University presents a time of transition for young adults that involves behavior adaptation in a new environment, with new relationships and changing support systems (1). University students are in a period of transition to adulthood marked by important lifestyle changes (2, 3). Indeed, when analyzing patterns of lifestyle change over the lifespan, a critical time for negative lifestyle behaviors appears to be in later adolescence and early adulthood (4–6). In this sense, the first year of university is a critical period because it is associated with the adoption of unhealthy lifestyle behaviors, where students experience changes in eating behaviors, physical activity, sleep patterns, and alcohol consumption (7–9).

Consequently, several meta-analyses have reported that the first year of university is accompanied by important changes in lifestyle behavior characterized by an increase in weight and percentage of body fat, changes in diet quality or eating behaviors, and decreased levels of physical activity (2, 8, 10–13). The main behaviors associated with weight gain were the consumption of sugary drinks, alcohol consumption, low consumption of vegetables and fruits, frequent self-consumption, eating unhealthy and low levels of food regulation (13). Moreover, a global survey of 23 countries with different income levels showed that 21.9% to 80.6% of university students are physically inactive (14). On the other hand, the transition to university life often leads students to modify their dietary habits, sleep patterns, and alcohol consumption due to increased autonomy, academic pressures, and new social environments (2, 12, 15).

According to the World Health Organization (WHO), a healthy lifestyle involves regular physical exercise, abstention from smoking, avoiding alcohol consumption, and eating healthy foods to prevent excess body weight gain (16). Currently, evidence supports that aspects of movement behavior such as levels of physical activity, sedentary time, and duration of sleep are interconnected as they occur throughout the 24-hour day, and thus, they should be assessed collectively (17, 18). In line with this, in a previous cross-sectional study, we reported that upon admission to university, overall adherence to the 24-hour movement guidelines is low, and a high percentage of physiotherapy students reported unhealthy lifestyle behaviors in Ecuador (6).

Several studies have analyzed changes in lifestyle behaviors at one or more years of follow-up in university students (5, 7, 19–22). However, only one published study has been performed in Latin American university students (9). Given the scarcity of published data about the behavior of these variables in this population. Thus, the aim of this study was to examine changes in lifestyle behavior, such as physical activity, sleep quality and duration, adherence to 24-hour movement guidelines, diet, and alcohol consumption in physiotherapy students after one year in the Universidad de Las Americas in Quito, Ecuador.

Of the 120 students considered for eligibility, 2 students were excluded due to uncontrolled diabetes mellitus, and 2 declined participation. Finally, 116 students were initially recruited; however, 16 dropped out during their first year of University. Therefore, 100 students were included in this study (Figure 1). Characteristics, sociodemographics, and anthropometrics of the students included are shown in Table 1. Of these 100 university students included; 60 were female (60%), 40 were male (40), and the mean age was 21.2 years old (SD = 1). A total of 70 students (70%) reported middle socioeconomic status, and 80 (80%) were not working. Additionally, 80 students (80%) did not present any diagnosed comorbidity (hypertension, diabetes mellitus or hypercholesterolemia). According to stratified BMI, 40 students (40%) had normal weight, 40 (40%) were overweight, and 19 (19%) had obesity.

Additionally, changes in the continuous anthropometrics and lifestyle variables between the baseline and one-year follow-up are shown in Table 2. The mean difference (MD) for weight was +5.8 kg [95% confidence interval (CI): 2.9 to 8.5; p < 0.001] and for BMI was +3.3 kg/m² (95% CI: 1.1 to 5.2; p = 0.001). The MDs for PSQI and AUDIT questionnaires increased by 1.0 point each (both p-values were less than 0.05).

Changes in categorical anthropometric and lifestyle variables between the baseline and one-year follow-up are shown in Table 3. Figure 2 shows the number of students with high levels of physical activity according to GPAQ, the Figure 3 shows the number of students experiencing significant sleep disturbances (PSQI > 5 points), the Figure 4 shows the number of students with harmful alcohol use (AUDIT > 8 points). Finally, the Figure 5 shows the number of students that meeting all recommendations of adherence to the overall 24-hour movement guidelines.

This observational study aimed to examine changes in lifestyle behavior in physiotherapy students after one year at the Universidad de Las Americas in Quito, Ecuador. The main findings of our study were, at the end of the first year of university, most students transitioned to unhealthy lifestyle behaviors characterized by an increase in weight and BMI, a decrease in the level of physical activity, low adherence to 24-hour movement guidelines, more sleep disturbance, a poor diet quality, and harmful alcohol consumption.

