Associations Between Body Mass Index, Visual Acuity, and Resting Heart Rate in Adolescents: A Multifactorial Analysis of Physical Examination Data

Body mass index (BMI), visual function and resting heart rate (RHR) are standard measurements in adolescent physical examinations, yet their interconnections and age- and gender-specific differences are not fully clarified. This multicentre retrospective cohort study analyzed 130,832 screening records of 8-17-year-old adolescents from 2022 to 2024, using mixed-effects models and stratified analyses to examine BMIs independent correlations with UCVA (UCVA) and RHR, alongside the moderating effects of age and sex. Boys presented higher BMI values and greater overweight/obesity prevalence, whereas girls had poorer UCVA. After adjusting for confounders, every 1 kg/m{superscript 2} increment in BMI correlated with a -0.008 log MAR change (a stronger effect in girls) and a 0.26 beat-per-minute rise in RHR. The inverse BMI-UCVA correlation peaked at ages 8-11, weakened among 12-16-year-olds, and reversed at age 17. RHR decreased steadily with age, being marginally lower in boys, with a notable age-sex interaction. Age and sex jointly shaped the correlations among the three indicators, whose statistically significant links varied across developmental periods. Therefore, integrated screening should assess all indicators comprehensively while accounting for age and gender disparities. We propose unified, sex and age-stratified adolescent screening and intervention strategies to simultaneously mitigate obesity, myopia and cardiovascular risks, rather than isolated single-disease prevention.