Health literacy linked to metabolic syndrome prevalence in Korean adults

Adequate health literacy was associated with lower metabolic syndrome prevalence among Korean adults in a nationwide cross-sectional analysis of the 2023–2024 Korea National Health and Nutrition Examination Survey. The survey-weighted study included 11,142 adults and estimated that 31.1% had metabolic syndrome. After adjustment for sociodemographic factors, adults with adequate health literacy had a prevalence ratio of 0.903, with a 95% confidence interval of 0.848–0.962 and P = 0.002. The corresponding odds ratio was 0.843. These findings describe an association at the population level, not evidence that health literacy prevents metabolic syndrome.

Researchers measured health literacy with a validated 10-item instrument whose scores range from 10 to 40. A score of at least 30 was classified as adequate. Metabolic syndrome was defined using harmonized criteria, and the analysis incorporated the survey’s complex sampling design and weights. The primary sequential logistic regression model adjusted first for age and sex and then for socioeconomic factors. Additional models adjusted for lifestyle factors and, separately, body mass index. The researchers also used restricted cubic splines to explore whether the association varied across the health-literacy range, alongside prespecified subgroup analyses and exploratory analyses of literacy domains and individual metabolic syndrome components. Survey-weighted modified Poisson regression was used to estimate prevalence ratios.

The association remained after lifestyle factors were included in the model. The adjusted prevalence ratio was 0.917, with a 95% confidence interval of 0.859–0.978. Adding body mass index modestly attenuated the estimate to 0.928, with a 95% confidence interval of 0.874–0.986; the interval still excluded 1. An exploratory restricted cubic spline suggested a nonlinear pattern, but that pattern was not statistically significant under a design-based test, for which P = 0.084. The study also found evidence that the association varied by sex, with P for interaction below 0.001. The inverse association was observed in women but not in men.

Results from the four health-literacy domains were exploratory. Separate models suggested inverse associations for the Healthcare and Technology & Resources domains, but the domains were highly intercorrelated and could not be distinguished in mutually adjusted models. The component-specific analyses were likewise exploratory; the supplied findings do not establish that literacy has a distinct relationship with any particular metabolic syndrome component. The results therefore support an overall association between adequate health literacy and lower prevalence of metabolic syndrome, while leaving the contribution of individual literacy domains unresolved.

The cross-sectional design is the study’s central limitation. It cannot determine whether health literacy is associated with the development of metabolic syndrome, whether metabolic syndrome is related to health literacy, or whether other factors influence both. The analysis also drew on two nationally representative survey cycles, but the authors noted that the stronger association among women warrants prospective confirmation. Within the study’s scope, the results identify health literacy as a correlate of prevalent metabolic syndrome in Korean adults and show that the relationship differed by sex. The study does not establish a causal effect or show that improving health literacy would change metabolic syndrome prevalence.

Subject of Research: Association between health literacy and metabolic syndrome prevalence in Korean adults

Article Title: Health literacy and metabolic syndrome in Korean adults: a nationwide cross-sectional analysis of KNHANES 2023–2024

Article References: Hwang, S., & Kim, H. M. (2026). Health literacy and metabolic syndrome in Korean adults: a nationwide cross-sectional analysis of KNHANES 2023–2024. BMC Public Health. https://doi.org/10.1186/s12889-026-29679-x

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29679-x

Keywords: health literacy, metabolic syndrome, KNHANES, Korean adults, cross-sectional study, prevalence ratio, sex differences, public health, survey-weighted analysis, health inequalities, Health, literacy