{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:00:36Z","timestamp":1786114836516,"version":"build-2736575974"},"reference-count":79,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72204143"],"award-info":[{"award-number":["72204143"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Natural Science Foundation of Shandong Province of China","award":["ZR2022QG081"],"award-info":[{"award-number":["ZR2022QG081"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,7,1]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Metabolic syndrome (MetS) poses a major public health challenge. This study examined how social environments and their interactions with lifestyle behaviours influence mortality, life expectancy and disease risks in adults with MetS from the UK and USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults with MetS were identified from the UK Biobank (2006\u20132010, n=60\u2009423; mean follow-up 12.8 years) and US National Health and Nutrition Examination Survey (NHANES) (1999\u20132018, n=11\u2009170; mean follow-up 8.0 years). Weighted scores for social environment (socioeconomic status, social capital, healthcare access, built environment) and healthy lifestyle (smoking, alcohol, physical activity, diet) were categorised into tertiles. Primary outcomes were all-cause and cause-specific mortality (cardiovascular disease (CVD), cerebrovascular disease (CBVD), chronic kidney disease (CKD)) in both cohorts and incident diseases in UK Biobank. Cox regression assessed associations and interactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Unfavourable (vs favourable) social environments were associated with higher all-cause mortality in UK Biobank (HR 1.72, 95%\u2009CI 1.62 to 1.83)\u2009and NHANES (HR 2.30, 95%\u2009CI 1.95 to 2.71), with consistent patterns for CVD, CBVD and CKD outcomes. Life expectancy at age 45 was reduced by 3.49 (95% CI 3.40 to 3.57) years (UK Biobank) and 7.81 (95% CI 7.56 to 8.07) years (NHANES). Social environments contributed substantially to mortality burden (population attributable fraction: 17.0% and 24.1%, respectively), largely driven by socioeconomic status and social capital. Significant interactions showed that healthy lifestyles conferred stronger protection in unfavourable environments. Joint exposure to unfavourable environment and unhealthy lifestyle markedly increased mortality risk (HRs 2.5\u20133.5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Unfavourable social environments consistently predict adverse outcomes in MetS across contexts. Their synergy with lifestyle behaviours underscores the need for integrated interventions addressing both environmental and behavioural factors, especially in disadvantaged populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004599","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T21:49:58Z","timestamp":1785966598000},"page":"e004599","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Social environments and lifestyles linked to mortality and future health risks in metabolic syndrome: evidence from UK and US nationwide cohort studies"],"prefix":"10.1136","volume":"4","author":[{"given":"Qiuyue","family":"Dong","sequence":"first","affiliation":[{"name":"School of Public Health, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengyue","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Social Security, School of Health Policy and Management, Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alimu","family":"Dayimu","sequence":"additional","affiliation":[{"name":"Cambridge Clinical Trials Unit Cancer Theme, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiantian","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China"},{"name":"Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YiLin","family":"Gai","sequence":"additional","affiliation":[{"name":"School of Public Health, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0542-4641","authenticated-orcid":false,"given":"Yunfei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanquan","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong"},{"name":"Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6167-2191","authenticated-orcid":false,"given":"Fan","family":"Jiang","sequence":"additional","affiliation":[{"name":"School of Public Health, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, China"},{"name":"Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health Professions; Global Health Institute, Marshall University, Huntington, West Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"2026080505001769000_4.3.e004599.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67402-8"},{"key":"2026080505001769000_4.3.e004599.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.09.032"},{"key":"2026080505001769000_4.3.e004599.