Introduction

Student lifestyle is increasingly recognized as an im­portant factor associated with long-term health outcomes and chronic diseases in adulthood [1]. The transition to university often brings substantial shifts in daily routines, including academic and social pressures, altered food environments, and changes in physical activity levels and sleep patterns [2]. In this context, studying behavioral health determinants, particularly physical activity and dietary habits, gains special significance, as they are highly modifiable and are prime targets for preventive interventions. Moreover, understanding these determinants is crucial for addressing health inequalities, as dispari­ties in lifestyle patterns and related health outcomes may emerge during this formative period and can persist throughout life.

Central and Eastern Europe (CEE), as well as the Eastern Mediterranean (EM), are of particular interest for comparative analysis, given their distinct heterogeneity in socio-economic conditions, food patterns, prevalence of unhealthy habits, and access to preventive services [3-5]. These regional disparities are associated with observable health inequalities. At the same time, the student population in most countries shares seve­ral common characteristics: a relatively young age and specific features of the student cohort [6], participation in educational processes marked by high cognitive demands and psychosocial stressors, a substantial proportion of time spent in sedentary settings coupled with low levels of physical activity and other health-promoting behaviors [7], as well as distinct leisure-time patterns and their shaping factors [8].

In this context, particular attention is paid to medical students, as their own lifestyle and attitudes towards health may influence their future professional activities, the effectiveness of patient counseling, and the promotion of healthy behaviors in society [9-11]. Research indicates that this group, despite their specialized education, frequently exhibits insufficient physical activity, a sedentary lifestyle, and unbalanced nutrition, as evidenced by studies in Poland and other CEE countries [12-15]. This underscores the relevance of not only assessing their lifestyle but also conducting a comparative analysis with non-medical students, particularly to identify how educational background and professional aspirations might mitigate or exacerbate existing health inequalities.

The aim of this review is to comparatively analyze student lifestyle factors (physical activity and dietary habits) in CEE and the EM, drawing upon existing research and discussing methodological approaches applicable for subsequent empirical analysis. Ultimately, this work seeks to lay the groundwork for understanding the regional drivers of health inequalities and informing interventions designed to mitigate them.

Review type and search strategy

This article offers a narrative review, employing a structured approach to synthesize current knowledge. Its primary aim is to identify methodological conside­rations for future cross-regional comparative studies on student lifestyle, ultimately seeking to enhance our understanding and address health inequalities effectively. The overarching goal is to explore how varying socio-economic, cultural, and environmental contexts contribute to differing lifestyle patterns and, consequently, to health inequalities among students. A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science databases. Key search terms included combinations of “student,” “university,” “physical activity,” “dietary habits,” “lifestyle,” “Central Europe,” “Eastern Europe,” “Eastern Mediterranean,” and country-specific terms within these regions. The search was limited to articles published in English up to April 2026. Relevant studies were selected based on their focus on student populations and their contributions to understanding physical activity, dietary patterns, or methodological aspects of cross-cultural health behavior research in the specified regions.

We primarily focused on peer-reviewed articles, reviews, and reports to ensure scientific rigor. Given the narrative nature of this review, a formal systematic review protocol or meta-analysis was not undertaken. Instead, a structured narrative synthesis was performed, integrating evidence from the included literature to construct a conceptual framework for future empirical work. Nevertheless, our search strategy prioritized comprehensiveness, employing predefined search terms and databases.

Theoretical foundations: student lifestyle as a system of health determinants

Theoretically, lifestyle is best understood as an intricate system of health determinants, incorporating beha­vioral, cognitive, and contextual elements [16]. Physical activity, nutrition, smoking, alcohol consumption, sleep patterns, and indicators of psycho-emotional well-being form interconnected practices that can either amplify or mitigate the risks of adverse outcomes [17-19]. Criti­cally, these interconnected practices are often unevenly distributed across diverse student populations and geographical regions, resulting in varying health outcomes and consequently reinforcing existing health inequalities.

