Multifactorial determinants of health status: insights from the MEDIET4ALL large-scale survey on eco-sociodemographic, psychological, and lifestyle (diet, physical activity, and sleep) factors.
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Ammar Achraf, Salem Atef, Boujelbane Mohamed Ali, Trabelsi Khaled, Bouaziz Bassem, Kerkeni Mohamed, Masmoudi Liwa, Heydenreich Juliane, Schallhorn Christiana, Müller Gabriel, Uyar Ayse Merve, Ghazzawi Hadeel Ali, Amawi Adam Tawfiq, Orhan Bekir Erhan, Grosso Giuseppe, Abdelkarim Osama, Driss Tarak, El Abed Kais, Zmijewski Piotr, Debeaufort Frédéric, Benbettaieb Nasreddine, Poulain Clément, Reyes Laura, Gamero Amparo, Cuenca-Ortolá Marta, Cilla Antonio, Francesca Nicola, Messina Concetta Maria, Viola Enrico, Lorenzen Björn, Filice Stefania, Lahiani Sadjia, Khaldi Taha, Souissi Nafaa, Boukhris Omar, Frias-Toral Evelyn, Jahrami Haitham, Husain Waqar, Mahdi Walid, Chtourou Hamdi, Schöllhorn Wolfgang I
Аннотация
METHODS: Data were collected from 4,010 participants (age: 37.2 ± 15.4 years; 59.5% female) across 10 Mediterranean and neighboring countries using the multinational MEDIET4ALL e-survey. Health status was categorized as healthy, at-risk, or with diseases. Multinomial logistic regression, Quade's Rank ANCOVA and series of multiple regression models were conducted.
RESULTS: Collectively, around 25% of respondents declared to be at-risk of or with known disease. BMI emerged as the strongest negative predictor of health status (β = -0.145), with both obesity and underweight significantly increasing the odds of being at risk (OR = 1.8 and 5.2, respectively) and having diseases (OR = 2.2 and 11.9, respectively). Other significant negative predictors included psychological distress (notably anxiety, β = -0.091), insomnia (β = -0.084), alcohol consumption (β = -0.053), and prolonged sitting time (β = -0.037). Conversely, life satisfaction was the strongest significant protective factor (β = 0.066), followed by higher education, better sleep quality, and adherence to the Mediterranean Diet and lifestyle (β = 0.034 to 0.050). Socio-economic disparities, including employment status (β = -0.045) and living environment (β = -0.031), also significantly influenced health outcomes with rural environment and employed individual showing lower odd ratios of being at-risk and/or having diseases (p < 0.001). Furthermore, individuals residing in Mediterranean regions, females, married or cohabiting individuals, and non-smokers exhibited significantly lower odds of being at-risk or having diseases (p < 0.05). While gender remained a significant predictor in the final refined comprehensive regression model (β = -0.049), marital status lost significance, suggesting that its protective effect may be mediated by psychological well-being and health-related behaviors.
CONCLUSION: These findings highlight the complex interplay of lifestyle, mental health, and socio-environmental factors in determining health outcomes, while emphasizing the urgent need for multi-level public health interventions, including policies promoting physical activity, healthy eating, mental well-being, and equitable healthcare access. Future research should employ longitudinal designs to establish causal relationships and guides preventive strategies.