Life Essentials 8 score and risk of metabolic syndrome: A dose-response analysis in the US population

There is limited research on the relationship between Life Essentials 8 (LE8) score and metabolic syndrome (MetS). Our aim is to examine the association between LE8 cardiovascular health metrics and risk of MetS in a nationally representative sample.

We conducted a cross-sectional study using data from 23,253 adults aged ≥20 years from the National Health and Nutrition Examination Survey (2005-2018). LE8 score (range 0-100) was calculated based on the American Heart Association's definitions of ideal cardiovascular health behaviors (physical activity, diet, smoking, and body mass index) and factors (total cholesterol, blood pressure, fasting plasma glucose, and fasting triglycerides). Metabolic syndrome comprises a cluster of metabolic disorders, including obesity, hypertension, hyperglycemia, and dyslipidemia. Multivariable logistic regression and restricted cubic spline models, mediation analysis, subgroup analysis and weighted quantile sum (WQS) regression were used to assess the relationship between LE8 score and MetS risk.

A total of 23,253 participants were included, of whom 7,932 had MetS and 15,321 did not. The average age of the participants was 50.7 years (standard deviation (SD) 12.3), with 49.24% being male. Participants with high LE8 category (80-100 points) had 98% lower odds of having MetS compared to those with low LE8 category (0-49 points) after adjusting for potential confounders (adjusted odds ratio [OR]: 0.02; 95% confidence interval [CI]: 0.02-0.03; P < 0.001). There was a monotonic decreasing dose-response relationship between LE8 score and predicted probability of MetS (P-overall <0.001; P-nonlinear <0.001). Several biomarkers including serum albumin, uric acid and neutrophil count emerged as potential mediators.

While our studies suggest a potential association between cardiovascular health factors and reduced MetS risk, the cross-sectional nature of our study limits causal inferences. The LE8 score could still serve as a useful screening tool to identify individuals at high risk for MetS, facilitating targeted prevention and treatment strategies.