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Metabolic syndrome, characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia, raises the risk of serious health problems such as heart disease, stroke, and metabolic dysfunctions. Recent reporting suggests that the global prevalence of metabolic syndrome is anywhere from 12.5% to 31.4%, depending on the diagnosis definition used.¹ Estimates for metabolic syndrome in the United States are at more than 30%,² and studies suggest that patients with metabolic syndrome are five times more likely to develop diabetes.³ In fact, data show that the incidence of metabolic syndrome often parallels the incidence of obesity and type 2 diabetes.⁴ Between 2017 and 2020, US obesity prevalence was estimated at 41.9%, according to the Centers for Disease Control and Prevention (CDC).⁵ The CDC also reported in 2022 that about 37.3 million people in the US (11.3% of the US population) have diabetes, with another 96 million US adults reported as prediabetic.⁶

Research suggests that an increase in high-calorie, low-fiber fast food, an increase in sedentary lifestyles, and a decrease in physical activity have contributed to the rising incidence of metabolic syndrome.^4,7-9 In addition, studies have also indicated potential increased risks of metabolic dysfunctions due to both chronic environmental toxicant exposures and short sleep durations.^10,11 Fortunately, clinical trials continue to report the effectiveness of accessible lifestyle-based interventions for the treatment or prevention of metabolic dysfunctions.^12-16

Screening for Metabolic Syndrome – The Physical Exam

Early intervention may help prevent metabolic syndrome, but in order to know when to intervene, you need to know which patients are at risk for the disorder. Before ordering lab tests, the first step in screening for metabolic syndrome can be as simple as conducting a brief physical exam for visceral adiposity and acanthosis nigricans.^17,18 Specifically, a simple waist-to-hip ratio may indicate an increased risk for diabetes, heart disease, and other complications.^19,20 In the following video, IFM educator Elizabeth Boham, MD, talks about how you can detect metabolic syndrome in the physical exam.

From Stress to Diet to Movement: Lifestyle Impacts on Metabolic Syndrome

Stress levels, disrupted circadian rhythms, and the health of the gut microbiota can influence metabolic health. A 2018 cross-sectional analysis suggests that the psychosocial stressors associated with shift work may contribute to higher metabolic syndrome incidence.²¹ In addition, a 2022 meta-analysis indicated a twofold increased risk of developing metabolic syndrome in healthcare shift workers compared to day workers.²² Another recent study suggests that the epidemic of metabolic syndrome is also associated with economic development, lifestyle transition, and dysbiosis of gut microbiota.²³ Although researchers can clearly establish a causal relationship between gut microbial profiles and metabolic syndrome in animal experiments, the relationship between them remains controversial in humans.²⁴ Additional clinical trials are needed to elucidate the complex interaction between gut microbiome balance and cardiometabolic health.^25,26

Dietary interventions have been shown to be effective in helping to prevent or control metabolic syndrome. In 2018, epidemiologic evidence suggested that novel trimethylated (betainized) compounds associated with glucose metabolism in humans are associated with diets rich in whole grains, and they improve insulin resistance and insulin secretion.²⁷ A 2023 systematic review investigated how consumption of berries (specifically blueberries, cranberries, and chokeberries) and their phytonutrients may impact inflammatory parameters associated with metabolic syndrome.²⁸ Several of the analyzed clinical trials suggested that berry intake improved lipid profiles and reduced inflammatory biomarkers.²⁸

Data from a cross-sectional analysis in adults suggests that a higher quality diet, assessed using the Dietary Approaches to Stop Hypertension (DASH) dietary quality score, is associated with improved adiposity measures and a less insulin-resistant, proinflammatory, pro-thrombotic, and proatherogenic cardiometabolic profile, which may impact central obesity and metabolic syndrome risk.²⁹ Evidence also suggests that regular physical activity, from aerobic exercise to dynamic resistance exercise and combination training, helps improve lipid profiles and reduce metabolic syndrome risk factors.^12,13

What other lifestyle modifications can help patients who struggle with metabolic syndrome? Learn more about tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.

