Metabolic syndrome: Prevent, recognize, counteract
Scientific support: Prof. Dr. Hans Hauner
At least every 4th person in Germany has what is known as metabolic syndrome. Metabolic syndrome is not an autonomous disease. Rather, it refers to the joint occurrence of several risk factors or clinical pictures that increase the risk of cardiovascular disease and type 2 diabetes.
These factors include severe abdominal obesity, elevated blood sugar levels, elevated blood lipid levels and high blood pressure. A healthy lifestyle with a balanced diet and sufficient exercise can help to prevent or effectively treat metabolic syndrome.

Contents
1. What is metabolic syndrome?
Metabolic syndrome is not an autonomous disease. Doctors use this term to describe the joint presence of several clinical pictures or risk factors.
These include:
- Severe overweight (obesity), especially in the abdominal area
- Elevated fasting blood sugar level
- Elevated blood lipid levels
- High blood pressure
Colloquially, metabolic syndrome is often referred to as the “deadly quartet” because of the four risk factors. This name has been chosen because it significantly increases the risk of cardiovascular disease, type 2 diabetes and a fatty liver. Each of these variables is in itself a risk factor for these diseases. However, if they occur together, the people affected are at particularly high risk.
Most people with metabolic syndrome also have insulin resistance. Metabolic syndrome is therefore sometimes also referred to as insulin resistance syndrome. Insulin resistance is considered a precursor to type 2 diabetes. In the case of insulin resistance, the sensitivity of the body cells to the blood sugar-lowering hormone insulin is reduced. Insulin resistance is mainly promoted by being overweight or severely overweight (obese).
Insulin resistance means that muscle, liver and fat cells no longer react as sensitively to insulin and absorb less sugar (glucose) from the blood. To compensate this and lower the blood sugar level, the pancreas releases more insulin. However, the fasting blood sugar level is nevertheless often elevated in the case of insulin resistance, in which case the onset of type 2 diabetes is imminent.
Researchers have long assumed that insulin resistance is the central factor underlying the development of metabolic syndrome. However, experts now believe that metabolic syndrome is not the result of a single disease-causing process. Insulin resistance probably plays a role, but is not the only cause of metabolic syndrome. However, it is not yet clear which other factors are important.
2. What increases the risk of metabolic syndrome?
The risk of metabolic syndrome can be increased by various factors, with an unhealthy lifestyle having the greatest effect. Metabolic syndrome is favored by:
- Lack of physical activity
- Increased alcohol consumption
- Increased salt consumption
- Too much fat and sugar in the diet
- Sleep disorders and lack of sleep
- Smoking
- Stress
In addition, some illnesses (for example a pronounced hypothyroidism) and some medications such as antidepressants or cortisone can also increase the risk of metabolic syndrome.
There is also a genetic predisposition to metabolic syndrome. If close family members (parents, grandparents) already have or have had metabolic syndrome, the risk of developing the disease yourself is also increased. More people have metabolic syndrome at an older age than at a younger age. Women are more frequently affected than men.
3. How is metabolic syndrome diagnosed?
If metabolic syndrome is suspected, the doctor will use the following tests to diagnose it:
- Determination of body mass index (BMI) and waist circumference
- Measurement of blood pressure at rest (24-hour blood pressure measurement if required)
- Blood test: Fasting blood sugar level, HDL and LDL cholesterol, triglycerides, uric acid
- Ultrasound examination of the upper abdomen
- Electrocardiogram (ECG) at rest (if necessary, an exercise ECG)
However, there are currently no standardized diagnostic criteria for metabolic syndrome. In recent decades, various definitions of metabolic syndrome have been proposed by different professional societies. The German national medical guideline “Type 2 diabetes” (2023) refers to a definition from 2009, which represents an initial harmonization of the various definitions and threshold values.
For a diagnosis of metabolic syndrome, at least 3 of the following 5 criteria must be present:
Diagnostic criteria | Threshold values |
Waist circumference for severe abdominal overweight (obesity)* | |
Men: 102 centimeters or larger Women: 88 centimeters or larger | |
Elevated triglycerides | 150 mg/dl (1.7 mmol/l) or greater or taking appropriate medication |
Low HDL cholesterol | Men: below 40 mg/dl (1.0 mmol/l) Women: below 50 mg/dl (1.3 mmol/l) or taking appropriate medication |
High blood pressure | |
Upper value: 130 mmHg or greater and/or lower value: 85 mmHg or greater or taking antihypertensive medication | |
Elevated fasting blood sugar level | 100 mg/dl (5.6 mmol/l) or greater or taking blood sugar-lowering medication |
*Population- and country-specific threshold values have been set for waist circumference. The values listed in the table apply to the European region.
