Original Article

Introducción

One of the greatest challenges facing global public health is the prevention of non-communicable diseases (NCDs), also known as chronic diseases, such as diabetes, cardiovascular diseases, cancer, or chronic respiratory diseases, which can become complicated and lead to disability in daily functioning and, in the long term, death. These NCDs develop due to the presence of various metabolic, behavioral, and environmental risk factors <sup>1 ➤
1. Instituto Nacional de Estadística e Informática (INEI). Perú: Enfermedades No Transmisibles y Transmisibles [Internet]. Lima; 2019 [citado el 20 de enero de 2021]. Disponible en: https://proyectos.inei.gob.pe/endes/2019/SALUD/ENFERMEDADES_ENDES_2019.pdf 2 ➤
2.Organización Mundial de Salud / Organización Panamericana de la Salud. Las ENT de un vistazo: Mortalidad de las enfermedades no transmisibles y prevalencia de sus factores de riesgo en la Región de las Américas [Internet]. Washington, D.C.; 2019 [citado el 05 de febrero de 2021]. Disponible en: https://iris.paho.org/handle/10665.2/51752</sup> .

NCDs account for 70% of mortality worldwide among the 30-69 age group. However, it has been observed that 80% of these deaths occur prematurely, especially in low- and middle-income countries. In Latin America, the prevalence of NCDs increased from 77.4% in the year 2000 to 80.7% in 2016, with a higher prevalence in women. Among the countries with an increase in this prevalence is Peru ^{3 ➤
3.Organización Mundial de la Salud y Programa de las Naciones Unidas para el Desarrollo. Hacer frente a las enfermedades no transmisibles durante la pandemia de COVID-19 y después de ella.; Ginebra: 2020 [citado el 15 de marzo de 2021]. Disponible en: https://iris.who.int/bitstream/handle/10665/335827/WHO-2019-nCoV-Non-communicable_diseases-Policy_brief-2020.1-spa.pdf?sequence=1&isAllowed=y 4 ➤
4.Organización Panamericana de la Salud. Indicadores básicos 2019. Tendencias de la salud en las Américas. Indicadores básicos 2019 [internet]. Washington, D.C.: OPS; 2019 [citado el 15 de marzo de 2021]. Disponible en: https://www3.paho.org/hq/index.php?option=com_content&view=article&id=15499:core-indicators-2019-health-trends-in-the-americas&Itemid=0&lang=es#gsc.tab=0} .

Four main factors have been evidenced in the development of NCDs: tobacco use, unhealthy diet, physical inactivity, and excessive alcohol consumption. These are part of a person's lifestyle and are modifiable behaviors, as they are influenced by economic, social, cultural, and psychological situations. The influence of an inadequate lifestyle (IAL) is present in 99% of obesity cases, followed by 91% for diabetes mellitus cases, and thirdly, 82% of heart disease cases ^{5 ➤
5.Galeano-Munoz L, Pinillos-Patino Y, Herazo-Beltran Y, Gonzalez- Prestan J, Lopez-Royero A. Factores de riesgo para enfermedad crónica no transmisible en jóvenes universitarios de un programa de las ciencias de la salud de Barranquilla. Revista Latinoamericana de Hipertensión [internet]. 2018 [citado el 1 de marzo de 2020];13(4):374-379. Disponible en: https://www.revhipertension.com/rlh_4_2018/13_factores_riesgos_enfermedad_cronica.pdf 6 ➤
6.De la Cruz-Vargas JA, Dysinger W, Herzog S, dos Santos F, Villegas H, Ezinwa M. Lifestyle Medicine: Working together to reverse the chronic disease epidemic in Latin America. Revista la Facultad Med Humana. 2017;17(1):10-12. doi: 10.25176/RFMH.v17.n1.742} .

The transition between adolescence and adulthood is a period of lifestyle change and personal development that can influence dietary behavior due to changes in the academic environment or economic situation. These factors show a strong association with diet in this age range ^{7 ➤
7.Winpenny E M, Penney TL, Corder K, White M, van Sluijs E M F. Change in diet in the period from adolescence to early adulthood: a systematic scoping review of longitudinal studies. International Journal Behav Nutr Phys Act. 2017 May 4;14(1):60. doi: 10.1186/s12966-017-0518-7 8 ➤
8.Sprake E F, Russell J M, Cecil J E, Cooper R J, Grabowski P, Pourshahidi L K, Barker M E. Dietary patterns of university students in the UK: a cross-sectional study. Nutr Journal. 2018;17(1):90. doi: 10.1186/s12937-018-0398-y} .

