A healthy lifestyle education intervention for metabolic syndrome risk reduction among office workers in Ethiopia: a single-blind, randomised controlled trial

The increasing prevalence of metabolic syndrome among office workers in Ethiopia underscores the urgent need for tailored health interventions. This study aimed to implement a healthy lifestyle education intervention designed to reduce the prevalence of metabolic syndrome and evaluate changes in participants' knowledge and attitudes regarding metabolic syndrome, cardiovascular diseases, and risk factors, as well as improvements in healthy lifestyle practices. This 9-month institution-based, single-masked, cluster-randomised controlled trial was conducted among bank employees in Bahir Dar. A total of 226 participants were screened based on waist circumference and blood pressure. The intervention was a personalised educational program focused on lifestyle modifications, delivered by health promotion experts, while the control group received general health advice based on the guidelines on clinical and programmatic management of major NCDs. Outcomes were assessed at baseline and after 9 months, with 207 participants included in the final analysis using an intention-to-treat approach, and generalised estimating equations to assess the intervention's effect between groups. The intervention group exhibited significant improvements, with decreases in waist circumference (5.33 cm), systolic blood pressure (6.96 mmHg), diastolic blood pressure (4·21 mmHg), total cholesterol (34.12 mg/dL), and low- density lipoprotein cholesterol (20·68 mg/dl) (all p < 0.0001). Knowledge scores increased by 7.29 points, fruit intake rose from 0.74 to 1.21 portions, and vegetable intake grew from 1.10 to 1.77 portions. Participation in moderate exercise rose from 29.52% to 53.33%. In contrast, the control group showed modest improvements in some components of metabolic syndrome risk factors. However, there were no significant changes in triglycerides, fasting blood glucose, and stress management, while high density lipoprotein cholesterol levels unfavorably declined in both groups. This study highlighted the impact of a tailored workplace-based healthy lifestyle education intervention on lifestyle behaviors and metabolic syndrome risk factors. The intervention led to positive changes in several behaviors and reduced some risk factors. However, it did not significantly improve triglyceride and fasting blood glucose levels, and there was an unexpected decrease in high density lipoprotein cholesterol. This unexpected decrease of high-density lipoprotein cholesterol may result from lifestyle shifts, including reduced fatty diet intake and rapid weight loss, and other metabolic adaptation process. Future research should focus on targeted strategies and long-term interventions to address these unexpected outcomes.Trial registration: ACTRN12623000409673p, registered April 24, 2023 and is completed.