Metabolic Syndrome

Last Updated: October 24, 2022

Metabolic syndrome refers to a group of cardiometabolic risk factors: abdominal obesity, high blood pressure, high fasting blood sugar, high blood triglycerides, and low HDL-C. If a person has at least three of these, they have metabolic syndrome.

Metabolic Syndrome falls under theDiabetes & Blood SugarandCardiovascular Healthcategories.

What is metabolic syndrome?

Metabolic syndrome (MetS), sometimes called “insulin resistance syndrome” or “syndrome X”, refers to a cluster of interrelated risk factors for cardiovascular disease and type 2 diabetes, specifically enlarged waist circumference, elevated triglycerides, high blood pressure, low high-density lipoprotein cholesterol, and impaired fasting glucose.[1] It’s estimated that the global prevalence of MetS is about 25%,[2] while in the United States it’s nearly 35%.[3]

What are the main signs and symptoms of metabolic syndrome?

Other than an enlarged waist circumference, which doesn’t always indicate the presence of MetS, there are typically no obvious signs or symptoms of the disease. Therefore, an evaluation by a medical doctor and blood work will be needed to determine the presence of MetS. In some cases, an individual will present with signs of specific risk factors, such as acanthosis nigricans (a darkening of the skin that appears in skin fold areas and is associated with insulin resistance) or xanthomas (yellowish-colored skin lesions that are associated with dyslipidemia).[1]

How is metabolic syndrome diagnosed?

To be diagnosed with MetS, an individual needs to have at least 3 of the following 5 risk factors:[4]

  • Enlarged waist circumference: ≥ 88 centimeters (35 inches) and ≥ 102 centimeters (40 inches) in women and men, respectively, with lower thresholds for Asian populations (≥ 80 centimeters and ≥ 85–90 centimeters in women and men, respectively)
  • Elevated triglycerides: ≥ 150 mg/dL (1.7 mmol/L)
  • High blood pressure: systolic ≥ 130 mm Hg and/or diastolic ≥ 85 mm Hg
  • Low high-density lipoprotein cholesterol: < 50 mg/dL (1.3 mmol/L) and < 40 mg/dL (1.0 mmol/L) in women and men, respectively
  • Impaired fasting glucose (or drug treatment of elevated glucose levels): ≥ 100 mg/dL (5.6 mmol/L)
What are some of the main medical treatments for metabolic syndrome?

The primary goal of clinical management is to reduce the risk of cardiovascular disease and type 2 diabetes.[5] Lifestyle interventions (i.e., changes in dietary and physical activity habits and smoking cessation) are the initial strategy to treat MetS, followed by pharmacological therapy — if necessary — to improve individual risk factors. There are no guidelines from medical organizations for the pharmacological treatment of MetS; pharmacological treatment depends on the individual’s unique circumstances and may include a statin to improve blood lipids, a glucagon-like peptide 1 receptor agonist (GLP-1 RA) or sodium-glucose cotransporter 2 (SGLT2) inhibitor to further reduce cardiovascular disease risk, metformin to increase insulin sensitivity, and/or a renin-angiotensin system (RAS) blocker to reduce blood pressure, among other drugs.[6][7][8] In people with severe obesity, bariatric surgery is a highly effective option.

How could diet affect metabolic syndrome?

Maintaining a healthy body weight is central to the prevention and management of MetS. Virtually any calorie-restricted diet — irrespective of its macronutrient distribution or meal frequency — that the individual can adhere to has the potential to improve MetS risk factors.[9] To achieve significant improvement of MetS risk factors, a weight loss of at least 5% of initial body weight is recommended, with greater improvements reported with further weight loss.[10]

Regarding specific dietary patterns, the Mediterranean diet, which is rich in minimally processed plant foods and olive oil, has the most robust evidence of improving MetS risk factors and reducing the prevalence of MetS.[11][12] The Dietary Approaches to Stop Hypertension (DASH) diet has also been shown to improve MetS risk factors, whereas a Western diet rich in red meat, saturated fatty acids, refined grains, and sugar is associated with an increased risk of MetS.[13]

Have any supplements been studied for metabolic syndrome?

