Introduction
Non-communicable diseases (NCDs) have emerged as a major global public health challenge, with obesity and hypertension contributing substantially to cardiovascular morbidity and premature mortality.[1] These conditions are closely interrelated and frequently coexist within the spectrum of metabolic syndrome, significantly increasing the risk of ischemic heart disease, stroke, diabetes mellitus, and renal disorders.[2] In recent decades, the prevalence of obesity and elevated blood pressure has increased considerably among young adults, reflecting changing dietary habits, sedentary lifestyles, psychological stress, and reduced physical activity. Early onset of these cardiometabolic risk factors during young adulthood predisposes individuals to long-term vascular complications and increased healthcare burden.[1-3]
The university period represents a critical transitional stage during which lifelong health-related behaviors are established. Undergraduate students are particularly vulnerable to unhealthy lifestyle practices because of academic stress, irregular sleep patterns, excessive screen time, inadequate physical activity, and frequent consumption of calorie-dense fast foods. These factors contribute significantly to weight gain, altered body composition, and elevated blood pressure levels. Consequently, obesity and hypertension are increasingly being recognized among university students, including those enrolled in healthcare-related disciplines.[4]
Medical and nursing undergraduates constitute a unique subgroup because, despite possessing knowledge regarding healthy lifestyle practices and disease prevention, they are frequently exposed to intense academic schedules, examination stress, sleep deprivation, and limited opportunities for regular exercise. The demanding nature of medical education often promotes unhealthy dietary patterns and sedentary behavior, thereby increasing susceptibility to obesity and hypertension. Furthermore, poor health among future healthcare professionals may adversely influence their quality of life, professional productivity, and effectiveness in counseling patients regarding preventive health practices.[5]
Body Mass Index (BMI), waist–hip ratio, and body fat composition are widely accepted indicators for assessing generalized and truncal obesity, while blood pressure measurement remains essential for early detection of hypertension. Early identification of these modifiable risk factors among healthcare students is important for implementing preventive strategies and promoting healthier institutional environments.[6]
Despite the growing burden of obesity and hypertension among young adults, limited concurrent epidemiological data are available regarding these risk factors among undergraduate medical and nursing students in many regions of India. Institution-specific data are essential for planning targeted health interventions and wellness programs. Therefore, the present study was undertaken to estimate the prevalence of obesity and hypertension among undergraduate students at a university medical institute using standardized anthropometric and blood pressure measurements.
Materials and Methods
Study Design and Setting
An institution-based cross-sectional observational study was conducted among undergraduate medical and nursing students at Sri Guru Ram Das Institute of Medical Sciences and Research, affiliated with Sri Guru Ram Das University of Health Sciences. The study was carried out after obtaining approval from the Institutional Ethics Committee in accordance with the ethical principles outlined in the Declaration of Helsinki.
Study Population and Sampling
The study population comprised undergraduate students enrolled in medical and nursing courses at the institute during the study period. Participants were recruited using a convenient sampling method. Students who provided written informed consent and were willing to participate were included in the study.
Inclusion Criteria
Undergraduate medical and nursing students willing to participate in the study.
Exclusion Criteria
Students receiving long-term pharmacological treatment for chronic medical illnesses, Students with known endocrine or systemic disorders likely to influence body composition or blood pressure measurements.
Data Collection Procedure
After explaining the objectives and methodology of the study, written informed consent was obtained from all participants. Demographic details and relevant clinical history were recorded using a structured proforma. Anthropometric and blood pressure measurements were performed by trained investigators using standardized protocols recommended by the World Health Organization (WHO).
Blood Pressure Measurement
Blood pressure was measured using a calibrated auscultatory sphygmomanometer with an appropriately sized cuff. Participants were instructed to avoid caffeine intake, smoking, and vigorous physical activity for at least 30 minutes prior to assessment. Measurements were recorded in a seated position after a minimum rest period of five minutes, with the arm supported at heart level. Two readings were obtained at an interval of five minutes, and the average value was considered for analysis. Blood pressure categories were classified according to the JNC VIII criteria as normal, prehypertension, stage 1 hypertension, and stage 2 hypertension.50
Anthropometric Assessment
Height was measured using a stadiometer to the nearest 0.1 cm with participants standing barefoot in the Frankfurt plane. Weight was recorded using a calibrated digital weighing scale to the nearest 0.1 kg while participants wore light clothing. Body Mass Index (BMI) was calculated using the formula:
BMI was categorized according to WHO recommendations for Asian populations. Waist circumference was measured at the midpoint between the lower margin of the last palpable rib and the iliac crest at the end of normal expiration. Hip circumference was measured at the level of the maximum gluteal protuberance, and waist–hip ratio was subsequently calculated to assess central obesity. Body fat percentage was determined using a standardized body composition analysis machine according to manufacturer guidelines.
