Lifestyle and non-communicable diseases risk factors: Changes in Nutrition, Sleep Patterns, Tobacco Use, Mental Health, and Physical Activity During the First Three Years of University: A Cohort Profile

Lifestyle and non-communicable diseases risk factors: Changes in Nutrition, Sleep Patterns, Tobacco Use, Mental Health, and Physical Activity During the First Three Years of University: A Cohort Profile | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Lifestyle and non-communicable diseases risk factors: Changes in Nutrition, Sleep Patterns, Tobacco Use, Mental Health, and Physical Activity During the First Three Years of University: A Cohort Profile Yosra Azizpour, Sarmad Salehi, Mina Mirzad, Yosef Farzi, Keyvan Karimi, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6710758/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: University students, particularly in the medical sciences, go through lifestyle changes during their higher education that influence their health status. These changes could happen in non-communicable diseases (NCDs) risk factors, including dietary intake, sleep patterns, use of tobacco, one's mental well-being, body dimensions, and physical activity status. The present study aimed to assess the above changes over the first three years of students’ education in Iran. Methods: The present study is a prospective cohort study to examine student lifestyle changes during the first three years of university. It evaluates the changes in lifestyle and NCDs risk factors over three years. In the first year, basic information was collected through a questionnaire, covering aspects such as nutrition, sleep patterns, tobacco use, mental health, and physical activity. Additionally, physical measurements—including height, weight, blood pressure, and waist circumference—were taken, along with laboratory examination for fasting blood sugar (FBS), liver enzymes, kidney function tests, and lipid profiles. In the second and third years, follow-ups on students' lifestyle changes will be conducted using similar questionnaires, and paraclinical tests will be repeated in the third year. To determine the sample size, the population proportion estimation formula was utilized, resulting in an initial estimate of 383 participants. This number was subsequently increased to 426 to account for a 10% non-response rate. Participants were selected proportionally based on the number of students in each faculty and stratified by gender. Newly arrived Iranian students over the age of 18 are eligible to participate. To ensure data accuracy, close supervision, observer training, and rigorous data quality control measures were implemented throughout the research process. Conclusion: The results of the study can help identify concerning patterns in student behavior and pave the way for the development of educational programs and interventions that enhance both students' physical and mental health while preventing the onset of NCDs in the future. Additionally, these findings could contribute to improved academic performance and increased productivity within academic environments. Lifestyle Medical Students NCDs Risk Factors Iran Background An appreciable proportion of the youth, university students in particular, are exposed to a wide range of health-related choices, making them more susceptible to unhealthy behaviors such as smoking, stress, poor diet, and a sedentary lifestyle [ 1 ]. The transition from high school to university significantly alters the social, physical, and emotional landscapes of young people, often leading to the emergence of certain behaviors such as unhealthy dietary practices, cigarette or alcohol use, and insufficient physical activity (PA), especially among students who are far from their families [ 2 ]. These habits increase the risk of suffering from Non-communicable diseases (NCDs) [ 2 ]. NCDs have both modifiable and non-modifiable risk factors. Non-modifiable factors include uncontrollable and inherent characteristics such as age, sex, and genetics. Modifiable factors encompass lifestyle behaviors that individuals can change. To effectively address the major NCDs, intervention programs are essential to promote lifestyle changes that can reduce risk [ 3 ]. Health promotion programs in academic environments target students and the public to prevent NCDs through healthy behaviors [ 1 ]. In a study involving 18,017 university students from 24 countries, researchers found a high prevalence of NCD risk factors. These included physical inactivity, poor diet, overweight or obesity, heavy alcohol consumption, and tobacco use. The results indicated a significant co-occurrence of these risk factors among the students [ 4 ]. Several studies have emphasized the widespread presence of physical inactivity, unhealthy eating habits, and tobacco use among students [ 2 , 5 – 7 ]. A systematic review revealed that about one-quarter of students worldwide are overweight or obese, a trend that presents significant health risks for this age group [ 8 ]. Mental health concerns among college students are an increasing global issue, as highlighted by the World Health Organization (WHO)’s World Mental Health Surveys International College Student Project [ 9 ]. Several studies indicate that medical students experience health issues, including depression, suicidal ideation, and stress [ 10 – 12 ]. In recent years, the lifestyle of students in Iran has changed significantly due to rapid social, economic, and cultural transformations. These changes are especially evident among new incoming university students, who face challenges such as adjusting to new living environments, managing academic pressures, and coping with increased stress. NCDs pose a major health issue in Iran, making it essential to understand and address the risk factors associated with them to effectively manage their impact [ 3 ]. It is very important to examine the lifestyle of students to identify modifiable risk factors. This research is a first prospective cohort study designed to investigate lifestyle changes among students at Tehran University of Medical Sciences over three years, as well as their relationship with risk factors for NCDs and academic performance. Methods Study Design and Data Collection Process This study is a prospective cohort study designed to investigate lifestyle changes among students at Tehran University of Medical Sciences over three years and their relationship with risk factors for NCDs and academic performance. Study Phases First Phase (First Year): In this phase, baseline information, including lifestyle factors (nutrition, sleep patterns, tobacco and alcohol use, mental health, and physical activity), was collected through questionnaires. Additionally, measurements of blood pressure, height, weight, waist circumference, and paraclinical tests were conducted. Second Phase (Second Years): This phase will involve follow-ups on students’ lifestyle changes using similar questionnaires. Third Phase (Third Years): This phase will involve follow-ups on students’ lifestyle changes using similar questionnaires. Paraclinical tests will be repeated in the third year. Trained field workers will guide and measure the participants during these stages to ensure the accuracy and consistency of their responses. The data collection in the first phase occurred in three main steps: Questionnaire Completion (step 1): Participants began by completing structured questionnaires that examine lifestyle factors such as nutrition, physical activity, sleep