high blood pressure is of major risk factors of preventable death with a dramatic rise in the prevalence in the last decade , even in young people ( 1 ) . adiposity has been established to be a risk factor for hypertension development ( 25 ) . people with elevated blood pressure showed high levels of body mass index ( bmi ) , waist circumference ( wc ) , skin - fold thickness ( sft ) and poor physical activity levels ( pal ) ( 6 ) . however , hypertension would not appear in all obese patients . differences in adiposity distribution may contribute to the heterogeneity dependent manifestations of obesity ( 7 , 8) . the bmi is a crude index of body fat mass ( bfm ) , which may not distinguish abdominal obesity from other types of obesity . abnormal fat distribution may exist in normal weight subjects with high blood pressure ( 9 ) . in some studies , wc as an indicator of abdominal obesity has been associated with hypertension independent of bmi ( 35 ) . however , some studies found bmi , wc and waist to hip ratio similar in degree of association with the prevalence of hypertension ( 3 , 10 ) and other reported bmi to be more predictive than wc and bfm ( 11 ) . other indexes , also , were tested in the relationship with blood pressure and metabolic disorders . as an example , a body shape index ( absi ) more associated with blood pressure than bmi or wc ( 12 , 13 ) . people who deposit fat viscerally rather than elsewhere in the body are at higher risk for hypertension ( 7 , 14 ) and alterations in the localization of body fat throughout life are associated with an increase in blood pressure ( 15 ) . on the contrary , a few studies reported the association of lean body mass ( lbm ) with blood pressure ( 2 , 16 ) . physical activity level and nutritional intakes , also , were associated with percent body fat ( 1719 ) and may interact with site - specific adipose tissue accumulation in controlling blood pressure . physical activity may play a role in decreasing blood pressure and cardiovascular disease by several mechanisms . however , hypertension remains the most prevalent cardiovascular risk factor among athletes ( 2022 ) and a relevant proportion of middle - aged athletes had masked hypertension ( 23 ) . since the relative contributions of the distribution of body composition to blood pressure in active young adults may be different from that in other populations , the purpose of this study was to determine which portion of the body composition , fat or lean body mass is more influencing blood pressure in physical education and sport teaching students in the city of ankara . this cross - sectional study was approved by the bioethical committee of the gazi university ( ankara , turkey ) . data was collected during the 2014 school year from physical education and sport teaching department in the city of ankara . the study population invited through announcements posted on the wall at the university and included self - referred 75 male and 58 female students , aged 20 to 35 . all students from fourth grade of four university degrees including physical education - sport teacher and trainer education with sport as compulsory course and degrees of sport management and recreation with sport as optional / elective course were invited to participate . the subject of the project was informed via declaration to invite students to participate in the voluntary measurements . permissions were collected in the form of written informed consent obtained from all students who participated in the study . the exclusion criteria were : 1 ) student refusal 2 ) preexisting medical conditions such severe hormonal abnormalities ( e.g. cushing s disease / syndrome ) ; diseases leading to swelling of subcutaneous tissues ; diseases leading to muscle wasting ; and metabolic bone diseases 3 ) taking medication that might affect body indexes 4 ) bmi>30 kg / m . forty - four were excluded due to the presence of the previously listed medical conditions , refusal or obesity . weight and height were measured by standard methods to the nearest 0.1 kg and 0.1 cm , respectively . bmi was calculated and later classified as under - weight ( bmi<18.5 kg / m2 ) , normal ( 18.5bmi<25 kg / m2 ) and overweight ( 25bmi<30 kg / m2 ) ( 24 ) . waist circumference was measured in a horizontal plane just between the iliac crest and costal margin of the lower rib to the nearest 0.1 cm ( seca201 ) . hip circumference was measured at the widest part over the buttocks to the nearest 0.1 cm . participants were classified according to cutoff point 90 for waist