Cited by 117Diabetes, Cardiovascular Risks, and LipoproteinsCardiac Health and Mental HealthAdipokines, Inflammation, and Metabolic Diseases

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Association between anxiety and metabolic syndrome: A systematic review and meta-analysis of epidemiological studies

Tang, Fang, Wang, Gangpu, Lian, Ying·2017·Psychoneuroendocrinology

DOI 10.1016/j.psyneuen.2016.11.025

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Abstract

Objective Epidemiological studies have repeatedly investigated the association between anxiety and metabolic syndrome (MetS). However, the results have been inconsistent. We performed a meta-analysis of observational studies to summarize the evidence regarding the relation of anxiety and MetS risk.Methods We performed a systematic literature search of all studies published in PubMed and EMBASE from its inception to June 2016. Cross-sectional and cohort studies that reported an association between the two conditions in adults were included. Data on prevalence, incidence, unadjusted or adjusted odds ratio (OR), and 95% CI were extracted or provided independently by the authors. Random effects model was used to report the pooled OR. The I 2 statistic was used to assess heterogeneity. Egger's test and Begger's test were used to evaluate the publication bias.Results The search yielded 18 cross-sectional studies and two cohort studies. The pooled finding from cross-sectional studies showed that anxiety had a significant positive association with MetS (OR 1.07, 95% CI 1.01-1.12), with moderate heterogeneity (I 2=45.7%, P=0.018). Findings from two cohort studies indicated that the association between anxiety and MetS was insignificant.Conclusion Our results suggest that there is an association between anxiety and MetS. In individuals with MetS anxiety should be detected and managed. Further prospective studies are needed to explore the bidirectional association between anxiety and MetS.

