Metabolic Syndrome

Metabolic syndrome affects about 1 in 3 adults in the United States. This group of conditions includes extra belly fat, high blood pressure, high blood sugar, and unhealthy cholesterol levels—all working together to significantly raise your risk for heart disease, stroke, and type 2 diabetes.

Table of contents

• What is metabolic syndrome?
• Other names for this condition
• How metabolic syndrome is diagnosed
• How common is metabolic syndrome?
• Signs and symptoms
• What causes metabolic syndrome?
• Who is at risk?
• Health dangers and complications
• Treatment approaches
• Preventing metabolic syndrome
• Living with metabolic syndrome

What is metabolic syndrome?

Metabolic syndrome is not a single disease but a collection of health conditions that often occur together and increase your risk of serious health problems^[1]. When you have several of these conditions at the same time, they work together to raise your chances of developing coronary heart disease (a condition where the arteries supplying blood to your heart become narrowed or blocked), type 2 diabetes, stroke, and other serious health complications^[1].

The main components of metabolic syndrome include obesity (especially around the belly), high blood pressure, high blood sugar, high levels of fats in your blood called triglycerides, and low levels of “good” HDL cholesterol^[2][3].

Insulin resistance syndrome, Syndrome X, Dysmetabolic syndrome

Other names for this condition

Healthcare professionals may refer to metabolic syndrome by several different names. It is also called insulin resistance syndrome because problems with how your body responds to insulin play a central role in the condition^[1][3]. Some doctors may use the older term “Syndrome X” or “Dysmetabolic syndrome”^[3].

How metabolic syndrome is diagnosed

You are diagnosed with metabolic syndrome when you have at least three or more of the following five conditions^[1][2][5]:

• A large waistline: This means a waist measurement of more than 40 inches for men or more than 35 inches for women. Extra fat around your stomach area is a bigger risk factor for heart disease than extra fat in other parts of your body. This is sometimes called “having an apple shape”^[1][5].
• High triglyceride levels: A blood test showing triglycerides of 150 milligrams per deciliter (mg/dL) or greater^[5][8].
• Low HDL cholesterol: HDL cholesterol less than 40 mg/dL in men or less than 50 mg/dL in women. HDL is sometimes called “good cholesterol” because it helps remove “bad” cholesterol from your blood vessels^[1][5].
• High blood pressure: Blood pressure readings of 130/85 millimeters of mercury (mm Hg) or higher. If your blood pressure rises and stays high for a long time, it can damage your heart and blood vessels^[1][5].
• High fasting blood sugar: A blood sugar level of 100 mg/dL or greater after not eating for several hours. This can indicate problems with how your body processes sugar^[5][8].

Your healthcare provider will diagnose metabolic syndrome based on a physical exam and blood tests^[6]. The physical exam includes measuring your waist size, and blood tests check your cholesterol, triglyceride, and blood sugar levels^[8].

How common is metabolic syndrome?

Metabolic syndrome is very common in the United States. About 1 in 3 adults have it^[1][3]. The number of people with metabolic syndrome has been growing in recent decades, along with rising obesity rates^[2][5]. More than one-fifth of Americans and Europeans are currently affected by this condition^[5].

Certain groups have higher rates of metabolic syndrome. Mexican Americans have the highest rate, followed by White and Black people^[6]. The prevalence is also higher among people with diabetes^[7].

Signs and symptoms

Most of the conditions that make up metabolic syndrome have no obvious signs or symptoms at first^[6][3]. For example, high blood pressure, high triglycerides, and low HDL cholesterol usually don’t cause symptoms you can feel^[3].

The most visible sign is a large waistline^[6]. People with metabolic syndrome typically have “apple-shaped” bodies, meaning they have larger waists and carry a lot of weight around their bellies^[2].

If you have high blood sugar, you might notice some symptoms such as^[2][3]:

• Feeling thirstier than usual
• Needing to urinate more often, especially at night
• Blurred vision
• Feeling tired
• Darkened skin in your armpits or the back and sides of your neck (a condition called acanthosis nigricans)

You should see a healthcare provider if you experience these symptoms^[3].

What causes metabolic syndrome?

The causes of metabolic syndrome are complex, and several factors work together to create the condition^[3]. Researchers believe that insulin resistance is the main driver behind metabolic syndrome^[3].