circumference . a body shape index ( absi ) was calculated as waist circumference/(bmi height ) with the cutoff point 40 ( 13 ) . wrist circumference was measured just distal to the styloid process at the wrist crease on the right arm using a tape measure . the formula r = height / wrist circumference was used to estimate body frame size . frame size was determined as small ( r>10.4 , 11.0 ) , medium ( r 9.610.4 , 10.111.0 ) and large ( r<9.6 , 10.1 ) respectively in males and females ( 24 ) . skinfold thickness was measured on the right side of the body at four sites ( biceps , triceps , subscapular , and suprailiac ) using holtain calipers ( holtain , crymych , uk ) to the nearest 0.1 cm . in all cases , two measurements were obtained and averaged ; with a third measurement taken if the first two differed by 0.1 cm . subscapular / triceps ratio ( str ) , an index of subcutaneous adipose tissue distribution ( central / peripheral ) , was also calculated . mid - arm circumference ( mac ) was measured to the nearest 0.1 cm between the acromion process of the scapula and the olecranon process at the tip of the elbow ( midpoint of the upper arm ) and mid - arm muscle circumference ( mamc ) was estimated combined mac with tsf measurements using standard methods ( 24 ) . body composition was assessed by leg - to - leg bioelectrical impedance analysis ( 25 ) with a tanita tbf-300ma body composition analyzer ( tanita corporation , tokyo , japan ) . bia measurements were done according to the manufacturer s guidelines at a frequency of 50 khz . fat mass index ( fmi ) calculated as fat mass / height and classified according the cutoff point of 8.2 in males and 11.8 in females ( 26 ) . basal metabolism rate ( bmr ) and bmr / kg body weight were estimated by the same instrument and according to bia derived body composition . then , grouping was done by percent body fat and sex ( 15% in men and 25% in women ) ( 24 ) . physical activity level was assessed by a validated questionnaire in which nine different metabolic equivalent ( met ) levels were ranged on a scale from sleep / rest ( 1 mets ) to high - intensity physical activities ( 7 mets ) ( 27 ) . participants were categorized into 3 groups as low , active and very active , according to the met values ( > 1.41.6 , > 1.61.9 and > 1.92.5 respectively ) ( 24 ) . usual dietary intake was obtained using a validated 52-item food frequency questionnaire ( ffq ) by trained dietitians and face - to - face interviews . participants were asked to report their dietary intake of foods based on questions with eight choices as follows : every meal , every day , 56 times a week , 34 times a week , 12 times a week , every 15 days , every month , rarely and never . dietary analysis of energy and macronutrients intake was done using a computer program bebis ( version 7.2 , pasific compony , istanbul , turkey ) . blood pressure ( bp ) was measured in the morning hours ( 8:30 am to 11:30 am ) by a trained expert . the subjects were advised to avoid tea , coffee , energy drinks , and physical exercises in the morning of the examination day until the measurements were taken . measurements were done after resting for at least 5 minutes in a sitting position two times ( with a 5-minute rest interval ) on the right arm using a mechanical sphygmomanometer ( model , spengler , france ) and the average of two bp measurements was calculated . pre - hypertension and hypertension were defined , respectively , as blood pressure 120 and/or 80 , and 140 and /or 90mmhg . all statistical analyses were performed by spss software version 20 ( spss inc . , chicago , il , usa ) and a p - value < 0.05 showed statistical significance . the normality of all variables was confirmed by kolmogorov - smirnov test ( p > 0.05 ) combined with normality plots . we used independent t test to compare body composition indexes , blood pressure , dietary intakes and physical activity level between two genders and all independent variables between two groups with normal and high blood pressure . the chi - square test was used to compare the distribution of high blood pressure , overweight and levels of physical activity between males and females abnormal bp by categorical bmi , wc , absi , bf% and fmi . to determine associated factors with systolic and diastolic blood pressure , at first , we used age adjusted linear regression for all individual variables . regression residual plots showed two outliers that after excluding them the assumptions of linear regression were confirmed . multivariable regression models were performed to