{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:03:01Z","timestamp":1787022181049,"version":"build-2736575974"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Non-Communicable diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran","award":["1401-4-221-63616"],"award-info":[{"award-number":["1401-4-221-63616"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prevalence of Metabolic Syndrome (MetS) increases with aging, significantly contributing to the rising burden of non-communicable diseases (NCDs). This study aimed to investigate over-time changes in the prevalence of MetS and its components among the elderly population of Iran.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from the 2016 and 2021 national STEPwise approach to non-communicable disease risk factor Surveillance (STEPS) for participants aged \u226565 who completed all three survey steps (questionnaire-based assessments, physical measurements, and laboratory tests) with no missing data on MetS components. According to the STEPS protocol, individuals with severe mental disorders, physical limitations that prevented measurements, or inability to provide laboratory samples were excluded. Using survey analysis techniques and weights, we ensured the findings are nationally representative. MetS was defined using the following criteria: National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII), International Diabetes Federation (IDF), American Heart Association\/National Heart, Lung, and Blood Institute (AHA\/NHLBI), and Joint Interim Statement (JIS). Regional IDF (RIDF) and regional JIS (RJIS) were defined by ethnicity-specific values of waist circumference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study included 4,000 elderly participants in 2016 and 3,849 in 2021, with a mean age of 74 and 72 years, respectively. Approximately 50% were female in both years, and the proportion of urban residents increased from 67% in 2016 to 75% in 2021. The national prevalence of MetS among the elderly increased significantly from 46.11%\u221266.38% in 2016 to 54.15%\u221273.98% in 2021 across different criteria, with an annual percent change of 2.19%\u22123.26%. Prevalence was higher in females and urban populations, while males showed a greater increase. High blood pressure, low high-density lipoprotein cholesterol, and central obesity were the most common components of MetS, while elevated triglycerides and high fasting plasma glucose showed the largest increases over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The escalating prevalence of MetS in the elderly is a matter of increasing concern, underscoring the need for targeted policy interventions aimed at promoting healthy aging, empowering the elderly, and advocating for lifestyle modifications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0331601","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T17:46:17Z","timestamp":1757526377000},"page":"e0331601","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Over-time changes in the prevalence of metabolic syndrome and its components among elderly population in Iran from 2016 to 2021; A nation-wide study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8288-4046","authenticated-orcid":true,"given":"Seyed Mohammad-Navid","family":"Ataei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Sheidaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Golestani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sepehr","family":"Khosravi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7460-6000","authenticated-orcid":true,"given":"Mohammad-Mahdi","family":"Rashidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0188-9721","authenticated-orcid":true,"given":"Ozra","family":"Tabatabaei-Malazy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8453-8446","authenticated-orcid":true,"given":"Rosa","family":"Haghshenas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazem","family":"Khalagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5386-7597","authenticated-orcid":true,"given":"Bagher","family":"Larijani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"pone.0331601.ref001","unstructured":"Noncommunicable diseases: World Health Organization. