Associations between social network addiction, anxiety symptoms, and risk of metabolic syndrome in Peruvian adolescents—a cross-sectional study

Abstract

Background
The link between physical and mental health and screen time in adolescents has been the subject of scientific scrutiny in recent years. However, there are few studies that have evaluated the association between social network addiction (SNA) and metabolic risk in this population.

Objective
This study determined the association between SNA and anxiety symptoms with the risk of metabolic syndrome (MetS) in adolescents.

Methods
A cross-sectional study was conducted in Peruvian adolescents aged 12 to 18 years, who completed a Social Network Addiction Questionnaire and the Generalized Anxiety Disorder 2-item scale (GAD-2), between September and November 2022. A total of 903 participants were included in the study using a non-probability convenience sample. Sociodemographic and anthropometric data were also collected. Binary logistic regression was used to explore the association between SNA and anxiety symptoms with MetS in a cross-sectional analysis.

Results
Males were more likely to have MetS than females (OR = 1.133, p = 0.028). Participants who were 16 years of age or older and those with excess body weight were 2.166, p = 0.013 and 19.414, p < 0.001 times more likely to have MetS, respectively. Additionally, SNA (OR = 1.517, p = 0.016) and the presence of anxiety symptoms (OR = 2.596, p < 0.001) were associated with MetS.

Conclusion
Our findings suggest associations between SNA, anxiety symptoms, and MetS among youth. However, more studies are needed to better understand this association and to deepen the possible clinical and public health implications.

Full text

Frontiers in Public Health 01 frontiersin.org
Associations between social
network addiction, anxiety
symptoms, and risk of metabolic
syndrome in Peruvian
adolescents—a cross-sectional
study
JacksaintSaintila
1
*, SusanM.Oblitas-Guerrero
2,
GiovannaLarrain-Tavara
2, IsabelG.Lizarraga-De-Maguiña
2,
FátimadelCarmenBernal-Corrales
2, ElmerLópez-López
1,
YaquelinE.Calizaya-Milla
3*, AntonioSerpa-Barrientos
4 and
CristianRamos-Vera
5
1 Escuela de Medicina Humana, Universidad Señor de Sipán, Chiclayo, Peru, 2 Escuela de Enfermería,
Universidad Señor de Sipán, Chiclayo, Peru, 3 Research Group for Nutrition and Lifestyle, Universidad
Peruana Unión, Lima, Peru, 4 Departamento de Psicología, Universidad Nacional Mayor de San
Marcos, Lima, Peru, 5 Area de Investigación, Universidad Cesar Vallejo (UCV), Lima, Peru
Background: The link between physical and mental health and screen time in
adolescents has been the subject of scientific scrutiny in recent years. However,
there are few studies that have evaluated the association between social network
addiction (SNA) and metabolic risk in this population.
Objective: This study determined the association between SNA and anxiety
symptoms with the risk of metabolic syndrome (MetS) in adolescents.
Methods: A cross-sectional study was conducted in Peruvian adolescents aged
12 to 18 years, who completed a Social Network Addiction Questionnaire and
the Generalized Anxiety Disorder 2-item scale (GAD-2), between September
and November 2022. A total of 903 participants were included in the study using
a non-probability convenience sample. Sociodemographic and anthropometric
data were also collected. Binary logistic regression was used to explore the
association between SNA and anxiety symptoms with MetS in a cross-sectional
analysis.
Results: Males were more likely to have MetS than females (OR = 1.133,
p= 0.028). Participants who were 16 years of age or older and those with excess
body weight were 2.166, p= 0.013 and 19.414, p< 0.001 times more likely to have
MetS, respectively. Additionally, SNA (OR = 1.517, p= 0.016) and the presence of
anxiety symptoms (OR = 2.596, p< 0.001) were associated with MetS.
Conclusion: Our findings suggest associations between SNA, anxiety symptoms,
and MetS among youth. However, more studies are needed to better understand
this association and to deepen the possible clinical and public health implications.
KEYWORDS
adolescents, anxiety symptoms, cardiometabolic risk, metabolic syndrome, obesity,
social network addiction
OPEN ACCESS
EDITED BY
Tim S. Nawrot,
University of Hasselt, Belgium
REVIEWED BY
L. M. Ho,
The University of Hong Kong,
Hong Kong SAR, China
Gellan Ahmed,
Assiut University, Egypt
*CORRESPONDENCE
Jacksaint Saintila
jacksaintsaintila@gmail.com
Yaquelin E. Calizaya-Milla
yaquelincalizaya@upeu.edu.pe
RECEIVED 18 July 2023
ACCEPTED 16 April 2024
PUBLISHED 01 May 2024
CITATION
Saintila J, Oblitas-Guerrero SM,
Larrain-Tavara G, Lizarraga-De-Maguiña IG,
Bernal-Corrales FdC, López-López E,
Calizaya-Milla YE, Serpa-Barrientos A and
Ramos-Vera C (2024) Associations between
social network addiction, anxiety symptoms,
and risk of metabolic syndrome in Peruvian
adolescents—a cross-sectional study.
Front. Public Health 12:1261133.
doi: 10.3389/fpubh.2024.1261133
COPYRIGHT
© 2024 Saintila, Oblitas-Guerrero, Larrain-
Tavara, Lizarraga-De-Maguiña, Bernal-
Corrales, López-López, Calizaya-Milla, Serpa-
Barrientos and Ramos-Vera. This is an open-
access article distributed under the terms of
the Creative Commons Attribution License
(CC BY). The use, distribution or reproduction
in other forums is permitted, provided the
original author(s) and the copyright owner(s)
are credited and that the original publication
in this journal is cited, in accordance with
accepted academic practice. No use,
distribution or reproduction is permitted
which does not comply with these terms.
TYPE Original Research
PUBLISHED 01 May 2024
DOI 10.3389/fpubh.2024.1261133