Because MetS is characterized by a cluster of cardiometabolic risk factors, a wide variety of supplements are of interest, including those purported to improve blood lipids, increase insulin sensitivity, decrease blood pressure, or reduce inflammation. Some of the most studied options are berberine, red yeast rice, fish oil, biotic supplements, curcumin, vitamin D, and garlic.[14][15]

Are there any other treatments for metabolic syndrome?

Regular exercise is important for the prevention and treatment of MetS. Sedentary behavior is associated with an increased risk of MetS,[16][17] whereas higher cardiorespiratory fitness (i.e., VO2max) is associated with a reduced risk of MetS.[18] Additionally, regular exercise has been shown to improve each MetS risk factor.[18] At a minimum, the physical activity guidelines of 150 minutes per week of moderate-intensity (or 75 minutes of vigorous-intensity) activity should be met.

Sleep hygiene interventions are also potentially useful because sleep deprivation increases hunger and energy intake and decrease insulin sensitivity.[19] Moreover, short sleep duration (<6 hours per night) and sleep apnea are associated with an increased risk of MetS.[20][21] Lastly, smoking cessation is recommended for the prevention and treatment of MetS.[13]

What causes metabolic syndrome?

MetS is caused by a combination of genetic[22][23] and environmental factors, namely a high caloric intake and physical inactivity.[24] The resultant excess adiposity — particularly in the intra-abdominal region (i.e., visceral fat) — leads to adipose tissue dysfunction and insulin resistance.

Expansion of visceral fat and insulin resistance increases circulating free fatty acids (FFAs), which infiltrate the liver and skeletal muscle and disrupt glucose and lipid homeostasis.[24] The liver and skeletal muscle respond by increasing the breakdown of FFAs, which results in decreased glucose uptake in muscle along with increased glucose and triglyceride production and increased high-density lipoprotein clearance in the liver.[25][15]

Additionally, expansion of visceral fat causes altered secretion of adipokines (i.e., hormones, cytokines, and other proteins secreted by fat tissue), including increased secretion of pro-inflammatory cytokines (e.g., interleukin-6, tumor necrosis factor alpha) and reduced secretion of adiponectin, contributing to a state of chronic low-grade inflammation and a deterioration in cardiometabolic health.[26]