patterns, tobacco use, alcohol consumption, and mental health. Physical Measurements (step 2): Participants underwent physical assessments that included measurements of height, weight, waist and neck circumference, blood pressure, and heart rate. Additionally, bioelectrical impedance (BI) method was conducted to evaluate body composition, providing objective insights into the students’ health status and identifying individuals at higher risk for NCDs. Laboratory Tests (step 3): Blood samples were collected after an overnight fast (8 to 12 hours). These samples will be analyzed to determine fasting blood glucose levels, lipid profiles, and markers of liver and kidney function. Sample Size To determine the sample size necessary for gathering the required information, we calculated it using the population proportion estimation formula while taking into account the key variable percentages. In this study, the largest initial sample size needed from the student population was 383. By applying a 10% non-response rate, the total estimated sample size increased to 426. The sample size from each faculty was selected in proportion to the number of students in each school and sex. Eligibility Criteria The eligibility criteria for this study were as follows: Participants had to be newly enrolled students at Tehran University of Medical Sciences, were aged 18 or older, and were willing to provide informed consent to participate. Students from countries other than Iran were excluded from the study. Additionally, we announced an open call, inviting anyone who wished to participate to voluntarily join the study Questionnaire The structure of the questionnaires and the tools used in this study were as follows (Additional File, Table S1) : Section 1: Basic demographic information of the interviewee, including age, sex, ethnicity, marital status, family residence area, insurance status, field of study, wealth status, parent education, and parent marital status, and number of family members Section 2: Behavioral assessments, which included a total of 149 along with the following questionnaires: In this section, questions about nutrition, physical activity, tobacco use, and alcohol consumption were developed based on the STEPwise approach to NCD risk factor surveillance (STEPS) questionnaire. In the tobacco use section, 10 questions regarding both ever and current use of tobacco products encompassed cigarettes (including any type of manufactured or rolled cigarettes and cigars), hookah, electronic cigarettes (such as vapes and pods), and cannabis. Additionally, the frequency of tobacco consumption, the age at which individuals began using cigarettes and hookahs, and questions related to exposure to secondhand smoke. The alcohol consumption section included 7 questions regarding both current (past 12 months) and ever alcohol consumption, the frequency of consumption, and the number of servings consumed during these intervals. For this study, we utilized the dietary section of the STEPS Survey, which consists of 17 questions regarding the number of meals, frequency (how many days per week) and quantity of servings of various food groups, including vegetables and fruits, bread and whole grains, meat and protein sources, and dairy products. The survey also assessed the frequency of consumption of fast food, sweetened beverages, and salty processed foods, along with focused on salt use. Furthermore, taking into account the student lifestyle, four questions were specifically designed to explore the use of supplements and vitamins, dieting (low fat, low calorie, fasting, ketogenic, vegetarian, etc.), and the number of meals consumed at the university. The second version of the Global Physical Activity Questionnaire (GPAQ-v2) (13), which consisted of 11 questions developed by the WHO, was utilized to assess physical activity and sedentary behavior. However, due to the students' unemployment, we eliminated the work-related questions and incorporated questions about transportation-related activities, recreational activities, and sedentary behavior. Additionally, in the study protocol, we included 12 questions covering personal and family medical history. The following tools were used to assess sleep patterns: the Pittsburgh Sleep Quality Index (PSQI) [13] , the STOP-Bang questionnaire [14] for screening obstructive sleep apnea, the Restless Leg Syndrome (RLS) questionnaire [15] and the Insomnia Severity Index (ISI) [16, 17]. These tools included 19, 8, 4, and 7 questions, respectively. The reliability and validity of the PSQI [18-20], STOP-Bang [21], RLS [22, 23], and ISI [24] had been previously assessed in Iran. The 12-item Short-Form Health Survey (SF-12) [25] was employed in this study to assess the quality of life and life satisfaction. The reliability and validity of this questionnaire had been previously evaluated in Iran by Montazeri et al. [26]. This section also included a question regarding self-reported health, which the student could rate on a scale from 0 to 100. Additionally, it features a 5-item Satisfaction with Life Scale (SWLS), where responses were measured on a five-point Likert scale ranging from strongly disagree to strongly agree [27] utilized a tool that had previously been evaluated for its reliability and validity in Iran [28, 29]. The Patient Health Questionnaire-9 (PHQ-9) [30], which consisted of 9 questions, and the Generalized Anxiety Disorder 7-item (GAD-7) [31] were used to assess the mental health status. The reliability and validity of both the PHQ-9 [32] and GAD-7 [33, 34] had been evaluated in Iran. The 10-item Smartphone Addiction Scale-Short Version (SAS-SV) [35] was used, to assess smartphone addiction, which its reliability and validity had been previously assessed in Iran [36]. In this Likert scale questionnaire, ten questions were presented, with response options including "I strongly disagree, "I disagree, "I slightly disagree, "I slightly agree, "I agree, and "I strongly agree. The 5-item General Academic Self-Efficacy Scale (GASE) by Midgley et al. [37]. was used to evaluate the academic self-efficacy, as its reliability and validity had been assessed in Iran by Arianfar et al. [38]. Academic self-efficacy was measured on a five-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). This section also included a question about self-reported academic performance, which student could rate on a scale from 0 to 100. Physical Measurements Physical measurements included recording height, weight, waist circumference, neck circumference, blood pressure, heart rate, and conducting BI method to assess body composition. Before use, the measuring equipment was calibrated to ensure accuracy. To maintain consistency, the same devices, standardized protocols, and identical assessment conditions was used for all participants. For example, scales were calibrated using a standard weight, and blood pressure devices were checked daily against a reference sphygmomanometer. All measurements were recorded to two decimal places, and separate areas were provided for male and female participants to ensure privacy during the process. All weight measurements were obtained with an accuracy of 1 kg using the same digital scale (Innofit, China), which was calibrated with a 5-kg standard weight before each use and after any movement of the device to minimize variability. Height measurements for all participants were taken with an accuracy of 1 cm using a standard meter. Participants stood upright with their heels, buttocks, and occiput (the back of