Lifestyle associations with hypertension and diabetes risk via metabolic function and physical indicators: a cross-sectional serial mediation model among community adults

Q: What are the key findings of this study?

Healthy lifestyle was associated with lower hypertension and diabetes risk via physical indicators (β = −0.360, P = 0.001) and sequential metabolic and physical pathways (β = −0.011, P = 0.021).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension and diabetes risk (n=6178). Intervention: Healthy and unhealthy lifestyle behaviors (physical activity, sleep quality, smoking, alcohol consumption, sedentary behavior). Primary outcome: Latent disease risk construct indicated by hypertension risk and diabetes risk (β = −0.360 (indirect effect of healthy lifestyle via physical indicators), p=0.001).

Q: What does this research mean for the field?

Lifestyle factors are associated with hypertension and diabetes risk primarily through indirect pathways mediated by metabolic function and physical indicators rather than direct effects. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Huanhuan Zhao; Erneng Zhou; Wenjuan Ou; Zengli Zou; Kejiang Li; Pingjing Wen

doi:10.3389/fmed.2026.1946501

November 2, 2026Frontiers in MedicineOpen Access

Lifestyle associations with hypertension and diabetes risk via metabolic function and physical indicators: a cross-sectional serial mediation model among community adults

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Key result

Healthy lifestyle is linked to lower hypertension and diabetes risk, mediated by physical indicators.

β = −0.360 (indirect effect of healthy lifestyle via physical indicators)
P=0.001
n=6,178

Why the study?

The study examined whether lifestyle is associated with hypertension and diabetes risk via sequential indirect pathways involving metabolic function and physical indicators among community adults.

Does lifestyle (healthy and unhealthy behaviors) associate with hypertension and diabetes risk via sequential indirect pathways involving metabolic function and physical indicators in community adults without prior hypertension or diabetes?

Key Points

To examine whether lifestyle behaviors are associated with hypertension and diabetes risk through sequential indirect pathways involving metabolic function and physical indicators.
Cross-sectional study conducted among 6,178 community adults in Nanning, southern China.
Structural equation modeling (SEM) and bias-corrected bootstrap analyses with 5,000 resamples were used to evaluate direct and indirect pathways connecting lifestyle, metabolic markers, physical indicators, and disease risk.
Physical indicators showed the strongest direct association with disease risk (β = 0.763, P < 0.001), while metabolic function was also positively associated with disease risk (β = 0.048, P = 0.010).
Healthy lifestyle was associated with lower disease risk via physical indicators alone (β = −0.360, P = 0.001) and through a sequential pathway via metabolic function and physical indicators (β = −0.011, P = 0.021).
Unhealthy lifestyle was indirectly associated with higher disease risk through metabolic function (β = 0.003, P = 0.036) and physical indicators (β = 0.092, P = 0.014), but its sequential indirect pathway was not statistically significant (P = 0.104).

Study Design

Type

Cross-Sectional (n=6,178)

Multicenter

Yes

Structured PICO

Does lifestyle (healthy and unhealthy behaviors) associate with hypertension and diabetes risk via sequential indirect pathways involving metabolic function and physical indicators in community adults without prior hypertension or diabetes?

P

Population

6,178 community adults in Nanning, China (67.1% female, 51.0% aged 41-60 years) without a prior diagnosis of hypertension or diabetes.

E

Exposure

Healthy lifestyle (physical activity meeting WHO recommendations and good sleep duration of 7–9 hours/night) and unhealthy lifestyle (smoking within the past 30 days, alcohol consumption ≥15 g/day pure alcohol, and sedentary behavior categorized into <4 h, 4–6 h, 6–8 h, and ≥8 h per day) evaluated as exogenous latent constructs in a structural equation model.