Insulin is a hormone your pancreas makes that helps control blood sugar levels. Insulin resistance happens when cells in your muscles, fat, and liver don’t respond properly to insulin^[3]. This means they can’t efficiently take up sugar from your blood or store it. As a result, your pancreas makes more insulin to try to overcome your increasing blood sugar levels—a condition called hyperinsulinemia^[3].

If your body can’t produce enough insulin to manage your blood sugar effectively, it leads to high blood sugar and can result in prediabetes (blood sugar levels higher than normal but not yet high enough to be called diabetes) or type 2 diabetes^[3]. Insulin resistance and high insulin levels can also contribute to obesity, cardiovascular disease, and fatty liver disease^[3].

Several factors can contribute to insulin resistance, including^[3]:

• Excess weight around your abdomen or obesity: Body fat releases chemicals that reduce the effectiveness of insulin. The more excess body fat you have, the greater the impact^[3].
• An inactive lifestyle: Lack of physical activity contributes to weight gain and insulin resistance^[6].
• Genetics: There appears to be a genetic link to metabolic syndrome, with ethnicity and family history playing a role^[3][6].

People with metabolic syndrome often also have excessive blood clotting and inflammation throughout the body. Researchers don’t yet know whether these conditions cause metabolic syndrome or make it worse^[6].

Who is at risk?

The most important risk factors for metabolic syndrome include having extra weight around your belly, living an inactive lifestyle, and insulin resistance^[3]. However, several other factors can increase your chances of developing metabolic syndrome^[6]:

• Age: Your risk increases as you get older, though metabolic syndrome can affect people of any age^[3].
• Ethnicity: Mexican Americans have the highest rate of metabolic syndrome, followed by White and Black people^[6]. People from Middle Eastern, South Asian, Chinese, Asian-Indian, South and Central American backgrounds may also be at higher risk^[7].
• Family history: Having a sibling or parent with diabetes increases your risk^[6].
• Diabetes or prediabetes: People who have diabetes or are at risk for developing it are more likely to have metabolic syndrome^[6].
• Polycystic ovary syndrome (PCOS): Women with this hormonal condition have an increased risk^[3][6].
• Certain medications: Some medicines that cause weight gain or changes in blood pressure, cholesterol, and blood sugar can increase your risk^[6].
• Unhealthy habits: Smoking, eating an unhealthy diet high in refined carbohydrates and saturated fats, and not exercising all contribute to metabolic syndrome^[7].
• Other health conditions: Having conditions such as fatty liver disease, chronic kidney disease, or certain autoimmune diseases can increase your risk^[3].

Health dangers and complications

Metabolic syndrome significantly increases your risk of developing serious health problems. People with metabolic syndrome are estimated to have a 2-fold increased risk of cardiovascular diseases and a 5-fold increased risk of diabetes, compared to people without the condition^[5].

All the individual conditions that make up metabolic syndrome increase your risk of cardiovascular disease, type 2 diabetes, and stroke. But when you have three or more together, your risk increases much more dramatically^[3]. You should see a diagnosis of metabolic syndrome as a warning sign to make changes to your health^[3].

If left untreated, metabolic syndrome can lead to^[3]:

• Heart disease and heart failure
• Heart attack
• Stroke
• Type 2 diabetes
• Conditions related to plaque buildup in artery walls (a process called atherosclerosis)
• Peripheral vascular disease (problems with blood flow to the legs and feet)
• Some forms of cancer, including colon cancer and breast cancer^[13]
• Organ damage, particularly to the pancreas, liver, and kidneys^[3][13]
• Fatty liver disease^[3]
• Sleep apnea (pauses in breathing during sleep)^[3][13]
• Chronic kidney disease^[5]
• Pregnancy complications, such as preeclampsia (dangerously high blood pressure during pregnancy) and gestational diabetes (diabetes that develops during pregnancy)^[13]
• Thinking and memory problems^[13]

Treatment approaches

The main goals of treating metabolic syndrome are to lower your risk of heart disease and to prevent type 2 diabetes if it hasn’t already developed^[9]. If you already have type 2 diabetes, treatment can lower your risk of heart disease by controlling all your risk factors^[9].

The good news is that metabolic syndrome is largely treatable through lifestyle changes, and you may be able to improve your condition or even reverse it^[1][13].

