ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Epidemiology and Prevention
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1608648
Nonlinear association of a composite metabolic in dex (ZJU index) with hypertension: a cross-sectio nal study of NHANES 2003-2018
Provisionally accepted
- The First People's Hospital of Neijiang, Neijiang, China
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Objective: To explore the association between the composite metabolic index (ZJU index) and hypertension using data from the National Health and Nutrition Examination Survey (NHANES).Methods: NHANES data from 2003–2018 were analyzed. Participants were categorized into hypertension and non-hypertension groups. Logistic regression models evaluated the relationship between ZJU index and hypertension. Restricted cubic spline (RCS) and threshold effect analyses assessed nonlinear associations. Subgroup and interaction analyses tested robustness and heterogeneity. The predictive ability of the ZJU index across age groups was evaluated using receiver operating characteristic (ROC) curves.Results: After adjusting for covariates, each unit increase in ZJU index was associated with a 7% higher odds of hypertension (OR=1.07; 95% CI: 1.06–1.07). Participants with higher ZJU index values had significantly increased risk compared to the reference group (OR=3.73; 95% CI: 3.25–4.29). RCS analyses indicated a nonlinear positive association, with a threshold inflection point at 53.22. Subgroup analyses confirmed consistent associations across all subgroups, while significant interactions were observed for age, education, diabetes history, and smoking status (P < 0.05). The ZJU index showed moderate predictive ability in individuals under 60 years (AUC=0.691) and low predictive value in those aged 60 and above (AUC=0.604).Conclusions: An elevated ZJU index is significantly associated with increased hypertension risk among U.S. adults, with a nonlinear dose-response relationship observed.
Keywords: ZJU index, Hypertension, NHANES, risk, Cross-sectional study
Received: 09 Apr 2025; Accepted: 04 Jun 2025.
Copyright: © 2025 Gong, Chen, Chen, Fan and Luo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiao Chen, The First People's Hospital of Neijiang, Neijiang, China
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