Physical activity reduces but does not fully counteract the detrimental associations between alcohol use and metabolic syndrome

BACKGROUND: This cross-sectional study investigated the main and interacting associations of physical activity (PA) and alcohol use with the number of metabolic syndrome (MetS) risk factors and odds of MetS. METHODS: We used 2011-2014 (N = 3227) and 2015-2020 (N = 5586) National Health and Nutrition Examination Survey data for adults (20-80 years). We categorized participants into quartiles for device-based PA (2011-2014) and meeting or not meeting recommendations (≥150 vs <150 min of PA/week) for self-reported PA (2015-2020). We calculated average self-reported drinks/day. MetS risk factors were: (1) waist circumference ≥88/≥102 cm for females/males; (2) triglycerides ≥150 mg/dl; (3) blood pressure ≥130 mm Hg/≥85 mm Hg; (4) fasting glucose ≥100 mg/dl; and (5) high-density lipoprotein cholesterol (HDL-C) <50/<40 mg/dl for females/males. We categorized participants with MetS if they had ≥3 risk factors. We examined the direct and moderating associations of PA and alcohol use with number of MetS risk factors and odds of MetS. RESULTS: Compared to Q1, adults in Q2-Q4 had fewer MetS risk factors (Q2: incidence rate ratio [IRR] = 0.90, 95% confidence interval [CI]: 0.84, 0.97; Q3: IRR = 0.80, 95% CI: 0.74, 0.87; Q4: IRR = 0.73, 95% CI: 0.67, 0.80). Compared to Q1, adults in Q3 and Q4 had lower odds of MetS when consuming ≤0.50 drinks/day (odds ratio [OR] = 0.44, 95%CI: 0.30, 0.64) or ≤0.75 drinks/day (OR = 0.43, 95%CI: 0.30, 0.60), respectively. Meeting PA recommendations was associated with fewer risk factors (IRR = 0.90, 95%CI: 0.84, 0.96). CIs were wide for some estimates due to sparsity of data at higher alcohol levels. CONCLUSIONS: Adults should consider engaging in more PA and limiting their alcohol use to reduce risk factors and overall MetS risk.