Background of study

Health promotion and prevention embodied in the concept of salutogenesis have received global attention from healthcare policymakers as a measure impacting limited resources for healthcare [1–4]. Lack of health preventive measures and good lifestyles may predispose individuals to diseases such as diabetes, hypertension, kidney conditions, and strokes, among others. Several studies relating to the lifestyle of students, non-academic staff, and communities have received considerable attention [5–10]. However, studies on the lifestyles of university lecturers and the connection to the occurrence of hypertension and diabetes have received very scanty attention even though higher educational status is believed to be inversely related to the occurrence of hypertension and diabetes. In recent times, available studies have reported that 57.18% of lecturers have high BP (>120 mmHg, > 80 mmHg) [11]. Another study in an urban university in Uganda reported 26.2% of hypertension among faculty [12]. Also, the study of Omorogiuwa et al. [13] found that the prevalence of diabetes was 9.8% with an incidental finding (unknown) contributing 6.1% among the faculty of a university in Nigeria. This paper, therefore, seeks to assess the modifiable lifestyle practices of lecturers in a Ghanaian university and the onset of hypertension and diabetes.

The study is underpinned by the Social Contract Theory. This theory, developed by Locke and Rousseau (1588–1704) highlights the mutual relationship between individual factors, behavior, and the environment. In its application to lecturers, the theory seems to suggest that lecturers’ beliefs about their ability to manage their health (self-efficacy), their social environment (colleagues, family), and their behaviors (e.g., exercise habits, dietary choices) all interact to influence their risk of developing hypertension and diabetes. Working as a university lecturer often comes with sedentary lifestyles such as spending long hours sitting at desks or in classrooms. This can contribute to weight gain and increased risk of hypertension and diabetes. For instance, the busy schedules of university lecturers can make it challenging to find time for regular exercise, healthy meal preparation, or stress management activities. In essence, the social contract theory provides a framework to integrate these elements to explain how individual perceptions, beliefs, and behaviors, in interaction with the unique context of university life, influence the development and progression of hypertension and diabetes in this profession.

Lifestyle can be understood as individuals’ behavior regarding the living conditions that inform their health experiences [14,15]. Accordingly, lifestyle is related to the human development trajectory of social, economic, political, and cultural factors in one bloc and risk factors of physical activities, dietary behavior, tobacco use, and alcohol consumption in another bloc [16–18]. University lecturers are part of the biological classifications, have social roles, are active players in the labor market, have political orientations, have diverse cultural issues, and are not exceptional to individuals who are implicated in physical inactivity, unhealthy dietary practices, excessive alcohol and tobacco use. Knowing the lifestyle of university lecturers regarding these variables is therefore essential and would inform policy on their health status and the occurrence of hypertension and diabetes.

In this research, modifiable lifestyles were categorized as issues on dietary intake (breakfast intake), skipping of meals, content of food intakes, eating times), physical activities (exercise status, frequency of exercises, intensity of workouts, mode of exercising), smoking status (categories of substances, frequency of smoking, tobacco intensity), occupational factors (hours of work, reporting and closing times, daily workloads, usage of daily break-out periods, management of work schedule tasks), alcohol status (categories of alcohol intakes, frequency of alcohol intakes and intensity of alcohol intakes).

Many studies have reported outcomes on lifestyle variables concerning university lecturers. For instance, a study conducted among university faculty members by Mohaghegh et. al. [19] found that 72.5% of the participants had low physical activity levels and only 18.8% had medium physical activity levels. Also, a study conducted by Klein et al., [20] among physician faculty at the University of Alberta found that only 47.2% mentioned undertaking energetic physical activity more than 3 days a week, while 33.0% mentioned moderate physical activity more than 3 days a week. Again, a study conducted in Brazil among university faculty found that, frequency and intensity of the physical activities culminated in improved physical performance of the professors. The study further reported that a low number of professors performed regular physical activities, so 42% of professors were at high risk of cardiovascular diseases [21]. In a gender-categorized study among university staff conducted in universities of the West Indies, the study found low levels of physical activity in 51.9% of males and 62.2% of females [22]. Smoking as a modifiable lifestyle remains a significant global health threat [23,24]. Though tobacco use has many forms, the predominant use is direct smoking. Some research outcomes have mentioned that smoking is prevalent among people of low socio-economic status [23,25]. Their findings imply that smoking is low among the educated population. This assertion is corroborated by the study outcome of Klein, Guenther & Ross [20] who found smoking to be rare among the physician faculty.

