Metabolic syndrome is the term used to describe a cluster of common medical problems including insulin resistance, abdominal obesity, high blood pressure, raised levels of blood triglyceride fats and low HDL-cholesterol levels. These can significantly raise your chance of developing heart disease, early age heart attacks, strokes and serious and life-threatening conditions.
It is believed that if you have a combination of three or more of these conditions, then you have metabolic syndrome. This combination is very common, affecting around 25% of UK adults and up to 50% of adults globally. It may also occur in children and young adults who are obese, and that figure is growing as obesity becomes more common.
In this article we look at what causes metabolic syndrome, how it is diagnosed, and what you can do to reduce your risk.
The term ‘metabolic syndrome’ has been used by doctors since the late 1980s, and the combination of conditions linked to it is used to identify people at high risk of developing type 2 diabetes and cardiovascular disease. It refers to specific conditions linked to obesity - particularly around the waist - and some which disturb the processes by which our bodies get energy. These include:
Obesity, defined as a waistline of at least 89 centimetres (35 inches) for women and 102 centimetres (40 inches) for men
High blood pressure, defined as higher than 130/85
Insulin resistance , diagnosed on a blood test where HbA1c is higher than 48 mmol/mol (or 6.5%)
High cholesterol, as defined by high triglycerides and low HDL levels
However, a diagnosis of metabolic syndrome does not take into account other factors such as age, smoking, gender and family history. Despite this, it is still felt by most healthcare professionals that it is a useful term as it can help to advise people who fit its criteria as to ways of preventing or reducing their longer term health risks associated with it.
Obesity is the major factor behind metabolic syndrome. Being heavily overweight - especially with lots of fat around your waist area - can increase the amount of free fatty acids in your body. These can increase levels of other chemicals and hormones that affect how our body regulates sugar levels, and so it may not respond as it should to insulin - the hormone that helps to keep our sugar levels stable. This is known as insulin resistance. If insulin resistance progresses this can lead to the development of type 2 diabetes.
Free fatty acids and insulin resistance can also increase your level of ‘bad’ LDL cholesterol and reduce the level of ‘good’ HDL cholesterol. Finally, insulin resistance can raise your blood pressure (as can being overweight) and levels of triglyceride fats in the blood.
Metabolic syndrome increases with increasing age, affecting more people over the age of 50. Your risk of metabolic syndrome is increased if you have other medical conditions such as non-alcoholic fatty liver disease, sleep apnoea or polycystic ovarian syndrome (PCOS). Having a family history of diabetes, high blood pressure and high cholesterol also increase your risk.
Metabolic syndrome alone increases your chance of infertility, and as PCOS is related, this then makes it even harder if you’re trying to get pregnant.
Reducing your risk is definitely possible although it can seem like it’s hard work to bring down your risk and get healthy. Medications can help, for example with high cholesterol and insulin resistance, but much of it comes down to you making substantial lifestyle changes. Let’s start with looking at some of the risk factors you can control yourself:
Being inactive. Not getting enough exercise (even walking for 20 to 30 minutes a day is beneficial) means you are more at risk as well as more likely to put on weight. Keeping moving and active through the day is as important as doing regular gym sessions or planned sporting activities. Getting at least 30 minutes of moderately intense physical activity most days helps build a healthier you.
Eating too much, or eating an unhealthy diet. Keeping a close watch on how much you eat as well as eating a diet rich in fresh fruit and vegetables and low in processed foods is a good starting point here. A well-balanced, nutritional diet includes foods low in salt, sugar and saturated fat, and a regular intake of fibre, fruit, vegetables and lean protein. The ability to lose weight (just 5% of your body weight for example) is a big factor in reducing both inflammation in the blood vessels and insulin resistance.
The Mediterranean diet and some plant-based diets have all been shown to be helpful in managing metabolic syndrome and have dietary themes common to all of them. These include lots of fresh fruit and vegetables, limited meat intake, few or no processed foods, whole grains every day and low-fat dairy products.
Poor sleep. Getting enough quality restful sleep is not only important for your body to work as effectively as it should, but can also affect how your body regulates your sugar levels.