Saintila et al. 10.3389/fpubh.2024.1261133
Frontiers in Public Health 02 frontiersin.org
Introduction
Metabolic syndrome (MetS) also known as “insulin resistance
syndrome” or “syndrome X” refers to the set of conditions that
increase the likelihood of developing cardiovascular and metabolic
diseases, including type 2 diabetes mellitus, hypertension, and
cardiovascular disease (1). Central obesity, which can bemeasured
through anthropometric parameters, such as waist and hip
circumferences and waist-hip ratio (WHR), constitutes one of the
main components of the MetS (2). In recent decades, the prevalence
of obesity in adolescents has increased signicantly worldwide (3),
which has been associated with an increased risk of developing
cardiometabolic diseases at an early age (4). In fact, since 1975, obesity
rates have increased considerably and have almost tripled in the
general population, and in the particular case of children and
adolescents, this increase is even greater, reaching almost a ve-fold
increase (3). In the national context, in recent years, there has been a
steady increase in the number of Peruvian adolescents at high and
very high risk of cardiometabolic diseases, as measured by the WHtR
(5), which, in turn, increases mortality risk. In Peru, there is a double
burden of morbidity due to, on the one hand, problems associated
with infectious diseases and malnutrition by decit and/or excess, and
on the other hand, a progressive increase in non-communicable
diseases (6).
Social networks are online platforms that allow users to create
personal proles and establish connections with other users in their
network (7). In recent years, the use of social networks has become an
increasingly frequent and popular activity among adolescents (8).
Social network platforms such as TikTok, Facebook, Twitter, among
others, can represent a valuable opportunity to connect and engage
adolescents with messages related to the adoption of healthy lifestyles,
such as proper diet and physical activity, which can bea preventive
element against MetS (9). However, excessive exposure to these digital
platforms could have negative consequences on the physical and
mental health of this population group (8). ere are few studies that
examine the relationship between SNA and MetS. However, wefound
a recent study that evaluated the link between adolescent social
networks and health in adulthood, suggesting that adolescents’ social
network position has lasting consequences for MetS in adulthood
(10). However, most studies have focused on body mass index (BMI),
pointing to a possible relationship between social media addiction,
excessive use of media, and an increased risk of developing obesity in
adolescents (11–13), which is related to cardiometabolic
problems (1, 4).
Anxiety symptoms are one of the most prevalent psychiatric
conditions in adolescence, aecting approximately 1in 4 adolescents
(14). ese symptoms may represent risk factors for anxiety disorders
encompassing various conditions such as agoraphobia, panic disorder,
specic phobias, separation anxiety disorder, social anxiety disorder,
and generalized anxiety disorder (15). Studies have shown that anxiety
symptoms are associated with an increased risk of cardiovascular
disease and other metabolic problems in young adults (16, 17).
Although there is less research examining these connections in
adolescents, a study recently found a statistically signicant
relationship between anxiety and some metabolic risk factors in this
population (18). Another study conducted in adolescents reported a
relationship between anxiety symptoms and insulin resistance (19),
which may lead to worsening metabolic outcomes in at-risk youth.
erefore, considering the above, it is important to deepen our
understanding of this relationship and explore the possible clinical
and public health implications. In this context, the present study aims
to examine the association between SNA, anxiety symptoms, and
MetS in adolescents, with the intention of contributing to a better
understanding of these phenomena and to the implementation of
eective preventive and therapeutic interventions.
Materials and methods
Design and study participants
A descriptive cross-sectional study was conducted during
September and November 2022. e sample was selected using
non-probabilistic sampling (20, 21). e researchers chose to use
non-probabilistic purpose sampling because it is relevant to obtain
data from respondents for this study (21–23). Data were collected
using a survey consisting of the following: (a) sociodemographic data
(e.g., age, sex, origin, place of residence, among others); (b) a validated
questionnaire and scale to assess symptoms of SNA and anxiety
symptoms, respectively; (c) in addition, information was collected on
body weight status, height, and waist circumference, to subsequently
estimate BMI, height-for-age (H/A), and waist-to-height
ratio (WHtR).
e survey was distributed to participants enrolled in two public
schools in the districts of Reque and Morrope, located in the city of
Chiclayo, Peru. Data collection was possible due to the support of
the directors of both schools and the teachers of each of the
classrooms weselected. e sample size was calculated using Free
Statistic Calculators version 4.0 (24). For the multiple regression
analysis, an eect size of 0.10, a statistical power of 0.80, 5
explanatory variables and a probability level of 0.05 were considered.
According to this calculation, a minimum sample size of 134
participants was required. However, in this study, a total of 903
students participated voluntarily, which far exceeds the calculated
sample size. Participants of both sexes, those without any pathology,
and those within the selected age range (12–18 years) were included.
However, adolescents whose parents did not give their written
informed consent were excluded from the study. Furthermore, 23
records were excluded due to missing data. e nal sample was
903 participants.
Ethical aspects
e study was carried out aer receiving the approval of the
Research Ethics Committee of the Universidad Señor de Sipán
(Registration and reference number: 0085-17052022-CIEI).
Subsequently, the directors of both schools were contacted to request
and obtain permission to meet with the parents of potential
participants. is meeting was to explain to all parents the purpose of
the study. Furthermore, considering that the participants were minors,
a procedure was implemented to guarantee participation with the
consent of the parents or legal guardians. Aer providing initial
explanations about the purpose of the study, an informed consent
question was included to beanswered by parents or legal guardians as
a prerequisite for adolescents to participate in the survey. erefore,

