Metabolic Syndrome in Nepal: A Systematic Review and Meta-Analysis of Prevalence, Heterogeneity and Public Health Implications
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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. Methods: 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 modified Newcastle-Ottawa Scale. 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. Results: Eight studies comprising 21,708 participants were included. The pooled prevalence of Metabolic Syndrome 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. Conclusions: 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.
