Objective Intensive lifestyle intervention significantly reduces the progression to diabetes in high-risk individuals. This study aimed to investigate the efficacy of early lifestyle intervention on high-risk groups of metabolic syndrome. Methods In a two-arm randomized controlled 1-year trial, we compared the effectiveness of a general recommendation-based program of lifestyle intervention carried out by trained professionals versus standard unstructured information given by physicians at reducing the prevalence of multiple metabolic and inflammatory abnormalities in 306 adults aged 45-64 years in Xiaogan city, China. Results At baseline, clinical/ anthropometric/laboratory and lifestyle characteristics of the intervention (n=153) and control (n=153) groups were not significantly different. The former significantly reduced total/saturated fat intake and increased polyunsaturated fat/fiber intake and exercise level compared to the controls. Weight, waist circumference, high-sensitivity C-reactive protein, and most of the metabolic syndrome components decreased in the intervention group and increased in the controls after 12 months. Lifestyle intervention significantly reduced metabolic syndrome (OR=0.28; 95% CI 0.18-0.44), with a 31% (95% CI21-41) absolute risk reduction, corresponding to 3.2 (95% CI, 2-5) patients needing to be treated to prevent 1 case after 12 months. The intervention significantly reduced the prevalence of central obesity (OR=0.33; 95% CI, 0.20-0.56), and hypertriglyceridemia (OR=0.48; 95% CI, 0.31-0.75) and the incidence of diabetes (OR=0.23; 95% CI, 0.06-0.85). Conclusions A lifestyle intervention based on general recommendations was effective in reducing multiple metabolic/inflammatory abnormalities. The usual care by clinical physicians was ineffective at modifying progressive metabolic deterioration in high-risk individuals.