test the association between independent variables and blood pressure , adjusting for age , bmi , wc and fat in - take . with the sample size of 133 ; a power value of 80% was generated . this cross - sectional study was approved by the bioethical committee of the gazi university ( ankara , turkey ) . data was collected during the 2014 school year from physical education and sport teaching department in the city of ankara . the study population invited through announcements posted on the wall at the university and included self - referred 75 male and 58 female students , aged 20 to 35 . all students from fourth grade of four university degrees including physical education - sport teacher and trainer education with sport as compulsory course and degrees of sport management and recreation with sport as optional / elective course were invited to participate . the subject of the project was informed via declaration to invite students to participate in the voluntary measurements . permissions were collected in the form of written informed consent obtained from all students who participated in the study . the exclusion criteria were : 1 ) student refusal 2 ) preexisting medical conditions such severe hormonal abnormalities ( e.g. cushing s disease / syndrome ) ; diseases leading to swelling of subcutaneous tissues ; diseases leading to muscle wasting ; and metabolic bone diseases 3 ) taking medication that might affect body indexes 4 ) bmi>30 kg / m . forty - four were excluded due to the presence of the previously listed medical conditions , refusal or obesity . weight and height were measured by standard methods to the nearest 0.1 kg and 0.1 cm , respectively . bmi was calculated and later classified as under - weight ( bmi<18.5 kg / m2 ) , normal ( 18.5bmi<25 kg / m2 ) and overweight ( 25bmi<30 kg / m2 ) ( 24 ) . waist circumference was measured in a horizontal plane just between the iliac crest and costal margin of the lower rib to the nearest 0.1 cm ( seca201 ) . hip circumference was measured at the widest part over the buttocks to the nearest 0.1 cm . participants were classified according to cutoff point 90 for waist circumference . a body shape index ( absi ) was calculated as waist circumference/(bmi height ) with the cutoff point 40 ( 13 ) . wrist circumference was measured just distal to the styloid process at the wrist crease on the right arm using a tape measure . the formula r = height / wrist circumference was used to estimate body frame size . frame size was determined as small ( r>10.4 , 11.0 ) , medium ( r 9.610.4 , 10.111.0 ) and large ( r<9.6 , 10.1 ) respectively in males and females ( 24 ) . skinfold thickness was measured on the right side of the body at four sites ( biceps , triceps , subscapular , and suprailiac ) using holtain calipers ( holtain , crymych , uk ) to the nearest 0.1 cm . in all cases , two measurements were obtained and averaged ; with a third measurement taken if the first two differed by 0.1 cm . subscapular / triceps ratio ( str ) , an index of subcutaneous adipose tissue distribution ( central / peripheral ) , was also calculated . mid - arm circumference ( mac ) was measured to the nearest 0.1 cm between the acromion process of the scapula and the olecranon process at the tip of the elbow ( midpoint of the upper arm ) and mid - arm muscle circumference ( mamc ) was estimated combined mac with tsf measurements using standard methods ( 24 ) . body composition was assessed by leg - to - leg bioelectrical impedance analysis ( 25 ) with a tanita tbf-300ma body composition analyzer ( tanita corporation , tokyo , japan ) . bia measurements were done according to the manufacturer s guidelines at a frequency of 50 khz . fat mass index ( fmi ) calculated as fat mass / height and classified according the cutoff point of 8.2 in males and 11.8 in females ( 26 ) . basal metabolism rate ( bmr ) and bmr / kg body weight were estimated by the same instrument and according to bia derived body composition . then , grouping was done by percent body fat and sex ( 15% in men and 25% in women ) ( 24 ) . physical activity level was assessed by a validated questionnaire in which nine different metabolic equivalent ( met ) levels were ranged on a scale from sleep / rest ( 1 mets ) to high - intensity physical activities ( 7 mets ) ( 27 ) . participants were categorized into 3 groups as low , active and very active , according to the met values ( > 1.41.6 , > 1.61.9 and > 1.92.5 respectively ) ( 24 ) . usual dietary intake was obtained using a validated 52-item food frequency questionnaire ( ffq ) by trained dietitians and face - to - face interviews . participants were asked to report their dietary intake of foods based on questions with eight choices as follows : every meal , every day , 56 times a week , 34 times a week , 12 times a week , every 15 days , every month , rarely and never . dietary analysis of energy and macronutrients intake was done using a computer program bebis ( version 7.2 , pasific compony , istanbul , turkey ) . blood pressure ( bp ) was measured in the morning hours ( 8:30 am to 11:30 am ) by a trained expert . the subjects were advised to avoid tea , coffee , energy drinks , and physical exercises in the morning of the examination day until the measurements were taken . measurements were done after resting for at least 5 minutes in a sitting position two times ( with a 5-minute rest interval ) on the right arm using a mechanical sphygmomanometer ( model , spengler , france ) and the average of two bp measurements was calculated . pre - hypertension and hypertension were defined , respectively , as blood pressure 120 and/or 80 , and 140 and /or 90mmhg . all statistical analyses were performed by spss software version 20 ( spss inc . , chicago , il , usa ) and a p - value < 0.05 showed statistical significance . the normality of all variables was confirmed by kolmogorov - smirnov test ( p > 0.05 ) combined with normality plots . we used independent t test to compare body composition indexes , blood pressure , dietary intakes and physical activity level between two genders and all independent variables between two groups with normal and high blood pressure . the chi - square test was used to compare the distribution of high blood pressure , overweight and levels of physical activity between males and females abnormal bp by categorical bmi , wc , absi , bf% and fmi . to determine associated factors with systolic and diastolic blood pressure , at first , we used age adjusted linear regression for all individual variables . regression residual plots showed two outliers that after excluding them the assumptions of linear regression were confirmed . multivariable regression models were performed to test the association between independent variables and blood pressure , adjusting for age , bmi , wc and fat in - take . with the sample size of 133 ; a power value of 80% was generated . overall , 133 ( response rate of 75.1% , 75 males and 58 females ) participants completed all measurements and the characteristics of them are presented in table 1 . the characteristics of anthropometric measurements and dietary intake in participants 
  bmi body mass index , absi a body shape index , wc waist circumference , hc hip circumference , ac arm circumference , mamc mid arm muscle circumference , biceps sft biceps skinfold thickness , triceps sft triceps skinfold thickness , sub scapular sft sub scapular skinfold thickness , supra iliac sft supra iliac skinfold thickness , sum of sft sum of skinfold thicknesses , bf body fat percent , lbm lean body mass , tbw total body water , fmi fat mass index , bmr basal metabolism rate , pal physical activity level , sbp systolic blood pressure , dbp diastolic blood pressure/ mean standard deviation and 1 , 2 and 3 quartiles/ p - value of independent t - test/ 95% ci confidence interval on the difference between mean distribution of categorical variables by genders has been shown in table 2 . the distribution of participants according to exercise course as compulsory or optional / elective and doing exercise as professional sport were not significant between two groups ( p=0.904 and p=0.635 respectively ) . distribution of categorical variables by genders sbp systolic blood pressure , dbp diastolic blood pressure , bp blood pressure ( definition by systolic and diastolic ) , bmi body mass index , pal physical activity level/ p - value for chi - square test for differences of distribution between males and females comparing body composition indexes , dietary in - take and physical activity level between two groups categorized by normal and abnormal blood pressure showed statistical significant differences in neither males nor females ( data not shown ) . chi - square test for comparing the distribution of abnormal blood pressures by categorical bmi , wc , absi , bf% and fmi showed that the prevalence of abnormal bp especially sbp is higher in overweight persons ( p=0.005 and 0.002 , respectively ) ( table 3 ) . an increase in the mean sbp was associated with an increase in daily calorie ( = 0.19 , p = 0.029 ) , protein ( = 0.19 , p = 0.027 ) , fat ( = 0.22 , p = 0.011 ) , fat / kg body weight ( = 0.19 , p = 0.029 ) and dbp was associated with fat ( = 0.14 , p = 0.040 ) intake . however , in each group , no associations were seen between dietary components and blood pressure ( table 4 ) . distribution as number ( % ) of abnormal bp by categorical bmi , wc , absi , bf% and fmi 