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“Поэтому лицам с уже диагностированным МС, в свою очередь, необходимо проводить психологическое обследование (скрининг) для выявления сопутствующих тревожно-депрессивных состояний [28, 32].”
Inversely Regulated Inflammation-Related Processes Mediate Anxiety–Obesity Links in Zebrafish Larvae and Adults
Yehuda, H., Madrer, N., Goldberg, D., Soreq, H., & Meerson, A. (2023) · Cells · doi:10.3390/cells12131794 · Cited by 5
“Although a high-fat diet and obesity are often reported to have adverse effects, inducing chronic low-grade inflammation [100,103] and increased risks of diabetes and cardiovascular diseases [8,103], recent studies report that HFDs and obesity can have a protective role, as implied by our study.”
BackgroundResult
Non-alcoholic fatty liver disease (NAFLD) and potential links to depression, anxiety, and chronic stress
Shea, S., Lionis, C., Kite, C., Atkinson, L., Chaggar, S. S., Randeva, H. S., & Kyrou, I. (2021) · Biomedicines · doi:10.3390/biomedicines9111697 · Cited by 4
“This significant association of anxiety with metabolic syndrome is also supported by systematic review and meta-analysis data, which pooled findings from 18 relevant cross-sectional studies [35].”
Background
Taste receptor type 1 member 3 enables western diet-induced anxiety in mice
Song, J. W., Lee, K.-H., Seong, H., Shin, D., & Shon, W.-J. (2023) · BMC Biology · doi:10.1186/s12915-023-01723-x · Cited by 4
“Several studies showed that high-calorie western diet-induced obesity is a potential risk factor for anxiety [29, 30].”
Background
Overgeneralization of autonomic defensive reactions in obesity
Manassero, E., Scarpina, F., Tagini, S., Concina, G., Scacchi, M., Pollo, A., Mauro, A., & Sacchetti, B. (2024) · Scientific Reports · doi:10.1038/s41598-024-72439-3 · Cited by 4
A prospective registry analysis of psychosocial and metabolic health between women with and without metabolic syndrome after a complicated pregnancy
Aldridge, E., Schubert, K. O., Pathirana, M. M., Sierp, S., Leemaqz, S., Roberts, C. T., Dekker, G., & Arstall, M. A. (2022) · BMC Women s Health · doi:10.1186/s12905-022-02035-y · Cited by 4
“The association between anxiety and metabolic syndrome has been more contentious, but a 2017 meta-analysis reported a significant positive association between the two [47].”
Background
The psychological burden associated with metabolic syndrome: Evidence from UK and US older adults
Robinson, E., Daly, M., & Putra, I. G. N. E. (2024) · Obesity Science & Practice · doi:10.1002/osp4.780 · Cited by 7
“5,17 In addition, MetSyn was associated with a range of other negative psychosocial factors, including hopelessness, cynical hostility, increased negative affect, decreased positive affect, social support and purpose in life.”
Background
Rutinitas Senam Hamil dengan Melahirkan Spontan
Universitas Lampung, L., Sari, R. D. P., Sutarto, S., Universitas Lampung, L., Utama, W. T., Universitas Lampung, L., Pratiwi, D., & Universitas Lampung, L. (2022) · Jurnal Ilmu Medis Indonesia · doi:10.35912/jimi.v2i2.1376 · Cited by 4
Effects of Physical Exercise on the Quality of Life of Type 2 Diabetes Patients
Tomás-Carús, P., Leite, N. J. C., & Raimundo, A. M. D. M. (2019) · IntechOpen eBooks · doi:10.5772/intechopen.87110 · Cited by 6
Development and validation of a predictive nomogram for the risk of MAFLD in postmenopausal women
Yang, M., Chen, X., Shen, Q., Xiong, Z., Liu, T., Leng, Y., & Jiao, Y. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1334924 · Cited by 3
“In the systematic review by Tang (29), two cohort studies were included, which reported no correlation between MetS and anxiety (30, 31).”
Presence of Mood and/or Anxiety Disorders Does Not Affect Success of Weight Management Therapies in Metabolic Dysfunction-Associated Steatotic Liver Disease
Bollinger, B., Cotter, R. J., Deng, Y., Ilagan‐Ying, Y. C., & Gupta, V. (2024) · Digestive Diseases and Sciences · doi:10.1007/s10620-024-08724-y · Cited by 3
