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. 2025 Jul 2;17:250. doi: 10.1186/s13098-025-01815-4

The association between alcohol and metabolic syndrome: a systematic review and meta-analysis

Maedeh Arshadi 1, Elahe Mansouri Yekta 2, Maryam Kazemi 1, Elham Khaledi 1, Zahra Beygi 1, Hosein Azizi 3,4, Farzad Khodamoradi 5,✉
PMCID: PMC12220093  PMID: 40604905

Abstract

Background

Some studies have shown that there is a relationship between alcohol and metabolic syndrome, and some studies have not found an association; considering the importance of this issue, the aim of this study is to review all the studies related to alcohol and its relationship with metabolic syndrome and to update the information.

Methods

PubMed, Scopus and Web of Science were searched to identify studies on the association between alcohol and metabolic syndrome from January 1, 2000 through August 13, 2023. The pooled OR and the 95% confidence intervals were used to measure the association between alcohol and metabolic syndrome by assuming a random effects meta-analytic model. Quality appraisal was undertaken using the Newcastle-Ottawa Scale.

Results

A total of 62 studies were included. In the association between use of alcohol and metabolic syndrome, the pooled OR for cross-sectional studies was 1.12 [95% CI: 1.07, 1.18] and the pooled OR for cohort studies was 1.12 [95% CI: 1.06, 1.18]. In cohort and cross-sectional studies, the association between alcohol dose and metabolic syndrome, was not significant. For the association between frequency of alcohol consumption and metabolic syndrome, the pooled OR for under 1 to 2 times a week, 2 times to 7 times a week and above 7 drink/week were 0.85 [95% CI: 0.78, 0.93], 0.80 [95% CI: 0.63, 1.01] and 1.02 [95% CI: 0.41, 2.56], respectively.

Conclusion

This study showed a positive relationship between alcohol consumption and metabolic syndrome. Therefore, it is recommended that further studies be conducted to accurately evaluate alcohol consumption and metabolic syndrome components, and for evaluate reducing or stopping alcohol consumption on metabolic syndrome, it is better to conduct clinical trial studies in the future.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13098-025-01815-4.

Keywords: Metabolic syndrome, Alcohol, Systematic review, Meta-analysis

Introduction

Metabolic syndrome (Mets) was described in the 20s, but it was introduced to medicine in 1988 by Raven [1]. Mets is known as a set of metabolic and physiological disorders that are often associated with insulin resistance [2]. This syndrome is characterized by a combination of risk factors such as abdominal obesity, high blood glucose, hypertension and dyslipidemia, which pose a significant risk to people worldwide [3]. A combination of improper nutrition and sedentary lifestyle leads to obesity and other disorders related to metabolic syndrome. In 2022, the global prevalence of Mets according to diagnostic criteria and its different definitions was reported from 12.5 to 31.4%, with the highest prevalence in America and Eastern Mediterranean regions in different definitions of Mets [4]. Until 2017, the prevalence of this syndrome was reported between 44 − 2.2% in Turkey, 41 − 16% in Saudi Arabia, 63 − 14% in Pakistan, 26–33% in Qatar, and 42 − 6% in Iran [5].

Low physical activity, excessive obesity, high alcohol consumption, smoking and some inappropriate dietary patterns are known as important risk factors for metabolic syndrome and increase the probability of developing this disease [6]. The results of previous studies show that there are complex relationships between alcohol consumption and components of metabolic syndrome. Some studies have reported an association between alcohol drinking and prevalent metabolic syndrome, and several studies have shown an inverse association. Many studies have reported that mild to moderate alcohol consumption has a favorable effect on lipids, central obesity, waist size, intermediate phenotypes of arterial blood pressure as well as fasting insulin and reduces the prevalence of metabolic syndrome [7–9]. A study also showed that regardless of the type of drink, alcohol consumption was associated with a lower prevalence of Mets [10]. In some other studies, it was shown that the pattern of drinking too much alcohol is related to various components of metabolic syndrome and causes an increase in the chances of developing metabolic syndrome [11, 12].

Since various studies have investigated the relationship between alcohol consumption and metabolic syndrome, but the results are contradictory, therefore the contradiction in the results shows the necessity of conducting a meta-analysis study on the relationship between alcohol consumption and metabolic syndrome and to update the information extensively. Also, the relationship between the dose and duration of alcohol consumption and its effect on metabolic syndrome has also been investigated.

Methods

Literature search strategy

To identify observational studies on the association between alcohol and metabolic syndrome, a comprehensive search was performed of several electronic databases, including PubMed, Scopus and Web of Science from January 1, 2000 through August 13, 2023. The search term comprised the following keywords: “Alcohol”, “Alcohol Drinking”, “Alcohol Consumption”, “Alcohol Intake”, “metabolic syndromes” and “metabolic syndrome”. Also, we investigated references of all the articles to identify studies that were not included during the initial search. The following inclusion criteria were selected for meta-analysis: the study comprised a cross-sectional or cohort study design, the primary outcome was a metabolic syndrome, the relative risk (RR) or odds ratio (OR) or hazard ratio (HR) and the corresponding 95% confidence interval (CI) of metabolic syndrome associated with alcohol were presented, and the studies were published in English. Furthermore, the exclusion criteria included intervention studies, letter to the editor, report, case report, review and meta-analysis.