Physical activity is viewed not only as an independent factor in preventing cardiovascular diseases and metabo­lic disorders but also as an indicator of overall self-regulation and adherence to health-preserving behaviors [20]. Nutrition acts as a channel of influence through diet quality (e.g., consumption of fruits, vegetables, and whole grains), energy balance, and micronutrient presence [21, 22]. Simultaneously, it is crucial to consider that contemporary models of nutrition and activity are often shaped by the urban environment, the accessibility of fast foods, academic schedules, and stress levels [23, 24]. These environmental and social determinants further contribute to variations in lifestyle choices, creating conditions for health disparities based on socio-economic status, geographical location, and cultural background.

In the student environment, behavioral mediators of health play a special role: sedentary time, irregular eating, replacing full meals with snacks, and the prevalence of unhealthy habits. At the same time, psychological and cognitive mechanisms (beliefs about health control, stress resistance levels, motivation for behavior change) determine receptiveness to recommendations and the ability to maintain healthy practices [25, 26].

It is also crucial to acknowledge the inherent diversity within the student population. Students are not a homogeneous group; their lifestyles and health determinants can be significantly influenced by factors such as gender, socio-economic status, cultural background, migration status, academic discipline, and living arrangements. Ignoring these internal variations can obscure critical insights into the differential impact of health policies and interventions, thus perpetuating health inequalities.

Methodological approaches in student lifestyle research

Research into student lifestyles requires the application of diverse methodological approaches for an adequate assessment of physical activity, dietary habits, and their impact on health. The choice of measurement tools and methods plays a key role in obtaining reliable and comparable data. The main approaches used in the litera­ture are presented below.

Assessment of physical activity

This is the most common method for assessing phy­sical activity levels (intensity, duration, frequency, type) over a specific period (e.g., a week). Examples include the International Physical Activity Questionnaire–Short Form (IPAQ-SF) [27, 28] and the Godin Leisure-Time Exercise Questionnaire [29]. Advantages: cost-effectiveness, ease of application in large samples. Disadvantages: reliance on respondent memory, tendency to overestimate activity levels.

The use of accelerometers or pedometers allows for more precise data on movement and energy expenditure [30, 31]. Accelerometers can differentiate types of activity and estimate time spent sedentary. However, their use is more costly and requires additional resources for data analysis.

Separate attention is paid to measuring time spent in sedentary positions, which is considered an independent health risk factor regardless of the overall level of phy­sical activity [5, 32].

Assessment of dietary habits

Various methodological approaches are employed for a comprehensive assessment of dietary habits. One of the key tools is Food Frequency Questionnaires (FFQs), which enable determining the regularity of consumption of specific foods and food groups over a long period, thus helping to identify characteristic dietary patterns [33]. FFQs can be adapted and validated for use in various cultural and linguistic groups, increasing the relevance and accuracy of measurements [34-37]. Additionally, studies focusing on student dietary habits make an important contribution to understanding dietary patterns and their relationship to health [38].

Alongside FFQs, detailed information on dietary composition is provided by 24-hour recalls and food diaries. These approaches yield comprehensive data but require significant time and effort from both respondents and researchers. Diet quality can be assessed by calculating indices based on food consumption data. Such indices, for example, the Healthy Eating Index, can be used to quantitatively evaluate dietary adherence to healthy eating recommendations [39].

The assessment of height, weight, waist circumference, and body mass index calculation are standard procedures for identifying overweight and obesity. Although these data are often collected through self-reporting, objective measurements can be employed to enhance accuracy.

Assessment of health status and psycho-emotional well-being

Health status assessment includes the analysis of self-reported chronic diseases and the frequency of complaints (e.g., pain syndromes, headaches, sleep disturbances). Psycho-emotional well-being is evaluated using standar­dized approaches (questionnaires/surveys) applied in stu­dies of student mental health and quality of life [40].

Mechanisms of influence and health policy perspectives

To fully grasp the intricate relationship between student lifestyles and health outcomes, a deeper exploration of underlying mechanisms and the pivotal role of health policies is imperative. Theoretical frameworks, including the Ecological Model of Health Behavior [41] and the Social Determinants of Health framework [42], offer crucial lenses for analyzing these complex interactions. These models posit that health behaviors are not solely individual choices but are shaped by multiple layers of influence, ranging from individual characteristics (e.g., knowledge, attitudes, beliefs) to interpersonal relationships (e.g., peer influence, family support), organizational factors (e.g., university policies, campus environment), community contexts (e.g., local infrastructure, cultural norms), and broader societal structures (e.g., national health policies, economic conditions).

