Key result
Higher fat mass to fat-free mass ratio is linked to ~19-fold higher hypertensive-range blood pressure risk.
Why the study?
Elevated BP during adolescence is an early marker of cardiovascular risk in settings experiencing under and overnutrition, but the relationship between detailed body composition and BP across nutritional extremes remained poorly understood.
Cross-Sectional (n=1,268)
Yes
In underweight and overweight South African adolescent girls, both DXA-derived fat mass and fat-free soft tissue mass—especially central fat distribution—as well as sedentary behavior and caregiver hypertension are positively associated with elevated and hypertensive-range blood pressure.
Answers are grounded in this paper and cite their sources.
DXA fat-to-lean ratio was associated with adolescent BP elevation; leaves open causality, prediction utility, and any practice change.
Background Elevated blood pressure (BP) during adolescence is an early marker of cardiovascular risk, particularly in settings experiencing under and overnutrition. However, the relationship between detailed body composition and BP across nutritional extremes remains poorly understood. We examined associations between dual-energy X-ray absorptiometry (DXA)-derived body composition and BP among underweight and overweight South African adolescent girls to assess multilevel correlates of BP. Methods The Ntshembo trial included 1268 girls 13-19-years from rural Agincourt and urban Soweto. Participants were selected as underweight or overweight. BP was measured in triplicate at a single visit and classified into clinic BP category ranges. DXA provided measures of fat mass (FM), fat-free soft tissue mass (FFSTM), and related indices. Results: Mean SBP and DBP were 110.0±11.2mmHg and 68.7±8.2mmHg, respectively; 21.1% of participants had elevated or hypertensive-range BP. Overweight adolescents had higher SBP and BP categories compared with underweight adolescents. DXA-derived adiposity measures were positively associated with SBP and BP category. FFSTM showed strong association with SBP. Higher FM/FFSTM was associated with elevated (RRR=4.25, 95%CI:1.77-10.20) and hypertensive-range BP (RRR=19.04, 95%CI:6.43–56.40). Caregiver hypertensive-range BP was independently associated with adolescent hypertensive-range BP (RRR=1.72-1.82). Sedentary behaviour independently associated with elevated BP, highlighting a modifiable behavioural target alongside intergenerational risk. Associations were more consistent for SBP than DBP. Conclusions both FM and FFSTM positively associated with BP, particularly SBP. Regional percentage analyses were consistent with higher BP when a greater proportion of total fat was distributed centrally rather than peripherally.
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Crouch et al. (2026) conducted a cross-sectional in Elevated blood pressure and malnutrition (underweight or overweight) (n=1,268). DXA-derived fat mass to fat-free soft tissue mass ratio (FM/FFSTM) vs. Normotensive blood pressure reference category across lower adiposity/body composition indices was evaluated on Hypertensive-range blood pressure (stage 1 or 2: >=130/80 mmHg) (RRR 19.04, 95% CI 6.43-56.40). Higher DXA-derived fat mass to fat-free soft tissue mass ratio was strongly associated with elevated (RRR 4.25, 95% CI 1.77-10.20) and hypertensive-range blood pressure (RRR 19.04, 95% CI 6.43-56.40).
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