INTRODUCTION

The beginning of university life is a critical stage for young people since changes in learning methods and the search for better academic results generate emotional conicts that can affect the feeling of hunger, appetite, and satiety, inuencing their state nutritional¹. Indeed, anthropometric alterations occur that can be reected in an increased or decreased body mass index (BMI).

Until 2016, according to the World Health Organization (WHO), 1.9 billion adults were overweight or obesed², the latter constituting an increasing health problem in Peru³, where approximately 60.2% of the population adult is overweight⁴. Among its consequences is the development of non-communicable diseases (NCDs) such as diabetes mellitus, arterial hypertension, metabolic syndrome, and polycystic ovary³.

On the other hand, stress, a process in which physiological, emotional, and behavioral responses are generated from a stimulus⁵, causes manifestations of a cardiac nature, muscle tension, alterations in breathing and digestive problems; in addition to impaired performance, sleep disorders, increased or decreased appetite, and anxiety⁶.

According to the WHO, physical activity (PA) refers to any body movement tha t require s energy consumption⁷. FA prevents the appearance of overweight, obesity, and ENT, it also has advantages in the psychological and cognitive states. However, physical inactivity constitutes an important risk factor for mortality worldwide⁸.

A sedentary lifestyle predisposes you to weight gain. In this regard, an association has been found between the former, nutritional status and moderate academic performance⁹; as well as a high frequency of overweight and obesity in medical students¹⁰. In these university students, the prevalence of a sedentary lifestyle is reported to be 46% in the US, 50% in Colombia, 70% in Chile, and 79% in Peru^11,12.

The disadvantages to performing PA, the low motivation to exercise, the low or no vegetable intake, and the tendency to consume fast food, energy drinks, and soft drinks as substitutes for breakfast or lunch, despite the knowledge of healthy eating patterns^13,14; In addition to increasing academic stress, they increase the risk to your health. Faced with such a problem, the present study evaluated the relationship between BMI, stress, physical activity, and eating habits in medical students.

METHODS

RESULTS

The sample consisted of 306 rst to sixth-year medical students: 195 men (63.7%) and 111 women (36.3%). There were 153 students with normal weight (50%), 121 with overweight (39.5%), and 32 with obesity (10.5%). The average age was 21.95 years (Table 1).

Regarding the frequency of eating habits in students according to BMI, Table 2 a signicant difference was found in the consumption of soft drinks (p = 0.030), legumes (p = 0.049), meat (p = 0.017) and alcohol (p = 0.005). People with increased BMI reported higher consumption of soft drinks, meat and alcohol, while lower intake of legumes. In relation to the foods of the categories pastry, sweets, fruits, and fast food, no signicant association was found. In addition, it was observed that the frequency of breakfast had a signicant difference in relation to BMI (p = 0.037) (Table 3).

Finding a lower frequency of its occasional have a signicant difference. consumption in students with normal weight (1.31%) when compared with those who were overweight (7.44%) and obesity (6.25%). The other variables studied (fasting, mid-morning, lunch, snack, and dinner) did not have a signicant difference. When evaluating the relationship between stress and BMI, it was observed that the levels of distress presented an association close to signicance (p = 0.055); being, such levels, lower in students with obesity (Figure 1).

Figure 1:  Level of distress in medical students according to body mass index. Statistical signicance, p value = 0.055 

Regarding the PA of the participants according to BMI, no signicant difference was found. Low physical activity was 36.6% in students with normal BMI, 42.2% in overweight students, and 43.9% in obese students (Table 4).

DISCUSIÓN

There are various factors that contribute to the quality of life of health sciences university students, among them, eating patterns stand out, which added to the practice of regular PA determine their nutritional status, which at the same time is indirectly related to the stress level of the individual since low physical activity is associated with its increase. Therefore, it is postulated that an imbalance between these components will be reected in the decrease or increase of the student's BMI and implies a greater risk of disease20. In this regard, in a study carried out by Urbanetto et al. In nursing students, a weight increase was evidenced in 52.60%, as well as high-stress levels in 29.50% and very high in 36.80%. Furthermore, overweight and obesity were associated with physical inactivity, increased frequency of meals in stressful situations, and unhealthy food intake²¹.