Undergraduate university students are a population susceptible to presenting these risk factors and are in a period of their lives where they are still constantly changing their habits, which can affect their health benefits. The stress that accompanies this phase of life leads them to adopt an IAL, mainly characterized by poor nutrition, physical inactivity, and the use of legal and illegal drugs. Therefore, each behavior is voluntary and influenced by various sociodemographic factors ^{9 ➤
9.Villavicencio Guardia MC. Estilos de vida y el rendimiento académico de los estudiantes de una Facultad de Enfermería en Perú. Conrado [internet]. 2020 [citado el 3 de abril 2021];16(74):112-119. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1990-86442020000300112 10 ➤
10.Campo F Y, Pombo L M, Teherán V A A. Estilos de vida saludable y conductas de riesgo en estudiantes de medicina. Revista de la Universidad Industrial de Santander Salud. 2016;48(3):301-309. doi: 10.18273/revsal.v48n3-2016004} .

Thus, concern for health promotion takes on greater interest among health science students, not only for themselves but also for the role they play and will continue to play throughout their professional careers. They provide the necessary means to modify behaviors that endanger their health and that of their patients by managing external and internal factors to achieve an adequate or healthy lifestyle (AL) ^{10 ➤
10Campo F Y, Pombo L M, Teherán V A A. Estilos de vida saludable y conductas de riesgo en estudiantes de medicina. Revista de la Universidad Industrial de Santander Salud. 2016;48(3):301-309. doi: 10.18273/revsal.v48n3-2016004 12 ➤
12.Crowley J, Ball L, Hiddink GJ. Nutrition in medical education: a systematic review. Lancet Planet Health. 2019;3(9):e379-e389. doi: 10.1016/S2542-5196(19)30171-8} .

For this reason, this study investigated whether there are factors associated with the development of an IAL among medical students. Additionally, the most frequently altered dimensions among students with IAL were identified.

METHODS

Study Design and Area

A cross-sectional and analytical study was conducted through a survey of students enrolled in the 1st to 12th cycles of the School of Human Medicine at the Universidad Privada Antenor Orrego in the city of Trujillo, Peru, during the academic semester of the first half of 2023

Population and Sample

The surveys of students who met the following criteria were included: aged 18 years or older, who agreed to participate by providing informed consent. Those with incomplete data or an incomplete FANTASTIC questionnaire were excluded. A non-probabilistic sampling method was used.

Variables and Instruments

It was determined whether the variables such as age, sex, marital status, employment activity, family responsibilities, study cycle, and place of residence were factors associated with an inadequate lifestyle (IAL) among medical students.

Lifestyle was determined using the FANTASTIC questionnaire, which consists of 30 items distributed across 10 dimensions: family and friends' core, physical activity and associations, nutritional habits, tobacco use, alcohol or other drug consumption, sleep condition and stress levels, type of work and personality traits, presence of introspection, health control situation, and sexual and other behaviors. Each dimension was composed of 3 items, and each item could score between 0 and 2 points.

Most items were answered according to a Likert scale. The total score from the 30 items was multiplied by 2 to obtain the final score, with a range between 0 and 120 points. This score was classified into five categories summarizing the lifestyle of the student being evaluated: 0 to 46: At risk, 47 to 72: Low, could improve, 73 to 84: Doing well, 85 to 102: Doing right, 103 to 120: Fantastic lifestyle.

IAL was considered in the categories "At risk" and "Low, could improve," whereas an adequate lifestyle was considered in the categories "Doing well," "Doing right," and "Fantastic lifestyle."

This questionnaire has been adapted to our Spanish language and validated in various Latin American countries, including ours, with very good reliability results in university students ^{13 ➤
13.Orejón D. Validación de un instrumento para medir el estilo de vida de estudiantes de la Facultad de Medicina Humana en la Universidad Ricardo Palma en el año 2017 [Tesis Licenciatura]. Lima: Facultad de Medicina Humana en la Universidad Ricardo Palma; 2019.} .

