Association of Healthy Lifestyle Score With Metabolic Syndrome in Hong Kong Chinese Women: An Age-Matched Nested Case-Control Study

Yao Jie Xie, Yunyang Deng, Qi Sun, Lin Yang, Chun Hao

Research output: Chapter in book / Conference proceedingConference article published in proceeding or bookAcademic researchpeer-review


Introduction: Limited studies explored the combined effect of lifestyles on metabolic syndrome (MetS), especially in Hong Kong Chinese people.

Hypothesis: We assessed the hypothesis that a combination of seven lifestyles, expressed as a healthy lifestyle score (HLS), was inversely associated with MetS.

Methods: A nested case-control study was conducted in a cohort named Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women (MECH-HK). We recruited 4,221 women aged ≥30 years at baseline (2019-2021) and followed up with 3,435 subjects at the second-round survey until September 2023. The MetS was diagnosed based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) (2005 version). Women who developed MetS between baseline and second-round survey and had no hypertension, diabetes, hyperlipemia, myocardial infarction, stroke, or cancers at baseline were selected as cases. Age-matched controls were selected using a 1:1 ratio. Seven lifestyles were included in the HLS, each was assigned 0 or 1 point. The 1-point criteria were: smoking (never smoker), physical activity (vigorous physical activity ≥75 min/week), sleep (Pittsburgh Sleep Quality Index ≤5), stress (Perceived Stress Scale-10 ≤13), fatigue (≤ the median of a 10-point Likert scale), diet (≥ the median of a healthy diet score), and alcohol (<20g/day). The overall score ranged from 0 to 7, where a higher score indicated better health. Leave-one-out test was performed by excluding the seven items from the HLS one at a time. A weighted HLS was generated based on the coefficient of each component in multivariable analysis.

Results: A total of 123 MetS patients (aged 56.6±7.5 years) and 123 controls (aged 56.9±7.8 years) were included. The number of MetS cases and total subjects for the lowest (0-2 points), middle (3-4 points), and highest (5-7 points) HLS groups were 40/64 (62.5%), 51/107 (47.7%), and 32/75 (42.7%), respectively. Compared to the lowest HLS group, the ORs (95% CIs) for the highest HLS group in univariable and multivariable analysis were 0.45 (0.23, 0.88) (P=0.021) and 0.46 (0.23, 0.94) (P=0.032), respectively. Among the seven components, smoking was the strongest contributor, followed by physical activity and diet. The results were consistent in the leave-one-out test and weighted HLS.

Conclusions: Higher HLS was associated with lower MetS risk in Hong Kong Chinese women. The combined healthy lifestyles could benefit the prevention of MetS.
Original languageEnglish
Title of host publicationCirculation
Publication statusPublished - 16 May 2024
EventEPI|Lifestyle Scientific Sessions 2024 - Chicago, United States
Duration: 18 Mar 202421 Mar 2024


ConferenceEPI|Lifestyle Scientific Sessions 2024
Country/TerritoryUnited States
Internet address


  • Lifestyle
  • Metabolic Syndrome
  • Case-Control Study

ASJC Scopus subject areas

  • Health Professions(all)


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