Metabolic Syndrome in Nepal: A Systematic Review and Meta-Analysis of Prevalence, Heterogeneity and Public Health Implications

Background Metabolic Syndrome is a cluster of cardiometabolic risk factors including abdominal obesity, dyslipidemia, hypertension, and hyperglycemia. Its prevalence in Nepal has been reported inconsistently, with figures ranging from very low to extremely high. Reliable evidence is needed to inform policy and prevention strategies.

We conducted a systematic review and meta-analysis of observational studies reporting the prevalence of Metabolic Syndrome among Nepalese adults. Databases searched included PubMed, Embase, Scopus, and Nepalese journals up to May 2025. Eligible studies used recognized diagnostic criteria, enrolled ≥100 participants, and were assessed for quality using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The primary analysis employed a binomial generalized linear mixed model (GLMM). Heterogeneity was quantified using I^2 and τ^2, and 95% prediction intervals were emphasized. Subgroup, sensitivity, and leave-one-out analyses were performed. Certainty of evidence was evaluated using GRADE.

Eight studies comprising 21,708 participants were included. The pooled prevalence of MetS was 21.3% (95% CI: 11.6–35.9%), but heterogeneity was extreme (I^2 = 99.4%). The 95% PI indicated that true prevalence in new populations could range from 2.0% to 78.6%. Subgroup analysis by setting (urban vs. mixed) did not explain the variability. Component analysis revealed high prevalence of low HDL (64.5%), abdominal obesity (59.5%), and hypertriglyceridemia (47.0%). GRADE certainty was very low for overall prevalence, but low to moderate for individual components.

Metabolic syndrome represents a significant but unevenly distributed burden in Nepal. The extreme heterogeneity underscores that national averages are misleading. Public health strategies should prioritize local data and address widespread dyslipidemia and obesity while future research must clarify the determinants of disparity. Competing Interest Statement The authors have declared no competing interest. Funding Statement No funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used ONLY openly available human data that were originally located at major databases like pubmed, scopus, embase and nepali local journals. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors https://github.com/Dr-Charlie/metabolic-syndrome-meta-analysis List of abbreviations - ATP III - Adult Treatment Panel III - CI - Confidence Interval - GLMM - Generalized Linear Mixed Model - GRADE - Grading of Recommendations Assessment, Development and Evaluation - HDL - High-Density Lipoprotein - IDF - International Diabetes Federation - JBI - Joanna Briggs Institute - MetS - Metabolic Syndrome - ML - Maximum Likelihood - NAFLD - Non-Alcoholic Fatty Liver Disease - NCEP - National Cholesterol Education Program - PI - Prediction Interval - PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PROSPERO - International Prospective Register of Systematic Reviews - REML - Restricted Maximum Likelihood