The study demonstrated a significant positive effect of behaviour change communication implemented for three months on metabolic syndrome and its components, which is consistent with a 12 week yoga-based lifestyle intervention among Indian adults with metabolic syndrome (21) and a 12 week life style education interventional in Thai adults (22). A systematic review of randomized controlled trials in different population groups also showed positive effect of life style modification interventions starting from 10 weeks duration (23). In this study, the likelihood of having metabolic syndrome was 8.5 times higher among the control group after adjusting for background variables indicating the significance of lifestyle modification interventions in the prevention of metabolic syndrome and related non-communicable diseases. This finding is consistent with the report of meta analyses of randomized controlled trials that showed life style modification intervention were effective in resolving metabolic syndrome (MetS) and reducing the severity of related abnormalities including fasting blood glucose, waist circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP), and triglycerides in subjects with MetS (12, 13,24).
The positive results imply the need for adopting a team approach to lifestyle modification programs in the management of MetS (25). It was suggested that multidisciplinary group approach is an effective and economically feasible strategy in the control of metabolic parameters (26). It was also reported that modifying diet together with frequent physical exercise can reduce the triglycerides concentration as well as SBD and DBP (24, 27, 28). The need for implementing effective lifestyle modifications to prevent MetS and its health consequences has been indicated (24, 29).
Sex and age were other variables associated with metabolic syndrome. It was observed that males were 4.7 times more likely to have metabolic syndrome as compared to females, which is consistent with other reports (30). For one year increase in age, the likelihood of metabolic syndrome was higher by 6%, which is similar to a report from elsewhere (31). The relationship between metabolic syndrome components with older age and male sex has also been reported (32).
It was also observed that the intervention group has significantly (P < 0.05) higher dereference in differences between baseline and end line surveys for serum levels of FBs, Triglycerides and T.cholestrol and higher levels of HDL compared to the control group. A similar finding was reported by studies from elsewhere (24; 27, 33). Likewise, the intervention group had a significant difference in differences in waist circumference similar to reports of studies elsewhere (34–35).
The results showed that intervention group the mean difference in differences was 4.2 mmHg (P < 0.05) for diastolic blood pressure and 6.5 mmHg (P < 0.001) for systolic blood pressure compared with controls. This finding is consistent with another study which showed that the mean diastolic blood pressure (DBP) and triglycerides decreased significantly in the intervention group in both sexes (36). A positive effect of life style modification on blood pressure has also been reported among Korean adults (37, 38).
It has been documented that interventions incorporating dietary, physical activity and other life style changes exerts beneficial effects on the various components of the metabolic syndrome and improves overall survival (13, 24, 27, 28, 29,). However, interventions targeting life style changes have the potential to succeed only if they are executed early to offer strong evidence to substantiating the development of appropriate public policies (14, 23).
Baseline body fat percent of the study participants was significantly associated with diastolic blood pressure such that for one year increase in baseline body fat percent the mean difference in differences in diastolic blood pressure was lower by 2.0(P < 0.05) mmHg. This could be related the effect of high body fat percent on the cardiovascular system which minimizes the difference in the blood pressure changes. The effect of body fat percent on increasing blood pressure has been documented by other studies (13, 38, 39,).
Multivariable linear regression analyses showed that the intervention has high difference of differences in LDL, Triglycerides, T.Cholestrol and fasting blood sugar (FBS). A similar positive effect of life style modification was reported on lipid profiles (40–41) and blood sugar level (42).
It was also observed that the difference of differences was lower by 30.5 mg/dl for LDL among males compared to females. This indicates that at the end of the follow up period, the decrease in LDL cholesterol was lower among men. The relationship between gender and Lipid profile is age dependent. At younger age men tend to have higher levels of LDL, while this relationship gets reversed during older age especially after menopause where women tend to have higher level of LDL( 43) implying the need for careful interpretation of this finding.
Similarly, participants who had high income and medium income had higher difference in differences for LDL and T.Cholestrol compared with those in lower income. Evidence shows that an increase in income without change in educational status was associated with poor lipid profiles (44). However, the positive association of income with differences in differences of LDL and T.Cholestrol could be due to the fact that income is highly associated with educational status in the study population (university staff), which in turn may affect the level of adherence to the behaviour change interventions(45).
The positive findings of the behaviour change communication observed in this study have wider practical implications for Ethiopia where both modifiable and non-modifiable risk factors for chronic non-communicable diseases are increasing from time to time while the commensurate preventive intervention are lagging behind. The non-modifiable risks factors include increased life expectancy to over 64 years (46) and history of high proportion of early life stunting (47–51). Early life stunting could generate a huge potential for emergence of epidemics of chronic non-communicable diseases due to organ stunting. It has been reported that early childhood malnutrition including during the fetal period leads to occurrence of chronic non-communicable diseases later in life (52). The modifiable risk factors include dietary transitions to more processed and low fibre high calorie diet and sedentary and motorized way of life (53–55). The positive effect of the intervention documented in these modifiable risk factors implies the need for enhancing such interventions using different strategies through the involvement of different sectors to curb the upsurge of non-communicable disease and associated consequences in the years to come.
The study employed an individually randomized controlled trial to generate empirical evidence on the effectiveness of intervention approaches. However, to avoid information contamination the end line data were collected from the control group earlier than the intervention group, which is not expected to have an effect in their dietary and other behavioural factors as the data from the intervention group was also collected in the same season.