the head) in contact with the wall to ensure proper alignment of the Frankfort plane. Waist circumference was measured with an accuracy of 1 cm using a cloth tape measure at the midpoint between the lowest rib and the hip, near the umbilicus. Neck circumference was measured at the level of the thyroid cartilage (Adam's apple) using a flexible cloth tape measure. The tape was carefully adjusted to ensure skin contact while verifying that there was no compression of the skin. Blood pressure was measured on the brachial artery in three rounds using sphygmomanometers Beurer (BM 20, Germany), with a three-minute interval in between, after the participant had rested for 15 minutes while sitting. The average of the second and third readings was used as the final blood pressure value. In addition, heart rate was measured during all three blood pressure measurement cycles using the Beurer BM 20 device, with the average of the second and third readings taken as the final heart rate value. Body composition was assessed using the OMRON Body Composition Monitor BF511, a validated method for evaluating body composition, including body fat percentage, visceral fat (up to 30 levels), and skeletal muscle percentage. The BF511 measures body fat percentage using the BI method. To ensure accurate results, the following conditions had to meet before measurements: 1. The individual had to properly hydrated.2. No exercise should have been performed for at least 4-6 hours prior to the measurement. 3. Participants had to refrain from consuming caffeine, alcohol, or diuretics for 24 hours before the measurement. 4. Participants had to wear light clothing to allow for direct contact with the electrodes. All measurements were recorded to two decimal places to ensure accuracy and consistency. These measurements were conducted for all eligible participants in a private setting during the second step of the process to ensure comfort. Laboratory Tests Following an 8 to 12-hour fasting period, venous blood samples (8 cc) are collected from participants using yellow-top gel tubes and purple-cap tubes containing EDTA. These samples are used for various hematological and biochemical tests, including a complete blood count (CBC), blood glucose, urea, creatinine, uric acid, total cholesterol, triglycerides, High-Density Lipoprotein Cholesterol (HDL-C), Low-Density Lipoprotein Cholesterol (LDL-C), aspartate transaminase (AST), and alanine transaminase (ALT). After allowing the samples to sit at room temperature for 30 to 60 minutes, the serum is separated for biochemical analysis. The serum sample and the purple-cap tube for the CBC are then stored in a refrigerator until analysis, which must be completed within 4 hours. According to study policies, blood sampling from students called for testing may proceed even if their fasting period is less than the required 8 to 12 hours; however, it is essential to record the exact fasting duration of each participant. For biochemical analysis, kits from Roche are used with the Roche-Hitachi Cobas C311 auto-analyzer (Roche Diagnostics, Germany). Blood samples from the purple-cap EDTA tubes will be analyzed using the Sysmex KX-21 hematology analyzer, which provides detailed CBC parameters, including red blood cell count, white blood cell count, platelet count, hemoglobin levels, hematocrit, and red blood cell indices. The test results will be automatically generated in Excel format as an output of the auto-analyzer upon completion of hematology and biochemical testing. The test results will be verified, and tests will be repeated as needed. The test results will be automatically generated in Excel format as an output of the auto-analyzer upon completion of hematology and biochemical testing. The test results will be verified, and tests will be repeated as needed. Data Management Once the questionnaire had been finalized and coded, the project's IT team uploaded the final version electronically. The process of designing and implementing the questionnaire involved creating a suitable software environment for its deployment. This included designing and coding the questions to accurately accommodate various question types, such as single-line, single-choice, and multiple-choice questions. We established logical skip patterns, allowing subsequent questions to appear based on participants' previous answers. To ensure data completeness, we placed restrictions on question responses, such as requiring valid numerical values or specific dates. Additionally, we created error messages for any mandatory questions that were left incomplete. A logical connection was maintained between different sections of the questionnaire to ensure that the data entered was stored cohesively and uniformly. We set up a system to transfer the collected data to a central server, ensuring both security and data integrity. We also implemented mechanisms to transfer laboratory results to the server, allowing for the integration of biochemical data with individual questionnaires and anthropometric data, thereby preserving coherence and consistency in the information. Extractable data formats provided for analysis and reporting purposes, particularly tailored for research and medical scales, to facilitate efficient data processing. This comprehensive approach ensured the effective, accurate, and secure management of questionnaire data, in conjunction with laboratory and other relevant measurements throughout the study. Training of Questionnaire Supervisors Since students can complete the questionnaires independently, the process did not involve traditional interview-based questioning. Instead, several individuals were selected as supervisors to assist students in accurately completing the questionnaires. These supervisors were available on the questionnaire platform and received adequate training on how to guide students. They provided assist if students have questions or need clarification about any aspect of the questionnaire, ensuring that their guidance does not influence the students' responses. The focus was solely on helping students understand the questions when necessary. At the research center, students had access to computer systems to complete the questionnaires in a quiet and comfortable environment. To enhance the accuracy of the responses, refreshments were available, and students had the option to take breaks as needed during the questionnaire completion process, resuming when they felt ready. Additionally, to improve the quality and precision of the questionnaire completion, several measures were implemented. A detailed "Questionnaire Supervisor Guide" will also be prepared, containing comprehensive explanations of all the questions to assist supervisors in guiding the students effectively. Before the actual data collection process, a pilot test was conducted to assess the performance of the supervisors and the accuracy of students' responses. The results of this pilot test helped identify any weaknesses or areas for improvement, allowing for necessary adjustments. Supervisors received ongoing feedback during the questionnaire completion process, and the supervising team or project manager regularly evaluated their performance, implementing corrective actions as needed to ensure continuous improvement in the quality and accuracy of questionnaire completion. Data Assurance and Quality Control One of the key components of this study was ensuring and maintaining the quality of the collected data. Special attention was given to aspects such as sampling, survey