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Epidemiology of Metabolic Syndrome

Epidemiology of Metabolic Syndrome

Contributor Bio

Melvin Marzan is currently a PhD Researcher at the Centre for Alcohol Policy Research (CAPR), School of Psychology and Public Health, La Trobe University. His research focuses on modelling the dose-response relationship of alcohol consumption and specific social harms and the potential impact of various pricing policies for social harm reduction in Australia.

Background: Epidemiology of Metabolic Syndrome

Clinicians and public health specialists consider metabolic syndrome as an emerging pandemic and a significant precursor to the epidemic of cardiovascular diseases or heart conditions, which include unhealthy blood vessels, blood clots, and structural problems.2,3 The current global estimates project that around 20–25 percent of adults have metabolic syndrome, making them three times more likely to have a stroke and heart attack and twice as likely to die when compared against people who are free from the syndrome.4,5

Some clinicians still do not recognize the need to refer to it as a metabolic syndrome collectively.6 It may be because the treatment for metabolic syndrome is the same treatment of each risk factor and condition. The best way to manage metabolic syndrome is by losing weight. 

Conditions and Risk Factors 

The current criteria for metabolic syndrome prescribe that three (3) out of five (5) of these conditions must be present to be diagnosed with metabolic syndrome:

  1. This involves a disproportionate amount of fat in the body, specifically in the abdominal (belly) area, and is often called abdominal obesity. The most common definition of abdominal obesity is having a waist circumference greater than 40 inches or 102 cm for men and greater than 35 inches or 88 cm for women. Some descriptions may vary based on the clinical background and sex. Excess fat in the waist and hips increases the risk of heart disease and other non-communicable diseases (NCDs).7

  2. Elevated Blood Pressure. Blood pressure is the force of blood movement within the walls of arteries as the heart contracts. High blood pressure can damage the heart and may lead to plaque buildup on the artery (tubes) walls.7 There are two (2) numbers when taking the blood pressure (ideally in the arm), for example, 120/80. The top number tells the pressure in the arteries when the heart is contracting. In contrast, the bottom number shows the pressure in the arteries when the heart is relaxed. Elevated blood pressure means the following:8

    1. The top number is greater than 120 mmHg8

    2. The bottom number is greater than 80 mmHg8

    3. You are taking antihypertensive medications2

  3. High Blood Sugar. Cells in the body need sugar to maintain their functions. The hormone called insulin helps the sugar get into the cells. If you have an inadequate level of insulin or if your body does not correctly respond to insulin, the sugar instead builds up in the blood rather than getting into the cells. High blood sugar is defined as a blood sugar level more than 100 mg/dl when tested at fasting (A fasting blood sugar test means you haven’t consumed anything except water for at least 8 hours). Although, the more accurate measurement is to take the average level of blood sugar in the last 3 months through the hemoglobin A1C test.1 The normal value range of A1C is 4 to 5.6 percent.9

  4. High Fat (Triglycerides) in the Blood. The fat-like substance in the blood is called triglycerides. Triglyceride levels of greater than 150 mg/dL are beyond the normal levels.  Sometimes some clinicians rely on the fasting triglyceride level (more than 150 to 180 mg/dL or 1.7 mmol/L).1,2

  5. Low Levels of Good Cholesterol (High Density Lipoprotein—HDL). The HDL is touted as the "good cholesterol" because it lowers the risk of developing heart attacks and other non-communicable diseases. Low HDL is defined as less than 40 mg/dL for men and less than 50 mg/dL for women.3,6

Causes and Risk Factors

Several conditions acting together lead to metabolic syndrome. Some factors that play a significant role in metabolism, such as genes and age (your risk increases as you grow older) are called "non-modifiable" risk factors.7 Family history and ethnicity are also non-modifiable risk factors that could impact the development of metabolic syndrome. Non-modifiable risk factors mean that it could not be changed.1,9

Body processes in some people, such as low-grade inflammation and excessive blood clotting may also escalate the risk of developing metabolic syndrome.2,3 Other conditions being studied are fatty liver or increased fatty deposits in the liver, gallstones, breathing problems during sleep, and development of a cyst in the ovaries of women.2,7

The good news, however, is that most of the conditions are "modifiable" and can be controlled. These are elevated blood sugar or insulin resistance, overweight and obesity, smoking, eating high-carbohydrate food, a large waistline, and a sedentary lifestyle.7

There are also people who may have an increased risk due to their current medication regimens such as those taking drugs that may lead to weight gain, alter blood pressure, or increase blood cholesterol and sugar levels.3 The examples of these drugs are medicines used to manage the human immunodeficiency virus (HIV), inflammation, allergies, and mental illnesses such as depression.7

Signs and Symptoms

As mentioned, metabolic syndrome is a set of conditions and risk factors like high blood pressure, obesity, and diabetes.1 The signs and symptoms of metabolic syndrome are consistent with those conditions.3,7 Large abdominal size, or waistline, may be a sign along with symptoms of diabetes like increased thirst, increased hunger, and increased urination.6,9 High blood pressure usually does not manifest unless taken by a blood pressure monitoring device called a sphygmomanometer. Although some people with high blood pressure may feel dizzy, experience nosebleed, or have headaches.7

