Metabolic Syndrome: What You Need to Know if You’re Young and Otherwise Healthy

Reviewed by Dr. Jonathan Bonnet, MD, MPH


Have you heard about metabolic syndrome lately? You’re not alone. The rise in metabolic syndrome in adults in recent years has made the topic even more prevalent and important than before.


Still, few adults understand the meaning of metabolic syndrome and which factors could put them at risk for serious health conditions and chronic diseases.


For young adults, preventive care is key to maintaining optimal health and quality of life. Which is why understanding the risk factors for metabolic syndrome and how to screen for their related diseases can help to lower your risk and improve your well-being in the long run.


What is metabolic syndrome?


Metabolic syndrome refers to a group of risk factors that increase your risk of certain diseases and health conditions, including heart disease, diabetes, and stroke.


Five risk factors that can put you at risk of metabolic syndrome include:



  • A larger waist circumference: Having a larger waist (in addition to at least two other metabolic syndrome risk factors) could increase your risk of metabolic syndrome, and especially heart disease. According to Johns Hopkins Medicine, that means having a waist size of more than 35 inches for women or more than 40 inches for men. However, some research suggests that increased waist circumference alone may not increase your risk of metabolic syndrome or mortality. It more depends on the amount of visceral fat (fat around the organs) in the abdomen.

  • High triglyceride levels: Typically defined as more than 150 mg/dL. Triglycerides are a type of fat present in the blood.

  • Low HDL cholesterol levels: Cholesterol is an organic molecule found throughout our body, and HDL is a type of cholesterol often referred to as “good cholesterol,” as it helps to remove choleserol from the arteries. Inversely, low HDL cholesterol levels can increase your risk of heart disease. Low HDL levels are typically classified as less than 40 mg/dL for men and less than 50 mg/dL for women.

  • High blood pressure: Having high blood pressure, or 130/80mm Hg or higher, is often found in people with insulin resistance.

  • High fasting glucose: Also referred to as impaired fasting blood glucose, having a level equal to or greater than 100 mg/dL can be an early sign of diabetes.


Importantly, the National Institutes of Health requires that you have at least three of the above metabolic risk factors to be diagnosed with metabolic syndrome.


Researchers are also exploring additional conditions that may affect metabolic syndrome, including:



  • Constant, low-grade inflammation throughout the body

  • Excessive blood clotting

  • A fatty liver

  • Polycystic ovarian syndrome (PCOS)

  • Gallstones

  • Breathing problems during sleep (including sleep apnea)


When should I start thinking about my risk of metabolic syndrome?


Starting in your 20s, working with your doctor to get the right lab tests done and interpret your personal and family health history can help to identify your personal risk of metabolic syndrome. Depending on individual risk factors, there may be several recommendations you can implement to reduce your risk earlier in life.


If my blood sugar is at a normal level, am I still at risk for metabolic disease?


Unfortunately, not all risk factors of metabolic syndrome are preventable. There are other factors that can impact your risk, like age, race, and genetics.


Though you can’t change your age, genetic makeup, or race, knowing how these factors may impact your risk for chronic conditions like diabetes can help you to know when to get screened to help prevent these conditions from developing.


Risk factors that can increase your risk of metabolic syndrome include:



  • Age: The older you are, the higher the risk of metabolic syndrome.

  • Race: African Americans and Mexican Americans are more at risk of metabolic syndrome. African American women are particularly at risk.

  • Weight: People with a BMI greater than 25.

  • Personal or family history of diabetes: Your personal and familial medical history matters. If you or a family member (generally a parent or grandparent) has had type 2 diabetes, you are at greater risk.

  • Smoking

  • History of excessive alcohol drinking

  • Stress

  • Being past menopause

  • Living a sedentary lifestyle


Which tests matter?


In addition to a review of your personal medical history and possible annual exam, your doctor may recommend getting certain lab tests done, including:



  • Insulin

  • Oral glucose tolerance test (OGTT) or oral glucose tolerance test with insulin (OGTT-I), the latter of which may be the most effective at diagnosing insulin resistance

  • Blood glucose (also called hemoglobin A1c, or HbA1c)

  • Blood pressure

  • Fasting lipid profile, including:


    • Total cholesterol

    • HDL cholesterol

    • LDL cholesterol

    • Triglycerides


  • Inflammatory markers

  • NMR Lipoprotein Analysis (i.e. lipoprotein particle counts and sizes)


Ultimately, insulin levels are the most important tests for early diagnosis, since it can take 5-10 years for glucose levels to become abnormal after insulin levels increase.


What is a continuous glucose monitor (CGM) and how do I know if I need one?


A continuous glucose monitor (CGM) is a device equipped with sensors that track glucose levels day and night.


Until recently, CGMs were recommended almost exclusively for people with diabetes. But proponents of using CGMs in healthy patients suggest that because other standard diagnostic tests (like the HbA1c test) are inaccurate predictors of average blood glucose levels, the levels measured by a CGM can be more indicative of a person's true metabolic health.


The experts, however, are still divided. If you’re at risk of metabolic syndrome and interested in getting a more rounded picture of your glucose levels, ask your provider about whether or not CGMs may be a helpful diagnostic tool for you.


Optimizing your metabolic health in the long run


Getting the right labs done and understanding the risks of metabolic syndrome are the first steps in optimizing your health. In other words, knowledge is power.


Once you’re aware of your personal risks and test levels, working with your doctor to incorporate heart-healthy changes may help you to prevent or delay metabolic syndrome and chronic disease.


Sources


Are continuous glucose monitors a waste of time for people without diabetes? (2021).


Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. (2016).


Metabolic Syndrome. (n.d.).


Metabolic Syndrome. (n.d.).


Patterns of Insulin Concentration During the OGTT Predict the Risk of Type 2 Diabetes in Japanese Americans. (2013).


Postprandial insulin assay as the earliest biomarker for diagnosing pre-diabetes, type 2 diabetes and increased cardiovascular risk. (2017).


The Importance of Waist Circumference in the Definition of Metabolic Syndrome. (2006).

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