“Patients with psychiatric conditions such as major depressive disorder (MDD) and generalized anxiety disorder (GAD) are more likely to develop metabolic syndrome than those without such conditions [3–5].”
Outcomes of metabolic syndrome and anxiety levels in light and heavy smokers
Şahin, M., & Yüzügüllü, D. (2025) · PeerJ · doi:10.7717/peerj.19069 · Cited by 5
“A recent meta-analysis of 18 cross-sectional studies examining anxiety ’ s impact on metabolic syndrome risk reported a modest yet discernible increase in risk (OR = 1.07) ( Tang, Wang & Lian, 2017 ).”
Influential
Stress and Anxiety Are Associated with Increased Metabolic Syndrome Risk Among Young Adults Living in the Deep South
Renna, M. E., Wilbourne, F. N., Johal, S. K., Fergerson, A. K., Behringer, K. F., Brandner, C. F., Stavres, J., & Graybeal, A. J. (2025) · Healthcare · doi:10.3390/healthcare13040359 · Cited by 4
“In addition to the numerous biological risks of MetS, psychological factors such as anxiety and depression are associated with MetS in middle-aged and older adults [6,7].”
Associations Between Anxiety Symptoms and Health-Related Quality of Life: A Population-Based Twin Study in Sri Lanka
Nas, Z., Zavos, H. M. S., Sumathipala, A., Jayaweera, K., Siribaddana, S., Hotopf, M. H., & Rijsdijk, F. V. (2021) · Behavior Genetics · doi:10.1007/s10519-021-10051-1 · Cited by 4
“Anxiety symptoms impact not only emotional wellbeing, but are also associated with chronic health problems (Davies and Allgulander 2013; El-Gabalawy et al. 2014; Tang et al. 2017), bodily pain (Lerman et al.”
Background
Re-establishing alliances: “Old Friends” confronting obesity, inflammation, and stress-related psychiatric disorders
Desmond, L. W., & Lowry, C. A. (2026) · Brain Behavior and Immunity Integrative · doi:10.1016/j.bbii.2026.100166 · Cited by 2
Risk of Glaucoma Associated with Components of Metabolic Disease in Taiwan: A Nationwide Population-Based Study
Chang, Y., Sung, F., Tzeng, Y., Mou, C.-H., Tien, P., Su, C.-W., & Teng, Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010305 · Cited by 2
“Studies have also linked MetD with age-related cataract [13], age-related macular degeneration (AMD) [10], obstructive sleep apnea (OSA) [14], nonalcoholic fatty liver disease [15], depression, anxiety [16,17], and hypothyroidism [18].”
Background
Environmental Factors in the Etiology of Mental Disorders in the Czech Republic
Hosák, L., Hosakova, K., Malekirad, M., Kamarádová, D., Zapletalová, J., & Látalová, K. (2023) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s379811 · Cited by 3
Prevalence and risk factors of anxiety symptoms in first-episode and drug-naïve major depressive disorder patients with metabolic syndrome
Liu, J., Yang, Y., Zhang, Y., Wang, H., Wei, W., Lang, X., & Zhang, X. (2023) · The European Journal of Psychiatry · doi:10.1016/j.ejpsy.2023.07.001 · Cited by 2
Hazardous alcohol use and cardiometabolic risk among firefighters
Levitt, D. E., Wohlgemuth, K. J., Burnham, E. F., Conner, M. J., Collier, J. J., & Mota, J. A. (2025) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.15517 · Cited by 2
Multidimensional analysis of the association between metabolic abnormality combinations and depressive symptoms in overweight and obese populations: Cross-sectional evidence from two multinational cohorts
Chen, Y.-X., Lin, Y., Yang, Q.-W., Ye, B., Gao, Z.-H., Hu, D.-S., Liu, J.-T., Yang, D.-C., Dong, Y., Cui, G.-W., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119794 · Cited by 3
Physical activity and exercise for the prevention and management of anxiety
Schuch, F. B., Stubbs, B., & Kandola, A. A. (2021) · Society for Transparency, Openness, and Replication in Kinesiology eBooks · doi:10.51224/b1016 · Cited by 2
“For example, people with anxiety disorders are at increased risk of cardiovascular disease (Batelaan et al., 2016), diabetes (Smith et al., 2018), and metabolic syndrome (Tang et al., 2017).”
Background
Relationship Between Depression, Generalized Anxiety, and Metabolic Syndrome Among Buddhist Temples Population in Nakhon Pathom-Thailand
Peltzer, K., & Pengpid, S. (2018) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs.60829 · Cited by 2
