1. Introduction
Advances in social, financial, and scientific fields have been related to diminished age-related mortality, accelerating world inhabitants growing older [
1]. The Kingdom of Saudi Arabia (KSA) mirrors this pattern: a 30-year enhance in life expectancy since 1960, reaching 76.4 years total in 2021, attributed to improved healthcare and residing circumstances [
2].
However, a vital analysis hole exists: whereas particular person life-style elements (bodily inactivity, poor weight-reduction plan, smoking, and weight problems) are recognized to be related to age-related illnesses, no examine has comprehensively examined the associations of those a number of life-style elements with multi-morbidity amongst Saudi Arabia’s quickly rising older grownup inhabitants. Population-level, context-specific information from the Arabian Gulf area addressing this hole are scarce.
Therefore, this examine’s goal is to look at the associations of particular person life-style elements with prevalent age-related morbidities in a big Saudi cohort, offering proof to information culturally acceptable preventive measures.
The WHO identifies 4 core NCD teams: cardiovascular illnesses (CVDs), cancers, persistent respiratory illnesses, and T2DM [
3]. Accordingly, we classify T2DM, COPD, and HTN (a CVD and main danger issue [
4]) as WHO core NCDs. CKD and OP usually are not WHO core NCDs. However, each are extremely prevalent amongst older Saudis, share the identical life-style danger elements, and contribute considerably to morbidity. CKD generally complicates T2DM and HTN, whereas OP will increase fracture danger. We due to this fact embody them as NCD-associated circumstances for a complete evaluation.
Aging includes physiological decline, which is related to elevated vulnerability to persistent illness [
5]. Saudi Arabia’s aged inhabitants aged 65 years and above is projected to proceed rising, reaching 18.4% of the whole inhabitants in 2050, accompanied by rising NCD prevalence, together with HTN, CVD, T2DM, OP, weight problems, bronchial asthma, kidney issues, most cancers, and metabolic syndrome [
6]. A latest cross-sectional examine reported that amongst Saudi adults aged 65 years and older, the prevalence of hypertension was 59.6%, diabetes was 52.8%, and excessive ldl cholesterol was 49.5% [
7].
Lifestyle elements—together with PA, weight-reduction plan, smoking, and physique mass—are established determinants of persistent illness growth, morbidity, and mortality [
8]. In KSA, adults aged 30–70 face an 18.6% chance of untimely dying from NCDs resembling ischemic coronary heart illness, most cancers, T2DM, and persistent respiratory illnesses [
9]. Higher ranges of PA are related to decrease prevalence of age-related illnesses and higher high quality of life in growing older populations. Conversely, bodily inactivity is a significant public well being concern, significantly amongst older adults [
6]. In KSA, fast socioeconomic and concrete growth has been accompanied by shifts in life-style patterns [
10]; 66.6% of the inhabitants is bodily inactive, with the very best charges within the 55–64 age group [
6]. In 2019, inadequate PA was related to 4.8% of deaths and a pair of.6% of NCD-related disability-adjusted life-years nationally [
11].
In KSA, a multi-city examine discovered that 34.4% of members didn’t comply with a nutritious diet [
12], whereas just one.53% met all Ministry of Health meals group suggestions and 43.2% met none. This poor dietary compliance is related to Saudi Arabia’s excessive NCD prevalence, which accounts for 73% of nationwide mortality [
13].
Cigarette smoke is a well-established correlate of CVD, in addition to respiratory, and different systemic illnesses [
14]. In KSA, smoking prevalence ranges from 17.3% (at all times smoking) to 30.7% (lively people who smoke)—with larger charges amongst males—and is recognized as the most typical lifestyle-related issue related to NCDs [
15]. A examine in jap Saudi Arabia recognized smoking because the main CVD correlate (9.4%) [
16], alongside HTN (40.8%) and T2DM (39.6%) [
17].
KSA ranks 14th globally in weight problems prevalence at 35.4% [
18], although a latest survey reported 25.3% weight problems and 48.1% chubby within the Aseer area [
19]. Higher physique mass index (BMI) is related to higher prevalence of NCDs, together with T2DM (OR = 1.52), hypercholesterolemia (OR = 1.69), HTN (OR = 1.61), lung illnesses (OR = 1.69), rheumatoid arthritis (OR = 1.57), sleep apnea (OR = 1.82), colon illnesses (OR = 1.31), and thyroid issues (OR = 1.8) [
12].
While particular person associations between life-style elements (bodily inactivity, unhealthy weight-reduction plan, smoking, and weight problems) and age-related NCDs are nicely established, this investigation instantly addresses the recognized hole by analyzing these associations in a big Saudi cohort.
2. Materials and Methods
2.1. Study Design and Data Collection
This cross-sectional examine recruited 2877 Saudi residents aged ≥30 years throughout a number of provinces in KSA utilizing comfort sampling.
