Health Literacy
Metabolic syndrome: the five risk factors
Metabolic syndrome isn't one disease — it's a cluster of risk factors that, together, substantially raise the risk of heart disease and type 2 diabetes.
The five criteria
Metabolic syndrome is diagnosed when a person has three or more of the following:[1]
| Factor | Threshold |
|---|---|
| Waist circumference | ≥40 in (men), ≥35 in (women) |
| Triglycerides | ≥150 mg/dL (or on medication for it) |
| HDL cholesterol | <40 mg/dL (men), <50 mg/dL (women) |
| Blood pressure | ≥130/85 mmHg (or on medication for it) |
| Fasting blood glucose | ≥100 mg/dL (or on medication for it) |
Each factor individually raises risk; having several together raises it more than the sum of the parts would suggest, which is exactly why they're tracked as a cluster.
What drives it
Insulin resistance sits at the center of most cases — cells respond less efficiently to insulin, so the pancreas produces more to compensate, which contributes to several of the five factors simultaneously. Excess visceral fat (the fat around abdominal organs, reflected in waist circumference) is both a cause and a consequence of that resistance.[1] See insulin and glucagon for the underlying physiology.
What has the strongest evidence for reversing it
- Modest weight loss — even 5-10% of body weight measurably improves multiple factors at once
- Regular physical activity — improves insulin sensitivity independent of weight change
- A Mediterranean-style diet — the dietary pattern with the strongest trial evidence for this specific cluster
- Reducing added sugar and refined carbohydrate — most directly targets triglycerides and blood glucose
Frequently asked questions
How many risk factors are needed to diagnose metabolic syndrome?
Three or more of five: elevated waist circumference, high triglycerides, low HDL cholesterol, high blood pressure, and elevated fasting blood glucose.
What causes metabolic syndrome?
Insulin resistance sits at the center of most cases, often accompanied by excess visceral fat around the abdominal organs, which is both a cause and consequence of that resistance.
What's most effective for reversing metabolic syndrome?
Modest weight loss of 5-10% of body weight, regular physical activity, a Mediterranean-style dietary pattern, and reducing added sugar and refined carbohydrate all have strong supporting evidence.
Keep reading: Insulin and glucagon · Understanding a lipid panel · The Mediterranean diet