Asociación entre porcentaje de grasa corporal y presión arterial media elevada en adultos peruanos: un estudio analítico

Association between body fat percentage and elevated mean arterial pressure in Peruvian adults: an analytical study

Introducción. El exceso de grasa corporal es un factor de riesgo independiente para hipertensión arterial. Sin embargo, esta relación ha sido poco explorada en grandes grupos poblacionales.

Objetivo. Evaluar la asociación entre el porcentaje de grasa corporal (%GC) y la presión arterial media (PAM) elevada en adultos peruanos.

Materiales y métodos. Estudio analítico y transversal basado en datos de 28 611 adultos peruanos que participaron en la Encuesta Demográfica y de Salud Familiar de 2022. Para evaluar la asociación entre %GC y PAM elevada se realizó un análisis bivariado (prueba chi-cuadrado con V de Cramer y cálculo de Odds Ratio [OR]) y un análisis multivariado (modelo de regresión logística linear binaria con eliminación hacia atrás). También se evaluó la correlación entre %GC y PAM (coeficiente de correlación de Spearman).

Resultados. De los 28 611 registros incluidos, 57.40% eran mujeres y 56.18% tenían un %GC elevado. El promedio de PAM fue significativamente mayor en aquellos con un %GC elevado tanto en mujeres (88.37 vs. 80.27) como en hombres (95.51 vs. 87.01). En el análisis bivariado, tener un %GC elevado se asoció significativamente con una mayor probabilidad de PAM elevada en mujeres (OR=4.897; p<0.001, V=0.294) y en hombres (OR=4.064; p<0.001, V=0.336). En el análisis multivariado, tener un %GC elevado aumentó la probabilidad de tener PAM elevada 2.6 (OR=2.65; p<0.001) y 2.15 (OR=2.150; p<0.001) veces en hombres y mujeres, respectivamente. La correlación entre %GC y PAM fue moderada en mujeres (Rho=0.464) y hombres (Rho=0.441).

Conclusiones. El %GC se asoció de forma independiente con mayor probabilidad de PAM elevada en adultos peruanos.

Introduction: Excess body fat is an independent risk factor for high blood pressure. However, this relationship has been scarcely explored in large population groups.

Objective: To evaluate the association between body fat percentage (BF%) and elevated mean arterial pressure (MAP) in Peruvian adults.

Materials and methods: Analytical, cross-sectional study based on data from 28 611 Peruvian adults who participated in the Encuesta Nacional Demográfica De Salud Familiar - 2022 (National Demographic and Family Health Survey 2022). To evaluate the association between BF% and elevated MAP, a bivariate analysis (chi-square test with Cramer's V and odds ratio [OR] calculation) and a multivariate analysis (binary linear logistic regression model with backward elimination) were performed. The correlation between BF% and MAP (Spearman’s correlation coefficient) was also evaluated.

Results: Of the 28 611 records included, 57.40% were women and 56.18% had a high BF%. The average MAP was significantly higher in individuals with a high BF% in both women (88.37 vs. 80.27) and men (95.51 vs. 87.01). In the bivariate analysis, having a high BF% was significantly associated with a higher probability of elevated MAP in women (OR=4.897; p<0.001, V=0.294) and men (OR=4.064; p<0.001, V=0.336). In the multivariate analysis, having a high BF% increased the probability of having high BP by 2.6 (OR=2.65; p<0.001) and 2.15 (OR=2.150; p<0.001) times in men and women, respectively. The correlation between BF% and MAP was moderate in women (Rho=0.464) and men (Rho=0.441).

Conclusions: BF% was independently associated with a higher probability of elevated MAP in Peruvian adults.

Original research

Alberto Guevara-Tirado1

1 Universidad Científica del Sur- Faculty of Medicine - Lima - Perú.

Open access

Received: 20/01/2025

Accepted: 19/12/2025

Corresponding author: Alberto Guevara-Tirado. E-mail: albertoguevara1986@gmail.com.

Keywords: Body Fat Distribution; Hypertension; Overweight; Measures of Association; Health Vulnerability (MeSH).

Palabras clave: Distribución de la Grasa Corporal; Hipertensión; Sobrepeso; Medidas de Asociación; Vulnerabilidad en Salud (DeCS).

How to cite: Guevara-Tirado A. Association between body fat percentage and elevated mean arterial pressure in Peruvian adults: an analytical study. Rev. Fac. Med. 2026;74:e118415. English. doi: https://doi.org/10.15446/revfacmed.v74.118415.