Indian Diabetes Risk Score (IDRS) Assessment
The Indian Diabetes Risk Score (IDRS) was used as a validated screening tool for estimating the risk of type 2 diabetes mellitus.52 The score was calculated based on age, abdominal obesity, physical activity, and family history of diabetes. Participants were categorized into low (<30), moderate (30–50), and high (>50) risk groups.
Statistical Analysis
Data were entered into Microsoft Excel and analyzed using appropriate statistical software. Continuous variables were expressed as mean ± standard deviation (SD), whereas categorical variables were presented as frequencies and percentages. The Chi-square test or Fisher’s exact test was applied to assess associations between categorical variables. Independent Student’s t-test was used for comparison between two groups, while one-way analysis of variance (ANOVA) was employed for comparison across multiple groups. A p-value of <0.05 was considered statistically significant.
Results
The study included 500 university students with a mean age of 20.69 ± 1.70 years, predominantly belonging to the 18-21 years age group (73.0%). Female participants constituted 67.6%, while MBBS students represented the majority (80.0%). Most students were from urban backgrounds (76.4%) and were hostel residents (95.2%). A positive family history of hypertension and diabetes mellitus was reported in nearly one-third of participants, whereas cardiovascular disease was less frequent (11.2%). Blood pressure assessment showed that 88.4% of students had normal blood pressure, while pre-hypertension and hypertension were observed in 10.6% and 1.0%, respectively. Mean systolic and diastolic blood pressures were 114.11 ± 7.92 mmHg and 72.95 ± 6.73 mmHg (Table 1).
| Variables | Frequency (%) / Mean ± SD |
| Age group (years) | |
| 18–21 | 365 (73.0) |
| 22–25 | 135 (27.0) |
| Mean age (years) | 20.69 ± 1.70 |
| Gender | |
| Female | 338 (67.6) |
| Male | 162 (32.4) |
| Course enrolled | |
| MBBS | 400 (80.0) |
| Nursing | 100 (20.0) |
| Demographic profile | |
| Rural | 118 (23.6) |
| Urban | 382 (76.4) |
| Type of residence | |
| Day scholar | 24 (4.8) |
| Hostel resident | 476 (95.2) |
| Family history | |
| Hypertension | 145 (29.0) |
| Diabetes mellitus | 144 (28.8) |
| Cardiovascular disease | 56 (11.2) |
| Blood Pressure Category | |
| Normal | 442 (88.4) |
| Pre-hypertension | 53 (10.6) |
| Hypertension | 5 (1.0) |
| Blood Pressure Parameters | Mean ± SD (mmHg) |
| Systolic blood pressure | 114.11 ± 7.92 |
| Diastolic blood pressure | 72.95 ± 6.73 |
Anthropometric assessment of the study participants demonstrated a mean height of 167.82± 8.93 cm and mean weight of 66.94±14.81 kg. The average waist circumference, hip circumference, and waist–hip ratio were 78.82±10.80 cm, 96.53±8.65 cm, and 0.81 ± 0.07, respectively. The mean BMI was 23.62 ± 4.05 kg/m², indicating a tendency toward higher body weight among students. Based on BMI classification, 34.8% had healthy weight, while overweight and obesity were observed in 20.4% and 34.4% participants, respectively. Central obesity was present in 23.4% students, highlighting a considerable burden of adiposity-related risk factors in the study population (Table 2).