Data had been collected through a Google Forms questionnaire disseminated by way of social media (Facebook, WhatsApp, Twitter, Telegram), focused e mail campaigns to institutional staff, and in-person interviews at social and office settings. Participants had been inspired to share the survey inside their networks. Sociodemographic traits (intercourse, marital standing, training, occupation) had been recorded.
Participation was voluntary, nameless, and confidential. Non-residents, people residing outdoors KSA, these below 30, and incomplete responses had been excluded.
2.2. Questionnaire
This on-line questionnaire assessed life-style habits and age-related illnesses amongst people aged ≥30 years in Saudi Arabia, together with each genders. Prior to administration, a pilot examine with 25 members aged ≥30 was performed to: consider query readability and understandability, estimate completion time, establish potential points or ambiguities, and guarantee environment friendly questionnaire administration. Based on pilot suggestions, the questionnaire was refined to enhance readability and comprehension, with particular questions and reply choices modified. The ultimate Arabic model consisted of six sections and took roughly 10–15 min to finish. Participants acquired knowledgeable consent detailing the examine’s goals, inclusion standards, information confidentiality, and estimated completion time previous to starting.
The questionnaire comprised six sections: the primary part collected sociodemographic information (age, gender, nationality, marital standing, employment, training); the second part assessed PA utilizing a modified Arabic IPAQ Short Form (IPAQ-SF), which evaluated leisure-time actions (e.g., strolling, biking, swimming) by depth, frequency, and length over the earlier seven days to categorize members into exercise ranges (sedentary, low, reasonable, or excessive). The third part assessed dietary habits, together with portion sizes, meals frequency and variety, consumption of particular meals teams (fruits, greens, entire grains, dairy, meat, processed meals), snacking, and emotional consuming. The fourth part addressed anthropometric measurements and weight administration behaviors, gathering self-reported weight and top for BMI calculation, and inquiring about weight reduction willingness, dietary change intentions, and PA engagement. The fifth part assessed smoking habits (present, former, by no means people who smoke), together with tobacco kind, depth (cigarettes/day), and length for present people who smoke. The sixth part evaluated medical standing, together with diagnoses of T2DM, HTN, respiratory/renal circumstances and OP; frequency of latest blood sugar/Blood stress (BP) measurements; remedy use; musculoskeletal circumstances (joint ache, fractures, restricted motion, bone mineral density (BMD) measurement); and signs of respiratory/urinary circumstances (cough, shortness of breath, dysuria, polyuria, urolithiasis).
2.3. Study Variables
2.3.1. Physical Activity (PA)
PA was assessed utilizing the quick type of the IPAQ, which was developed by an International Consensus Group spearheaded by the WHO. The IPAQ has demonstrated acceptable test-retest reliability and reasonable correlation with goal exercise measures in grownup populations. Participants reported the frequency (days per week) and length (minutes per day) of strolling, moderate-intensity, and vigorous-intensity exercise. Participants had been categorized as bodily lively in the event that they engaged in at the very least 150 min of moderate-intensity exercise, or 75 min of vigorous-intensity exercise, or an equal mixture per week. Those not assembly this threshold had been categorized as bodily inactive. This binary classification aligns with public well being pointers defining a minimal threshold for well being advantages, facilitates easy interpretation, allows comparability with population-level surveillance information (e.g., WHO Global Action Plan on PA) [
20], and instantly identifies people failing to fulfill advisable exercise ranges—the first goal for life-style interventions.
2.3.2. Diet
Dietary habits had been assessed utilizing a 14-item meals frequency questionnaire capturing portion sizes, meals frequency, and variety throughout key meals teams (fruits, greens, entire grains, dairy, meat, processed meals, snacks, and emotional consuming behaviors). Responses had been transformed into every day or weekly consumption estimates. A weight-reduction plan high quality rating was calculated based mostly on the AHEI, a validated instrument for assessing dietary high quality. Each of the 11 elements was scored from 0 to 10, yielding a complete rating vary of 0–110.
Participants with a complete AHEI rating of ≥65 had been categorized as adhering to a nutritious diet, whereas these scoring <65 had been categorized as following an unhealthy weight-reduction plan. This binary classification is grounded in WHO dietary suggestions, aligns with world public well being targets, facilitates comparability with nationwide and worldwide surveillance information (e.g., the WHO Global Action Plan for the Prevention and Control of NCDs) [
3], and instantly identifies people failing to fulfill advisable dietary pointers—a key modifiable danger issue for persistent illnesses.
2.3.3. Smoking
Tobacco use was assessed utilizing standardized questions tailored from the WHO GATS. Participants had been requested: “Do you currently smoke any tobacco products, including cigarettes, waterpipe (shisha), cigars, or pipes, on a daily basis, less than daily, or not at all?”
