Association of Blood Pressure with Metabolic Factors, Stress Levels, Physical Activity, and Nutrient Intake in Overweight or Obese Ecuadorian University Students: A Study Based on Mediation Analysis

Abstract

Background: Obesity is a worldwide public health problem, affecting organs and systems. It is also a cardiovascular risk factor, which facilitates the development of diseases, such as arterial hypertension, dyslipidemia, and diabetes, which are used as criteria for the diagnosis of metabolically unhealthy obesity. Objective: To analyze the association between blood pressure and metabolic health factors, stress level, and nutrient intake in overweight and obese university students through mediation analysis. Methods: A quantitative, non-experimental, cross-sectional, correlational, and quantitative study was conducted in a sample of 230 obese/overweight university students selected by a multistage mass random sampling method. To evaluate habitual dietary intakes, a CFCA food frequency questionnaire was applied; a DASS-21 scale was used to evaluate stress; blood pressure and anthropometric data were collected; insulin levels, lipid profile, and glucose were determined using fasting blood samples. Statistical analysis was performed using univariate methods (frequencies, trend, and dispersion measures) and a mediational model. Results: The majority were young people aged 18 years (18.7%), with morning and afternoon shifts (60%), overweight (76.1%), and obese (23.9%). Not all obese people have arterial hypertension; however, an increase in BMI increases the risk of suffering from this disease. Model 1 showed that certain types of stress and sex at birth have an important relationship with diastolic blood pressure, mediated in some cases by weight. In Model 2, weight is a significant mediator in the relationship between moderate stress and systolic BP, and between sex at birth and systolic BP, thus allowing us to contribute to the understanding of how these variables are interrelated. Conclusions: This suggests that severe stress and sex at birth not only affect BP directly, but also do so through their effect on weight. Thus, both pathways contribute to understanding the relationship between stress, sex at birth, and diastolic and systolic blood pressure. Nevertheless, the results of this study provide empirical knowledge to design evidence-based prevention and treatment strategies.