Alcohol consumption has been mentioned as a lifestyle that predisposes many people to non-communicable diseases. For instance, in the UK, alcohol is the 3^rd lifestyle risk factor for morbidity and mortality aside from smoking and obesity [26]. A study conducted at a UK university reported that 39% of academic respondents were habitual alcohol consumers [27]. Similarly, a study by Klein et al., [20] reported that 86.2% of physician faculty members consumed alcohol.

University lecturers need a prime health status to accomplish their responsibilities, such as teaching, research, postgraduate training, university administration, and community services. In achieving this, meal intake is key. Meal intake is considered a building block in the maintenance of the functional activity of the body and hence is linked to the quality of life of an individual. However, some individuals including lecturers skip meals such as breakfast, lunch, or supper which has become an aspect of their lifestyle [28]. Skipping meals is adversely associated with several biomarkers and cardiometabolic risk factors, including weight gain, dyslipidemia, blood pressure, insulin resistance, and diabetes [29].

Again, the quality and quantity of food consumed are another aspect of a modifiable lifestyle important to human life. Many research outcomes have linked the increase in NCDs to unwholesome dietary behavior such as patronage of fatty processed meats, saturated fat, refined grains, salt, and sugars [30–34]. Aside from many dietary intakes lacking a balanced diet, available evidence also portrays low or lack of fruit and vegetable intake [33]. A study conducted among university professors in the Melilla campus of the University of Granada found two eating patterns. These were identified as a ‘western pattern’ (characterized by the consumption of dairy products, eggs, meat, sausages, refined oils, butter, sugar, processed baked goods, sugar-containing beverages, and alcoholic drinks) and a ‘mediterranean pattern’ (characterized by consumption of olive oil, fish, fruits, nuts, vegetables, pulses, cereals, and honey) as reported by Lopez-Olivares et al. [34].

From the above narrations, modifiable lifestyle assessment is essential as primary prevention towards a healthy life [35]. In this logic, the academic setting is seen as an unexplored but key environment for the promotion of a healthy lifestyle, which may impact the transfer of knowledge to students and other bodies.

An assessment of the prevalence of hypertension and diabetes among lecturers in a Ghanaian university using their lifestyle practices is significant because it can reveal opportunities to improve their well-being, job satisfaction, and overall effectiveness, which can positively impact the quality of education they provide. By understanding how lifestyle choices affect lecturers’ physical and mental health, universities can implement targeted interventions and support systems to promote a healthier and more productive academic environment.

University lecturers are an important professional group for the development of every country. However, not much is known about their lifestyle practices concerning the occurrence of hypertension and diabetes. This study, therefore, attempts to assess the occurrence of hypertension and diabetes among lecturers in a Ghanaian university using their lifestyles as precursors. It is believed that the outcome of this study may inform policy on health measures among university lecturers.

Materials and methods

Sample size calculation

The formulae of Yamane [37] were used to calculate the sample size below:

where n = is the population of Lecturers at KNUST

E = is the level of precision

Therefore:

The study involved 205 participants. We could not use the 270 participants due to budget constrained especially relating to the biochemical test. Simple proportions were applied to secure the sample of lecturers in each college.

Results

Sociodemographic characteristics of lecturers

The study participants were 205 including 176 (85.9%) males. The mean age was 46.3 ± 9.4SD years with a range of 27–73 years. A majority (39.0%) were in age category 50 and above. The study found that 173 (84.4%) participants were married, and most of them were senior lecturers and lecturers representing 76(37.1%) and 75 (36.6%) respectively. The participants were fairly representative of all the colleges of the KNUST as shown in Table 1.

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Table 1. Sociodemographic characteristics of respondents.

https://doi.org/10.1371/journal.pone.0338910.t001

Dietary behavior

The majority of participants (62%) take breakfast. About 49.76% of Lecturers consistently take lunch on campus. However, 42.93% are most likely to skip lunch. Carbohydrate makes up the majority of the food content in 173 (84.4%) of the participants with only 11(5.4%) taking more fruits and vegetables in their diets as illustrated in Table 2.