implementation, data entry and collection, and data analysis, all of which were closely monitored. To ensure high accuracy in data collection and the proper completion of questionnaires, the entire surveying process for all participants was documented in the system. A monitoring checklist for completing the questionnaire and conducting anthropometric measurements was prepared by the monitoring unit. This checklist included items related to the preparation and formulation of the questionnaire, as well as key considerations during the survey implementation. Supervisors were responsible for completing this checklist and reporting any issues or potential shortcomings. These reports were submitted daily to the project manager to quickly identify and resolve any problems. Abbreviations ALT Alanine Transaminase AST Aspartate Transaminase BI Bioelectrical Impedance CBC Complete Blood Count FBS Fasting Blood Sugar GAD-7 Generalized Anxiety Disorder 7-item GASE General Academic Self-Efficacy Scale GPAQ Global Physical Activity Questionnaire HDL-C High-Density Lipoprotein Cholesterol ISI Insomnia Severity Index LDL-C Low-Density Lipoprotein Cholesterol NCDs Non-communicable Diseases PHQ-9 Patient Health Questionnaire-9 PA Physical Activity PSQI Pittsburgh Sleep Quality Index RLS Restless Leg Syndrome PHQ-9 Patient Health Questionnaire-9 PSQI Pittsburgh Sleep Quality Index SWLS Satisfaction with Life Scale SF-12 12-item Short-Form Health Survey SAS-SV Smartphone Addiction Scale-Short Version STEPS STEPwise approach to NCD risk factor surveillance WHO World Health Organization Declarations Acknowledgements We sincerely thank the Educational Deputies of the Faculties at Tehran University of Medical Sciences for their valuable participation in implementing this project. Additionally, we would like to express our gratitude to OpenAI's ChatGPT, WORDVICE. AI and Grammarly for their assistance in language editing the manuscript. The contributions from ChatGPT greatly improved the clarity and quality. Authors' contributions Y.A., writing—original draft, writing—review and editing, Y.A., S.S., M.M., Y.F., K.K., P.Z., N.B., A.N., F.R., O.T., N.R., writing—review and editing, designed and planned the study, visualization, conceptualization and data curation. K.S., and S.A., writing—review and editing, visualization, designed and planned the study, conceptualization, data curation and supervision. All authors read and approved the final manuscript. Funding This study was funded and supported by Tehran University of Medical Sciences (TUMS); Grant no, 74365. Data Availability The dataset is available from the corresponding author on reasonable request. Ethics approval and consent to participate Ethical approval for the study was granted by the Research Ethics Committees of Endocrine & Metabolism Research Institute - Tehran University of Medical Sciences (ID: IR.TUMS.EMRI.REC.1403.112). Additionally, in accordance with the Declaration of Helsinki, written informed consent was obtained from all participants before their involvement in the study. Consent for publication Not applicable. Competing interests The author(s) declare that they have no competing interests Authors' Details 1 Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 3 Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran. 4 Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran. 5 Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran 6 Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran References Alzahrani SH, Malik AA, Bashawri J, Shaheen SA, Shaheen MM, Alsaib AA, et al. 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Iranian Journal of Medical Education. 2019;19(0):169-79. Additional Declarations No competing interests reported. Supplementary Files TableS1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6710758","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":472211058,"identity":"51d1f865-f967-4caf-9661-07ce24a53dd1","order_by":0,"name":"Yosra Azizpour","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Yosra","middleName":"","lastName":"Azizpour","suffix":""},{"id":472211060,"identity":"280be879-eb19-4ae7-8bf1-2f80f292a151","order_by":1,"name":"Sarmad Salehi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sarmad","middleName":"","lastName":"Salehi","suffix":""},{"id":472211061,"identity":"78f8c947-869c-45f4-a557-9dea5c55b350","order_by":2,"name":"Mina Mirzad","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mina","middleName":"","lastName":"Mirzad","suffix":""},{"id":472211063,"identity":"eb03b89f-1650-48c2-9799-d5d92a2b2290","order_by":3,"name":"Yosef Farzi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Yosef","middleName":"","lastName":"Farzi","suffix":""},{"id":472211065,"identity":"8dd31664-6ce1-4cce-8a4e-e57f87c0576c","order_by":4,"name":"Keyvan Karimi","email":"","orcid":"","institution":"Tehran University of Medical 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Sciences","correspondingAuthor":false,"prefix":"","firstName":"Nazila","middleName":"","lastName":"Rezaei","suffix":""},{"id":472211081,"identity":"118eb8a3-32bc-4158-aff6-36a3858890f3","order_by":11,"name":"Khosro Sadeghniiat","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Khosro","middleName":"","lastName":"Sadeghniiat","suffix":""},{"id":472211082,"identity":"53597c9a-8320-4410-8715-bc286474ec57","order_by":12,"name":"Samaneh Akbarpour","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYDACHh4og735wIEPQJqNnWgtPMcSD84AaWEmWouEj/FhMJuQFv6eswc/V+6wSdw+g8fgsM2vbfJ8zAyMHz7m4NYicbYvWfLsmbTEObfbCg7n9t02bGNmYJacuQ2PNed5DCQb2w4nzpA5vOFwbs9tRqAWNmZePFrkz/MY/wRrkUgwOGzZc9ueoBaDsz1mEFskUgwOM/y4nUhQi+GZc2mWjWfSjGfwHEs42NtwO7mNmbEZr1/kzuQevtm4w0Z2Bnvz4Q8//ty2nd/efPDDR3zeBwHGBhijDYVLjBaGP4QVj4JRMApGwcgDADuZWPBn0u5KAAAAAElFTkSuQmCC","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Samaneh","middleName":"","lastName":"Akbarpour","suffix":""}],"badges":[],"createdAt":"2025-05-20 20:38:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6710758/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6710758/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90885081,"identity":"bbc9e1a9-cf71-4c3d-86b3-e3a63d8e9249","added_by":"auto","created_at":"2025-09-09 10:02:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":607734,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6710758/v1/e0f22dc0-04cc-44e3-89d9-a9040545a6f7.pdf"},{"id":85828144,"identity":"a5aeaadb-3d1b-4717-94e2-b87b0baa7af8","added_by":"auto","created_at":"2025-07-02 07:26:05","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":25478,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6710758/v1/fb132198408cef8eb6a5970b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Lifestyle and non-communicable diseases risk factors: Changes in Nutrition, Sleep Patterns, Tobacco Use, Mental Health, and Physical Activity During the First Three Years of University: A Cohort Profile","fulltext":[{"header":"Background","content":"\u003cp\u003eAn appreciable proportion of the youth, university students in particular, are exposed to a wide range of health-related choices, making them more susceptible to unhealthy behaviors such as smoking, stress, poor diet, and a sedentary lifestyle [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The transition from high school to university significantly alters the social, physical, and emotional landscapes of young people, often leading to the emergence of certain behaviors such as unhealthy dietary practices, cigarette or alcohol use, and insufficient physical