Cómo citar: Guevara-Tirado A. [Asociación entre porcentaje de grasa corporal y presión arterial media elevada en adultos peruanos: un estudio analítico]. Rev. Fac. Med. 2026;74:e118415. English. doi: https://doi.org/10.15446/revfacmed.v74.118415.

Copyright: ©2026 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, as long as the original author and source are credited.

Abstract

Resumen

Introduction

Body fat percentage (BF%) is defined as the percentage of total fat in relation to total body mass and, together with body mass index (BMI), is one of the most common ways to measure body composition and health risks.1,2 This body composition measure is more accurate than BMI, as the latter does not distinguish between adipose tissue and lean body mass, ignores fat distribution,3,4 and does not consider variations in adipose mass between sexes or conditions such as pregnancy, cancer, and osteoporosis.5 Accordingly, although BMI is a relevant anthropometric measure for epidemiological screening studies, it may result in an inadequate assessment of individual cases.5,6

Excess body fat is a pathophysiological determinant of high blood pressure.7 The mechanisms by which obese individuals may develop hypertension (AHT) include sympathetic nervous system hyperactivation, renin-angiotensin-aldosterone system stimulation, alterations in adipose tissue-derived cytokines, insulin resistance, and structural and functional renal changes.7

In obese individuals, visceral fat accumulation and insulin resistance induce abnormal glucose metabolism and high blood pressure.8 Furthermore, excess visceral, perirenal, and renal sinus fat compresses the kidney, which, together with increased renal sympathetic nerve activity, contributes to renin-angiotensin-aldosterone system activation.9 Similarly, the accumulation of perirenal adipose tissue may obstruct the renal parenchyma and vessels, which may lead to increased sodium reabsorption, resulting in higher blood pressure.10 Finally, excess weight is associated with increased sympathetic nervous system activity (mediated by elevated leptin levels and the central POMC-MC4R pathway), which promotes the development of AHT.11

The prevalence of obesity has more than doubled since 1980,12 and according to the World Health Organization (WHO), 2.5 billion adults (aged 18 years and older) worldwide were overweight in 2022, with more than 890 million of them suffering from obesity.13 In Peru, overweight and obesity rates are also on the rise,14 with official data from the Encuesta Demográfica y de Salud Familiar (ENDES) 2024 (Demographic and Family Health Survey 2024) showing that 62% of the population over the age of 15 is overweight (36.5% overweight and 25.7% obese).15,16

The WHO estimated that nearly 1.4 billion adults aged 30 to 79 were living with AHT in 2024, representing 33% of the population in this age range.17 In the Americas, at least 30% of the population has high blood pressure, and that percentage can be as high as 48% in some countries.18 In Peru, according to the ENDES 2023, 19.3% of the population aged 15 years or older had AHT,19,20 making it a significant public health problem.

Since excess weight is an independent risk factor for AHT—one of the leading causes of cardiovascular morbidity and mortality—21,22 it is appropriate to study the relationship between BF% and blood pressure from a national epidemiological perspective in Peru, considering that anthropometric, socioeconomic, and lifestyle characteristics in the country differ substantially between rural, urban, and indigenous areas, as well as between populations in other developing and developed countries.23 These specificities might alter the magnitude and pattern of association between body fat and blood pressure. Therefore, the objective of this study is to evaluate the association between BF% and elevated mean arterial pressure (MAP) in Peruvian adults.

Materials and methods

Study design and data analysis

Analytical, cross-sectional study in which secondary data from the ENDES 2022 survey were evaluated. This survey was conducted between January 1 and December 31, 2022, in 35 287 households (out of 36 650) throughout Peru.24 The ENDES is a complex, probabilistic, two-stage, independent population survey that assesses the demographic and health dynamics of the Peruvian population on an annual basis.25 For sampling purposes, this survey uses the cube method, which, after undergoing a pilot test, allows obtaining balanced samples with estimates of totals approximately equal to the characteristics of the survey’s target population. It replicates the population structure within the selected sample, taking into account age groups, sex, and other balancing variables, thereby improving the coverage of target populations and the statistical accuracy of the main indicators.25

The study was performed following the recommendations of the REporting of studies Conducted using Observational Routinely-collected Data (RECORD) guidelines.26

Adults (≥18 years) with data on blood pressure (measured twice consecutively) and abdominal circumference (N=34 301) were considered eligible. Records of respondents with incomplete data for the variables of interest and those who reported having been diagnosed with diabetes mellitus were excluded, resulting in a sample of 28 611 individuals (16 423 women and 12 188 men) (Figure 1).

Figure 1. Sample selection flowchart.

ENDES: Encuesta Demográfica y de Salud Familiar (Demographic and Family Health Survey); MAP: mean arterial pressure; WC: waist circumference.