In our country, the FANTASTIC questionnaire has been applied to healthcare workers. Villar et al. analyzed the reliability of this instrument and obtained a reliability score using Cronbach's alpha analysis of 0.778 <sup>14 ➤
14. Villar-López M, Ballinas-Sueldo Y, Gutiérrez C, Angulo-Bazán Y. Análisis de la confiabilidad del Test Fantastico para medir Estilos De Vida Saludables en trabajadores evaluados por el Programa “Reforma De Vida” Del Seguro Social De Salud (EsSalud). Revista Peru Med Integrativa. 2016;1(2):17. doi:10.26722/rpmi.2016.12.15</sup> .

Secondarily, the dimensions of the FANTASTIC questionnaire that were most frequently associated with IAL were identified.

Procedures

The research was approved by the Research and Ethics Unit of the School of Human Medicine at the Universidad Privada Antenor Orrego. A survey was then sent via a Google Forms URL to students through their institutional email, which included informed consent. The survey consisted of two parts: the first part involved collecting sociodemographic variables and the factors to be investigated, and the second part was the FANTASTIC questionnaire ^{14 ➤
14.Villar-López M, Ballinas-Sueldo Y, Gutiérrez C, Angulo-Bazán Y. Análisis de la confiabilidad del Test Fantastico para medir Estilos De Vida Saludables en trabajadores evaluados por el Programa “Reforma De Vida” Del Seguro Social De Salud (EsSalud). Revista Peru Med Integrativa. 2016;1(2):17. doi:10.26722/rpmi.2016.12.15} , which was the instrument used to identify and assess lifestyle.

Statistical Analysis

For data analysis, SPSS V.26 software was used. Descriptive statistics were applied, with frequencies and proportions used for qualitative variables, and means and standard deviations (SD) calculated for quantitative variables. Prevalence Ratio (PR) was calculated to determine the association of the proposed factors with IAL, considering significance at p < 0,05.

Ethical Aspects

The research was approved by the Research and Ethics Unit of the School of Human Medicine at the Universidad Privada Antenor Orrego (Resolution No. 0130-2022-FMEHU-UPAO). All participants provided informed consent and responded anonymously from a computer or electronic device with internet access.

RESULTS

A total of 258 students participated; their average age was 20.7 ± 3.5 years, 66.3% were female, 97.3% were single, 87.6% did not work while studying, 86.8% did not have any family members dependent on them, 78.7% lived in an urban area, and 18.6% were in their first study cycle (Table 1).

A total of 112 students (43.4%) exhibited an inadequate lifestyle (IAL), while the remaining 146 (56.6%) had an adequate lifestyle (AL) (Table 2). In Table 2, it is observed that those with IAL had an average age of 20.7 ± 3.1 years, 72.3% were female, 98.2% were single, 89.3% did not work while studying, 86.6% did not have any family members dependent on them, 82.1% lived in an urban area, and 16.1% were in their first study cycle. On the other hand, students with AL had an average age of 20.7 ± 3.8 years, 61.6% were female, 96.6% were single, 86.3% did not work while studying, 87.0% did not have any family members dependent on them, 76% lived in an urban area, and 20.5% were in their first study cycle.

The most prevalent characteristics in participants with IAL were being female, single, not working while studying, not having a dependent family member, residing in urban areas, and being students in the 3rd to 10th study cycles. When the bivariate analysis of the studied factors and lifestyle type was performed, no significant difference was found in the factors investigated (Table 2).

Additionally, multivariate analysis was performed, where the crude prevalence ratio (PRc) and adjusted prevalence ratio (PRa) were determined for all variables considered as factors associated with an inadequate lifestyle in medical students. In the results of the analysis, no significant association was found (Table 3).

In Table 4, the mean score with its standard deviation of the 10 dimensions that make up the FANTASTIC questionnaire is presented; the scores ranged between 2.84 and 5.04. It was found that the four dimensions with the lowest scores were physical activity (3.02 ± 1.53 points), sleep and stress (3.00 ± 1.48 points), introspection (3.01 ± 1.50 points), and health control (2.84 ± 1.55 points).

