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Metabolic Syndrome and Its Burden on Global Health
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Metabolic Syndrome and Its Burden on Global Health

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: 20 October 2025 | Viewed by 2086

Special Issue Editors

Dr. Umberto Goglia

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Guest Editor
Endocrinology and Diabetology Unit, ASLCN1, 12100 Cuneo, Italy
Interests: endocrine; diabetes; metabolic diseases; cardiovascular disease
Dr. Luca Monge

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Guest Editor
AMD-Italian Association of Clinical Diabetologists, 00192 Rome, Italy
Interests: endocrine; diabetes and metabolic diseases; diabetic foot
Prof. Dr. Elena Succurro

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Guest Editor
Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
Interests: prediabetes; type 2 diabetes; myocardial insulin resistance; cardiovascular organ damage; sex differences in predia-betes; type 2 diabetes and cardiovascular disease; mechanism of action of SGLT2i; gestational diabetes
Special Issues, Collections and Topics in MDPI journals
Dr. Livia Pisciotta

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Guest Editor
1. Dietetics and Clinical Nutrition Unit, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
2. Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
Interests: clinical nutrition; clinical lipidology; genetics of dyslipidemias
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Salvatore De Rosa

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Guest Editor
Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
Interests: cardiovascular disease; biomarkers; interventional cardiology; atherothrombosis; atherosclerosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Metabolic syndrome, previously known as “syndrome X” or “insulin resistance syndrome”, is a widespread and complex condition characterized by an aggregation of metabolic dysregulations influenced by both genetic and environmental factors. This condition manifests in the context of insulin resistance and chronic low-grade inflammation. The prevalence of metabolic syndrome is increasing globally, particularly among certain populations such as women, young adults, and specific ethnic groups, highlighting underlying health disparities.
The clinical disorders included in metabolic syndrome share symptoms and signs that affect various tissues and organs within a highly complex and interplaying hormonal and molecular network.  Energy balance and nutrient utilization are critical for the development of specific diseases in both healthy individuals and those affected by metabolic syndrome.
This syndrome significantly contributes to highly prevalent conditions such as obesity, with the accumulation of visceral and epicardial adipose tissue, type 2 diabetes mellitus, and metabolic dysfunction-associated steatotic liver disease (MASLD). Additionally, it notably increases the risk of cardiovascular disease (particularly diabetic cardiomyopathy, vascular and valvular calcifications, and heart failure) and chronic kidney disease, profoundly affecting morbidity and mortality.
Together, these conditions represent a significant clinical and economic burden, posing a pandemic-scale challenge for the coming decades, particularly concerning treatment and prevention.

Dr. Umberto Goglia
Dr. Luca Monge
Prof. Dr. Elena Succurro
Dr. Livia Pisciotta
Prof. Dr. Salvatore De Rosa
Guest Editors

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Keywords

  • insulin resistance
  • chronic low-grade inflammation
  • gut microbiota
  • energy balance
  • obesity
  • hyperlipidemia
  • metabolic dysfunction-associated steatotic liver (MASLD)
  • type 2 diabetes mellitus
  • heart failure
  • diabetic cardiomyopathy
  • cardio-nephro-metabolic syndrome
  • metabolic syndrome sex differences
  • metabolic syndrome and health inequity
  • metabolic syndrome health-economic burden

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Published Papers (5 papers)

