Discriminating Metabolic Health Status in a Cohort of Nursing Students: Protocol for a Cross-Sectional Study
Authors: West Sarah L , Bates Holly , Watson Jessica , Brenner Ingrid K M 
Published: August 2020

Background
Obesity is currently a worldwide health crisis. Nurses are integral members of the primary health care team and have an important role in managing obesity and administering physical activity (PA) for patients. However, research shows that nurses tend to be overweight or obese, have poor metabolic health, and do not meet PA recommendations. This is problematic because PA is linked to both physiological and psychological well-being and may also influence how nurses counsel their patients. Nursing students are the next generation of nurses; however, there is limited research examining PA (among other lifestyle factors) and metabolic health in nursing students.

Objective
The goal of this research is to examine multiple lifestyle factors (including PA, nutrition, sleep, and stress) and determine whether these factors are associated with metabolic health in full-time undergraduate nursing students.

Methods
An estimated 320 nursing students (18 years of age and older) will be assessed for their metabolic health. Metabolic status will be determined by measuring body mass index (BMI), waist-to-hip ratio (WHR), body fat percentage [skinfold measures (FitSystems Inc)], resting blood pressure [automated oscillatory (Omron Healthcare Inc)], and fasting blood glucose (glucometer). Lifestyle factors will also be measured, including PA and sleep [the International Physical Activity Questionnaire (IPAQ) and 7-day accelerometry (wGT3X-BT, Actigraph LLC)], nutrition [3-day diet log (Nutritionist Pro, Axxya Systems)], and stress [the Depression Anxiety Stress Scale, heart rate variability assessments, and salivary cortisol (ELISA, Eagle Biosciences)]. The association between metabolic status and PA, sleep quantity and quality, nutrition, and stress will be examined by linear regression analyses. Differences by year of study in metabolic health status, PA, sleep, nutrition, and stress will be examined by 1-way analyses of variance (ANOVAs). To determine the ability of PA, sleep, nutrition, and stress to discriminate prevalent overweight and obesity or poor metabolic status, logistic regression and receiver operating characteristic (ROC) curves will be constructed. Statistical analyses will be performed in Stata (version 16.1, StataCorp LLC).

Results
Based on pilot data, we believe senior nursing students will have worse metabolic health (ie, higher BMI and WHR, increased body fat percentage, higher blood pressure, and increased fasting blood glucose) compared to first-year students. We hypothesize that poor PA participation, poor sleep quantity and quality, increased food intake, poor nutrition, and increased stress will be associated with worse metabolic health in full-time nursing students. The study received funding in February 2020. Due to the coronavirus disease 2019 (COVID-19) pandemic, work on this study has been delayed. We are currently completing our application for institutional research ethics approval. Data collection is projected to begin in January 2021, with data collection and analyses expected to be completed by May 2022.

Conclusions
This study will be the first published research to examine the relationship between lifestyle choices and metabolic status in nursing students attending a Canadian institution. More importantly, the results of this study will support the development of an informed intervention that will target the identified lifestyle factors, improving the physiological and mental health and well-being of nursing students.

International Registered Report Identifier (IRRID)
PRR1-10.2196/21342