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Clustering patterns of behavioral and metabolic risk factors for noncommunicable diseases in Iran: findings from a national STEPS survey.

Mohammad Amin Kharaghani·Safdar Masoumi·Arash Bagherian Ghotbi·Yosra Azizpour·Mina Mirzad·Sepehr Khosravi·Mostafa Moghimi Kheirabady·Moez Shaabanian·Nazila Rezaei·Mahbube Ebrahimpur·Ali Golestani
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Abstract

BACKGROUND: Noncommunicable diseases (NCDs) are the leading cause of mortality in Iran, driven by behavioral and metabolic risk factors that frequently co-occur. OBJECTIVE: To identify patterns of co-occurring behavioral and metabolic NCD risk factors among Iranian adults and characterize their demographic and socioeconomic correlates. METHODS: This cross-sectional study analyzed data from 16,618 adults aged ≥25 years who participated in Iran's 2021 nationally representative STEPS survey. Thirteen behavioral and metabolic variables, including physical activity, nutrition score, smoking frequency, alcohol intake, salt intake, body mass index, blood pressure, fasting plasma glucose, and lipid markers, were entered into a K-means clustering analysis. Clusters were characterized by their risk profiles and demographic/socioeconomic attributes. Multinomial logistic regression examined associations between cluster membership and sociodemographic factors. RESULTS: Five distinct behavioral-metabolic clusters emerged. The smokers-drinkers (SD) cluster (3.1%) comprised mostly older, less-educated men with high smoking and alcohol use. The healthy-low-risk (HLR) cluster (40.3%) showed favorable profiles and included younger, more educated individuals. The physically active (PA) cluster (6.6%) was characterized mainly by younger men with markedly high physical activity levels. The dyslipidemic (DLP) cluster (26.0%) exhibited high dyslipidemia and overweight prevalence, while the hypertensive-diabetic (HTD) cluster (24.0%) had the highest obesity, hypertension, and diabetes rates, common among older urban adults. CONCLUSION: Behavioral and metabolic NCD risk factors in Iran formed five distinct co-occurrence patterns. Nearly half of adults belonged to metabolically high-risk clusters, highlighting the need for targeted prevention strategies that combine lifestyle interventions with screening and management of obesity, hypertension, diabetes, and dyslipidemia.

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HumansIranMaleNoncommunicable DiseasesRisk FactorsMiddle AgedAdultCross-Sectional StudiesCluster AnalysisFemaleHealth BehaviorSocioeconomic FactorsHealth SurveysAlcohol DrinkingAgedSmokingClustering AlgorithmsExerciseNoncommunicable diseasescluster analysishealth surveysrisk factorsJournal Article

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Mohammad Amin Kharaghani, Safdar Masoumi, Arash Bagherian Ghotbi, Yosra Azizpour, Mina Mirzad, Sepehr Khosravi, Mostafa Moghimi Kheirabady, Moez Shaabanian, Nazila Rezaei, Mahbube Ebrahimpur, Ali Golestani. 2026-08-10. Clustering patterns of behavioral and metabolic risk factors for noncommunicable diseases in Iran: findings from a national STEPS survey.. https://doi.org/10.1080/16549716.2026.2712185

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