activity (PA), especially among students who are far from their families [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These habits increase the risk of suffering from Non-communicable diseases (NCDs) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. NCDs have both modifiable and non-modifiable risk factors. Non-modifiable factors include uncontrollable and inherent characteristics such as age, sex, and genetics. Modifiable factors encompass lifestyle behaviors that individuals can change. To effectively address the major NCDs, intervention programs are essential to promote lifestyle changes that can reduce risk [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Health promotion programs in academic environments target students and the public to prevent NCDs through healthy behaviors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a study involving 18,017 university students from 24 countries, researchers found a high prevalence of NCD risk factors. These included physical inactivity, poor diet, overweight or obesity, heavy alcohol consumption, and tobacco use. The results indicated a significant co-occurrence of these risk factors among the students [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Several studies have emphasized the widespread presence of physical inactivity, unhealthy eating habits, and tobacco use among students [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A systematic review revealed that about one-quarter of students worldwide are overweight or obese, a trend that presents significant health risks for this age group [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Mental health concerns among college students are an increasing global issue, as highlighted by the World Health Organization (WHO)\u0026rsquo;s World Mental Health Surveys International College Student Project [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Several studies indicate that medical students experience health issues, including depression, suicidal ideation, and stress [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, the lifestyle of students in Iran has changed significantly due to rapid social, economic, and cultural transformations. These changes are especially evident among new incoming university students, who face challenges such as adjusting to new living environments, managing academic pressures, and coping with increased stress. NCDs pose a major health issue in Iran, making it essential to understand and address the risk factors associated with them to effectively manage their impact [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is very important to examine the lifestyle of students to identify modifiable risk factors.\u003c/p\u003e \u003cp\u003eThis research is a first prospective cohort study designed to investigate lifestyle changes among students at Tehran University of Medical Sciences over three years, as well as their relationship with risk factors for NCDs and academic performance.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Data Collection Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a prospective cohort study designed to investigate lifestyle changes among students at Tehran University of Medical Sciences over three years and their relationship with risk factors for NCDs and academic performance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Phases\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFirst Phase (First Year): In this phase, baseline information, including lifestyle factors (nutrition, sleep patterns, tobacco and alcohol use, mental health, and physical activity), was collected through questionnaires. Additionally, measurements of blood pressure, height, weight, waist circumference, and paraclinical tests were conducted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSecond Phase (Second Years): This phase will involve follow-ups on students\u0026rsquo; lifestyle changes using similar questionnaires.\u003c/p\u003e\n\u003cp\u003eThird Phase (Third Years): This phase will involve follow-ups on students\u0026rsquo; lifestyle changes using similar questionnaires. Paraclinical tests will be repeated in the third year. Trained field workers will guide and measure the participants during these stages to ensure the accuracy and consistency of their responses.\u003c/p\u003e\n\u003cp\u003eThe data collection in the first phase occurred in three main steps:\u003c/p\u003e\n\u003cp\u003eQuestionnaire Completion (step 1): Participants began by completing structured questionnaires that examine lifestyle factors such as nutrition, physical activity, sleep patterns, tobacco use, alcohol consumption, and mental health.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Physical Measurements (step 2): Participants underwent physical assessments that included measurements of height, weight, waist and neck circumference, blood pressure, and heart rate. Additionally, bioelectrical impedance (BI) method was conducted to evaluate body composition, providing objective insights into the students\u0026rsquo; health status and identifying individuals at higher risk for NCDs.\u003c/p\u003e\n\u003cp\u003eLaboratory Tests (step 3): Blood samples were collected after an overnight fast (8 to 12 hours). These samples will be analyzed to determine fasting blood glucose levels, lipid profiles, and markers of liver and kidney function.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo determine the sample size necessary for gathering the required information, we calculated it using the population proportion estimation formula\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1751440680.png\" width=\"169\" height=\"61\"\u003e\u003c/p\u003e\n\u003cp\u003ewhile taking into account the key variable percentages. In this study, the largest initial sample size needed from the student population was 383. By applying a 10% non-response rate, the total estimated sample size increased to 426. The sample size from each faculty was selected in proportion to the number of students in each school and sex.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe eligibility criteria for this study were as follows: Participants had to be newly enrolled students at Tehran University of Medical Sciences, were aged 18 or older, and were willing to provide informed consent to participate. Students from countries other than Iran were excluded from the study. Additionally, we announced an open call, inviting anyone who wished to participate to voluntarily join the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe structure of the questionnaires and the tools used in this study were as follows \u003cstrong\u003e(Additional File, Table S1)\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eSection 1: Basic demographic information of the interviewee, including age, sex, ethnicity, marital status, family residence area, insurance status, field of study, wealth status, parent education, and parent marital status, and number of family members\u003c/p\u003e\n\u003cp\u003eSection 2: Behavioral assessments, which included a total of 149 along with the following questionnaires:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this section, questions about nutrition, physical activity, tobacco use, and alcohol consumption were developed based on the STEPwise approach to NCD risk factor surveillance (STEPS) questionnaire. In the tobacco use section, 10 questions regarding both ever and current use of tobacco products encompassed cigarettes (including any type of manufactured or rolled cigarettes and cigars), hookah, electronic cigarettes (such as vapes and pods), and cannabis. Additionally, the frequency of tobacco consumption, the age at which individuals began using cigarettes and hookahs, and questions related to exposure to secondhand smoke.