Adherence to 24-h movement guidelines and its associations with dietary behavior and mental health among university students from five ASEAN countries

Despite growing evidence linking 24-h movement behaviors to health outcomes, there is limited research examining these relationships among university students in Southeast Asia. Therefore, the purpose of this study was to examine the prevalence and associations of adherence to 24-h movement guidelines (HMG) with dietary behaviour and mental health among university students in ASEAN. A multi-center cross-sectional survey was conducted in 2015 included 3223 university students from five ASEAN nations-Indonesia, Malaysia, Myanmar, Thailand, and Vietnam-aged 18 to 30 years, selected by stratified random sampling. Established measures included demographics, social support, perceived stress, self-rated health status, body mass index, six dietary behaviours, eight mental health outcomes, and adherence to 24-h movement guidelines (24-HMG) was assessed based on self-reported physical activity (≥ 150 min/week), sedentary time (≤ 480 min/day), screen time (≤ 180 min/day), and sleep duration (7-9 h). The relationship between dietary behaviours, mental health indicators and meeting the 24-HMG number was investigated using logistic regression models, adjusted for relevant confounders. Among 3,223 participants, 11.7% met all three 24-h movement guidelines, while 13.1% met none, and 37.6% met either one or two guidelines. Adherence to all guidelines was higher among males, participants aged 22-30 years, and those from lower-income countries (Indonesia, Myanmar, and Vietnam). Multiple logistic regression analyses, adjusted for relevant confounders, revealed that meeting more movement guidelines was associated with: Increased odds of healthy dietary behaviors (fruit and vegetable intake: Adjusted Odds Ratio-AOR: 1.96, 95% Confidence intervals-CI: 1.35-2.83; breakfast intake: AOR: 2.48, 95% CI: 1.84-3.34; meal frequency: AOR: 1.83, 95% CI: 1.36-2.45; low soft drink intake: AOR: 2.20, 95% CI: 1.54-3.14; high sugared coffee or tea intake: AOR: 0.39, 95% CI: 0.24-0.61; low fast food intake: AOR: 1.46, 95% CI: 1.08-1.96; and low snacking: AOR: 2.71, 95% CI: 2.00-3.66), and Decreased odds of mental health issues (depressive symptoms: AOR: 0.43, 95% CI: 0.26-0.70; suicidal behaviour: AOR: 0.66, 95% CI: 0.47-0.93; pathological internet use: AOR: 0.60, 95% CI: 0.45-0.81; hazardous or harmful alcohol use: AOR: 0.44, 95% CI: 0.29-0.66; illicit drug use: AOR: 0.38, 95% CI: 0.20-0.73; and had poorer sleep quality: AOR: 0.33, 95% CI: 0.16-0.68). No significant associations were found between guideline adherence and PTSD symptoms or tobacco use (p > 0.05). This is the first study to look at the prevalence, correlates, and relationships between 24-HMG adherence and dietary behaviour and mental health outcomes among university students in ASEAN. This pioneering study among ASEAN university students demonstrates that adherence to 24-h movement guidelines is associated with better dietary behaviours and mental health outcomes in a dose-response manner. Future university health policies should incorporate 24-h movement guidelines into existing health promotion strategies, particularly in resource-limited settings.