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/noncommunicable-diseases"},{"key":"pone.0331601.ref002","doi-asserted-by":"crossref","first-page":"1253506","DOI":"10.3389\/fpubh.2023.1253506","article-title":"Metabolic diseases and healthy aging: identifying environmental and behavioral risk factors and promoting public health","volume":"11","author":"K Zhang","year":"2023","journal-title":"Front Public Health"},{"issue":"1","key":"pone.0331601.ref003","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1089\/met.2016.0082","article-title":"Metabolic syndrome development during aging with special reference to obesity without the metabolic syndrome","volume":"15","author":"V Roos","year":"2017","journal-title":"Metabol Syndr Relat Disord"},{"issue":"10440","key":"pone.0331601.ref004","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1016\/S0140-6736(24)00933-4","article-title":"Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"403","author":"GBD 2021 Risk Factors Collaborators.","year":"2024","journal-title":"Lancet"},{"issue":"3","key":"pone.0331601.ref005","article-title":"The global burden of metabolic disease: data from 2000 to 2019","volume":"35","author":"NWS Chew","year":"2023","journal-title":"Cell Metab"},{"issue":"10397","key":"pone.0331601.ref006","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021","volume":"402","author":"GBD 2021 Diabetes Collaborators.","year":"2023","journal-title":"Lancet"},{"key":"pone.0331601.ref007","doi-asserted-by":"crossref","first-page":"109924","DOI":"10.1016\/j.diabres.2022.109924","article-title":"Geographic distribution of metabolic syndrome and its components in the general adult population: a meta-analysis of global data from 28 million individuals","volume":"188","author":"JJ Noubiap","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"issue":"1","key":"pone.0331601.ref008","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1186\/s12877-022-03672-6","article-title":"Trends and influence factors in the prevalence, intervention, and control of metabolic syndrome among US adults, 1999-2018","volume":"22","author":"C Yang","year":"2022","journal-title":"BMC Geriatr"},{"issue":"3","key":"pone.0331601.ref009","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1089\/met.2008.0077","article-title":"Prevalence of metabolic syndrome according to Adult Treatment Panel III and International Diabetes Federation criteria: a population-based study","volume":"7","author":"A Bener","year":"2009","journal-title":"Metab Syndr Relat Disord"},{"issue":"1","key":"pone.0331601.ref010","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s13098-020-00610-7","article-title":"Metabolic syndrome amongst adults in Jordan: prevalence, trend, and its association with socio-demographic characteristics","volume":"12","author":"K Ajlouni","year":"2020","journal-title":"Diabetol Metab Syndr"},{"issue":"9","key":"pone.0331601.ref011","doi-asserted-by":"crossref","first-page":"634","DOI":"10.34172\/aim.2022.99","article-title":"Protocol design for surveillance of risk factors of non\u2013communicable diseases during the COVID-19 pandemic: an experience from Iran STEPS Survey 2021","volume":"25","author":"S Djalalinia","year":"2022","journal-title":"Arch Iran Med"},{"issue":"3","key":"pone.0331601.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0241926","article-title":"A nationwide study of metabolic syndrome prevalence in Iran; a comparative analysis of six definitions","volume":"16","author":"O Tabatabaei-Malazy","year":"2021","journal-title":"PLoS One"},{"key":"pone.0331601.ref013","unstructured":"World Health Organization. STEPwise approach to NCD risk factor surveillance (STEPS). 2023. Available from: https:\/\/www.who.int\/teams\/noncommunicable-diseases\/surveillance\/systems-tools\/steps"},{"issue":"9","key":"pone.0331601.ref014","first-page":"608","article-title":"Protocol design for large-scale cross-sectional studies of surveillance of risk factors of non-communicable diseases in Iran: STEPs 2016","volume":"20","author":"S Djalalinia","year":"2017","journal-title":"Arch Iran Med"},{"key":"pone.0331601.ref015","unstructured":"World Health Organization. STEPS Manual 2017. https:\/\/www.who.int\/teams\/noncommunicable-diseases\/surveillance\/systems-tools\/steps\/manuals"},{"issue":"25","key":"pone.0331601.ref016","doi-asserted-by":"crossref","first-page":"3143","DOI":"10.1161\/circ.106.25.3143","article-title":"Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report","volume":"106","author":"National Cholesterol Education Program","year":"2002","journal-title":"Circulation"},{"issue":"5","key":"pone.0331601.ref017","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1111\/j.1464-5491.2006.01858.x","article-title":"Metabolic syndrome--a new world-wide definition. A Consensus Statement from the International Diabetes Federation","volume":"23","author":"KGMM Alberti","year":"2006","journal-title":"Diabet Med"},{"issue":"17","key":"pone.0331601.ref018","doi-asserted-by":"crossref","first-page":"2735","DOI":"10.1161\/CIRCULATIONAHA.105.169404","article-title":"Diagnosis and management of the metabolic syndrome: an American Heart Association\/National Heart, Lung, and Blood Institute Scientific Statement","volume":"112","author":"SM