\u0026nbsp;The alcohol consumption section included 7 questions regarding both current (past 12 months) and ever alcohol consumption, the frequency of consumption, and the number of servings consumed during these intervals. For this study, we utilized the dietary section of the STEPS Survey, which consists of 17 questions regarding the number of meals, frequency (how many days per week) and quantity of servings of various food groups, including vegetables and fruits, bread and whole grains, meat and protein sources, and dairy products. The survey also assessed the frequency of consumption of fast food, sweetened beverages, and salty processed foods, along with focused on salt use. Furthermore, taking into account the student lifestyle, four questions were specifically designed to explore the use of supplements and vitamins, dieting (low fat, low calorie, fasting, ketogenic, vegetarian, etc.), and the number of meals consumed at the university. The second version of the Global Physical Activity Questionnaire (GPAQ-v2) (13), which consisted of 11 questions developed by the WHO, was utilized to assess physical activity and sedentary behavior.\u0026nbsp;However, due to the students\u0026apos; unemployment, we eliminated the work-related questions and incorporated questions about transportation-related activities, recreational activities, and sedentary behavior.\u003c/p\u003e\n\u003cp\u003eAdditionally, in the study protocol, we included 12 questions covering personal and family medical history.\u003c/p\u003e\n\u003cp\u003eThe following tools were used to assess sleep patterns: the Pittsburgh Sleep Quality Index (PSQI)\u003cspan dir=\"RTL\"\u003e\u0026nbsp;[13]\u003c/span\u003e, the STOP-Bang questionnaire [14] for screening obstructive sleep apnea, the Restless Leg Syndrome (RLS) questionnaire [15] and the Insomnia Severity Index (ISI) [16, 17]. These tools included 19, 8, 4, and 7 questions, respectively. The reliability and validity of the PSQI [18-20], STOP-Bang [21], RLS [22, 23], and ISI [24] had been previously assessed in Iran.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe 12-item Short-Form Health Survey (SF-12) [25]\u0026nbsp; was employed in this study to assess the quality of life and life satisfaction. The reliability and validity of this questionnaire had been previously evaluated in Iran by Montazeri et al. [26]. This section also included a question regarding self-reported health, which the student could rate on a scale from 0 to 100. Additionally, it features a 5-item Satisfaction with Life Scale (SWLS), where responses were measured on a five-point Likert scale ranging from strongly disagree to strongly agree [27] utilized a tool that had previously been evaluated for its reliability and validity in Iran [28, 29]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Patient Health Questionnaire-9 (PHQ-9) [30], which consisted of 9 questions, and the Generalized Anxiety Disorder 7-item (GAD-7) [31] were used to assess the mental health status. The reliability and validity of both the PHQ-9 [32] and GAD-7 [33, 34] had been evaluated in Iran.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe 10-item Smartphone Addiction Scale-Short Version (SAS-SV) [35] was used, to assess smartphone addiction, which its reliability and validity had been previously assessed in Iran [36]. In this Likert scale questionnaire, ten questions were presented, with response options including \u0026quot;I strongly disagree, \u0026quot;I disagree, \u0026quot;I slightly disagree, \u0026quot;I slightly agree, \u0026quot;I agree, and \u0026quot;I strongly agree.\u003c/p\u003e\n\u003cp\u003eThe 5-item General Academic Self-Efficacy Scale (GASE) by Midgley et al. [37]. was used to evaluate the academic self-efficacy, as its reliability and validity had been assessed in Iran by Arianfar et al. [38]. Academic self-efficacy was measured on a five-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). This section also included a question about self-reported academic performance, which student could rate on a scale from 0 to 100.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical Measurements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhysical measurements included recording height, weight, waist circumference, neck circumference, blood pressure, heart rate, and conducting BI method to assess body composition. Before use, the measuring equipment was calibrated to ensure accuracy. To maintain consistency, the same devices, standardized protocols, and identical assessment conditions was used for all participants. For example, scales were calibrated using a standard weight, and blood pressure devices were checked daily against a reference sphygmomanometer. All measurements were recorded to two decimal places, and separate areas were provided for male and female participants to ensure privacy during the process.\u0026nbsp;All weight measurements were obtained with an accuracy of 1 kg using the same digital scale (Innofit, China), which was calibrated with a 5-kg standard weight before each use and after any movement of the device to minimize variability. Height measurements for all participants were taken with an accuracy of 1 cm using a standard meter. Participants stood upright with their heels, buttocks, and occiput (the back of the head) in contact with the wall to ensure proper alignment of the Frankfort plane. Waist circumference was measured with an accuracy of 1 cm using a cloth tape measure at the midpoint between the lowest rib and the hip, near the umbilicus. Neck circumference was measured at the level of the thyroid cartilage (Adam\u0026apos;s apple) using a flexible cloth tape measure. The tape was carefully adjusted to ensure skin contact while verifying that there was no compression of the skin. Blood pressure was measured on the brachial artery in three rounds using sphygmomanometers Beurer (BM 20, Germany), with a three-minute interval in between, after the participant had rested for 15 minutes while sitting. The average of the second and third readings was used as the final blood pressure value. In addition, heart rate was measured during all three blood pressure measurement cycles using the Beurer BM 20 device, with the average of the second and third readings taken as the final heart rate value.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eBody composition was assessed using the OMRON Body Composition Monitor BF511, a validated method for evaluating body composition, including body fat percentage, visceral fat (up to 30 levels), and skeletal muscle percentage. The BF511 measures body fat percentage using the BI method. To ensure accurate results, the following conditions had to meet before measurements: 1. The individual had to properly hydrated.2. No exercise should have been performed for at least 4-6 hours prior to the measurement. 3. Participants had to refrain from consuming caffeine, alcohol, or diuretics for 24 hours before the measurement. 4. Participants had to wear light clothing to allow for direct contact with the electrodes. All measurements were recorded to two decimal places to ensure accuracy and consistency. These measurements were conducted for all eligible participants in a private setting during the second step of the process to ensure comfort.