| Parameters | Mean ± SD | Minimum | Maximum |
| Height (cm) | 167.82 ± 8.93 | 147.0 | 194.0 |
| Weight (kg) | 66.94 ± 14.81 | 38.3 | 116.8 |
| Waist circumference (cm) | 78.82 ± 10.80 | 53.0 | 119.0 |
| Hip circumference (cm) | 96.53 ± 8.65 | 70.0 | 130.0 |
| Waist–hip ratio | 0.81 ± 0.07 | 0.60 | 1.11 |
| BMI (kg/m²) | 23.62 ± 4.05 | ||
| BMI Categories | Frequency (%) | ||
| Underweight (<18.5 kg/m²) | 52 (10.4) | ||
| Healthy weight (18.5–22.9 kg/m²) | 174 (34.8) | ||
| Overweight (23.0–24.9 kg/m²) | 102 (20.4) | ||
| Obesity (≥25 kg/m²) | 172 (34.4) | ||
| Central Obesity | Frequency (%) | ||
| Absent | 383 (76.6) | ||
| Present | 117 (23.4) |
The association analysis revealed that overweight, obesity, and central obesity were significantly associated with pre-hypertension/hypertension among students (p<0.001). The prevalence of elevated blood pressure increased progressively from underweight (1.9%) to obese participants (20.9%), indicating a strong relationship between excess body weight and blood pressure abnormalities. Students with central obesity showed a markedly higher prevalence of pre-hypertension/hypertension compared to those without central obesity (24.8% vs. 7.6%). Urban students also demonstrated significantly higher blood pressure abnormalities than rural students (13.6% vs. 5.1%; p=0.036). However, no statistically significant association was observed with age group, gender, or type of residence (Table 3)
| Variables | Normal n (%) | Pre-hypertension/ Hypertension n (%) | p-value |
| Age group | 0.742 | ||
| 18–21 years | 322 (88.2) | 43 (11.8) | |
| 22–25 years | 120 (88.9) | 15 (11.1) | |
| Gender | 0.742 | ||
| Female | 304 (89.9) | 34 (10.1) | |
| Male | 138 (85.2) | 24 (14.8) | |
| BMI category | <0.001* | ||
| Underweight | 51 (98.1) | 1 (1.9) | |
| Healthy weight | 167 (96.0) | 7 (4.0) | |
| Overweight | 88 (86.3) | 14 (13.7) | |
| Obesity | 136 (79.1) | 36 (20.9) | |
| Central obesity | <0.001* | ||
| Absent | 354 (92.4) | 29 (7.6) | |
| Present | 88 (75.2) | 29 (24.8) | |
| Demographic profile | 0.036* | ||
| Rural | 112 (94.9) | 6 (5.1) | |
| Urban | 330 (86.4) | 52 (13.6) | |
| Residence | 0.844 | ||
| Day scholar | 21 (87.5) | 3 (12.5) | |
| Hostel | 421 (88.4) | 55 (11.6) |
*Statistically significant
A significant association was observed between elevated blood pressure and family history of hypertension as well as diabetes mellitus. Students with a positive family history of hypertension showed a markedly higher prevalence of pre-hypertension/hypertension compared to those without such history (20.7% vs. 7.9%; p<0.001). Similarly, participants with a family history of diabetes mellitus demonstrated higher blood pressure abnormalities than their counterparts (17.4% vs. 9.3%; p=0.019). In contrast, family history of cardiovascular disease did not show a statistically significant association with blood pressure status (p=0.562). These findings highlight the important contribution of hereditary and metabolic risk factors to early blood pressure changes among young adults (Table 4).
| Variables | Normal n (%) | Pre-hypertension/ Hypertension n (%) | p-value |
| Family history of hypertension | <0.001* | ||
| Absent | 327 (92.1) | 28 (7.9) | |
| Present | 115 (79.3) | 30 (20.7) | |
| Family history of diabetes mellitus | 0.019* | ||
| Absent | 323 (90.7) | 33 (9.3) | |
| Present | 119 (82.6) | 25 (17.4) | |
| Family history of cardiovascular disease | 0.562 | ||
| Absent | 391 (88.1) | 53 (11.9) | |
| Present | 51 (91.1) | 5 (8.9) |
*Statistically significant
The analysis demonstrated a significant association between blood pressure status, body fat composition, and Indian Diabetes Risk Score (IDRS). Participants with pre-hypertension exhibited higher mean body fat percentage compared to those with normal blood pressure (30.41 ± 6.46% vs. 24.91 ± 5.77%; p<0.001). Similarly, IDRS values increased significantly with worsening blood pressure status, with the highest scores observed among hypertensive participants. Students with central obesity also had markedly elevated IDRS compared to those without central obesity (27.86 ± 10.57 vs. 15.85 ± 7.11; p<0.001). These findings indicate a close relationship between adiposity, metabolic risk, and early cardiovascular abnormalities in young adults (Table 5).
| Variables | N | Mean ± SD | p-value |
| Body fat composition (%) according to blood pressure | <0.001* | ||
| Normal BP | 442 | 24.91 ± 5.77 | |
| Pre-hypertension | 53 | 30.41 ± 6.46 | |
| Hypertension | 5 | 24.28 ± 12.06 | |
| IDRS according to blood pressure | <0.001* | ||
| Normal BP | 442 | 17.62 ± 8.67 | |
| Pre-hypertension | 53 | 26.23 ± 11.80 | |
| Hypertension | 5 | 30.00 ± 12.25 | |
| IDRS according to central obesity | <0.001* | ||
| Absent | 383 | 15.85 ± 7.11 | |
| Present | 117 | 27.86 ± 10.57 |
*Statistically significant
Discussion
The present study demonstrated a considerable burden of obesity and elevated blood pressure among undergraduate medical and nursing students, highlighting the growing cardiometabolic risk in young adults. More than half of the participants were either overweight or obese, while prehypertension and hypertension were observed in 10.6% and 1.0% students, respectively. These findings are consistent with the rising trend of obesity and early cardiovascular risk factors reported among university students globally. Previous studies by Chenji et al.[7]; Sharda et al.[8] and Lahole et al.[9] similarly documented increasing obesity and abnormal blood pressure among medical students, emphasizing the transition of non-communicable disease risk into younger age groups.