Heart-healthy lifestyle changes

Heart-healthy lifestyle changes are the first line of treatment for metabolic syndrome^[9][8]. You may need to work with a dietitian and a physical therapist to help find a diet and exercise plan that works for you^[9]. Key lifestyle changes include:

Choosing heart-healthy foods: A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats, sodium (salt), added sugars, and alcohol^[9]. Your doctor may recommend specific eating plans such as the DASH (Dietary Approaches to Stop Hypertension) eating plan, a healthy vegetarian diet, or the Mediterranean diet^[8][9]. It’s important to be aware of portion sizes and to restrict calories^[8].

Aiming for a healthy weight: If you are overweight, losing just 3% to 5% of your current weight can help manage some risk factors, such as high cholesterol and diabetes, that raise your risk of heart disease^[9][8]. Losing 10% of your body weight can be especially beneficial^[13].

Getting regular physical activity: Health experts recommend getting at least 30 minutes of exercise, such as brisk walking, on most days of the week^[9][8]. Regular physical activity can help manage risk factors like high cholesterol, high blood pressure, and excess weight. Look for ways to increase activity any chance you get, such as walking instead of driving and using the stairs instead of an elevator^[8].

Managing stress: Learning how to manage stress, relax, and cope with problems can improve your physical and emotional health^[9].

Quitting smoking: If you smoke, quit. If you don’t smoke, don’t start^[9][13].

Medications

If healthy lifestyle changes alone are not enough, you may need medicines to help control your blood pressure, cholesterol, blood sugar, or blood clotting^[6][9]. Several types of medications can help:

• ACE inhibitors can lower blood pressure and have also been shown to reduce insulin resistance^[18].
• Metformin is used to help prevent diabetes in people with metabolic syndrome^[18].
• Aspirin may be recommended to prevent the blood from becoming sticky and forming clots^[18].

Weight loss surgery

In some cases, weight loss surgery (also called gastric bypass or bariatric surgery) may help treat metabolic syndrome^[9][13].

Treatment for related conditions

You may also need treatment for other health conditions that caused your metabolic syndrome or can make it worse^[9]. Each of the individual markers of metabolic syndrome increases your risk for heart disease, so treating them all is important^[13].

Preventing metabolic syndrome

The best way to prevent metabolic syndrome is to adopt a heart-healthy lifestyle^[6]. The same healthy lifestyle changes used to treat metabolic syndrome can also prevent it from developing in the first place^[1].

Key prevention steps include^[6]:

• Eating a heart-healthy diet that includes a variety of nutritious foods, including fruits, vegetables, whole grains, and lean meats, while limiting saturated and trans fats
• Maintaining a healthy weight
• Getting regular physical activity
• Managing stress
• Quitting smoking or not starting if you don’t already smoke
• Limiting alcohol consumption

It’s important to take action before any health numbers become critical—such as when you gain an extra 5 to 10 pounds, need a bigger pants waist size, or show rising blood pressure, cholesterol, or sugar levels^[21].

Living with metabolic syndrome

If you have metabolic syndrome, you should work closely with your healthcare team to manage your condition and reduce your risk of serious complications^[18]. Regular monitoring and continued commitment to healthy lifestyle changes are essential.

Measuring your progress

It may be useful to measure your waistline so that you know where you started and can track your progress^[18]. To correctly measure your waist circumference: Stand and place a tape measure around your middle, just above your hipbones. Make sure the tape is horizontal around the waist. Keep the tape snug around the waist, but not compressing the skin. Measure your waist just after you breathe out^[18].

Even putting on an extra three to five pounds can be a potential warning sign. The more extra weight you carry, the greater the risk for high belly fat^[21].

Daily management strategies

Try to exercise at least 30 minutes a day on most days. You should feel your heart rate climb. Swimming, biking, and gardening all count^[18]. If you have a pedometer, use it to track the number of steps you take each day and aim for 10,000 or more^[18].

Be mindful of what is on your plate when eating. It’s important to be aware of portion sizes and to consider restricting simple carbohydrates like white bread, potatoes, white rice and pasta, and sweets; replace them with complex carbohydrates^[18].

Pay attention to your waistline and other health numbers^[18][21]. If you are at risk for metabolic syndrome or have at least one of the conditions that make it up (such as high blood pressure), you should ask your healthcare professional about testing for the other markers^[2][23].

The sooner you can make changes to improve your health, the better your chances of preventing or reversing metabolic syndrome and avoiding serious complications^[23].