Lifestyle factors, notably inadequate eating patterns, emerge as pivotal determinants influencing the onset and progression of chronic diseases (1). Inadequate dietary patterns have emerged as significant contributors to the development of obesity and various diseases of civilization, presenting a pressing public health concern globally. These dietary patterns, characterized by excessive intake of energy-dense foods high in sugars, unhealthy fats, and processed ingredients, coupled with insufficient consumption of nutrient-rich whole foods, have been closely linked to the rising prevalence of obesity and overweight populations. Furthermore, such dietary habits are implicated in the onset and progression of chronic diseases such as type 2 diabetes, cardiovascular diseases, hypertension, and certain cancers (2–4).

Nurses play a vital role in chronic disease management, serving as frontline healthcare providers. Their responsibilities encompass patient education, monitoring, and coordination of care to enhance patient outcomes. Nurses often facilitate lifestyle interventions, medication adherence, and provide emotional support to individuals with chronic conditions. Their holistic approach addresses not only the physical aspects of the disease but also the psychological and social components, promoting a patient-centered care model. The collaborative efforts of nurses contribute significantly to the overall well-being and quality of life of individuals living with chronic diseases (5, 6).

Beyond their dedicated roles in patient care, nurses should actively participate in monitoring and managing their own health. Nurses must maintain adequate eating behavior for several reasons. Firstly, nurses play a pivotal role in promoting health, and their own well-being sets an example for others. Secondly, proper nutrition contributes to sustained energy levels, enhancing nurses’ ability to meet the physical and mental demands of their profession. Additionally, adequate eating behavior is linked to overall health, reducing the risk of chronic diseases that could affect job performance. Lastly, nurses with healthy eating habits are better equipped to educate and guide patients on lifestyle choices, creating a positive impact on public health (1, 7, 8).

Recognizing the intricate relationship between nurses’ eating behavior and their overall well-being is paramount for fostering a comprehensive and proactive approach to healthcare (9). In light of this, our study delves into the evaluation of eating behavior and demographic factors influencing chronic disease diagnosis, focusing specifically on a sample of community nurses from Romania. This research aims to unravel the nuanced connections between nurses’ lifestyles, eating habits, and their susceptibility to chronic conditions, offering valuable insights for promoting individual health and advancing healthcare practices.

Out of the sample, the majority were females, making 95.1% (749). The largest age group in the sample was 40–49.9 years old, consisting of 380 individuals (48.2%). A significant proportion of the nurses, 36.5% had worked as community nurses for more than 10 years, while 32.7% had worked between 5–9.9 years. The mean age of the whole group was 43.4 years with a standard deviation of 7.8 years, ranging from 22 to 65 years old. On average, the group had worked as community nurses for 8 years, ranging from 0 to 22 years (Table 1).

Regarding personal status and education, most of the nurses were in a relationship, comprising 87.9% or 693 individuals, and 74.9% had obtained at most an ISCED 4 diploma. Only 15.7% or 124 individuals reported an excellent or very good perceived health status. The mean BMI of the group was 26.5 kg/m². Among the participants, 36.3% were overweight, 20.6% were classified as obese, 2.2% were underweight and 41.0% had a normal weight (Table 1). Using the presence/absence of chronic disease as a factor, no significant differences were found between the different categories in the following variables: gender (p = 0.834), social status (p = 0.605), and education level (p = 0.180). However, the group with the chronic disease did exhibit higher age [47.1 (7.0) vs. 42.3 (7.7)] and experience as community nurses [11.3 (6.5) vs. 9.1 (6.6)], than those without chronic disease. Additionally, the group with chronic diseases reported greater stress levels and perceived their health status to be lower. In terms of nutrition status, those with chronic disease had a higher reported BMI of 28.4 (5.4) kg/m², than those without chronic disease which had a mean of 25.9 (4.7) kg/m², the difference being significant (Table 1).

In terms of chronic diseases, 24.9% or 191 individuals reported having at least one diagnosed by a physician. Among all community nurses, 16.5% had one chronic disease, 4.6% had two, and 3.2% had three or more. The community nurses reported several diagnoses of chronic diseases, with hypertension being the most prevalent at 9.8% (77 cases). This was followed by obesity at 4.4% (35 cases), thyroid diseases at 3.8% (30 cases), and dyslipidemia at 3.7% (29 cases). Type II diabetes had a prevalence of 2.2% with 17 cases, while heart failure and ischemic heart disease recorded 1.9% (15 cases) and 1.6% (13 cases) point prevalence, respectively. Asthma had a point prevalence of 1.4% (11 cases), while other diseases had significantly lower point prevalence (data not shown).