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Research

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12 pages, 374 KiB  
Article
Diagnosis and Monitoring of Metabolic Dysfunction Associated with Fatty Liver Disease in Primary Care Patients with Risk Factors—EsteatoGal Study
by Nerea Sánchez-Varela, Sergio Cinza-Sanjurjo, Tatiana Danif-Ferreira, Liseth I. Medina I Araujo, Diego G. Mosteiro Gabriel Miguéns, Daniel Rey-Aldana, Manuel Portela-Romero and on behalf of the EsteatoGal Researchers
J. Clin. Med. 2025, 14(9), 3089; https://doi.org/10.3390/jcm14093089 (registering DOI) - 29 Apr 2025
Abstract
Objective: The objective of this study was to calculate the epidemiological impact of metabolic dysfunction associated with fatty liver disease (MAFLD) and hepatic fibrosis in primary care (PC). Secondarily, we assessed the correlation between serological markers (FIB-4, ELF test), abdominal ultrasound, and [...] Read more.
Objective: The objective of this study was to calculate the epidemiological impact of metabolic dysfunction associated with fatty liver disease (MAFLD) and hepatic fibrosis in primary care (PC). Secondarily, we assessed the correlation between serological markers (FIB-4, ELF test), abdominal ultrasound, and transient elastography in the early detection of MAFLD. Methods: An observational prospective study was designed to determine the prevalence of MAFLD and to assess the correlation between complementary tests. Patients were recruited from five health centres. Eligible participants were adults aged between 18 and 70 years with at least one metabolic risk factor, including being overweight (BMI 25–29.9 kg/m2) or obese (BMI > 30 kg/m2), or diagnosed with type 2 diabetes mellitus (T2DM), dyslipidemia, or metabolic syndrome. The prevalence of MAFLD was calculated. Correlations between diagnostic tests were evaluated using Pearson’s correlation coefficient. Results: A total of 98 patients was included. Using CAP (controlled attenuation parameter) measurements, the prevalence of MAFLD was found to be 67.7%, and the prevalence of hepatic fibrosis was 6.5%. The correlation between conventional ultrasound and CAP from FibroScan® for the diagnosis of MAFLD was low and not statistically significant (0.160 [95% CI: −0.100; 0.400], p = 0.226). In contrast, the diagnosis of hepatic fibrosis using FibroScan® in PC showed a high correlation with diagnoses performed in gastroenterology department (0.942 [95% CI: 0.844; 0.979], p < 0.001). The correlation with biochemical markers was low and not statistically significant for both FIB-4 (0.125 [95% CI: −0.129; 0.363], p = 0.334) and the ELF test (0.159 [95% CI: −0.111; 0.407], p = 0.246). Conclusions: Two out of three patients with metabolic risk factors were diagnosed with MAFLD, while hepatic fibrosis diagnoses were uncommon. These results reinforce the validity of using FibroScan® in PC. Full article
(This article belongs to the Special Issue Metabolic Syndrome and Its Burden on Global Health)
16 pages, 1143 KiB  
Article
Use of Metabolic Scores and Lipid Ratios to Predict Metabolic Dysfunction-Associated Steatotic Liver Disease Onset in Patients with Inflammatory Bowel Diseases
by Ludovico Abenavoli, Giuseppe Guido Maria Scarlata, Massimo Borelli, Evelina Suraci, Raffaella Marasco, Maria Imeneo, Rocco Spagnuolo and Francesco Luzza
J. Clin. Med. 2025, 14(9), 2973; https://doi.org/10.3390/jcm14092973 - 25 Apr 2025
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Abstract
Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized in inflammatory bowel disease (IBD) patients due to chronic inflammation and metabolic disturbances. However, reliable non-invasive biomarkers for MASLD prediction in this population are lacking. This study evaluated the predictive value of metabolic [...] Read more.
Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized in inflammatory bowel disease (IBD) patients due to chronic inflammation and metabolic disturbances. However, reliable non-invasive biomarkers for MASLD prediction in this population are lacking. This study evaluated the predictive value of metabolic scores and lipid ratios for MASLD onset in IBD patients. Methods: An observational retrospective study was conducted on 358 IBD patients at the “Renato Dulbecco” Teaching Hospital in Catanzaro, Italy, in a period between 1 January 2021 and 31 December 2024. Clinical and laboratory data, including metabolic scores and lipid ratios, were analyzed using the chi-square and Kruskal–Wallis tests as appropriate. Post hoc comparisons were conducted using Dunn’s test. Receiver operating characteristic analysis assessed their predictive accuracy for MASLD. p < 0.05 was considered significant. Results: IBD-MASLD patients had a significantly higher body mass index (BMI, 27 ± 4 vs. 22 ± 2 kg/m2; p < 0.001), waist circumference (100 ± 11 vs. 85 ± 4 cm; p < 0.001), other anthropometric parameters, metabolic scores, and lipid ratios than IBD-only patients. The metabolic score for insulin resistance [METS-IR, area under curve (AUC = 0.754)] and waist circumference (AUC = 0.754) exhibited the highest predictive accuracy, followed by the lipid accumulation product (LAP, AUC = 0.737), BMI (AUC = 0.709), and triglyceride/high-density lipoprotein (TG/HDL, AUC = 0.701). Insulin resistance scores, including the homeostasis model assessment of insulin resistance (AUC = 0.680) and triglyceride-glucose index (AUC = 0.674), were of moderate predictive use. The visceral adiposity index (AUC = 0.664) and low-density lipoprotein/high-density lipoprotein (AUC = 0.656) showed lower discriminative ability, while the fibrosis-4 index (AUC = 0.562) had the weakest diagnostic performance. Conclusions: Our findings suggest that MASLD in IBD is primarily driven by cardiometabolic dysfunction. The introduction of the METS-IR, LAP, and TG/HDL into clinical assessments of IBD patients could prove useful in preventing liver and cardiovascular complications in this setting. Full article
(This article belongs to the Special Issue Metabolic Syndrome and Its Burden on Global Health)
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15 pages, 2336 KiB  
Article
A Longitudinal Assessment of Metabolic Syndrome
by Dilbar Aidarbekova, Karlygash Sadykova, Yerbolat Saruarov, Nursultan Nurdinov, Mira Zhunissova, Kumissay Babayeva, Dinara Nemetova, Ainur Turmanbayeva, Aigerim Bekenova, Gulnaz Nuskabayeva and Antonio Sarria-Santamera
J. Clin. Med. 2025, 14(3), 747; https://doi.org/10.3390/jcm14030747 - 24 Jan 2025
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Abstract
Background/Objectives: Metabolic syndrome (MetS) is a combination of conditions including central obesity, high blood pressure, high glucose levels, and abnormal triglycerides and cholesterol, which together increase the chances of heart disease, diabetes, and even death. The rates of MetS are different around [...] Read more.
Background/Objectives: Metabolic syndrome (MetS) is a combination of conditions including central obesity, high blood pressure, high glucose levels, and abnormal triglycerides and cholesterol, which together increase the chances of heart disease, diabetes, and even death. The rates of MetS are different around the world, with 20–30% in Europe and 21.8–23.9% in Kazakhstan. Because MetS changes over time, it is important to study the dynamics of their components to improve prevention and treatments. This work aims to obtain the incidence of MetS and to evaluate the specific components associated with the emergence of new MetS cases in this population. Methods: This is a longitudinal study with a 10-year follow-up in Turkestan city between 2012 and 2024. Information was collected through physical exams, blood tests, and anthropometric measurements. Logistic regression and ROC curve analysis were used to find which factors increase the incidence of MetS. Results: Among 434 participants analyzed (78.8% women, and mean age 40.87, 66% < 2 MetS components, 20% had MetS blood pressure, and 65.9% had MetS waist circumference), the incidence of MetS at follow-up was 40%. The key risk factors for newly diagnosed MetS included elevated blood pressure and increased waist circumference. Multivariate analyses highlighted these components as the strongest predictors of MetS, with significant associations observed for participants with two or more MetS components at baseline. Conclusions: Elevated blood pressure and central obesity were identified as pivotal contributors to MetS progression. Given the rising prevalence of Mets and its implications, these results show the need to start treatment and check these risks early to prevent serious health problems. Full article
(This article belongs to the Special Issue Metabolic Syndrome and Its Burden on Global Health)
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Review