 * 
  bmi body mass index , wc waist circumference , absi a body shape index , bf% body fat percent , fmi fat mass index , bmr basal metabolism rate/ p - value for chi - square test for differences of distribution of abnormal bp by categorical bmi , wc , absi , bf% and fmi/ p - value for fisher s exact test age adjusted calorie and macronutrient intake association with bp 

 * 
  regression r - squared ,  standardized beta coefficient , se standard error of the regression , p - value of linear regression , ci confidence interval for beta/ no significant difference within both genders furthermore , after adjustment for calorie intake , the association between systolic blood pressure and dietary macronutrients were disappeared . age adjusted association of anthropometric measurements and body composition with sbp and dbp were shown in table 56 . age adjusted association of anthropometric measurements and body composition with sbp bmi body mass index , wc waist circumference , hc hip circumference , ac arm circumference , mamc mid arm muscle circumference , biceps sft biceps skinfold thickness , triceps sft triceps skinfold thickness , sub scapular sft sub scapular skinfold thickness , supra iliac sft supra iliac skinfold thickness , sum of sft sum of skinfold thicknesses , bmr basal metabolism rate bf body fat , lbm lean body mass , absi a body shape index , fmi fat mass index/ regression r - squared ,  standardized beta coefficient , se standard error of the regression , p - value of linear regression , ci confidence interval for beta/ no significant difference within both genders age adjusted association of anthropometric measurements and body composition with dbp bmi body mass index , wc waist circumference , hc hip circumference , ac arm circumference , mamc mid arm muscle circumference , biceps sft biceps skinfold thickness , triceps sft triceps skinfold thickness , sub scapular sft sub scapular skinfold thickness , supra iliac sft supra iliac skin - fold thickness , sum of sft sum of skinfold thicknesses , bmr basal metabolism rate bf body fat , lbm lean body mass , absi a body shape index , fmi fat mass index/ regression r - squared ,  standardized beta coefficient , se standard error of the regression , p - value of linear regression , ci confidence interval for beta/ no significant difference within both genders . in addition , independent t test showed significant difference only in the cases arm circumference ( p=0.040 ) , mamc ( p=0.008 ) , bmr ( p=0.029 ) and , lbm ( p=0.014 ) between the two groups with normal and abnormal bp ( data not shown ) . because the variables identified to associate with blood pressure ( mamc , bmr , lbm , calorie , protein and fat intake ) showed a strong significant correlation with each other ( r>0.8 p<0.001 ) and considering these variables as cause and effect according to the studies reported the association of bmi , wc and fm with blood pressure , multivariate regression models were done for those variables ( table 7 ) . when adjusted for age , bmi and wc ( m1 ) , mamc , bmr , lbm but not calorie intake were associated with sbp and dbp . after additional adjustment for fat intake / kg body weight ( m2 ) , mamc , bmr and lbm maintained positive correlations with sbp . adjusted correlation of obesity - related indexes with blood pressure mamc , mid arm muscle circumference ; bmr , basal metabolism rate ; ffm , fat free mass ; m1 , adjustment for age , bmi and wc ; m2 , adjustment for dietary fat intake / kg body weight in addition to m1 overall , 133 ( response rate of 75.1% , 75 males and 58 females ) participants completed all measurements and the characteristics of them are presented in table 1 . the characteristics of anthropometric measurements and dietary intake in participants 