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  48. Weight - Akbari M, Lankarani KB, Tabrizi R, Ghayour-Mobarhan M, Peymani P, Ferns G, Ghaderi A, Asemi ZThe Effects of Curcumin on Weight Loss Among Patients With Metabolic Syndrome and Related Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Front Pharmacol.(2019)
  49. C-Reactive Protein (CRP) - Tabrizi R, Vakili S, Akbari M, Mirhosseini N, Lankarani KB, Rahimi M, Mobini M, Jafarnejad S, Vahedpoor Z, Asemi ZThe effects of curcumin-containing supplements on biomarkers of inflammation and oxidative stress: A systematic review and meta-analysis of randomized controlled trials.Phytother Res.(2019-Feb)
  50. High-density lipoprotein (HDL) - Reyhaneh Yousefi, Azadeh Mottaghi, Atoosa SaidpourSpirulina platensis effectively ameliorates anthropometric measurements and obesity-related metabolic disorders in obese or overweight healthy individuals: A randomized controlled trialComplement Ther Med.(2018 Oct)
  51. High-density lipoprotein (HDL) - Zahra Hamedifard, Alireza Milajerdi, Željko Reiner, Mohsen Taghizadeh, Fariba Kolahdooz, Zatollah AsemiThe effects of spirulina on glycemic control and serum lipoproteins in patients with metabolic syndrome and related disorders: A systematic review and meta-analysis of randomized controlled trialsPhytother Res.(2019 Oct)
  52. High-density lipoprotein (HDL) - Jun-jie Zhang, Zhi-bing Wu, You-jin Cai, Bin Ke, Ying-juan Huang, Chao-ping Qiu, Yu-bing Yang, Lan-ying Shi, Jian QinL-carnitine ameliorated fasting-induced fatigue, hunger, and metabolic abnormalities in patients with metabolic syndrome: a randomized controlled studyNutr J.(2014 Nov 26)
  53. High-density lipoprotein (HDL) - Munji Choi, Seongmin Park, Myoungsook LeeL-Carnitine's Effect on the Biomarkers of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsNutrients.(2020 Sep 12)
  54. Total cholesterol - Johri A, et alProgression of atherosclerosis with carnitine supplementation: a randomized controlled trial in the metabolic syndromeNutr Metab..()
  55. Blood Pressure - Ruggenenti P, Cattaneo D, Loriga G, Ledda F, Motterlini N, Gherardi G, Orisio S, Remuzzi GAmeliorating hypertension and insulin resistance in subjects at increased cardiovascular risk: effects of acetyl-L-carnitine therapyHypertension.(2009 Sep)
  56. High-density lipoprotein (HDL) - Schwab U, Alfthan G, Aro A, Uusitupa MLong-term effect of betaine on risk factors associated with the metabolic syndrome in healthy subjectsEur J Clin Nutr.(2011 Jan)
  57. Homocysteine - Alfthan G, Tapani K, Nissinen K, Saarela J, Aro AThe effect of low doses of betaine on plasma homocysteine in healthy volunteersBr J Nutr.(2004 Oct)
  58. High-density lipoprotein (HDL) - Ezgi Bellikci-Koyu, Banu Pınar Sarer-Yurekli, Yakut Akyon, Fadime Aydin-Kose, Cem Karagozlu, Ahmet Gokhan Ozgen, Annika Brinkmann, Andreas Nitsche, Koray Ergunay, Engin Yilmaz, Zehra BuyuktuncerEffects of Regular Kefir Consumption on Gut Microbiota in Patients with Metabolic Syndrome: A Parallel-Group, Randomized, Controlled StudyNutrients.(2019 Sep 4)
  59. High-density lipoprotein (HDL) - Ghizi ACdS et alKefir improves blood parameters and reduces cardiovascular risks in patients with metabolic syndromePharmaNutrition.()
  60. High-density lipoprotein (HDL) - Laso N, Brugué E, Vidal J, Ros E, Arnaiz JA, Carné X, Vidal S, Mas S, Deulofeu R, Lafuente AEffects of milk supplementation with conjugated linoleic acid (isomers cis-9, trans-11 and trans-10, cis-12) on body composition and metabolic syndrome componentsBr J Nutr.(2007 Oct)
