Overview flow chart of the study design and enrollment
The complete study design consisted of five steps, including enrollment, screening, preprocessing, inclusion, and classification. For enrollment, 11,814, 3,926, and 2,101 individuals were initially recruited in the HeQing, JinQiao, and JinYang communities based on the prospective Shanghai Community Cohort Establishment and Follow-up (NCT04517513). For screening, 2,238 participants were excluded according to the exclusion criteria (see STAR Methods). For preprocessing, 2,049 participants with incomplete information were excluded. Finally, 13,554 participants were included in this study. Participants were classified into the HC (n = 2,274; no use of lipid-lowering, antidiabetic, or antihypertensive drugs), pre-MetS (n = 7,776; clustering of <3 traditional risk factors, including obesity, hypertension, dyslipidemia, and dyslipidemia), and MetS (n = 3,504; clustering of ≥3 traditional risk factors) groups according to the statement of the Chinese Diabetes Society 2004. Participants were also classified into five subgroups (RFN1–5) according to the present number of four MetS risk factors or into 16 subclusters (RF0000–RF111) considering a combination of risk factors (0/1 = absence/presence of each risk factor). For more details, see Table 2. RFN indicates the number of traditional MetS risk factors.