Introduction

In 1999 the World Health Organization pointed out that a healthy lifestyle refers to the way of life in which the risk of being seriously injured or dying early is reduced ¹. In 2018, a study reported that the majority of university students in the health area did not identify the relationship of lifestyles with health or risk factors ². This data is worrisome and may be a reflection of sociocultural patterns that explain the persistence of unhealthy habits despite the dissemination of proper information in the country. Conditions such as obesity are a result of poor lifestyles and have been considered a national pandemic in Mexico since 2016 ³. Starting in 2020, the COVID-19 pandemic increased the alert status of the health system due to the greater vulnerability of overweight people to the infectious disease. In university students from the city of Hermosillo, Sonora in Mexico, the prevalence of lifestyles with high levels of sedentary lifestyle and abusive alcohol consumption or other substances was reported ^4-5. Consumption of alcoholic drinks is usually associated with parties, meetings, food consumption and even as an escape door from stress through a moment of relaxation; additionally, it has been explained that it contributes to develop excess weight ^6-7 and that, in addition, it is directly related to physical inactivity and the presence of greater cardiovascular risk ⁸.

The health plenitude traditionally characteristic of young people becomes uncertain in the face of lifestyles that increase risk factors for diseases that directly affect life quality. University context favors the independence and personal spontaneity of its members; however, maybe not all of them are prepared to act appropriately against the development of harmful habits ⁹. According to a report by Cruz-Rodríguez, et al., considering the vulnerability of university students due to their predisposition to skip meals and adequate food intake, it is necessary to implement facilitating strategies so that university students can acquire a healthy eating lifestyle and physical activity (PA by its acronym in English) ¹⁰. Hence, the assessment and control of changes in body composition are part of a strategy for promoting health among the student population. The timely identification of cardiovascular risk factors is pertinent in all life stages, nursing staff can influence the promotion of self-care and prevention of health risks for young people.

Most analyzes of variables of interest in this project have not considered the nutritional intake detail and have used cross-sectional research approaches. As an additional analysis, it was proposed to estimate the influence of time by using a two-level longitudinal analysis. The research objective was to analyze the differences in lifestyles regarding the regular nutrient intake, energy consumption and PA according to alcohol consumption in university students.

Methodology

Descriptive, longitudinal correlational design study with two measurements in a non-probabilistic convenience sample of university students affiliated to an academic nutrition unit in Hermosillo, Sonora, Mexico. From the retrospective analysis of the personal file of a population of 160 participants from a previous research study, the changes in the variables of interest were estimated with respect to an assessment carried out in 2017. Current and available students of the university were included who agreed to voluntarily participate in a study that involved answering a questionnaire and measuring their body composition. Incomplete data was removed. Identification data including gender, age, alcohol use, and current tobacco use of the participants were recorded. Alcohol consumption and tobacco use during the last month was asked with an open dichotomous question (positive, negative). Nutritional macronutrient intake was estimated using the R24H Multi-Step 24-Hour Reminder. It is a retrospective method that consists of questioning the subject about everything he ingested the day before, that is, solids and liquids. It helps to determine food, energy, and nutrient intake ¹¹. The application time ranged between 20 and 30 minutes; the interviewer asked about the characteristics of food and beverages consumed, such as the method of preparation, trade name, and ingredients used. During the application of this questionnaire, food models and food composition tables ¹² were used to estimate the amount in grams. It has been reported that this questionnaire is a tool that, appropriately applied, is useful for the assessment of dietary intake at population level through individual questionnaires ^13-14.

PA was considered by estimating the metabolic equivalent unit (METs) with the short version of seven questions of the Spanish version of the International Physical Activity Questionnaire identified as Cuestionario Internacional de Actividad Física¹⁵. Its validity and reliability have been appropriate in Mexican adults regarding the evaluation with accelerometry with correlations in a range of .74 to .89 (16). During a pilot test in a small subsample, the test-retest reliability of this questionnaire was reviewed with acceptable values (α=.81).

Body composition included measurement of height, waist circumference (WC), and body weight, following the international standards of the International Society for the Advancement of Kinanthropometry (ISAK). Electrical bioimpedance was measured with the Body Scan Plus II® multifrequency analyzer (Jawson Medical brand, Korea, 2008) and body mass index (BMI) was estimated by dividing weight by the square of height. Measurements were taken in the morning, fasting for four hours, without having performed strenuous PA in the last 12 hours, with bladder emptying prior to measurement, and wearing light clothing.

Authorization was obtained from the University and the Research Coordination of the Faculty of Sports Organization of the University (REPRIN-FOD-61). Students were called to participate in the Nutritional Care Center following security measures to comply with the Helsinki Declaration guidelines.

The Statistical Package for Social Science (SPSS) version 21.0® program was used. Analyzes are presented with mean and standard deviation, or with percentages. A description of the complete sample is presented and a comparison is made between those who drink and do not drink alcohol drinks during the second measurement. An alpha value of .05 was considered. Inferential analyzes were performed considering the distribution of data with Mann-Whitney U tests, Spearman and Wilcoxon correlation tests.

Results

Participants were on average 21.6 years old (SD=1.0). In relation to current alcohol consumption, 54.2% of women and 73.7% of men drank alcohol. From those who did it, 22.5% also smoked and 47.5% were overweight. While among those who did not drink alcohol, only 2.7% of them were reported as smokers, and 40.5% were overweight (Table 1).

Statistical significant differences were observed regarding TEC and carbohydrate intake between those who drank and did not drank alcohol, with higher values for those who did it.

Regarding students who consumed alcohol, the WC (waist circumference) was only associated with caloric (p<.01) and lipid (p<.05) consumption. Among those who did not consume alcohol, a direct statistically significant association of BMI with caloric expenditure and TEC was observed, statistically significant inverse association between BMI and caloric intake (p<.05), and statistically significant indirect association between TEC and protein consumption (p<.05). In both groups, a positive association was observed between: TEC and PA, caloric intake and macronutrient intake, and, between protein consumption and lipid intake (p<.01), (Table 2).

The retrospective analysis was used to determine changes between consumption patterns, body composition, and PA among sample participants. With the Wilcoxon test, only the percentage of BF showed differences between measurements. Between 2017 and 2020 measurements, both groups showed an increase in BMI (p<.02). Lower values were observed in the second measurement with respect to the first, with higher response averages for those who did consume alcohol in relation to those who did not do it. Moreover, participants who did not consume alcohol showed differences regarding WC (p=.03), caloric intake, and TEC (p< .01 in both cases), (Figure 1).

Source: Own development

Figure 1 Changes in caloric consumption and energy consumption of the participants with respect to the assessment of the year 2017 vs 2020. 2020 (n= 67). 

Discussion

In a sample of university students in the health area who were classified regarding alcohol consumption, the differences between body composition, regular nutrient intake, energy consumption and PA have been exposed. Four out of ten participants were overweight, with a higher incidence among those who consume alcohol. Statistical significant differences were observed regarding TEC, carbohydrate intake, WC and BF between those who consume and do not consume alcohol. The influence of alcohol consumption on the development of excess weight can arise through several mechanisms: a). Caloric intake of alcohol, b). Stimulation of the simultaneous intake of other foods such as sugary drinks and high-calorie foods such as red meat and fried foods, and c). Inhibition of satiety hormones (leptin) and stimuli at the central brain level, increasing appetite and stimulating energy intake ⁷.

Consumption of alcoholic drinks favors the development of excess weight since it is associated to energy intake (7 kcal/g), inhibition of fat oxidation and plasma leptin levels ¹⁷, allowing the accumulation of both, subcutaneous and visceral fats, in inadequate amounts with physiological consequences that can generate or aggravate non-communicable chronic diseases such as obesity ¹⁸, where a sedentary lifestyle has been recognized as a risk factor ¹⁹. Therefore, the adequate regulation of weight and body composition also implies maintaining an energy balance, controlling the intake of macronutrients through the diet (carbohydrates, proteins, lipids) ²⁰ and stopping habits that are harmful to health such as alcohol consumption. It should be noted that higher prevalence of alcohol and tobacco consumption is more common in men than in women, which matches with the findings of other studies on the university population in Spain ^21-22.

It has been pointed out that gender and country of origin influence the choice of healthy and unhealthy foods ^23-24; just to mention an example, in some contexts for women sensory attractiveness and body weight are very important while for men this is not significant ²⁴. However, women have shown a tendency to consume more sweet foods than men ²³. And it certainly has been reported that reducing alcohol consumption in middle-aged women is favorable for glucose regulation ²⁵.

Significant statistical differences were found regarding TEC and carbohydrate consumption between those who consume and do not consume alcohol, with higher values for those who are consumers. When comparing between physically active and inactive people, it is identified that inactive people are more likely to be obese ¹⁷, without forgetting that, in addition, lower alcohol consumption has been reported as more PA is practiced. Other authors have reported that excessive alcohol consumption has been associated with lower levels of physical competence, additionally this could be a consequence of inducing a shift away from healthy lifestyles ²⁶.

PA presented a direct significant statistical association with TEC. In general, moderate intensity physical exercise, equivalent to approximately 1,200 to 2,000 kcal per week, may be sufficient to prevent weight gain greater than 3% of total body weight ²⁷, coupled with lower energy consumption ranging from 743.3 METs/wk for women and 1263.0 METs/wk for men ²⁸. Finally, a statistically significant direct association was seen between the consumption of proteins and lipids. Regarding the ingestion of macronutrients, there are authors who state that proteins are specially modified from the diet in order to modulate body weight ¹⁸; however, it can be possible to show an excessive calorie consumption and, specifically, the consumption of carbohydrates, which is associated with an increase in body mass, BF and WC ²⁹, thus, giving a positive energy balance with consequences already widely mentioned.

Social influence and the tendency to experiment during university education can lead to the regular development of sedentary lifestyles and with little time to eat, in which unhealthy eating styles are eaten between meals, eating foods of little nutritional value, and with increased consumption of alcohol and tobacco ^17,28. Some environmental factors favor malnutrition due to excess: the ease and preference for sweet or salty foods with high caloric value, a high intake of fats and rapidly absorbed carbohydrates ¹⁷.

Eating habits, the consumption of harmful substances or the regular performance of PA are conditioning factors of a healthy lifestyle ²⁶. The physical, social, and psychological consequences of alcohol consumption can negatively influence the individual who is the consumer, the family and the society, making educational and preventive interventions necessary ³⁰. Activities such as maintaining regular eating times and schedules, controlling the quality and quantity of nutrients and food consumed in a temporal framework could help stabilize body composition indicators ¹⁷. It could be that alcohol consumption relaxes the measures and intention to maintain a healthy lifestyle in the university population.

The value of the findings of this study lies in the detail of the caloric and macronutrient consumption report that is presented in addition to the measurement by bioimpedance analysis; additionally, the longitudinal analysis of the changes in relation to time offered added value for the observation of trends and patterns of comparative behavior according to alcohol consumption. In this sample, evidence of the protective value of PA was obtained to increase TEC, reduce caloric intake, and BF. Limitations are related to sample representativeness, in addition to lack of use of objective methods such as accelerometry to measure PA. Given the findings regarding alcohol consumption and tobacco consumption, the evaluation of these aspects with valid and reliable questionnaires represents another area of opportunity to consider in future work. Besides, upcoming investigations should consider the approach of longitudinal approaches and with objective measurements that give greater support to results obtained by questionnaires.

Conclusions

In this study, anthropometric differences and eating styles and PA between participants who consume and do not consume alcohol have been identified. Alcohol consumption leads to greater body composition, caloric consumption, and carbohydrate intake; in contrast, those who reported not consuming alcohol had lower energy expenditure compared to those who did consume alcohol. Between 2017 and 2020, an increase in the BMI of the participants was observed, at the same time, caloric consumption and energy consumption decreased. This may lead to a greater possibility of being overweight due to the association of these consumption and spending patterns. PA was associated to a higher TEC, so it could be considered a protective factor to face the risks related to consumption. Awareness of the influence of harmful habits on changes in body composition offers a scientific basis to guide the additional implications of these behaviors. Highlighting the importance of ensuring appropriate eating and PA patterns and preventing unhealthy habits among university students is useful to reduce health risks in this population group. Nurses can apply this information to promote health through educational strategies aimed at young people.

Conflicts of interest

The authors stated there was no conflict of interest.

Financing

Thanks for the support of the Program for Professional Development for Higher Education.