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.