Healthy lifestyles and academic performance of Malaysian students: A cross-sectional study

University students' lifestyle behaviors may influence academic performance, yet evidence from Malaysia remains limited. This observational cross-sectional study aimed to examine associations between healthy lifestyle behaviors and academic performance among Malaysian university students using an online questionnaire (April-June 2020) among Malaysian students aged 18 to 25 years. After exclusions, 431 respondents were analyzed. Self-reported lifestyle behaviors over the prior 4 weeks, including diet (meal regularity, skipping meals, meals/snacks per day, fast food, sweet beverages, coffee, water), sleep (hours, regularity, late bedtime, regular wake-up), physical activity (exercise), and substance use (tobacco). Academic performance measured by Cumulative Grade Point Average (CGPA), categorized as Low (<2.5), Medium (2.5-3.5; reference), and High (>3.5). Statistical analysis included: Descriptive statistics; analysis of variance (ANOVA)/χ2 or Fisher tests; Pearson correlation between CGPA (continuous) and behaviors; multinomial logistic regression reporting Relative Risk Ratios (RRR) with 95% confidence intervals (CI); least absolute shrinkage and selection operator as sensitivity analysis. Sleep hours correlated positively with CGPA, R = 0.16 (95% CI 0.067-0.251), P < .001; meals per day correlated positively, R = 0.15 (95% CI 0.056-0.241), P < .001; sweet-beverage intake correlated negatively, r=-0.12 (95% CI - 0.212 to - 0.026), P = .009. In multinomial models (reference: Medium CGPA), skipping meals was associated with Low CGPA, RRR 0.13 (95% CI 0.02-0.98), P = .048; for High CGPA, overweight status RRR 0.46 (95% CI 0.21-0.99), P = .046; sweet beverages 3 times/day RRR 0.33 (95% CI 0.12-0.89), P = .020; 3 to 4 meals/day RRR 1.92 (95% CI 1.20-3.05), P = .002; 1 snack/day RRR 2.21 (95% CI 1.24-3.93), P = .003. Self-perceived good sleep quality was inversely associated with Medium and High CGPA. Healthy dietary patterns and appropriate weight are associated with better academic performance. University health promotion targeting regular meals and reduced sugary-drink intake may support academic success; longitudinal studies with objective sleep measures are warranted.