However, the term metabolic syndrome and its definition and meaning are sometimes the subject of controversy. There is still no consensus as to whether the joint consideration of the factors in a syndrome provides an additional benefit and whether an additional risk prediction can be derived from the combination of individual risk factors.
4. How is metabolic syndrome treated?
The treatment of metabolic syndrome consists of treating the individual clinical pictures or counteracting the individual risk factors:
- Severe overweight (obesity), especially in the abdomen
- Elevated blood sugar levels
- Elevated blood lipid levels
- Increased blood pressure
The aim of the therapy is to prevent the development of cardiovascular disease or type 2 diabetes as far as possible.
Weight reduction
As regards weight loss, doctors recommend a combination of dietary changes, more exercise and a change in behavior. Behavioral change supports the consistent implementation and long-term maintenance of a healthy lifestyle.
Blood sugar, blood lipids, blood pressure
The lifestyle change required to lose weight also has a direct positive effect on blood sugar, blood lipids and blood pressure. Nevertheless, additional drug treatment is often necessary.
5. How can you prevent metabolic syndrome?
The prevention of metabolic syndrome is very similar to its treatment. First and foremost, a healthy body weight should be maintained or existing excess weight be reduced. A healthy lifestyle can help to prevent elevated blood sugar, blood lipid and blood pressure levels.
A healthy lifestyle to prevent metabolic syndrome includes above all:
Ask your doctor for helpful recommendations and tips.
Balanced diet
It is recommended that you eat a balanced diet. This diet should contain all the necessary nutrients. Energy intake (calorie intake) should be based on individual needs which should not be exceeded. In case of overweight or severe overweight (obesity), you should cut back on calories to reduce your weight.
To achieve this, the nutritional recommendations “Eat and drink well” given by the German Nutrition Society (DGE) can be helpful.
Eat plenty of colorful fruit and vegetables
Vegetables and fruit provide plenty of vitamins, minerals, fibers, and phytochemicals. They are good for your health and contribute to satiety. The daily menu should contain at least 5 portions (550 grams) of – preferably seasonal – fruit and vegetables.
Consume legumes and nuts regularly
Legumes, such as peas, beans and lentils, are rich in proteins, vitamins, minerals, fibers and phytochemicals. Nuts additionally provide essential fatty acids and promote your heart health. Pulses should be eaten at least once a week (125 grams). A small handful (25 grams) of nuts is recommended daily.
Choose whole-grain products
When it comes to cereal products such as bread, pasta, rice and flour, whole grains are the best choice for your health. Whole-grain products are more filling and contain more vitamins and minerals than white flour products. The fibers in whole grains in particular reduce the risk of many diseases such as type 2 diabetes and cardiovascular disease. Eat 5 portions (300 grams) of cereals and cereal products daily.
Choose vegetable oils
Vegetable oils are rich in essential fatty acids and vitamin E. For example, give preference to rapeseed oil and margarine made from it or walnut, linseed, soybean and olive oil. Consume a small portion (10 grams) daily.
Have some milk and dairy products daily
Milk and dairy products provide protein, calcium, vitamin B2 and iodine in particular. They support bone health. 2 portions (e.g. 400 grams of milk) should be consumed daily. If you use plant-based milk alternatives, ensure sufficient supply of calcium, vitamin B2 and iodine.
Aim for 1 or 2 portions of fish every week
Fatty fish such as salmon, mackerel and herring provide valuable omega-3 fatty acids. Sea fish such as codfish or redfish additionally contain iodine. 1 to 2 portions (180 grams) of fish per week are recommended.
Limit meat and sausage intake – less is more
Meat contains readily available iron, as well as selenium and zinc. However, too much beef, pork, lamb and goat, and especially sausage, increase the risk of cardiovascular diseases and colon carcinoma. In addition, the production of meat and sausage products has a much greater impact on the environment than that of plant-based foods. No more than 300 grams of meat and sausage should be eaten per week.
Avoid sweet, salty and fatty foods
Many processed foods such as sausages, pastries, confectionery, fast food and convenience products often contain hidden sugar, salt and fat. High consumption of such foods increases the risk of overweight, high blood pressure, cardiovascular disease and type 2 diabetes.
Make water your beverage of choice
Drink around 1.5 liters of fluid a day. Water or other calorie-free drinks such as unsweetened tea are best. Sugar-sweetened and alcoholic drinks are not recommended.
Enjoy your meals
Take your time when eating and take a break. In addition, eating slowly and consciously promotes the feeling of satiation. Eating in company can also have a positive effect on wellbeing.