Saintila et al. 10.3389/fpubh.2024.1261133
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informed consent was obtained from all subjects prior to their
participation in the study.
Measurement instruments
Social network addiction questionnaire
is instrument was originally developed by Escurra and Salas in
2014 and was constructed using a sample of 380 participants (36.3%
men and 63.7% women) in Lima, Peru (25). is questionnaire is
made up of 24 items on a 5-point Likert scale ranging from never to
always (assigned scores from 0 to 4). In addition, it has 23 direct items
and 1 inverse item. A higher score indicates a higher level of SNA. e
validity and reliability of the instrument was analyzed, showing a
Cronbach’s Alpha coecient (α) = 0.95, therefore, it has adequate
internal consistency. Additionally, the instrument evaluation was
carried out on a sample of 744 adolescents aged 17 to 19 years,
reporting a reliability of α = 0.86 (26). In the current study, the internal
consistency of the instrument was also tested, evidencing α = 0.89.
Generalized anxiety disorder (GAD-2)
e Generalized Anxiety Disorder 2-item Scale was used to
measure emotional state. is instrument is composed of item 1 of the
GAD-7 “Feeling of nervousness, anxiety, or being on edge” and by
item 2 “Not being able to stop worrying or controlling worries” and is
assessed through the question: “Indicate how oen you have
experienced the following problems in the last 15 days” (27, 28). ese
items have 4 response options where never = 0, less than half of the
days = 1, more than half of the days = 2, and almost every day = 3. A
cuto score greater than or equal to 3 on GAD-2 is an indicator of a
probable clinically relevant anxiety disorder, while a score less than 3
indicates the absence of anxiety symptoms (29). Total scores range
from 0 to 6 (28, 30, 31). In this study, the version adapted and validated
for the Peruvian population was used and presented an adequate
Cronbach’s α coecient (α = 0.81) (32).
Sociodemographic data
Sociodemographic and economic data were collected through a
registration form, which is composed of sociodemographic factors
such as age in years (11–12 and 16–18), sex (male and female),
residence (urban and rural), level of education of parents (elementary,
technical, and university), marital status of parents (married,
cohabiting, single, divorced, and widowed), family income in “soles
(PEN)” (<2,149.00 PEN, 2,149.00 PEN–10,746.00 PEN,
and > 10,746.00 PEN), among others.
Anthropometric data
BMI
Weight and height were measured using a calibrated SECA 700
mechanical column scale with a capacity of 220 kg and a measuring
range of 60 to 200 cm (SECA®, Hamburg, Germany). Anthropometric
evaluation was performed by a professional nutritionist in the early
hours of the day for one week. Furthermore, the measurements were
performed with the participants walking barefoot and wearing the
minimum amount of clothing. e BMI was calculated, and the
classication was made according to the parameters established by the
World Health Organization. A BMI z score was determined and
classied as follows: “underweight,” BMI z-score < −1; “normal,” BMI
z score −1 to 1; and “overweight” (z > 1) (33).
Height/age (H/A)
Furthermore, H / A was calculated and classied based on the
reference data corresponding to the Peruvian standards in the public
health system: >2 standard deviation (SD), “normal or adequate”
(H/A ≥ −2 to ≤2 SD), “low” (H/A < −2 to −3 SD), and “severe low”
(H/A < −3). For the purposes of the current study, it is necessary to
specify that short and very severe height was recategorized as short
height (34, 35).
Waist-to-height ratio (WHtR)
Waist circumference (WC) was measured in triplicate using a
Cescorf (Cescorf Equipamentos Para Esporte Ltda—Epp, Brazil) self-
retractable metallic steel tape measure. Measurement of the WC was
made considering the midpoint of the axillary line, in the distance that
goes from the ridge of the last rib to the iliac spine (36).
Outcome
Aer obtaining WC measurements, WHtR was determined by
dividing the waist circumference of each participant by their respective
height. is anthropometric parameter is valued for its ability to
provide an accurate indication of the distribution of adipose tissue in
the body (33, 37). It is a simple index that oers immediate
identication and interpretation, being particularly useful in the early
identication of abdominal obesity in children (38). As a result, it
makes it possible to anticipate potential risks related to cardiometabolic
disorders (2, 37, 39). In the evaluation process, a cuto point of 0.5
was identied. at is, participants who had a WHtR index greater
than 0.5 were classied as adolescents at risk of MetS (2, 33, 37, 39, 40).
Statistical analysis
A Microso Excel spreadsheet was used for data collection and
coding. en, for data processing and analysis, the IBM SPSS statistical
soware package, version 26 (SPSS Inc., Chicago, IL, UnitedStates) was
used. Descriptive analysis of the variables was performed using tables of
absolute frequencies and percentages. To explore whether
sociodemographic data, anthropometric data, SNA, and anxiety
symptoms were dierent according to sex and MetS, the chi-square
statistical test was used. Finally, an exploration of the association of the
factors inuencing MetS (dependent variable) was carried out using a
binary logistic regression model. Weconsidered sex, age, overweight,
SNA, and anxiety symptoms as independent variables. ese variables
had a probability value (p-value) of less than 0.05 in a preliminary
bivariate analysis, and therefore were incorporated in the bivariate logistic
regression analysis.
Results
A total of 903 schoolchildren voluntarily decided to participate in
the study; of these, 56% were female. e highest proportion (68.8%)
were between 12 and 15 years of age. Regarding the level of education
of parents, 76.6% of mothers and 69.2% of fathers reported basic

