Negative emotionality is associated with an increased risk for developing the metabolic syndrome (MetS). Presumably, negative emotionality partly confers such risk via alterations in peripheral autonomic and neuroendocrine effector pathways that promote metabolic pathophysiology. Conversely, protection against risk for the MetS may be conferred by an individual’s tendency to use cognitive strategies to regulate negative emotions. However, the brain systems by which cognitive emotion regulation relates to the MetS are unknown. Accordingly, we examined whether prefrontal and cingulate brain systems that jointly support cognitive emotion regulation and control peripheral physiological responses to negative emotional states represent a pathway linking emotion regulation to the MetS. Middle-aged adults (N=139; 74 men; mean age, 40.39 ± 6.2 years) underwent an fMRI scan while performing a Stroop color-word task that requires cognitive control, evokes a negative emotional state, and engages prefrontal and cingulate brain areas. Individual differences in self-reported tendencies to use cognitive reappraisal as an emotion regulation strategy were assessed by the Emotion Regulation Questionnaire (ERQ). The presence of the MetS was determined using the criteria of the National Cholesterol Education Program, Adult Treatment Panel III. After adjusting for age and sex, frequent cognitive reappraisal usage was associated with reduced likelihood of having the MetS and with meeting fewer MetS criteria. Moreover, fMRI psychophysiological interaction analyses revealed that increasing task-evoked functional connectivity between the dorsal anterior cingulate (dACC) and dorsolateral prefrontal cortex (DLPFC) was associated with frequent cognitive reappraisal usage, reduced presence of the MetS, and meeting less MetS criteria, net the influence of age and sex. In an exploratory mediation analysis, this positive dACC-DLPFC connectivity mediated the association between cognitive reappraisal and the MetS. Individuals who frequently use cognitive reappraisal may be at lesser MetS risk in part via an enhanced capacity to recruit prefrontal cognitive control systems during negative affective states
