Non-communicable diseases including cardiovascular diseases (CVD) and diabetes have become the leading causes of mortality and morbidity among Palestinians. A low level of high-density lipoproteins (HDL) is a major modifiable risk factor for CVD. This study aimed to determine the prevalence and risk factors associated with low HDL among adult Palestini-ans. A specific objective was to establish the prevalence of metabolic syndrome among adult Palestinians. A cross-sectional study was conducted in the West Bank from 2018 to 2019 to achieve study objectives. A total of 1086 participants (526[48.3%] women and 560[51.7%] men) aged 18-65 years were included in this study. National Cholesterol Education Program (NCEP-ATP-III) criterion was used to define metabolic syndrome. Low HDL-cholesterol was highly prevalent among Palestinians (560[51.6%]) with no differences between men (288[51.3%]) and women (272[51.8%]) (p value=0.876). Levels of HDL ranged from 13.8 to 91.4 milligrams per deciliter (mg/dl) in men with a mean level of 40.53±10.48 mg/dl and from 21.0 to 98.6 mg/dl in women with a mean level of 50.30±12.5mg/dl. According to NCEP-ATP definition, metabolic syndrome was highly prevalent among adult Palestinians (366[33.8%]) with no differences between men (192[34.2%]) and women (174[33.2%]) (p value=0.707). The univariate analysis revealed that metabolic syndrome (Odd ratio (OR), 10.79, 95% Confidence Interval (CI) (7.78-14.9)) and all increased metabolic abnormalities including triglycerides (OR,4.284, 95%CI (3.23-5.681)), fasting blood sugar (OR, 2.145, 95%CI (1.561-2.949)), blood pressure (OR, 2.133, 95%CI (1.671-2.272)), waist circumfer-ences (OR, 2.506, 95%CI (1.937-3.242)), and obesity (OR, 2.176, 95%CI (1.685-2.809)) were significantly associated with low HDL (p value <0.001). The univariate analysis re-vealed also a significant association between low HDL and being married (OR, 2.183, 95%CI (1.695-2.817)), smoking (OR, 1.704, 95%CI (1.269-2.289)), and exposure to pesticides (OR, 1.702, 95%CI (11.164-2.489)) (p value <0.001). Logistic-Regression Model identified only increased triglycerides (OR, 3.341, 95%CI (2.165-5.155), p value <0.001)) and increased waist circumferences (OR, 1.841, 95%CI (1.200-2.825), p value=0.005)) to be significantly associated with low HDL. Although low HDL was highly prevalent among overweight and obese (412[38.08%]), it was highly prevalent among underweight and normal weight adults (147 [13.59%]). Low HDL was highly prevalent among adult Palestinians with dyslipidemia and central obesity being the most associated abnormalities. Action should be taken to pre-vent the rise of preventable non-communicable diseases. If no action is taken to reduce these diseases, they will become an increasing burden for the Palestinian health system.

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