“This study did not find, contrary to the general findings of two meta-reviews (5, 8), an association between MDD, GAD, and MetS among a temples population in Nakhon Pathom in Thailand.”
BackgroundResult
Fatores sociodemográficos e clínicos associados à ansiedade em mulheres hipertensas: estudo transversal
da Silva, T. C., Santos, V. B., Cavalcante, Á. M. R. Z., Hirano, G. S. B., Lopes, J. D. L., & de Barros, A. L. B. L. (2023) · Acta Paulista de Enfermagem · doi:10.37689/acta-ape/2023ao02951 · Cited by 4
AFFECTIVE DISORDERS IN MEN WITH ARTERIAL HYPERTENSION IN COMBINATION WITH METABOLIC SYNDROME
Yaskevich, R. A., & Moskalenko, O. L. (2023) · Siberian Journal of Life Sciences and Agriculture · doi:10.12731/2658-6649-2023-15-1-327-345 · Cited by 3
Identifying the Role of Vasopressin and Oxytocin in the Microbiota-Gut-Brain-Behavior Axis
Peters, N. V. (2022) · Digital Archive @ GSU · doi:10.57709/14972899 · Cited by 2
Association of Depression with Metabolic Syndrome in Highly Educated Ethnic Koreans of China: A Case–Control Study
Wen, Y., Liu, G., Shang, Y.-W., & Wáng, Q. (2021) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s280716 · Cited by 2
Evaluation of inflammatory and metabolic impairments regarding depression dimensions: a case control study
Sabri, Y., & Abdelsalam, N. M. (2022) · Middle East Current Psychiatry · doi:10.1186/s43045-022-00178-0 · Cited by 2
“Recently, anxiety disorders have been related to metabolic syndrome [17].”
BackgroundInfluential
Koexistenz von Depression, Angst, traumatischem Stress und körperlicher Krankheit – allgemeine Positionen
Kapfhammer, H. (2022) · Springer eBooks · doi:10.1007/978-3-662-65873-4_1 · Cited by 1
Induction of obesity by a high-carbohydrate diet in zebrafish modulates genes related to feeding behavior and inflammation
Virote, B. D. C. R., da Silva, K. C. D., Júnior, R. E. M., Carneiro, W. F., Valadares, L. P. D. A., de Souza, S. P., Guimarães, I. G., Cagnini, D. Q., Godard, A. L. B., Vianna, A. R. D. C. B., et al. (2025) · Life Sciences · doi:10.1016/j.lfs.2025.123807 · Cited by 1
Risk of acute myocardial infarction and ischemic stroke in young patients with Somatic Symptom Disorder: A nationwide study in Korea
Kim, I. B., Kim, J., Choi, H. S., Lee, J., Choi, J., Kim, E., Kim, H., Kim, H.-J., & Lee, S.-H. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120667 · Cited by 1
Interrelationship Between Socioeconomic Status, Depression, and Neuropathy in People with Diabetes: A Cross-Sectional Study
Pasha, R., Quartey, G., Kalteniece, A., Faber, C. G., Lauria, G., Marshall, A. G., Azmi, S., Malik, R. A., Soran, H., & Ferdousi, M. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15093215 · Cited by 1
“However, given the cross-sectional design, these relationships remain associative and causal pathways cannot be established. https://doi.org/10.3390/jcm15093215 Depression has further been linked with metabolic syndrome, characterised by hyperglycaemia, dyslipidaemia, and central obesity [23].”
Influential
Metabolic Syndrome and Psychological Effects of Exercise in Hemodialysis Patients
Hornik, B., Duława, J., & Durmała, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182211952 · Cited by 1
“Most of the authors suggested the need for further prospective studies to determine a two-way relationship between these clinical conditions [57].”
Background
AFFECTIVE DISORDERS IN WOMEN WITH ARTERIAL HYPERTENSION IN COMBINATION WITH METABOLIC SYNDROME
Yaskevich, R. A., & Moskalenko, O. L. (2023) · Siberian Journal of Life Sciences and Agriculture · doi:10.12731/2658-6649-2023-15-2-284-302 · Cited by 1
FEATURES OF INDICATORS OF SITUATIONAL AND PERSONAL ANXIETY IN PATIENTS WITH METABOLIC SYNDROME
Moskalenko, O. L., Каспарова, И. Э., & Yaskevich, R. A. (2023) · Russian Journal of Education and Psychology · doi:10.12731/2658-4034-2023-14-4-228-247 · Cited by 1
Prevalence and Predictors of Depression among Medical Students of Imo State University, Owerri, South Eastern Nigeria.
Oluoha, R. U., Offiong, A. A., N., O. P., Nwaigbo, E., & Ifeanyi, N. (2023) · International Journal of TROPICAL DISEASE & Health · doi:10.9734/ijtdh/2023/v44i241507 · Cited by 1