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Frontiers in Public Health 04 frontiersin.org
education. Most parents were married (46.4%), had a monthly income
<2,149.00 (74.6%), and reported having more than two sons (57.9%).
More than half of the respondents reported that they live with their
parents (55.3%). e sociodemographic characteristics of the
participants are shown in Table1.
e results of the association between H/A, BMI, SNA, and
anxiety symptoms are shown in Table2. MetS was generally observed
among men (67.1%, p= 0.046), in the age range of 16–18 (78.3%,
p< 0.001), in those with excess body weight (90.1%, p< 0.001), SNA
(85.5%, p= 0.039) and anxiety symptoms (63.2%, p= 0.007).
A binary logistic regression model was used to explore the
variables that predict the probability that adolescents will present
MetS and the results are shown in Table3. In this analysis, males
were more likely to present MetS than females (OR = 1.133,
p= 0.028). Participants who were 16 years of age or older and
those with excess body weight were 2.166, p= 0.013 and 19.414,
p < 0.001 times more likely to have MetS, respectively.
Furthermore, SNA (OR = 1.517, p= 0.016) and the presence of
anxiety symptoms (OR = 2.596, p< 0.001) were associated with the
risk of MetS.
Discussion
In this cross-sectional study, we determined the association
between SNA and anxiety symptoms with the risk of MetS in Peruvian
adolescents aged 12 to 18 years. e main ndings were as follows:
Male sex, participants who were 16 years of age or older and those who
had excess body weight were more likely to present MetS. Furthermore,
it is highlighted that SNA and anxiety symptoms were associated
with MetS.
Previous studies have documented the inuence of sex and age on
the anthropometric prole, more precisely MetS, measured through
the WHtR (4, 41–43). e results of the logistic regression analysis of
the current study revealed that men were more likely to have MetS
compared to females; furthermore, wefound that a higher proportion
of men had MetS. It should benoted that the current study used
WHtR to determine MetS. Similarly, the ndings of the research
conducted in Brazilian adolescents showed that boys had a higher
mean WHtR and a higher WHtR at the 95th percentile (41). Similarly,
other studies in adolescents reported that boys were more likely to
report MetS factors, such as high blood pressure, elevated cholesterol,
TABLE1 Sociodemographic characteristics of the participants (N= 903).
Variable n%
Sex Female 497 55.0
Male 406 45.0
Age 12–15 621 68.8
16–18 282 31.2
Mother’s education None 107 11.8
Basic 692 76.6
Technical 67 7.4
University 36 4.0
Father’s education None 109 12.1
Basic 625 69.2
Technical 92 10.2
University 77 8.5
Parents’ marital status Married 419 46.4
Cohabitant 208 23.0
Single 139 15.4
Divorced 105 11.6
Widowed 31 3.4
With whom youlive With mother and father 499 55.3
Only with father 94 10.4
Only with mother 201 22.3
With another family member 103 12.2
Monthly income <2,149.00 PEN*674 74.6
2,149.00–10,746.00 PEN 168 18.6
>10,746.00 PEN 60 6.6
Number of children One son 140 15.5
Two sons 240 26.6
More than two sons 523 57.9
*e ISO code for Peruvian currency is PEN, a standardized 3-letter code according to the ISO-4217 currency code standard.