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Table 2. Dietary behavior among lecturers.

https://doi.org/10.1371/journal.pone.0338910.t002

Risk factors for the occurrence of hypertension and diabetes

The study found that 30% of lectures do not undertake any form of exercise, 61.95% undertake mild exercises and 33% do exercises once a week. Moreover, 61% of the lecturers do not consume alcohol and 54% do not often take in soft drinks. Concerning dietary intake, the study found that 34.6% admitted they eat late due to their job and 50% asserted that they sometimes eat late. Moreover, 98% of lecturers do not smoke as shown in Table 3.

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Table 3. Risk factors for the occurrence of hypertension and diabetes.

https://doi.org/10.1371/journal.pone.0338910.t003

Distribution of lifestyle factors for hypertension using blood pressure of lecturers as the outcome

The study assessed the lifestyle factors associated with the blood pressure outcome of Lecturers. The study found that, among lecturers who do not consume alcohol, 44% have normal BP while 62.57% have high BP. However, among the moderate alcohol consumers, 50% have normal BP and 32.09% have high BP. Among moderate soft drink consumers, 53.5% were found to have high blood pressure. In addition, 35% and 50% of lecturers who regularly or occasionally eat late due to work have high blood pressure as shown in Table 4. All lifestyle factors show no statistical association with BP when the Chi-square test of independence was performed.

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Table 4. Distribution of accentuating hypertension by blood pressure among participants.

https://doi.org/10.1371/journal.pone.0338910.t004

Anthropometric and biochemical characteristics of lecturers

The study assessed the anthropometric and biochemical parameters of Lecturers. About 54.6% of lecturers have high BP (systolic >130 mmHg, diastolic >90 mmHg). Assessment of BMI parameters, weight, and height indicated that 15.6% of lecturers had a healthy weight, while 50.7% and 33.7% were overweight and obese, respectively. With regards to the blood glucose status of Lecturers, it was revealed that 97.07% of lecturers had normal fasting blood glucose (< 5.6 mmol/L) and 85.85% of lecturers had normal random blood sugar (<11.1mmol/dL) levels. The prevalence of hypertension and diabetes was 54.6% and 17.07% respectively. Also, more than half of the study population was recorded as overweight, as shown in Table 5.

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Table 5. Distribution of anthropometric and biochemical characteristics of participants.

https://doi.org/10.1371/journal.pone.0338910.t005

Sociodemographic factors and blood pressure of lecturers

The study also investigated the association between socio-demographic factors and the blood pressure of Lecturers. It was discovered that 90.91% of male lecturers had elevated BP whereas 93.10% of female lecturers also had elevated BP. Furthermore, there was no significant difference between a lecturers’ age (p = 0.044) and blood pressure. Additionally, of the 174 Lecturers who are not married, separated, or divorced, 90.23% of them had hypertension. Hypertension was identified to be associated (p = 0.036) with lectures across all colleges; the majority (18.54%) of lecturers in the health sciences had very high BP, followed by those in engineering (16.10%), with a minority in Agriculture and Natural Resources (12.68%) shown in Table 6.

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Table 6. Distribution of sociodemographic factors by blood pressure among participants.

https://doi.org/10.1371/journal.pone.0338910.t006

Dietary behaviour and blood pressure among lecturers

Although none of the factors evaluated showed a statistical association with high BP, the findings showed that 90.55% of lecturers who ate breakfast had hypertension, while 91.18% who did not eat lunch during working hours were also hypertensive. About 90.91% of lecturers identified to be hypertensive reported they were most likely to skip lunch. Most lecturers (91.91%) consumed a lot of carbohydrates in their diets (Table 7).

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Table 7. Distribution of dietary factors by blood pressure among lecturers.

https://doi.org/10.1371/journal.pone.0338910.t007

Physical activities and blood pressure among lecturers

The study found that, among those who undertake mild exercises, 62% were found to be hypertensive. Also, the study found that, 26.7% of the lecturers who had not checked their blood pressure before had high blood pressure as shown in Table 8 below.