Smoking and drinking too much alcohol. Both these lifestyle choices can raise your risk so try to quit smoking if you smoke, and keep your alcohol intake to within the recommended limits. Alcohol also contains lots of ‘hidden calories’ that can cause you to put on weight without knowing it.
Stress is an understated risk factor in disease progression and where possible you should manage your emotional, mental, and physical wellbeing.
There are also risk factors you can either do little about or which may not be obvious. These include:
Getting older. The risk of metabolic syndrome increases as we age, especially over the age of 50.
A family history of diabetes or metabolic syndrome.
Low socio-economic status. This can increase risk factors such as smoking, poor diet and an unhealthy lifestyle.
Medical conditions such as polycystic ovarian syndrome (PCOS), psoriasis and sleep apnoea.
Gender. Women have a slightly higher risk than men because of hormone changes that occur after the menopause. These can increase the risk of putting weight on around the waist, raise blood sugar levels and reduce ‘good’ HDL cholesterol in the body.
If you think you are overweight or obese, it’s worth seeing your doctor to consider if there are any medical problems contributing to this, and any means by which the NHS can help – local weight loss programmes or exercise on prescription, for example. Newer treatments - such as Wegovy - may also be considered.
Your doctor will typically diagnose metabolic syndrome based on your medical and family history, a physical examination, and diagnostic tests such as blood tests. They may also order heart tests such as an ECG or ECHO scan to check how well your heart is working and if you have developed any complications from metabolic syndrome. They will also ask whether anyone in your family has a history of metabolic syndrome or diabetes and whether you exercise regularly and eat a healthy diet.
During the examination your doctor may measure your waist as one of the conditions of metabolic syndrome is abdominal obesity, where your waist measures more than 40 inches for men and 35 inches for women. Blood tests include checking for blood sugar, cholesterol and triglyceride levels.
Your blood pressure will also be checked. For most adults, a healthy blood pressure is less than 120/80 mm Hg (millimeters of mercury) but one of the conditions of metabolic syndrome is if your blood pressure is consistently higher than 130/85 mmHg.
If you have any risk factors your doctor will assess these regularly and will encourage you to undertake lifestyle changes to reduce your risk.
Lifestyle change is the number one way that metabolic syndrome is treated but if this does not work then medication - or even occasionally weight loss surgery - may be needed. If you have other health conditions that caused your metabolic syndrome, or which are making it worse, then these may need medical treatment. Key lifestyle changes to treat it include:
Following a heart-healthy diet rich in fruits, vegetables, and whole grains and low in saturated fats, salt, added sugars, and alcohol.
Trying to keep to a healthy weight. If you are overweight, losing just 3% to 5% of your weight can help reduce risk factors such as high blood pressure, raised cholesterol levels and diabetes - all of which can increase your risk of heart disease.
Getting regular exercise and keeping physically active.
Reducing stress and anxiety.
Getting enough quality sleep (aim for at least seven hours each night).
If lifestyle changes are not sufficient then medication may be needed. Common examples of this include:
Blood pressure treatment. Examples of medicines commonly used to treat high blood pressure include diuretics (‘water tablets’), beta blockers, ACE inhibitors, calcium-channel blockers and angiotensin receptor blockers. Some diuretics and water tablets can slightly increase the risk of type 2 diabetes in people with metabolic syndrome and your doctor will advise you about this.
Cholesterol treatment. Medicines such as statins, ezetimibe and bempedoic acid are all commonly used to help reduce total cholesterol levels, reduce ‘bad’ LDL levels and increase ‘good’ HDL levels. The National Institute for Health and Care Excellence, or NICE, no longer recommends the routine use of fibrates, bile acid sequestrants or nicotinic acid for this in the UK.
Treatment for glucose intolerance or insulin resistance. These include drugs such as metformin, glitazones and SGLT2-inhibitors.
Aspirin, which may help to reduce the risk of heart attacks or strokes in metabolic syndrome.
If you feel you may be at risk of developing metabolic syndrome, have any of the risk factors for it or have a family history of metabolic syndrome then discuss this with your doctor. If they feel it is appropriate they can arrange some simple tests to see if you are at risk or if there are any changes already present that can then be treated.
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