Saintila et al. 10.3389/fpubh.2024.1261133
Frontiers in Public Health 05 frontiersin.org
glucose, and triglyceride levels (42, 43). Although in some studies
MetS patterns do not dier in both sexes (44), however, there are
mechanisms that support evidence of sex dierences (42, 43, 45, 46).
In general, it has been found that men have higher visceral adipose
tissue, intramyocellular and intrahepatic lipids than women, which
could partly explain why they have a higher MetS (46). On the other
hand, males tend to have higher blood pressure and cholesterol levels
than women from puberty onward, which can also contribute to a
higher cardiovascular risk (42, 43). In hormonal terms, it has been
found that testosterone levels in men can negatively aect glucose
metabolism and increase the risk of insulin resistance and type 2
diabetes, which are considered cardiometabolic complications (45).
Chronological age remains one of the strongest predictors of
cardiometabolic events (47). In the present study, we found that
participants who were 16 or older tended to report MetS; furthermore,
an age ≥ 16 years was signicantly associated with MetS. ese ndings
are similar to the results reported in a recent study conducted in
Peruvian adolescents where the highest proportion of those with MetS,
measured by WHtR, were aged 15 to 17 years vs. 12 to 14 years (4). In
addition, these results conrm the ndings of research that measured
waist circumference and WHtR in US children and adolescents (48).
is study showed that the relative changes in WHtR increased with
increasing age, and that the greatest relative change was observed in
men and women between 18 and 19 years of age (48). Chronological age
is an important determinant of health, since it coincides with the critical
moments of increasing body fat and, therefore, of the development of
diseases (49). In fact, as age increases, the risk of developing various
chronic cardiometabolic diseases and conditions increases (48, 50). In
addition, the physical and mental changes that occur with age can aect
the quality of life and a person’s ability to perform daily activities (51).
However, it is important to note that the premature onset of age-related
diseases in younger people suggests a discrepancy between
TABLE2 Chi-square analysis of MetS.
Variables MetS Non MetS
n%n%χ2p-value
Sex
Female 50 32.9 436 58.1 0.421 0.046*
Male 102 67.1 315 41.9
Age (years) 15.440 <0.001*
12–15 33 21.7 412 54.8
16–18 119 78.3 339 45.2
H/A
Inadequate H/A 52 34.2 286 38.1 0.809 0.368
Adequate H/A 100 65.8 465 61.9
BMI
Normal 15 9.9 479 63.8 148.290 <0.001*
Excess body weight 137 90.1 272 36.2
SNA
Yes 130 85.5 90 12.0 0.721 0.039*
No 22 14.5 661 88.0
Anxiety symptoms
Yes 96 63.2 246 32.8 0.948 0.007*
No 56 36.8 505 67.2
*Statistically signicant, p< 0.05 [Chi-square (χ2)]. p represents the probability that MetS is associated with sociodemographic and anthropometric data, social network addiction, and anxiety
symptoms. H/A, height/age; BMI, body mass index; MetS, Metabolic syndrome; SNA, Addiction to social networks.
TABLE3 Binary logistic regression analysis of factors associated with MetS.
Variables 95% CI
BORBpLower Upper
Sex (0 = female, 1 = male) 0.125 1.133 0.028 0.770 1.667
Age (year) (0 = <16, 1 = ≥16) 0.773 2.166 0.013 1.386 3.387
Excess bo dy weight (0 = no, 1 = yes) 2.966 19.414 <0.001 10.911 34.544
SNA (0 = no, 1 = yes) 0.417 1.517 0.016 0.844 2.727
Anxiety symptoms (0 = no, 1 = yes) 0.954 2.596 <0.001 1.713 3.933
χ2= 173,114, df = 5, p< 0.001; Cox and Snell R-squared = 0.174, Nagelkerke R-squared = 0.293.
B, Beta coecient; p, probability ; ORB, Odds ratio; 95% CI, 95% condence inter val; SNA, soci al network addic tion.