Stay active and watch your weight
A balanced, wholesome diet and physical activity belong together. Daily exercise and an active lifestyle promote bone health and reduce the risk of developing overweight and many other diseases.
Mediterranean diet
A Mediterranean diet has proven to be particularly beneficial for prevention, but also for people who already have metabolic syndrome. This is a predominantly plant-based dietrich in vegetables, fruit, whole-grain products, pulses, nuts and olive oil as the main source of fat.
This is supplemented by moderate consumption of dairy products such as cheese and yoghurt, fish and poultry and optionally red wine in moderation. Red meat, sweets and soft drinks are only consumed in small quantities.
Studies show that a Mediterranean diet can have a positive effect on the various components of metabolic syndrome – abdominal obesity, high blood pressure, elevated blood lipid levels and elevated blood sugar levels.
Regular exercise and sport
Regular exercise and sport can help to prevent the development of metabolic syndrome. Before starting an exercise program, a medical examination should be carried out and it should be clarified with the doctor which types of sport are suitable.
A combination of endurance training and strength training is generally recommended for people with metabolic syndrome. Experts recommend at least 150 minutes of endurance training per week (e.g. 5 times 30 minutes). This also includes brisk walking, cycling or swimming. In addition, muscle-strengthening exercises should be carried out at least two days a week.
It also makes sense not only to exercise consciously and regularly, but also to incorporate more activity into one’s everyday life. For example, walk or cycle more often instead of driving. Break up long periods of sitting by taking exercise breaks and take the stairs instead of the elevator.
Sources:
Alberti, K. G. et al.: Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. In: Circulation, 2009, 120: 1640-1645
Almeda-Valdés, P. et al.: Metabolic syndrome and non-alcoholic fatty liver disease. In: Ann Hepatol, 2009, 8: S18-S24
Beigh, S. H. et al.: Prevalence of metabolic syndrome and gender differences. In: Bioinformation, 2012, 8: 613-616
Bundesärztekammer et al.: Nationale Versorgungsleitlinie Typ-2-Diabetes. Langfassung. Version 3.0. 2023
Bundesministerium für Gesundheit: Bewegungsempfehlungen: Nationale Empfehlungen für Bewegung und Bewegungsförderung. (Letzter Abruf: 07.05.2024)
Castro-Barquero, S. et al.: Dietary Strategies for Metabolic Syndrome: A Comprehensive Review. In: Nutrients, 2020, 12: 2983
Cheng, A. Y. et al.: Metabolic syndrome under fire: weighing in on the truth. In: Can J Cardiol, 2006, 22: 379-382
Coughlin, S. R. et al.: Obstsructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. In: Eur Heart J, 2004, 25: 735-741
Deutsche Gesellschaft für Ernährung: Gut essen und trinken – die DGE-Empfehlungen. (Letzter Abruf: 07.05.2024)
Dustin, D. et al.: Carbohydrate Intakes Below Recommendations With a High Intake of Fat Are Associated With Higher Prevalence of Metabolic Syndrome. In: J Acad Nutr Diet, 2023, 123: 1022-1032.e13
Goins, R. K. et al.: Consumption of foods and beverages rich in added sugar associated with incident metabolic syndrome: Coronary Artery Risk Development in Young Adults (CARDIA) study. In: Eur J Prev Cardiol, 2024, 3: zwad409
Grundy, S. M. et al.: Diagnosis and Management of the Metabolic Syndrome An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. In: Circulation, 2005, 112: 2735-2752
Hildrum, B. et al.: Age-specific prevalence of the metabolic syndrome defined by the International Diabetes Federation and the National Cholesterol Education Program: the Norwegian HUNT 2 study. In: BMC Public Health, 2007, 29: 220
Kahn, R. et al.: The metabolic syndrome: time for a critical appraisal. In: Diabetologia, 2005, 48: 1684-1699
Neuhauser, H. et al.: Estimation of the metabolic syndrome prevalence in the general population in Germany. In: J Public Health, 2008, 16: 221-227
Saklayen, M. G.: The Global Epidemic of the Metabolic Syndrome. In: Curr Hypertens Rep, 2018, 20: 12
Takase, H. et al.: Dietary salt intake predicts future development of metabolic syndrome in the general population. In: Hypertens Res, 2023, 46: 236-243
Tamashiro, K. L. et al.: Chronic stress, metabolism, and metabolic syndrome. In: Stress, 2011, 14: 468-474
Tsai, H. H. et al.: Cigarette smoking and PM2.5 might jointly exacerbate the risk of metabolic syndrome. In: Front Public Health, 2024, 15: 1234799
As of: 07.05.2024