- Also Known As:
- Syndrome X
- Dysmetabolic Syndrome
- Insulin Resistance Syndrome
- Obesity Syndrome
- Reaven Syndrome
This page was fact checked by our expert Medical Review Board for accuracy and objectivity. Read more about our editorial policy and review process..
What is metabolic syndrome?
- Excess fat around the waist (abdominal obesity)
- Decreased ability to process glucose (increased blood glucose and/or insulin resistance)
- Unhealthy lipid levels (dyslipidemia), including high triglycerides and low level of high-density lipoprotein (HDL, the “good” cholesterol)
- High blood pressure (hypertension)
Metabolic syndrome is a common condition that goes by many names (dysmetabolic syndrome, syndrome X, insulin resistance syndrome, obesity syndrome, and Reaven syndrome). Most people identified as having this syndrome have been educated about the importance of watching for signs and symptoms of diabetes (e.g., being screened for type 2 diabetes every 3 years with a fasting glucose or hemoglobin A1c), having blood pressure monitored and lipid levels checked, and exercising – but there has been little to tie all of these factors together except following a “healthier lifestyle.”
About one-third of American adults have metabolic syndrome. It can affect anyone at any age, but it is most frequently seen in people who are inactive and significantly overweight, with most of their excess fat in the abdominal area. This fat is both under the skin and around the abdominal organs.
While several national and international organizations use certain criteria to define metabolic syndrome, others, including the American Diabetes Association (ADA), question the value of the specific diagnosis of metabolic syndrome. They point out that the criteria, taken together, are no more useful at predicting the risk of cardiovascular disease or diabetes than the individual criteria considered separately. The science needs to be clearer, suggests the ADA, before metabolic syndrome be considered a definable syndrome.
The World Health Organization (WHO) was the first to publish an internationally accepted definition for metabolic syndrome in 1998, but the criteria that have received the most widespread acceptance and use in the United States are those established in 2002 as guidelines in the third report of the National Cholesterol Education Program expert panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III).
In 2005, the American Heart Association (AHA) in conjunction with the NHLBI also released a scientific statement regarding metabolic syndrome that includes a set of criteria that defines the condition. In order to provide more consistency in both patient care and research, the International Diabetes Federation, NHLBI, AHA, World Heart Federation, and the International Association for the Study of Obesity published a joint statement in 2009 that describes a “harmonized” definition of metabolic syndrome. Waist circumference, with population and country-specific criteria, replaced obesity as a measure of body status.
The table below summarizes the sets of criteria:
Criteria for Clinical Diagnosis of Metabolic Syndrome
|Clinical Measure||WHO (1998)||AHA/NHLBI (2005)||Harmonization Definition (2005)|
|Criteria for diagnosis||Insulin resistance plus two of the other criteria below||Three of the criteria listed below||Obesity as defined by waist circumference plus two of the other criteria below|
|Waist circumference (as the definition of obesity)||≥40 inches (102 centimeters, cm) in men,
≥35 inches (88 cm) in women
|≥37 inches (95 centimeters, cm) in men,
≥31 inches (80 cm) in women
|Body mass index (BMI)||BMI >30 kilograms/meter2|
|Triglycerides||≥150 milligrams/deciliter (mg/dL)||≥150 mg/dL or treatment for high triglycerides||≥150 mg/dL or treatment for high triglycerides|
|HDL-C||<35 mg/dL in men,
<39 mg/dL in women
|<40 mg/dL in men,
<50 mg/dL in women or treatment for low HDL-C
|<40 mg/dL in men,
<50 mg/dL in women or treatment for low HDL-C
|Blood pressure||≥140/90 mm Hg||Systolic ≥130 or diastolic ≥85 mm Hg or taking blood pressure medication||Systolic ≥130 or diastolic ≥85 mm Hg or taking blood pressure medication|
|Glucose||Impaired glucose tolerance, impaired fasting glucose or type 2 diabetes||Fasting >100 mg/dL or taking diabetes medication||Fasting ≥100 mg/dL|
|Elevated urine albumin (microalbuminuria)||Yes||No||No|
Also frequently seen with metabolic syndrome are tendencies for excessive blood clotting and inflammation. While obvious symptoms of heart disease may be absent, these features are a warning of an increased likelihood of clogged arteries, heart disease, stroke, diabetes, kidney disease, and even premature death. If left untreated, complications from diseases associated with untreated metabolic syndrome can develop in as few as 15 years. Those who have metabolic syndrome and also smoke tend to have an even poorer prognosis.
The root cause of most cases of metabolic syndrome can be traced back to poor eating habits, a sedentary lifestyle, and obesity. In some cases, a diagnosis of metabolic syndrome has also been assigned to those already diagnosed with hypertension or with poorly controlled diabetes. There also seems to be an association with non-alcoholic fatty liver disease, polycystic ovary syndrome, gout, darkening and thickening of the skin around the neck, underarms, and skin folds (acanthosis nigricans), and some cancers. A few cases are thought to be linked to genetic factors.
