Food Insecurity, Energy Adequacy, and Direction-Specific Malnutrition Among University Students: A Cross-Sectional Study

Food insecurity may influence nutritional status through pathways that are not fully captured by short-term energy intake, and associations may differ between underweight and excess weight. This cross-sectional study examined 99 Biology students at Universitas Negeri Makassar. Food insecurity was assessed using an adapted 10-item U.S. Adult Food Security Survey Module, dietary intake using one 24-hour food recall, and nutritional status using measured body mass index. Spearman correlation, Kruskal-Wallis tests, direction-specific logistic regression, and multinomial logistic regression as a sensitivity analysis were performed. Overall, 55.6% of students were food insecure, 81.8% had energy intake below 100% of the recommended allowance on the recall day, and 33.3% were underweight. Food insecurity score was not significantly correlated with energy intake, energy adequacy, or BMI. In the binary model comparing underweight with normal BMI, each one-point increase in food insecurity score was associated with 23% higher odds of underweight after adjustment for energy adequacy and sex (aOR=1.23; 95% CI 1.01-1.50; p=0.036). The multinomial estimate for underweight versus normal was similar but borderline significant (RRR=1.19; 95% CI 1.00-1.43; p=0.056). These direction-specific findings should be interpreted as exploratory and warrant confirmation in larger and more diverse samples.