Source: Own elaboration.

It should be noted that respondents with type 2 diabetes mellitus were not included, as this disease is associated with changes in body weight27 and with both macrovascular and microvascular complications that can alter systemic blood pressure.28

Variables and measurements

Information on the following variables was obtained from the ENDES 2022 database: age (classified as young adult [18-39 years], middle-aged adult [40-59 years], and older adult [≥60 years]), sex, educational level, ethnicity, native language, age of alcohol initiation (adolescence, young adult, and middle adult), marital status, waist circumference, nutritional status based on BMI (underweight [BMI<18.5kg/m2], normal weight [BMI=18.50-24.99kg/m2], overweight [BMI=25-29.99kg/m2], obesity [BMI≥30kg/m2]), systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP. Importantly, MAP (dependent variable) was calculated based on blood pressure data using the conventional formula MAP = (SBP + (2 × DBP)) / 3.

According to the ENDES 2022 technical data sheet, blood pressure was measured twice: once after a 5-minute rest period and then again 10 minutes after the first measurement. For this study, the second measurement was used, and MAP was classified as normal (60-89.99 millimeters of mercury [mmHg]) or high (≥90 mmHg).29

On the other hand, BF% (main independent variable) was calculated in the SPSS software (version 25) using the formula BF% = (1.39 × BMI) + (0.16 × age) - ((10.34 × sex) - 9),30 where males were assigned a value of 1 and females a value of 0. BF% was classified as normal (men: 8–24%; women: 21–34%) and elevated (men: ≥25%; women: ≥35%).31

The variables age, waist circumference, age of alcohol initiation, ethnicity, and native language were considered as confounding and adjustment variables in the multivariate analysis.

Statistical analysis

Prior to analysis, data cleaning was performed, involving the rectification of incorrect data (correction of decimals), typos, inconsistent category formats, and numerical values, as well as data transformation for the calculation of BF% values. No duplicate data, outliers, null values, or missing values were found.

Data are described using absolute frequencies and percentages for qualitative variables and means and standard deviations for quantitative variables, as the distribution was found to be normal (Kolmogorov-Smirnov test).

Concerning inferential analysis, a bivariate analysis (Pearson's chi-square test) was performed to evaluate differences in MAP between individuals with high BF% and individuals with normal BF%.

To evaluate the association between BF% and elevated MAP, a bivariate analysis was first performed (chi-square test with Cramer's V and calculation of odds ratio [OR] with their respective 95% confidence intervals [95% CI]), followed by a multivariate analysis using a binary linear logistic regression model that included the Wald test; the exponential of B, representing the adjusted ORs with a Nagelkerke R2 coefficient of 0.23% in men and 0.29% in women; and a omnibus test with a statistical significance value of p<0.001. Variables were selected using the backward elimination method, resulting in the inclusion of the following variables in the model: age of alcohol initiation, alcohol use, waist circumference, ethnicity, and native language.

Finally, the correlation between BF% and MAP was evaluated using the Spearman’s correlation coefficient (Rho). This statistical test was used because the data showed a nonparametric distribution (Kolmogorov-Smirnov test).

All statistical analyses were performed for both men and women. A statistical significance level of p<0.05 was considered. The analyses were performed using SPSS StatisticsTM software (version 25).

Ethical considerations

The study followed the ethical principles for biomedical research involving human subjects established in the Declaration of Helsinki32 and was authorized for the use of open data by the Peruvian Ministry of Health through the National Institute of Health by means of Resolution No. 001-2023-UDT-OTIC-INS dated November 11, 2023. It should be noted that the database used (available at: https://bit.ly/4un943r) does not contain personal data that could be used to identify participants.

Results

Of the 28 611 records included in the analysis, 56.90% belonged to young adults and 57.40% to women. In addition, 55.50% reported having started drinking alcohol as young adults, 38.70% were overweight, and the most common educational level was high school degree (68.00%). The characteristics of the respondents are presented in Table 1.

Table 1. Characteristics of the Peruvian adult population studied (n=28 611).