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory Tests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing an 8 to 12-hour fasting period, venous blood samples (8 cc) are collected from participants using yellow-top gel tubes and purple-cap tubes containing EDTA. These samples are used for various hematological and biochemical tests, including a complete blood count (CBC), blood glucose, urea, creatinine, uric acid, total cholesterol, triglycerides, High-Density Lipoprotein Cholesterol (HDL-C), Low-Density Lipoprotein Cholesterol (LDL-C), aspartate transaminase (AST), and alanine transaminase (ALT). After allowing the samples to sit at room temperature for 30 to 60 minutes, the serum is separated for biochemical analysis. The serum sample and the purple-cap tube for the CBC are then stored in a refrigerator until analysis, which must be completed within 4 hours. According to study policies, blood sampling from students called for testing may proceed even if their fasting period is less than the required 8 to 12 hours; however, it is essential to record the exact fasting duration of each participant. For biochemical analysis, kits from Roche are used with the Roche-Hitachi Cobas C311 auto-analyzer (Roche Diagnostics, Germany). Blood samples from the purple-cap EDTA tubes will be analyzed using the Sysmex KX-21 hematology analyzer, which provides detailed CBC parameters, including red blood cell count, white blood cell count, platelet count, hemoglobin levels, hematocrit, and red blood cell indices. The test results will be automatically generated in Excel format as an output of the auto-analyzer upon completion of hematology and biochemical testing. The test results will be verified, and tests will be repeated as needed.\u003c/p\u003e\n\u003cp\u003eThe test results will be automatically generated in Excel format as an output of the auto-analyzer upon completion of hematology and biochemical testing. The test results will be verified, and tests will be repeated as needed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Management\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnce the questionnaire had been finalized and coded, the project\u0026apos;s IT team uploaded the final version electronically. The process of designing and implementing the questionnaire involved creating a suitable software environment for its deployment. This included designing and coding the questions to accurately accommodate various question types, such as single-line, single-choice, and multiple-choice questions. We established logical skip patterns, allowing subsequent questions to appear based on participants\u0026apos; previous answers. To ensure data completeness, we placed restrictions on question responses, such as requiring valid numerical values or specific dates. Additionally, we created error messages for any mandatory questions that were left incomplete. A logical connection was maintained between different sections of the questionnaire to ensure that the data entered was stored cohesively and uniformly. We set up a system to transfer the collected data to a central server, ensuring both security and data integrity. We also implemented mechanisms to transfer laboratory results to the server, allowing for the integration of biochemical data with individual questionnaires and anthropometric data, thereby preserving coherence and consistency in the information. Extractable data formats provided for analysis and reporting purposes, particularly tailored for research and medical scales, to facilitate efficient data processing. This comprehensive approach ensured the effective, accurate, and secure management of questionnaire data, in conjunction with laboratory and other relevant measurements throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTraining of Questionnaire Supervisors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince students can complete the questionnaires independently, the process did not involve traditional interview-based questioning. Instead, several individuals were selected as supervisors to assist students in accurately completing the questionnaires. These supervisors were available on the questionnaire platform and received adequate training on how to guide students. They provided assist if students have questions or need clarification about any aspect of the questionnaire, ensuring that their guidance does not influence the students\u0026apos; responses. The focus was solely on helping students understand the questions when necessary. At the research center, students had access to computer systems to complete the questionnaires in a quiet and comfortable environment. To enhance the accuracy of the responses, refreshments were available, and students had the option to take breaks as needed during the questionnaire completion process, resuming when they felt ready. Additionally, to improve the quality and precision of the questionnaire completion, several measures were implemented. A detailed \u0026quot;Questionnaire Supervisor Guide\u0026quot; will also be prepared, containing comprehensive explanations of all the questions to assist supervisors in guiding the students effectively. Before the actual data collection process, a pilot test was conducted to assess the performance of the supervisors and the accuracy of students\u0026apos; responses. The results of this pilot test helped identify any weaknesses or areas for improvement, allowing for necessary adjustments. Supervisors received ongoing feedback during the questionnaire completion process, and the supervising team or project manager regularly evaluated their performance, implementing corrective actions as needed to ensure continuous improvement in the quality and accuracy of questionnaire completion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Assurance and Quality Control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the key components of this study was ensuring and maintaining the quality of the collected data. Special attention was given to aspects such as sampling, survey implementation, data entry and collection, and data analysis, all of which were closely monitored. To ensure high accuracy in data collection and the proper completion of questionnaires, the entire surveying process for all participants was documented in the system. A monitoring checklist for completing the questionnaire and conducting anthropometric measurements was prepared by the monitoring unit. This checklist included items related to the preparation and formulation of the questionnaire, as well as key considerations during the survey implementation. Supervisors were responsible for completing this checklist and reporting any issues or potential shortcomings. These reports were submitted daily to the project manager to quickly identify and resolve any problems.