For students, these mechanisms manifest in various ways:

• Socio-economic factors: Income level, parental education, and access to financial resources significantly impact dietary choices (e.g., affordability of nutritious foods), ability to engage in physical activity (e.g., gym memberships, sports equipment), and exposure to health risks (e.g., living conditions, stress levels). Health inequalities often correlate with socio-econo­mic disparities, as students from less privileged backgrounds may face greater barriers to adopting and maintaining healthy lifestyles.

• Cultural and environmental factors: Deeply ingrained cultural norms dictate food preferences, social attitudes towards physical activity, and acceptance of substance use. The urban environment, with its accessibility to fast food, limited green spaces, and sedentary entertainment options, often contrasts with traditional lifestyles. Religious beliefs and local traditions, particularly evident in the EM, also play a crucial role in shaping dietary practices and attitudes towards alcohol consumption.

• Systemic and policy factors: National health policies, university-level health promotion programs, and the structure of healthcare systems significantly influence student health behaviors. Differences in public health spending, educational curricula (e.g., health education), and regulatory frameworks (e.g., tobacco and alcohol controls) between CEE countries and the EM lead to varying levels of support for healthy living. For instance, some universities may offer comprehensive sports facilities and nutrition counseling, while others may lack such resources. Effective interventions often require a multi-sectoral approach, integrating health promotion into academic curricula, providing accessible and affordable healthy food options on campus, and fostering environments conducive to physical activity. Conversely, the absence or inadequacy of such policies can perpetuate and exacerbate existing health inequalities.

When comparing these regions, CEE, for instance, frequently contends with the lingering legacies of shifting political and economic systems, which have inevitably influenced health infrastructure and public health priorities. While many countries are now integrated into European Union health strategies, implementation varies, and older habits persist. In the EM, cultural and religious factors often heavily influence health policies (e.g., strict alcohol regulations in some countries), alongside socio-economic disparities and, in some areas, political instability, which can hinder the development and implementation of comprehensive health promotion strategies.

Examples of successful interventions include university-based wellness programs promoting physical activity through organized sports and fitness classes, nutrition education workshops, and mental health support services. However, these are not universally available or equally effective across all contexts. Critically, policy interventions targeting upstream determinants, aimed at improving food environments, increasing access to safe recreational spaces, and integrating health literacy into education at all levels, hold significant potential for reducing health inequalities among students.

Methodological features of comparative studies

Comparing data across different countries necessitates a critically important step: the cross-cultural vali­dation of questionnaires and methodologies. Direct, unadapted use of instruments risks distorted results [3, 7]. Such methodological rigor is particularly vital when investigating health inequalities, as inaccurate data can obscure true disparities or create misleading ones.

For data comparability, the application of standar­dized data collection protocols is desirable, especially when conducting multicenter studies. These standardiz­ed protocols are essential for ensuring that any identified differences in health behaviors or outcomes are genuine and not artifacts of measurement variation, thereby strengthening the evidence base for health inequality research.

Social, economic, cultural, and educational contexts of each country should be considered, as these factors can influence both behavioral patterns and the interpretation of results. Differences in research design, instruments used, and conditions of conduct (e.g., during the COVID-19 pandemic) can significantly hinder direct comparison and require caution in drawing conclusions. Understanding these contextual nuances is paramount for accurately interpreting the origins and manifestations of health inequalities in student populations.

In a review, it is appropriate to additionally define a logical-analytical framework for comparative analysis and to indicate which lifestyle components should be operationalized in subsequent empirical studies.