Participants who responded “daily” had been categorized as people who smoke. Those who responded “less than daily” or “not at all” had been categorized as non-smokers. Former people who smoke (those that had smoked ≥100 tobacco merchandise of their lifetime however didn’t presently smoke) had been included within the non-smoker group until in any other case analyzed individually.
This binary classification captures routine every day tobacco publicity—the first driver of smoking-related well being dangers. It aligns with normal public well being surveillance definitions (e.g., the WHO STEPwise method and GATS) [
21], facilitates easy interpretation, allows comparability with nationwide and worldwide prevalence information, and instantly identifies people at elevated danger for tobacco-related illnesses.
2.3.4. Obesity
Classifying members based mostly on WHO BMI cutoffs (regular weight < 25 kg/m
2; chubby ≥ 25 to <30 kg/m
2; overweight ≥ 30 kg/m
2) offers a standardized, internationally acknowledged measure of weight problems. This categorization aligns with world public well being surveillance frameworks (e.g., WHO Obesity and Overweight Fact Sheet) [
22], allows direct comparability with nationwide and worldwide prevalence information, and facilitates scientific interpretation given the well-established dose-dependent relationship between elevated BMI and persistent illness danger. By distinguishing regular weight, chubby, and weight problems, this classification identifies subgroups at progressively larger danger for CVD, T2DM, and different obesity-related circumstances, thereby informing focused preventive and therapeutic interventions.
2.3.5. Data Quality Control
Participants with implausible BMI values (<12 or >60 kg/m2) or unrealistic PA experiences (>16 h/day) had been excluded from related analyses to cut back misclassification bias.
2.4. Classification of Outcome Variables
The WHO identifies 4 core NCD teams: CVD, cancers, persistent respiratory illnesses, and T2DM [
3]. We classify T2DM, COPD, and HTN (a CVD [
4]) as WHO core NCDs.
CKD and OP usually are not WHO core NCDs. However, each are extremely prevalent amongst older Saudis, share the identical life-style danger elements, and contribute considerably to morbidity. CKD generally complicates T2DM and HTN, whereas OP will increase fracture danger. We due to this fact embody them as NCD-associated circumstances.
2.5. Statistical Analysis
All statistical analyses had been carried out utilizing Microsoft Excel (model 16.0). Associations between categorical variables had been assessed utilizing the chi-square check. Descriptive statistics (prevalence percentages) had been calculated for every NCD throughout life-style issue classes (PA, weight-reduction plan, weight problems, smoking), age teams, and intercourse.
Chi-square assessments had been used to match illness prevalence throughout: PA (lively vs. inactive), weight-reduction plan (wholesome vs. unhealthy), smoking (smoker vs. non-smoker), weight problems (regular weight, chubby, overweight), age teams (30–40, 41–50, 51–60, >60 years) and intercourse (male vs. feminine)
For 2 × 2 comparisons, levels of freedom (df) = 1. For weight problems (3 classes), df = 2. For age teams (4 classes), df = 3. Statistical significance was set at p < 0.05.
3. Results
3.1. Lifestyle Profiles of the Study Participants
The examine discovered that 36.3% of members had been bodily lively versus 63.7% inactive; 17.1% had been people who smoke and 82.9% non-smokers. Body weight distribution confirmed 45.9% as regular weight, 31.4% chubby and 22.7% overweight. Regarding weight-reduction plan, 53.3% adhered to a nutritious diet whereas 46.7% adopted an unhealthy weight-reduction plan (
Table 1).
3.2. Classification of Outcome Variables
In this examine, we embody each WHO core NCDs (T2DM, COPD, and HTN) and NCD-associated circumstances (OP and CKD), which share widespread life-style danger elements [
3,
4]. The classification of every situation is indicated in
Table 2.
3.3. Prevalence of Age-Related Diseases by Age, Sex, and Lifestyle Factors
The prevalence of T2DM, HTN, OP, respiratory illnesses, and renal illnesses is offered total and by age, intercourse, PA, weight-reduction plan, weight problems, and smoking. OP was the most typical situation (22.0%), adopted by T2DM (21.8%). Disease prevalence was related to age and was constantly larger amongst bodily inactive members, these with unhealthy diets, and people who smoke. While weight problems was related to considerably larger prevalence of T2DM, HTN, respiratory illnesses, and renal illnesses, this gradient was not evident for OP (
Table 3).
3.4. Statistical Associations Between Lifestyle Factors, Age Groups, Sex, and NCDs (Chi-Square Tests)
Table 4 summarizes the chi-square check outcomes for all associations between life-style elements, age teams, intercourse, and NCDs.
PA was considerably related to T2DM (χ2 = 8.81, p = 0.003), HTN (χ2 = 7.41, p = 0.007), and OP (χ2 = 8.92, p = 0.003), however not with respiratory (p = 0.119) or renal circumstances (p = 0.427). Thus, bodily inactivity was considerably related to larger prevalence of T2DM, HTN, and OP in comparison with lively people.