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eALT Alanine Transaminase\u003c/p\u003e\n\u003cp\u003eAST Aspartate Transaminase\u003c/p\u003e\n\u003cp\u003eBI Bioelectrical Impedance\u003c/p\u003e\n\u003cp\u003eCBC Complete Blood Count\u003c/p\u003e\n\u003cp\u003eFBS Fasting Blood Sugar\u003c/p\u003e\n\u003cp\u003eGAD-7 Generalized Anxiety Disorder 7-item\u003c/p\u003e\n\u003cp\u003eGASE General Academic Self-Efficacy Scale\u003c/p\u003e\n\u003cp\u003eGPAQ Global Physical Activity Questionnaire\u003c/p\u003e\n\u003cp\u003eHDL-C High-Density Lipoprotein Cholesterol\u003c/p\u003e\n\u003cp\u003eISI Insomnia Severity Index\u003c/p\u003e\n\u003cp\u003eLDL-C Low-Density Lipoprotein Cholesterol\u003c/p\u003e\n\u003cp\u003eNCDs Non-communicable Diseases\u003c/p\u003e\n\u003cp\u003ePHQ-9 Patient Health Questionnaire-9\u003c/p\u003e\n\u003cp\u003ePA Physical Activity\u003c/p\u003e\n\u003cp\u003ePSQI Pittsburgh Sleep Quality Index\u003c/p\u003e\n\u003cp\u003eRLS Restless Leg Syndrome\u003c/p\u003e\n\u003cp\u003ePHQ-9 Patient Health Questionnaire-9\u003c/p\u003e\n\u003cp\u003ePSQI Pittsburgh Sleep Quality Index\u003c/p\u003e\n\u003cp\u003eSWLS Satisfaction with Life Scale\u003c/p\u003e\n\u003cp\u003eSF-12 12-item Short-Form Health Survey\u003c/p\u003e\n\u003cp\u003eSAS-SV Smartphone Addiction Scale-Short Version\u003c/p\u003e\n\u003cp\u003eSTEPS STEPwise approach to NCD risk factor surveillance\u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank the Educational Deputies of the Faculties at Tehran University of Medical Sciences for their valuable participation in implementing this project. Additionally, we would like to express our gratitude to OpenAI\u0026apos;s ChatGPT, WORDVICE. AI and Grammarly for their assistance in language editing the manuscript. The contributions from ChatGPT greatly improved the clarity and quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.A., writing\u0026mdash;original draft, writing\u0026mdash;review and editing, Y.A., S.S., M.M., Y.F., K.K., P.Z., N.B., A.N., F.R., O.T., N.R., writing\u0026mdash;review and editing, designed and planned the study, visualization, conceptualization and data curation. K.S., and S.A., writing\u0026mdash;review and editing, visualization, designed and planned the study, conceptualization, data curation and supervision. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded and supported by Tehran University of Medical Sciences (TUMS); Grant no, 74365.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was granted by the Research Ethics Committees of Endocrine \u0026amp; Metabolism Research Institute - Tehran University of Medical Sciences (ID: IR.TUMS.EMRI.REC.1403.112). Additionally, in accordance with the Declaration of Helsinki, written informed consent was obtained from all participants before their involvement in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.\u003c/p\u003e\n\u003cp\u003e2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.\u003c/p\u003e\n\u003cp\u003e3 Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.\u003c/p\u003e\n\u003cp\u003e4 Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran.\u003c/p\u003e\n\u003cp\u003e5 Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran\u003c/p\u003e\n\u003cp\u003e6 Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlzahrani SH, Malik AA, Bashawri J, Shaheen SA, Shaheen MM, Alsaib AA, et al. 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Generalized Anxiety Disorder 7-Item Scale and Templer\u0026rsquo;s Death Anxiety Scale in Iranian inpatients with COVID-19: evaluation of psychometric properties and diagnostic accuracy. Middle East Journal of Rehabilitation and Health Studies. 2021;8(4).\u003c/li\u003e\n\u003cli\u003eNaeinian M, Shaeiri M, Sharif M, Hadian M. To study reliability and validity for a brief measure for assessing Generalized Anxiety Disorder (GAD-7). Clinical psychology and personality. 2011;9(1):41-50.\u003c/li\u003e\n\u003cli\u003eKwon M, Kim D-J, Cho H, Yang S. The smartphone addiction scale: development and validation of a short version for adolescents. PloS one. 2013;8(12):e83558.\u003c/li\u003e\n\u003cli\u003eEsmaeilpour F, Letafatkar A, Baker JS, Dutheil F, Khazaei O, Rabiei P, et al. Reliability and construct validity of the smartphone addiction scale short version (SAS-SV) in Iranian students. Journal of Public Health. 2021:1-9.\u003c/li\u003e\n\u003cli\u003eMidgley C. Manual for the patterns of adaptive learning scales. University of Michigan. 2000.\u003c/li\u003e\n\u003cli\u003eArianfar A, Sarmadi MR, Seyf MH, Zarrabian F. Presenting A Causal Model for Factors Affecting Self-Regulated Learning Among MSc Students of Paramedical Sciences in Shahid Beheshti University of Medical Sciences. Iranian Journal of Medical Education. 2019;19(0):169-79.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":true,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lifestyle, Medical Students, NCDs Risk Factors, Iran","lastPublishedDoi":"10.21203/rs.3.rs-6710758/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6710758/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eUniversity students, particularly in the medical sciences, go through lifestyle changes during their higher education that influence their health status. These changes could happen in non-communicable diseases (NCDs) risk factors, including dietary intake, sleep patterns, use of tobacco, one's mental well-being, body dimensions, and physical activity status. The present study aimed to assess the above changes over the first three years of students’ education in Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe present study is a prospective cohort study to examine student lifestyle changes during the first three years of university. It evaluates the changes in lifestyle and NCDs risk factors over three years. In the first year, basic information was collected through a questionnaire, covering aspects such as nutrition, sleep patterns, tobacco use, mental health, and physical activity. Additionally, physical measurements—including height, weight, blood pressure, and waist circumference—were taken, along with laboratory examination for fasting blood sugar (FBS), liver enzymes, kidney function tests, and lipid profiles. In the second and third years, follow-ups on students' lifestyle changes will be conducted using similar questionnaires, and paraclinical tests will be repeated in the third year. To determine the sample size, the population proportion estimation formula was utilized, resulting in an initial estimate of 383 participants. This number was subsequently increased to 426 to account for a 10% non-response rate. Participants were selected proportionally based on the number of students in each faculty and stratified by gender. Newly arrived Iranian students over the age of 18 are eligible to participate. To ensure data accuracy, close supervision, observer training, and rigorous data quality control measures were implemented throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe results of the study can help identify concerning patterns in student behavior and pave the way for the development of educational programs and interventions that enhance both students' physical and mental health while preventing the onset of NCDs in the future. Additionally, these findings could contribute to improved academic performance and increased productivity within academic environments.\u003c/p\u003e","manuscriptTitle":"Lifestyle and non-communicable diseases risk factors: Changes in Nutrition, Sleep Patterns, Tobacco Use, Mental Health, and Physical Activity During the First Three Years of University: A Cohort Profile","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-02 07:26:00","doi":"10.21203/rs.3.rs-6710758/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b49d7d42-985e-4f58-a355-ada6e37b7ea3","owner":[],"postedDate":"July 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T09:54:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-02 07:26:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6710758","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6710758","identity":"rs-6710758","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}