  61. High-density lipoprotein (HDL) - de Bock M, Derraik JG, Brennan CM, Biggs JB, Morgan PE, Hodgkinson SC, Hofman PL, Cutfield WSOlive (Olea europaea L.) Leaf Polyphenols Improve Insulin Sensitivity in Middle-Aged Overweight Men: A Randomized, Placebo-Controlled, Crossover TrialPLoS One.(2013)
  62. High-density lipoprotein (HDL) - Gómez-Arbeláez D, Lahera V, Oubiña P, Valero-Muñoz M, de Las Heras N, Rodríguez Y, García RG, Camacho PA, López-Jaramillo PAged garlic extract improves adiponectin levels in subjects with metabolic syndrome: a double-blind, placebo-controlled, randomized, crossover studyMediators Inflamm.(2013)
  63. High-density lipoprotein (HDL) - Gurrola-Díaz CM, García-López PM, Sánchez-Enríquez S, Troyo-Sanromán R, Andrade-González I, Gómez-Leyva JFEffects of Hibiscus sabdariffa extract powder and preventive treatment (diet) on the lipid profiles of patients with metabolic syndrome (MeSy)Phytomedicine.(2010 Jun)
  64. High-density lipoprotein (HDL) - Sivaprakasapillai B, Edirisinghe I, Randolph J, Steinberg F, Kappagoda TEffect of grape seed extract on blood pressure in subjects with the metabolic syndromeMetabolism.(2009 Dec)
  65. High-density lipoprotein (HDL) - Iqbal N, Cardillo S, Volger S, Bloedon LT, Anderson RA, Boston R, Szapary POChromium picolinate does not improve key features of metabolic syndrome in obese nondiabetic adultsMetab Syndr Relat Disord.(2009 Apr)
  66. High-density lipoprotein (HDL) - Ali A, Ma Y, Reynolds J, Wise JP Sr, Inzucchi SE, Katz DLChromium effects on glucose tolerance and insulin sensitivity in persons at risk for diabetes mellitusEndocr Pract.(2011 Jan-Feb)
  67. Blood Pressure - Ghanbari M, Amini MR, Djafarian K, Shab-Bidar SThe effects of chromium supplementation on blood pressure: a systematic review and meta-analysis of randomized clinical trials.Eur J Clin Nutr.(2022-Mar)
  68. C-Reactive Protein (CRP) - Zhang X, Cui L, Chen B, Xiong Q, Zhan Y, Ye J, Yin QEffect of chromium supplementation on hs-CRP, TNF-α and IL-6 as risk factor for cardiovascular diseases: A meta-analysis of randomized-controlled trials.Complement Ther Clin Pract.(2021-Feb)
  69. Apolipoprotein B - Shahinfar H, Amini MR, Sheikhhossein F, Djafari F, Jafari A, Shab-Bidar SThe effect of chromium supplementation on apolipoproteins: A systematic review and meta-analysis of randomized clinical trials.Clin Nutr ESPEN.(2020-Dec)
  70. Malondialdehyde (MDA) - Morvaridzadeh M, Estêvão MD, Qorbani M, Heydari H, Hosseini AS, Fazelian S, Belančić A, Persad E, Rezamand G, Heshmati JThe effect of chromium intake on oxidative stress parameters: A systematic review and meta-analysis.J Trace Elem Med Biol.(2022-Jan)
  71. High-density lipoprotein (HDL) - Maeba R, Hara H, Ishikawa H, Hayashi S, Yoshimura N, Kusano J, Takeoka Y, Yasuda D, Okazaki T, Kinoshita M, Teramoto TMyo-inositol treatment increases serum plasmalogens and decreases small dense LDL, particularly in hyperlipidemic subjects with metabolic syndromeJ Nutr Sci Vitaminol (Tokyo).(2008 Jun)
  72. High-density lipoprotein (HDL) - Santamaria A, Giordano D, Corrado F, Pintaudi B, Interdonato ML, Vieste GD, Benedetto AD, D'Anna ROne-year effects of myo-inositol supplementation in postmenopausal women with metabolic syndromeClimacteric.(2012 Oct)
  73. Blood Pressure - M Nordio, E ProiettiThe combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation aloneEur Rev Med Pharmacol Sci.(2012 May)
  74. High-density lipoprotein (HDL) - Blond E, Rieusset J, Alligier M, Lambert-Porcheron S, Bendridi N, Gabert L, Chetiveaux M, Debard C, Chauvin MA, Normand S, Roth H, de Gouville AC, Krempf M, Vidal H, Goudable J, Laville M, “Niacin” Study GroupNicotinic acid effects on insulin sensitivity and hepatic lipid metabolism: an in vivo to in vitro studyHorm Metab Res.(2014 Jun)
