Visceral and total adiposity as determinants of hypertension risk in a multiethnic population: A cross-sectional analysis

Ethnic variations in the relationship between adiposity and arterial hypertension are of growing interest due to their implications for tailored cardiovascular prevention strategies. This study aimed to evaluate the association between body fat distribution and hypertension across different ethnic groups in a multiethnic population. Methods: A cross-sectional study was conducted in 2024 involving 440 adults of Afro-descendant, Indigenous, and Mestizo backgrounds. Participants were recruited from primary health centers located in the provinces of Imbabura and Carchi, Ecuador. Body fat percentage and visceral fat levels were measured using bioelectrical impedance analysis. The normality of continuous variables was assessed via the Kolmogorov-Smirnov test with Lilliefors correction. Associations between adiposity indicators and hypertension were explored through binary logistic regression models, Mann-Whitney U tests, and stratified probability models by ethnicity. Results: Body fat percentage displayed an approximately normal distribution, while visceral fat levels were right-skewed, reflecting a subgroup with elevated visceral adiposity. Ethnic differences were evident in the adiposity-hypertension relationship. Afro-descendant participants showed the steepest probability gradient for hypertension at higher body fat levels. Indigenous individuals exhibited a flatter probability curve for total body fat, but a markedly steeper increase in hypertension risk with rising visceral fat levels. Mestizo participants and the global population followed intermediate patterns. Conclusions: Distinct ethnic patterns in the association between fat distribution and hypertension highlight the need for population-specific cardiovascular risk assessment and prevention strategies. Visceral adiposity emerged as a particularly strong marker of hypertension risk in Indigenous participants, underscoring its relevance in tailored interventions.