Evaluation of various obesity indicators as predictors of elevated blood pressure in Chinese adolescents

Abstract Background This study aims to assess the relationship between various obesity indicators and elevated blood pressure (BP) among Chinese adolescents, identifying which indicators can predict the risk of elevated BP. Methods From October 2023 to January 2024, a questionnaire survey and medical examination were conducted on 10,609 adolescents aged 12–17 years in Shiyan City, China, using convenience sampling. Conventional besity indicators were measured including body mass index (BMI), ponderal index (PI), waist circumference (WC), waist-to-hip ratio (WHR), conicity index (CI). Additionally, novel obesity indicators such as waist-to-height ratio (WHtR), body shape index (ABSI), body roundness index (BRI), abdominal volume index (AVI), a new hip index (HI), and body adiposity index (BAI), were also calculated. To assess the effectiveness of these obesity indicators in predicting elevated BP, receiver operating characteristic (ROC) curves were used. Multivariate logistic regression was employed to examine the relationship between these obesity indicators and the risk of elevated BP. Results The overall detection rate of elevated BP among adolescents was 22%, with rates of 20.1% in boys and 24.2% in girls. ROC curve analysis demonstrated statistically significant areas under the curve for predicting elevated BP using Z-scores of the following obesity indicators: BMI, WC, WHtR, WHR, AVI, HI, CI, PI, ABSI, and BAI. The optimal cut-off values for these indicators were: BMI: 0.153, WC: 0.121, WHtR: 0.069, WHR: 0.387, AVI: 0.058, HI: 0.444, CI: 0.444, PI: 0.419, ABSI: 0.282, and BAI: 0.301. Multivariate logistic regression identified HI Z-scores, BAI Z-scores, and WHtR Z-scores as significant predictors of elevated BP risk in adolescents. Specifically, participants with HI Z-scores ≥ 0.444 had a 0.22-fold higher risk of elevated BP. Similarly, those with BAI Z-scores ≥ 0.301, WHtR Z-scores ≥ 0.069 exhibited 0.28, 0.33 times greater risk, respectively, compared to individuals with lower values. Conclusion BMI, WC, WHtR, WHR, AVI, HI, CI, PI, ABSI, and BAI were statistically associated with elevated blood pressure in adolescents, but their predictive power was limited. Higher Z-scores of HI, BAI, and WHtR were identified as independent risk factors for elevated BP in this population.