The connection between POPs and metabolic syndrome

The right food plan for cardiometabolic patients

Microbiome health and cardiometabolic conditions

The cardiometabolic-focused exam for all body types

References

1. Noubiap JJ, Nansseu JR, Lontchi-Yimagou E, et al. Geographic distribution of metabolic syndrome and its components in the general adult population: a meta-analysis of global data from 28 million individuals. Diabetes Res Clin Pract. 2022;188:109924. doi:1016/j.diabres.2022.109924
2. Moore JX, Chaudhary N, Akinyemiju T. Metabolic syndrome prevalence by race/ethnicity and sex in the United States, National Health and Nutrition Examination Survey, 1988-2012. Prev Chronic Dis. 2017;14:E24. doi:5888/pcd14.160287
3. Regufe VMG, Pinto CMCB, Perez PMVHC. Metabolic syndrome in type 2 diabetic patients: a review of current evidence. Porto Biomed J. 2020;5(6):e101. doi:1097/j.pbj.0000000000000101
4. Saklayen MG. The global epidemic of the metabolic syndrome. Curr Hypertens Rep. 2018;20(2):12. doi:1007/s11906-018-0812-z
5. Division of Nutrition, Physical Activity, and Obesity. Adult obesity facts. Centers for Disease Control and Prevention. Reviewed May 17, 2022. Accessed June 7, 2023. https://www.cdc.gov/obesity/data/adult.html
6. National diabetes statistics report. Centers for Disease Control and Prevention. Reviewed June 29, 2022. Accessed June 7, 2023. https://www.cdc.gov/diabetes/data/statistics-report/index.html
7. Muñoz-Cabrejas A, Guallar-Castillón P, Laclaustra M, Sandoval-Insausti H, Moreno-Franco B. Association between sugar-sweetened beverage consumption and the risk of the metabolic syndrome: a systematic review and meta-analysis. Nutrients. 2023;15(2):430. doi:3390/nu15020430
8. Frías JRG, Cadena LH, Villarreal AB, et al. Effect of ultra-processed food intake on metabolic syndrome components and body fat in children and adolescents: a systematic review based on cohort studies. Nutrition. 2023;111:112038. doi:1016/j.nut.2023.112038
9. Wu J, Zhang H, Yang L, et al. Sedentary time and the risk of metabolic syndrome: a systematic review and dose-response meta-analysis. Obes Rev. 2022;23(12):e13510. doi:1111/obr.13510
10.  Lamat H, Sauvant-Rochat MP, Tauveron I, et al. Metabolic syndrome and pesticides: a systematic review and meta-analysis. Environ Pollut. 2022;305:119288. doi:1016/j.envpol.2022.119288
11.  Dejenie TA, G/Medhin MT, Admasu FT, et al. Impact of objectively-measured sleep duration on cardiometabolic health: a systematic review of recent evidence. Front Endocrinol (Lausanne). 2022;13:1064969. doi:3389/fendo.2022.1064969
12.  Tan A, Thomas RL, Campbell MD, Prior SL, Bracken RM, Churm R. Effects of exercise training on metabolic syndrome risk factors in post-menopausal women – a systematic review and meta-analysis of randomised controlled trials. Clin Nutr. 2023;42(3):337-351. doi:1016/j.clnu.2023.01.008
13.  Wood G, Taylor E, Ng V, et al. Estimating the effect of aerobic exercise training on novel lipid biomarkers: a systematic review and multivariate meta-analysis of randomized controlled trials. Sports Med. 2023;53(4):871-886. doi:1007/s40279-023-01817-0
14.  Sanogo F, Xu K, Cortessis VK, Weigensberg MJ, Watanabe RM. Mind- and body-based interventions improve glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis. J Integr Complement Med. 2023;29(2):69-79. doi:1089/jicm.2022.0586
