“Unlocking Health: A Global Network Analysis of Lifestyle Influences and Outcomes in 29 Nations”

Background:

Our objective was to determine the primary lifestyle factor, the one with the greatest impact within clusters of lifestyle variables; the principal health outcome, the most significant among health outcomes; and the bridge lifestyle, the one most closely linked to health outcomes across 29 nations to enhance resource distribution for local comprehensive health enhancements.

Methods:

Between July 2020 and August 2021, we conducted a survey involving 16,461 adults across 29 countries who reported alterations in 18 lifestyle factors and 13 health outcomes as a result of the pandemic. For each nation, three types of networks were created using network analysis: lifestyle, health outcome, and bridge networks. We identified the variables with the highest bridge expected influence as either central or bridge variables. The validation of the networks comprised nonparametric methods and case-dropping subset bootstrapping, and tests of centrality differences confirmed that the central or bridge variables exhibited substantially higher expected influence than other variables within the same network.

Results:

Out of 87 networks, 75 were validated with correlation stability coefficients exceeding 0.25. Nine predominant lifestyle types were recognized in 28 countries: cooking at home (in 11 countries), types of food in daily meals (in one country), reduced smoking of tobacco (in two countries), decreased alcohol intake (in two countries), shorter sitting durations (in three countries), less snacking (in five countries), lower consumption of sugary drinks (in five countries), having meals at home (in two countries), utilizing alternative medicine or natural health products (in one country). Six principal health outcomes were recorded among 28 countries: social support received (in three countries), physical health (in one country), sleep quality (in four countries), overall quality of life (in seven countries), reduced mental burden (in three countries), and less emotional distress (in 13 countries). Three bridge lifestyles were recognized in 19 countries: types of food in daily meals (in one country), cooking at home (in one country), and total exercise amounts (in 17 countries). The centrality difference test indicated that the central and bridge variables had significantly greater centrality indices compared to others within their networks (P < 0.05).

Conclusions:

Across 29 nations, cooking at home, reduced emotional distress, and total exercise emerged as commonly recognized central lifestyle, health outcome, and bridge lifestyle factors, respectively. Nonetheless, marked regional disparities necessitate customized interventions and resource distributions to effectively tackle unique local key variables and enhance holistic health in each region. The study’s cross-sectional approach and reliance on self-reported data may restrict generalizability, underscoring the importance of cautious interpretation and the need for additional longitudinal studies.

Keywords:

global; cross-country comparisons; lifestyle; health outcomes; network analysis.