  75. High-density lipoprotein (HDL) - Parker N Hyde, Teryn N Sapper, Christopher D Crabtree, Richard A LaFountain, Madison L Bowling, Alex Buga, Brandon Fell, Fionn T McSwiney, Ryan M Dickerson, Vincent J Miller, Debbie Scandling, Orlando P Simonetti, Stephen D Phinney, William J Kraemer, Sarah A King, Ronald M Krauss, Jeff S VolekDietary carbohydrate restriction improves metabolic syndrome independent of weight lossJCI Insight.(2019 Jun 20)
  76. High-density lipoprotein (HDL) - Afitska K, Clavel J, Kisters K, Vormann J, Werner TMagnesium citrate supplementation decreased blood pressure and HbA1c in normomagnesemic subjects with metabolic syndrome: a 12-week, placebo-controlled, double-blinded pilot trial.Magnes Res.(2021-Aug-01)
  77. Triglycerides - Hashemipour M, Kelishadi R, Shapouri J, Sarrafzadegan N, Amini M, Tavakoli N, Movahedian-Attar A, Mirmoghtadaee P, Poursafa PEffect of zinc supplementation on insulin resistance and components of the metabolic syndrome in prepubertal obese childrenHormones (Athens).(2009 Oct-Dec)
  78. Lipid Peroxidation - Kara E, Gunay M, Cicioglu I, Ozal M, Kilic M, Mogulkoc R, Baltaci AKEffect of zinc supplementation on antioxidant activity in young wrestlersBiol Trace Elem Res.(2010 Apr)
  79. Blood Pressure - Simão AN, Lozovoy MA, Bahls LD, Morimoto HK, Simão TN, Matsuo T, Dichi IBlood pressure decrease with ingestion of a soya product (kinako) or fish oil in women with the metabolic syndrome: role of adiponectin and nitric oxideBr J Nutr.(2012 Feb 8)
  80. Blood Pressure - Sola S, Mir MQ, Cheema FA, Khan-Merchant N, Menon RG, Parthasarathy S, Khan BVIrbesartan and lipoic acid improve endothelial function and reduce markers of inflammation in the metabolic syndrome: results of the Irbesartan and Lipoic Acid in Endothelial Dysfunction (ISLAND) studyCirculation.(2005 Jan 25)
  81. Blood Pressure - Young JM, Florkowski CM, Molyneux SL, McEwan RG, Frampton CM, Nicholls MG, Scott RS, George PMA randomized, double-blind, placebo-controlled crossover study of coenzyme Q10 therapy in hypertensive patients with the metabolic syndromeAm J Hypertens.(2012 Feb)
  82. Weight - Arpita Basu, Karah Sanchez, Misti J Leyva, Mingyuan Wu, Nancy M Betts, Christopher E Aston, Timothy J LyonsGreen tea supplementation affects body weight, lipids, and lipid peroxidation in obese subjects with metabolic syndromeJ Am Coll Nutr.(2010 Feb)
  83. Weight - Fujioka K, Greenway F, Sheard J, Ying YThe effects of grapefruit on weight and insulin resistance: relationship to the metabolic syndromeJ Med Food.(2006 Spring)
  84. Liver Enzymes - Samira Yarmohammadi, Reza Hosseini-Ghatar, Sahar Foshati, Mojgan Moradi, Niloofar Hemati, Sajjad Moradi, Mohammad Ali Hojjati Kermani, Mohammad Hosein Farzaei, Haroon KhanEffect of Chlorella vulgaris on Liver Function Biomarkers: a Systematic Review and Meta-AnalysisClin Nutr Res.(2021 Jan 29)
  85. C-Reactive Protein (CRP) - Wei Y, Zhang X, Meng Y, Wang Q, Xu H, Chen LThe Effects of Resistant Starch on Biomarkers of Inflammation and Oxidative Stress: A Systematic Review and Meta-Analysis.Nutr Cancer.(2022)
  86. C-Reactive Protein (CRP) - Jiang Z, Qu H, Chen K, Gao ZBeneficial effects of folic acid on inflammatory markers in the patients with metabolic syndrome: Meta-analysis and meta-regression of data from 511 participants in 10 randomized controlled trials.Crit Rev Food Sci Nutr.(2022-Dec-28)
  87. Risk Of Cardiovascular Disease - Parker J, Hashmi O, Dutton D, Mavrodaris A, Stranges S, Kandala NB, Clarke A, Franco OHLevels of vitamin D and cardiometabolic disorders: systematic review and meta-analysisMaturitas.(2010 Mar)