Diagnosis and treatment of metabolic syndrome. Meta-analysis
Keywords:
síndrome metabólico; resistencia a insulina; intervención en estilo de vida; farmacoterapia; cirugía bariátricaAbstract
Introduction: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that increases the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM).
Objective: To expose the actual state about diagnostic and treatment strategies of Metabolic Syndrome.
Methods: A systematic review and meta-analysis of clinical practice guidelines, observational studies, and randomized clinical trials published up to 2024 was conducted, evaluating diagnostic criteria and the effectiveness of lifestyle interventions, pharmacotherapy, and bariatric surgery.
Development: MetS doubles the risk of CVD (RR 2.35; 95 % CI 1.98–2.79), myocardial infarction (RR 1.99; 95 % CI 1.56–2.54), stroke (RR 2.27; 95 % CI 1.77–2.91), all-cause mortality (RR 1.58; 95 % CI 1.35–1.85), and cardiovascular mortality (RR 2.40; 95 % CI 1.90–3.03), and increases the risk of T2DM approximately fourfold (RR 4.00; 95 % CI 3.10–5.20). Lifestyle interventions are the most effective strategy for reversing MetS (OR 3.81; 95 % CI 2.65–5.48), followed by pharmacotherapy (OR 1.59; 95 % CI 1.22–2.07) and bariatric surgery (resolution in up to 93% of patients; proportion 0.93; 95 % CI 0.85–0.97).
Conclusions: MetS significantly increases morbidity and mortality risk; its management should be comprehensive and stepwise, prioritizing lifestyle modifications, with complementary use of pharmacotherapy and surgery in selected cases.
Downloads
References
Stone NJ, Smith SC Jr, Orringer CE, Rigotti NA, Navar AM, Khan SS, Jones DW, et al. Managing Atherosclerotic Cardiovascular Risk in Young Adults: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022[citado 06/03/2025];79(8):819-836. https://doi.org/10.1016/j.jacc.2021.12.016
Noubiap JJ, Nansseu JR, Nyaga UF, Ndoadoumgue AL, Ngouo AT, Tounouga DN, et al. Worldwide trends in metabolic syndrome from 2000 to 2023: a systematic review and modelling analysis. Nat Commun. 2025 [citado 08/03/2025];17(1):573. https://doi.org/10.1038/s41467-025-67268-5
Nieto FJ, Peppard PE, Engelman CD, et al. Prevalence of metabolic syndrome in the United States: National Health and Nutrition Examination Survey 2003–2006. Centers for Disease Control and Prevention Web site. 2009 [citado 12/01/2026]. Disponible en: https://stacks.cdc.gov/view/cdc/5448
Neeland IJ, Lim S, Tchernof A, Gastaldelli A, Rangaswami J, Ndumele CE, et al. Metabolic syndrome.Nat Rev Dis Primers. 2024 [citado 19/11/2025];10(1):77. https://doi.org/10.1038/s41572-024-00563-5
Młynarska E, Bojdo K, Frankenstein H, Krawiranda K, Kustosik N, Lisińska W, et al. Endothelial Dysfunction as the Common Pathway Linking Obesity, Hypertension and Atherosclerosis. Int J Mol Sci. 2025 [citado 17/11/2025];26(20):10096. https://doi.org/10.3390/ijms262010096
Rosenzweig JL, Bakris GL, Berglund LF, Hivert MF, Horton ES, Kalyani RR, et al. Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2019 [citado 06/08/2025];104(9):3939-3985. https://doi.org/10.1210/jc.2019-01338
Park S, Lee J, Seok JW, Park CG, Jun J. Comprehensive lifestyle modification interventions for metabolic syndrome: A systematic review and meta-analysis. J Nurs Scholarsh. 2024 [citado 16/09/2025];56(2):249-259. https://doi.org/10.1111/jnu.12946
Yamaoka K, Tango T. Effects of lifestyle modification on metabolic syndrome: a systematic review and meta-analysis. BMC Med. 2012 [citado 16/09/2025];10:138. https://doi.org/10.1186/1741-7015-10-138
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. PLoS Medicine. 2021 [citado 11/10/2025];18(3):e1003583. https://doi.org/10.1371/journal.pmed.1003583
