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What is metabolic syndrome?

Metabolic syndrome is a group of five conditions that can lead to cardiovascular diseasediabetes mellitus, cerebrovascular disease, metabolic and other health problems. Metabolic syndrome is diagnosed when someone has three or more of these risk factors: 

Although each of these is a risk factor for cardiovascular disease, when a person has three or more and is diagnosed with metabolic syndrome, the chance of developing a serious cardiovascular condition increases. For example, hypertension is an important risk factor for cardiovascular disease, but when combined with high fasting blood sugar levels and central obesity (large waistline), the chance for developing cardiovascular disease is even higher.

Metabolic syndrome is a serious health condition that causes people to run higher risks of heart disease, diabetes mellitus, cerebrovascular disease and diseases related to fatty buildups in artery walls (atherosclerosis). Underlying causes of metabolic syndrome include overweight and obesity, insulin resistance, sedentarism genetic factors and increasing age. 

Although metabolic syndrome is a serious condition, you can reduce your risks significantly by losing weight; increasing your physical activity; eating a heart-healthy diet that’s rich in whole grains, fruits, vegetables and fish; and working with your health care team to monitor and manage your blood glucose, blood cholesterol and blood pressure. 

People with metabolic syndrome have an increased risk for cardiovascular disease and diabetes compared with those who don’t have it. Risk increases when more components of metabolic syndrome are present. 

Metabolic syndrome is also associated with a generalized metabolic disorder called insulin resistance, which prevents people from using insulin efficiently. That’s why metabolic syndrome is also called insulin resistance syndrome.

Why is it important to understand metabolic syndrome?

People with metabolic syndrome are at increased risk for:

  • Coronary heart disease and heart attack. When the arteries that supply blood to the heart become narrowed or blocked by fatty deposits (plaque), the amount of blood and oxygen reaching the heart is decreased, which can cause chest pain or a heart attack.
  • Type 2 diabetes. Diabetes occurs when the body can’t make enough insulin or is unable to use insulin properly. This causes sugars to build up in the blood and increases risks for kidney failure and cardiovascular disease.

Although these risks are significant, there is good news. Metabolic syndrome can be treated and you can reduce your risks for cardiovascular events by:

Metabolic syndrome and COVID-19

A population-based study and UK Biobank studies showed that patients with metabolic syndrome are highly susceptible to SARS-CoV-2 infection. Recent meta-analyses showed that metabolic syndrome is significantly associated with the development of severe COVID-19

Metabolic syndrome is a risk factor that influences COVID-19 progression and prognosis. The prevalence of obese, diabetic, hypertensive or liver damage patients with severe cases of COVID-19, in multiple countries, demonstrates the importance of the care with this risk group, in treating the syndrome.


What causes metabolic syndrome?


Although some people are genetically prone to developing metabolic syndrome, others develop it as result of their sedentarism, bad eating habits or other circumstances. Metabolic syndrome is closely linked to overweight or obesity and inactivity.

It’s also linked to a condition called insulin resistance. Normally, your digestive system breaks down the foods you eat into sugar. Insulin is a hormone made by your pancreas that helps sugar enter your target organs to be used as fuel.

In people with insulin resistance, target organs don’t respond normally to insulin and glucose can’t enter the cells as easily. As a result, your blood sugar levels rise even as your body churns out more and more insulin to try to lower your blood sugar










Who’s at risk for metabolic syndrome?

Metabolic syndrome has become increasingly common in the United States. Over 1/3 of U.S. adults have metabolic syndrome. It’s also increasing globally.                                                                        

  • Obesity/overweight: Obesity is an important potential cause of metabolic syndrome. Excessive fat in and around the stomach is strongly associated with metabolic syndrome. However, the reasons abdominal obesity and metabolic syndrome seem to be linked are complex and not fully understood. 
  • Insulin resistance: Metabolic syndrome is closely associated with a generalized metabolic disorder called insulin resistance. This is when the body can’t use insulin efficiently. Some people are genetically predisposed to insulin resistance. 
  • Diabetes. You’re more likely to have metabolic syndrome if you had diabetes during pregnancy or if you have a family history of type 2 diabetes.
  • Race and gender: Although Black men are less likely than white men to have metabolic syndrome, Black women have a higher rate than white women. 
  • Ethnicity. In the United States, Hispanics appear to be at the greatest risk of developing metabolic syndrome. The reasons for this are not entirely clear.
  • Age: Risk for metabolic syndrome increases with age.
  • Other diseases. Your risk of metabolic syndrome is higher if you’ve ever had nonalcoholic fatty liver disease, polycystic ovary syndrome or sleep apnea