Framework for comparative analysis

To conduct a comparative analysis of student lifestyle factors in CEE and EM countries, a multi-level approach is proposed [43, 44]. The comparison involves key indicators, including physical activity levels, dietary habits, and contextual factors. Physical activity levels will be assessed using standardized metrics such as metabolic equivalents, total activity time of varying intensity, and detailed by activity types (walking, moderate, intense). Special attention will be paid to sedentary behavior indicators as an independent risk factor. The analysis of dietary habits will include the frequency of consumption of different food groups (fruits, vegetables, whole grains, highly processed foods, sugary drinks), an assessment of eating patterns (regularity of meals, missed meals, snacks), and qualitative aspects of the diet [45, 46]. Socio-economic conditions (income level, parental educational status), cultural characteristics of the regions, as well as academic workload and stress levels typical for the student environment will be considered as contextual factors explaining differences in lifestyle. These contextual factors are particularly relevant for identifying the underlying drivers of health inequalities, as they shape access to resources, opportunities for healthy living, and individual choices. The logic of data interpretation will be based on identifying both general trends and specific differences between regions, determined by socio-cultural, economic, and educational systems. Special attention will be paid to identifying connections between beha­vioral factors and health indicators, as well as potential points for targeted interventions aimed at reducing identified inequalities.

The multi-level approach will also explicitly consider the heterogeneity of the student population by analyzing how physical activity levels and dietary habits vary across different demographic groups (e.g., gender, age, socio-economic background, international students) and academic disciplines, which is essential for understanding the distribution and drivers of health inequalities.

Conceptual scheme of an integrated questionnaire tool for further research

Considering the primary research data reviewed in this overview, it seems appropriate to propose a constructive (conceptual) scheme for an integrated questionnaire tool to organize the findings and support the planning of the subsequent empirical stage [45]. This scheme illustrates how key constructs described in the literature can be methodically and coherently combined into a single instrument, rather than serving as a ready-made research protocol within the scope of this review. Such integrated approaches are increasingly recognized for their ability to provide a holistic view of student health behaviors. For assessing physical activity IPAQ-SF [27, 28] is a logical choice, capturing activity over a specified period. This can be complemented by an independent measure of sedentary behavior, reco­gnized as a distinct lifestyle component [5, 32]. Research consistently highlights the relationship between physical activity levels and indicators of psychosocial functioning, a correlation particularly pertinent to the student population [47]. To assess dietary habits, a food frequency approach is advisable. This method involves cataloging the consumption of specific food groups (e.g., vegetables, fruits, whole grains, highly processed foods, sugary drinks) and the frequency of snacking [33, 35]. The development and cross-cultural validation of such integrated scales are crucial for ensuring the reliability and comparability of data across different settings [48]. Additionally, the proposed conceptual framework may include contextual variables that facilitate the interpretation of links between behavioral factors and health status (e.g., smoking/alcohol consumption as lifestyle elements, as well as subjective indicators of health or well-being) [49, 50]. By including these contextual factors, the integrated questionnaire can provide a more nuanced understanding of how social determinants are associated with health behaviors and contribute to health inequalities. However, the specific set of items, translation and cultural adaptation strategy, and the procedure for verifying measurement equivalence should be determined during the planning stage of an empirical study, considering the requirements for data comparability in cross-country comparisons. Thus, the presented components are conceptual elements of future research and are subject to refinement in accordance with its objectives, design, and measurement validity requirements.

Specifics of student lifestyle in CEE and the EM: key regional patterns and influences

Student lifestyle in CEE countries and the EM is uniquely shaped by a complex interplay of academic workload, urban environments, food accessibility, and deeply ingrained cultural norms regarding physical activity, nutrition, smoking, and alcohol consumption. While general trends in health behaviors are observable across student populations globally, comparative analysis in these regions highlights distinct patterns influenced by their specific socio-economic and cultural trajectories, often resulting in discernible health inequalities among different student subgroups and across regions.

Beyond these factors, the pervasive influence of digital technologies and the online environment demands specific consideration. Enhanced screen time, extensive engagement with social media, and the convenience of online food delivery services collectively reshape physical activity patterns and dietary habits. While offering opportunities for health promotion, the digital landscape also presents risks for sedentary behavior, disrupted sleep, and behavioral addictions, which contribute to distinct health challenges for students in both regions.