O

Outcome

Latent construct of disease risk operationalized by two observed ordinal indicators: hypertension risk (high risk defined as persistent blood pressure 120–139/80–89 mmHg, particularly with family history; low risk defined as <120/80 mmHg without family history) and diabetes risk (high risk defined as fasting plasma glucose 6.1–6.9 mmol/L and/or 2-hour postprandial glucose 7.8–11.0 mmol/L, particularly with family history; low risk defined as fasting plasma glucose 3.9–6.1 mmol/L, 2-hour postprandial glucose <7.8 mmol/L, and no family history).surrogate

Main Result

Effect estimate: β = −0.360 (indirect effect of healthy lifestyle via physical indicators)

p-value: p=0.001

In community adults without diagnosed hypertension or diabetes, lifestyle behaviors are associated with hypertension and diabetes risk primarily through indirect mediating pathways involving metabolic function and physical indicators (SBP, BMI, WHR), supporting integrated lifestyle and early metabolic risk management.

Limitations

Cross-sectional design cannot establish causality and findings should be interpreted as correlational
Dichotomous or ordinal coding of lifestyle variables discards some dose-response information
Binary and ordinal observed indicators were treated as continuous variables under maximum likelihood estimation, which can bias estimates
Cross-sectional design; findings should be interpreted as correlational and cannot establish causality
Dichotomous or ordinal coding of lifestyle variables discards some dose–response information
Binary or ordinal observed indicators were treated as continuous variables under maximum likelihood estimation, which can bias estimates when indicators are strongly non-normal

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Implication

May support combined lifestyle-metabolic screening in community adults; extends pathway associations but remains hypothesis-generating pending prospective data.

Abstract

Objective To examine whether lifestyle is associated with hypertension and diabetes risk via sequential indirect pathways involving metabolic function and physical indicators among community adults. Methods A cross-sectional study was conducted among 6,178 community adults in Nanning, southern China. Structural equation modeling (SEM) was used to examine the direct and indirect associations among lifestyle, metabolic function, physical indicators, and disease risk. Bias-corrected bootstrap analyses with 5,000 resamples were performed to evaluate indirect associations. Results The model showed acceptable fit (CFI = 0.917, RMSEA = 0.048); the chi-square/df ratio (5.19) was elevated, as is common in samples of this size. Physical indicators exhibited the strongest direct association with disease risk ( β = 0.763, P < 0.001), while metabolic function was also positively associated with disease risk ( β = 0.048, P = 0.010). Healthy lifestyle was associated with lower disease risk via indirect pathways involving physical indicators alone ( β = −0.360, P = 0.001) and via the sequential indirect pathway involving metabolic function and physical indicators ( β = −0.011, P = 0.021). For unhealthy lifestyle, indirect associations with higher disease risk were observed via metabolic function ( β = 0.003, P = 0.036) and physical indicators ( β = 0.092, P = 0.014), whereas the sequential indirect pathway was not statistically significant ( P = 0.104). Direct associations of lifestyle with disease risk were small in magnitude (| β | ≤ 0.035) and of limited clinical importance; only the direct association of unhealthy lifestyle reached statistical significance ( β = −0.035, P = 0.013). Conclusion In this cross-sectional sample, lifestyle was associated with hypertension and diabetes risk primarily via indirect pathways involving metabolic function and physical indicators. These findings should be interpreted as correlational and cannot establish causality. They highlight the importance of integrated lifestyle management and early metabolic risk assessment for the prevention of hypertension and diabetes in community settings.

Discussion

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Cite This Study

Zhao et al. (2026) conducted a cross-sectional in Hypertension and diabetes risk (n=6,178). Healthy and unhealthy lifestyle behaviors (physical activity, sleep quality, smoking, alcohol consumption, sedentary behavior) was evaluated on Latent disease risk construct indicated by hypertension risk and diabetes risk (β = −0.360 (indirect effect of healthy lifestyle via physical indicators), p=0.001). Healthy lifestyle was associated with lower hypertension and diabetes risk via physical indicators (β = −0.360, P = 0.001) and sequential metabolic and physical pathways (β = −0.011, P = 0.021).

synapsesocial.com/papers/6aea773089a8acbed9c87b5b https://doi.org/10.3389/fmed.2026.1946501

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Lifestyle associations with hypertension and diabetes risk via metabolic function and physical indicators: a cross-sectional serial mediation model among community adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Lifestyle associations with hypertension and diabetes risk via metabolic function and physical indicators: a cross-sectional serial mediation model among community adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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