Grundy","year":"2005","journal-title":"Circulation"},{"issue":"16","key":"pone.0331601.ref019","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1161\/CIRCULATIONAHA.109.192644","article-title":"Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity","volume":"120","author":"KG Alberti","year":"2009","journal-title":"Circulation"},{"issue":"5","key":"pone.0331601.ref020","first-page":"426","article-title":"Appropriate definition of metabolic syndrome among Iranian adults: report of the Iranian National Committee of Obesity","volume":"13","author":"F Azizi","year":"2010","journal-title":"Arch Iran Med"},{"issue":"1","key":"pone.0331601.ref021","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/j.dsx.2018.11.055","article-title":"Prevalence of metabolic syndrome in Iran: A meta-analysis of 69 studies","volume":"13","author":"K Kalan Farmanfarma","year":"2019","journal-title":"Diabetes Metab Syndr"},{"key":"pone.0331601.ref022","unstructured":"World Bank Group. Population ages 65 and above, total - Iran, Islamic Rep. 2022. Available from: https:\/\/data.worldbank.org\/indicator\/SP.POP.65UP.TO?locations=IR"},{"issue":"5","key":"pone.0331601.ref023","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1111\/1753-0407.12438","article-title":"Prevalence of metabolic syndrome in Iran: a 2011 update","volume":"9","author":"S Noshad","year":"2017","journal-title":"J Diabetes"},{"issue":"3","key":"pone.0331601.ref024","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.dsx.2017.12.023","article-title":"Metabolic syndrome prevalence in the Iranian adult\u2019s general population and its trend: a systematic review and meta-analysis of observational studies","volume":"12","author":"Y Mokhayeri","year":"2018","journal-title":"Diabetes Metab Syndr"},{"key":"pone.0331601.ref025","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2021.811006","article-title":"Prevalence of metabolic syndrome and associated risk factors in the United Arab Emirates: a cross-sectional population-based study","volume":"9","author":"I Mahmoud","year":"2022","journal-title":"Front Public Health"},{"issue":"1","key":"pone.0331601.ref026","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1186\/s12889-020-08609-5","article-title":"Prevalence of metabolic syndrome in primary health settings in Qatar: a cross sectional study","volume":"20","author":"MA Syed","year":"2020","journal-title":"BMC Public Health"},{"issue":"3","key":"pone.0331601.ref027","doi-asserted-by":"crossref","DOI":"10.1016\/j.archger.2010.11.021","article-title":"Metabolic syndrome (MS) in elderly: a cross sectional survey","volume":"53","author":"G Akbulut","year":"2011","journal-title":"Arch Gerontol Geriatr"},{"key":"pone.0331601.ref028","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1590\/0034-7167-2018-0620","article-title":"Factors associated with metabolic syndrome in older adults: a population-based study","volume":"72","author":"PAB Silva","year":"2019","journal-title":"Rev Bras Enferm"},{"key":"pone.0331601.ref029","doi-asserted-by":"crossref","unstructured":"Heidari-Foroozan M, Rezaei N, Malekpour MR, Behnoush AH, Ahmadi N, Abbasi-Kangevari M. Hypertension prevalence and cascade of care in Iran: updates from the STEPs 2021 national and subnational survey. 2024.","DOI":"10.21203\/rs.3.rs-3842876\/v1"},{"issue":"1","key":"pone.0331601.ref030","doi-asserted-by":"crossref","first-page":"15499","DOI":"10.1038\/s41598-023-42341-5","article-title":"Prevalence of plasma lipid abnormalities and associated risk factors among Iranian adults based on the findings from STEPs survey 2021","volume":"13","author":"J Khanali","year":"2023","journal-title":"Sci Rep"},{"issue":"2","key":"pone.0331601.ref031","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1007\/s40200-023-01310-5","article-title":"General and abdominal obesity trends in the Iranian adult population from 2004 to 2021","volume":"22","author":"N Efazati","year":"2023","journal-title":"J Diabetes Metab Disord"},{"issue":"2","key":"pone.0331601.ref032","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1007\/s40200-023-01308-z","article-title":"The diabetes cascade of care through the 14 years in Iran: findings of nationwide STEPS surveys 2007\u20132021","volume":"22","author":"A Ameli","year":"2023","journal-title":"J Diabetes Metab Disord"},{"issue":"8","key":"pone.0331601.ref033","article-title":"Cardiovascular risk factor burden in Africa and the Middle East: the Africa Middle East Cardiovascular Epidemiological (ACE) study","volume":"9","author":"AA Alsheikh-Ali","year":"2014","journal-title":"PLoS One"},{"issue":"4","key":"pone.0331601.ref034","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.jacl.2012.05.002","article-title":"Prevalence of lipid abnormalities in the United States: the National Health and Nutrition Examination