All of the factors associated with metabolic syndrome are interrelated. Obesity and lack of exercise tend to lead to insulin resistance. Insulin resistance has a negative effect on lipid production, increasing VLDL (very low-density lipoprotein), LDL (low-density lipoprotein – the “bad” cholesterol), and triglyceride levels in the blood and decreasing HDL (high-density lipoprotein – the “good” cholesterol). This can lead to fatty plaque deposits in the arteries which, over time, can lead to cardiovascular disease and strokes. Insulin resistance also leads to increased insulin and glucose levels in the blood. Excess insulin increases sodium retention by the kidneys, which increases blood pressure and can lead to hypertension. Chronically elevated glucose levels in turn damage blood vessels and organs, such as the kidneys.
About Metabolic Syndrome
Your healthcare practitioner may suspect that you have metabolic syndrome if you have excess weight around your waist and do not get enough exercise, but both laboratory and non-laboratory tests are important in establishing the diagnosis. Recommended tests include:
- Glucose testing—to help diagnose diabetes or detect a decreased ability to process glucose (impaired glucose tolerance), which can eventually result in diabetes
- Hemoglobin A1c—can be used for the diagnosis of diabetes and to monitor the condition
- Lipid panel—measures HDL-C, LDL-C, triglycerides, and VLDL to detect unhealthy lipid levels
There are other laboratory tests that are not recommended for diagnosing metabolic syndrome but may ordered by some healthcare practitioners to provide additional information. Examples include:
- Urine albumin—elevated albumin in the urine is an early indicator of kidney disease; this test is used to help monitor people with diabetes and is recommended under the WHO criteria.
- hs-CRP—this is a measure of low levels of inflammation that may be tested as part of an evaluation of cardiac risk.
- Blood pressure readings—to monitor your blood pressure and check for hypertension
- Weight and waist circumference—to determine if you have abdominal obesity
- Body Mass Index (BMI)—this is an alternate way to measure obesity that is used by many healthcare practitioners; it is calculated by taking: (Weight in pounds X 705) / (height in inches squared). For example: (150 pounds X 705) / (67 inches X 67 inches) = a BMI of 23.5. An adult with a BMI greater than 30 is considered obese. This calculation does not, however, describe where the excess weight is on the body.
The primary treatment for metabolic syndrome is making changes to your lifestyle to address obesity, such as losing weight, eating a healthy diet, and exercising regularly. You should also stop smoking cigarettes.
Weight loss and exercise can:
- Lower blood pressure levels
- Increase insulin sensitivity
- Lower triglyceride and LDL levels
- Raise HDL levels
- Decrease risk of cardiovascular disease and stroke
Drug treatment may be necessary to address other aspects of metabolic syndrome. Hypertension should be treated. Statins may be prescribed to treat unhealthy lipid levels. Some healthcare practitioners may prescribe medications to increase insulin sensitivity (although there is not widespread agreement on this).
You should work with your healthcare practitioner and other medical professionals, such as a nutritionist, to develop an individualized treatment plan and to monitor its effectiveness.
For Health Professionals: Metabolic Syndrome
Insulin is a hormone that allows glucose to move into tissue cells, where is it is used for energy production. Insulin then prompts the liver to either store the remaining excess blood glucose as glycogen (for short-term energy storage) and/or to use it to produce fatty acids (which then become triglycerides). In people with insulin resistance, additional insulin must be released by the pancreas to overcome the tissue cells’ resistance and allow glucose to enter the cells. In response to insulin resistance, the pancreas can produce more insulin in an attempt to maintain normal levels of insulin action. However, despite increased insulin, if insulin action is deficient, elevated glucose will result. Over time, increased glucose levels can harm blood vessels and organs such as the kidneys and eyes. Increased insulin levels can increase sodium retention by the kidneys, resulting in increases in blood pressure (which can lead to hypertension).
The liver uses triglycerides, cholesterol, and protein to make triglyceride-rich very low-density lipoproteins (VLDL). In the blood, an enzyme removes triglycerides from VLDL to first produce intermediate density lipoproteins (IDL) and then low-density lipoproteins (LDL – the “bad” cholesterol). LDL is not all bad; it is an essential part of lipid metabolism and is necessary for the integrity of cell walls and for sex hormone and steroid production. However, in excess, LDL can oxidize and accumulate, eventually leading to fatty deposits in artery walls and to hardening and scarring of the blood vessels (and to cardiovascular disease and blood clots). These fatty deposits in the walls of arteries are the pathological lesions of atherosclerosis.
LDL molecules are produced in a variety of sizes. Small dense LDL (sdLDL) are thought to be more prone to have their cholesterol deposited in artery walls than their larger counterparts. In obese and/or insulin-resistant people, excessive amounts of VLDL and triglycerides remain in the blood and lead to increases in the number of sdLDL produced.
High-density lipoprotein (HDL – the “good” cholesterol) ordinarily transports excess cholesterol from the tissues back to the liver. In the liver, the cholesterol is either recycled for future use or excreted into bile. HDL’s reverse transport is the only way that cells can get rid of excess cholesterol. It helps protect the arteries and, if there is enough HDL present, it can even reverse the build up of fatty plaques in the arteries. When there are excessive amounts of VLDL and triglyceride present, however, HDL concentrations in the blood decrease.
