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Chronic Disease Management Strategies / Diabetes, Cardiovascular Risks, and Lipoproteins · Journal article
Global Health Action · August 10, 2026
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This cross-sectional analysis of Iran's 2021 STEPS survey identified five distinct clusters of co-occurring behavioral and metabolic NCD risk factors in 16,618 adults, ranging from a healthy-low-risk group (40.3%) to high-risk metabolic clusters (dyslipidemic 26.0%, hypertensive-diabetic 24.0%). The findings characterize demographic and socioeconomic correlates of risk factor clustering but do not test interventions or causal relationships; they provide descriptive evidence for population-level risk stratification and targeted prevention strategy design.
Cross-sectional survey with K-means clustering analysis. Iranian adults aged ≥25 years participating in the nationally representative 2021 STEPS survey.. n = 16,618. Iran.
Five distinct clusters identified: smokers–drinkers (3.1%), healthy-low-risk (40.3%), physically active (6.6%), dyslipidemic (26.0%), and hypertensive-diabetic (24.0%) Healthy-low-risk cluster comprised younger, more educated individuals (40.3% of sample) Hypertensive-diabetic cluster had highest obesity, hypertension, and diabetes rates, common among older urban adults (24.0%)
No clinical outcome follow-up; no measurement of morbidity, mortality, or NCD incidence by cluster.
Clinicians and public health planners should recognize that Iranian adults segregate into distinct behavioral-metabolic phenotypes with different demographic profiles, which could inform targeted screening and prevention strategies for NCD risk factors. The finding that 50% of the population falls into high-risk metabolic clusters suggests substantial need for intervention at population and clinical levels.
A cross-sectional descriptive clustering analysis identifying co-occurrence patterns of NCD risk factors without a comparator, control group, or causal inference; informs population phenotyping but does not test an intervention or establish practice-changing evidence.
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Quoted from the source exactly as published.
Clinicians and public health planners should recognize that Iranian adults segregate into distinct behavioral-metabolic phenotypes with different demographic profiles, which could inform targeted screening and prevention strategies for NCD risk factors. The finding that 50% of the population falls into high-risk metabolic clusters suggests substantial need for intervention at population and clinical levels.
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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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