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What is metabolic syndrome?
Metabolic syndrome sounds like a single disease, but in practice it involves several disorders that often come on insidiously at the same time. Many people don't notice anything clearly until their blood pressure rises, their blood sugar starts to be too high or their waistline increases even though their everyday life looks more or less the same as before. That's why metabolic syndrome raises many questions such as; how does it feel, who is affected and when should you react?
Metabolic syndrome – a combination of risk factors
Metabolic syndrome means that several cardiometabolic risk factors exist at the same time. The classic components are abdominal obesity, elevated blood pressure, elevated triglycerides, low HDL cholesterol and elevated fasting blood sugar. When at least three of these occur simultaneously, the most common guidelines speak of metabolic syndrome. It is therefore not a symptom in itself, but rather a pattern that shows that the body has more difficulty managing energy metabolism, insulin and blood fats. In the long term, the risk of type 2 diabetes, cardiovascular disease and stroke increases.
In the clinic, the condition is often discovered during a health check rather than during an emergency doctor's visit.
What symptoms can metabolic syndrome cause?
The most common symptom description is actually that you don't feel anything at all. High blood pressure, high triglycerides and low HDL often do not cause any clear everyday symptoms. Therefore, a person can feel fully functional but still have a clearly elevated risk profile in their test results.
The symptom or sign that is most often noticed is increased abdominal circumference. You feel that clothes fit differently around your stomach, your waistline increases or your body becomes more of an "apple shape" than before. Abdominal obesity is particularly relevant because fat tissue around the abdomen is strongly linked to insulin resistance and unfavorable blood lipids.
If blood sugar rises more pronouncedly, you may experience symptoms such as increased thirst, more frequent urination, fatigue or blurred vision. This often indicates that the disorder in sugar metabolism has become more advanced, sometimes on the way to or already compatible with diabetes.
Some also describe a diffuse lack of energy after meals, weight gain around the stomach or a deterioration in fitness. Such complaints are nonspecific and not sufficient for diagnosis, but they may be a reason to check blood pressure, blood sugar and blood lipids.
Why does metabolic syndrome occur?
The central mechanism is often insulin resistance, which means that the body's cells respond less well to insulin. The pancreas then needs to produce more insulin to keep blood sugar in check. Over time, blood sugar, fat metabolism and blood pressure are negatively affected.
Overweight, especially increased abdominal fat, is one of the strongest driving forces. Physical inactivity, heredity, advancing age, lack of sleep and certain hormonal conditions can also contribute. MedlinePlus also highlights that conditions such as polycystic ovary syndrome can co-occur with metabolic syndrome.
For many, the condition develops gradually over several years. A common example is a person who sits a lot at work, moves less than before, gains a few kilos per year and gradually develops higher blood pressure and worse blood lipid values without noticing any dramatic change from week to week.
How is the diagnosis made and what values are looked at?
The diagnosis is based on measurable risk markers, not on a single feeling in the body. Healthcare usually assesses waist circumference, blood pressure, fasting glucose and blood lipids. Several guidelines use the threshold of at least three of five criteria to define metabolic syndrome.
The five components are:
- increased waist circumference or abdominal obesity
- triglycerides of 1.7 mmol/L or higher, or treatment for this
- HDL cholesterol below 1.0 mmol/L in men or below 1.3 mmol/L in women, or treatment
- blood pressure of 130/85 mmHg or higher, or blood pressure treatment
- fasting glucose of 6.0 mmol/L or higher, or treatment for elevated blood sugar
Waist circumference is not assessed identically in all guidelines. The International Diabetes Federation uses ethnicity-specific cut-off values for abdominal obesity, while the harmonized international definition emphasizes that three out of five deviations are sufficient and that waist circumference in particular may need to be interpreted based on population and background.
In Sweden, the most important thing in practice is not to know every cut-off value by heart, but to understand which tests are needed. A health check-up with blood pressure, waist circumference, glucose and blood lipids often provides a clear first picture. If you are already monitoring your values for, for example, cholesterol, HbA1c or fasting glucose, those results can also contribute to the assessment, even though the diagnosis of metabolic syndrome is usually based on the entire risk pattern.
What can you do if you have metabolic syndrome?
Treatment is aimed at the causes and individual risk factors. Weight loss, more daily exercise and regular cardio training can improve blood pressure, triglycerides, blood sugar and insulin resistance. Even a weight loss of 3–5 percent can produce measurable improvements, and greater effects are often seen at 5–10 percent in people who are overweight.
Diet plays a big role, but it doesn't have to be extreme to help. For many, it works better to reduce the intake of energy-dense, ultra-processed foods and sugary drinks, increase the amount of vegetables, legumes, whole grains and fish, and have regular meals. In the case of high triglycerides, alcohol and high sugar intake are particularly relevant to review.
Sometimes lifestyle changes alone are not enough. In this case, medication may be needed for blood pressure, blood lipids or diabetes risk, depending on test results and overall risk profile. Treatment is tailored to the individual, as one person may need support for blood pressure while another primarily needs measures against blood sugar or triglycerides.
When should you get tested for metabolic syndrome?
It is wise to get tested if you know that you have gained weight around your stomach, have higher blood pressure, have diabetes in your family or feel that your energy and fitness have changed without a clear explanation. The same applies if previous tests have shown borderline values for glucose or blood fats. Metabolic syndrome is common in the borderlands where much can still be influenced.
You should also consider testing if you have a sedentary job, sleep poorly for a long time or are already being treated for one of the components, such as high blood pressure. If you have one risk factor, there is often reason to check the others, as they often occur together.
An early test is not just about finding the disease. It can also show that you are close to the border and provide a concrete starting point for change.
Metabolic syndrome is in many ways the body's way of showing that the load has become greater than the reserve capacity. The interesting thing is that the development can often be influenced long before complications arise, if you catch the signals in time and follow them with the right testing.