In regards to chronic disease treatment, it is noteworthy that only 22 out of 191 individuals (11.5%) who reported a chronic condition did not adhere to their prescribed treatment plan. Interestingly, all of these non-adherers reported only a single chronic condition. Additionally, it is worth mentioning that for both heart failure and ischemic heart disease, all patients followed their prescribed treatment plan.

To the best of our knowledge, this is the first study to shed light on the eating habits concerning chronic diseases in community nurses from Romania. This assessment is important for future programs targeting improvement in eating habits in community nurses, with personal benefits, but also for their patients’ benefits, because being able to provide nutrition screening and appropriate nutrition advice is essential to improve healthy eating and subsequent health outcomes of their patients.

The trend of chronic diseases in Europe is marked by a significant rise in prevalence, posing substantial challenges to healthcare systems. Lifestyle factors, including sedentary behavior and poor dietary habits, contribute to the increasing burden of diseases such as diabetes, cardiovascular conditions, and obesity. Aging populations further amplify this trend, as chronic diseases are often more prevalent in older demographics (19, 20). In our analysis, we found that among individuals with an age range from 22 to 65 years, the point prevalence of any chronic disease was 24.2%, and for those with more than two chronic diseases, it was 7.8%.

This increase in multimorbidity among adults under the age of 65 challenges the traditional perception that chronic conditions primarily affect older populations. Overall, the prevalence of multimorbidity across Europe is estimated to be 39.2% with a 95% confidence interval of 33.2–45.2%, with higher prevalences in Europe in women 43.4% (24.8–50.0), compared to men 37.4% (31.7–55.1) (21). The burden of multimorbidity not only impacts individual well-being but also poses significant challenges to healthcare systems in terms of management and resource allocation (21, 22).

According to our study, the predictive model for the association between demographics and eating habits with chronic disease diagnosis found that individuals diagnosed with chronic disease tend to experience higher levels of stress, perceive their health status as poor, have an older age and higher BMI, and consume more carbohydrates compared to those without a diagnosis.

Individuals diagnosed with chronic conditions often report a lower perceived health status, reflecting the multifaceted impact of these conditions on well-being. The psychological and emotional burden associated with chronic diseases can contribute to a negative perception of overall health (23). Conversely, those with a positive perception of health may exhibit better coping mechanisms and adherence to healthcare recommendations. Understanding the interplay between chronic diseases and subjective health assessments is crucial for comprehensive health management and targeted interventions (24).

While age is not a modifiable factor, factors such as high levels of stress, high BMI, and low food intake quality can be improved. Incorporating mindfulness practices, like meditation and deep breathing exercises, can effectively reduce stress levels, promoting mental well-being (25, 26). The management of BMI can include practicing a regular exercise routine, including both aerobic and strength-training exercises, which are a key strategy for promoting weight loss and improving overall physical health (27). Interventions providing education plus personalized advice and feedback empower individuals to make healthier food choices, emphasizing a balanced diet rich in fruits, vegetables, whole grains, and lean proteins to enhance overall food quality (28). Behavioral interventions, such as goal-setting and self-monitoring, can foster sustainable lifestyle changes, aiding in stress reduction, BMI management, and the adoption of healthier eating habits (1). Systemic interventions to improve walkability, access to healthy food and sport facilities are equally important (29).

Our investigation of the eating habits of community nurses analyzed both the quality of their food intake using the Low Carbohydrate Diet (LCD) score, which is a score based on deciles of macronutrients, as well as their intuitive eating habits with the Intuitive Eating Score 2 (IES-2) index. Our findings revealed that community nurses with a high carbohydrate intake had a much higher prevalence of chronic disease (45.0%) compared to those in the middle (27.7%) and low carbohydrate diet tertiles (27.2%), but no effect was found between LCD score and BMI.