Diet was considerably related to T2DM (χ2 = 11.36, p = 0.001), HTN (χ2 = 18.80, p < 0.001), and respiratory circumstances (χ2 = 9.55, p = 0.002), however not with OP (p = 0.791) or renal circumstances (p = 0.718). Thus, an unhealthy weight-reduction plan was related to larger prevalence of T2DM, HTN, and respiratory illnesses.
Smoking was considerably related to T2DM (χ2 = 6.20, p = 0.013), respiratory circumstances (χ2 = 19.57, p < 0.001), and renal circumstances (χ2 = 4.57, p = 0.033), however not with HTN (p = 0.215) or OP (p = 0.242). Thus, smoking was related to larger prevalence of T2DM, respiratory illnesses, and renal illnesses.
Obesity was considerably related to all circumstances besides OP (p = 0.905) and renal circumstances (p = 0.143). The strongest affiliation was noticed for T2DM (χ2 = 136.47, p < 0.001), the place larger BMI classes had been related to progressively larger prevalence (14.9% in regular weight, 20.8% in chubby, and 37.1% in overweight). Obesity was additionally considerably related to HTN (χ2 = 33.95, p < 0.001) and respiratory circumstances (χ2 = 21.42, p < 0.001). No vital associations had been noticed for OP (p = 0.905) or renal circumstances (p = 0.143).
Age teams had been considerably related to all circumstances besides respiratory circumstances (p = 0.058). The strongest age-related associations had been noticed for OP (χ2 = 148.63, p < 0.001) and HTN (χ2 = 35.99, p < 0.001).
Sex was considerably related solely with OP (χ2 = 5.01, p = 0.025), the place females had a better prevalence (23.4%) in comparison with males (19.7%). No vital intercourse variations had been noticed for T2DM (p = 0.374), HTN (p = 0.174), or renal circumstances (p = 0.740). Respiratory circumstances confirmed a borderline non-significant affiliation (p = 0.052), with larger prevalence in males (5.1% vs. 3.8%).
3.5. Type 2 Diabetes Mellitus
The examine discovered an total T2DM prevalence of 21.8%, rising with age: 18.5% (30–40 years), 20.8% (41–50), 23.8% (51–60), and 23.0% (>60) (χ
2 = 8.47,
p = 0.037). Prevalence was larger in females (22.3%) than males (20.9%), however this distinction was not statistically vital (χ
2 = 0.79,
p = 0.374). Prevalence was considerably decrease amongst bodily lively (18.8%) vs. inactive (23.5%) people (χ
2 = 8.81,
p = 0.003), and amongst these with wholesome diets (19.3%) vs. unhealthy diets (24.6%) (χ
2 = 11.36,
p = 0.001). Obesity was considerably related to larger prevalence (37.1% in overweight, 20.8% in chubby, 14.9% in normal-weight) (χ
2 = 136.47,
p < 0.001). Smoking was additionally considerably related to larger prevalence (26.6% in people who smoke vs. 21.1% in non-smokers) (χ
2 = 6.20,
p = 0.013) (
Figure 1 and
Table 3).
3.6. Hypertension
The examine discovered an total HTN prevalence of 13.4%, related to age: 7.2% (30–40 years), 11.4% (41–50), 15.8% (51–60), and 17.3% (>60) (χ
2 = 35.99,
p < 0.001). Prevalence was larger in ladies (14.0%) than males (12.2%), however this distinction was not statistically vital (χ
2 = 1.85,
p = 0.174). Prevalence was considerably decrease amongst bodily lively (11.1%) vs. inactive (14.6%) people (χ
2 = 7.41,
p = 0.007), and amongst these with wholesome diets (10.8%) vs. unhealthy diets (16.3%) (χ
2 = 18.80,
p < 0.001). Obesity was considerably related to larger prevalence (17.6% in overweight, 16.2% in chubby, 9.3% in normal-weight) (χ
2 = 33.95,
p < 0.001). Smoking was related to larger prevalence (15.3% in people who smoke vs. 13.1% in non-smokers), however this distinction was not statistically vital (χ
2 = 1.54,
p = 0.215) (
Figure 2 and
Table 3).
3.7. Osteoporosis
The examine revealed an total OP prevalence of twenty-two%, which was considerably related to age: 7.4% (30–40 years), 18.6% (41–50), 27.6% (51–60), and 30.3% (>60) (χ
2 = 148.63,
p < 0.001). Prevalence was considerably larger in females (23.4%) than males (19.7%) (χ
2 = 5.01,
p = 0.025). Prevalence was considerably decrease amongst bodily lively (19.0%) vs. inactive (23.8%) people (χ
2 = 8.92,
p = 0.003). The distinction by weight-reduction plan was minimal (21.9% nutritious diet vs. 22.2% unhealthy weight-reduction plan) and never statistically vital (χ
2 = 0.07,
p = 0.791). No vital affiliation was noticed with physique weight (21.8% regular, 22.0% chubby, 22.5% overweight) (χ
2 = 0.20,
p = 0.905). Smoking was related to barely larger prevalence (24.3% people who smoke vs. 21.7% non-smokers), however this distinction was not statistically vital (χ
2 = 1.37,
p = 0.242) (
Figure 3 and
Table 3).