Our findings confirm the observations that the trend of unhealthy lifestyles and poor dietary habits is increasing at the end of the first year of university (5, 7, 9). Although, most of these studies were not conducted in health students. This could be a factor that modifies the results due to these students' having greater knowledge of lifestyle behaviors (34). Despite, this trend can be attributed to numerous factors, including peer pressure, being away from home for a considerable number of hours, the pressure of studying, accessibility of fast foods, and the limited choices of healthy foods on university campuses, in addition to the influence of social media (3, 35). Accordingly, universities should implement prevention and promotion strategies that modify university settings to improve healthy lifestyle behaviors among their students (6).

Regarding weight gain, two meta-analyses reported that university students gain an average of 1.75 kg and 1.55 kg during their first year, respectively (10, 11). Likewise, another meta-analysis reported that first-year university students, on average, gained 1.36 kg over a period of six weeks to eight months. Indeed, 60.9% of students gained weight, and within those, the average weight gained was 3.38 kg (8). It is important to highlight that these meta-analyses do not include studies conducted in Latin America. Our findings agree with a study conducted in Faculty of Health students of one private University of Chile, which reported that students gain an average of 5.9 kg at the end of their first year of university (9).

There is consensus that a critical time for the increase in the prevalence of overweight/obesity appears to be in later adolescence and early adulthood (36). During this period, there is a significant decrease in the level of physical activity (37). According with our findings, another study showed a decrease of 147.9 total METs at one year of follow-up from the upon admission to university (9). Given the low levels of physical activity and unhealthy eating, it is not surprising that the prevalence of overweight/obesity has reached epidemic proportions in young adults in the last decade (38). At the end of the follow-up, the students significantly increased the proportion of overweight/obesity and decreased levels of physical activity. According to our findings, a systematic review reported that insufficient activity is a serious health concern among university students (39). Despite this, there are no studies that have analyzed whether the levels of physical inactivity in students belonging to health careers are similar to those in other careers or faculties. We think that our results could be influenced because our cohort were physiotherapy students, however, similar studies are lacking to compare our findings.

Adequate sleep quality and duration have a critical role in optimal physical health, immune function, mental health, and cognition (40). Unfortunately, attending university is often associated with insufficient sleep (41). After one year of university, 79 students (79%) of our sample had significant sleep disturbance. Usually, factors such as reduced parental support, increased stress from academic loads, and unhealthy lifestyle behaviors result in sleep disorders in this population (42). There are also no studies that have compared sleep quality between students from health faculties and students from other faculties. We could hypothesize that faculties of health students having a better awareness of sleep health and therefore having better sleep habits, which could improve their sleep quality in some degree. However, further research are needed to close this knowledge gap.

Currently, no published studies have evaluated changes in adherence to the overall 24-hour movement guidelines among Latin American university students. Despite this, one study conducted in eight Latin American countries reported that the proportion of adults (aged 18 to 64 years old) who met all three of the 24-hour movement guidelines was low (1.6%) (43). Interestingly, this study showed that sociodemographic factors such as being a woman and having a middle or high education level were associated with a lower probability of meeting all three guidelines (43). Consistent with these findings, our study reports that only six students (6%) met the overall 24-hour movement guidelines. Unfortunately, the lack of similar published studies of Latin American university students prevents us from comparing our findings within this geographical location.

University is often associated with students having more autonomy over their dietary choices. Specifically, factors such as cost, skipping meals, inadequate variety of foods, snacking, and frequent consumption of fast foods increase students' risk of poor health (38). Previous studies have shown that students' diets are characterized by low consumption of fresh fruits and vegetables, monounsaturated fatty acids, polyunsaturated fatty acids, and fish, coupled with increased intake of sugar, alcohol, and fast food (2, 5, 7, 44). Consistent with these findings, our study revealed that 80 students (80%) in the sample exhibited a need for improvements in diet quality and reported engaging in unhealthy eating habits.

In our study, we report a total of 30 students (30%) with harmful alcohol consumption. Consistent with our findings, another study of university students in Ecuador reported that the prevalence of harmful alcohol consumption, above the cutoff score of eight in the AUDIT questionnaire, was high. Almost 50% of male students and 25% of female students reported harmful alcohol consumption (33). The rates of harmful alcohol consumption reported in our study are similar to Europe and South America (where rates range between 23% and 33% for males and 10% and 22% for females) (45).

At the end of the first year of university, most students showed unhealthy lifestyle behaviors characterized by an increase in weight and BMI, a decrease in the level of physical activity, low adherence to 24-hour movement guidelines, more sleep disturbance, poor diet quality, and harmful alcohol consumption. This indicates a need to address this problem during this critical period for developing interventions to improve lifestyle behaviors and prevent the occurrence of non-communicable chronic diseases. In the university, there is significant scope to implement specific strategies to foster healthier lifestyles in their students. However, more research is needed in Latin American universities.