Many factors that contribute to metabolic syndrome can be addressed through lifestyle changes such as diet, exercise and weight loss. By making these changes, you can greatly reduce your risks.


What are the symptoms of metabolic syndrome?

Most of the conditions that make up metabolic syndrome have no signs or symptoms. But a large waistline is a visible sign of overweight or obesity. 

Metabolic syndrome is a cluster of conditions and is diagnosed by a health care provider. If you have a large waist circumference and other conditions that define metabolic syndrome including elevated triglycerides, high blood sugar or high blood pressure, be sure to discuss your risk for metabolic syndrome with your health care provider. 



Having metabolic syndrome can increase your risk of developing:

  • Type 2 diabetes. If you don’t make lifestyle changes to control your excess weight, you may develop insulin resistance, which can cause your blood sugar levels to rise. Eventually, insulin resistance can lead to type 2 diabetes.
  • Heart and blood vessel disease. High cholesterol and high blood pressure can contribute to the buildup of plaques in your arteries. These plaques can narrow and harden your arteries, which can lead to a heart attack or stroke

How is metabolic syndrome diagnosed? 

Metabolic syndrome is diagnosed when you have three or more of these conditions:

  • Central or abdominal obesity (measured by waist circumference)
    • Men – greater than 40 inches
    • Women – greater than 35 inches
  • High triglycerides – 150 milligrams per deciliter (mg/dL) or more, or you’re taking medicine for high triglycerides
  • Low HDL cholesterol, or you’re taking medicine for low HDL cholesterol
    • Men – Less than 40 mg/dL
    • Women – Less than 50 mg/dL
  • High blood pressure – 130/85 millimeters of mercury (mm Hg) or more, or you’re taking medicine for high blood pressure
  • High fasting glucose (blood sugar) –100 mg/dL or more, or you’re taking medicine for high blood glucose


Prevention and treatment of metabolic syndrome

A lifelong commitment to a healthy lifestyle may prevent the conditions that cause metabolic syndrome. A healthy lifestyle includes

  • Balanced diet. Adopt a diet rich in whole grains, fruits, vegetables, skinless poultry, fish, nuts, low-fat or fat-free dairy products, lean meats and vegetable protein.

Healthy-eating plans, such as the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet, emphasize eating

  • Reducing or managing stress. Physical activity, meditation, yoga and other programs can help you handle stress and improve your emotional and physical health.
  • Active lifestyle. Aim for at least 150 minutes of moderate-intensity physical activity a week. Walking is the easiest place to start, but you may want to find something else you like to do that gets your heart rate up such as jogging, cycling, swimming. If needed, break your exercise up into several short sessions throughout the day to reach your goal.
  • Losing weight. Reduce your risk for heart disease by successfully losing weight and keeping it off. Learn your recommended calorie intake, the amount of food calories you’re consuming, and the energy calories you’re burning off with different levels of physical activity. Balance healthy eating with a healthy level of exercise to reach your goals

Losing 7% of your body weight can reduce insulin resistance and blood pressure and decrease your risk of diabetes. In fact, any amount of weight loss is beneficial. If you’re struggling with losing weight and keeping it off, talk to your doctor about what options might be available to help you, such as medications or weight-loss surgery.

  • Not smoking. Quitting smoking is the one risk factor that get rid of makes everything else better. Giving up cigarettes greatly improves your overall health. Talk to your doctor if you need help quitting.
  • When lifestyle changes alone don’t control the conditions related to metabolic syndrome, your health care professional may prescribe medications to control blood pressure, cholesterol and other symptoms. 

Gracia Martin Pierre-Pierre, MD CAQSM