Aim. To assess in adults from Benin changes in cardiometabolic risk (CMR) using both the Framingham risk score (FRS) and metabolic syndrome (MetS) and to examine the effects of diet, and lifestyles, controlling for location and socioeconomic status. Methods. Apparently healthy subjects ( ) aged 25–60 years and randomly selected in the largest city, a small town, and rural areas were included in the four-year longitudinal study. Along with CMR factors, socioeconomic, diet and lifestyle data were collected in individual interviews. A food score based on consumption frequency of four “sentinel” food groups (meat and poultry, dairy, eggs, and vegetables) was developed. Lifestyle included physical activity, alcohol and tobacco use. Education and income (proxy) were the socioeconomic variables. Results. Among the subjects with four-year follow-up data ( ), 13.5% were at risk at baseline, showing MetS or FRS ≥ 10%. The incidence of MetS and FRS ≥ 10% during follow-up was 8.2% and 5%, respectively. CMR deteriorated in 21% of subjects. Diet and lifestyle mediated location and income effects on CMR evolution. Low food scores and inactivity increased the likelihood of CMR deterioration. Conclusion. Combining MetS and FRS might be appropriate for surveillance purposes in order to better capture CMR and inform preventive measures. 1. Introduction The burden of noncommunicable diseases such as diabetes and cardiovascular disease (CVD) is rapidly rising in low-income countries [1]. The increasing prevalence of noncommunicable diseases may be partly explained by the on-going nutrition transition process with major changes in diet and lifestyle patterns. These changes are characterized by shifts from traditional diets typically high in fiber and low in fat to westernized diets high in saturated fat, sugar, salt, and processed foods, combined with a more sedentary lifestyle, stress exposure, and less physical activity all of which increase cardiometabolic risk (CMR) factors [2]. Previous studies in sub-Saharan African countries [3] confirmed the relationship between nutrition transition and the increase of CMR factors. In a previous paper, we reported increasing CMR factors over four years in Benin adults who were apparently healthy at onset of study. The four-year incidence rates of abdominal obesity, insulin resistance (based on HOMA), and low HDL cholesterol were, respectively, 10.8%, 30.7%, and 30.2%, and that of the metabolic syndrome (Mets) 9% [4]. However, it was felt that the MetS does not give a proper measure of CMR profile in this population for reasons
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