Association Between Dietary Patterns, Physical Activity, and BMI with Hypertension Among Rural Indonesian Farmers: A Cross Sectional Study Using a Nutritional Ecology Perspective
Abstract
Introduction: Hypertension is a major non-communicable disease with a high prevalence in Indonesia, particularly in rural areas. Although farmers are generally engaged in physical labor, lifestyle factors such as unhealthy dietary patterns and poor nutritional status may contribute to elevated blood pressure. The existing literature has yet to fully integrate dietary patterns, physical activity, and BMI within a nutritional ecology framework to understand hypertension among rural farming populations; this study addresses that gap.This study aimed to analyze the association between dietary patterns, physical activity, and Body Mass Index/BMI (nutritional status) with hypertension among farmers in Kanreapia Village, Indonesia.
Methods: A cross-sectional study was conducted involving 908 farmers aged 35–59 years, selected through simple random sampling. Data were collected via structured interviews and measurements of blood pressure and anthropometry. Data analysis included univariate, bivariate (Chi-Square test), and multivariate analysis using logistic regression.
Results: The prevalence of hypertension among respondents was 51.2%. Bivariate analysis showed significant associations between age, smoking habits, risky dietary patterns (such as consumption of salty foods, grilled foods, processed meats, and instant noodles), and BMI with hypertension (p< 0.05). However, multivariate analysis identified only nutritional status (BMI) as significantly associated with hypertension (p < 0.001; OR = 0.41; CI: 0.508–0.809). Other variables were not statistically significant, including salty food consumption (OR = 0.999; CI: 0.758–1.316), grilled foods (OR = 0.963; CI: 0.613–1.514), processed meat/chicken/fish with preservatives (OR = 1.202; CI: 0.774–1.866), instant foods (OR = 0.957; CI: 0.729–1.255), and fruit consumption as a fiber source (OR = 1.124; CI: 0.847–1.491).
Conclusion: Nutritional status is the main determinant of hypertension among farmers, even though risky dietary patterns and physical activity showed significant associations in bivariate analysis. Public health interventions focusing on weight management and nutrition education are essential to reduce hypertension risk in rural farming communities.
Downloads
References
- World Health Organization. (2023). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension
- Badan Penelitian dan Pengembangan Kesehatan. (2018). Laporan Nasional Riset Kesehatan Dasar (Riskesdas) 2018. Kementerian Kesehatan Republik Indonesia. https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/
- Kementerian Kesehatan Republik Indonesia. (2023). Laporan SKI 2023 dalam Angka. Kementerian Kesehatan Republik Indonesia. https://www.badankebijakan.kemkes.go.id/ski-2023-dalam-angka/
- Rust P, Ekmekcioglu C. Impact of Salt Intake on the Pathogenesis and Treatment of Hypertension. Adv Exp Med Biol. 2017;956:61-84. doi: 10.1007/5584_2016_147. PMID: 27757935. https://doi.org/10.1007/5584_2016_147
- Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R, Dominiczak AF, Grassi G, Jordan J, Poulter NR, Rodgers A, Whelton PK. Hypertension. Nat Rev Dis Primers. 2018 Mar 22;4:18014. doi: 10.1038/nrdp.2018.14. PMID: 29565029; PMCID: PMC6477925. https://doi.org/10.1038/nrdp.2018.14
- Dun Q, Xu W, Fu M, Wu N, Moore JB, Yu T, Li X, Du Y, Zhang B, Wang Q, Duan Y, Meng Z, Tian S, Zou Y. Physical Activity, Obesity, and Hypertension among Adults in a Rapidly Urbanised City. Int J Hypertens. 2021 Aug 11;2021:9982562. doi: 10.1155/2021/9982562. PMID: 34422409; PMCID: PMC8376427. https://doi.org/10.1155/2021/9982562
- Al Thani, M., Al Thani, A. A., Al-Chetachi, W., Al Malki, B., Khalifa, S. A. H., Bakri, A. H., Hwalla, N., Nasreddine, L., & Naja, F. (2015). Lifestyle Patterns Are Associated with Elevated Blood Pressure among Qatari Women of Reproductive Age: A Cross-Sectional National Study. Nutrients, 7(9), 7593-7615. https://doi.org/10.3390/nu7095355
- Huang B, Xiao T, Grekousis G, Zhao H, He J, Dong G, Liu Y. Greenness-air pollution-physical activity-hypertension association among middle-aged and older adults: Evidence from urban and rural China. Environ Res. 2021 Apr;195:110836. doi: 10.1016/j.envres.2021.110836. Epub 2021 Feb 4. PMID: 33549617. https://doi.org/10.1016/j.envres.2021.110836
- Shen X, Li K, Chen P, Feng R, Liang H, Tong G, Chen J, Chai J, Shi Y, Xie S, Wang D. Associations of blood pressure with common factors among left-behind farmers in rural China: a cross-sectional study using quantile regression analysis. Medicine (Baltimore). 2015 Jan;94(2):e142. doi: 10.1097/MD.0000000000000142. PMID: 25590833; PMCID: PMC4602542. https://doi.org/10.1097/md.0000000000000142
- Prihartono NA, Fitria L, Ramdhan DH, Fitriyani F, Fauzia S, Woskie S. Determinants of Hypertension amongst Rice Farmers in West Java, Indonesia. Int J Environ Res Public Health. 2022 Jan 20;19(3):1152. doi: 10.3390/ijerph19031152. PMID: 35162176; PMCID: PMC8834778. https://doi.org/10.3390/ijerph19031152
