Metabolic syndrome doubles worldwide over two decades

By Dr. Priyom Bose, Ph.D.Reviewed by Lauren HardakerApr 15 2026

A sweeping global study reveals how metabolic syndrome is rising faster than expected, driven by aging populations, urban lifestyles, and widening health disparities across regions. 

Study: Worldwide trends in metabolic syndrome from 2000 to 2023: a systematic review and modelling analysis. Image credit: Kateryna Kon/Shutterstock.com

A recent study in Nature Communications systematically reviewed the literature and applied a Bayesian modeling analysis to map the worldwide spread of metabolic syndrome over the past two decades, using key demographic and geographic factors to identify where the burden is greatest and how it has changed.

A multifactorial syndrome with global consequences

Metabolic syndrome (MetS) is a cluster of interrelated metabolic abnormalities, including obesity, insulin resistance, hypertension, dyslipidemia, and elevated fasting glucose. Together, these risk factors impose a substantial burden on global health.

The individual components of MetS are among the leading drivers of mortality and disability-adjusted life years (DALYs) worldwide, with elevated blood pressure alone accounting for over 10 million deaths and 218 million DALYs. In addition, obesity contributes to 5 million deaths and 160 million DALYs, a burden that is increasing particularly rapidly in low- and middle-income countries.

MetS arises from a combination of genetic and environmental factors, primarily chronic energy imbalance driven by poor diet and physical inactivity. Genetic susceptibility related to metabolic pathways can amplify risk, while obesogenic environments accelerate progression.

Despite ongoing debate around specific thresholds and classification systems, MetS remains a clinically and epidemiologically valuable construct for identifying individuals at elevated risk of type 2 diabetes (T2D), cardiovascular disease (CVD), chronic kidney disease, and premature mortality, often before overt disease has developed. Extensive efforts have characterized individual cardiometabolic risk factors at the population level, yet their co-occurrence within the MetS framework has been far less systematically examined.

Assessing the global burden of MetS from 2000 to 2023

Researchers conducted a systematic review combined with modeling to estimate MetS prevalence among men and women from 2000 to 2023 across 198 countries and territories, grouped into 21 regions and nine super-regions based on geographical proximity and national income. Countries were stratified by income level and urbanicity, categorized into four quartiles.

Although studies using different diagnostic criteria were included, MetS was defined for estimation purposes using the harmonized Joint Interim Statement (JIS) framework as ≥3 of 5 components: elevated fasting plasma glucose, raised blood pressure, elevated triglycerides, low high-density lipoprotein cholesterol (HDL-C), and central obesity.

All relevant articles were obtained from PubMed, Excerpta Medica Database, Web of Knowledge, African Journals Online, and Global Index Medicus up to September 20, 2022, with no language restrictions. Population-based observational studies reporting crude MetS prevalence in adults, regardless of geographic location or diagnostic criteria, were included. Eligibility criteria included probability sampling, a minimum of 30 participants, and a general population without restrictions on specific health conditions.

A Bayesian multilevel logistic regression model was used to estimate MetS prevalence globally, regionally, and nationally from 2000 to 2023, separately by sex. Posterior predictions were generated for all countries, including those with limited or no primary data, using annual time-varying covariates, including age distribution, GDP per capita, and urbanicity, from 2000 to 2023, meaning many country-level estimates are model-derived rather than directly observed and carry associated uncertainty intervals.

A significant rise in global burden of metabolic syndrome from 2000 to 2023

A total of 597 studies met eligibility criteria and were included. These studies encompassed over 45.5 million participants across urban, rural, and mixed settings, with nationally representative data from 44 countries spanning all major world regions except Oceania.

MetS prevalence more than doubled over two decades, rising from 11.9 % in 2000 to 28.4 % in 2023, with women rising from 14.7 % to 31.0 % and men from 9.0 % to 25.7 %. By 2023, approximately 1.54 billion adults were living with MetS, with cases rising from 277 to 846 million in women and 166 to 692 million in men, driven primarily by rising prevalence.

Prevalence rose consistently with income and urbanicity, though women in lower-income and less urbanized settings carried a disproportionately higher burden than men. While MetS prevalence was similar in early adulthood, women surpassed men from midlife onward, peaking at approximately 55 % versus 45 % in the early-to-mid 70s. Case burden peaked among women aged 50–54 (82.8 million), and men aged 35–39 (84.3 million), with women disproportionately affected at older ages across all strata, especially in high-income, highly urbanized settings.

Regional variation was substantial, with prevalence in 2023 ranging from 7.5 % to 45.0 % among women and 6.5 % to 59.6 % among men. The largest increases occurred in East Asia among women at 28.1 %, and Central Europe among men at 42.7 %, and the direction of sex differences varied, with men exceeding women in Southwestern Europe and women exceeding men in Southern Latin America.

East Asia and South Asia accounted for the greatest share of the global burden. East Asia alone had 212 million women and 157 million men affected, with cases rising 5.4-fold and 17.8-fold, respectively, since 2000. Drivers varied by region, with decomposition analyses indicating contributions from rising prevalence, population growth, and aging differing across settings.

Across all regions, prevalence rose with age, peaking at 65–74 years and highest in Central Europe, East Asia, and high-income English-speaking countries. Women surpassed men after age 45 in most regions, consistent with global age- and sex-based patterns.

Across 198 countries, prevalence increased in 196 for both sexes, at least doubling in 66 countries among women and 139 among men. The highest levels were observed in Bermuda and Puerto Rico among women, and in Bermuda and the Czech Republic among men, with the lowest in Sub-Saharan Africa and select Asian countries.

Women had a higher prevalence than men in 102 countries, with the sex gap ranging from −36.7 percentage points (pp) in France to +51.6 pp in Hong Kong; the steepest increases occurred among women in Guyana at 33.0 % and among men in Romania at 51.5 %.

Conclusions

The escalating prevalence of MetS represents a major and growing global public health challenge. Without targeted and context-specific interventions, its trajectory may continue to increase the burden on health systems and contribute to rising cardiometabolic disease.

Policymakers, clinicians, and researchers must work in concert to develop evidence-based, population-specific approaches that address the underlying drivers of this epidemic and promote long-term metabolic health across all regions and demographics, while accounting for regional data gaps and uncertainty in modeled estimates.