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2012.05.018"},{"key":"2026080505001769000_4.3.e004599.4","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-140-3-200402030-00007"},{"key":"2026080505001769000_4.3.e004599.5","doi-asserted-by":"publisher","DOI":"10.1093\/postmj\/qgad008"},{"key":"2026080505001769000_4.3.e004599.6","unstructured":"Metabolic syndrome. 2025 Available: https:\/\/www.heartuk.org.uk\/genetic-conditions\/metabolic-syndrome"},{"key":"2026080505001769000_4.3.e004599.7","doi-asserted-by":"crossref","DOI":"10.1007\/s11906-018-0812-z","article-title":"The Global Epidemic of the Metabolic Syndrome","volume":"20","author":"Saklayen","year":"2018","journal-title":"Curr Hypertens Rep"},{"key":"2026080505001769000_4.3.e004599.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12940-022-00894-4","article-title":"The neighbourhood environment and profiles of the metabolic syndrome","volume":"21","author":"Barnett","year":"2022","journal-title":"Environ Health"},{"key":"2026080505001769000_4.3.e004599.9","first-page":"1751","article-title":"Social determinants of health and metabolic syndrome in Colombian older adults","volume":"34","author":"Reyes-Ortiz","year":"2024","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"2026080505001769000_4.3.e004599.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjdrc-2020-001272","article-title":"Associations between social network properties and metabolic syndrome and the mediating effect of physical activity: findings from the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort","volume":"8","author":"Kim","year":"2020","journal-title":"BMJ Open Diabetes Res Care"},{"key":"2026080505001769000_4.3.e004599.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-022-12684-1","article-title":"Socioeconomic differences in metabolic syndrome development: examining the mediating role of chronic stress using the Lifelines Cohort Study","volume":"22","author":"Hoveling","year":"2022","journal-title":"BMC Public Health"},{"key":"2026080505001769000_4.3.e004599.12","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1016\/j.dsx.2019.04.003","article-title":"Socio-economics status and metabolic syndrome: A meta-analysis","volume":"13","author":"Blanquet","year":"2019","journal-title":"Diabetes Metab Syndr"},{"key":"2026080505001769000_4.3.e004599.13","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.35783","article-title":"Social and Environmental Determinants of Health and Cardio-Kidney-Metabolic Syndrome-Related Mortality","volume":"7","author":"Vieira de Oliveira Salerno","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026080505001769000_4.3.e004599.14","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.124.034996","article-title":"Social Risk Profile and Cardiovascular\u2010Kidney\u2010Metabolic Syndrome in US Adults","volume":"13","author":"Li","year":"2024","journal-title":"JAHA"},{"key":"2026080505001769000_4.3.e004599.15","doi-asserted-by":"crossref","DOI":"10.1007\/s11886-025-02336-2","article-title":"Social Determinants of Cardiovascular Health: Yes, They Matter-But What Can We Do to Address Them?","volume":"28","author":"Metlock","year":"2026","journal-title":"Curr Cardiol Rep"},{"key":"2026080505001769000_4.3.e004599.16","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.45309","article-title":"Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages by Social Determinants of Health","volume":"7","author":"Zhu","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026080505001769000_4.3.e004599.17","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-022-00746-8"},{"key":"2026080505001769000_4.3.e004599.18","doi-asserted-by":"crossref","first-page":"258","DOI":"10.2337\/dci20-0053","article-title":"Social Determinants of Health and Diabetes: A Scientific Review","volume":"44","author":"Hill-Briggs","year":"2020","journal-title":"Diabetes Care"},{"key":"2026080505001769000_4.3.e004599.19","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1007\/s11606-019-04832-y","article-title":"The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis","volume":"34","author":"Marciano","year":"2019","journal-title":"J Gen Intern Med"},{"key":"2026080505001769000_4.3.e004599.20","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1186\/s12967-023-04062-1","article-title":"Emerging healthy lifestyle factors and all-cause mortality among people with metabolic syndrome and metabolic syndrome-like characteristics in NHANES","volume":"21","author":"Niu","year":"2023","journal-title":"J Transl Med"},{"key":"2026080505001769000_4.3.e004599.21","doi-asserted-by":"crossref","DOI":"10.1186\/1741-7015-10-138","article-title":"Effects of lifestyle modification on metabolic syndrome: a systematic review and meta-analysis","volume":"10","author":"Yamaoka","year":"2012","journal-title":"BMC Med"},{"key":"2026080505001769000_4.3.e004599.22","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001779","article-title":"UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age","volume":"12","author":"Sudlow","year":"2015","journal-title":"PLoS Med"},{"key":"2026080505001769000_4.3.e004599.23","unstructured":"National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC) . Data from: the national health and nutrition examination survey. US Department of Health and Human Services, Centers for Disease Control and Prevention; 2015. Available: https:\/\/www.cdc.gov\/nchs\/nhanes\/index.html"},{"key":"2026080505001769000_4.3.e004599.24","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13439"},{"key":"2026080505001769000_4.3.e004599.