The purpose of the present study was to specify the risk factors associated with the regression and progression of metabolic syndrome (MetS).

This study was a two-phase cohort study conducted over four years. The participants included a total of 540 individuals (aged ≥ 18 years) who completed both study phases. They were classified into three categories: regressed, progressed, and unchanged MetS. In both phases of the study, demographic, biochemical, and anthropometric parameters of every individual were evaluated. Differences (delta: Δ) between the first and the second phases were computed in terms of the study variables. The unchanged MetS group was regarded as the reference category.

According to the IDF criteria, in the second phase of the study, the regression and progression of MetS were reported in 42 (7.7%) and 112 (20.7%) individuals, respectively. According to the ATP III criteria, the regression and progression of MetS were reported in 42 (7.7%) and 117 (21.6%) individuals, respectively, in the second phase of the study. Results obtained from the multivariate analysis showed that raised age, positive Δ-TG, and Δ-FBS yielded a significant increase in the odds of MetS progression according to the IDF and ATP III criteria, whereas negative Δ-HDL and Δ-Neutrophil-to-lymphocyte ratio (Δ-NLR) led to an increase in the odds of MetS progression. In contrast, according to the IDF and ATP III criteria, positive Δ-HDL and negative Δ-TG yielded a significant increase in the odds of MetS regression.

Controlling hyperglycemia, hypertriglyceridemia, and HDL can be regarded as a crucial, non-invasive, and available technique for altering the trend of MetS.