Low-carbohydrate diets have gained popularity due to their effectiveness in achieving short-term weight loss, which is further enhanced when coupled with high-protein diets (30, 31). However, recent studies have yielded inconsistent findings regarding their long-term impact on diabetes (32, 33). Though useful and popular for short-term weight loss and short-term reduction in cardiovascular risk factors (34), diets low in carbohydrates and high in fat, especially saturated fat put a supplementary risk for all-cause mortality (33–35). On the other hand, increased consumption of dietary carbohydrate intake is associated with an increased risk of cardiovascular disease, the risk increasing by 1.02 times for every 5% rise in dietary carbohydrate consumption (36). The ARIC cohort showed a U-shaped all-cause mortality, with the lowest risk of mortality in diets with 50–55% energy from carbohydrates (37). The source of fat and protein further modulated the increased mortality in high and low percentages of energy from carbohydrates, with plant sources having a protective effect and animal-derived fat or protein having a detrimental effect on all-cause mortality (37).

Intuitive eating is a holistic approach to nutrition that prioritizes one’s body cues over external diet rules. By listening to and trusting internal signals, such as hunger and fullness, one can develop a mindful and non-restrictive relationship with food that promotes overall well-being and a healthier relationship with eating. Recent meta-analyses have found that those who practice intuitive eating tend to have a lower BMI (38) and a higher quality diet (39). In our study, higher levels of intuitive eating were linked to lower BMI levels and lower energy intake and higher percentage of adequate intake of fat. We discovered that nurses in the highest tertile of intuitive eating had significantly lower BMI values of 25.26 (4.37), compared to those in the lowest tertile of intuitive eating, who had BMI values of 27.40 (5.26). Additionally, energy intake was found to be associated with tertiles of intuitive eating score, with the highest tertile of intuitive eating being linked to lower energy intake with a mean of 1773.0 (566.4) kcal when compared to other tertiles 2008.1 (623.7) kcal, respective 1959.8 (620.3) kcal.

Our research has shown that community nurses with more age and experience tend to have higher intuitive scores. This may be attributed to the fact that as individuals age, they develop a greater understanding of their body and personal preferences, leading to a more refined and knowledgeable approach to intuitive eating. The principles of intuitive eating are in line with mindfulness techniques, which encourage individuals to be fully present and aware of their eating habits (40). Our investigation did not uncover any previous studies utilizing the Intuitive Eating Scale 2 (IES-2) specifically among nurses.

Nurses often experience high levels of occupational stress due to demanding workloads, long hours, and the emotionally charged nature of their profession, impacting their mental well-being and work performance (41, 42). Chronic stress triggers physiological responses that can contribute to the development and exacerbation of chronic diseases, including cardiovascular conditions and metabolic disorders (43, 44). Stress often influences unhealthy coping behaviors, such as poor dietary choices and lack of exercise, which are linked to the development of chronic conditions like obesity and diabetes (43, 45). The interplay between chronic stress and chronic diseases forms a complex cycle, where stress exacerbates the conditions, and the presence of chronic diseases can, in turn, amplify stress levels, highlighting the importance of holistic approaches to health management (44).

The Body Mass Index (BMI) analysis in Europe reveals an increasing prevalence of overweight and obesity across diverse populations (46, 47). Elevated BMI is closely linked to the rising incidence of chronic diseases, including diabetes, cardiovascular conditions, and certain cancers. The NCD Risk Factor Collaboration reports a mean BMI of 27.3 (26.3–27.7) kg/m² for Romania, which is comparable to our sample’s BMI of 26.5 (5.0) kg/m². The prevalence of obesity in the community nurse cohort, measured by weight and height, is 20.6% and the prevalence of combined overweight and obesity is 56.9%, consistent with other estimates (48). There is a significant difference in the prevalence of the diagnosis of obesity reported by nurses in the chronic diseases section of just 4.4% and the prevalence obtained from measurements of 20.6%. The missed diagnosis of obesity remains a prevalent concern in healthcare, as it often goes unrecognized due to societal misconceptions and biases. Healthcare providers may not consistently assess or address obesity during routine examinations, leading to underdiagnosis in both adult and child populations (49–51). The consequences of missed obesity diagnoses include delayed intervention and increased risk for associated health conditions such as diabetes, cardiovascular diseases, and mental health issues (52, 53).