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Table 8. Physical activities among lecturers distributed by blood pressure.

https://doi.org/10.1371/journal.pone.0338910.t008

Association between sociodemographic, dietary behaviour and BP among lecturers—Logistic Regression Model

In the bivariate logistic regression model, it was discovered that the age group of 40–49 (p = 0.036) and the affiliation with colleges for lecturers (p = 0.016) are linked with high BP. However, in the multivariate model, only the category of lecturers who were affiliated with colleges in COHS/COS/COE were associated with high BP. In addition, it can be seen from the results that the odds of female lecturers developing high BP is 48% higher compared to male lecturers [AOR: 1.48; 95% CI (0.27–7.96)]. Lecturers from the Colleges of Health, Science and Engineering were 4 times [COR: 4.11; 95% CI (1.30–12.95)] more likely to develop high BP when compared to those in the Colleges of Art and Built Environment, Agriculture and Natural Resources and Humanities and Social Sciences in the bivariate model.

However, in the multivariate model, it was clear that the odd ratio increased to around 5 times higher [AOR: 4.86; 95% CI (1.31–18.06)] among lecturers in the colleges of health, science and engineering than it did among their counterparts from other colleges. The study also revealed that lecturers who do not eat lunch during working hours were more than two times [AOR: 2.6 (0.28–23.72)] more likely to have high BPs compared to those who eat lunch.

Furthermore, it can be noted that lecturers with larger intakes of carbohydrates had odds that are 1.88 times [AOR: 1.88; 95% CI (0.18–19.99)] than those with higher intakes of proteins, Table 9.

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Table 9. Association between socio-demographic, dietary behaviour, and BP among lecturers—Logistic Regression Model.

https://doi.org/10.1371/journal.pone.0338910.t009

Discussion

This study sought to evaluate the cardiovascular risk factors of university lecturers in Ghana. We found that close to one-third of respondents had family members who had suffered from hypertension or diabetes. In instances where evidence shows there is the existence of high blood pressure or diabetes among family members individuals may have twice the risk of being diagnosed with high blood pressure or diabetes or both along the life course trajectory, and this conforms to the study results of Nelson & Menna [38]. A family history of hypertension or diabetes significantly increases an individual’s risk of developing these conditions, and a third of respondents having such a history suggests a heightened prevalence of these diseases within their community. This family link indicates a potential genetic predisposition, and also highlights the importance of lifestyle factors and social support in managing and preventing these diseases

Aside from biological disorders, modifiable lifestyle factors such as dietary behavior, excessive alcohol intake, physical inactivity, and excessive tobacco consumption are significantly associated with the occurrence of hypertension and diabetes. Breakfast uptake is essential for the body’s function. Our study reported that a little over half of lecturers take breakfast, while one-third do not consistently take breakfast. This has a positive impact on the health of university lecturers. This is supported by a study conducted at the University of Ohio, which mentioned that people who skip breakfast may miss some major nutrients [39,40]. We realized that among the lecturers interviewed, half of the respondents took lunch during working hours on campus, while a little over one-third were not consistent with lunch uptake. A lack of consistent lunch uptake among lecturers, particularly over one-third, can lead to decreased energy levels, impaired cognitive function, and reduced overall productivity. This can negatively impact teaching quality, student engagement, and potentially affect the lecturers’ own well-being. However, our study finding on lunch uptake is contrary to the study outcome of academics at the University of Kent in Britain, where research on daily records of their activities on the 15th day of each month over a year showed that a little under half of them skipped lunch for various reasons [41].

Our study noted that the majority of the food contents taken by the lecturers are carbohydrates, as against only 5.37% of fruits and vegetables. A diet profoundly skewed towards carbohydrates with minimal fruit and vegetable intake can have several negative health implications. While carbohydrates are a necessary source of energy, an imbalance can lead to weight gain, increased risk of metabolic syndrome, and potentially type 2 diabetes. Equally, a lack of fruit and vegetable intake among lecturers may reduce the intake of essential fiber, minerals, vitamins, and other phytochemicals, which are critical for overall health and disease prevention among lecturers. A search through the literature could not pin down any study implicating university lecturers as high or low fruit and vegetable consumers. However, juxtaposing population-based studies, several reports have consistently indicated a low intake of fruits and vegetables below the recommended consumption of 5 or more servings of fruits or vegetables per day in a typical week [33–44].