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15 pages, 592 KiB  
Review
Developmental Trends of Metabolic Syndrome in the Past Two Decades: A Narrative Review
by Ahmad A. Obeidat, Mousa N. Ahmad, Mai A. Ghabashi, Awfa Y. Alazzeh, Salam M. Habib, Dalia Abu Al-Haijaa and Firas S. Azzeh
J. Clin. Med. 2025, 14(7), 2402; https://doi.org/10.3390/jcm14072402 - 31 Mar 2025
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Abstract
Background/Objectives: Metabolic syndrome (MetS) is a complex disorder characterized by insulin resistance (IR), central obesity, atherogenic dyslipidemia, and higher glucose levels. It increases the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), imposing an economic burden on the healthcare [...] Read more.
Background/Objectives: Metabolic syndrome (MetS) is a complex disorder characterized by insulin resistance (IR), central obesity, atherogenic dyslipidemia, and higher glucose levels. It increases the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), imposing an economic burden on the healthcare system. However, the historical origins of MetS as well as the development and evolution of its definitions have not been conclusively documented in the literature. This study seeks to enhance the understanding of the developmental trends of MetS during the preceding two decades, placing particular emphasis on the definition, diagnosis and prevalence. Methods: An extensive search was performed from 1920 to 2023 across prominent scientific research engines, including Scopus, PubMed, MDPI, and others. Results: Despite advancements, many aspects of MetS remain inadequately understood. As the understanding of the nature and pathophysiology of MetS progresses, the development and refinement of its diagnostic criteria, and assessment and treatment guidelines will continue. Additionally, there exists significant variation in the global prevalence of metabolic syndrome, ranging from 14 to 39%. This prevalence is projected to increase due to the adoption of less healthy dietary patterns and sedentary lifestyles. The observed disparities in metabolic syndrome prevalence can be attributed to multiple factors, including demographic characteristics. Furthermore, the lack of a standardized definition across studies also contributes to the variation in reported prevalence rates. Conclusions: Further studies focusing on the standardization of the MetS definition across different research are crucial. The establishment of consistent criteria would enhance the reliability and validity of research findings, enabling more meaningful comparisons and interpretations. Full article
(This article belongs to the Special Issue Metabolic Syndrome and Its Burden on Global Health)
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Other