In Table 5, the frequency of students' responses to each of the items that make up the four dimensions with the lowest scores in the FANTASTIC questionnaire is shown.

DISCUSSION

Female students were the majority of participants in this survey to evaluate lifestyle. Although the proportion of female and male students was 66.3% and 33.7%, respectively, these findings were similar to those reported by Ramírez-Vélez et al. ^{15 ➤
15.Ramírez-Vélez R, Triana-Reina HR, Carrillo HA, Ramos-Sepúlveda JA, Rubio F, Poches-Franco L, et al. A cross-sectional study of Colombian University students' self-perceived lifestyle. Springerplus. 2015;4:289. doi: 10.1186/s40064-015-1043-2} , Jiménez and Hernández ^{16 ➤
16.Jiménez-Morgan S y Hernández-Elizondo J. Actividad física y otros hábitos de vida de estudiantes de Medicina de la Universidad de Costa Rica. Pensar En Movimiento: Revista De Ciencias Del Ejercicio Y La Salud. 2016;14(1):1-14. doi: 10.15517/pensarmov.v14i1.19294} , Canova-Barrios ^{17 ➤
17.Canova-Barrios C. Estilo de vida de estudiantes universitarios de enfermería de Santa Marta, Colombia. Rev Colomb Enfermería. 2017;14(12):23. doi: 10.18270/rce.v14i12.2025} , Cáceres and Morales <sup>18 ➤
18. Cáceres AB, Morales I. Estilo de vida de estudiantes de medicina chilenos durante la pandemia por COVID-19. Rev. Fac. Med. Hum. 2022;22(1):60-68. doi: 10.25176/rfmh.v22i1.4125</sup> and Silva et al. ^{19 ➤
19.Martins JMS, Ferreira EAL, Valete COS, Gramasco HHF. Fantastic Lifestyle Questionnaire applied to undergraduate medical students during the COVID-19 pandemic: a factor analysis. Rev Assoc Med Bras (1992). 2022;68(5):658-663. doi: 10.1590/1806-9282.20220026} , where female participants predominated. However, this differs from the findings of Pacheco et al. ^{20 ➤
20.Pacheco RL, Santos-Silva DA, Gordia AP, Bianchini TM, Petroski EL. Sociodemographic determinants of university students' lifestyles. Rev Salud Pública. 2014;16(3):382-393. doi: 10.15446/rsap.v16n3.33164} , Alzahrani et al. ^{21 ➤
21.Alzahrani SH, Malik AA, Bashawri J, Shaheen SA, Shaheen MM, Alsaib AA, et al. Health-promoting lifestyle profile and associated factors among medical students in a Saudi university. SAGE Open Med. 2019;7(1):1-7. doi: 10.1177/2050312119838426.} and Montenegro and Ruiz ^{22 ➤
22.Montenegro, A., & Ruíz, A. Factores asociados a los estilos de vida en los estudiantes universitarios. Una aplicación del instrumento fantástico. Revista Actividad Física y Deporte. 2019;6(1):87-108. doi: 10.31910/rdafd.v6.n1.2020.1432} , where the majority of participants were male.

Female students were more prevalent in having IAL, something also described by Alzahrani et al. ^{21 ➤
21.Alzahrani SH, Malik AA, Bashawri J, Shaheen SA, Shaheen MM, Alsaib AA, et al. Health-promoting lifestyle profile and associated factors among medical students in a Saudi university. SAGE Open Med. 2019;7(1):1-7. doi: 10.1177/2050312119838426.} , where women showed inadequate lifestyle scores. However, this contrasts with what was reported by Cáceres and Morales ^{18 ➤
18.Cáceres AB, Morales I. Estilo de vida de estudiantes de medicina chilenos durante la pandemia por COVID-19. Rev. Fac. Med. Hum. 2022;22(1):60-68. doi: 10.25176/rfmh.v22i1.4125} , Montenegro and Ruiz ^{22 ➤
22.Montenegro, A., & Ruíz, A. Factores asociados a los estilos de vida en los estudiantes universitarios. Una aplicación del instrumento fantástico. Revista Actividad Física y Deporte. 2019;6(1):87-108. doi: 10.31910/rdafd.v6.n1.2020.1432} and Fang et al. ^{23 ➤
23.Fang M de los A, Hernández R, Gutiérrez T, Del Ángel B, Aspera T, Pérez ME. Estilo de vida y su asociación con variables sociodemográficas en universitarios. Ciencia Latina Revista Científica Multidisciplinar. 2023;7(2):8915-27. doi: 10.37811/cl_rcm.v7i2.6003} , where females exhibited better lifestyle habits compared to males.

