Leisure-Time Physical Activity, Sedentary Behaviour and Diet Quality are Associated with Metabolic Syndrome Severity: The PREDIMED-Plus Study
Authors: Gallardo-Alfaro Laura , Bibiloni Maria del Mar , Mascaró Catalina M. , Montemayor Sofía , Ruiz-Canela Miguel , Salas-Salvadó Jordi , Corella Dolores , Fitó Montserrat , Romaguera Dora , Vioque Jesús , Alonso-Gómez Ángel M. , Wärnberg Julia , Martínez J. Alfredo , Serra-Majem Lluís , Estruch Ramon , Fernández-García José Carlos , Lapetra José , Pintó Xavier , García Ríos Antonio , Bueno-Cavanillas Aurora , Gaforio José J. , Matía-Martín Pilar , Daimiel Lidia , Micó-Pérez Rafael M. , Vidal Josep , Vázquez Clotilde , Ros Emilio , Fernandez-Lázaro Cesar Ignacio , Becerra-Tomás Nerea , Gimenez-Alba Ignacio Manuel , Zomeño María Dolors , Konieczna Jadwiga , Compañ-Gabucio Laura , Tojal-Sierra Lucas , Pérez-López Jéssica , Zulet M. Ángeles , Casañas-Quintana Tamara , Castro-Barquero Sara , Gómez-Pérez Ana María , Santos-Lozano José Manuel , Galera Ana , Basterra-Gortari F. Javier , Basora Josep , Saiz Carmen , Pérez-Vega Karla Alejandra , Galmés-Panadés Aina M. , Tercero-Maciá Cristina , Sorto-Sánchez Carolina , Sayón-Orea Carmen , García-Gavilán Jesús , Muñoz-Martínez Júlia , Tur Josep A. 
Published: April 2020

Healthy lifestyle factors, such as physical activity (PA) and Mediterranean diet (MD), decrease the likelihood of developing metabolic syndrome (MetS). The aim of this study was to report main lifestyle components and related factors according to the MetS severity. Cross-sectional analysis was done of baseline lifestyle factors from 5739 participants with overweight/obesity and MetS features (aged 55–75 years) included in the PREDIMED-PLUS primary cardiovascular prevention randomized trial. Participants were categorized in tertiles according to a validated MetS severity score (MetSSS). Anthropometrics, visceral adiposity index, dietary nutrient intake, biochemical marker levels, as well as a Dietary Inflammatory Index and depression symptoms (Beck Depression Inventory-II) were measured. Diet quality was assessed using a 17-item energy-restricted MD questionnaire. Duration and intensity of PA was self-reported using the Minnesota-REGICOR Short Physical Activity Questionnaire. Sedentary behaviours were measured using the Spanish version of the Nurses’ Health Study questionnaire. The 30 s chair stand test was also assessed. Participants with highest MetSSS showed higher values of cardiovascular risk factors (except for total cholesterol and LDL cholesterol), depression risk, sedentary and TV viewing time, and lower moderate and vigorous leisure-time physical activity (LTPA). Highest MetSSS participants tended to a pro-inflammatory dietary pattern and tended to lower MD adherence. In addition, they showed lower carbohydrate and nut intake and higher intake of protein, saturated and trans fatty acids, cholesterol, iodine, sodium, red and processed meat products, other oils different from olive oil and spirit alcoholic drinks. The highest MetS severity score was associated with lower moderate and vigorous LTPA and higher sedentary time and depression risk, as they tended to a pro-inflammatory dietary pattern and lower MD adherence.