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2023.11.019"},{"key":"2026080505001769000_4.3.e004599.26","doi-asserted-by":"crossref","first-page":"1410871","DOI":"10.3389\/fimmu.2024.1410871","article-title":"Association of inflammatory score with all-cause and cardiovascular mortality in patients with metabolic syndrome: NHANES longitudinal cohort study","volume":"15","author":"Chen","year":"2024","journal-title":"Front Immunol"},{"key":"2026080505001769000_4.3.e004599.27","doi-asserted-by":"crossref","DOI":"10.1093\/gerona\/glae128","article-title":"Social Environment, Lifestyle, and Genetic Predisposition With Dementia Risk: A Long-Term Longitudinal Study Among Older Adults","volume":"79","author":"Chen","year":"2024","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2026080505001769000_4.3.e004599.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2012.08.007"},{"key":"2026080505001769000_4.3.e004599.29","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(23)00081-6"},{"key":"2026080505001769000_4.3.e004599.30","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.048026"},{"key":"2026080505001769000_4.3.e004599.31","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.46"},{"key":"2026080505001769000_4.3.e004599.32","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.1007\/s00125-022-05761-y","article-title":"Associations of polysocial risk score, lifestyle and genetic factors with incident type 2 diabetes: a prospective cohort study","volume":"65","author":"Zhao","year":"2022","journal-title":"Diabetologia"},{"key":"2026080505001769000_4.3.e004599.33","doi-asserted-by":"publisher","DOI":"10.1093\/nutrit\/nux014"},{"key":"2026080505001769000_4.3.e004599.34","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph19169936","article-title":"Association of a Healthy Lifestyle with All-Cause, Cause-Specific Mortality and Incident Cancer among Individuals with Metabolic Syndrome: A Prospective Cohort Study in UK Biobank","volume":"19","author":"Wu","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2026080505001769000_4.3.e004599.35","unstructured":"World Health Organization . Tackling NCDs: \u2018best buys\u2019 and other recommended interventions for the prevention and control of noncommunicable diseases. 2017. Available: https:\/\/iris.who.int\/bitstream\/handle\/10665\/259232\/WHO-NMH-NVI-17.9-eng.pdf?sequence=1&isAllowed=y"},{"key":"2026080505001769000_4.3.e004599.36","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-077310","article-title":"Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses","volume":"384","author":"Lane","year":"2024","journal-title":"BMJ"},{"key":"2026080505001769000_4.3.e004599.37","doi-asserted-by":"crossref","first-page":"968","DOI":"10.5603\/EP.a2022.0058","article-title":"Association of sleep duration and sleep quality with the risk of metabolic syndrome in adults: a systematic review and meta-analysis","volume":"73","author":"Hu","year":"2022","journal-title":"Endokrynol Pol"},{"key":"2026080505001769000_4.3.e004599.38","doi-asserted-by":"crossref","first-page":"e155","DOI":"10.1016\/S2468-2667(23)00306-7","article-title":"Effects of education on adult mortality: a global systematic review and meta-analysis","volume":"9","author":"Balaj","year":"2024","journal-title":"Lancet Public Health"},{"key":"2026080505001769000_4.3.e004599.39","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/S2213-8587(18)30288-2","article-title":"Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3\u00b76 million adults in the UK","volume":"6","author":"Bhaskaran","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026080505001769000_4.3.e004599.40","doi-asserted-by":"crossref","first-page":"103596","DOI":"10.1016\/j.eclinm.2025.103596","article-title":"Association between cardiovascular-kidney-metabolic syndrome, lifestyle, and all-cause and cause-specific mortality: a prospective cohort study","volume":"90","author":"Wang","year":"2025","journal-title":"eClinicalMedicine"},{"key":"2026080505001769000_4.3.e004599.41","doi-asserted-by":"publisher","DOI":"10.1038\/nrn3475"},{"key":"2026080505001769000_4.3.e004599.42","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.026493","article-title":"Effects