On the other hand, gender has been cited by other authors as a determinant of lifestyle behaviors that promote health ^{23 ➤
23.Fang M de los A, Hernández R, Gutiérrez T, Del Ángel B, Aspera T, Pérez ME. Estilo de vida y su asociación con variables sociodemográficas en universitarios. Ciencia Latina Revista Científica Multidisciplinar. 2023;7(2):8915-27. doi: 10.37811/cl_rcm.v7i2.6003} , <sup>24 ➤
24. García-Laguna D, García-Salamanca G, Tapiero-Paipa Y, Ramos D. Determinantes de los estilos de vida y su implicación en la salud de jóvenes universitarios. Revista Hacia la Promoción la Salud [Internet]. 2012 [citado el 12 de marzo de 2020];17(2):169-85. Dsiponible en: https://www.redalyc.org/pdf/3091/309126826012.pdf</sup> . In fact, many social practices are gender-typed in society, and sports are often considered a male-dominated domain where male students tend to spend their free time on sports activities, while female students prefer to spend this time with family ^{21 ➤
21.Alzahrani SH, Malik AA, Bashawri J, Shaheen SA, Shaheen MM, Alsaib AA, et al. Health-promoting lifestyle profile and associated factors among medical students in a Saudi university. SAGE Open Med. 2019;7(1):1-7. doi: 10.1177/2050312119838426.} . However, some unhealthy behaviors are also associated with males, such as distancing from family, tobacco, and alcohol consumption ^{23 ➤
23.Fang M de los A, Hernández R, Gutiérrez T, Del Ángel B, Aspera T, Pérez ME. Estilo de vida y su asociación con variables sociodemográficas en universitarios. Ciencia Latina Revista Científica Multidisciplinar. 2023;7(2):8915-27. doi: 10.37811/cl_rcm.v7i2.6003} .

Some studies have established that socioeconomic status is associated with healthy practices ^{25 ➤
25.White CM, St. John PD, Cheverie MR, Iraniparast M, Tyas SL. The role of income and occupation in the association of education with healthy aging: Results from a population-based, prospective cohort study Health behavior, health promotion and society. BMC Public Health. 2015;15(1):1-11. doi: 10.1186/s12889-015-2504-9} , ^{26 ➤
26.Al-Naggar RA, Bobryshev Y V., Mohd Noor NAB. Lifestyle practice among malaysian university students. Asian Pacific J Cancer Prev. 2013;14(3):1895-903. doi: 10.7314/apjcp.2013.14.3.1895 .} . However, within university life, this factor could present both situations; higher income may encourage students to adopt the active social life of this particular environment, but it may also provide easy access to the negative aspects of university life, such as physical inactivity ^{23 ➤
23.Fang M de los A, Hernández R, Gutiérrez T, Del Ángel B, Aspera T, Pérez ME. Estilo de vida y su asociación con variables sociodemográficas en universitarios. Ciencia Latina Revista Científica Multidisciplinar. 2023;7(2):8915-27. doi: 10.37811/cl_rcm.v7i2.6003} , ^{27 ➤
27.Shekhar R, Prasad N, Singh T. Lifestyle factors influencing medical and nursing student’s health status at the rural health‑care institute. J Educ Health Promot [Internet]. 2022;11(1):21. doi: 10.4103/jehp.jehp_206_21.} .

Students aged 25 or younger had the highest prevalence of IAL, a finding similar to what was reported by Montenegro and Ruíz ^{22 ➤
22.Montenegro, A., & Ruíz, A. Factores asociados a los estilos de vida en los estudiantes universitarios. Una aplicación del instrumento fantástico. Revista Actividad Física y Deporte. 2019;6(1):87-108. doi: 10.31910/rdafd.v6.n1.2020.1432} , whose study indicated that those under 26 years of age showed very poor or average lifestyles. This differs from what was reported by Fang et al. ^{23 ➤
23.Fang M de los A, Hernández R, Gutiérrez T, Del Ángel B, Aspera T, Pérez ME. Estilo de vida y su asociación con variables sociodemográficas en universitarios. Ciencia Latina Revista Científica Multidisciplinar. 2023;7(2):8915-27. doi: 10.37811/cl_rcm.v7i2.6003} , who noted that, as participants' age increased, the dimensions of family/friends, tobacco, and alcohol were associated with IAL.

