Body mass index, body fat percentage, and visceral fat as mediators in the association between health literacy and hypertension among residents living in rural and suburban areas

Tham T Nguyen; Minh H Nguyen; Yen H Nguyen; Thao T P Nguyen; Manh H Giap; Tung D X Tran; Thu T M Pham; Khue M Pham; Kien T Nguyen; Vinh-Tuyen T Le; Chien-Tien Su; Tuyen Van Duong

doi:10.3389/fmed.2022.877013

Body mass index, body fat percentage, and visceral fat as mediators in the association between health literacy and hypertension among residents living in rural and suburban areas

Front Med (Lausanne). 2022 Sep 6:9:877013. doi: 10.3389/fmed.2022.877013. eCollection 2022.

Authors

Tham T Nguyen¹, Minh H Nguyen², Yen H Nguyen^{3

4

5}, Thao T P Nguyen⁶, Manh H Giap⁷, Tung D X Tran^{8

9}, Thu T M Pham^{1

10}, Khue M Pham¹, Kien T Nguyen¹¹, Vinh-Tuyen T Le^{12

13}, Chien-Tien Su^{14

15}, Tuyen Van Duong^{2

16}

Affiliations

¹ Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam.
² International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
³ Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.
⁴ Department of Pharmacy, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam.
⁵ Ph.D. Program in School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
⁶ Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
⁷ Emergency Department, Bai Chay Hospital, Hạ Long, Vietnam.
⁸ Stem Cell Unit, Van Hanh Hospital, Ho Chi Minh, Vietnam.
⁹ Hi-Tech Institute, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam.
¹⁰ School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
¹¹ Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi, Vietnam.
¹² Department of Pharmacognosy - Traditional Pharmacy - Pharmaceutical Botanic, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.
¹³ Ph.D. Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
¹⁴ School of Public Health, Taipei Medical University, Taipei, Taiwan.
¹⁵ Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
¹⁶ School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan.

Abstract

Background: Hypertension is a major cause of death and disability worldwide. Enhancing health literacy (HL) may help to alleviate the risk of hypertension and its burden. However, evidence on the association between HL and hypertension and potential mechanisms remain to be explored.

Objectives: This study examined the association between HL and hypertension; and explored whether body mass index (BMI), body fat percentage (PBF), and visceral fat (VF) were mediators of this association in people who resided in rural and suburban areas in Vietnam.

Methods: A cross-sectional survey was conducted from 1st July to 31st December 2019, involving 1655 residents and exploring participants' sociodemographic characteristics, HL, health-related behaviors, comorbidities, body composition, and blood pressure (BP). People with systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or using antihypertensive medication were classified as having hypertension. Multiple logistic regression and mediation analyses were used to explore associations.

Results: The hypertension prevalence was 41.9% (694/1,655). In adjusted models, a higher HL score was associated with a lower hypertension likelihood (OR = 0.96; 95%CI = 0.95-0.97; p < 0.001). Factors associated with a higher odd of hypertension were overweight/obese (OR = 1.69; 95%CI = 1.24-2.29; p = 0.001), high PBF (OR = 2.35; 95%CI = 1.85-2.99; p < 0.001), and high VF (OR = 2.27; 95%CI = 1.63-3.16; p < 0.001). Notably, PBF significantly mediated the association between HL and hypertension (indirect effect, OR = 0.99; 95%CI = 0.98-0.99; p = 0.009; percent mediated = 8.56%). The mediating roles of BMI and VF were not found.

Conclusion: The prevalence of hypertension was relatively high. People with better HL were less likely to have hypertension. The association between HL and hypertension was partially explained by PBF. Strategic approaches are required to improve people's HL and body fat which further help to manage hypertension in rural and suburban areas.

Keywords: body fat percentage; body mass index; health literacy; hypertension; rural people; visceral fat.