The Role of Lifestyle Behaviors in the Association Between Behavioral Procrastination and Metabolic Syndrome: A Cross-Sectional Study of 92,184 Workers

Background: Procrastination has been associated with unfavorable health behaviors and poorer health outcomes, but the extent to which lifestyle-related characteristics statistically overlap with the association between procrastination and metabolic syndrome (MetS) remains unclear. This study examined the cross-sectional association between operational Pure Procrastination Scale-9 (PPS-9) categories and MetS and quantified changes in this association after incorporation of physical activity, Mediterranean diet adherence, and smoking. Methods: A cross-sectional study was conducted among 92,184 Spanish workers aged 18–69 years undergoing occupational health examinations between 2021 and 2024. Participants were classified into four operational, non-clinical PPS-9 categories: very low/absent, moderate, high, and very high. MetS was primarily defined according to Joint Interim Statement criteria. Sequential logistic regression models were adjusted for age, sex, education, social class, physical activity, Mediterranean diet adherence, and current smoking. Statistical attenuation was calculated on the log-odds scale relative to the sociodemographic-adjusted model. Interaction and sensitivity analyses were also performed. Results: MetS prevalence increased progressively across operational PPS-9 categories, from 0.4% in the very low/absent category to 5.2%, 16.7%, and 37.3% in the moderate, high, and very high categories, respectively. Higher PPS-9 categories were also associated with markedly lower physical activity and Mediterranean diet adherence. After adjustment for age, sex, education, and social class, higher operational PPS-9 categories remained associated with greater odds of prevalent MetS. However, the magnitude of the odds ratios was influenced by the exceptionally low MetS prevalence in the reference category, and these estimates should not be interpreted as prevalence ratios. Marginally standardized analyses showed that adjustment for physical activity and Mediterranean diet adherence reduced absolute risk differences between PPS-9 categories, with larger reductions following adjustment for physical activity. In the fully adjusted model, absolute risk differences relative to the very low/absent category were 3.76, 10.95, and 22.31 percentage points for the moderate, high, and very high categories, respectively. These findings were consistent with the descriptive pattern of the sequential logistic models, while avoiding reliance solely on changes in logistic regression coefficients. Significant statistical interactions were observed for physical activity and Mediterranean diet adherence. The graded association remained consistent across multiple sensitivity analyses. Conclusions: Higher operational PPS-9 categories were strongly associated with less favorable lifestyle profiles and a higher prevalence of MetS in this large occupational population. Physical activity and Mediterranean diet adherence showed substantial statistical overlap with the PPS-9–MetS association, although a graded association remained after multivariable adjustment. These cross-sectional findings do not establish temporal, mediational, or causal relationships and warrant confirmation in longitudinal studies.