Metabolic syndrome is a condition that appears to increase the risk of a cluster of diseases, such as type 2 diabetes, cardiovascular disease, and high cholesterol.
Metabolic syndrome is not a single disease but a group of related risk factors that together increase the likelihood of developing cardiovascular disease and type 2 diabetes.
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Metabolic syndrome is sometimes referred to as insulin resistance syndrome, reflecting the underlying role of insulin resistance in its development.
Metabolic syndrome is a cluster of five conditions that increase the risk of heart disease, stroke, and type 2 diabetes.
A doctor typically diagnoses metabolic syndrome when three or more of the following
- Abdominal (central) obesity
- Waist circumference greater than 40 inches (102 cm) in men
- Waist circumference greater than 35 inches (88 cm) in women
- Elevated fasting blood glucose
- Fasting blood sugar 100 mg/dL or higher
- High blood pressure
- Blood pressure 130/85 mm Hg or higher, or use of blood-pressure–lowering medication
- High triglyceride levels
- Triglycerides 150 mg/dL or higher, or treatment for elevated triglycerides
- Low HDL (“good”) cholesterol
- 40 mg/dL or less in men
- 50 mg/dL or less in women
Having three or more of these risk factors significantly increases the likelihood of developing cardiovascular disease, including heart attack and stroke, as well as type 2 diabetes.
Diagnosis initially aims to identify those people who could be at risk of metabolic syndrome, but who may benefit from lifestyle modifications rather than drug treatments.
High blood glucose levels, high blood pressure, lipid and cholesterol abnormalities can often be targeted early with lifestyle measures.
However, some people may already be using medication for some aspect of metabolic syndrome, such as high blood pressure, when they receive their diagnosis.
Losing weight, especially in the upper body, can be an effective treatment.
Suggested measures for preventing and treating abnormal cholesterol and other aspects of metabolic syndrome include
- eating a “heart-healthy diet” that is low in sugar, fat, and sodium
- exercising regularly
- quitting smoking
- reducing alcohol intake
The AHA
Drug treatment
If drug treatment is recommended, this is usually with metformin.
This can help certain high risk groups, especially people with high blood glucose levels and those on the spectrum of obesity that is not manageable with dietary and lifestyle modifications.
Metformin is sold under the following brand names in the U.S.:
- Fortamet
- Glucophage
- Glumetza
- Riomet
The drug is not officially licensed for the prevention of diabetes in people at high risk due to metabolic syndrome. However, some physicians
Other medications may also be used to manage components of metabolic syndrome. For example, statins are commonly prescribed for individuals with elevated high low-density lipoprotein (LDL) cholesterol, while antihypertensive medications are used to control high blood pressure.
Antihypertensive drugs are used to treat high blood pressure.
In many cases, lifestyle interventions, such as dietary changes, increased physical activity, and weight loss are recommended as the first line of treatment, particularly for individuals at lower overall
The DASH diet is recommended for preventing and treating metabolic syndrome. The diet aims to prevent hypertension.
The DASH diet:
- emphasizes choosing foods from healthy, nutrient-rich sources
- limits intake of red meat, sodium, saturated fat, total fat, and sugar-sweetened foods and beverages
- encourages consumption of fruits and vegetables, whole grains, fish, and nuts
The DASH diet focuses on the quality of the foods eaten rather than on calorie restriction, but individuals who wish to lose weight can follow the diet at a lower calorie level.
Not all medical guidelines use the same thresholds for diagnosing metabolic syndrome, and some differences remain in how it is defined.
Additionally, a person may have high blood pressure, elevated blood glucose, or abnormal lipid levels that are not directly related to obesity.
The current diagnostic criteria were developed to harmonize definitions across guidelines, but doctors also consider an individual’s overall health, risk factors, and circumstances when making a diagnosis.
Metabolic syndrome and childhood obesity
Metabolic syndrome, sometimes abbreviated to MetS, can start in childhood, alongside early obesity, dyslipidemia, and high blood pressure.
Due to concerns about the rise in obesity among young people in recent years, some have called for early screening to identify those with a higher cardiovascular risk.
This could help target changes toward a healthier lifestyle and reduce the risk of health problems later in life.
How and when to screen for and diagnose metabolic syndrome and obesity in children, however, remains controversial. One reason is that growing children show wide variance in these factors.
According to the Centers for Disease Control (CDC), in the United States overall,
Metabolic syndrome is a collection of risk factors, so there is not a single cause.
Having central obesity or overweight is a major factor, but abnormal blood lipid and cholesterol levels, high blood pressure, and prediabetes also contribute to cardiometabolic risk.
Unavoidable risk factors, such as family history and ethnic background, can increase the chance of developing some components.
However, lifestyle choices can impact all these factors.
A diet that is high in fat and sugar, together with a lack of exercise, has been associated with the development of obesity and related conditions.
However, symptoms such as insulin resistance do not necessarily accompany obesity or indicate metabolic syndrome.
Insulin resistance, is a feature of metabolic syndrome and obesity, and it can lead to cardiovascular disease and type 2 diabetes, but it can also be a sign of other conditions.
Examples include Cushing’s disease, polycystic ovary syndrome (PCOS), nonalcoholic fatty liver disease, and chronic kidney disease.
Other problems that are sometimes associated with metabolic syndrome, insulin resistance, and high blood sugar include low-level inflammation and blood-clotting defects. These can also contribute to the development of cardiovascular disease.
The following factors
- a large waistline
- a family history of metabolic syndrome or related conditions, such as type 2 diabetes or heart disease
- sedentary lifestyle combined with a high-calorie diet
- insulin resistance or prediabetes
- the use of certain medications
Some medications, such as those used to treat inflammation, HIV, allergies, or depression, can contribute to weight gain or cause changes in blood pressure, cholesterol, or blood sugar levels, which may increase the risk of metabolic syndrome.
Find out more from the following MNT pages:
- How much should I weigh? This article includes information on various measures of obesity, including BMI, waist-to-hip ratio, and body fat percentage
- How to lose weight. This article provides information on how to adjust diet and exercise and lose the high-risk fat tissue