3.8. Respiratory Conditions
Respiratory circumstances had an total prevalence of 4.3%, with prevalence various by age —2.6% (30–40 years), 3.8% (41–50), 4.9% (51–60), and 5.4% (>60)—however this affiliation was not statistically vital (χ
2 = 7.47,
p = 0.058). Prevalence was larger in males (5.1%) than females (3.8%), however this distinction was not statistically vital (χ
2 = 3.78,
p = 0.052, borderline). Prevalence was decrease amongst bodily lively (3.4%) vs. inactive (4.8%) people, however this distinction was not statistically vital (χ
2 = 2.43,
p = 0.119). Prevalence was considerably decrease amongst these with wholesome diets (3.2%) vs. unhealthy diets (5.5%) (χ
2 = 9.55,
p = 0.002). Obesity was considerably related to larger prevalence (6.7% overweight, 5.2% chubby, 2.4% normal-weight) (χ
2 = 21.42,
p < 0.001). Smoking was considerably related to larger prevalence (7.9% people who smoke vs. 3.7% non-smokers) (χ
2 = 19.57,
p < 0.001) (
Figure 4 and
Table 3).
3.9. Chronic Kidney Disease
The total prevalence of renal circumstances was 5.1%, considerably related to age from 2.4% (30–40 years) to 7.1% (>60 years) (χ
2 = 12.31,
p = 0.006). Prevalence was barely larger in females (5.2%) than males (4.9%), however this distinction was not statistically vital (χ
2 = 0.11,
p = 0.740). Prevalence was larger amongst bodily inactive (5.4% vs. 4.6%) individuals and people with unhealthy diets (5.4% vs. 4.8%), however these variations weren’t statistically vital (
p = 0.427 and
p = 0.718, respectively). Prevalence different by physique weight (4.3% regular, 5.3% chubby, 6.4% overweight), however this affiliation was not statistically vital (χ
2 = 3.89,
p = 0.143). Smoking was considerably related to larger prevalence (7.1% people who smoke vs. 4.8% non-smokers) (χ
2 = 4.57,
p = 0.033) (
Figure 5 and
Table 3).
4. Discussion
4.1. Type 2 Diabetes Mellitus (T2DM)
In this cohort, the general prevalence of T2DM was 21.8%, which aligns carefully with the nationally reported grownup prevalence of 23.7% [
23], suggesting our pattern is consultant of the broader Saudi inhabitants with respect to T2DM burden.
T2DM prevalence elevated progressively from 18.5% (age 30–40) to 23.8% (age 51–60) (χ
2 = 8.47,
p = 0.037). This age-related enhance is in line with well-established age-related physiological modifications together with insulin resistance and declining pancreatic operate, and prevalent vitamin D deficiency in KSA’s aged additionally impairs insulin sensitivity [
6,
24]. However, we noticed a plateau above age 60 (23.0%), which can mirror survivor bias or improved illness administration amongst older adults who’ve survived with T2DM. This plateau warrants additional investigation in longitudinal Saudi cohorts.
Contrary to earlier Saudi research reporting considerably larger T2DM prevalence amongst ladies attributed to higher weight problems charges (59.2% vs. 40.8%) [
25,
26], we discovered a modest distinction (22.3% in females vs. 20.9% in males) that was not statistically vital (χ
2 = 0.79,
p = 0.374). This narrower hole means that intercourse disparities in T2DM could also be diminishing in KSA, probably resulting from altering life-style patterns or improved healthcare entry for girls.
Inactive members had considerably larger T2DM prevalence (23.5%) than lively members (18.8%) (χ
2 = 8.81,
p = 0.003)—a 4.7 share level distinction. While this affiliation is anticipated [
27], the magnitude in our cohort is smaller than reported in some Western populations [
28,
29], doubtlessly resulting from residual confounding or measurement variations in PA classification. Nonetheless, our findings assist that selling PA amongst older Saudi adults may contribute to decrease T2DM prevalence.
An unhealthy weight-reduction plan was related to considerably larger T2DM prevalence (24.6% vs. 19.3% for a nutritious diet) (χ
2 = 11.36,
p = 0.001). This 5.3 share level distinction is clinically significant, although causality can’t be inferred. The excessive reported consumption of soppy drinks (67%) and vitality drinks (~30%) in KSA [
30] might partially clarify this affiliation, although we didn’t instantly assess particular dietary elements. Reverse causality is feasible: people recognized with T2DM might undertake more healthy diets, attenuating the noticed affiliation.