More on Epidemiology of Metabolic Syndrome

4 Meanwhile, the global prevalence of type 2 diabetes increased from 108 million in 1980 to 422 million in 2014, according to the World Health Organization.10 Like obesity, type 2 diabetes also tends to occur more in poor and middle-income countries than in high-income countries.10Actual global data on metabolic syndrome is elusive because it is harder to measure. Yet, if the current estimate that it is three times more common than type 2 diabetes4 is correct, it would be safe to assume that over a quarter of the world’s population is affected with metabolic syndrome.4

Diagnosis and Treatment

The diagnosis of metabolic syndrome is often based on physical examination by the physician and blood tests for sugar, fats, and cholesterol in the blood. Blood pressure will be measured with a blood pressure monitor, and a consistent reading of beyond 120 for the numerator and beyond 80 for the denominator may be considered elevated blood pressure. Blood sugar levels can be measured at fasting (before you eat anything at breakfast) or anytime if the doctor requests an HA1C, which measures the average blood sugar level for the last 3 months.

Standard lipid blood tests include the total cholesterol, low-density lipoprotein (LDL) or the "bad cholesterol," high-density lipoprotein (HDL) or "good cholesterol," and triglycerides, which is the fat in the blood. The normal level of blood cholesterol is <200 mg/dL, while a level of 60 mg/dL or 1.55 mmol/L is considered an optimum level. The target level of fats in the blood (triglyceride) is less than 150 mg/dL (1.7 mmol/L)

The primary goal of treatment and management of metabolic syndrome is to address the underlying cause such as obesity, hypertension, or type 2 diabetes. It may include medicines or drugs to control the conditions of metabolic syndrome. However, the most effective means to manage metabolic syndrome is to adopt a healthy lifestyle, such as losing weight, moving and exercising more, and eating a well-balanced and healthy diet.1,2,3,5,7,9

Management includes the following:

  1. Modifying your diet3,7

    1. High Fiber diet - Increasing in the diet to more than 30 grams daily, such as eating foods like beans, green leafy vegetables, and fruits

    2. Low-salt and low fat diet

    3. Diet high in whole grains, nuts, vegetables, and olive oil or the Mediterranean diet

  2. Quitting smoking and consuming alcohol in moderation7

  3. Exercising more than 30 minutes per day on at least 5 days a week2

  4. Taking medicine and drugs to control blood sugar or lower the blood pressure

  5. Drinking a lot of fluids

  6. Taking probiotics. Current research supports enhancing gut microbiota by eating or taking supplements with good bacteria to help good bacteria in the gut reproduce. Eating yogurt may also help manage the condition.11

Drink HRW tablets largely reversed metabolic syndrome in a 6-month trial.

1 Huang, P.L. (2009). A comprehensive definition for metabolic syndrome.Disease Models & Mechanisms 2(5-6). 231-7

2 Sherling, D.H., Perumareddi P., & Hennekens, C.H. (2017). Metabolic syndrome. Journal of Cardiovascular Pharmacology and Therapeutics, 22(4), 365–367.

3 Xu, H., et al. (2019). Etiology of metabolic syndrome and dietary intervention. International Journal of Molecular Sciences, 20(1).

4 Saklayen, M.G. (2018). The Global Epidemic of the Metabolic Syndrome. Current Hypertension Reports, 20(2), 12.

5 O'Neill, S., & O'Driscoll, L. (2015). Metabolic syndrome: A closer look at the growing epidemic and its associated pathologies. Obesity Reviews, 16(1), 1–12.

6 Svačina, Š. (2019). Current views on metabolic syndrome. Vnitr Lek, 64(12), 1156–1159.

7 United States National Heart, Lung, and Blood Institute. (2019). Metabolic syndrome. United States.

8 Flack, J.M. & Adekola, B. (2020). Blood pressure and the new ACC/AHA hypertension guidelines. Trends in Cardiovascular Medicine, 30(3), 160–164.

9 Roberts, C.K., Hevener, A.L. & Barnard, R.J. (2013). Metabolic syndrome and insulin resistance: Underlying causes and modification by exercise training. Comprehensive Physiology, 3(1), 1–58.

10 World Health Organization. (2020). W. Diabetes. [cited 2020 September]; Available from:

11 Dabke, K., Hendrick, G. & Devkota, S. (2019). The gut microbiome and metabolic syndrome. The Journal of Clinical Investigation, 129(10), 4050–4057.

Metabolic syndrome pertains to a set of conditions such as obesity, increased blood sugar, hypertension, elevated fat-like (triglyceride) levels in the blood, and low levels of “good cholesterol.”1 These conditions increase the risk of a person developing heart diseases and type-2 diabetes. The term “metabolic” is a biochemical process to maintain the integrity and functioning of our cells.