Again, our study found that one-third of lecturers do not undertake any form of exercise, while a little over half of the lecturers undertake some mild exercises. This is consistent with the study outcomes of Mohaghegh et. al. [19] where a little over two-thirds of the participants had low physical activity levels and only one-fifth had medium physical activity levels. A significant portion of lecturers not exercising poses several health and performance risks, while the “mild exercise” group might not be reaping the full benefits of physical activity. The implications range from increased risk of chronic diseases to potential negative impacts on cognitive function and overall well-being. Lack of physical activity is a major risk factor for obesity, type 2 diabetes, cardiovascular diseases, and some types of cancer. Exercise is crucial for maintaining a healthy heart and blood vessels. The majority of lecturers not exercising can lead to a decline in cardiovascular fitness. fatigue and decreased overall energy levels. It is therefore not surprising to note that over half of our respondents mentioned they had been informed they have hypertension, and 21% mentioned they have been told they have diabetes. This outcome aligns well with the study by Marcio et. al. [21] who reported that a low number of lecturers performed regular physical activities so and a little under half of lecturers were at high risk of cardiovascular diseases.

The alcohol consumption patterns among lecturers at Kwame Nkrumah University of Science and Technology (KNUST) are generally positive, with a significant proportion not consuming alcohol at all, and another substantial portion being infrequent consumers. This suggests a relatively healthy overall trend, but it’s crucial to understand the implications of even moderate alcohol use on academic and professional life of lecturers. Alcohol consumption, even at moderate levels, can have negative effects on academic performance, including absenteeism, difficulty completing tasks, and reduced productivity. It can also affect lecturers’ health, potentially leading to disorganization, ill health, and a less productive work environment. Barring all other confounders, it is believed that alcohol-related diseases may be minimal among lecturers in KNUST. However, our finding is contrary to the study outcomes of Awoliyi et. al. [27] who discovered that 39% of academic respondents were habitual alcohol consumers in a UK University. Similarly, we also recorded contrary results from the study outcome of Klein et al. [20], who found that the majority of physician faculty members consume alcohol. However, our study noted that, of the lecturers who are moderate alcohol consumers and habitual alcohol consumers, one-third of the sample and very few are hypertensive, respectively (see Table 4). The existence of these two conditions is not too good for the holistic health of lecturers in an academic institution.

We further inquired about the frequency of soft drink consumption among lecturers on campus. In our Ghanaian parlance, soft drinks are typically drinks with high sugar content, such as Coca-Cola, Fanta, Malta, Maltina, Pepsi Cola, Sprite, and a host of other soft drinks available in markets in Ghana. Our study, however, noted that over half of the lecturers took soft drinks, though not often. As half of university lecturers are noted of taking soft drinks, it could have several implications, primarily concerning health. Soft drinks are often high in sugar and calories, contributing to weight gain and increasing the risk of obesity. Obesity, in turn, is linked to a higher risk of type 2 diabetes, heart diseases, and other chronic conditions. A search through the literature did not yield any complementary or contrary study reporting on soft drink consumption among university lecturers. However, a critical look at the cumulative numbers of soft drink consumers (those who take soft drinks often and those who do not take soft drinks often) revealed that 72.20% of the lecturers in this bracket were hypertensive (see Table 4). The already fragile health conditions of these lecturers may be exacerbated by certain ingredients in soft drinks, which may be hazardous to health if consumed in large quantities and over sustained period of time [45]. For instance, research outcomes have demonstrated that most soft drinks contain phosphorus. A high level of phosphorus in the blood (“hyperphosphatemia”) can lead to kidney diseases and vice-versa, and subsequently lower calcium levels with associated risk of brittle bone and cardiovascular diseases [45,46].

The discovery that one-third to one-half of lecturers are habitual late eaters has several significant implications. It suggests potential health risks, including increased risk of type 2 diabetes and cardiovascular issues due to disruptions in glucose metabolism. It could also indicate a link between late eating and unhealthy eating habits, potentially leading to weight gain. Furthermore, it highlights a need to address the factors, both personal and environmental, that contribute to this trend among lecturers. A search through the literature did not yield any corresponding studies reporting on the eating time of lecturers. However, community-based studies reporting on the negative impact of eating late were found [47–49]. For instance, Vujović, [48] found that eating four hours later makes a significant modification in hunger levels, burning calories after meals, and fat storage. Also, Reynolds [49] mentioned that late eating may have implications for the occurrence of conditions such as weight gain, diabetes, increased body fat, and impaired weight loss success. Conspicuously, these findings transport physiological and molecular mechanisms fundamental to the association between late eating and increased obesity risk with implications for diabetes and hypertension. Perhaps this may explain why about one-third of the late eaters and half of the inconsistently late eaters have hypertension (see Table 4, late eating variable). Equally, our study recorded one-third and a little over half of lecturers as having elevated BP (>120, < 129 mmHg, > 80 mmHg or less) and hypertension (>130 mmHg, > 90 mmHg) respectively (see Table 5). Again, our data also reveals that half of the lecturers are overweight (>25.0 > 30 kg/m²) and one-third are obese (>30 kg/m²) which are clear indications of the negative effects of late eating, though other factors may be contributors (see Table 5). This result is consistent with a study conducted in a large urban university where close to half of the respondents were classified as obese [50]. The results are also consistent with a cross-sectional study from the Amazon Basin where poor cardiovascular health was found in almost all the University Professors [51].