Obesity confirmed the strongest affiliation with T2DM in our cohort: prevalence was 37.1% amongst overweight members, in contrast with 20.8% amongst chubby and 14.9% amongst normal-weight people (χ
2 = 136.47,
p < 0.001). This gradient—a 22.2 share level distinction between overweight and normal-weight teams—is in line with earlier Saudi analysis demonstrating a robust affiliation between weight problems and T2DM [
31]. These findings spotlight weight administration as a precedence intervention goal on this inhabitants.
Smokers had considerably larger T2DM prevalence (26.6%) than non-smokers (21.1%) (χ
2 = 6.20,
p = 0.013). This 5.5 share level distinction aligns with established proof linking smoking to insulin resistance [
32,
33]. Given that smoking prevalence in KSA reveals marked gender disparity (males: 27.5%; ladies: 3.7%) [
34], the general affiliation we noticed could also be pushed predominantly by male members.
4.2. Hypertension
In this cohort, the general prevalence of HTN was 13.4%, which is decrease than the nationally reported pooled prevalence of twenty-two.7% [
35]. This discrepancy might mirror variations in case definition (self-reported analysis vs. measured blood stress) or age distribution, as undiagnosed HTN is widespread in Saudi Arabia.
HTN prevalence was considerably related to age: from 7.2% (age 30–40) to 17.3% (age > 60) (χ
2 = 35.99,
p < 0.001). This age-related enhance is in line with earlier Saudi experiences [
36,
37].
HTN prevalence was larger in females (14.0%) than males (12.2%), however this distinction was not statistically vital (χ
2 = 1.85,
p = 0.174). Previous Saudi research have reported that postmenopausal ladies have larger charges than males, in line with a examine that reported 13.78% in ladies vs. 8.5% in males [
38,
39]. Our discovering of a non-significant distinction might mirror {that a} substantial portion of our feminine members had been premenopausal, or that our pattern dimension was inadequate to detect a small intercourse distinction.
Inactive members had considerably larger HTN prevalence (14.6%) than lively members (11.1%) (χ
2 = 7.41,
p = 0.007). Previous Saudi information reported that 78.2% of hypertensive people have inadequate PA [
38]. Our findings verify an inverse affiliation between PA and HTN. However, because of the cross-sectional design, we can’t decide whether or not inactivity precedes HTN or whether or not people recognized with HTN turn into much less lively.
An unhealthy weight-reduction plan was related to considerably larger HTN prevalence (16.3% vs. 10.8% for nutritious diet) (χ
2 = 18.80,
p < 0.001). This discovering aligns with latest nationwide information that point out poor adherence to dietary pointers, with one 2025 examine reporting a median adherence rating of solely 26 out of 100 factors amongst Saudi adults [
40], and one other discovering that 56.1% of younger Saudi females confirmed low adherence to nationwide dietary suggestions [
41].
Obesity was considerably related to larger HTN prevalence (17.6% in overweight, 16.2% in chubby, 9.3% in normal-weight) (χ
2 = 33.95,
p < 0.001). Recent analysis reported that people with Class 3 weight problems (BMI ≥ 40 kg/m
2) had 2.60 instances the percentages of HTN in comparison with these with regular BMI [
42]. Notably, the rise from regular weight to chubby (9.3% to 16.2%) was steeper than from chubby to overweight (16.2% to 17.6%), suggesting that stopping the transition from regular weight to chubby could also be significantly vital for HTN prevention.
Smokers had larger HTN prevalence (15.3%) than non-smokers (13.1%), however this distinction was not statistically vital (χ
2 = 1.54,
p = 0.215). Recent analysis in KSA has confirmed that people who smoke exhibit larger blood stress readings, with heavy people who smoke exhibiting elevated systolic and diastolic ranges in comparison with non-smokers [
43]. The non-significant discovering in our examine might mirror our binary classification of smoking (which doesn’t seize depth or pack-years) or the low proportion of feminine people who smoke in our pattern.
4.3. Osteoporosis
In this cohort, the general prevalence of OP was 22.0%, which falls inside the vary reported in earlier Saudi research (23.4% to 39.5%) and is barely larger than the worldwide meta-analytic estimate of 18.3% [
44].
OP prevalence was considerably related to age: 7.4% (age 30–40) to 30.3% (age > 60) (χ
2 = 148.63,
p < 0.001). This robust age-related affiliation is in line with the earlier literature [
45].
In this cohort, OP prevalence was considerably larger in females (23.4%) than in males (19.7%) (χ
2 = 5.01,
p = 0.025). This feminine predominance is in line with younger females being at larger danger for OP resulting from low dairy consumption and sedentary habits [
41]. Females aged 50 years and older have a four-fold larger prevalence of OP and a two-fold larger prevalence of osteopenia than males [
44].
