Metabolic Syndrome (MetS) is a cluster of interrelated risk factors that significantly increases the likelihood of developing cardiovascular disease, type 2 diabetes mellitus, and all-cause mortality (1). These risk factors typically include abdominal obesity, dyslipidemia, hypertension, and insulin resistance (2). In recent years, the prevalence of MetS has surged in urban settings, largely attributed to lifestyle changes driven by rapid urbanization, sedentary behavior, and poor dietary habits (3,4).

Urban populations, especially in low- and middle-income countries, are increasingly adopting energy-dense diets and sedentary routines, leading to the escalation of obesity and other metabolic abnormalities (5). According to recent estimates, nearly one-third of adults in urban India may meet the diagnostic criteria for MetS (6). This rising burden not only challenges healthcare infrastructure but also increases the socioeconomic burden due to reduced workforce productivity and increased healthcare costs (7).

Evidence suggests that lifestyle interventions focusing on diet, physical activity, and behavior change are effective in managing MetS and its individual components (8). However, traditional, unisectoral health education strategies often fail to yield sustained behavioral change, particularly in urban environments where social and environmental determinants significantly influence health behaviors (9). A multisectoral approach—engaging various stakeholders such as public health institutions, municipal bodies, fitness experts, and nutritionists—has been recommended to address these complex lifestyle-related disorders (10).

Despite global recognition of the need for integrated interventions, few community-based studies in urban areas have evaluated the effectiveness of such multisectoral programs on MetS outcomes. The present study aims to assess the impact of a structured lifestyle modification program involving multiple sectors on metabolic parameters among individuals with MetS residing in urban areas.

Adults aged 30 to 60 years who met the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria for Metabolic Syndrome were eligible for inclusion. Individuals with diagnosed chronic illnesses requiring ongoing medical therapy (e.g., cancer, end-stage renal disease), pregnancy, or who were already enrolled in any structured lifestyle modification program were excluded. Using a prevalence estimate of MetS at 30%, a confidence level of 95%, and a power of 80%, the minimum required sample size was calculated as 135 per group, which was rounded to 150 to accommodate potential dropouts.

Randomization and Group Allocation
Eligible participants were recruited through community health screenings and then randomized into intervention (n = 150) and control (n = 150) groups using computer-generated random numbers. Informed written consent was obtained from all participants prior to enrollment.

Intervention Program

The intervention group underwent a structured multisectoral lifestyle modification program that involved:

• Nutritional Counseling: Individualized dietary plans and group sessions conducted monthly by certified dietitians focusing on reducing saturated fats, refined sugars, and increasing intake of whole grains, fruits, and vegetables.
• Physical Activity Sessions: Supervised aerobic exercise and yoga sessions conducted thrice a week in local community centers by trained instructors.
• Stress Management: Monthly workshops on mindfulness, breathing techniques, and mental health awareness.
• Health Education: Community meetings and distribution of educational material, supported by collaboration with local NGOs and municipal health workers.

The control group received standard verbal health advice during the initial screening but no structured follow-up or interventions.

Data Collection and Variables Measured
Baseline data were collected using a structured questionnaire that included sociodemographic details, medical history, dietary habits, physical activity levels, and substance use. Anthropometric measurements such as waist circumference, weight, and height were recorded using standard protocols. Blood pressure was measured using a calibrated digital sphygmomanometer. Fasting blood samples were collected for glucose, triglycerides, and HDL cholesterol levels using enzymatic colorimetric methods at a certified laboratory.

Outcome Measures

The primary outcome was the change in the prevalence of Metabolic Syndrome after 12 months. Secondary outcomes included changes in individual metabolic parameters (waist circumference, fasting glucose, triglycerides, HDL cholesterol, and blood pressure).

Statistical Analysis

Data were analyzed using SPSS version 25. Descriptive statistics were used to summarize the baseline characteristics. Paired t-tests were used to assess pre- and post-intervention differences within each group, while independent t-tests compared differences between groups. A p-value <0.05 was considered statistically significant.

A total of 300 participants were enrolled, with 150 individuals in both the intervention and control groups. The mean age of participants was 45.3 ± 7.6 years in the intervention group and 44.8 ± 6.9 years in the control group. Gender distribution was comparable, with males constituting 52% in the intervention group and 49% in the control group.