Nutritional habits, such as eating fast food, sweets, soft drinks, and, in some cases, alcohol, are related to an increase in BMI. In the present work, the students with increased BMI indicated a higher consumption of soft drinks, meat, and alcohol; as well as a lower intake of legumes. In relation to the nutritional status according to eating habits, according to an investigation carried out by Reyes et al., Malnutrition due to excess or deciency is more frequent in university students with inadequate eating habits²².

Thus, Becerra-Bulla et al., When evaluating the relationship between eating habits and changes in the nutritional status of medical students, whose BMI showed an increasing trend while the students passed through the race, found a high consumption of dairy products , meats, and fruit; regular intake of vegetables, packaged foods and fried foods; and occasional fast food and soda²³. Torres-Mallma et al., After comparing the consumption of fast food and soft drinks, among first and sixth year medical students, found an increase in their consumption in the last group, a signicant difference was also found in terms of alcohol intake, being more frequent in older students¹⁴. In contrast to previous studies, at present, no signicant difference was shown for pastry, candy, vegetables, or fast food.

The regular eating pattern includes breakfast, lunch, and dinner; Eliminating one of these main meals in the long term has negative health effects²⁴.

According to the literature, the importance of breakfast is that it provides the greatest amount of energy for daily activities; therefore, its omission negatively affects the performance and health of the student. Likewise, it has been shown that eating a breakfast rich in ber and fruits reduces the risk of overweight and reduces the appearance of chronic non-communicable diseases²⁰. Torres-Mallma et al. found, in Peruvian medical students, that 51.3% of the participants always ate breakfast, which they attributed to factors such as class hours, study ov e rl o ad, sl e ep qua l it y, and socioeconomic aspects¹⁴. In a cohort conducted by Wennberg et al., It was found that irregular food intake, mainly poor breakfast consumption during adolescence, predicted the appearance of metabolic syndrome in adulthood¹⁸.

In contrast, in the present investigation, it was found that young people consume breakfast daily by 95.75%. Despite this, it is still necessary to reinforce education in habits and food consumption that must be carried out as a plan of nutritional programs included in university education.

On the other hand, stress has been divided into positive or "eustress" and negative or "distress". Especially, the latter, if it persists and becomes chronic, keeps the body in constant overstimulation, which predisposes to the development of various pathologies²⁵. In the current study, the levels of distress according to the BMI showed a difference close to signicance, with the lowest levels in obese students. In this regard, in a study carried out by Jalca-Ávila et al., In which the role of stress as a trigger for the increase in BMI in Clinical Laboratory students was evaluated, despite not nding an association with obesity, it was observed between being overweight and low and medium stress levels²⁶.

Various factors related to the increase in BMI in medical students were studied. It was found that PA classied as low, according to the IPAQ questionnaire, represents a sedentary lifestyle. It is pointed out that the decrease in physical activity due to sedentary lifestyle is a risk factor for increasing overweight and obesity²⁷, but it was not corroborated in the present study; however, the percentage of sedentary lifestyle was 39.54%, being higher in the population with a high BMI. Santillán et al. measured the level of PA in medical and business administration students and found that the former are more sedentary (66%)²⁸. Unlike the present work, Choque et al. In 200 rst-year medical students they only found a 23% prevalence of sedentary lifestyle, but they had a lower frequency of being overweight 17% and obesity 1%²⁹.

The findings of this research can be extrapolated to medical students with characteristics similar to those described. The intervention of factors such as geographic area, cultural differences, socioeconomic condition, and academic requirement must be taken into account.

In addition, it is recommended to establish a program of nutritional guidance, anti-stress therapy, and physical activity throughout the race to reduce the increase in BMI. It is also suggested to carry out similar investigations taking into account the control of other variables such as age, gender, and year of study, comparing the groups; study the effect of the COVID-19 pandemic on stress level, PA, BMI, and eating behaviors in medical students; as well as to follow up the students by applying the questionnaires immediately after completing the evaluations.

The COVID-19 pandemic limited the development of the research, as well as the call for the target sample; in addition, it prevented the performance of subsequent anthropometric controls.

CONCLUSIONS

The rise in BMI in medical students was associated with inappropriate eating habits such as higher intake of alcoholic beverages, meats, soft drinks, and lower consumption of legumes, as well as a higher frequency of occasional breakfast consumption. Low levels of distress and physical activity were more frequent in obese patients, although without signicant association.