Habitual salt addition and self-reported cardiometabolic conditions among Saudi university students: a multi-region cross-sectional study.

BACKGROUND

Modifiable cardiometabolic risk factors include reported added salt, added sugar, and ultra-processed food (UPF) consumption. The combined dietary burden of UPF consumption and its associations with body mass index (BMI) and cardiometabolic disease remain unexamined among Saudi Arabian university students.

METHODS

This cross-sectional study included university students (N = 564) from four Saudi regions (March-May 2023). A validated semi-quantitative food frequency questionnaire assessed dietary exposure; a composite UPF score was derived from six NOVA-classified items. Multivariable linear regression examined diet-BMI associations; Firth-penalized logistic regression was pre-specified for the rare-event composite outcome (14 events; 2.5%) but did not converge to stable estimates; the reported disease association is therefore an unadjusted Fisher's exact test. The multivariable BMI regression was adjusted for age, sex, academic level, college type, region, marital status, physical activity level (low/moderate/high), and total sedentary screen-time index.

RESULTS

Mean BMI was 22.22 ± 4.04 kg/m2; 64.0% of the sample were of normal weight. Habitual salt addition was reported by 87.1% of participants; high reported added salt (≥1 teaspoon/day) by 19.0%; high added sugar (≥3 teaspoon/day) by 16.0%. No dietary exposure was associated with BMI after adjustment (all p > 0.05). High reported added salt was significantly associated with prevalent self-reported cardiometabolic conditions (odds ratio 3.29; 95% confidence interval 1.04-10.42; p = 0.043); added sugar and UPF tertile were not. A sodium-smoking interaction on BMI was non-significant in the fully adjusted model (likelihood ratio test p = 0.053) and was treated as exploratory.

CONCLUSION

This study provides the first multi-region evidence that high reported added salt was significantly associated with prevalent self-reported cardiometabolic conditions among Saudi university students despite a predominantly normal-weight profile. Given the small event count (n = 14) and cross-sectional design, these findings are exploratory only and do not support causal conclusions. Sodium reduction and salt literacy may warrant attention as NCD prevention strategies in this setting. Prospective studies with objective biomarkers are needed to establish causality.