Understanding socioeconomic differences in metabolic syndrome remission among adults: what is the mediating role of health behaviors?

Liza A. Hoveling*, Aart C. Liefbroer, Ute Bültmann, Nynke Smidt

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Background: Although the incidence of metabolic syndrome (MetS) strongly varies based on individuals’ socioeconomic position (SEP), as yet no studies have examined the SEP-MetS remission relationship. Our aim is to longitudinally assess the associations between SEP measures education, income and occupational prestige, and MetS remission, and whether these associations are mediated by health behaviors, including physical activity, smoking, alcohol intake and diet quality. Methods: A subsample (n = 16,818) of the adult Lifelines Cohort Study with MetS at baseline was used. MetS remission was measured upon second assessment (median follow-up time 3.8 years), defined according to NCEP-ATPIII criteria. To estimate direct associations between SEP, health behaviors and MetS remission multivariable logistic regression analyses were used. To estimate the mediating percentages of health behaviors that explain the SEP-MetS remission relationship the Karlson-Holm-Breen method was used. Analyses were adjusted for age, sex, the other SEP measures and follow-up time. Results: At the second assessment, 42.7% of the participants experienced MetS remission. Education and income were positively associated with MetS remission, but occupational prestige was not. The association between education and MetS remission could partly (11.9%) be explained by health behaviors, but not the association between income and MetS remission. Conclusions: Individuals with higher education more often experienced remission from MetS, mainly because individuals with higher education were more likely to have healthier behaviors. However, individuals with higher income more often experienced MetS remissions, regardless of their health behaviors. The occupational prestige of individuals was not associated with MetS remission.

Original languageEnglish
Article number147
Pages (from-to)1-10
Number of pages10
JournalInternational Journal of Behavioral Nutrition and Physical Activity
Early online date9 Nov 2021
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
This work was supported by The Netherlands Organization for Health Research and Development (ZonMw) [grant number 531003011]. ZonMw had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Funding Information:
We wish to acknowledge the services of the Lifelines Cohort Study, the contributing research centers delivering data to Lifelines, and all study participants. The Lifelines Biobank initiative was made possible by subsidy from the Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Economic Affairs, the University Medical Center Groningen (UMCG the Netherlands), University Groningen and the northern provinces of the Netherlands.

Publisher Copyright:
© 2021, The Author(s).


  • Alcohol drinking
  • Diet
  • Longitudinal studies
  • Mediation
  • Metabolic syndrome
  • Physical activity
  • Smoking
  • Socioeconomic factors


Dive into the research topics of 'Understanding socioeconomic differences in metabolic syndrome remission among adults: what is the mediating role of health behaviors?'. Together they form a unique fingerprint.

Cite this