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chronological and biological age, pointing out that chronological age is
not always representative of true biological age, because several disease/
morbidity factors may berelated to biological age (50). Beyond this
discrepancy, it is important to consider age as an important factor in
assessing adolescent health and in planning long-term disease
prevention and treatment strategies.
Global obesity and MetS, measured using WHtR, are two
anthropometric factors that are associated with the onset and
development of noncommunicable diseases (1). e measurement of
both factors is particularly important in adolescents, since adolescence
is a high-risk stage and one of the most critical periods of life, due to
constant changes in lifestyle (52). Evidence for the association between
global obesity and MetS has been demonstrated in both adolescents and
the general population (4, 49, 53, 54). In our study, wefound that those
who had excess body weight were more likely to present MetS. ese
results are consistent with the ndings of a study conducted in Spanish
schoolchildren aged 6 to 15 years, showing a relationship between excess
body weight and abdominal obesity, a metabolic risk factor (49).
Similarly, the results of a recent study conducted in 506 adolescents aged
10 to 19 years of age from dierent schools in Brazil reported that
normal weight obesity, which is dened as excess body fat in normal
weight individuals, is associated with MetS, assessed through waist
circumference (53). Some possible justication why obesity is related to
increased waist circumference in adolescents is the fact that excess body
fat accumulates predominantly in the abdominal region (1). It is worth
mentioning that abdominal fat, also known as visceral fat, is
metabolically active and can release pro-inammatory fatty acids and
adipokines, which contribute to the development of insulin resistance,
dyslipidemia and other MetS factors (53, 54). erefore, assessment of
MetS measured through WHtR in obese and normal weight adolescents
can be useful to identify those with a higher risk of developing
cardiovascular and metabolic diseases.
Another relevant nding of this study is the fact that SNA is
associated with MetS. is connection is especially relevant in the
current times since the use of social networks has become a
widespread and popular activity among adolescents (8). Although
there is a paucity of research analyzing the relationship between SNA
and MetS, our ndings are in line with a recent study that evaluated
the relationship between adolescents’ social networks and their health
in adulthood suggesting that their position in their social network
during adolescence has lasting implications for MetS in adulthood
(10). It should benoted that most studies have focused on BMI,
pointing to a possible relationship between SNA and excessive media
use with an increased risk of developing obesity in children and
adolescents (11–13, 55), which is related to cardiometabolic problems
(1, 4). erefore, it is important to highlight that excessive exposure
to digital platforms could have negative eects on the cardiovascular
health of this population group through the onset of obesity (56). is
suggests that the eect of SNA on MetS could bemediated by obesity.
Although it is important to note that structural equation modeling
was not used in this study to explore these relationships in depth, our
ndings provide a clear picture of how cardiometabolic disease is
inuenced by SNA and obesity. is sets the groundwork for future
research using mediation models, which will help to better understand
these relationships. e mechanism for this association may bethat
excessive and sedentary use of social networks reduces the time that