Study selection

Initially, we screened the titles and abstracts of all studies to identify those that met the inclusion criteria. For those that were difficult to determine with titles and abstracts only, full-text assessment was conducted. Two authors (MA and FKH) screened the full text final and the decision was made for each study after reading the full text of all potentially eligible articles. In cases of disagreement, a third review author was consulted or was resolved by discussion. In total, 22,136 articles were retrieved, of which a total of 62 articles remained after the review process shown in Fig. 1.

Fig. 1.

Fig. 1

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Flow chart depicting the study selection process (screening)

Data Extraction

A structured data extraction form was used to extract data from the papers. The extracted data included: the last name of the first author, publication year, country, design, study population, sample size, age, and confounder. Extraction of data was done by the same two review authors (MA and FKH), who conducted the study selection independently.

Definition

Dose of alcohol

The dose and amount of alcohol consumption varied in different studies. Our study was categorized based on the study by Lee S [13] and Vidot DC [14] and the US Centers for Disease Control and Prevention [15]. In this way, 0 to 15 g per day were considered as light consumption, 15 to 30 g per day as moderate consumption, and more than 30 g per day as heavy consumption. Also, alcohol consumption per week by gender was considered as low drinker (females: 1–3 drinks/week; males: 1–7 drinks/week), moderate drinker (females: 3–7 drinks/week; males: 7–14 drinks/week) and heavy (females: >7 drinks/week; males: >14 drinks/week). In general, for studies that did not separate alcohol consumption by gender, on average, less than 2 times per week was considered as light consumption, 2 to 7 times per week was considered as moderate consumption, and more than seven times per week as heavy consumption.

Metabolic syndrome

In most studies, the definitions used for metabolic syndrome are based on the criteria of the modified United States National Cholesterol Education Program, Adult Treatment Panel (NCEP-ATP) III and International Diabetes Federation definition (IDF) as follows:

Metabolic syndrome (Mets): is defined according to NCEP-ATP III Guideline. Patients had at least three of the following risk features to be categorized under the Mets group: waist circumference (WC) ≥ 102 cm in men and ≥ 88 cm in women, triglycerides (TG) ≥ 150 mg/dl, reduced high-density lipoprotein-cholesterol, (HDL-C) < 40 mg/dl in men and < 50 mg/dl in women, blood pressure ≥ 130 mmHg systolic blood pressure (SBP) or ≥ 85 mmHg diastolic blood pressure (DBP), fasting blood glucose (FBG) ≥ 110 mg/dl.

According to IDF, metabolic syndrome is diagnosed based on waist circumference ≥ 90th percentile in combination with any two clinical measures of the following elements: blood pressure (≥ 130/85 MmHg), glucose (fasting plasma glucose (FPG) ≥ 100 mg/dL), and lipids (serum triglyceride ≥ 150 mg/dL or serum HDL-C < 40 mg/dl).

Evaluating the quality of articles

The quality of studies was assessed using the Newcastle-Ottawa quality assessment scale (NOS) adapted for observational studies [16]. The NOS is based on three domains including the selection of study groups, comparability of groups and description of exposure and outcome. This scale including eight items and star scores assesses the quality of each study in each domain. All items except the comparability domain have one star (the maximum score based on stars for the comparability domain is two). Totally, earned stars are calculated as the total quality score for each study. Based on these criteria, study quality was rated on a scale from one star, very poor, to 10 stars, high quality. Studies are rated as high (7–10), medium (5–6) or low quality (< 4). Two review authors (MA and FKH) completed the quality assessment independently. In cases of disagreement or items that remained unclear, a third review author was consulted.

Statistical analysis

The pooled OR and the 95% confidence intervals were used to measure the association between alcohol and metabolic syndrome by assuming a random effects meta-analytic model. We used estimates adjusted. Statistical heterogeneity was evaluated using Cochran’s Q-test and I2 statistic. subgroup analysis was carried out according to use of alcohol (cross-sectional and cohort), the dose (light, moderate and heavy), frequency of alcohol consumption (under 1 to 2 times a week, 2 times to 7 times a week and above 7 drinks/week). Leave-one-out sensitivity analysis was performed to identify influential studies in meta-analysis. Publication bias was determined by the funnel plot and Begg’s and Egger’s tests. The p-value of < 0.05 is considered statistically significant. The analyses were performed using Stata software version 14.

