Combined healthy behaviors and cardiometabolic risk in university students: a biomarker-based cross-sectional study

Background Unfavorable lifestyle behaviors commonly cluster during university life, yet their combined association with continuous cardiometabolic risk (CMR) remains insufficiently characterized in university populations. Objective To evaluate the association between the accumulation of healthy behaviors and CMR in university students. Methods A cross-sectional study using convenience sampling was conducted among 307 students at a private university in Chiclayo, northern Peru. Five self-reported behaviors were assessed: regular breakfast consumption, physical activity ≥ 3 times/week, fruit intake ≥ 2 servings/day, vegetable intake ≥ 2 servings/day, and sleep duration of 7–9 h. A Healthy Lifestyle Behavior Index (0–100) was constructed by rescaling each of the five behaviors from 0 to 1. The component scores were averaged and multiplied by 100; a separate favorable behavior count (0–5) was also calculated. The CMR score integrated waist circumference (WC), mean arterial pressure, glucose, ln-triglycerides, and HDL-cholesterol, standardized by sex. Associations were estimated using linear regression models with HC3 robust standard errors and adjusted for sociodemographic variables. Results Overall, 25.7% of participants exhibited 0–1 favorable behaviors, 51.1% exhibited 2–3, and 23.1% exhibited 4–5. Each 10-point increase in the healthy behavior index was associated with a reduction of 0.127 standard deviations (SD) in the CMR score ( β = − 0.127 ; 95% CI: − 0.179 to − 0.075 ; p < 0.001 ). Compared to the group with 4–5 behaviors, the groups with 2–3 and 0–1 behaviors had higher risk scores ( β = 0.267 ; 95% CI: 0.017 to 0.516 ; and β = 0.682 ; 95% CI: 0.395 to 0.968 , respectively). Conclusion A greater accumulation of healthy lifestyle behaviors was associated with a more favorable cardiometabolic profile in university students; given the cross-sectional design, these findings should not be interpreted causally.