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Epidemiology and Population Health

Combined lifestyle factors and metabolic syndrome risk: a systematic review and meta-analysis

International Journal of Obesity volume 49, pages 226–236 (2025)Cite this article

Subjects

Abstract

Background/Objectives

The metabolic syndrome is a complex condition influenced by many factors including lifestyle. Recently, more and more studies explored the relationships between combined lifestyle factors (often measured as lifestyle scores/indices) and metabolic syndrome due to the co-occurrence of these factors. These scores/indices considered potential interactions among lifestyle factors, offering a more comprehensive understanding of their relationship with metabolic syndrome. However, no review/meta-analysis has been conducted to summarize existing evidence. Thus, this study aimed to synthesize the associations between lifestyle scores/indices and metabolic syndrome in cross-sectional and cohort studies.

Subjects/Methods

A literature search was performed in Embase and Medline. Multivariable-adjusted estimates were synthesized using random-effects models. In research where higher scores indicated better health, we used original estimates directly. In studies where higher scores denoted poorer health, we first calculated the coefficients and standard errors based on original estimates. Afterward, we reversed coefficients’ directions and recalculated new estimates. Thus, the pooled estimates compared the healthiest with the least-healthy lifestyles (the highest vs. lowest scores/indices). Subgroup analyses were conducted based on study design, region, baseline time, baseline age, sex, health status, metabolic syndrome diagnosis, and lifestyles’ number. Sensitivity analyses were performed by including only high-quality studies and employing leave-one-out analyses.

Results

Nineteen studies from 16 publications were included. Physical activity, diet, and smoking were the top three included lifestyle factors. Compared to participants with the least-healthy lifestyles, those with the healthiest lifestyles had a 43% lower metabolic syndrome risk (95% confidence interval = 0.41–0.73). In subgroup analyses, healthy lifestyle scores/indices were inversely associated with both metabolic syndrome prevalence in cross-sectional studies (Odds ratio = 0.62; 95% confidence interval = 0.51–0.73) and metabolic syndrome incidence in cohort studies (Odds ratio = 0.40; 95% confidence interval = 0.11–0.68). The inverse association was consistent in other subgroup and sensitivity analyses.

Conclusions

Adherence to a healthy lifestyle pattern was beneficial to metabolic syndrome prevention.

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Data availability

All data are available from the correspondence author on reasonable request.

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Acknowledgements

We would like to express our gratitude to the Early Career Scheme, Research Grants Council of the University Grants Committee: HK (grant number: 25101418); General Research Fund, Research Grants Council of the University Grants Committee: HK (grant number: 15100822); and Central Research Grant of the Hong Kong Polytechnic University (grant number: P0009671). The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript.

Author information

Authors and Affiliations

  1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden

    Yunyang Deng

  2. School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China

    Qingling Yang, Fei-Wan Ngai & Yao Jie Xie

  3. School of Public Health, Sun Yat-Sen University, Guangzhou, China

    Chun Hao & Harry Haoxiang Wang

  4. College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, EH8 9AG, UK

    Harry Haoxiang Wang

  5. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China

    Tongyu Ma

  6. Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China

    Xiangyan Chen

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Contributions

YD: conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, writing – original draft, writing – review & editing; QY: formal analysis, validation, writing – review & editing; CH, HHW, TM, XC, FWN: investigation, supervision, validation, writing – review & editing; YJX: conceptualization, funding acquisition, project administration, supervision, validation, writing – review & editing.

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Correspondence to Yao Jie Xie.

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Deng, Y., Yang, Q., Hao, C. et al. Combined lifestyle factors and metabolic syndrome risk: a systematic review and meta-analysis. Int J Obes 49, 226–236 (2025). https://doi.org/10.1038/s41366-024-01671-8

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