The marital status with the highest prevalence of IAL was found among single students (98.2% versus 96.6% of those with AL), a finding opposite to that found by Montenegro and Ruiz ^{22 ➤
22.Montenegro, A., & Ruíz, A. Factores asociados a los estilos de vida en los estudiantes universitarios. Una aplicación del instrumento fantástico. Revista Actividad Física y Deporte. 2019;6(1):87-108. doi: 10.31910/rdafd.v6.n1.2020.1432} and Shekhar et al. ^{27 ➤
27.Shekhar R, Prasad N, Singh T. Lifestyle factors influencing medical and nursing student’s health status at the rural health‑care institute. J Educ Health Promot [Internet]. 2022;11(1):21. doi: 10.4103/jehp.jehp_206_21} , where those who were married had a higher prevalence of AL.

Students who dedicated themselves solely to studying mostly had IAL, a finding similar to what was reported by Montenegro and Ruíz ^{22 ➤
22.Montenegro, A., & Ruíz, A. Factores asociados a los estilos de vida en los estudiantes universitarios. Una aplicación del instrumento fantástico. Revista Actividad Física y Deporte. 2019;6(1):87-108. doi: 10.31910/rdafd.v6.n1.2020.1432} . Residing in an urban area had a higher frequency of IAL compared to semi-urban and rural areas, a result similar to what was reported by Shekhar et al. ^{27 ➤
27.Shekhar R, Prasad N, Singh T. Lifestyle factors influencing medical and nursing student’s health status at the rural health‑care institute. J Educ Health Promot [Internet]. 2022;11(1):21. doi: 10.4103/jehp.jehp_206_21} .

The academic cycles where IAL was most prevalent were those between the third and tenth cycles, similar to what was reported by Alzahrani et al. ^{21 ➤
21.Alzahrani SH, Malik AA, Bashawri J, Shaheen SA, Shaheen MM, Alsaib AA, et al. Health-promoting lifestyle profile and associated factors among medical students in a Saudi university. SAGE Open Med. 2019;7(1):1-7. doi: 10.1177/2050312119838426.} , where IAL was found among students in the fifth and sixth cycles, particularly concerning stress management, and by Fang et al. ^{23 ➤
23.Fang M de los A, Hernández R, Gutiérrez T, Del Ángel B, Aspera T, Pérez ME. Estilo de vida y su asociación con variables sociodemográficas en universitarios. Ciencia Latina Revista Científica Multidisciplinar. 2023;7(2):8915-27. doi: 10.37811/cl_rcm.v7i2.6003} , who determined that students in the sixth, seventh, and eighth cycles had IAL due to increased tobacco use. Our findings could be related to the fact that, during intermediate academic semesters, most students' physical activity decreases, adequate sleep hours decrease, and stress increases. However, stress management improves with age, and introspection and health control are less managed at younger ages and with less medical education.

The academic cycle represents another factor that can influence lifestyle. In fact, it has been shown that stress management improves with age and experience ^{23 ➤
23.Fang M de los A, Hernández R, Gutiérrez T, Del Ángel B, Aspera T, Pérez ME. Estilo de vida y su asociación con variables sociodemográficas en universitarios. Ciencia Latina Revista Científica Multidisciplinar. 2023;7(2):8915-27. doi: 10.37811/cl_rcm.v7i2.6003} Additionally, education and training have proven effective in raising awareness about improving lifestyle among students. Studies conducted among medical students have also shown that the more they practice healthy behaviors, the more committed they are to educating patients about health-promoting behaviors ^{24 ➤
24.García-Laguna D, García-Salamanca G, Tapiero-Paipa Y, Ramos D. Determinantes de los estilos de vida y su implicación en la salud de jóvenes universitarios. Revista Hacia la Promoción la Salud [Internet]. 2012 [citado el 12 de marzo de 2020];17(2):169-85. Dsiponible en: https://www.redalyc.org/pdf/3091/309126826012.pdf} .

