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Association of lifestyle factors and suboptimal health status: a cross-sectional study of Chinese students

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      Suboptimal health status (SHS) is considered to be an intermediate status between disease and health, and is characterised by a decline in vitality, in physiological function and in the capacity for adaptation. Although the incidence of SHS is high, the underlying causes remain unclear. Lifestyle is one of the most important factors affecting health status; however, the relationship between SHS and lifestyle has not been elucidated.


      Cross-sectional survey.


      A questionnaire, based on ‘Health Promoting Lifestyle Profile-II (HPLP-II)’ and ‘Sub-Health Measurement Scale V1.0 (SHMS V1.0)’, was sent to four colleges in four districts (Guangzhou, Foshan, Zhanjiang and Shaoguan) of China between May and July 2013.


      A total of 12 429 questionnaires were distributed during the study period, and 11 144 completed responses were received.


      The prevalence rates for the ‘healthy’, ‘SHS’ and ‘disease’ groups of respondents (students) were 22.81% (2542), 55.9% (6234) and 21.25% (2368), respectively. Most of the students reported a ‘moderate’ or ‘good’ lifestyle. There were significant differences in lifestyle and health status between the two genders. It was notable that health status was significantly positively correlated with lifestyle (r=0.563). For every dimension of the HPLP-II model, the mean values were lower for those participants who reported as ‘SHS’ or ‘disease’ than for those who reported that they were ‘healthy’. The individual dimensions of the HPLP-II model, including ‘spiritual growth’, ‘health responsibility’, ‘physical activity’, ‘interpersonal relations’ and ‘stress management’ were all related to SHS.


      Health status is significantly positively correlated with lifestyle. Poor lifestyle is a risk factor for SHS. Conversely, adopting a healthier lifestyle can improve SHS.

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      Most cited references 31

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      Changes in diet and lifestyle and long-term weight gain in women and men.

       Le Hao,  Frank Hu,  Eric Rimm (2011)
      Specific dietary and other lifestyle behaviors may affect the success of the straightforward-sounding strategy "eat less and exercise more" for preventing long-term weight gain. We performed prospective investigations involving three separate cohorts that included 120,877 U.S. women and men who were free of chronic diseases and not obese at baseline, with follow-up periods from 1986 to 2006, 1991 to 2003, and 1986 to 2006. The relationships between changes in lifestyle factors and weight change were evaluated at 4-year intervals, with multivariable adjustments made for age, baseline body-mass index for each period, and all lifestyle factors simultaneously. Cohort-specific and sex-specific results were similar and were pooled with the use of an inverse-variance-weighted meta-analysis. Within each 4-year period, participants gained an average of 3.35 lb (5th to 95th percentile, -4.1 to 12.4). On the basis of increased daily servings of individual dietary components, 4-year weight change was most strongly associated with the intake of potato chips (1.69 lb), potatoes (1.28 lb), sugar-sweetened beverages (1.00 lb), unprocessed red meats (0.95 lb), and processed meats (0.93 lb) and was inversely associated with the intake of vegetables (-0.22 lb), whole grains (-0.37 lb), fruits (-0.49 lb), nuts (-0.57 lb), and yogurt (-0.82 lb) (P≤0.005 for each comparison). Aggregate dietary changes were associated with substantial differences in weight change (3.93 lb across quintiles of dietary change). Other lifestyle factors were also independently associated with weight change (P 8 hours of sleep), and television watching (0.31 lb per hour per day). Specific dietary and lifestyle factors are independently associated with long-term weight gain, with a substantial aggregate effect and implications for strategies to prevent obesity. (Funded by the National Institutes of Health and others.).
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        The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals.

        The aim of this study was to meta-analyze epidemiological studies and clinical trials that have assessed the effect of a Mediterranean diet on metabolic syndrome (MS) as well as its components. The Mediterranean diet has long been associated with low cardiovascular disease risk in adult population. The authors conducted a systematic review and random effects meta-analysis of epidemiological studies and randomized controlled trials, including English-language publications in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials until April 30, 2010; 50 original research studies (35 clinical trials, 2 prospective and 13 cross-sectional), with 534,906 participants, were included in the analysis. The combined effect of prospective studies and clinical trials showed that adherence to the Mediterranean diet was associated with reduced risk of MS (log hazard ratio: -0.69, 95% confidence interval [CI]: -1.24 to -1.16). Additionally, results from clinical studies (mean difference, 95% CI) revealed the protective role of the Mediterranean diet on components of MS, like waist circumference (-0.42 cm, 95% CI: -0.82 to -0.02), high-density lipoprotein cholesterol (1.17 mg/dl, 95% CI: 0.38 to 1.96), triglycerides (-6.14 mg/dl, 95% CI: -10.35 to -1.93), systolic (-2.35 mm Hg, 95% CI: -3.51 to -1.18) and diastolic blood pressure (-1.58 mm Hg, 95% CI: -2.02 to -1.13), and glucose (-3.89 mg/dl, 95% CI:-5.84 to -1.95), whereas results from epidemiological studies also confirmed those of clinical trials. These results are of considerable public health importance, because this dietary pattern can be easily adopted by all population groups and various cultures and cost-effectively serve for primary and secondary prevention of the MS and its individual components. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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          The Health-Promoting Lifestyle Profile: development and psychometric characteristics.

          This article describes the development and initial psychometric evaluation of an instrument to measure health-promoting life-style. Based on responses from 952 adults in midwestern communities, the Health-Promoting Lifestyle Profile was evaluated using item analysis, factor analysis, and reliability measures. Factor analysis isolated six dimensions: Self-Actualization, Health Responsibility, Exercise, Nutrition, Interpersonal Support, and Stress Management. These six factors accounted for 47.1% of the variance in the 48-item measure. Second-order factor analysis yielded a single factor, interpreted as Health-Promoting Lifestyle. The alpha reliability coefficient for the total scale is .922; alpha coefficients for the subscales range from .702 to .904. Further evaluation of the measure with different populations appears warranted. This instrument will enable researchers to investigate patterns and determinants of health-promoting life-style, as well as the effects of interventions to alter life-style.

            Author and article information

            [1 ]Department of Traditional Chinese Medicine, Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong, China
            [2 ]School of Traditional Chinese Medicine, Southern Medical University , Guangzhou, Guangdong, China
            [3 ]Department of Rheumatic diseases, The First Affiliated Hospital of Guangzhou University of Chinese Medicine , Guangzhou, China
            Author notes
            [Correspondence to ] Ren Luo; and Dr Xiaoshan Zhao; zhaoxs0609@

            JB and YH contributed equally to this work.

            BMJ Open
            BMJ Open
            BMJ Open
            BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
            20 June 2014
            : 4
            : 6
            24951109 4067885 bmjopen-2014-005156 10.1136/bmjopen-2014-005156
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