Baseline Characteristics

Both groups were comparable at baseline with respect to all metabolic parameters, indicating appropriate randomization (Table 1).

Table 1: Baseline Characteristics of Study Participants

Post-Intervention Outcomes

After 12 months, the intervention group showed significant improvements in all metabolic parameters compared to the control group. Waist circumference, fasting glucose, and triglyceride levels reduced markedly in the intervention group, while HDL cholesterol increased (Table 2).

Table 2: Changes in Metabolic Parameters After 12 Months

*p < 0.05, **p < 0.01

Change in Metabolic Syndrome Prevalence

At baseline, all participants met the criteria for Metabolic Syndrome. After the intervention, the prevalence reduced to 64% in the intervention group, whereas 98% of participants in the control group continued to meet the diagnostic criteria (Table 3).

Table 3: Prevalence of Metabolic Syndrome Before and After the Intervention

The present study demonstrates that a structured, multisectoral lifestyle intervention significantly improves metabolic parameters and reduces the prevalence of Metabolic Syndrome (MetS) among urban adults. After 12 months of targeted intervention involving dietary counseling, physical activity promotion, stress management, and community engagement, significant improvements were observed in waist circumference, fasting blood glucose, triglycerides, HDL cholesterol, and systolic blood pressure.

The findings are consistent with earlier studies emphasizing the role of lifestyle changes in reversing components of MetS (1,2). Interventions that target multiple risk factors through a community-based approach tend to yield better outcomes than isolated efforts (3). In our study, the integration of services from various sectors likely contributed to the effectiveness of the intervention by enhancing accessibility, personalization, and adherence.

Reduction in abdominal obesity, indicated by the decreased waist circumference, aligns with studies demonstrating the central role of visceral fat in the pathophysiology of MetS (4,5). Regular aerobic exercise, coupled with dietary modifications, has been shown to lower adiposity and improve insulin sensitivity (6). These mechanisms may explain the observed improvement in fasting glucose and triglyceride levels, two major diagnostic components of MetS (7,8).

Notably, the modest but significant increase in HDL cholesterol in the intervention group is clinically relevant, as low HDL is strongly linked to atherosclerotic cardiovascular disease (9). Structured exercise regimens and consumption of unsaturated fats have been shown to elevate HDL concentrations, supporting our findings (10).

The significant decline in systolic blood pressure in the intervention group may be attributed to combined effects of improved diet, stress reduction, and physical activity. Prior evidence suggests that interventions promoting the DASH diet and mindfulness-based stress reduction can effectively reduce blood pressure (11,12). These findings reinforce the necessity of addressing psychological stress alongside physical health in MetS management.

The reduction in overall prevalence of MetS by 36% in the intervention group is encouraging and aligns with the outcomes of similar community-based trials conducted in both high-income and middle-income countries (13,14). Importantly, the minimal change in the control group underlines the importance of structured and sustained engagement rather than passive health education.

Our study supports the effectiveness of a multisectoral, community-oriented model in combating non-communicable diseases, particularly in resource-constrained urban settings. Unlike clinical interventions that often require high-cost medical infrastructure, community-based models foster sustainability through active local participation and cross-sector collaboration (15).

This study had several limitations. The quasi-experimental design, while practical, is inherently prone to selection bias. Although the two communities were demographically similar, unmeasured confounding factors may have influenced the outcomes. Additionally, the reliance on self-reported behavioral data (diet, exercise, stress) may have introduced reporting bias. The absence of long-term follow-up limits the ability to assess the sustainability of health gains beyond the study period.

Future research should aim to replicate these findings in varied urban settings and examine long-term outcomes. Incorporating mobile health technologies and community health workers could further enhance scalability and cost-effectiveness. Policy frameworks that integrate such interventions into public health systems will be essential for wide-scale impact.

This community-based trial demonstrates that a structured, multisectoral lifestyle modification program can significantly reduce the prevalence and severity of Metabolic Syndrome in urban populations. Improvements in key metabolic parameters, including waist circumference, blood glucose, lipid profile, and blood pressure, highlight the effectiveness of integrated public health strategies. Such community-driven interventions hold promise for addressing the growing burden of non-communicable diseases in urban settings.

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