In the present study, the average scores of the dimensions in the FANTASTIC questionnaire ranged between 2.84 and 5.04, similar to what was reported by Montenegro and Ruíz ^{22 ➤
22.Montenegro, A., & Ruíz, A. Factores asociados a los estilos de vida en los estudiantes universitarios. Una aplicación del instrumento fantástico. Revista Actividad Física y Deporte. 2019;6(1):87-108. doi: 10.31910/rdafd.v6.n1.2020.1432} , and different from what was found by Canova-Barrios ^{17 ➤
17.Canova-Barrios C. Estilo de vida de estudiantes universitarios de enfermería de Santa Marta, Colombia. Rev Colomb Enfermería. 2017;14(12):23. doi: 10.18270/rce.v14i12.2025} where the dimension scores did not exceed two points.

Our study found no association between the proposed sociodemographic and family factors and IAL among students from the School of Human Medicine. These findings are similar to those reported by Alzahrani et al. ^{21 ➤
21.Alzahrani SH, Malik AA, Bashawri J, Shaheen SA, Shaheen MM, Alsaib AA, et al. Health-promoting lifestyle profile and associated factors among medical students in a Saudi university. SAGE Open Med. 2019;7(1):1-7. doi: 10.1177/2050312119838426.} and Montenegro y Ruíz ^{22 ➤
22.Montenegro, A., & Ruíz, A. Factores asociados a los estilos de vida en los estudiantes universitarios. Una aplicación del instrumento fantástico. Revista Actividad Física y Deporte. 2019;6(1):87-108. doi: 10.31910/rdafd.v6.n1.2020.1432} , who also did not find sociodemographic factors associated with the lifestyles of medical students.

Similarly, in this study, the average scores of the 10 dimensions of the FANTASTIC questionnaire were determined to identify which had the lowest scores among participants with an inadequate lifestyle (IAL) (Table 4). Additionally, the responses to the items in the 4 dimensions with the lowest scores were broken down, providing an opportunity to specifically strengthen these areas (Table 5). The identified dimensions were health control, sleep and stress, introspection, and physical activity, the latter being frequently reported in previous studies of similar populations <sup>16 ➤
16. Jiménez-Morgan S y Hernández-Elizondo J. Actividad física y otros hábitos de vida de estudiantes de Medicina de la Universidad de Costa Rica. Pensar En Movimiento: Revista De Ciencias Del Ejercicio Y La Salud. 2016;14(1):1-14. doi: 10.15517/pensarmov.v14i1.19294 17 ➤
17. Canova-Barrios C. Estilo de vida de estudiantes universitarios de enfermería de Santa Marta, Colombia. Rev Colomb Enfermería. 2017;14(12):23. doi: 10.18270/rce.v14i12.2025 22 ➤
22. Montenegro, A., & Ruíz, A. Factores asociados a los estilos de vida en los estudiantes universitarios. Una aplicación del instrumento fantástico. Revista Actividad Física y Deporte. 2019;6(1):87-108. doi: 10.31910/rdafd.v6.n1.2020.1432 26 ➤
26. Al-Naggar RA, Bobryshev Y V., Mohd Noor NAB. Lifestyle practice among malaysian university students. Asian Pacific J Cancer Prev. 2013;14(3):1895-903. doi: 10.7314/apjcp.2013.14.3.1895 28 ➤
28. Andraus GS, Vieira FM, Candido GM, Patino GP, Bernardelli RS, de Palma HLA. Associations between Lifestyle and Sociodemographic Factors in Medical Students: A Cross Sectional Study. J Lifestyle Med. 2023;13(1):73-82. doi: 10.15280/jlm.2023.13.1.73. 29 ➤
29.Mazurek Melnyk B, Slevin C, Militello L, Hoying J, Teall A, McGovern C. Physical health, lifestyle beliefs and behaviors, and mental health of entering graduate health professional students: Evidence to support screening and early intervention. Journal of the American Association of Nurse Practitioners. 2016; 28(4):204-211. doi: 10.1002/2327-6924.12350</sup> .