Sources Used in Current Review
Saklayen, M. The Global Epidemic of the Metabolic Syndrome. Curr Hypertens Rep. 2018; 20(2): 12. Published online 2018 Feb 26. doi: 10.1007/s11906-018-0812-z. Accessed September 2019.
(March 16, 2017) Moore J, et al. Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988–2012. Available online at https://www.cdc.gov/pcd/issues/2017/16_0287.htm. Accessed September 2019.
(©2015) American Heart Association. What is Metabolic Syndrome? Available online at https://www.heart.org/-/media/files/health-topics/answers-by-heart/what-is-metabolic-syndrome-300322.pdf?la=en. Accessed September 2019.
(January 2013) National Heart, Lung, and Blood Institute. Metabolic Syndrome. Available online at https://www.nhlbi.nih.gov/health-topics/metabolic-syndrome. Accessed September 2019.
Sources Used in Previous Reviews
Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.
(2003 March 03, Reviewed). Metabolic Syndrome. Cleveland Clinic Health Information Center. Available online at http://www.clevelandclinic.org/health/health-info/docs/3000/3057.asp?index=10783.
Syndrome X or Metabolic Syndrome. American Heart Association. Available online at http://www.americanheart.org/presenter.jhtml?identifier=534.
Metabolic Syndrome. American Heart Association. Available online at http://www.americanheart.org/presenter.jhtml?identifier=4756.
The Metabolic Syndrome. American Diabetes Association. Available online at http://www.diabetes.org/weightloss-and-exercise/weightloss/metabolicsyndrome.jsp.
Blackburn, G. and Bevis, L. (2003 September 12, Updated). The Obesity Epidemic: Prevention and Treatment of the Metabolic Syndrome. Available online at http://www.medscape.com/viewprogram/2015.
Peters Harmel, A. and Berger, D. (2003 August 24 – 29). Clinical Implications of the Metabolic Syndrome. Medscape coverage of: 18th International Diabetes Federation Congress. Available online at http://www.medscape.com/viewarticle/462881.
Hoefner, D. (2003 October). The ruthless malady: metabolic syndrome. MLO. Available online at http://www.mlo-online.com.
Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry. AACC Press, Washington, DC. Pp 296.
(2007 April). What Is Metabolic Syndrome? NHLBI. Available online at http://www.nhlbi.nih.gov/. Accessed on 3/9/08.
Blaha, M. and Elasy, T. (2006). Clinical Use of the Metabolic Syndrome:Why the Confusion? Clinical Diabetes v 24 (3). Available online at http://clinical.diabetesjournals.org/. Accessed on 3/9/08.
(January 2006) Pizzi, R. Agreeing to Disagree ADA, AHA Publish Opposing Views on Metabolic Syndrome. Clinical Laboratory News Volume 32, No. 1.
American Diabetes Association. Diabetes Research Summary, Is the Metabolic Syndrome Really a Syndrome? Available online at http://www.diabetes.org. Accessed June 2008.
(22 May 2008) Sattar N, et al. Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. The Lancet 2008; 371:1927-1935. Available online at http://www.thelancet.com. Accessed June 2008.
(Updated 2011 November 3). What Is Metabolic Syndrome? National Heart Lung and Blood Institute [On-line information]. Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/ms/. Accessed November 2011.
Mayo Clinic staff (Updated 2011 October 8). Metabolic syndrome. Mayo Clinic Medical [On-line information]. Available online at http://www.mayoclinic.com/health/metabolic%20syndrome/DS00522/METHOD=print. Accessed November 2011.
Wang, S. (Updated 2011 November 9). Metabolic Syndrome. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/165124-overview. Accessed November 2011.
Eckman, A. (2011 June 28). Metabolic syndrome. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/007290.htm. Accessed November 2011.
(2010 March). The Metabolic Syndrome. The Hormone Foundation [On-line information]. PDF available for download at http://www.hormone.org/Resources/upload/metabolic-syndrome-bilingual-042010.pdf. Accessed November 2011.
Roberts, W. (Updated 2011 May). Metabolic Syndrome. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/MetabolicSyndrome.html. Accessed November 2011.
2016 review performed by Lei Fu, PhD, DABCC, FACB, FCACB, Clinical Biochemist, Sunnybrook Health Sciences Centre, University of Toronto and the Editorial Review Board.
Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009 Oct 20. 120 (16):1640-5.
Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539–553.
National Cholesterol Education Program (NCEP) Adult Treatment Panel III final report. Circulation 2002;106:3143–3421.
Grundy, SM, et al. Diagnosis and Management of the Metabolic Syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735–2752.
(November 6, 2015) National Heart, Lung, and Blood Institute. What is Metabolic Syndrome? Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/ms. Accessed February 2016.
(December 27, 2015) Wang S. Metabolic Syndrome. Medscape Reference. Available online at http://emedicine.medscape.com/article/165124-overview. Accessed February 2016.
Huang P. A comprehensive definition for metabolic syndrome. Dis Model Mech. 2009 May-Jun; 2(5-6): 231–237. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675814/. Accessed February 2016.