  bmi body mass index , absi a body shape index , wc waist circumference , hc hip circumference , ac arm circumference , mamc mid arm muscle circumference , biceps sft biceps skinfold thickness , triceps sft triceps skinfold thickness , sub scapular sft sub scapular skinfold thickness , supra iliac sft supra iliac skinfold thickness , sum of sft sum of skinfold thicknesses , bf body fat percent , lbm lean body mass , tbw total body water , fmi fat mass index , bmr basal metabolism rate , pal physical activity level , sbp systolic blood pressure , dbp diastolic blood pressure/ mean standard deviation and 1 , 2 and 3 quartiles/ p - value of independent t - test/ 95% ci confidence interval on the difference between mean distribution of categorical variables by genders has been shown in table 2 . the distribution of participants according to exercise course as compulsory or optional / elective and doing exercise as professional sport were not significant between two groups ( p=0.904 and p=0.635 respectively ) . distribution of categorical variables by genders sbp systolic blood pressure , dbp diastolic blood pressure , bp blood pressure ( definition by systolic and diastolic ) , bmi body mass index , pal physical activity level/ p - value for chi - square test for differences of distribution between males and females comparing body composition indexes , dietary in - take and physical activity level between two groups categorized by normal and abnormal blood pressure showed statistical significant differences in neither males nor females ( data not shown ) . chi - square test for comparing the distribution of abnormal blood pressures by categorical bmi , wc , absi , bf% and fmi showed that the prevalence of abnormal bp especially sbp is higher in overweight persons ( p=0.005 and 0.002 , respectively ) ( table 3 ) . an increase in the mean sbp was associated with an increase in daily calorie ( = 0.19 , p = 0.029 ) , protein ( = 0.19 , p = 0.027 ) , fat ( = 0.22 , p = 0.011 ) , fat / kg body weight ( = 0.19 , p = 0.029 ) and dbp was associated with fat ( = 0.14 , p = 0.040 ) intake . however , in each group , no associations were seen between dietary components and blood pressure ( table 4 ) . distribution as number ( % ) of abnormal bp by categorical bmi , wc , absi , bf% and fmi 

 * 
  bmi body mass index , wc waist circumference , absi a body shape index , bf% body fat percent , fmi fat mass index , bmr basal metabolism rate/ p - value for chi - square test for differences of distribution of abnormal bp by categorical bmi , wc , absi , bf% and fmi/ p - value for fisher s exact test age adjusted calorie and macronutrient intake association with bp 

 * 
  regression r - squared ,  standardized beta coefficient , se standard error of the regression , p - value of linear regression , ci confidence interval for beta/ no significant difference within both genders furthermore , after adjustment for calorie intake , the association between systolic blood pressure and dietary macronutrients were disappeared . age adjusted association of anthropometric measurements and body composition with sbp and dbp were shown in table 56 . age adjusted association of anthropometric measurements and body composition with sbp bmi body mass index , wc waist circumference , hc hip circumference , ac arm circumference , mamc mid arm muscle circumference , biceps sft biceps skinfold thickness , triceps sft triceps skinfold thickness , sub scapular sft sub scapular skinfold thickness , supra iliac sft supra iliac skinfold thickness , sum of sft sum of skinfold thicknesses , bmr basal metabolism rate bf body fat , lbm lean body mass , absi a body shape index , fmi fat mass index/ regression r - squared ,  standardized beta coefficient , se standard error of the regression , p - value of linear regression , ci confidence interval for beta/ no significant difference within both genders age adjusted association of anthropometric measurements and body composition with dbp bmi body mass index , wc waist circumference , hc hip circumference , ac arm circumference , mamc mid arm muscle circumference , biceps sft biceps skinfold thickness , triceps sft triceps skinfold thickness , sub scapular sft sub scapular skinfold thickness , supra iliac sft supra iliac skin - fold thickness , sum of sft sum of skinfold thicknesses , bmr basal metabolism rate bf body fat , lbm lean body mass , absi a body shape index , fmi fat mass index/ regression r - squared ,  standardized beta coefficient , se standard error of the regression , p - value of linear regression , ci confidence interval for beta/ no significant difference within both genders . in addition , independent t test showed significant difference only in the cases arm circumference ( p=0.040 ) , mamc ( p=0.008 ) , bmr ( p=0.029 ) and , lbm ( p=0.014 ) between the two groups with normal and abnormal bp ( data not shown ) . because the variables identified to associate with blood pressure ( mamc , bmr , lbm , calorie , protein and fat intake ) showed a strong significant