Aerobic fitness, lipid ratio, visceral adiposity index and risk of hypertension in adolescents: An observational study

Abstract

Background: Hypertension (HTN) is a significant global health concern due to its rising prevalence and associated risks of cardiovascular disease, chronic kidney disease, and other comorbidities. The increasing rates of HTN among youth have been partly attributed to the global rise in childhood obesity, lipid abnormalities, and sedentary lifestyles.

Aim: To investigate the independent associations of aerobic fitness (AF), the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio, visceral adiposity index (VAI), and resting blood pressure (BP) in Nigerian adolescents.

Methods: A multistage sampling technique was used to select 403 in-school adolescents aged 11-19 years in Kogi East, Nigeria. Participants were assessed for AF, TG/HDL-C ratio, VAI, systolic BP (SBP), and diastolic BP (DBP). The associations between the independent variables and the risk of systolic and diastolic HTN were examined using multivariate regression models, controlling for age and maturity status. Receiver operating characteristics curve (ROC) and area under the curve (AUC) were employed to determine the predictive capacities of the independent variables.

Results: The overall prevalence of systolic HTN was 5.5% (girls: 7%; boys: 4%) while diastolic HTN was 12.7% (girls: 16.9%; boys: 8.4%). Among girls, all independent variables showed significant associations with SBP, including fitness (P < 0.001), TG/HDL-C (P < 0.001), and VAI (P < 0.001), with VAI showing the strongest association. In boys, all independent variables except VAI (P = 0.063) were significantly associated with SBP, with fitness showing the stronger predictive power (Fitness, P < 0.001; TG/HDL-C, P = 0.029). For DBP, all independent variables, except fitness in girls (P = 0.099), were significantly associated (P < 0.001) in both sexes. Unfit boys were 1.1 times more likely to develop systolic HTN (95%CI: 1.01-1.15, P = 0.018) and had 1.1 times higher odds of developing diastolic HTN (95%CI: 1.03-1.13, P = 0.001). Only the ROC for DBP turned up significant (P < 0.001) AUCs for TG/HDL-C and VAI in girls only, with 0.6 and 1.0 thresholds respectively.

Conclusion: AF, dyslipidemia, and visceral adipose tissue dysfunction were independently associated with the risk of HTN in Nigerian adolescents. These findings highlight the importance of promoting a healthy diet and encouraging aerobic physical activity among adolescents to reduce the risk of HTN.

Keywords: Abdominal adiposity; Adolescents; Cardiovascular health; Dyslipidemia; Fitness; Hypertension; Triglyceride-to-high-density lipoprotein cholesterol ratio.

Figure 1

Prevalence of Hypertension risk among participants. Sys HTN: Systolic hypertension; Dias HTN: Diastolic hypertension.

Figure 2

Cardiovascular disease risk by systolic blood pressure status. BMI: Body mass index; WC: Waist circumference; AF: Aerobic fitness; DBP: Diastolic blood pressure; TG/HDL: Triglyceride-to-high-density lipoprotein cholesterol; VAI: Visceral adiposity index.

Figure 3

Sex-specific areas under the curves of fitness, Atherogenic index of the plasma, Visceral adiposity index for Diastolic blood pressure in participants. AF: Aerobic fitness; AIP: Atherogenic index of the plasma; VAI: Visceral adiposity index