Moreover, our study also assessed the smoking status of lecturers. We found that the overwhelming majority of the lecturers do not smoke in any form. This is in line with the study outcome of Owusu-Dabo et. al., [25] who reported that smoking is prevalent among people of low socio-economic status. A similar study reported by Klein et al. [20] found smoking to be rare among the physician faculty. The fact that the overwhelming majority of lecturers do not smoke cigarettes or any form can have several positive implications for lecturers’ health, students and the institution. It can reduce secondhand smoke exposure, potentially improve the overall academic environment, and serve as a positive role model for students. Smoking can negatively affect academic performance, and non-smoking role models can influence students’ decisions.

However, it can be seen from the results (see Table 9) that, the odds of female lecturers developing high BP is 48% higher compared to male lecturers [AOR: 1.48; 95% CI (0.27–7.96)]. A 48% higher risk of high blood pressure (hypertension) in female lecturers compared to male lecturers suggests a significant gender disparity in cardiovascular health within this specific profession. This difference highlights the need for targeted interventions and awareness campaigns to address potential risk factors and promote healthier lifestyles among female academics. This is similar to the study outcome of Alinaitwe et al [12], which reported of higher prevalence of hypertension among female lecturers in an urban university. More studies are needed to investigate the specific mechanisms underlying gender differences in hypertension among lecturers and to develop effective prevention and management strategies. However, our result is contrary to population-based studies, which reported higher odds of males developing hypertension than females [52,53].

The study found a significant difference in the age category of lecturers (p = 0.044) across the study participants. Studies linking university lecturer age categories with hypertension reveal a higher prevalence of hypertension in older age groups [12,50,54–56]. This suggests that age is a significant risk factor for hypertension, with older lecturers experiencing higher blood pressure compared to their younger counterparts. However, our study could not establish any significant link between a lecturers age and occurrence of diabetes and this can be explained by other confounders outside the scope of this study.

Conclusion

The study titled “Assessment of Hypertension and Diabetes among Lecturers in a Ghanaian University - Setting Lifestyle Practices as Precursors” explores the relationship between lifestyle practices and the prevalence of hypertension and diabetes among university lecturers in Ghana. The study employs a cross-sectional design involving 205 lecturers and analyzes data using descriptive statistics and regression methods. Key findings reveal that a significant proportion of lecturers are either overweight or obese, with a concerning number not engaging in regular exercise. Age is a statistically significant factor associated with increased blood pressure, particularly among those aged 50 and above. The study concludes that modifiable lifestyle practices are key precursors for the occurence of hypertension and diabetes among this population.

Recommendations

The findings of this study underscore the need for targeted, multi-component interventions at the institutional and individual level to address modifiable lifestyle practices among lecturers. Recommendations are focused on promoting physical activity, healthy nutrition, and regular health monitoring.

Direction of future study

Future studies should involve more than three universities in Ghana so that the various parameters emerging out of the study can be generalized.

Acknowledgments

The authors thank the Provost and Management of the College of Health Sciences, KNUST. The Authors are also indebted to the Office of the Registrar-KNUST for officially notifying lecturers to participate in this research. Our profound appreciation also goes to the Provosts of the various colleges for permitting us to interact with Lecturers in their Colleges. Finally, we are grateful to the Nurses recruited from the KNUST Hospital for their role in the data collection process. We also thank Lecturers (participants) for participating in this study. Lastly, to all those who contributed differently but are not named here, we appreciate your efforts.