Prevalence of multiple behavioral risk factors for chronic diseases in medical students and associations with their academic performance.

Purpose Multiple behavioral risk factors (MBRFs) related to lifestyle have been associated with non-communicable diseases, but there is limited evidence on their prevalence in undergraduate medical students and their association with their academic performance. Methods During 1989-2017, data from 1,447 medical students of University of Crete, Greece (mean age 21.8±2.2yrs), were analyzed. MBRFs assessed included smoking, high body weight, physical inactivity, risky alcohol consumption and low consumption of fruits/vegetables. Academic performance was based on the grades received in the mandatory Clinical Nutrition course and the overall Medical degree (scale of 0-10). Results From the sample, 25.8% were smokers, 30.7% had high body weight and 67.2% had low consumption of fruits/vegetables. Prevalence of having ‘no MBRFs’ and having ‘multiple clustering’ or ‘3+ factors’ was 15.8% and 12.3%, respectively. Men had almost twice the prevalence of multiple clustering than women (16.5% vs. 8.4%, p<0.001). Participants who had none, compared to 3+, MBRFs had higher mean grades in the Clinical Nutrition course (6.34 vs. 5.94, p=0.027, p-trend=0.003) and overall degree (7.39 vs. 7.22, p=0.021, p-trend=0.002). As the number of MBRFs increased (from ‘none’ to ‘1’, ‘2’ and ‘3+’ factors), the proportion of graduates receiving a distinction also decreased (6.1%, 3.3%, 3.3% and 0.0%, respectively, p-trend=0.001). Conclusion Overall, high prevalence of MBRFs was observed in this sample of medical students, while MBRF clustering was prospectively inversely associated with academic performance. These findings highlight the need for preventive lifestyle strategies to improve these students’ behavioral risk factors and academic performance during their studies.