Author(s): JINGFENG, C., CHEN, Z., FENGHUA, S., Institution: EDUCATION UNIVERSITY OF HONG KONG, Country: CHINA, Abstract-ID: 1599

INTRODUCTION:
Metabolic syndrome (MetS) in adults with overweight or obesity elevates cardiovascular risk. Various exercise and dietary interventions exist, but their comparative efficacy remains unclear. Therefore, we conducted this network meta-analysis (NMA) to rank the effect of those interventions for MetS.
METHODS:
PubMed, Embase, Cochrane Library, Web of Science, and Scopus were searched through December 27, 2025. Randomized controlled trials (RCTs) enrolling adults with MetS that compared exercise, dietary, or combined interventions with controls were eligible. The standard random-effects NMA compared all intervention nodes; inconsistency was assessed using design-by-treatment interactions and node-splitting tests. Interventions were classified into 24 nodes: exercise modalities including moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), resistance training (RT), and their combinations; dietary approaches including caloric restriction (CR), Mediterranean diet, low-carbohydrate (LowCarb), Dietary Approaches to Stop Hypertension (DASH), intermittent fasting (IF), and other dietary strategies, along with combined exercise-diet interventions. Ten outcomes were analyzed. Confidence in Network Meta-Analysis (CINeMA) rated NMA evidence certainty.
RESULTS:
A total of 78 RCTs (8,619 participants, 193 arms, 24 nodes) with a median intervention duration of 12 weeks were included. Heterogeneity was low to moderate for most outcomes (I2: 5.0-62.2%), except TC (69.5%). Global inconsistency (design-by-treatment test) was absent for WC, TG, and weight but present for 7 outcomes; node-splitting revealed few locally inconsistent comparisons (mean 4.8%). In NMA, HIIT and MICT were the most effective exercise modalities. HIIT significantly improved WC (-4.86 cm), SBP (-6.41 mmHg), DBP (-6.23 mmHg), weight (-3.89 kg), and HDL-C (+3.79 mg/dL). MICT significantly reduced WC (-3.38 cm), SBP (-6.30 mmHg), DBP (-4.20 mmHg), and weight (-3.50 kg). Combined exercise (MICT+RT) significantly reduced FBG (-7.08 mg/dL) and weight (-3.58 kg), and increased HDL-C (+2.91 mg/dL). RT alone reduced FBG (-5.65 mg/dL) and increased HDL-C (+4.44 mg/dL). No single dietary intervention achieved consistent significance across outcomes. CINeMA certainty was moderate for 3 outcomes, low for 5, and very low for 2.
CONCLUSION:
HIIT and MICT were the most effective exercise modalities across MetS outcomes. Combined exercise (MICT+RT) was particularly effective for glycemic control and HDL-C. Our results may provide evidence for future intervention for MetS.