The Predictive Ability and Trend of Continuous Metabolic Syndrome (cMets) Score as a Marker for the Presence of Metabolic Syndrome among Iranian Adults from 2007 to 2025 Using STEPS Studies.

BACKGROUND: This study aimed to establish a nationally representative Continuous Metabolic Syndrome (cMetS) sample of Iranian adults, validate its predictive ability for MetS components, determine age- and gender-specific cutoff points, and assess 15-year trends. METHODS: This secondary analytical cross-sectional study utilized data from the nationally representative four WHO STEPS surveys (2005-2021) among adults aged 25-60 with complete metabolic measurements. cMetS was calculated by combining residuals of waist circumference, mean arterial pressure, glucose, high-density lipoprotein-cholesterol, and triglycerides. A lower cMetS score suggests a more favorable metabolic profile. Optimal cutoff points for cMetS were determined using receiver operator characteristic curve analysis. To assess the validity of our cutoff, we conducted two distinct phases. In addition, a generalized additive model predicted cMetS values until 2025. RESULTS: Among 18030 adults, 8419 (46.7%) had MetS in 2021. The overall cMetS cutoff point for predicting the presence of MetS was 0.47 with sensitivity 80.09% (79.39-80.79), specificity 81.94% (81.27-82.61), and AUC 89.20% (88.65-89.75). In 2020, the overall cMetS score for both genders was 0.22 (95% Prediction Interval [PI]: 0.20-0.24), with men having a higher score of 0.34 (95% PI: 0.3-0.37) compared to women at 0.13 (95% PI: 0.11-0.15). Projections indicate that the overall cMetS score is expected to decrease to 0.2 (95% PI: 0.15-0.25) by 2025. The 15-year trend of cMetS scores indicated a declining pattern. CONCLUSIONS: This comprehensive study across the nation affirmed the reliability of the cMetS score within a sample of Iranian adults based on population data and is significant for its provision of a nationally representative viewpoint on the adult population of Iran, introducing a novel approach for assessing trends in cMetS scores.