Metabolic Syndrome

What is Metabolic Syndrome?

Metabolic syndrome (MetS) refers to a group of interrelated conditions that collectively serve as significant modifiable risk factors for various chronic diseases, including cardiovascular disease, hypertension, type 2 diabetes, and stroke. It is a cluster of at least three of five medical conditions: abdominal obesity, high blood pressure, elevated blood sugar, elevated triglycerides, and low serum high-density lipoprotein (HDL)¹.

Metabolic syndrome presents challenges for the public health care system and affects patient health outcomes. Its prevalence has increased globally, influenced by factors such as urbanization, sedentary lifestyles, and dietary patterns. About one-third of the US adult population have MetS. MetS management emphasizes lifestyle modifications, such as healthy dietary choices, improved physical activity, exercises and management of excess visceral and ectopic body fat.

Diagnosis

Several health organizations have developed a definition for MetS but as of 2023, the most widely used clinical definition comes from the US National Cholesterol Education Program Adult Panel III (2001) which requires at least three of the following²:

• Central obesity: waist circumference ≥ 102 cm or 40 inches (male), ≥ 88 cm or 35 inches(female)
• Dyslipidemia: TG ≥ 1.7 mmol/L (150 mg/dL)
• Dyslipidemia: HDL-C < 40 mg/dL (male), < 50 mg/dL (female)
• Blood pressure ≥ 130/85 mmHg (or treated for hypertension)
• Fasting plasma glucose ≥ 6.1 mmol/L (110 mg/dL)

Signs and Symptoms

The major sign of MetS is central obesity which is demonstrated by adipose tissue accumulation around the waist and trunk³. Other signs or symptoms of MetS include high blood pressure, low HDL, elevated Triglycerides (TG), impaired fasting glucose, insulin resistance, or prediabetes. Metabolic syndrome (MetS) is often associated with additional conditions such as fatty liver, hyperuricemia, polycystic ovarian syndrome (PCOS), erectile dysfunction, and acanthosis nigricans. Adults presenting with these comorbidities are considered at elevated risk for MetS and should undergo appropriate screening as indicated.

Causes

The pathophysiology of MetS is a complex process that has not been completely clarified. Studies indicate that several factors may contribute, including elevated serum glucose levels, insulin resistance, dietary habits (such as consumption of sugar-sweetened beverages), stress, physical inactivity, weight gain, aging, disrupted sleep patterns, mood disorders, use of psychotropic medications, excessive alcohol intake, and possible genetic influences.

Prevention and Management

The prevention and management of metabolic syndrome focus on lifestyle changes, including regular exercise, healthier eating patterns, increased physical activity, and addressing conditions such as hypertension, obesity, hyperlipidemia, and prediabetes or insulin resistance. The following strategies are based on current evidence and present recommended methods for preventing and managing this condition.

Exercise and Physical Activity

Studies show that only one in five adults and teens participate in routine exercise and physical activity to maintain good health. According to the American Heart Association and recommendations published by the US. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, the following guidelines for physical activity have been stipulated⁷.

Recommendations for Adults

• It is recommended to engage in at least 150 minutes per week of moderate-intensity aerobic activity, or 75 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination of both. These activities should ideally be distributed evenly throughout the week. Moderate intensity corresponds to achieving 50–70% of an individual’s maximal heart rate, whereas vigorous intensity involves reaching 70–85% of maximal heart rate.
• Add moderate- to high-intensity muscle-strengthening activity (such as resistance or weights) on at least 2 days per week.

Recommendations for Kids and Adolescents

• Children 3-5 years old should be physically active and have plenty of opportunities to move throughout the day,
• Kids 6-17 years old should get at least 60 minutes per day of moderate- to vigorous-intensity physical activity, mostly aerobics.
• Include vigorous-intensity activity on at least 3 days per week.
• Include muscle- and bone-strengthening (weight-bearing) activities on at least 3 days per week.

The guidelines reflect scientific findings about the relationships among physical activity, health, disease prevention, and quality of life. These recommendations are outlined in the Physical Activity Guidelines for Americans, second edition.

