METABOLIS SYNDROME

Evidence-based recommendation for surveillance of metabolic syndrome (IGHGa)b,c
This page is part of the PanCare Follow-up recommendations for surveillance of late effects. Click here, for more information on these recommendations.

Who is at risk for metabolic syndrome?

CAYA cancer survivors treated with

  • cranial or craniospinal radiotherapy
  • TBI

What metabolic syndrome problems might occur?

  • Metabolic syndrome is characterized by the presence of multiple cardiovascular risk factors and is defined according to the NCEP ATP
    III criteria. The diagnosis requires at least three of the following abnormalities: b
    • Overweight or obesity
    • Elevated triglyceride levels
    • Reduced HDL cholesterol (HDL-C ) levels
    • Hypertension
    • Hyperglycemia

What surveillance modality should be used, when should it be started and at what frequency should it be performed?

  Height, weight, BMI, waist
circumference		 Blood pressure  Fasting blood glucose with
or without HbA1 		 Fasting lipid profile b 
Cranial or
craniospinal
radiotherapy 		 At least every 2 years, with
consideration of more
frequent testing (up to
annually) d
Starting at entry into long
term follow-up		 At least every 2 years, with
consideration of more
frequent testing (up to
annually) d
Starting at entry into long
term follow-up		 At least every 5 years, with
consideration of more
frequent testing (up to
annually) d
tarting no later than the
age of 40 years e		 At least every 5 years, with
consideration of more
frequent testing (up to
annually) d
tarting no later than the
age of 40 years e
TBI At least every 2 years, with
consideration of more
frequent testing (up to
annually) d
Starting at entry into long
term follow-up		 At least every 2 years, with
consideration of more
frequent testing (up to
annually) d
Starting at entry into long
term follow-up		 At least every 2 years, with
consideration of more
frequent testing (up to
annually) d
Starting at entry into long
term follow-up		 At least every 2 years, with
consideration of more
frequent testing (up to
annually) d
Starting at entry into long
term follow-up

What other advice should be given?

  • Counsel about healthy lifestyle and discuss potential lifestyle interventions, such as referral to a dietician or lifestyle coach

What should be done if abnormalities are identified?

  • Evaluate for other features of the metabolic syndrome
  • Refer to the appropriate healthcare professional for targeted treatment and management of identified abnormalities
  • Consider referral to an endocrinologist for further (endocrine) evaluation and/or management of metabolic syndrome

Disclaimer

While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.

PanCareFollowUp has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 824982. The material presented and views expressed here are the responsibility of the author(s) only. The EU Commission takes no responsibility for any use made of the information set out.

a This recommendation reflects the recommendations of the IGHG Metabolic syndrome guideline (Metabolic syndrome in childhood, adolescent, and young adult cancer survivors: recommendations for surveillance from the International Late Effects of Childhood Cancer Guideline Harmonization Group, European Journal of Endocrinology, 2025; accessible through https://www.ighg.org/guidelines/topics/metabolicsyndrome/).

b Metabolic syndrome is defined by the NCEP ATP III criteria. For adults, metabolic syndrome is present if a patient has 3 or more of the following criteria: 1) waist circumference >102 cm in men or >88 cm in women; 2) triglyceride levels ≥150mg/dL (≥1.69 mmol/L); 3) HDL-C <40 mg/dL (<1.03 mmol/L) in men or <50 mg/dL (<1.30 mmol/L) in women or on current treatment for high cholesterol; 4) blood pressure ≥130/85 mmHg or on current treatment for hypertension; 5) glucose ≥100 mg/dL (≥5.6 mmol/L). For children, metabolic syndrome is present if a patient has 3 or more of the following criteria: 1) waist circumference ≥90th percentile for age, sex, and ethnicity; 2) triglyceride levels ≥110mg/dL (≥1.24 mmol/L); 3) HDL-C <40 mg/dL (<1.03 mmol/L); 4) systolic or diastolic blood pressure blood pressure ≥90th percentile for age, sex, and ethnicity; 5) glucose ≥100 mg/dL (≥5.6 mmol/L) or a diagnosis of type 2 diabetes.

c Recommendations for the individual components of the metabolic syndrome are specified in the Consensus-based recommendation for surveillance of impaired glucose metabolism and diabetes mellitus, Consensus-based recommendation for surveillance of dyslipidaemia, Consensus-based recommendation for surveillance of overweight and obesity, and Consensus-based recommendation for surveillance of hypertension.

d Considering the presence of other cardiovascular risk factors.

e Earlier initiation of surveillance should be considered for survivors of any age in whom the presence of individual components has already been diagnosed.