Physically lively members had considerably decrease OP prevalence (19.0%) than inactive members (23.8%) (χ
2 = 8.92,
p = 0.003). Previous Saudi analysis reported that PH is extra prevalent amongst people with OP (60.65%) than with out (39.32%) [
46]. Consistent bodily exercise can contribute to improved BMD [
45]. However, because of the cross-sectional design, we can’t decide whether or not bodily inactivity precedes OP or whether or not people with OP turn into much less lively resulting from ache or frailty.
The distinction in OP prevalence between a nutritious diet (21.9%) and an unhealthy weight-reduction plan (22.2%) was minimal and never statistically vital (χ
2 = 0.07,
p = 0.791). This discovering aligns with a latest 2025 meta-analysis, which reported that Western/unhealthful dietary patterns usually are not considerably related to OP danger (OR: 1.12; 95% CI: 0.78–1.62;
p > 0.05) [
47].
No vital affiliation was noticed between physique weight and OP prevalence: 21.8% in normal-weight, 22.0% in chubby, and 22.5% in overweight people (χ
2 = 0.20,
p = 0.905). This discovering contrasts with worldwide research reporting a protecting impact of upper BMI in opposition to OP, the place extra physique weight locations mechanical stress on the skeleton—thereby stimulating osteoblast exercise and rising BMD—reinforcing BMI as a protecting determinant of bone mass [
48]. The absence of an affiliation in our cohort might mirror that our members had been predominantly younger to middle-aged adults, or that the mechanical and hormonal results of weight problems on bone density are extra carefully linked to fracture danger than to the analysis of OP [
49].
Smokers had larger OP prevalence (24.3%) than non-smokers (21.7%), however this distinction was not statistically vital (χ
2 = 1.37,
p = 0.242). This non-significant discovering might mirror our binary classification of smoking (which doesn’t seize pack-years or length) or the low proportion of feminine people who smoke in our pattern. However, cigarette smoking is a significant life-style danger issue for bone well being, because it triggers mobile and molecular disruptions that trigger an imbalance in bone turnover, finally resulting in diminished bone mass, osteoporosis, and an elevated danger of fractures [
50].
4.4. Chronic Obstructive Pulmonary Disease (COPD)
In this cohort, the general prevalence of respiratory circumstances was 4.3%, which aligns carefully with the nationally reported prevalence of 4.2% for COPD amongst Saudi adults aged 40 years and older [
51].
Respiratory situation prevalence elevated with age from 2.6% (age 30–40) to five.4% (age > 60), however this affiliation was not statistically vital (χ
2 = 7.47,
p = 0.058, borderline). This age-related sample is in line with earlier Saudi experiences on COPD prevalence [
52].
Prevalence was larger in males (5.1%) than females (3.8%), however this distinction was not statistically vital (χ
2 = 3.78,
p = 0.052, borderline). This remark concurs with earlier Saudi research, which have decided that the prevalence of COPD within the inhabitants aged 40 years or older is bigger in males (5.7%) than in females (2.5%) [
51].
Physically lively members had decrease respiratory situation prevalence (3.4%) than inactive members (4.8%), however this distinction was not statistically vital (χ
2 = 2.43,
p = 0.119). However, a 2026 examine reported an inverse relationship between PA and COPD prevalence, discovering that inactive adults had a considerably larger prevalence (9.15%) than lively adults (3.50%) [
53].
Participants with wholesome diets had considerably decrease respiratory situation prevalence (3.2%) than these with unhealthy diets (5.5%) (χ
2 = 9.55,
p = 0.002). This discovering aligns with prior proof that means that adherence to a wholesome dietary sample can scale back the danger of lung impairment, whereas a Western-style (unhealthy) weight-reduction plan is related to a better danger of COPD [
54].
Obesity was considerably related to larger respiratory situation prevalence: 2.4% in normal-weight, 5.2% in chubby, and 6.7% in overweight people (χ
2 = 21.42,
p < 0.001). A Saudi examine reported that 71% of sufferers with COPD had been both chubby or overweight [
55]. Our findings verify a robust affiliation between weight problems and respiratory circumstances on this inhabitants.
Smoking was considerably related to larger respiratory situation prevalence: 7.9% in people who smoke vs. 3.7% in non-smokers (χ
2 = 19.57,
p < 0.001). This discovering is according to a considerable physique of proof wherein the persistent oxidative stress triggered by long-term cigarette smoke publicity is implicated within the growth of COPD [
14], together with in Saudi Arabia, the place COPD prevalence rose by 48.6% from 1990 to 2019, with smoking driving 44% of the illness burden, reinforcing the hyperlink between smoking and rising COPD charges [
56].
