Background: For many years the indigenous communities in Purulia district, West Bengal have been facing undernutrition. However, nutritional transition has simultaneously increased risk of overweight, prediabetes, and Metabolic Syndrome. This coexistence could be understood better as multiple burden of malnutrition. 

Materials and Methods: A cross-sectional study was conducted among 436 adult males and 525 females aged 18 years and above, including eight tribal communities of Purulia district. Frequencies and percentages were used to describe categorical variables. Binary logistic regression analysis was performed to study the association between Metabolic Syndrome and lifestyle behaviours. 

Results: The prevalence of prediabetes and MetS was found to be 40.6% and 26.3% respectively. Low physical activity (AOR 12.346, p <0.001), intake of junk food (AOR 1.818, p<0.001) and alcohol consumption (AOR 1.934, p<0.001) were found to be significantly associated with MetS. 

Conclusion: Prevalence of prediabetes and Metabolic Syndrome was very high among the studied population. Low physical activity, regular intake of junk food and alcohol were found to be important modifiable lifestyle behaviour associated with Metabolic Syndrome. Therefore the public health burden of malnutrition requires to be treated as multiple burden of malnutrition for better policy implementation.