Variable	Category	Frequency (n)	Percentage (%)
Age group	Young adult	16 279	56.900
	Middle-aged adult	7 124	24.9
	Older adult	5 208	18.2
Sex	Female	16 423	57.4
	Male	12 188	42.6
Ethnicity	Non-mixed race	13 704	47.9
	Mixed race	14 907	52.1
Educational level	Up to secondary school	19 455	68.00
	Technical/university	9 156	32
Native language	Quechua	5 979	20.9
	Aymara	658	2.3
	Other native languages	601	2.1
	Spanish	21 373	74.7
SBP	>140mmHg	2 203	7.7
	≤139mmHg	26 408	92.3
DBP	>90mmHg	2 088	7.3
	≤89mmHg	26 523	92.7
Age of alcohol initiation	Adolescence (12–17 years)	9 584	33.5
	Young adult (18–39 years)	15 879	55.50
	Middle-aged adult (40–59 years)	200	0.7
	Older adult (≥60 years)	2 948	10.3
Marital status	Single	9 385	32.8
	Married/cohabiting	19 226	67.2
Waist circumference	Normal (≤81 cm for women; ≤94 cm for men)	14 272	49.9
	Elevated (>81 cm for women; >94 cm for men)	14 339	50.1
Nutritional status (BMI)	Underweight	629	2.2
	Normal	9 498	33.20
	Overweight	11 072	38.70
	Obese	7 412	25.9

SBP: systolic blood pressure; DBP: diastolic blood pressure; BMI: body mass index.

Source: Own elaboration.

In turn, 56.18% (n=16,074) of respondents had a high BF%, which was more common in women (59.18%, n=9 719 vs. 52.14%, n=6 355). In addition, the average MAP was significantly higher in individuals with elevated BF% in both women (88.37 vs. 80.27; p<0.001) and men (95.51 vs. 87.01; p<0.001) (Table 2).

Table 2. Average mean blood pressure based on high and normal body fat percentage in Peruvian men and women.

		n (%)	Average MAP	SD	p-value
Females (n=16 423) (Mean BF%=36%)	High BF%	9 719 (59.18%)	88.37	11.197	(p<0.001)
	Normal BF%	6 704 (40.82%)	80.27	8.758
Males (n=12 188) (Mean BF%=24%)	High BF%	6 355 (52.14%)	95.51	11.511	(p<0.001)
	Normal BF%	5 833 (47.86%)	87.01	9.222

MAP: mean arterial pressure; BF%: body fat percentage.

Source: Own elaboration.

Regarding MAP, 30.06% (n=10 890) had elevated MAP, with a much higher frequency in men (53.58%, n=6 531 vs. 26.54%, n=4 359). In accordance with the results of the bivariate analysis, having a high BF% was significantly associated with a higher probability of elevated MAP in both women (OR=4.897, 95%CI: 4.452-5.299; p<0.001, V=0.294) and men (OR=4.064, 95%CI: 3.767-4.383; p<0.001, V=0.336). The proportion of individuals with elevated MAP was higher in women with elevated BF% than in men with elevated BF% (83.21% vs. 67.77%) (Table 3).

Table 3. Association between body fat percentage and elevated mean blood pressure in adult Peruvian women and men. Bivariate analysis.

	Women							Men
	Elevated MAP n=4 359	Normal MAP n=12 064	Total (n=16 423)	p-value	Cramer's V	OR	95%CI	Elevated MAP n=6 531	Normal MAP n=5 657	Total (n=12 188)	p-value	Cramer's V	OR	95%CI
Elevated BF%	3 627 (83.21%)	6 092 (51.50%)	9 719 (59.18%)	<0.001	0.294	4.897	4.452-5.299	4 426 (67.77%)	1 929 (34.10%)	6 355 (52.14%)	<0.001	0.336	4.064	3.767-4.383
Normal BF%	732 (16.79%)	5 972 (49.50%)	6 704 (40.82%)					2 105 (32.23%)	3 728 (65.90%)	5 833 (47.86%)

MAP: mean arterial pressure; BF%: body fat percentage.

Source: Own elaboration.

The adjusted multivariate analysis found that women with high BF% had a 2.6-fold higher probability of developing elevated MAP than those with normal BF% (OR=2.65, 95% CI: 2.329-3.007; p<0.001). In men, having a high BF% increased this probability 2.1 times (OR=2.15, 95% CI=1.891-2.444; p<0.001) (Table 4).

Finally, BF% and MAP were positively and moderately correlated in both men and women (Rho=0.441 and Rho=0.464) (Table 5).

Table 4. Association between high body fat percentage and high blood pressure in Peruvian adults (binary logistic regression model).

	Women			Men
	p-value	Exp(B)	95%CI	Valor p	Exp(B)	95%CI
Body fat % - high	<0.001	2.647	2.329-3.007	<0.001	2.15	1.891-2.444
Age of alcohol initiation - young adult	0.045	1.128	1.002-1.269	0.024	1.148	1.018-1.295
Waist circumference - high	<0.001	1.580	1.331-1.675	<0.001	1.76	1.580-1.959
Ethnicity - mixed race	0.064	0.91	0.823-1.005	0.01	0.875	0.790-0,969
Native language - Spanish	<0.001	0.816	0.723-0.922	0.002	0.822	0.726-0,930
Age - young adult	<0.001	2.611	2.373-2.873	<0.001	2.592	2.350-2.858

Source: Own elaboration.

