Metabolic syndrome a scary epidemic that few can define

Will the new class of weight-loss drugs battle this cluster of conditions that affect lifespan?

By Brian Dunleavy
Having unhealthy levels of sugar and fat in the blood, elevated cholesterol, high blood pressure and abdominal obesity are the culprits of metabolic syndrome. Photo by TheOtherKev/Pixabay
1 of 4 | Having unhealthy levels of sugar and fat in the blood, elevated cholesterol, high blood pressure and abdominal obesity are the culprits of metabolic syndrome. Photo by TheOtherKev/Pixabay

NEW YORK, May 31 (UPI) -- Not many people know what metabolic syndrome is, even though the cluster of conditions impacts their overall health and, potentially, their lifespans, experts told UPI.

Having unhealthy levels of sugar and fat in the blood, elevated cholesterol, high blood pressure and abdominal obesity are the culprits.


Being diagnosed with three or more of these conditions means someone has metabolic syndrome, and that increases a person's risk for heart disease, diabetes, stroke and atherosclerosis, according to the American Heart Association.

It also raises the risk for certain types of cancers and death, research suggests.

As many as one-third of adults in the United States meet the criteria for metabolic syndrome, the Centers for Disease Control and Prevention estimates. Yet, it's rarely given as a diagnosis by doctors, said Dr. Ronald M. Krauss, a senior scientist at Children's Hospital Oakland Research Institute in California.


"One of the reasons metabolic syndrome may not be widely discussed is that, in medicine, we usually treat the conditions that lead to the diagnosis being made, and not the diagnosis itself," Krauss, who is also a professor of medicine at the University of California, San Francisco, told UPI in a phone interview

"It's not like a single disease, and I don't know that patients would learn anything more by the application of the term metabolic syndrome, as opposed to their doctor telling them their waist is too big or their blood pressure is too high," he said.

However, this doesn't mean physicians and public health experts aren't concerned about the rise in metabolic syndrome nationally, Krauss said.

Prevalence increasing

A recent analysis by Asian and European scientists suggests the prevalence of metabolic syndrome in the United States increased from to 32% from 28% between 1999 and 2014.

Based on CDC estimates, roughly 35% of adults across the country met the criteria for the syndrome almost a decade ago.

However, the actual number of people with it may be even higher, given how common the conditions that make it up are, according to Tali Elfassy, a research assistant professor at the University of Miami Miller School of Medicine, who has researched the topic.


To meet the criteria for metabolic syndrome, people must have at least three of five common health conditions, said Dr. Philip Greenland, a professor of cardiology and preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.

The conditions include abdominal obesity, or a "large waist circumference," Greenland told UPI in a phone interview.

This is a measure of fat distribution in the body, and is based on research suggesting that the concentration of fat in the abdomen increases a person's risk for heart disease, he said.

Starting point

Both Krauss and Greenland agree that abdominal obesity, or being severely overweight, is the "starting point" for metabolic syndrome.

"I don't recall that I've seen a lean person with metabolic syndrome," Greenland said.

More than 40% of adults in the United States meet the criteria for obesity, or being severely overweight, the CDC estimates.

However, the prevalence of abdominal obesity, which is not based on body weight, may be as high as 67% in women and 50% in men, research suggests.

In addition to abdominal obesity, a person with high blood pressure, high cholesterol, high triglycerides and/or high blood sugar meets the criteria for metabolic syndrome.

Nearly half of all adults in the United States -- or 120 million people -- have high blood pressure, according to the American Heart Association, and as many as 28% are using cholesterol-lowering medications, a recent study estimates.


More than 38 million adults have Type 2 diabetes, which is caused by elevated blood sugar levels, while another 98 million have prediabetes, or blood sugar that is higher than what is considered healthy but does not yet meet the threshold for diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Many of these conditions have been linked with obesity, Elfassy told UPI in a phone interview.

"Metabolic syndrome is really a cluster of conditions that I would argue are obesity driven," she said.

All of the conditions that make up metabolic syndrome increase a person's risk for heart disease and stroke, which can lead to premature death, according to Krauss, who was one of the expert specialists who was involved in early efforts to define the term.

However, more recent research has linked metabolic syndrome with a higher risk for a colon cancer diagnosis before age 50 years and an elevated risk for breast cancer and death from the disease, among women.

"We know that obesity is associated with increased inflammation in the body and that inflammation can cause cancer," Elfassy said.

"We also know that fat cells release hormones that can cause cancer," she said.


Treated for components

Still, even though most people with metabolic syndrome don't hear that they have it from their doctors, they are likely -- or at least hopefully -- being treated for its components, Northwestern's Greenland said.

"If you have diabetes alone, we say, 'You have diabetes,' and treat you for it, or if you have high blood pressure, we tell you and treat you for it," Greenland said.

"The problem is, if they also have high cholesterol, that means they may be taking three drugs, all of which have side effects," he said.

That's why specialists like Krauss and Greenland believe the first-line treatment for people who meet the criteria for metabolic syndrome is dietary change and exercise.

"If people are willing to make the usual kinds of adjustments in diet that would lead to weight loss, as well as increase physical activity, that's usually a good approach -- without the side effects associated with prescription drugs," Greenland said.

"Not everyone needs to take a pill," he said.

That said, an emerging class of prescription weight-loss drugs -- semaglutide, or Wegovy, and tirzepatide, or Zepbound - may change the way metabolic syndrome is treated, Greenland said.

"Although there are no drugs targeting metabolic syndrome specifically, we do now have these weight-loss drugs that also have positive implications for the secondary effects on the metabolic system of being overweight," Greenland said.


"These medications not only can reduce body weight, but they also can help lower blood sugar and blood fat," he said.

Whether that will change the conversation around metabolic syndrome, or even start it, in doctors' offices remains to be seen, according to Krauss.

"I'm not sure using the umbrella term 'metabolic syndrome' would replace the need to focus on the specific factors that cause it," Krauss said.

"However, patients should definitely be counseled on the risks of metabolic syndrome, even if the term never comes up."

Latest Headlines