of Objective and Perceived Social Isolation on Cardiovascular and Brain Health: A Scientific Statement From the American Heart Association","volume":"11","author":"Cen\u00e9","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2026080505001769000_4.3.e004599.43","doi-asserted-by":"crossref","DOI":"10.18637\/jss.v070.i08","article-title":"flexsurv: A Platform for Parametric Survival Modeling in R","volume":"70","author":"Jackson","year":"2016","journal-title":"J Stat Softw"},{"key":"2026080505001769000_4.3.e004599.44","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v045.i05"},{"key":"2026080505001769000_4.3.e004599.45","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1177\/1077558716682170","article-title":"Patients\u2019 Financially Driven Delay of GP Visits: Is It Less Likely to Occur in Stronger Primary Care Systems?","volume":"75","author":"Detollenaere","year":"2018","journal-title":"Med Care Res Rev"},{"key":"2026080505001769000_4.3.e004599.46","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1001\/jamainternmed.2014.6888","article-title":"Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the Measuring Economic Insecurity in Diabetes study","volume":"175","author":"Berkowitz","year":"2015","journal-title":"JAMA Intern Med"},{"key":"2026080505001769000_4.3.e004599.47","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181c12e53"},{"key":"2026080505001769000_4.3.e004599.48","doi-asserted-by":"crossref","first-page":"172","DOI":"10.2174\/1874944501912010172","article-title":"Determinants of Health Literacy and Healthy Lifestyle against Metabolic Syndrome among Major Ethnic Groups of Sarawak, Malaysia: A Multi-Group Path Analysis","volume":"12","author":"Froze","year":"2019","journal-title":"TOPHJ"},{"key":"2026080505001769000_4.3.e004599.49","doi-asserted-by":"crossref","DOI":"10.3390\/nu12010015","article-title":"Ethnicity and Metabolic Syndrome: Implications for Assessment, Management and Prevention","volume":"12","author":"Lear","year":"2019","journal-title":"Nutrients"},{"key":"2026080505001769000_4.3.e004599.50","doi-asserted-by":"crossref","DOI":"10.1186\/s12939-014-0119-x","article-title":"An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity","volume":"13","author":"Hankivsky","year":"2014","journal-title":"Int J Equity Health"},{"key":"2026080505001769000_4.3.e004599.51","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2008.078923"},{"key":"2026080505001769000_4.3.e004599.52","doi-asserted-by":"publisher","DOI":"10.1159\/000088705"},{"key":"2026080505001769000_4.3.e004599.53","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/NCM.0000000000000590","article-title":"Addressing Social Determinants of Health: A Care Coordination Approach for Professional Case Managers","volume":"27","author":"Campagna","year":"2022","journal-title":"Prof Case Manag"},{"key":"2026080505001769000_4.3.e004599.54","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-14-1193","article-title":"The impact of the major causes of death on life expectancy in China: a 60-year longitudinal study","volume":"14","author":"Liu","year":"2014","journal-title":"BMC Public Health"},{"key":"2026080505001769000_4.3.e004599.55","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.028926","article-title":"Lifestyle Behaviors and Cardiometabolic Diseases by Race and Ethnicity and Social Risk Factors Among US Young Adults, 2011 to 2018","volume":"12","author":"Shi","year":"2023","journal-title":"JAHA"},{"key":"2026080505001769000_4.3.e004599.56","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-316250"},{"key":"2026080505001769000_4.3.e004599.57","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2004.06.050"},{"key":"2026080505001769000_4.3.e004599.58","doi-asserted-by":"crossref","DOI":"10.3402\/gha.v8.28865","article-title":"Explaining the role of the social determinants of health on health inequality in South Africa","volume":"8","author":"Ataguba","year":"2015","journal-title":"Glob Health Action"},{"key":"2026080505001769000_4.3.e004599.59","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.socscimed.2013.12.018","article-title":"Social capital, mental health and biomarkers in Chile: assessing the effects of social capital in a middle-income country","volume":"105","author":"Riumallo-Herl","year":"2014","journal-title":"Soc Sci Med"},{"key":"2026080505001769000_4.3.e004599.60","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-17361-2"},{"key":"2026080505001769000_4.3.e004599.61","doi-asserted-by":"crossref","DOI":"10.1155\/2013\/516475","article-title":"Association between Lifestyle Factors and Metabolic Syndrome among African Americans in the United States","volume":"2013","author":"Bhanushali","year":"2013","journal-title":"J Nutr Metab"},{"key":"2026080505001769000_4.3.e004599.62","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/1478-7547-11-19","article-title":"Heterogeneity