Abstract
Objective
This study aimed to determine the prevalence of metabolic syndrome and to examine its association with Mediterranean diet adherence and physical activity among women receiving adjuvant endocrine therapy for hormone receptor-positive breast cancer, in North Africa.Methods
This cross-sectional study recruited 150 women in Oran, Algeria (May 2022-December 2025), receiving either tamoxifen (n = 73) or aromatase inhibitors (n = 77). Metabolic syndrome was defined per International Diabetes Federation 2006 criteria. Mediterranean diet adherence was assessed using a culturally adapted 14-item Mediterranean Diet Adherence Screener (adapted MEDAS). Physical activity level (PAL) was estimated using GENI software and entered as a continuous variable in the primary analysis, with sedentary/non-sedentary categorization (PAL Results
Metabolic syndrome was highly prevalent, affecting 68.0% of participants. Although overall prevalence did not differ between treatment groups (aromatase inhibitors: 72.7% vs. tamoxifen: 63.0%; p = 0.202), the two regimens differed in individual metabolic abnormalities: aromatase inhibitor users had lower HDL-cholesterol, higher fasting glucose, and higher blood pressure, while tamoxifen users had higher triglycerides. In multivariable analysis, higher PAL (OR = 0.44 per 0.1-unit increase; 95% CI: 0.28-0.68; p p = 0.001) were independently associated with lower odds of metabolic syndrome. The model showed an apparent AUC of 0.832 (5-fold cross-validated AUC: 0.800) and satisfactory calibration (Hosmer-Lemeshow p = 0.400).Conclusion
Metabolic syndrome affects more than two-thirds of breast cancer survivors receiving endocrine therapy, and was independently associated with lower Mediterranean diet adherence and lower physical activity. Given the cross-sectional design, these associations cannot establish causality; nonetheless, these findings support further prospective and interventional research to determine whether modifying these behaviors could reduce this risk.