correlation with each other ( r>0.8 p<0.001 ) and considering these variables as cause and effect according to the studies reported the association of bmi , wc and fm with blood pressure , multivariate regression models were done for those variables ( table 7 ) . when adjusted for age , bmi and wc ( m1 ) , mamc , bmr , lbm but not calorie intake were associated with sbp and dbp . after additional adjustment for fat intake / kg body weight ( m2 ) , mamc , bmr and lbm maintained positive correlations with sbp . adjusted correlation of obesity - related indexes with blood pressure mamc , mid arm muscle circumference ; bmr , basal metabolism rate ; ffm , fat free mass ; m1 , adjustment for age , bmi and wc ; m2 , adjustment for dietary fat intake / kg body weight in addition to m1 the main finding of this study is that although bmi is associated with abnormal bp , lbm may be a more determinant factor linearly associated with bp in people with studied profile . whereas no relationship was found between bp and other anthropometric or body composition indexes especially the distribution of body fat and wc , which have , been reported in other studies . the prevalence of pre - hypertension and hypertension was significantly higher in males ( 41.3% and 9.3% in males vs. 20.7% and 6.9% in females , respectively ) . sbp and dbp were significantly higher in males than females ; that is consistent with other studies ( 11 ) . in a systematic review , the prevalence of high blood pressure varied from 0% to 45% in different elite athletes ( 28 ) and masked hypertension has been reported in 38% of male runners ( 23 ) . despite the established association between adiposity and hypertension development ( 5 , 11 , 12 , 2931 ) , we were unable to show a linear association between bmi and bp . the prevalence of abnormal bp in over - weight participants was higher than in normal ( 73.7% vs. 39.5% ) that is consistent with other studies ( 6 , 11 ) . however , both sbp and dbp were higher in overweight compared to normal - weight groups ; this did not reach to significant levels about dbp . on the other hand , people with elevated bp may have high levels of bmi , wc , and sft ( 6 ) which were not seen in the present study . the association of bp with bmi , wc and bf% has been reported previously ( 11 , 12 , 2931 ) . some studies reported bmi , wc and whr similar in degree of association with the prevalence of hypertension ( 3 , 10 ) ; whereas some others as bmi more significant than wc and fm ( 11 , 31 ) . a study showed absi as a better predictor of bp than bmi or wc ( 12 ) and a survey the absi less associated with incident hypertension than waist circumference and bmi ( 29 ) . the inconsistency in the results of studies may be due to e.g. the bmi is a crude index of weight for height and does not distinguish the distribution of fat in the body or lbm from fm ( 3 ) or wc may not be in all cases an appropriate surrogate for visceral fat ( 32 ) . no entry of obese people in this study may be of reasons making unable to show the relative association with obesity indexes . on the other hand , high bmi values associated with abnormal bp may be as likely to be because an individual has a high muscle - mass for their stature , the predictor seen in this study . the results of this paper agree with the findings of the few studies reported the association between lmb and bp . those studies have been reported bmi and lbm as significant predictors of sbp and dbp ( 2 , 16 ) with stronger positive correlation with the lbm index than that with fm index irrespective of gender ( 16 ) . it is possible in athletes , especially who emphasizes on building muscles , subcutaneous fat around the arm or other muscular sites would burn as a source of fuel for working muscles . this may make visceral fat , according to calorie intake , to remain or ever increase along with muscle enlargement ( 33 ) and lead to metabolic abnormalities ( 34 ) in spite of exercise or higher physical activity levels . in other words , under conditions of less subcutaneous adipose tissue , excess triglyceride may be stored in other depots , such as visceral adipose tissue , which may be more predictors of metabolic disorders ( 7 , 14 , 34 , 