in cost-effectiveness of lifestyle counseling for metabolic syndrome risk groups -primary care patients in Sweden","volume":"11","author":"Feldman","year":"2013","journal-title":"Cost Eff Resour Alloc"},{"key":"2026080505001769000_4.3.e004599.63","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(18)30200-7"},{"key":"2026080505001769000_4.3.e004599.64","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-11014-1","article-title":"Socioeconomic inequalities in lifestyle risk factors across low- and middle-income countries","volume":"21","author":"Dieteren","year":"2021","journal-title":"BMC Public Health"},{"key":"2026080505001769000_4.3.e004599.65","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1089\/met.2016.0113","article-title":"Effectiveness of a Community-Based Physical Activity and Nutrition Behavior Intervention on Features of the Metabolic Syndrome: A Cluster-Randomized Controlled Trial","volume":"15","author":"Tran","year":"2017","journal-title":"Metab Syndr Relat Disord"},{"key":"2026080505001769000_4.3.e004599.66","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2010.07.001"},{"key":"2026080505001769000_4.3.e004599.67","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-007-9171-9"},{"key":"2026080505001769000_4.3.e004599.68","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e31817b8ee4"},{"key":"2026080505001769000_4.3.e004599.69","doi-asserted-by":"publisher","DOI":"10.3945\/an.115.009415"},{"key":"2026080505001769000_4.3.e004599.70","doi-asserted-by":"crossref","DOI":"10.1186\/s12966-017-0613-9","article-title":"Systematic literature review of built environment effects on physical activity and active transport - an update and new findings on health equity","volume":"14","author":"Smith","year":"2017","journal-title":"Int J Behav Nutr Phys Act"},{"key":"2026080505001769000_4.3.e004599.71","doi-asserted-by":"crossref","first-page":"79","DOI":"10.7705\/biomedica.6113","article-title":"Built environment interventions and physical activity levels: A systematic review","volume":"42","author":"Barradas","year":"2022","journal-title":"Biomedica"},{"key":"2026080505001769000_4.3.e004599.72","doi-asserted-by":"crossref","DOI":"10.1111\/obr.13171","article-title":"Associations between the built environment and dietary intake, physical activity, and obesity: A scoping review of reviews","volume":"22","author":"Dixon","year":"2021","journal-title":"Obes Rev"},{"key":"2026080505001769000_4.3.e004599.73","doi-asserted-by":"crossref","DOI":"10.3390\/nu13030723","article-title":"Identifying Clusters of Adherence to Cardiovascular Risk Reduction Behaviors and Persistence with Medication in New Lipid-Lowering Drug Users. Impact on Healthcare Utilization","volume":"13","author":"Malo","year":"2021","journal-title":"Nutrients"},{"key":"2026080505001769000_4.3.e004599.74","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-017-4883-6","article-title":"Social capital and health in China: exploring the mediating role of lifestyle","volume":"17","author":"Xue","year":"2017","journal-title":"BMC Public Health"},{"key":"2026080505001769000_4.3.e004599.75","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811408482"},{"key":"2026080505001769000_4.3.e004599.76","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-013806","article-title":"Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews","volume":"6","author":"Howells","year":"2016","journal-title":"BMJ Open"},{"key":"2026080505001769000_4.3.e004599.77","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ypmed.2016.09.009","article-title":"The context of context: Examining the associations between healthy and unhealthy measures of neighborhood food, physical activity, and social environments","volume":"93","author":"Myers","year":"2016","journal-title":"Prev Med"},{"key":"2026080505001769000_4.3.e004599.78","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-0733"},{"key":"2026080505001769000_4.3.e004599.79","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.conctc.2016.05.004","article-title":"Lifestyle modification intervention for overweight and obese Hispanic pregnant women: development, implementation, lessons learned and future applications","volume":"3","author":"Torres","year":"2016","journal-title":"Contemp Clin Trials Commun"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-004599","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T21:50:06Z","timestamp":1785966606000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-004599"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":79,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,8,5]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjph-2025-004599"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-004599","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}