Key result
Body fat percentage identifies ~48% more at-risk medical students than BMI.
Why the study?
Academic stress may activate the hypothalamic-pituitary-adrenal axis, contributing to sleep disturbances and metabolic dysfunction, but cardiometabolic risk capture beyond BMI stratified by sex needed evaluation.
Do anthropometric parameters, behavioral factors, and salivary cortisol associate with cardiometabolic risk in medical students?
Cross-Sectional (n=153)
No
Do anthropometric parameters, behavioral factors, and salivary cortisol associate with cardiometabolic risk in medical students?
Absolute Event Rate: 54.4% vs 36.8%
Body fat percentage outperforms BMI in detecting cardiometabolic risk among medical students, with findings supporting an academic stress-HPA activation-sleep disruption-metabolic risk model.
BFP may detect more cardiometabolic risk than BMI in medical students; leaves open prospective validation before clinical adoption.
Introduction and Objective: Academic stress may activate the hypothalamic-pituitary-adrenal (HPA) axis, contributing to sleep disturbances and metabolic dysfunction in university students. BFP, behavioral questionnaires, and salivary cortisol may capture cardiometabolic risk beyond BMI, particularly when stratified by sex. This study aimed to evaluate the association between anthropometric parameters, behavioral factors (sleep, physical activity, diet), salivary cortisol, and cardiometabolic risk in second-year medical students (FCM-UNC), with sex-based analysis. Methods: Cross-sectional study in two stages (FCM-UNC, 2024; n=153; 104 women/47 men). Stage 1: BMI, BFP (CUN-BAE formula), FINDRISK score, Pittsburgh Sleep Quality Index, IPAQ, and dietary questionnaire. Stage 2 (at-risk subgroup, n=33; FINDRISK≥7 and/or BMI≥25 and/or elevated BFP): fasting metabolic panel, C-reactive protein (CRP), and morning salivary cortisol (8-9 AM). Statistics: Mann-Whitney U, Spearman, Kruskal-Wallis; p<0.05. Results: Mean age 21.6±2.5 years. Men showed higher BMI (25.6±3.5 vs 23.4±3.4 kg/m², p=0.0003); women higher BFP (30.2±5.5% vs 22.5±4.7%, p<0.001). BFP detected more at-risk students than BMI (54.4% vs 36.8%). Sleep quality correlated inversely with FINDRISK (rho=-0.172, p=0.034). In the at-risk subgroup: 51.5% had elevated ALT (subclinical NAFLD), 36.4% low HDL, and 63.6% salivary cortisol above threshold (>0.40 µg/dL), consistent with chronic HPA activation. BFP correlated with CRP (r=0.445, p=0.0095); BMI with uric acid (r=0.415, p=0.0162). Conclusion: Sex-specific cardiometabolic risk patterns were identified: men with greater overweight by BMI, women with greater adiposity by BFP and physical inactivity. Sleep-metabolic risk correlation and elevated cortisol support an academic stress-HPA activation-sleep disruption-metabolic risk model. BFP outperformed BMI in risk detection. Differentiated prevention strategies are warranted. Disclosure L. Mezzano: None. G. Reartes: None. V.V. Ojeda Heredia: Speaker's Bureau; Current; Novo Nordisk, Lilly Diabetes. Other - Research Protocol; Current; Roche Diabetes Care. M.S. Marchesini: None. V.A. Rodriguez: None. C.A. Dimuro: None. A. Dain: None. Funding SECyT-UNC RES N 258/23
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Mezzano et al. (2026) conducted a cross-sectional in Cardiometabolic risk and academic stress (n=153). Body Fat Percentage (BFP) vs. Body Mass Index (BMI) was evaluated on Detection of at-risk students. Body fat percentage detected more cardiometabolic risk in medical students than BMI (54.4% vs 36.8%), revealing sex-specific patterns of adiposity and overweight.
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