 35 ) . furthermore , as the proportion of visceral fat increases , subcutaneous fat decreased ( 36 ) and may no longer be a good method of estimating body fat . thus , the ability to retain fat in the subcutaneous depot rather than visceral and hepatic fat may be beneficial , since it is associated with reduced metabolic disorders ( 36 ) . another possibility of a relationship between lbm and bp may be related to training induced left ventricular hypertrophy ( lvh ) ( 37 ) . exercise affected androgen synthesis ( 38 ) may contribute to increase lbm including heart muscle mass ( 39 ) in athletes . as , a significant negative association was shown between sbp and body fm in girls ( 16 ) which attributed to the protective effect of estrogens on blood pressure ( 40 , 41 ) . on the contrary , androgens appear to be vasoconstriction and cause cardiac hypertrophy ( 42 , 43 ) . furthermore , high bp may be associated with lvh ( 28 , 44 ) or a higher left ventricular mass / volume ratio ( 23 ) . in other words , lbm or mamc in this population may be indirect indicators of heart muscle mass and heart pumping power . on the relationship between dietary intakes and bp , sbp was associated with daily calorie intake and dbp was associated with fat intake . the beneficial effects of low fat diet on both sbp and dbp have been reported earlier ( 45 ) . people on low fat diet have lower bp , and the benefit was attributed to a more favorable lipid profile ( 4648 ) . it seems that , according the present study , high calorie and high fat intake may be determinants of abnormal sbp and dbp , respectively . as , lifestyle changes , including a combination of caloric restriction and exercise are performed to control bp levels in obese hypertensive patients ( 45 , 5052 ) . despite these findings , there are a number of limitations with the present study , e.g. the cutoffs for bf% with better properties for screening hypertension had been identified 20.4% for men and 34.1% for women ( 53 ) . in our study , percent body fat ranged from 5.1 to 25.5% and from 6.7 to 40.9% with the third tertile of 16.4% and 27.07% in males and females , respectively . lack of sample size above the identified cutoffs may be of causes not to show the relationship between body fat and blood pressure . unfortunately , we were unable to enroll all students in this study . therefore , voluntarily participating of invited subjects may have caused tending to miss some subjects with especial characteristics . this study confirms the association of bmi with abnormal bp , but lbm may be a more determinant factor for abnormal bp in active non - obese young adults . lbm or mamc may be indirect indicators of heart muscle mass and heart pumping power , which affects bp . the association of bmi with high blood pressure may not always be due to body fat mass but also to lbm especially in athletes or who do exercise . thus , considering the characteristics of the target population and identifying major risk factors of abnormal bp would be important in prevention and treatment of hypertension . ethical issues ( including plagiarism , informed consent , misconduct , data fabrication and/or falsification , double publication and/or submission , redundancy , etc . ) have been completely observed by the authors .
background : the aim of this study was to assess the predictive capacity of body composition estimated by bioelectrical impedance analysis ( bia ) to identify abnormal blood pressure in physical education and sport teaching students in the city of ankara.methods:data for this cross - sectional study were obtained in the city of ankara in 2014 . 
 a total of 133 students aged 2035 yr participated in this study . 
 anthropometric measurements were measured . 
 body composition was assessed by bia . physical activity level ( pal ) and usual dietary intake were assessed . 
 pre - hypertension and hypertension were defined , respectively , as bp 120 and/or 80 , and 140 and /or 90 mmhg.results:more overweight students showed abnormal bp especially sbp ( p=0.005 and 0.002 , respectively ) . 
 age adjusted regression showed significant association between arm circumference ( = 0.176 , p 0.044 ) , mid arm muscle circumference ( mamc ) ( = 0.235 , p 0.007 ) , lean body mass ( lbm ) ( = 0.238 , p 0.006 ) , basal metabolism rate ( bmr ) ( = 0.219 , p 0.012 ) and sbp and , also , mamc ( = 0.201 , p 0.022 ) , lbm ( = 0.203 , p 0.021 ) , bmr ( = 0.189 , p 0.030 ) and dbp . fat intake was associated with dbp ( = 0.14 , p = 0.040 ) . 
 multivariate regression models adjusted for age , bmi , wc and fat intake / kg body weight showed positive association of sbp with mamc , bmr and lbm ( p<0.05).conclusion : the relationship between blood pressure and body composition in young adults may be associated to lbm and mamc . 
 lbm or mamc in this population may be indirect indicators of heart muscle mass and heart pumping power .