Diet

Adopting dietary habits that support the management of metabolic syndrome (MetS) aligns with the broader category of healthy diets recommended for lifestyle modifications in other chronic conditions. Such nutritional approaches have been shown to decrease the risk of metabolic syndrome, obesity, cardiovascular disease, cancer, cognitive decline, diabetes, and mortality⁸. Evidence-based research indicates that certain types of dietary modifications are effective in managing metabolic syndrome (MetS). These include a low-calorie diet, reduced-carbohydrate diet, Mediterranean diet, diets rich in fruits and vegetables, and diets high in monounsaturated fats such as those found in plant oils, nuts, and seeds⁹. Moreover, studies have demonstrated that adhering to consistent meal timing and refraining from late-night eating are associated with a decreased risk of metabolic syndrome (MetS)¹⁰.

Weight Loss
Optimal results in weight reduction and sustaining a lower body weight are typically attained through a combination of decreased caloric consumption and enhanced physical activity. Other weight management strategies involve recently approved pharmacological agents such as Glucagon-like-peptide-1 (GLP-1) receptor agonists, as well as bariatric surgical procedures.

Medication
Currently, there is no single medication specifically indicated for the treatment of Metabolic Syndrome. Typically, the individual conditions constituting MetS are managed independently according to their respective therapeutic guidelines11. For instance, antihypertensive agents such as diuretics, calcium channel blockers, ACE inhibitors, and ARBs are commonly utilized for managing hypertension. Multiple classes of pharmacological agents are approved for addressing dyslipidemia when abnormalities in LDL cholesterol, triglycerides, or HDL cholesterol are identified. GLP-1 receptor agonists, including semaglutide and tirzepatide, may be prescribed for weight management. The therapeutic objective is to target each contributing condition of metabolic syndrome according to evidence-based guidelines to mitigate the cumulative risk factors associated with chronic diseases and mortality.

References

1. Neeland, I.J., Lim, S., Tchernof, A. et al (2024). Metabolic syndrome. Nat Rev Dis Primers 10, 77. https://doi.org/10.1038/s41572-024-00563-5
2. Expert Panel on Detection, Evaluation (May 2001). “Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol in Adults”. JAMA. 285 (19): 2486–97. doi:10.1001/jama.285.19.2486. PMID 11368702
3. “Metabolic Syndrome”. Diabetes.co.uk. 15 January 2019.
4. Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB (November 2010). “Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis”. Diabetes Care. 33 (11): 2477–83. doi:10.2337/dc10-1079. PMC 2963518. PMID 20693348.
5. Xi B, He D, Zhang M, Xue J, Zhou D (August 2014). “Short sleep duration predicts risk of metabolic syndrome: a systematic review and meta-analysis”. Sleep Medicine Reviews. 18 (4): 293–97. doi:10.1016/j.smrv.2013.06.001. PMID 23890470
6. Pollex RL, Hegele RA (September 2006). “Genetic determinants of the metabolic syndrome”. Nature Clinical Practice Cardiovascular Medicine. 3 (9): 482–89. doi:10.1038/ncpcardio0638. PMID 16932765. S2CID 24558150.
7. Haozhe Wang, Yike Zhang, Meimei Sun, Zhou Chen (2025). Nonlinear association of physical activity with early cardiovascular-kidney-metabolic syndrome risk: a comprehensive analysis of NHANES data from 2007 to 2018, BMC Public Health, 25, 1.https://doi.org/10.1186/s12889-025-23157-6
8. Gizem Helvacı, Fatma Tayhan (2025). Determinants and relationships of digital addiction, diet quality, and physical activity in adolescents, Frontiers in Public Health, 10.3389/fpubh.2025.1654322, 13.
9. Esposito, K., Ciotola, M. and Giugliano, D. (2007), Mediterranean diet, and the metabolic syndrome. Mol. Nutr. Food Res., 51: 1268-1274. https://doi.org/10.1002/mnfr.200600297
10. Alkhulaifi, F. (2022). “Meal Timing, Meal Frequency and Metabolic Syndrome”. Nutrients. 14 (1719): 1719. doi:10.3390/nu14091719. PMC 9102985. PMID 35565686.
11. Srikanthan K, Feyh A, Visweshwar H, Shapiro JI, Sodhi K (2016). “Systematic Review of Metabolic Syndrome Biomarkers: A Panel for Early Detection, Management, and Risk Stratification in the West Virginian Population”. International Journal of Medical Sciences. 13 (1): 25–38. doi:10.7150/ijms.13800. PMC 4716817. PMID 26816492.