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22 pages, 6140 KiB  
Systematic Review
Effect of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) on Left Ventricular Mechanics in Patients Without Overt Cardiac Disease: A Systematic Review and Meta-Analysis
by Andrea Sonaglioni, Federica Cerini, Valeria Fagiani, Gian Luigi Nicolosi, Maria Grazia Rumi, Michele Lombardo and Paola Muti
J. Clin. Med. 2025, 14(8), 2690; https://doi.org/10.3390/jcm14082690 - 15 Apr 2025
Viewed by 225
Abstract
Background: Over the last two decades, a fair number of echocardiographic studies have investigated the influence of metabolic dysfunction-associated steatotic liver disease (MASLD) on myocardial strain and strain rate parameters assessed by speckle tracking echocardiography (STE) in individuals without overt heart disease, reporting [...] Read more.
Background: Over the last two decades, a fair number of echocardiographic studies have investigated the influence of metabolic dysfunction-associated steatotic liver disease (MASLD) on myocardial strain and strain rate parameters assessed by speckle tracking echocardiography (STE) in individuals without overt heart disease, reporting not univocal results. We aimed at analyzing the main findings of these studies. Methods: All studies examining conventional echoDoppler parameters by transthoracic echocardiography (TTE) and left ventricular (LV) mechanics [LV-global longitudinal strain (GLS), LV-global strain rate in systole (GSRs), in early diastole (GSRe) and late diastole (GSRl)] by STE in MASLD patients without known heart disease vs. healthy individuals, were searched on PubMed, Embase and Scopus databases. The primary endpoint was to quantify the effect of MASLD on LV-GLS in individuals without overt cardiac disease. Continuous data [LV-GLS, LV-GLSRs, LV-GLSRe, LV-GLSRl and left ventricular ejection fraction (LVEF)] were pooled as the standardized mean difference (SMD) comparing MASLD cohorts with healthy controls. Results: A total of 11 studies were included, totaling 1348 MASLD patients and 6098 healthy controls. Overall, MASLD showed a medium effect on LV-GLS (SMD −0.6894; 95%CI −0.895, −0.472, p < 0.001) and LV-GLSRs (SMD −0.753; 95%CI −1.501, −0.006, p = 0.048), a large effect on LV-GLSRe (SMD −0.837; 95%CI −1.662, −0.012, p = 0.047) and a small and not statistically significant effect on LV-GLSRl (SMD −0.375; 95%CI −1.113, 0.363, p = 0.319) and LVEF (SMD −0.134; 95%CI −0.285, 0.017, p = 0.083). The overall I2 statistic was 86.4%, 89.4%, 90.9%, 89.6% and 72.5% for LV-GLS, LV-GLSRs, LV-GLSRe, LV-GLSRl and LVEF studies, respectively, indicating high between-study heterogeneity. Egger’s test for LV-GLS studies gave a p value of 0.11, 0.26, 0.40, 0.32 and 0.42 for LV-GLS, LV-GLSRs, LV-GLSRe, LV-GLSRl and LVEF studies, respectively, thus excluding publication bias. Meta-regression analysis excluded any correlation between potential confounders and LV-GLS in MASLD individuals (all p > 0.05). Sensitivity analysis confirmed the robustness of study results. Conclusions: MASLD has a medium effect on LV-GLS, independently of demographics, anthropometrics and the cardiovascular disease burden. STE analysis may allow early detection of subclinical LV systolic dysfunction in MASLD patients, potentially identifying those who may develop heart failure later in life. Full article
(This article belongs to the Special Issue Metabolic Syndrome and Its Burden on Global Health)
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