In CEE, a notable characteristic of student physical activity is its variability. Studies often report a decrease in physical activity levels as students’ progress through their academic careers, often correlating with increased study demands and a shift towards predominantly sedentary educational and leisure pursuits [7, 23]. Despite traditional sports and outdoor activities remaining popular, the influence of modern urban living and screen-time activities contributes significantly to prolonged sedentary behavior. For instance, research from Poland [12-15], Lithuania [14], and other CEE countries consistently highlights insufficient physical activity among students, including medical students, pointing to a pervasive sedentary lifestyle that persists despite health knowledge. These patterns contribute to a higher risk of non-communicable diseases and, when coupled with socio-economic disparities, can exacerbate health inequalities within and between student cohorts. Dietary habits in CEE students frequently present a mixed picture. While traditional diets, rich in locally sourced produce, still have a presence, there’s a growing trend towards consuming highly processed foods, high-energy-density snacks, and sugary beverages, influenced by Westernization and the availability of fast-food options [2, 4, 21-24, 34, 45, 49]. This often results in irregular eating patterns and increased snacking. Cultural perceptions and economic factors play a substantial role, with some studies in Central Europe explicitly comparing dietary patterns and highlighting regional nuances [49]. Regarding substance use, smoking and alcohol consumption are prevalent concerns. Cultural acceptance of social drinking and, in some areas, smoking, alongside academic stress, contribute to these risk behaviors [1, 48]. Such variances in dietary and substance use patterns across socio-economic strata and geographical areas within CEE further underscore the presence of health inequalities.

In the EM region, student lifestyle patterns share some similarities with CEE but also exhibit unique cultural and socio-economic influences. Physical activity levels can be impacted by climate conditions, limited access to sports facilities, and cultural norms that may restrict certain types of physical activity for some groups. Sedentary behavior remains a significant challenge, often exacerbated by academic demands and modern entertainment options. Dietary habits in the EM region are often characterized by a blend of traditional Mediterranean diets (rich in fruits, vegetables, and olive oil) and newer patterns involving increased consumption of fast food, sugary drinks, and processed snacks [33, 35]. Socio-economic disparities and rapid urbanization can influence food choices and accessibility to nutritious options. Smoking, particularly waterpipe (shisha) use, and alcohol consumption (though often culturally or religiously restricted in some EM countries) are important health behaviors among students, with specific regional patterns of prevalence and social acceptance [48]. These regional and cultural specificities in lifestyle choices, mediated by socio-economic factors, contribute to distinct profiles of health risks and thus to varying degrees of health inequalities within the EM student population and in comparison to other regions.

Across both regions, academic pressures and psychosocial stressors consistently emerge as significant contextual factors influencing lifestyle choices. Students’ coping mechanisms, often involving diet or physical activity changes, highlight the interconnectedness of mental well-being with health behaviors [46-47]. Furthermore, the varying degrees of public health policy implementation and health education across countries in these regions contribute to the heterogeneity of student health behaviors [3, 7]. This heterogeneity, particularly when linked to socio-economic disadvantage or limited access to supportive environments, is associated with health inequalities. Understanding these regional specifics is paramount for developing culturally sensitive and effective preventive interventions aimed at mitigating these inequalities and promoting equitable health outcomes.

These patterns elevate the risk of non-communicable diseases. Moreover, when combined with socio-economic disparities or particular vulnerabilities among international students or those from marginalized backgrounds, they can markedly exacerbate health inequalities both within and between student cohorts.

Conclusions

This narrative review distinctly underscores the urgent need for a comprehensive comparative analysis of student lifestyle factors across CEE and the EM. Such an analysis is not merely warranted but highly relevant for effectively addressing prevailing health inequalities. This endeavor critically hinges on adopting consistent measurement methodologies and ensuring instrument comparability. We reaffirm that widely used approaches, such as the IPAQ-SF complemented by objective measures such as accelerometers for physical activity assessment, and FFQs alongside food diaries for dietary habit evaluation (with dietary quality assessed via derived indices), remain foundational. Importantly, our review identifies critical research gaps, especially the dearth of studies rigorously analyzing the complex interplay of socio-economic, cultural, and policy factors that shape student lifestyles and health disparities across these diverse regions. Future multicenter comparative studies are therefore imperative. To effectively implement such complex projects, establishing robust research consortia, fostering cross-cultural validation, and harmonizing data collection protocols across participating countries will be paramount.

Disclosures

1. Institutional review board statement: The study was approved by the Bioethics Committee of the District Medical Chamber in Krakow (approval no. 96/KBL/OIL/2026).

2. Assistance with the article: None.

3. Financial support and sponsorship: No external funding.

4. Conflicts of interest: The authors declare no conflict of interest.

References