Background: Metabolic Syndrome has been defined as a complex of risk factors that increase the risk of cardiovascular disease, type 2 Diabetes and all-cause mortality. Dyslipidemia, abdominal obesity, elevated Fasting Blood Glucose and elevated Blood pressure are established clusters of risk factors for Metabolic Syndrome. Smoking, Alcohol use, sedentary behavior and Depression continue to be major public health issues. Several studies have shown association between Smoking, Alcohol use, depression and metabolic syndrome. No study has revealed association between clusters of adverse behavioral risk factors and depression in individuals with Metabolic Syndrome.

Objective: To investigate the relationship between clusters of adverse behavioral risk factors and depression in American Adults with Metabolic Syndrome.

Methods: logistic regression and NHANES 2009 – 2010 and 2011 – 2012 data were utilized to measure the association between the independent variables and the outcome variable.

Results: Smoking was significantly associated with increased odds of depression among Non-Hispanic Whites (OR = 2.67 [(95% CI = 1.66 – 4.30]), Non-Hispanic Blacks (OR = 2.38 [95% CI = 1.49 – 3.81]), Mexican Americans (OR= 2.87 [95% CI= 1.33 - 6.21]) and other races/ethnicities (OR= 2.4 [95% CI= 1.18 - 4.86}). A joint occurrence of alcohol use and smoking was associated with 2.78 (95% CI = 1.96 – 3.91), 3.00 (95% CI = 1.80 – 5.02), 2.81 (95% CI = 1.51 – 5.22), 2.86 (95% CI = 1.13 – 7.28) increased odds of depression in the total sample, NHW, NHB and MA respectively. Joint occurrence of Smoking and Sedentarism was associated with 2.30 (95% CI = 1.20 – 4.40) and 2.59 (95% CI = 1.03 – 6.54) increased odds of depression in the total sample and NHW respectively. Joint occurrence of Alcohol use, smoking and Sedentarism was associated with 2.30 (95% CI = 1.05 - 5.03) and 2.77 (95% CI = 1.03 - 6.54) increased odds of depression in the total and NHW respectively.

Conclusion: The study established that being a current smoker was significantly associated with increased odds of depression. The joint occurrence of selected behavioral risk factors was positively associated with depression in individuals who met the criteria for Metabolic Syndrome. People who are diagnosed with Metabolic Syndrome need to be evaluated for the risk of adverse behavioral risk factors and depression. Intervention should be designed to target individuals with these risk factors among those with Metabolic Syndrome.