external eating is positively associated with fast-food and balanced dietary pattern after adjusting for confounders [β = 0.006, 95% confidence interval (CI) : (0.002, 0.011), P = 0.002; β = 0.005, 95% CI: (0.001, 0.010), P = 0.016], external eating was negatively associated with modern dietary pattern [β = –0.005, 95% CI: (–0.009, –0.001), P = 0.018].

External eating exhibits a significant negative association with modern dietary pattern among middle school students. Therefore, middle school students should be guided to correctly deal with external eating, so as to establish a reasonable dietary pattern.