A cross-sectional study was conducted from February to May 2024.

“Is there a correlation between anthropometric variation and body composition indices with hypertension among older adults in the West Bank of Palestine?”

The study recruited a convenience sampling of Palestinian adults from major public health centers in Nablus, Ramallah, and Hebron, representing the northern, central, and southern regions of the West Bank.

Participants were eligible if they were adults aged 60 years or older, did not use anticonvulsants, had no physical disorders affecting body measurements, and provided informed consent. Additionally, participants needed to stand independently on the body composition analyzer without mobility limitations. Moreover, participants with underlying conditions such as diabetes, chronic kidney disease, or cardiovascular diseases (conditions that can independently affect blood pressure) were excluded. Furthermore, Potential confounders such as diet, physical activity, and medication use were controlled.

A body composition analyzer (TANITA BC-418MA®) was used to measure body weight (kg), fat mass (kg), percentage of fat mass (%), and fat-free mass (kg) to the nearest 0.1 kg. This was done twice when participants were dressed in light clothing without shoes. All measurements were taken in the morning while participants were fasting, had emptied their bladder, and were wearing light clothing and no shoes. After entering the basic information (sex, age, height) of the participant, choose an appropriate model for ordinary people or athletes, and then the test begins.

Body measurements, including Height and Weight, Waist circumference (WC), and Hip circumference (HC) were measured. Trained technicians made all these measurements following the procedures established by the ISAK [19] . Barefoot height was measured using a wall-mounted stadiometer to the nearest 0.1 cm. WC measured with a tape measure at the midpoint between the last floating rib and the highest crest of the iliac. Hip circumference was measured at the widest part of the buttocks using a flexible tape measure. WHR ratio was calculated as a WC (cm) divided by HC (cm).

The increasing obesity rates in Palestine have been assessed through various national health surveys and studies employing standardized anthropometric measurements. A key method involves calculating the Body Mass Index (BMI), which is derived from an individual’s weight and height. According to the World Health Organization (WHO), a BMI of 25 or above classifies an individual as overweight, while a BMI of 30 or above indicates obesity.

Blood pressure was measured in the morning by trained clinical staff in a controlled clinic setting. The automated sphygmomanometer followed the recommendations of the European Heart Society (on the right arm in a semi-flexed position at heart level, with participants in a supine position and after 10 min of rest). Hypertension was defined according to the American Heart Association as systolic blood pressure (SBP) ≥ 130 mmHg and diastolic blood pressure (DBP) ≥ 80 mmHg, while normotension was defined as SBP < 120 mmHg and DBP < 80 mmHg [20] .

For all the analyses, descriptive statistics were done by (SPSS version 26. Chicago. IL, USA). P values < 0.05 were considered to be statistically significant. A partial correlation coefficient was used to evaluate the connection between anthropometric indices (BMI, WC, HC, and WHR) and systolic diastolic BP. A logistic regression model was used to assess the association between anthropometric indices and hypertension, adjusting for potential confounders such as age and sex. Comparisons of body composition variables across blood pressure categories (normal vs. hypertensive) were performed using t-test. Obesity levels were grouped into five body mass index categories (BMI < 18.50: underweight, BMI 18.50 - 24.9: normal weight, BMI 25.00 - 29.9: overweight, BMI ≥ 30: obese [4] .

Ethical Consideration

All participants were informed orally and voluntarily agreed to participate in the research. Approval of the research protocol was taken from the Palestine Ahliya University. Before data collection, each participant was informed that this interview and anthropometric measurements would be completely voluntary. No personally identifiable information was collected to maintain participant confidentiality, and there was no risk of participating in this study. Permission has been obtained from the Ministry of Health in Palestine.

Data were collected from 79 older adult participants. Their mean age was 68.28 ± 5.76 years. For anthropometric indicators, the mean height was 167.81 ± 9.83 m and weight 84.10 ± 16.79 kg. Their mean B.M.I. was 29.86 ± 5.56 kg/m². Nearly half of the participants were obese (49.4%) or overweight (27.8%). The mean waist circumference was 94.27 ± 10.04 cm, with a hip circumference being 95.96 ± 12.35 cm. Meanwhile, the mean waist-to-hip ratio was 0.99 ± 0.06. Systolic and diastolic blood pressure means hypertensive (135.46 ± 15.89 mmHg, 84.19 ± 7.47 mmHg, respectively), with almost a third (25.3%) having normal blood pressure ( Table 1 ).

All anthropometric measurements showed significant correlations with systolic and diastolic blood pressure (p < 0.01), except for the Waist-Hip Ratio (WHR) and systolic blood pressure, which exhibited a significant correlation at p < 0.05. These findings suggest that increased blood pressure is associated with increased anthropometric measurements ( Table 2 ).

WC = waist circumference; HC = hip circumference; BMI = body mass index; WHR = waist-to-hip ratio; SBP = systolic blood pressure; DBP = diastolic blood pressure. Hypertensive is where SBP ≥ 130 mmHg and DBP ≥ 80 mmHg; Normotensive is where SBP < 120 mmHg and DBP < 80 mmHg [20] .

WC = waist circumference; HC = hip circumference; BMI = body mass index; WHR = waist-to-hip ratio. ** Correlation is significant at the 0.01 level (2-tailed). * Correlation is significant at the 0.05 level (2-tailed).

An independent sample t-tests were conducted to compare anthropometric indices between hypertensive and normotensive participants. Significant differences were observed in all anthropometric measurements for hypertensive and normotensive participants. Hypertensive participants exhibited significantly higher values for BMI, waist circumference, and hip circumference compared to normotensive subjects (p < 0.001 for all comparisons), as seen in Table 3 .

WC = waist circumference; HC = hip circumference; BMI = body mass index; WHR = waist-to-hip ratio.

Logistic regression analysis was conducted to assess the effect of anthropometric measurements; there were no independent predictors of hypertension. The lack of significant predictors in the logistic regression analysis may be due to small sample size ( Table 4 ).

WC = waist circumference; HC = hip circumference; BMI = body mass index; WHR = waist-t hip ratio.

Based on these findings, public health initiatives should focus on targeted obesity prevention and hypertension screening programs. Implementing community-based lifestyle interventions, such as promoting physical activity, improving dietary habits through nutrition education, and reducing salt intake, could help address risk factors. Additionally, early screening for hypertension in high-risk groups, integrating anthropometric assessments in routine health check-ups, and increasing public awareness about obesity-related health risks would enhance prevention efforts. Furthermore, replication the study with large sample size of population and analyze whether the relationship between obesity and hypertension varies across different age groups and gender within the elderly population.