Survey 2003-2006","volume":"6","author":"PP T\u00f3th","year":"2012","journal-title":"J Clin Lipidol"},{"issue":"10107","key":"pone.0331601.ref035","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.1016\/S0140-6736(17)32252-3","article-title":"Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study","volume":"390","author":"M Dehghan","year":"2017","journal-title":"Lancet"},{"key":"pone.0331601.ref036","first-page":"260","article-title":"Using drug sales data to evaluate the epidemiology of cardiometabolic risk factors and their inequality: an ecological study on atorvastatin and total cholesterol in Iran","volume":"29","author":"A Ahmadvand","year":"2015","journal-title":"Med J Islam Repub Iran"},{"key":"pone.0331601.ref037","doi-asserted-by":"crossref","DOI":"10.1016\/S0002-9149(98)00035-6","article-title":"Effects of statins on triglyceride metabolism","volume":"81","author":"HN Ginsberg","year":"1998","journal-title":"Am J Cardiol"},{"key":"pone.0331601.ref038","doi-asserted-by":"crossref","DOI":"10.1016\/j.ehjsup.2004.04.002","article-title":"Are the effects of statins on HDL-cholesterol clinically relevant?","volume":"6","author":"M CHAPMAN","year":"2004","journal-title":"Eur Heart J Suppl"},{"issue":"10","key":"pone.0331601.ref039","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/S2213-8587(17)30283-8","article-title":"Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study","volume":"5","author":"A Mente","year":"2017","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"pone.0331601.ref040","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12902-023-01270-0","article-title":"The association between healthy lifestyle score and risk of metabolic syndrome in Iranian adults: a cross-sectional study","volume":"23","author":"M Vajdi","year":"2023","journal-title":"BMC Endocr Disord"},{"key":"pone.0331601.ref041","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s13293-015-0033-y","article-title":"Sex differences in metabolic homeostasis, diabetes, and obesity","volume":"6","author":"F Mauvais-Jarvis","year":"2015","journal-title":"Biol Sex Differ"},{"issue":"5","key":"pone.0331601.ref042","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.2337\/diacare.27.5.1047","article-title":"Global prevalence of diabetes: estimates for the year 2000 and projections for 2030","volume":"27","author":"S Wild","year":"2004","journal-title":"Diabetes Care"},{"issue":"2","key":"pone.0331601.ref043","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s40200-018-0375-1","article-title":"Menopause and metabolic syndrome in the Middle East countries; a systematic review and meta-analysis study","volume":"17","author":"O Tabatabaei-Malazy","year":"2018","journal-title":"J Diabetes Metab Disord"},{"issue":"11","key":"pone.0331601.ref044","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1016\/S2213-8587(19)30179-2","article-title":"Metabolic health in the Middle East and north Africa","volume":"7","author":"F Azizi","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"5","key":"pone.0331601.ref045","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0010587","article-title":"Sex differences in obesity associated with total fertility rate","volume":"5","author":"R Brooks","year":"2010","journal-title":"PLoS One"},{"issue":"10","key":"pone.0331601.ref046","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1111\/obr.12051","article-title":"Trends in overweight by educational level in 33 low- and middle-income countries: the role of parity, age at first birth and breastfeeding","volume":"14","author":"S Lopez-Arana","year":"2013","journal-title":"Obes Rev"},{"issue":"1","key":"pone.0331601.ref047","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s11019-022-10129-5","article-title":"Vulnerability, ageism, and health: is it helpful to label older adults as a vulnerable group in health care?","volume":"26","author":"E Langmann","year":"2022","journal-title":"Med Health Care and Philos"},{"issue":"3","key":"pone.0331601.ref048","doi-asserted-by":"crossref","first-page":"466","DOI":"10.3390\/healthcare10030466","article-title":"Effect of a community gerontology program on the control of metabolic syndrome in Mexican older adults","volume":"10","author":"VM Mendoza-N\u00fa\u00f1ez","year":"2022","journal-title":"Healthcare (Basel)"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331601","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T17:46:27Z","timestamp":1757526387000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331601"}},"subtitle":[],"editor":[{"given":"Patricia","family":"Khashayar,","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":48,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0331601","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,10]]}}}