Abstract
BACKGROUND/OBJECTIVES: Eating disorders, including food neophobia and restrictive eating behaviors, are pervasive among university students. This study evaluated the psychometric properties of the Nine-Item Avoidant/Restrictive Food Intake Disorder Scale (NIAS), Düsseldorf Orthorexia Scale (DOS), Night Eating Syndrome Questionnaire (NESQ), Zung's Self-Rating Depression Scale (SDS), and Perceived Stress Scale (PSS) among university students in China and Pakistan to assess reliability and validity and explore the relationships between eating behaviors and mental health. METHODS: Initially, responses from 1056 university students from China and Pakistan were obtained, which were reduced to 1002 after screening. Sociodemographic data were collected. Descriptive statistics, reliability analysis, and Confirmatory Factor Analysis (CFA) were performed using SPSS and Analysis of Moment Structures (AMOS). RESULTS: The demographic data showed that 52% of the participants were female and 48% were male, with a mean age of 22.13 ± 3.86 years. Most were single (93.2%) and had a mean BMI of 22.06 ± 4.02 kg/m(2). The NIAS showed high internal consistency (Cronbach's Alpha: 0.731), and the CFA revealed strong factor loadings (0.57-0.79). The DOS showed good psychometric properties (factor loadings: 0.53-0.77). The NESQ indicated higher night eating behaviors in Chinese students, who also had higher stress (PSS: Mean Difference = 4.116, 95% CI: 3.36-4.87) and depression (SDS: Mean Difference = 0.229, 95% CI: 0.19-0.27) compared to Pakistani students, who showed more restrictive eating behaviors (NIAS: Mean Difference = -0.422, 95% CI: -0.51 to -0.33). CONCLUSIONS: The psychometric evaluation demonstrated strong reliability and validity in assessing eating behaviors and mental health among university students in China and Pakistan. These findings highlight cultural differences, with Chinese students showing higher levels of stress and depression and Pakistani students exhibiting more restrictive eating behaviors. These results suggest the need for culturally tailored interventions to address food-related mental health issues and improve students' well-being.