would bedevoted to physical activities (57). Studies that have provided
evidence to support this theory show that when the amount of time
adolescents spend in front of screens is reduced, their level of physical
activity increases (12). Another reason for this relationship is the fact
that it has been suggested that the consumption of hypercaloric foods
can increase in parallel with the time spent on the media and social
networks (58, 59). is hypothesis is supported by research showing
that high use of social networks among adolescents is associated with
unhealthy dietary behaviors (60), and that energy intake in adolescents
decreases when sedentary behaviors are reduced (59).
Finally, in this study, wefound that anxiety symptoms are associated
with MetS. Although little research has been done on the relationship
between anxiety and metabolic risk factors in adolescents, however, a
recent study has found a signicant association between anxiety and
some metabolic risk factors in this population group (18). Similarly,
another study conducted in adolescents reported a relationship between
anxiety symptoms and insulin resistance (19), which may lead to
worsening metabolic outcomes in at-risk youth. Furthermore, studies
have shown that anxiety symptoms are associated with an increased risk
of cardiovascular disease and other metabolic problems in young adults
(16, 17). Anxiety is a common aective disorder in children and
adolescents, aecting approximately 1 in 12 children and 1 in 4
adolescents, and is one of the most common mental health problems in
these populations (14). One of the possible reasons why anxiety
symptoms are associated with MetS is that this disorder can contribute
to increased intake of unhealthy foods and decreased physical activity
(61). In particular, it is possible that people with anxiety are more likely
to have a sedentary lifestyle, increasing the risk of obesity and
cardiovascular disease (61). Furthermore, anxiety symptoms can
increase the release of stress hormones, such as cortisol, which can
promote abdominal fat gain and insulin resistance (19, 62).
Limitations and future research
When interpreting the results of this study, certain limitations
should be taken into account, which will benet future lines of
research. First, the study was a cross-sectional design; therefore, it
does not allow establishing the possibility of causality, that is, it cannot
beconsidered that having SNA, anxiety symptoms, or excess body
weight can lead to an increase in WHtR; therefore, longitudinal
studies that follow participants over time are needed to determine
whether the initial presence of SNA, anxiety symptoms, or overweight
predicts future increases in WHtR. Second, in relation to the
anthropometric data, this is cross-sectional information, where a
single measurement was taken for each student and there is no
follow-up data to evaluate the evolution of weight and height over
time. erefore, the results presented are based on single
measurements taken in dierent age groups. Considering this,
wecannot evaluate how these anthropometric parameters evolve with
age. However, in the specic case of WHtR, an advantage of using this
index is that it does not appear to beage dependent at certain levels
and therefore it may bepossible to use a single cut-o value for all
children (63). Nonetheless, it is important to point out that there is no
consensus on a single WHtR cut-o point to predict the risk of MetS
risk in adolescents (64). Given the lack of consensus on a single WHtR
cut-o point for predicting the risk of MetS in adolescents, further
studies are needed to explore and validate uniform criteria. is could
include comparative analyses of dierent cut-o values in dierent
adolescent populations to identify those that are most predictive of