- Sims, L. S., & Smiciklas?Wright, H. (1978). An ecological systems perspective: Its application to nutrition policy, program design and evaluation. Ecology of Food and Nutrition, 7(3), 173–179. Received 01 Jun 1978, Published online: 31 Aug 2010. https://doi.org/10.1080/03670244.1978.9990527
- Li, S., Liang, X., & Yao, T. (2022). Association Between Dietary Patterns and the Risk of Hypertension Among General Population in China and America. Highlights in Science, Engineering and Technology, 2, 72–81. https://doi.org/10.54097/hset.v2i.557
- Zhao, D., Qi, Y., Zheng, Z., Wang, Y., Zhang, X. Y., Li, H. J., Liu, H. H., Zhang, X. T., Du, J., & Liu, J. (2011). Dietary factors associated with hypertension. Nature Reviews Cardiology, 8(8), 456–465. https://doi.org/10.1038/NRCARDIO.2011.75
- Cai, J., Sun, X., M, L., Luo, R., Wang, W., Wang, Z., Akkaif, M. A., & Li, H. (2024). Dietary factors in relation to hypertension: a mendelian randomization study. Journal of Health Population and Nutrition, 43(1). https://doi.org/10.1186/s41043-024-00575-7
- Li, F., Yang, W., Sun, S., He, W., Xu, S., Han, B., & Ma, M. (2024). Dietary factors and hypertension: A Mendelian randomization analysis. Food Science and Nutrition, 12, 2502–2510. https://doi.org/10.1002/fsn3.3931
- Reddy, K. S., & Katan, M. B. (2004). Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Public health nutrition, 7(1a), 167-186. https://doi.org/10.1079/PHN2003587
- Lelong, H., Blacher, J., Baudry, J., Adriouch, S., Galan, P., Fezeu, L., Hercberg, S., & Kesse-Guyot, E. (2017). Individual and Combined Effects of Dietary Factors on Risk of Incident Hypertension: Prospective Analysis From the NutriNet-Santé Cohort. Hypertension, 70(4), 712–720. https://doi.org/10.1161/HYPERTENSIONAHA.117.09622
- Montes de Oca, P. V. (2019). Dietary Factors and Hypertension in Adult Women in France and Mexico. https://tel.archives-ouvertes.fr/tel-02486209/document
- Sun, B., Shi, X., Wang, T., & Zhang, D. (2018). Exploration of the Association between Dietary Fiber Intake and Hypertension among U.S. Adults Using 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines: NHANES 2007?2014. Nutrients, 10(8), 1091. https://doi.org/10.3390/NU10081091
- Borgi, L., Muraki, I., Satija, A., Willett, W. C., Rimm, E. B., & Forman, J. P. (2016). Fruit and vegetable consumption and the incidence of hypertension in three prospective cohort studies. Hypertension, 67(2), 288–293. https://doi.org/10.1161/HYPERTENSIONAHA.115.06497
- Schutte, A. E. (2020). Fruit intake and reduced risk of hypertension: are there any forbidden fruits? European Journal of Preventive Cardiology, 27(1), 36–38. https://doi.org/10.1177/2047487319876767
- Hayes, P. S., Ferrara, A., Keating, A., McKnight, K., & O’Regan, A. (2022). Physical Activity and Hypertension. Reviews in Cardiovascular Medicine, 23(9), 302. https://doi.org/10.31083/j.rcm2309302
- Zhang, J., Rong, J., Hui, Z., & Yan, Y. (2024). The Association Between Daily Physical Activity and Risk of Hypertension in Middle-Aged and Older Adults: A Nationwide Cohort Study in China. Journal of Clinical and Nursing Research, 8(9), 83–92. https://doi.org/10.26689/jcnr.v8i9.8378
- Maharani, I., Saraswati, P. A. S., Artini, I. G. A., & Utama, A. A. G. E. S. (2024). The correlation between physical activity and hypertension in menopausal women. Physical Therapy Journal of Indonesia, 5(1), 86–90. https://doi.org/10.51559/ptji.v5i1.197
- Park, K. N., & Kim, S. (2022). Association between Hypertension and Physical Activity as Measured by Wearable Devices in Older Adults. 10(2), 13–18. https://doi.org/10.32337/kacpt.2022.10.2.13
- Angelina, C., Azmeila, S., Nasution, M. R., & Sitorus, M. S. (2024). The Relationship between Body Mass Index (BMI) and Degree of Hypertension in Hypertensive Patients. Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI), 6(3), 88–95. https://doi.org/10.32734/jetromi.v6i3.14965
- Inamdar, A. (2024). Correlation of body mass index (bmi) with systolic and diastolic blood pressure in rural indian patients. Journal of Hypertension. https://doi.org/10.1097/01.hjh.0001021788.95421.3f
- Gupta, R., Parray, A. A., Kothadia, R. J., Pulock, O. S., Pinky, S. D., Haider, S. S., Akonde, M., & Haider, M. R. (2024). The association between body mass index and abdominal obesity with hypertension among South Asian population: findings from nationally representative surveys. Clinical Hypertension, 30(1). https://doi.org/10.1186/s40885-023-00257-2
- Xiao, W., Han, P., Song, L., Yang, J., Zhou, L., Deng, X., Zheng, J., Lang, Y., Hai, Z., Zhao, Y., Chen, H., Zhang, W., Huang, H., & Sun, N. (2024). A Retrospective Study to Investigate the Relationship Between Body Mass Index and Hemodynamic Characteristics in Hypertensive Patients. Journal of Clinical Hypertension. https://doi.org/10.1111/jch.14946
- Dustan, H. P. (2009). Obesity and hypertension. Clinical Cardiology, 12. https://doi.org/10.1002/CLC.4960121313
- Cunha, C. L. P. (2023). Obesity-Induced Hypertension. Arq. Bras. Cardiol., 120(7), e20230391. https://dx.doi.org/10.36660/abc.20230391
Copyright (c) 2025 Media Publikasi Promosi Kesehatan Indonesia (MPPKI)

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.