According to our study, hypertension exhibited the highest point prevalence (9.8%) among chronic reported diseases. The prevalence of hypertension (in males and females) has doubled worldwide between 1990 and 2019 (54). According to the same review (54), in Romania, the prevalence of hypertension is 43.9% (with 95% CI 35.1–52.8) with a detection awareness of 74.6% (with 95%CI 61.8–85.4). The alarming increase in hypertension diagnosis highlights an unsettling trend in multimorbidity. Hypertension frequently acts, along with heart diseases, and diabetes, as a primary contributor in later multimorbidity (55).

Treatment non-adherence in our group was 11.5% of all patients with a chronic disease. Non-adherence to treatment poses a significant risk to multimorbidity, as individuals with chronic conditions may experience worsening health outcomes when failing to follow prescribed medical plans. The complex interplay of multiple chronic diseases can exacerbate if treatments are not consistently adhered to, leading to increased morbidity and complications (56, 57). Poor adherence to medication regimens, lifestyle modifications, and regular health check-ups may contribute to the progression and development of additional chronic conditions. Addressing non-adherence is crucial in preventing the cascade of health issues associated with multimorbidity, highlighting the importance of patient education, support systems, and healthcare interventions to promote treatment compliance (1, 55).

Our study has certain limitations, such as self-reporting bias and selection bias. The self-reported bias pertains not only to the nutrition evaluation, but also to the reported diagnosis of chronic disease. It is important to note that the design of this study was cross sectional, which means that no causality can be established between eating patterns and the presence of chronic diseases. Instead, the findings can only be interpreted as associations. Although the response rate of our study was good, it is common knowledge that individuals who participate in nutrition studies are typically more interested in nutrition and healthy living than those who do not participate. There is a predominantly female cohort, however this is concordant with the prevalence of female community nurses in Romania.

The present study on the eating habits and health profiles of community nurses in Romania provides comprehensive insights, which may serve as a foundation for future research endeavors. Given the findings of this study, several key areas warrant further attention. Longitudinal studies could clarify on the dynamic nature of dietary patterns, stress levels, and chronic disease diagnoses among nurses over time, thereby facilitating a deeper understanding of their interchange. Moreover, comparative research across diverse healthcare settings and regions could provide valuable insights into the factors influencing these outcomes.

Additionally, intervention studies targeting modifiable factors identified in this research, such as stress reduction techniques, healthy weight management strategies, and nutritional education programs, could be explored to assess their effectiveness in promoting overall well-being among healthcare professionals. Such research would not only benefit the healthcare professionals but also the patients they serve. It is widely acknowledged that the health of healthcare professionals is directly linked to the quality of care that patients receive, and therefore, interventions that improve the health and well-being of healthcare professionals can have a positive impact on patient outcomes (58, 59).

Lastly, collaborative efforts between healthcare institutions, policymakers, and researchers are essential to develop and implement tailored programs that prioritize the health and resilience of nurses, thereby contributing to the mitigation of the burden of chronic diseases within healthcare systems. The implementation of such programs would require a concerted effort and the development of strategies that are feasible, sustainable, and evidence-based. Overall, these research endeavors can contribute significantly to the advancement of knowledge in this field and ultimately lead to positive health outcomes for healthcare professionals and patients alike.

This study provides a comprehensive insight into the eating habits and health profiles of community nurses in Romania, uncovering noteworthy associations between dietary patterns, stress levels, and chronic disease diagnoses. The prevalence of chronic diseases among this population, particularly hypertension, underscores the importance of targeted interventions for healthcare professionals. Notably, the study identifies modifiable factors, including stress, BMI, and dietary habits based on high carbohydrate diets, offering potential avenues for personalized health interventions. The findings emphasize the need for holistic strategies, encompassing stress reduction, healthy weight management, and nutritional education to enhance overall well-being. As healthcare systems struggle with the increasing burden of chronic diseases, these insights contribute to the development of tailored programs that prioritize the health and resilience of healthcare providers.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by the Research Ethics Committee of Victor Babes University of Medicine and Pharmacy. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

L-MO: Conceptualization, Investigation, Writing – original draft, Methodology. MP: Conceptualization, Data curation, Investigation, Methodology, Writing – review & editing. AC-E: Conceptualization, Data curation, Methodology, Writing – review & editing. CS: Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft.