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

  • Manolis LinardakisEmail author
  • Angeliki Papadaki
  • Emmanouil Smpokos
  • Anthony Kafatos
  • Christos Lionis
Original Article



Multiple behavioral risk factors (MBRFs) related to lifestyle have been associated with non-communicable diseases, but there is limited evidence on their prevalence in undergraduate medical students and their association with academic performance.


During 1989–2017, data from 1447 medical students of the University of Crete, Greece (mean age 21.8 ± 2.2 years), were analyzed. MBRFs assessed included smoking, high body weight, physical inactivity, risky alcohol consumption and low consumption of fruits and vegetables. Academic performance was based on the grades received in the mandatory Clinical Nutrition course and the overall medical degree (scale of 0–10).


Of the sample, 25.8% were smokers, 30.7% had high body weight, and 67.2% had low consumption of fruits and vegetables. Prevalence of having ‘no MBRFs’ and having ‘multiple clustering’ and ‘3+ factors’ was 15.8% and 12.3%, respectively. Men had almost twice the prevalence of multiple clustering compared with women (16.5% vs. 8.4%, p < 0.001). Participants who had none compared with 3+ MBRFs had higher mean grades in the Clinical Nutrition course (6.34 vs. 5.94, p = 0.027, p = 0.003) and overall degree (7.39 vs. 7.22, p = 0.021, p = 0.002). As the number of MBRFs increased (from ‘none’ to ‘1,’ ‘2’ and ‘3+’ factors), the proportion of graduates receiving a distinction also decreased (6.1%, 3.3%, 3.3% and 0.0%, respectively, p = 0.001).


Overall, high prevalence of MBRFs was observed in this sample of medical students, while MBRF clustering was prospectively inversely associated with academic performance. These findings highlight the need for preventive lifestyle strategies to improve these students’ behavioral risk factors and academic performance during their studies.


Behavioral risk factors Chronic diseases Medical students Academic performance Grades Bachelor 



The authors thank all students who participated in this study. We also thank to Mrs. Eleutheria Tzorakis, Olympia Ksilouris and Sofia Flouris for their valuable assistance in data preparation.

Compliance with ethical standards

Disclosure of potential conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of the University Hospital of Heraklion, Crete, Greece, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Social Medicine, Faculty of MedicineUniversity of CreteCreteGreece
  2. 2.Internal Evaluation Group (IEG), Faculty of MedicineUniversity of CreteCreteGreece
  3. 3.Centre for Exercise, Nutrition & Health Sciences, School for Policy StudiesUniversity of BristolBristolUK

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