Metabolic syndrome explained

Share:

What is the metabolic syndrome?

The metabolic syndrome is not a single disease but a cluster of interconnected conditions that occur together and significantly raise the risk of type 2 diabetes, heart disease and stroke. It is one of the most common — and most underrecognised — health conditions in the developed world.

A person is generally considered to have the metabolic syndrome when they have three or more of the following: excess abdominal fat, high blood pressure, high blood sugar, high triglycerides (a type of blood fat) and low HDL ("good") cholesterol. Each of these conditions carries its own health risks, with this risk increasing when several of the conditions occur together. 

In Australia, it is estimated that around one in three adults meets the criteria for the metabolic syndrome.

What causes metabolic syndrome?

One of the underlying drivers of the metabolic syndrome is insulin resistance — a state in which the body's cells become less responsive to insulin, requiring the pancreas to produce more of it to maintain normal blood sugar levels. Over time, this compensatory mechanism falters, blood sugar rises and a cascade of metabolic disruptions follows.
Insulin resistance is strongly linked to excess body fat, particularly visceral fat — the fat stored deep in the abdomen around the organs — which is metabolically active and promotes chronic low-grade inflammation throughout the body. Physical inactivity, a diet high in refined carbohydrates and ultra-processed foods, poor sleep and chronic stress all contribute.

Genetics also play a role. Some people are more predisposed to insulin resistance than others, which is one of the reasons that the metabolic syndrome is more prevalent in certain ethnic groups, including South Asian, East Asian, Aboriginal and Torres Strait Islander communities, even at lower body weights.

Why does it matter?

People with the metabolic syndrome are around five times more likely to develop type 2 diabetes and two to three times more likely to develop cardiovascular disease compared to those without the metabolic syndrome. They also have elevated risk of fatty liver disease, sleep apnoea, certain cancers and polycystic ovary syndrome (PCOS).

Despite its prevalence and seriousness, the metabolic syndrome often goes undiagnosed because each individual component may seem mild and there are frequently no obvious symptoms until a significant health event occurs.

How is the metabolic syndrome managed?

The good news is that the metabolic syndrome responds well to lifestyle intervention — and in many cases the individual components can be substantially improved or even reversed through sustained lifestyle changes.

Physical activity is particularly powerful, improving insulin sensitivity, reducing abdominal fat, lowering blood pressure and improving cholesterol and triglyceride levels.

Dietary change — particularly reducing refined carbohydrates, added sugars and ultra-processed foods while increasing vegetables, whole grains and healthy fats — can have a rapid and meaningful effect on metabolic markers.

Weight loss, even modest amounts of 5 to 10 per cent of body weight, can significantly improve all components of the syndrome. Managing stress and improving sleep are also important and often overlooked contributors.

Where lifestyle change alone is insufficient, medications may be used to address specific components — blood pressure medications, statins, metformin and newer cardiometabolic medications including SGLT2 inhibitors and GLP-1 receptor agonists can all play a role.

Disclaimer
While reasonable efforts have been made to ensure the accuracy of this material, the information is provided on the basis that persons undertake responsibility for assessing the relevance and accuracy of its content. In particular, readers should seek independent professional medical advice from their general practitioner or specialist in relation to their own individual circumstance or condition before making any decisions based on this information. The material also includes summarised guidelines or recommendations based on information provided by third parties. The Baker Heart and Diabetes Institute disclaims to the extent permitted by law, all liability including negligence for claims of losses, expenses, damages and costs that the reader may incur (or suffer) from acting on or refraining from action as a result of all information in these materials.