Table 5. Spearman’s correlation between body fat percentage and mean arterial pressure in Peruvian adults.

	Rho	p-value	n
Women	0.464	<0.001	16 423
Men	0.441	<0.001	12 188

Rho: Spearman’s correlation coefficient.

Source: Own elaboration.

Discussion

In this study, conducted with data from more than 28 000 Peruvian adults, it was found that a high BF% is consistently associated with a higher probability of elevated MAP in both men and women. These findings are consistent with reports from studies such as the one conducted by Li et al.33 in 38 913 adults from five rural areas in the province of Henan, China, and Nguyen et al.34 in 1 655 adults from four cities and provinces in Vietnam (rural and suburban areas), which found that BF% was significantly associated with the prevalence of AHT (SBP ≥140 mmHg and/or DBP ≥90 mmHg), confirming that body fat accumulation is an independent risk factor for AHT.

It is worth mentioning that, unlike the studies by Li et al.33 and Nguyen et al.,34 which included clinical definitions of AHT, the present study focused on MAP as a continuous and sensitive marker of hemodynamic load. This showed that the magnitude of the association is robust, even in a subclinical range, where the traditional criteria for AHT are not yet met, but there is already a sustained increase in diastolic blood pressure. Furthermore, while Li et al.33 and Nguyen et al.34 focused on specific rural and suburban cohorts, the present analysis included a nationally representative sample (>16 000 women and 12 000 men), which strengthens the external validity of the findings.

Another noteworthy finding concerns the differences observed between sexes. In women, high BF% was associated with almost five times the probability of having elevated MAP in the bivariate analysis, while this probability was 2.6 times higher after multivariate adjustment. In men, although the association was also significant, its magnitude was slightly lower (a 4-fold and 2-fold increased probability, respectively). This difference could be explained by the differential distribution of body fat by sex, as women accumulate more subcutaneous adipose tissue and men accumulate more visceral fat, which influences different hemodynamic and metabolic mechanisms.35,36

Plausible explanations for these findings have to do with sympathetic nervous system activation, plasma volume expansion, and increased peripheral vascular resistance, phenomena described in subjects with excess adipose tissue.37,38 Likewise, the role of mediators such as leptin and chronic inflammation could also contribute to elevated MAP in this context.39

It is necessary to point out that the literature on the association between BF% and MAP in the general population is scarce and that most available studies have used clinical definitions of HTA without considering MAP as a continuous marker.33,34 In this regard, the results of this study are particularly relevant for public health and clinical practice, as they demonstrate that a high BF%, even in individuals without overt obesity, represents a significant risk factor for elevated MAP, thereby supporting the inclusion of body composition measurements in routine cardiovascular risk assessment.

Similarly, our findings highlight the need to implement preventive interventions aimed not only at monitoring BMI, but also at reducing total and visceral fat by adopting healthy lifestyle habits. At the population level, they support the need to design and implement screening and education programs aimed at the early detection of individuals at risk and, thus, reduce the future burden of morbidity and mortality from HTA and cardiovascular disease in the country.

However, this raises questions that need to be addressed in future research: What is the BF% threshold at which MAP increases significantly? Are there differences in this relationship depending on the type of adiposity (visceral or subcutaneous)? What pathophysiological mechanisms explain the variations observed between men and women? Finally, could body fat reduction interventions modify blood pressure trajectory at an early stage? Addressing these questions is key to deepening our understanding of the connection between adiposity and cardiovascular risk.

This study has limitations that should be considered when interpreting the results. First, due to its cross-sectional design, it was not possible to establish causal relationships between BF% and MAP, but only associations. Second, the data come from a secondary database of a population survey, which could involve variability in collection procedures. Third, detailed information on physical activity, diet, and use of antihypertensive therapy was not available, and these factors could influence the observed relationship and need to be explored in further studies.

Conclusions

Body fat percentage was independently associated with a higher probability of elevated MAP in Peruvian adults. This finding confirms that there is a consistent relationship between adipose tissue accumulation and hemodynamic load in the general population. Although this association was observed in both sexes, MAP was higher in men with a high BF%.

Conflicts of interest

None stated by the author.

Funding

None stated by the author.

Acknowledgements

To the Instituto Nacional de Estadística e Informática - INEI (National Institute of Statistics and Informatics) of Peru, for making data available on its website and allowing free access to it, facilitating the development of this research.

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