NMR Metabolomics for Marker Discovery of Metabolic Syndrome
Quesada‐Vázquez, S., Hernández-Baixauli, J., Navarro‐Masip, È., & Escoté, X. (2022) · Biomarkers in disease · doi:10.1007/978-3-031-07389-2_39 · Cited by 1
Depresijas un trauksmes saistība ar kardiovaskulārām slimībām un kardiovaskulārās mirstības risku (SCORE) tuvāko 10 gadu laikā primārajā aprūpē Latvijā. Promocijas darbs
Ivanovs, R. (2020) · doi:10.25143/prom-rsu_2020-03_pd · Cited by 1
Psychophysiological Status and Life Quality in Individuals with Metabolic Syndrome Living in Central Kazakhstan
Koichubekov, B., Sorokina, M., Korshukov, I., Bakirova, R., Bekov, E. K., & Omarbekova, N. (2020) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2020.3729
“Several prior studies of MetS have documented that anxiety had a significant positive association with MetS [43], [44].”
Background
Metabolic syndrome in psychiatric outpatients in a tertiary care center in Eastern India
Chakraborty, K., Chatterjee, M., Bhattacharyya, R., Dan, A., & Neogi, R. (2020) · International Journal of Community Medicine and Public Health · doi:10.18203/2394-6040.ijcmph20205690 · Cited by 1
“07).(19) Indian studies have reported a prevalence of MS ranging from 24% to 62.”
Background
The Relationship Between Coronavirus Anxiety Level and Emotional Eating in Individuals with Metabolic Syndrome: A Comparative StudyPreprint
Değirmenci, D. M., Uğurlu, Y. K., & Alemdar, D. K. (2021) · Research Square · doi:10.21203/rs.3.rs-161715/v1
“including 18 cross-sectional studies revealed a correlation between anxiety and MetS [5].”
Background
BARBQTCM Survey: Einfluss von Schlafstörungen auf die TCM-Akzeptanz bei Übergewicht und Adipositas
Panhofer, P., Vlasak, T., Pfefferkorn, U., Stockert, K., Bijak, M., Stockenhuber, D., & Rothe, S. (2021) · Deutsche Zeitschrift für Akupunktur · doi:10.1007/s42212-020-00343-8
“Das Psycho-SoziALe Metabolische Syndrom (PSALMS) umfasst eine Vielzahl metabolischer [6], endokriner [17, 81] und psychosozialer Störungen [14, 83]: Fettleber [19], Insulinresistenz [42] und Diabetes mellitus [6], Bluthochdruck [32, 45], Dyslipidämie [86], Depressionen [27], (soziale) Phobien [84], Stress [8, 47] sowi…”
Background
Associação entre alimentação, ansiedade, depressão e estado nutricional: efeitos sobre absenteísmo e despesas em saúde entre indivíduos adultos residentes no município de São Paulo (SP)
Hypólito, T. M. (2021) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.6.2021.tde-24062021-193148 · Cited by 2
Does State Anxiety Affect the Outcome of an Oral Glucose Tolerance Test?
Gezer, E., Demirhan, Y., Selek, A., Cantürk, Z., ÇETİNASLAN, B., Sözen, M., & Karatoprak, A. P. (2021) · Medical Journal of Western Black Sea · doi:10.29058/mjwbs.931394
NMR Metabolomics for Marker Discovery of Metabolic Syndrome
Quesada‐Vázquez, S., Hernández-Baixauli, J., Navarro‐Masip, È., & Escoté, X. (2022) · Biomarkers in disease · doi:10.1007/978-3-030-81304-8_39-1

Authors: Tang, F., Wang, G., & Lian, Y.
Affiliations: Shandong University (CN)
Fourth People’s Hospital of Jinan (CN)
Corresponding author: Lian, Ying
ORCID: Tang, Fang
Wang, Gangpu
Lian, Ying
Venue: Psychoneuroendocrinology
Publisher: Elsevier BV
Published: 2017-03
Volume: 77
Pages: 112-121
ISSN: 0306-4530 (ISSN-L)
DOI: 10.1016/j.psyneuen.2016.11.025
OpenAlex: W2558935924
Cited by: 117
References: 49
Citations by year: 2026: 4 · 2025: 9 · 2024: 16 · 2023: 21 · 2022: 18 · 2021: 24 · 2020: 11 · 2019: 4 · 2018: 8 · 2017: 2
FWCI: 0.69
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Psychoneuroendocrinology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
Keywords: anxiety, metabolic syndrome, psychological stress, cardiovascular risk factors, bidirectional relationship, prevalence, incidence
MeSH terms: Anxiety, Anxiety Disorders, Humans, Comorbidity, Prevalence, Metabolic Syndrome

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Association between anxiety and metabolic syndrome: A systematic review and meta-analysis of epidemiological studies

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