Uric Acid, BMI, and Neutrophil Lymphocyte Ratio Mediate the Relationship Between Soft Drink Consumption and Systolic Blood Pressure: A Nationwide Structural Equation Model Pathways Among Adolescents and Young Adults Across Indonesia

Background: Adolescent hypertension is an emerging global issue, with metabolic and inflammatory dysregulation potentially preceding cardiovascular disease. Increasing soft drinks and fast food consumption has been associated with obesity and metabolic imbalance. However, the biological pathways connecting these dietary behaviours to blood pressure remain weakly understood in Indonesian adolescents. Objectives: To investigate mediating effects of body mass index, uric acid, and neutrophil-to-lymphocyte ratio on relationship between soft-drink and fast-food consumption and systolic blood pressure among Indonesian adolescents and young adults. Methods: A nationwide, community-based cross-sectional study was conducted among 500 adolescents aged 10–24 years, representing Indonesia’s major ethnic regions. Dietary intake was assessed using semi-quantitative food frequency questionnaire. Clinical measurements included body mass index, uric acid, neutrophil-to-lymphocyte ratio, and systolic blood pressure. Bivariate and multivariate analyses followed by mediation and multi-group analyses. Results: The mean systolic blood pressure was 110.84mmHg; soft-drink consumption correlated with uric acid, Body Mass Index, and systolic blood pressure ( p < 0.001). In multiple regression, Body Mass Index (β = 0.36, p < 0.01) and soft drink-fast food consumption interaction (β = 0.27, p < 0.01) independently predicted systolic blood pressure. A significant indirect effect of soft-drink consumption on systolic blood pressure mediated by Body Mass Index, Neutrophil-to- Lymphocyte Ratio, and uric acid (β = 0.02, p < 0.05). Multi-group analysis indicated that effects of fast-food and soft-drink intake on body mass index and neutrophil-to-lymphocyte ratio did not differ significantly across gender or uric acid. Conclusions: Soft-drink consumption indirectly increases systolic blood pressure through metabolic and inflammatory mechanisms. Early nursing-led interventions that promote healthy diets, metabolic screening, and school-based health education are crucial to mitigating subclinical cardiovascular risk.