Moseley AM, Rahman P, Wells GA, Zadro JR, Sherrington C, et al. Agreement between the Cochrane risk of bias tool and Physiotherapy Evidence Database (PEDro) scale: A meta-epidemiological study of randomized controlled trials of physical therapy interventions. PLoS One. 2019 [citado 11/10/2025];14(9):e0222770. https://doi.org/10.1371/journal.pone.0222770
Yamato TP, Maher C, Koes B, Moseley A. The PEDro scale had acceptably high convergent validity, construct validity, and interrater reliability in evaluating methodological quality of pharmaceutical trials. J Clin Epidemiol. 2017 [citado 11/10/2025];86:176-181. https://doi.org/10.1016/j.jclinepi.2017.03.002
Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009 [citado 11/10/2025];62(10):1013-1020. https://doi.org/10.1016/j.jclinepi.2008.10.009
Luijendijk HJ, Page MJ, Burger H, Koolman X. Assessing risk of bias: a proposal for a unified framework for observational studies and randomized trials. BMC Med Res Methodol. 2020 [citado 11/10/2025];20(1):237. https://doi.org/10.1186/s12874-020-01115-7
Rao G, Lopez-Jimenez F, Boyd J, D'Amico F, Durant NH, Hlatky MA, et al. Methodological Standards for Meta-Analyses and Qualitative Systematic Reviews of Cardiac Prevention and Treatment Studies: A Scientific Statement from the American Heart Association. Circulation. 2017 [citado 11/10/2025];136(10):e172-e194. https://doi.org/10.1161/CIR.0000000000000523
van Namen M, Prendergast L, Peiris C. Supervised lifestyle intervention for people with metabolic syndrome improves outcomes and reduces individual risk factors of metabolic syndrome: A systematic review and meta-analysis. Metabolism. 2019 [citado 11/10/2025];101:153988. https://doi.org/10.1016/j.metabol.2019.153988
Powell LH, Berkley-Patton J, Drees BM, Kelly Karavolos K, Lohse B, Masters KS, et al. Lifestyle Intervention for Sustained Remission of Metabolic Syndrome: A Randomized Clinical Trial. JAMA Intern Med. 2025 [citado 11/10/2025];186(1):67-77. Disponible en: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2841069
Purnell JQ, Selzer F, Smith MD, Berk PD, Courcoulas AP, Inabnet WB, et al. Metabolic syndrome prevalence and associations in a bariatric surgery cohort from the Longitudinal Assessment of Bariatric Surgery-2 study. Metab Syndr Relat Disord. 2014 [citado 11/10/2025];12(2):86-94. https://doi.org/10.1089/met.2013.0116
Nie Y, Zong H, Li Z, Wang P, Zhang N, Biao Zhou, et al. Cardiovascular disease among bariatric surgery candidates: coronary artery screening and the impact of metabolic syndrome. Diabetol Metab Syndr. 2024 [citado 11/10/2025];16(1):180. https://doi.org/10.1186/s13098-024-01425-6
Batsis JA, Romero Corral A, Collazo Clavell ML, Sarr MG, Somers VK, Francisco Lopez-Jimenez. Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc. 2008 [citado 11/10/2025];83(8):897-907. https://doi.org/10.4065/83.8.897
Ragavan S, Elhelw O, Majeed W, Alkhaffaf B, Senapati S, Basil J. Ammori, et al. Weight Loss Following Bariatric Surgery in People with or without Metabolic Syndrome: A 5-Year Observational Comparative Study. J Clin Med. 2024 [citado 11/10/2025];13(1):256. https://doi.org/10.3390/jcm13010256
Norris P, Gow J, Arthur T, Conway A, Fleming FJ, Nicholas R. Metabolic syndrome and surgical complications: a systematic review and meta-analysis of 13 million individuals. Int J Surg. 2024 [citado 11/10/2025];110(1):541-553. https://doi.org/10.1097/JS9.0000000000000834
Domínguez Alvarado GA, Otero Rosales MC, Cala Duran JC, Serrano Gómez S, Carrero Barragan TY. Domínguez Alvarado PN, et al. The effect of bariatric surgery on metabolic syndrome: A retrospective cohort study in Colombia. Health Sci Rep. 2023 [citado 11/10/2025];6(2):e1090. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC9886857/
Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, et al. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004 [citado 11/10/2025];292(12):1440-1446. Disponible en: https://pubmed.ncbi.nlm.nih.gov/15383514/
Celletti F, Farrar J, De Regil L. World Health Organization Guideline on the Use and Indications of Glucagon-Like Peptide-1 Therapies for the Treatment of Obesity in Adults. JAMA. 2025 [citado 11/10/2025];335(5):434-438. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2842199
Bannuru RR; ADA Professional Practice Committee (PPC). Introduction and methodology: Standards of Care in Overweight and Obesity-2025. BMJ Open Diabetes Res Care. 2025 [citado 11/10/2025];13(Suppl 1):e004928. https://doi.org/10.1136/bmjdrc-2025-004928
Valerio CM, Saraiva JFK, Valente F. van de Sande-Lee S, Rocha VZ, Rached FH, et al. Brazilian evidence-based guideline on the management of obesity and prevention of cardiovascular disease and obesity-associated complications: a position statement by five medical societies. Diabetol Metab Syndr. 2025 [citado 11/10/2025];17:432. (2025). https://doi.org/10.1186/s13098-025-01954-8
Pennington B, Cummins E, Chandler A, Fotheringham J. Challenges in Modelling the Cost Effectiveness of Pharmacotherapies for Obesity. Pharmacoeconomics. 2025 [citado 11/11/2025];43(10):1171-1178. https://doi.org/10.1007/s40273-025-01520-0
Lear SA, Gasevic D. Ethnicity and Metabolic Syndrome: Implications for Assessment, Management and Prevention. Nutrients. 2019 [citado 11/10/2025];12(1):15. https://doi.org/10.3390/nu12010015
Bruna Mejias A, San Martin J, Arciniegas Diaz D, Meneses Caroca T, Salamanca Cerda A, Beas-Gambi A, et al. Comparison of the Mediterranean Diet and Other Therapeutic Strategies in Metabolic Syndrome: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2025 [citado 11/10/2025];26(12):5887. https://doi.org/10.3390/ijms26125887
Sangouni AA, Hosseinzadeh M, Parastouei K. Effect of dietary approaches to stop hypertension diet on insulin resistance and lipid accumulation product in subjects with metabolic syndrome. Sci Rep. 2025 [citado 11/10/2025];15(1):17025. https://doi.org/10.1038/s41598-025-01013-2Principio
Nilsson PM, Tuomilehto J, Rydén L. The metabolic syndrome - What is it and how should it be managed? Eur J Prev Cardiol. 2019 [citado 11/10/2025];26(2_suppl):33-46. https://doi.org/10.1177/2047487319886404
Lim S, Eckel RH. Pharmacological treatment and therapeutic perspectives of metabolic syndrome. Rev Endocr Metab Disord. 2014 [citado 11/10/2025];15(4):329-341. https://doi.org/10.1007/s11154-014-9298-4
Dean YE, Mohamed MI, Shokri A, Nassar M, Omayer A, Shahid M, et al. Bariatric Surgery and Remission of Metabolic Syndrome: A Meta-analysis of Randomised Controlled Trials and Prospective Studies. Obes Surg. 2025 [citado 11/10/2025];35(4):1337-1349. https://doi.org/10.1007/s11695-025-07750-7
Laddu D, Neeland IJ, Carnethon M, Stanford FC, Mongraw-Chaffin MM, Bethany Barone Gibbs, et al. Implementation of Obesity Science In to Clinical Practice: A Scientific Statement From the American Heart Association. Circulation. 2024 [citado 11/10/2025];150(1). https://doi.org/10.1161/CIR.0000000000001221
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sulema de la Caridad Hernández Batista, Sonia Noemí González Benítez, María Teresa Díaz Armas, Alexander Expósito Lara
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
ACCESS AND DISTRIBUTION POLICY
All published articles are open access contributions, which are distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License which permits unrestricted non-commercial use, distribution and reproduction in any medium, provided that the primary source of publication is properly cited.