15.  Sarsangi P, Salehi-Abargouei A, Ebrahimpour-Koujan S, Esmaillzadeh A. Association between adherence to the Mediterranean diet and risk of type 2 diabetes: an updated systematic review and dose-response meta-analysis of prospective cohort studies. Adv Nutr. 2022;13(5):1787-1798. doi:1093/advances/nmac046
16.  Long Y, Ye H, Yang J, et al. Effects of a vegetarian diet combined with aerobic exercise on glycemic control, insulin resistance, and body composition: a systematic review and meta-analysis. Eat Weight Disord. 2023;28(1):9. doi:1007/s40519-023-01536-5
17.  Rico-Martín S, Calderón-García JF, Sánchez-Rey P, Franco-Antonio C, Martínez Alvarez M, Sánchez Muñoz-Torrero JF. Effectiveness of body roundness index in predicting metabolic syndrome: a systematic review and meta-analysis. Obes Rev. 2020;21(7):e13023. doi:1111/obr.13023
18.  Philip NE, Girisha BS, Shetty S, Pinto AM, Noronha TM. Estimation of metabolic syndrome in acanthosis nigricans – a hospital based cross-sectional study. Indian J Dermatol.  2022;67(1):92. doi:4103/ijd.ijd_442_21
19.  Löffler-Wirth H, Willscher E, Ahnert P, et al. Novel anthropometry based on 3D-bodyscans applied to a large population based cohort. PLoS One. 2016;11(7):e0159887. doi:1371/journal.pone.0159887
20.  Apple and pear body shapes. Mayo Clinic. Accessed June 7, 2023. http://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/multimedia/apple-and-pear-body-shapes/img-20006114
21.  Santos AE, Araújo LF, Griep RH, et al. Shift work, job strain, and metabolic syndrome: cross-sectional analysis of ELSA-Brasil. Am J Ind Med. 2018;61(11):911-918. doi:1002/ajim.22910
22.  Sooriyaarachchi P, Jayawardena R, Pavey T, King NA. Shift work and the risk for metabolic syndrome among healthcare workers: a systematic review and meta-analysis. Obes Rev. 2022;23(10):e13489. doi:1111/obr.13489
23.  He Y, Wu W, Wu S, et al. Linking gut microbiota, metabolic syndrome and economic status based on a population-level analysis. Microbiome. 2018;6(1):172. doi:1186/s40168-018-0557-6
24.  Wang PX, Deng XR, Zhang CH, Yuan HJ. Gut microbiota and metabolic syndrome. Chin Med J. 2020;133(7):808-816. doi:1097/cm9.0000000000000696
25.  Attaye I, Warmbrunn MV, Boot ANAF, et al. A systematic review and meta-analysis of dietary interventions modulating gut microbiota and cardiometabolic diseases—striving for new standards in microbiome studies. Gastroenterology. 2022;162(7):1911-1932. doi:1053/j.gastro.2022.02.011
26.  Bona MD, Torres CHM, Lima SCVC, Morais AHA, Lima AÂM, Maciel BLL. Intestinal barrier permeability in obese individuals with or without metabolic syndrome: a systematic review. Nutrients. 2022;14(17):3649. doi:3390/nu14173649
27.  Kärkkäinen O, Lankinen MA, Vitale M, et al. Diets rich in whole grains increase betainized compounds associated with glucose metabolism. Am J Clin Nutr. 2018;108(5):971-979. doi:1093/ajcn/nqy169
28.  Venturi S, Marino M, Cioffi I, et al. Berry dietary interventions in metabolic syndrome: new insights. Nutrients. 2023;15(8):1906. doi:3390/nu15081906
29.  Phillips CM, Harrington JM, Perry IJ. Relationship between dietary quality, determined by DASH score, and cardiometabolic health biomarkers: a cross-sectional analysis in adults. Clin Nutr. 2019;38(4):1620-1628. doi:1016/j.clnu.2018.08.028