Association of World Index for Sustainability and Health Score with metabolic syndrome in Iranian adults from the PERSIAN Dena cohort study

Metabolic syndrome (MetS) affects 20-25% of adults worldwide, with a concerning prevalence of approximately 32% observed in Iran. While various dietary patterns have been linked to MetS, the association between sustainable diets and MetS remains underexplored. This study investigates the association between the World Index for Sustainability and Health (WISH) score and MetS among Iranian adults. In this cross-sectional study, 2971 adults aged 35 to 70 years were selected from the PERSIAN Dena Cohort data. Dietary intake was assessed using validated food frequency questionnaires (FFQs). The WISH score was calculated based on thirteen food items, taking into account both health and environmental sustainability. In this study, the criteria established by the National Cholesterol Education Program (NCEP ATP III) were used to define the MetS. Individuals with the highest WISH score had 48% lower odds of having metabolic syndrome compared with those with the lowest score (adjusted OR 0.52; 95% CI 0.30-0.89). The odds of having MetS (P for trend = 0.002) and certain components, such as abdominal adiposity (P for trend = 0.001), abnormal glucose homeostasis (P for trend < 0.001), and elevated serum triglycerides (P for trend = 0.030), decrease with increasing quartiles of WISH after controlling for potential confounders.Higher adherence to environmentally sustainable and healthy dietary patterns, as measured by WISH scores, is associated with lower odds of MetS among Iranian adults. These findings underscore the importance of promoting sustainable diets for both human health and environmental benefits.