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Patient education: The metabolic syndrome (Beyond the Basics)

James B Meigs, MD, MPH
Section Editors
David M Nathan, MD
Joseph I Wolfsdorf, MB, BCh
Deputy Editor
Daniel J Sullivan, MD, MPH
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The metabolic syndrome, also called insulin resistance syndrome or syndrome X, is not a disease but a group of characteristics. These characteristics include obesity, high blood pressure, elevated blood sugar levels, and high triglycerides (fat-like substances in the blood). Having a combination of these characteristics increases your risk of developing type 2 diabetes and heart disease. Keeping your weight, blood sugar, and cholesterol and triglyceride levels under control can help you to live longer and decrease your risk of heart attack and stroke.

There is controversy as to whether metabolic syndrome is really a "syndrome."

More detailed information about metabolic information is available by subscription. (See "The metabolic syndrome (insulin resistance syndrome or syndrome X)".)


The metabolic syndrome is a group of characteristics. You do not need to have all of the characteristics to have it. However, a person with one characteristic is more likely to have others. Most expert groups define metabolic syndrome as the presence of three or more of the following characteristics in a person:

Obesity, especially in the abdominal area (defined by some groups as a waist size greater than 94 to 102 cm [38 to 41 in] in men or greater than 80 cm [32 in] in women)

Impaired glycemia (fasting blood sugar of 100 to 125 mg/dL [5.6 to 7 mmol/L] or glycated hemoglobin [A1C] 5.7 to 6.4 percent)

Increased blood pressure (130/85 mmHg or higher) or if you take medicine for high blood pressure

Increased fasting levels of triglycerides (greater than 150 to 180 mg/dL or 1.7 mmol/L) or decreased fasting high-density lipoprotein (HDL) cholesterol (less than 40 mg/dL or 1 mmol/L for men or 50 mg/dL or 1.3 mmol/L for women) or if you take medicine for high triglycerides or low HDL cholesterol


Metabolic syndrome is becoming increasingly common. In one study performed between 1999 and 2002, more than 34 percent of participants were classified as having metabolic syndrome [1]. This number is significantly increased from a similar study performed between 1988 and 1994, when 22 percent of people had metabolic syndrome.

The following factors are thought to increase the risk of developing metabolic syndrome:

Being overweight (body mass index of 25 kg/m2 or more) (calculator 1 and calculator 2)

Menopause (in women)

Increasing age


Eating a high-carbohydrate diet

Lack of physical activity

Family history of diabetes or metabolic syndrome

Health risks associated with metabolic syndrome

Diabetes — Type 2 diabetes is much more likely to develop among people with the metabolic syndrome [2]. Healthy lifestyle changes, such as weight loss and exercise, can help to reduce the risk of developing type 2 diabetes. (See "Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)".)

Cardiovascular disease — People with metabolic syndrome are at increased risk for developing cardiovascular disease. Cardiovascular disease includes coronary artery disease (collections of fatty plaques inside the heart's blood vessels), cerebrovascular disease (collections of fatty plaques inside the blood vessels leading to the brain), and high blood pressure. Cardiovascular disease can lead to heart attack, stroke, or angina (chest pain).


The metabolic syndrome is diagnosed based upon a physical exam and a blood test of your blood sugar (either fasting [before breakfast] blood sugar or a test any time of A1C), cholesterol, and triglyceride levels. A description of how blood glucose and cholesterol levels are measured is available separately. (See "Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)" and "Patient education: High cholesterol and lipids (hyperlipidemia) (Beyond the Basics)".)


The goals of treatment for the metabolic syndrome are to:

Reduce or eliminate underlying problems (eg, obesity, lack of activity) by losing weight and becoming more active

Treat cardiovascular risk factors, such as high blood pressure and cholesterol, if these problems persist despite losing weight and exercising

Weight loss — Management of the metabolic syndrome usually includes losing weight and becoming more active. Your diet should be low in fat and cholesterol.

The Mediterranean diet is high in fruits, vegetables, nuts, whole grains, and olive oil. This diet can help to lower weight, blood pressure, lipids, and improve insulin resistance.

The DASH (Dietary Approaches to Stop Hypertension) diet can reduce blood pressure, weight, lipids, and fasting blood glucose levels. The DASH diet requires you to eat no more than 2400 mg of sodium per day, four to five servings of fruit, four to five servings of vegetables, and two to three servings of low-fat dairy products; all foods must contain less than 25 percent total fat per serving. (See "Patient education: Low-sodium diet (Beyond the Basics)".)

Exercise — Exercise can help with weight loss and can also help to reduce the size of the abdomen, especially in women. Experts recommend at least 30 minutes of moderate physical activity, such as brisk walking, most days of the week. (See "Patient education: Exercise (Beyond the Basics)".)

Reduce the risk of type 2 diabetes — Losing weight (if you are overweight or obese) and staying active can reduce the risk of developing type 2 diabetes.

Reduce cholesterol — High levels of low-density lipoprotein (LDL) (bad) cholesterol increase the risk of coronary artery disease. In people with metabolic syndrome, an LDL level of less than 80 to 100 mg/dL is recommended.

If diet and weight loss do not adequately reduce your LDL levels, a medicine may be recommended. Treatment of high LDL levels is discussed separately. (See "Patient education: High cholesterol and lipids (hyperlipidemia) (Beyond the Basics)".)

Reduce blood pressure — Keeping your blood pressure in a healthy range is an important goal, especially in people with the metabolic syndrome.

High blood pressure is a blood pressure greater than or equal to 130 mmHg systolic or greater than or equal to 80 mmHg diastolic mmHg

Elevated blood pressure is a blood pressure of 120-129 mmHg systolic and less than 80 mmHg diastolic

Some experts recommend treatment if your blood pressure is greater than 130/80 mmHg.

If diet and weight loss do not reduce your blood pressure enough, one or more blood pressure medicines may be recommended. Treatment of high blood pressure is discussed separately. (See "Patient education: High blood pressure treatment in adults (Beyond the Basics)".)

Quit smoking — Smoking cigarettes significantly increases the risk of coronary artery disease and has many other health risks as well. You and your family are strongly advised to stop cigarette smoking. (See "Patient education: Quitting smoking (Beyond the Basics)".)


Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Type 2 diabetes (The Basics)
Patient education: Metabolic syndrome (The Basics)
Patient education: High triglycerides (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)
Patient education: High cholesterol and lipids (hyperlipidemia) (Beyond the Basics)
Patient education: Low-sodium diet (Beyond the Basics)
Patient education: Exercise (Beyond the Basics)
Patient education: High blood pressure treatment in adults (Beyond the Basics)
Patient education: Quitting smoking (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Insulin resistance: Definition and clinical spectrum
The metabolic syndrome (insulin resistance syndrome or syndrome X)

The following organizations also provide reliable health information.

National Library of Medicine


American Diabetes Association


American Heart Association



Literature review current through: Nov 2017. | This topic last updated: Tue Nov 21 00:00:00 GMT 2017.
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