A significant association was observed between BMI and blood pressure status, with obese students demonstrating a markedly higher prevalence of prehypertension and hypertension compared to participants with healthy BMI. Similar observations have been reported by Pengpid et al.[10]; Parsekar et al.[11] and Sah et al.[12] who identified obesity as an independent predictor of elevated blood pressure in young adults. Excess adiposity contributes to sympathetic overactivity, insulin resistance, endothelial dysfunction, and activation of the renin–angiotensin–aldosterone system, thereby predisposing individuals to hypertension and future cardiovascular disease.
Central obesity also showed a strong relationship with blood pressure abnormalities and elevated Indian Diabetes Risk Score (IDRS). Participants with central obesity had significantly higher IDRS values, indicating clustering of metabolic risk factors at an early age. Comparable findings have been reported by Lahole et al.[9] and Sharda et al.[10] where waist circumference and waist–hip ratio correlated positively with systolic and diastolic blood pressure. These observations reinforce the importance of incorporating waist circumference assessment into routine student health screening programs, as visceral adiposity is a more sensitive marker of cardiometabolic risk than BMI alone.
The study further demonstrated significant associations between elevated blood pressure and family history of hypertension and diabetes mellitus, suggesting an important contribution of genetic predisposition and shared lifestyle behaviors. Similar findings have been documented by Moussa et al.[13]; Qaiser et al.[14] and Kale et al.[15] who identified positive family history as a major determinant of prehypertension and hypertension among university students. Urban background was also associated with higher blood pressure prevalence, possibly reflecting sedentary lifestyle patterns, unhealthy dietary habits, and psychosocial stress associated with urban living.
Overall, the findings underscore the urgent need for early preventive interventions, including lifestyle modification, regular screening, nutritional counseling, and promotion of physical activity among healthcare students to reduce future cardiovascular and metabolic disease burden.
Conclusion
The present study demonstrates a considerable burden of obesity and elevated blood pressure among undergraduate medical and nursing students, with more than half of the participants being overweight or obese and a notable proportion exhibiting prehypertension. Significant associations of elevated blood pressure with general obesity, central obesity, body fat percentage, family history of hypertension, and diabetes mellitus highlight the early clustering of cardiometabolic risk factors in young adults. These findings emphasize the importance of routine screening, lifestyle modification, nutritional awareness, stress reduction, and promotion of regular physical activity within educational institutions. Early preventive interventions among healthcare students are essential to reduce future cardiovascular and metabolic disease burden and to promote healthier future healthcare professionals.
Limitations
The study has certain limitations that should be acknowledged. Being a cross-sectional study, causal relationships between obesity and hypertension could not be established. The study was conducted at a single tertiary care institution, which may limit the generalizability of the findings to other populations. Convenience sampling may have introduced selection bias. Important behavioral determinants such as dietary habits, physical activity, sleep quality, psychological stress, and substance use were not assessed. Additionally, the relatively small number of hypertensive participants may have reduced the statistical power for subgroup comparisons.
Future Directions
Future multicentric longitudinal studies involving larger and more diverse student populations are recommended to better understand the progression of obesity and hypertension during medical training. Incorporation of detailed lifestyle, dietary, psychological, and biochemical assessments would provide deeper insight into underlying risk factors. Interventional studies evaluating the effectiveness of structured wellness programs, physical activity initiatives, nutritional counseling, and stress management strategies among healthcare students are also warranted. Early institution-based preventive models may play a crucial role in reducing long-term cardiometabolic risk among young adults.
Declarations
Ethical Approval and Consent to Participate
All procedures performed in this case series were conducted in accordance with the ethical standards of the institutional research committee and the 1964 Declaration of Helsinki and its later amendments. Ethical approval was obtained from the Institutional Ethics Committee (SGRD/IEC/2024-373). Written informed consent was obtained from all individual participants or their legal guardians included in the study prior to any procedures.
Consent for Publication
Written informed consent for the publication of clinical details and accompanying images was obtained from the patients or their legal representatives. All data has been meticulously anonymized to ensure patient confidentiality and privacy.
Availability of Data and Materials
The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request, in compliance with institutional data sharing policies and ethical restrictions.
Competing Interests
The authors declare that they have no financial or non-financial competing interests that could inappropriately influence or bias the integrity of this research.
Funding
This research received no specific grant or financial support from any funding agency in the public, commercial, or not-for-profit sectors.
Authors’ Contributions
All authors contributed significantly to the study's conception, design, data acquisition, and analysis. Each author participated in drafting the manuscript and performing critical revisions for intellectual content. The final version of the manuscript has been reviewed and approved by all authors for submission.