Untangling the role of diet quality and other risk factors in the severity of metabolic syndrome: Insights from the Hoveyzeh Cohort study using structural equation modeling

Authors

Farnush Bakhshimoghaddam 1, Elham Maraghi 2, Ali Mohammad Hadianfard 3, Bahman Cheraghian 4, Sima Jafarirad 5

  1. Nutrition and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
  2. Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address: maraghi-e@ajums.ac.ir.
  3. Department of Health Information Technology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran. Electronic address: hadianfard-a@ajums.ac.ir.
  4. Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address: cheraghian-b@ajums.ac.ir.
  5. Nutrition and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Abstract

Aims: In this study, we aim to employ structural equation modeling (SEM) to assess the relationships between adherence to diet quality scores, such as the Dietary Diversity Score (DDS), Paleolithic Diet Score (PDS), and EAT-Lancet Diet Score, and other risk factors, including, demographic, socio-economic, behavioral, and clinical characteristics, with MetS severity.

Methods: This cross-sectional study involved 8,086 participants from the Hoveyzeh Cohort Study (3,486 males and 4,600 females). Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire, which was also used to calculate energy-adjusted diet scores. Anthropometric, biochemical, and blood pressure measurements were evaluated following standardized protocols. The interrelationships between risk factors and MetS severity were analyzed using SEM.

Results: The models indicated that the DDS had a statistically significant association with MetS severity through direct effects (βFemales = -0.04; βMales = -0.04) and indirect effects (βFemales = -0.06; βMales = -0.09). Similarly, the PDS showed a statistically significant inverse relationship with MetS severity, including direct effects (βFemales = -0.03; βMales = -0.02) and indirect effects (βFemales = -0.05; βMales = -0.07). In contrast, the EAT-Lancet Diet Score demonstrated a statistically significant inverse association with MetS severity only through indirect effects (βFemales = -0.04; βMales = -0.03).

Conclusion: The findings emphasize that improving diet quality as a means of managing modifiable risk factors may reduce MetS severity.

Keywords: Cohort study; Conceptual model; Diet quality; Metabolic syndrome; Structural equation modeling.

How to Cite

Bakhshimoghaddam F, Maraghi E, Hadianfard AM, Cheraghian B, Jafarirad S. Untangling the role of diet quality and other risk factors in the severity of metabolic syndrome: Insights from the Hoveyzeh Cohort study using structural equation modeling. Diabetes Res Clin Pract. 2025 Aug 25;228:112436. doi: 10.1016/j.diabres.2025.112436. Epub ahead of print. PMID: 40865881.

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Untangling the role of diet quality and other risk factors in the severity of metabolic syndrome: Insights from the Hoveyzeh Cohort study using structural equation modeling

Tags: Cohort Study, Conceptual model, Diet quality, Metabolic Syndrome, Structural equation modeling, The Hoveyzeh cohort study