Saintila et al. 10.3389/fpubh.2024.1261133
Frontiers in Public Health 07 frontiersin.org
MetS risk. ird, data on SNA and anxiety symptoms were self-
reported, which may lead to measurement errors. However, both
instruments were validated in the Peruvian population. erefore,
future research on anxiety symptoms could be based on medical
diagnoses rather than self-report alone. Medical diagnoses provide a
more objective and detailed assessment of anxiety status by combining
clinical observations, medical records, and, in some cases,
psychometric tests administered by professionals (65). Finally, it is
important to note that the inability to generalize the ndings to a
larger population, due to the type of sampling used and the number
of participants involved, is an obvious limitation in the current study.
erefore, it is important to interpret the results with caution and
within the specic context of the selected sample group. In addition,
studies using probability sampling methods are suggested to verify
and expand on the ndings of the current study.
Public health implications
Despite these limitations, webelieve that the current study is of
public health relevance due to its potential impact on the long-term
health of adolescents. Adolescents are a vulnerable and growing
population; therefore, habits and behaviors acquired at this stage can
inuence their health in adulthood. In addition, SNA, anxiety
symptoms, and obesity are mental and physical health problems that
have been increasing in the adolescent population in recent years. If
these problems are related to an increased risk of MetS, they need to
beaddressed early and eectively. erefore, it is important to conduct
further research to conrm the relationship between these factors and
to develop and implement preventive and treatment interventions
targeting this vulnerable population. Furthermore, it is essential that
health professionals, educators, and public health authorities inform
and educate both adolescents and their parents about the importance
of a healthy and balanced life, including responsible use of social
networks, management of stress and anxiety, and maintaining a
healthy weight.
Conclusion
e ndings of this cross-sectional study suggest that men were
more likely to have MetS compared to females; furthermore, wefound
that a higher proportion of men had higher MetS. Furthermore, it is
notable that participants 16 years or older tended to report a higher
level of MetS; furthermore, an age ≥ 16 years was signicantly
associated with the risk of MetS. Similarly, excess body weight, SNA,
and anxiety symptoms were associated with the risk of MetS. Given
the impact of MetS on health, more eorts are needed to better
understand the associated factors for the implementation of eective
preventive and therapeutic interventions.
Data availability statement
e raw data supporting the conclusions of this article will
bemade available by the authors, without undue reservation.
Ethics statement
e studies involving humans were approved by Research Ethics
Committee of the Universidad Señor de Sipán (Registration and
reference number: 0085-17052022-CIEI). e studies were conducted
in accordance with the local legislation and institutional requirements.
Written informed consent for participation in this study was provided
by the participants’ legal guardians/next of kin.
Author contributions
JS: Conceptualization, Funding acquisition, Investigation,
Methodology, Project administration, Supervision, Visualization,
Writing – original dra, Writing – review & editing. SO-G:
Conceptualization, Data curation, Funding acquisition, Investigation,
Project administration, Resources, Writing – original dra. GL-T:
Conceptualization, Methodology, Project administration, Resources,
Visualization, Writing – original dra. IL-D-M: Conceptualization,
Data curation, Funding acquisition, Writing – original dra. FB-C:
Funding acquisition, Investigation, Methodology, Writing – original
dra. EL-L: Conceptualization, Funding acquisition, Methodology,
Project administration, Writing – review & editing. YC-M:
Conceptualization, Data curation, Investigation, Project
administration, Visualization, Writing – original dra, Writing –
review & editing. AS-B: Investigation, Methodology, Validation,
Visualization, Writing – review & editing. CR-V: Formal Analysis,
Investigation, Methodology, Supervision, Visualization, Writing –
review & editing.
Funding
e author(s) declare nancial support was received for the
research, authorship, and/or publication of this article. e study was
nanced by the Universidad Señor de Sipán through the Vice
Rectorate for Research, Grant: 082-2022-PD-USS and approved by
RESOLUCIÓN DE DIRECTORIO N° 079-2022-PD-USS.
Acknowledgments
The authors are grateful for the support provided by the Vice
Rectorate for Research and the Research Department of the
School of Sciences of Sipan University. We also thank Dr.
Millones-Gómez Pablo A. and Dr. Pérez-Delgado Orlando for
their administrative support in the execution of the study. Finally,
wethank all parents and students who decided to participate in
this study.
Conflict of interest
e authors declare that the research was conducted in the
absence of any commercial or nancial relationships that could
beconstrued as a potential conict of interest.

Saintila et al. 10.3389/fpubh.2024.1261133
Frontiers in Public Health 08 frontiersin.org
Publisher’s note
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and do not necessarily represent those of their aliated
organizations, or those of the publisher, the editors and the
reviewers. Any product that may be evaluated in this article, or claim
that may be made by its manufacturer, is not guaranteed or endorsed
by the publisher.
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