4.5. Chronic Kidney Disease (CKD)
In this cohort, the general prevalence of renal illness was 5.1%, which is decrease than the worldwide estimate of roughly 10% [
57]. This discrepancy might mirror that our renal illness variable captures recognized CKD solely, whereas many people with early-stage CKD stay undiagnosed.
Renal illness prevalence elevated considerably with age: from 2.4% (age 30–40) to 7.1% (age >60) (χ
2 = 12.31,
p = 0.006). The age-related rise in CKD is basically pushed by the rising prevalence of key danger elements resembling diabetes, HTN, weight problems, and CVD [
58].
Prevalence was barely larger in females (5.2%) than males (4.9%), however this distinction was not statistically vital (χ
2 = 0.11,
p = 0.740). This discovering aligns with a earlier examine that reported no vital sex-based variations with respect to illness length or related danger elements. However, in contrast with females, males have a 50% higher probability of illness development to end-stage renal illness (ESRD) [
58].
Inactive members had larger renal illness prevalence (5.4%) than lively members (4.6%), however this distinction was not statistically vital (χ
2 = 0.63,
p = 0.427). In distinction, a better degree of moderate-to-vigorous PA demonstrated an inverse affiliation with CKD danger, similar to a 38% decrease probability of creating the situation [
59]. Similarly, relative to mild PA, reasonable and vigorous exercise lowered the danger of incident CKD by 13% and 21%, respectively [
60].
Participants with unhealthy diets had larger renal illness prevalence (5.4%) than these with wholesome diets (4.8%), however this distinction was not statistically vital (χ
2 = 0.13,
p = 0.718). Nevertheless, regardless of this null discovering in our cohort, dietary modification is well known as a key safety measure and a cornerstone of therapeutic intervention for CKD [
60]. A latest meta-analysis, comprising six research with a complete of 568,213 members and 16,694 documented CKD circumstances, demonstrated a statistically vital inverse relationship between adherence to high-quality dietary patterns, particularly the Dietary Approaches to Stop HTN, and the danger of creating CKD [
61].
Renal illness prevalence related to physique weight (4.3% in normal-weight, 5.3% in chubby, 6.4% in overweight), however this affiliation was not statistically vital (χ
2 = 3.89,
p = 0.143). However, our findings align with a 2024 Saudi registry examine of 2912 CKD sufferers, which reported that 37% had been overweight and 25% had been chubby—reinforcing the well-established affiliation between weight problems and CKD, whereby weight problems triggers glomerular and tubular damage through inflammatory pathways, regardless of the non-significant affiliation noticed in our cohort [
62].
Smokers had considerably larger renal illness prevalence (7.1%) than non-smokers (4.8%) (χ
2 = 4.57,
p = 0.033). This discovering aligns with earlier analysis exhibiting that lively smoking is an unbiased danger issue for each the event of CKD and its accelerated development to ESKD. The poisonous results of smoking are nicely documented and contain each direct oxidative stress-mediated nephrotoxicity and oblique renal damage [
63]. Consistent with this, a Saudi examine reported that 33.3% of the CKD inhabitants are people who smoke [
62].
4.6. Strengths and Limitations
There are a number of limitations to this examine. While the cross-sectional design precludes causal inference, it offers a sensible method to estimate illness prevalence and establish related elements. The massive pattern dimension (n = 2877) and simultaneous evaluation of a number of NCDs and life-style elements are vital strengths.
Although self-reported information might introduce bias, this method enabled environment friendly information assortment utilizing validated devices (IPAQ, GATS) and stays essentially the most sensible methodology for assessing a number of life-style behaviors in population-based research.
Although comfort sampling through on-line platforms limits generalizability, it enabled environment friendly recruitment from a number of Saudi provinces. The consistency of our prevalence estimates with nationwide information (e.g., T2DM: 21.8% vs. 23.7%) suggests affordable representativeness regardless of sampling limitations.
Binary classification of life-style elements has limitations, together with lack of dose-response data. However, this method aligns with WHO pointers, allows comparability with surveillance information, and identifies intervention targets. All cutoffs had been based mostly on validated devices (IPAQ, AHEI, GATS) and acknowledged requirements.
Chi-square assessments had been acceptable for our categorical variables, permitting environment friendly testing of associations throughout 30 comparisons. The massive pattern dimension ensured secure estimates, whereas Microsoft Excel ensured transparency and reproducibility.
A significant limitation of this examine is the absence of multivariate logistic regression evaluation. Our chi-square assessments examined unadjusted associations solely and didn’t account for potential confounding elements resembling age, intercourse, and the overlap between life-style elements (e.g., smoking is extra prevalent in males; weight problems will increase with age). Therefore, we can’t decide whether or not the noticed associations are unbiased or pushed by confounders. We advocate that future research make use of multivariate logistic regression to verify the unbiased associations reported right here.