Meanwhile, the dimensions least associated with IAL, because they obtained the highest scores, were those related to alcohol consumption, tobacco use, other behaviors, and family and friends. This differs from what has been reported by other researchers, where alcohol and tobacco consumption were frequently associated with IAL among students

However, it is similar to what was described by Cáceres and Morales <sup>18 ➤
18. Cáceres AB, Morales I. Estilo de vida de estudiantes de medicina chilenos durante la pandemia por COVID-19. Rev. Fac. Med. Hum. 2022;22(1):60-68. doi: 10.25176/rfmh.v22i1.4125</sup> and Martins et al. ^{19 ➤
19.Martins JMS, Ferreira EAL, Valete COS, Gramasco HHF. Fantastic Lifestyle Questionnaire applied to undergraduate medical students during the COVID-19 pandemic: a factor analysis. Rev Assoc Med Bras (1992). 2022;68(5):658-663. doi: 10.1590/1806-9282.20220026} .

The COVID-19 pandemic caused university classes to be held virtually from 2020 to 2022 due to the restriction on free movement until the population was vaccinated against SARS-CoV-2. In our country, classes were made mandatory in person starting in 2023, which meant that the participating population was exposed to additional factors related to suboptimal physical activity, inadequate nutrition, and stress. Martins et al. ^{19 ➤
19.Martins JMS, Ferreira EAL, Valete COS, Gramasco HHF. Fantastic Lifestyle Questionnaire applied to undergraduate medical students during the COVID-19 pandemic: a factor analysis. Rev Assoc Med Bras (1992). 2022;68(5):658-663. doi: 10.1590/1806-9282.20220026} conducted a study during the COVID-19 pandemic at a public university in Brazil, finding that 42.6% of the 61 medical students had an IAL, and the predominantly compromised domains were sleep, nutrition, stress, and physical activity. This contrasts with what was reported by Cáceres and Morales ^{18 ➤
18.Cáceres AB, Morales I. Estilo de vida de estudiantes de medicina chilenos durante la pandemia por COVID-19. Rev. Fac. Med. Hum. 2022;22(1):60-68. doi: 10.25176/rfmh.v22i1.4125} , who found that in 72 medical students from Adventist public and private universities in Chile, Argentina, and Bolivia, 4.2% of participants had IAL, and in these students, the predominantly compromised domains were nutrition, health control, and physical activity; it is important to mention that 61.1% of the students identified as non-omnivorous diet consumers.

The identification of factors associated with IAL and the predominantly compromised domains in university students has led to interventions focused on physical activity, establishing dietary intake guidelines for better results, and reducing the risk of developing non-communicable diseases (NCDs) in the long term. Higher education institutions are an appropriate setting to begin promoting healthy and adequate lifestyle practices among their students ^{30 ➤
30.Plotnikoff R C, Costigan S A, Williams R L, Hutchesson M J, Kennedy S G, Robards SL et al. Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2015 Apr 1;12:45. doi: 10.1186/s12966-015-0203-7. 32 ➤
32.Belogianni K, Baldwin C. Types of Interventions Targeting Dietary, Physical Activity, and Weight-Related Outcomes among University Students: A Systematic Review of Systematic Reviews. Adv Nutr. 2019 Sep 1;10(5):848-863. doi: 10.1093/advances/nmz027}

Among the limitations of this study are those inherent in a cross-sectional design, where a cause-effect relationship cannot be established, as well as the reliance on participants' memory to answer the questionnaire. The research was conducted at a single private university, which limits the generalization of our results. The sample size, the studied association factors, as well as the use of a non-probabilistic convenience sampling method may have introduced biases that could be controlled in future studies.

n: number of participants

n: number of participants. SD: standard deviation

*PRc: Crude Prevalence Ratio. CI**: Confidence Interval. ***PRa: Adjusted Prevalence Ratio. vs.: versus.

IAL: Inadequate lifestyle. AL: Adequate lifestyle. n: number of participants.

Conclusion

Age, gender, marital status, employment activity, having family responsibilities, study cycle, and place of residence were not factors associated with an inadequate lifestyle (IAL) among students of the School of Medicine at the Universidad Privada Antenor Orrego. The most prevalent dimensions in students with IAL were health control, sleep and stress, introspection, and physical activity.