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Metabolic Syndrome

(Syndrome X; Insulin Resistance Syndrome)


Shauna M. Levy

, MD, MS, Tulane University School of Medicine;

Michelle Nessen

, MD, Tulane University School of Medicine

Reviewed/Revised Nov 2023

Metabolic syndrome is characterized by a large waist circumference (due to excess abdominal fat), high blood pressure, resistance to the effects of insulin (insulin resistance) or diabetes, and abnormal levels of cholesterol and other fats in the blood (dyslipidemia).

Metabolic syndrome is a serious problem. In the United States, more than 40% of people over 50 may have it. Even children and adolescents can develop metabolic syndrome, but how many have it is unknown.

Metabolic syndrome is more likely to develop when people store excess fat in the abdomen (apple-shaped) rather than around the hips (pear-shaped). The following people tend to store excess fat in the abdomen:

  • Most men

  • Women after menopause

Storing excess fat in the abdomen increases the risk of the following:

Chronic stress may increase the risk of developing metabolic syndrome. It may also cause hormonal changes that contribute to accumulation of excess fat in the abdomen and cause the body to stop responding normally to insulin (called insulin resistance), Chronic stress may cause levels of high-density lipoprotein (HDL—the "good") cholesterol to decrease. Abnormal levels of lipids (such as a low level of HDL) can increase the risk of metabolic syndrome.

Metabolic syndrome is more common among people who smoke than among people who do not. Smoking can increase triglyceride levels and decrease HDL levels.

Metabolic syndrome itself causes no symptoms.

Diagnosis of Metabolic Syndrome

  • Waist circumference

  • Blood pressure measurement

  • Blood tests to measure sugar and fat (lipid) levels after fasting

Waist circumference should be measured in all people because even people who are not overweight or appear lean can store excess fat in the abdomen. The greater the waist circumference, the higher the risk of metabolic syndrome and its complications. The waist circumference that increases risk of complications due to obesity varies by ethnic group and sex.

If waist circumference is high, doctors should measure blood pressure and blood sugar and fat levels after fasting. Levels of both blood sugar and fats are often abnormal.

Metabolic syndrome has many different definitions, but it is most often diagnosed when the waist circumference is 40 inches (102 centimeters) or more in men or 35 inches (88 centimeters) or more in women (indicating excess fat in the abdomen) and when people have or are being treated for two or more of the following:

  • A fasting blood sugar level of 100 mg/dL (milligrams per deciliter) or higher

  • Blood pressure of 130/85 mm Hg (millimeters of mercury) or higher

  • A fasting blood triglyceride (a fat) level of 150 mg/dL or higher

  • A high density lipoprotein (HDL—the good) cholesterol level of less than 40 mg/dL for men or less than 50 mg/dL for women

Treatment of Metabolic Syndrome

  • Physical activity and a heart-healthy diet

  • Treatment of high blood sugar, high blood pressure, and abnormal fat levels

  • Sometimes metformin or statins

  • Medications to treat obesity and metabolic and bariatric surgery

  • Smoking cessation

  • Stress management

The initial treatment of metabolic syndrome involves physical activity and a heart-healthy diet. Each part of metabolic syndrome should also be treated with medications if necessary.

If people have diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Symptoms of diabetes may... read more or a high blood sugar level, medications that increase the body’s sensitivity to insulin, such as metformin or a thiazolidinedione (such as rosiglitazone or pioglitazone), may help. Also, physical activity is important for people with diabetes because it enables the body to use blood sugar more efficiently and can often help lower the blood sugar level.

Ways to reduce stress (which can increase the risk of metabolic syndrome) include deep breathing exercises, meditation, psychologic support, and counseling).

Drugs Mentioned In This Article

Generic Name Select Brand Names
Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet, RIOMET ER
alli, Xenical
Adipex-P, Atti-Plex P , Atti-Plex P Spansule , Fastin, Ionamin, Lomaira , Pro-Fast HS, Pro-Fast SA, Pro-Fast SR , Suprenza, Tara-8
Saxenda, Victoza
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