Associations between food-related behaviours, nutrient intake and nutritional status through Structural Equation Model (SEM) among clients undergoing Community-Based Treatment and Rehabilitation (CBTaR): A cross-sectional study in Kelantan, Malaysia.

OBJECTIVE

To examine the associations between food-related behaviours and nutrient intake on nutritional status among clients undergoing Community-Based Treatment and Rehabilitation (CBTaR) in Kelantan, Malaysia.

DESIGN

Cross-sectional analytical study.

SETTING

Seven CBTaR centres (n=7) across the state of Kelantan, Malaysia.

PARTICIPANTS

A total of 393 adult clients (aged 18 years and above) enrolled in CBTaR programmes between June and December 2022 were selected through stratified random sampling.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was nutritional status, assessed using body mass index. Secondary outcomes included nutrient intake (macronutrients and micronutrients) and food-related behaviours (emotional eating, external eating, restrained eating and food addiction), measured through Bahasa Malaysia validated questionnaires and 24-hour dietary recalls. All variables were introduced into the structural equation modelling to examine the associations among these variables and their association with nutritional status.

RESULTS

The results revealed that food-related behaviour was significantly associated with the nutrient intake (β=-0.524, p≤0.001). Additionally, the drug use profile significantly determined the food-related behaviour (β=-0.129, p=0.006) and nutritional status (β=-0.134, p=0.007). Nutrient intake was found to be a significant predictor of nutritional status (β=-0.213, p≤0.001). Sociodemographic and drug use profiles were significantly correlated with nutritional outcomes through behavioural and dietary associations. Importance-performance map analysis identified nutrient intake as the most impactful variable, highlighting the need for urgent intervention (R2=0.272).

CONCLUSIONS

This study highlights that nutrient intake is a significant predictor associated with food-related behaviours on nutritional status among individuals with substance use disorder. Integrating nutrition counselling and behavioural interventions into CBTaR services may improve recovery and long-term health outcomes.