Healthy lifestyle index and its association with hypertension among community adults in Sri Lanka: A cross-sectional study

Autoři: Ami Fukunaga aff001;  Yosuke Inoue aff001;  Nadeeka Chandraratne aff002;  Miwa Yamaguchi aff001;  Keisuke Kuwahara aff001;  Susantha Indrawansa aff005;  Nalika Gunawardena aff006;  Tetsuya Mizoue aff001;  Diyanath Samarasinghe aff007
Působiště autorů: Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan aff001;  Management, Development & Planning Unit, Ministry of Health, Colombo, Sri Lanka aff002;  International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan aff003;  Graduate School of Public Health, Teikyo University, Tokyo, Japan aff004;  The Foundation for Health Promotion, Dehiwala, Sri Lanka aff005;  Office for Sri Lanka, World Health Organization Country, Colombo, Sri Lanka aff006;  Department of Psychological Medicine, University of Colombo, Colombo, Sri Lanka aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article



To investigate the association between a healthy lifestyle index (HLI) (i.e., a composite score comprising multiple lifestyle factors) and hypertension among community adults living in Sri Lanka.


The present study used baseline information of a cluster randomized controlled trial among 456 adults aged 27–65 years in a semi-urban community in Colombo, Sri Lanka. The HLI was constructed by summing a number of low-risk lifestyle factors: low body mass index, sufficient physical activity, non-smoking, low alcohol consumption, and sufficient fruit and vegetable consumption. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or the use of antihypertensive medication. A logistic regression model was used to investigate the association between the HLI (low: 0–2; middle: 3; high: 4–5) and hypertension.


A total of 178 (39%) participants were hypertensive. Compared with the low HLI group, multivariate-adjusted odds ratios (95% confidence intervals) of hypertension were 0.72 (0.44–1.19) and 0.28 (0.15–0.54) for the middle and high HLI groups, respectively (p-trend <0.001).


The present study provides essential evidence on an inverse association between adherence to healthy lifestyles and hypertension.

Klíčová slova:

Alcohol consumption – Blood pressure – Body Mass Index – diabetes mellitus – Hypertension – Physical activity – Rice – Schools


1. NCD Risk Factor Collaboration. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet. 2017;389(10064):37–55. doi: 10.1016/S0140-6736(16)31919-5 27863813

2. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–60. doi: 10.1016/S0140-6736(12)61766-8 23245609

3. World Health Organization. Noncommunicable diseases country profiles 2018. Available from:

4. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation. 2016;134(6):441–50. doi: 10.1161/CIRCULATIONAHA.115.018912 27502908

5. Sarki AM, Nduka CU, Stranges S, Kandala NB, Uthman OA. Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Medicine. 2015;94(50):e1959. doi: 10.1097/MD.0000000000001959 26683910

6. Basu S, Millett C. Social epidemiology of hypertension in middle-income countries: determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study. Hypertension. 2013;62(1):18–26. doi: 10.1161/HYPERTENSIONAHA.113.01374 23670299

7. Owolabi M, Olowoyo P, Miranda JJ, Akinyemi R, Feng W, Yaria J, et al. Gaps in Hypertension Guidelines in Low- and Middle-Income Versus High-Income Countries: A Systematic Review. Hypertension. 2016;68(6):1328–37. doi: 10.1161/HYPERTENSIONAHA.116.08290 27698059

8. Livingstone KM, McNaughton SA. A Health Behavior Score is Associated with Hypertension and Obesity Among Australian Adults. Obesity. 2017;25(9):1610–7. doi: 10.1002/oby.21911 28712161

9. Villegas R, Kearney PM, Perry IJ. The cumulative effect of core lifestyle behaviours on the prevalence of hypertension and dyslipidemia. BMC Public Health. 2008;8:210. doi: 10.1186/1471-2458-8-210 18554385

10. Nguyen B, Bauman A, Ding D. Association between lifestyle risk factors and incident hypertension among middle-aged and older Australians. Prev Med. 2019;118:73–80. doi: 10.1016/j.ypmed.2018.10.007 30316880

11. Cohen L, Curhan GC, Forman JP. Influence of age on the association between lifestyle factors and risk of hypertension. J Am Soc Hypertens. 2012;6(4):284–90. doi: 10.1016/j.jash.2012.06.002 22789880

12. Banda JA, Clouston K, Sui X, Hooker SP, Lee CD, Blair SN. Protective health factors and incident hypertension in men. Am J Hypertens. 2010;23(6):599–605. doi: 10.1038/ajh.2010.26 20224555

13. Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 2009;302(4):401–11. doi: 10.1001/jama.2009.1060 19622819

14. Noble N, Paul C, Turon H, Oldmeadow C. Which modifiable health risk behaviours are related? A systematic review of the clustering of Smoking, Nutrition, Alcohol and Physical activity ('SNAP') health risk factors. Prev Med. 2015;81:16–41. doi: 10.1016/j.ypmed.2015.07.003 26190368

15. Meader N, King K, Moe-Byrne T, Wright K, Graham H, Petticrew M, et al. A systematic review on the clustering and co-occurrence of multiple risk behaviours. BMC Public Health. 2016;16:657. doi: 10.1186/s12889-016-3373-6 27473458

16. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3–21. doi: 10.1111/j.1753-4887.2011.00456.x 22221213

17. World Bank. GDP (current US$). Available from:

18. Institute for Health Metrics and Evaluation. GBD Profile: Sri Lanka. Available from:

19. Katulanda P, Ranasinghe P, Jayawardena R, Constantine GR, Rezvi Sheriff MH, Matthews DR. The prevalence, predictors and associations of hypertension in Sri Lanka: a cross-sectional population based national survey. Clin Exp Hypertens. 2014;36(7):484–91. doi: 10.3109/10641963.2013.863321 24433043

20. Chandraratne N, Yamaguchi M, Indrawansa S, Gunawardena N, Kuwahara K, Islam Z, et al. The effect of youths as change agents on cardiovascular disease risk factors among adult neighbours: a cluster randomised controlled trial in Sri Lanka. BMC Public Health. 2019;19(1):893. doi: 10.1186/s12889-019-7142-1 31286931

21. Ministry of International and Home Affairs and Provincial Councils and Local Government. Grama Niladhari Divisions in Sri Lanka. Available from:

22. World Health Organization. Global Database on Body Mass Index. Available from:

23. World Health Organization. Global recommendations on physical activity for health. Available from:;sequence=1.

24. World Health Organization. WHO framework convention on tobacco control. Available from:

25. U.S. Department of Agriculture. Dietary guidelines for Americans 2015–2020.

26. Ministry of Health, World Health Organization. Food based dietary guidelines for Sri Lankans. Available from:

27. Andriolo V, Dietrich S, Knuppel S, Bernigau W, Boeing H. Traditional risk factors for essential hypertension: analysis of their specific combinations in the EPIC-Potsdam cohort. Sci Rep. 2019;9(1):1501. doi: 10.1038/s41598-019-38783-5 30728434

28. He FJ, MacGregor GA. Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2002;16(11):761–70. doi: 10.1038/sj.jhh.1001459 12444537

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