Results

Study characteristics

Search strategy and the algorithm of study selection are shown in Fig. 1. According to the keywords and MeSH terms and Emtree terms a total of 22,136 studies were identified. Subsequently, after identifying relevant studies and removing duplicates and considering the inclusion and exclusion criteria, 11,582, 1756, and 648 studies were excluded after reviewing their titles, abstracts, and full-texts, respectively. Finally, 62 related studies in quality analysis were evaluated and received inclusion criteria. Of these, fifteen studies were conducted in China, seven studies in the United States, seven studies in Taiwan, five studies in Korea, three studies in Ethiopia, and other studies were in other parts of the world. The cut-off score of 7 or higher was considered as the studies with high quality and 5–6 was considered as the studies with moderate quality. Fifty-six studies were 7 or higher, that they had high levels of quality. Six studies range of 5–6, which had moderate levels of quality. Supplementary Table 1 summarizes the characteristics of selected studies.

Use of alcohol and metabolic syndrome

Figure 2 presents the results of the random-effects meta-analysis and the pooled adjusted OR for the association between use of alcohol and metabolic syndrome stratified by design (cross-sectional, cohort). Based on results, the pooled OR for cross-sectional studies was 1.12 [95% CI: 1.07, 1.18] which represents a 12% increase in metabolic syndrome. The pooled OR for cohort studies was 1.12 [95% CI: 1.06, 1.18] which represents a 12% increase in metabolic syndrome. However, there is evidence of significant heterogeneity among cross-sectional studies (I2 = 84.2%; P = 0.000), but there is no evidence of heterogeneity among cohort studies (I2 = 22.5%; P = 0.271). Sensitivity analysis showed that there is no single study as a potential source of heterogeneity. We determined the possibility of publication bias using the funnel plot (Fig. 3) as well as Begg’s and Egger’s tests in studies. The studies are almost symmetrical scattered on both sides of the vertical line showing the absence of publication bias. Based on Begg’s (P = 0.814) and Egger’s (P = 0.733) tests we found no evidence of publication bias.

Fig. 2.

Fig. 2

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Forest plot of the association between use of alcohol and metabolic syndrome

Fig. 3.

Fig. 3

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Funnel plot for publication bias

Alcohol dose and metabolic syndrome

The results of the relationship between alcohol dose and metabolic syndrome stratified by dose (light, moderate and heavy) are shown in Figs. 4 and 5. With respect to results, the pooled OR in cohort study (Fig. 4) for light, moderate and heavy were 0.92 [95% CI: 0.82, 1.04], 0.87 [95% CI: 0.73, 1.03] and 1.11 [95% CI: 0.81, 1.54], respectively, which represents no association was found between dose of alcohol and metabolic syndrome in cohort study. There is evidence of significant heterogeneity among subgroups light (I2 = 60.4%; P = 0.056), moderate (I2 = 73.9%; P = 0.009) and heavy (I2 = 92%; P = 0.000) in cohort study. Based on results, the pooled OR for cross-sectional studies (Fig. 5) for light, moderate and heavy were 0.92 [95% CI: 0.74, 1.14], 0.83 [95% CI: 0.68, 1.01] and 1.16 [95% CI: 0.95, 1.42], respectively, which represents no association was found between dose of alcohol and metabolic syndrome. There is evidence of significant heterogeneity among sub-groups light (I2 = 86.2%; P = 0.000), moderate (I2 = 80.8%; P = 0.000) and heavy (I2 = 80.1%; P = 0.000). Sensitivity analysis showed that the studies by Matthew S and Ying liu were the source of observed heterogeneity [7, 17]. Based on Begg’s (P = 0.168) and Egger’s (P = 0.369) tests we found no evidence of publication bias.

Fig. 4.

Fig. 4

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Forest plot of the relationship between alcohol dose and metabolic syndrome in cohort study

Fig. 5.

Fig. 5

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Forest plot of the relationship between alcohol dose and metabolic syndrome in cross sectional study

Frequency of alcohol consumption and metabolic syndrome

Figure 6 presents the results of the pooled adjusted OR for the association between frequency of alcohol consumption and metabolic syndrome stratified by frequency (under 1 to 2 times a week, 2 times to 7 times a week and above 7 drink/week). Based on the results, the pooled OR for Under 1 to 2 times a week was 0.85 [95% CI: 0.78, 0.93] which represents 15% decrease in metabolic syndrome, but no association was found between 2 times to 7 times a week 0.80 [95% CI: 0.63, 1.01] and above 7 drink/week 1.02 [95% CI: 0.41, 2.56] and metabolic syndrome. There is no evidence of heterogeneity among subgroup under 1 to 2 times a week (I2 = 0.0%; P = 0.532), but there is significant heterogeneity among subgroups 2 times to 7 times a week (I2 = 62.3%; P = 0.021) and above 7 drink/week (I2 = 94.5%; P = 0.000). Sensitivity analysis showed that the study by Matthew S and Goodman were the source of observed heterogeneity [7]. Based on Begg’s (P = 0.621) and Egger’s (P = 0.309) tests we found no evidence of publication bias.

Fig. 6.

Fig. 6

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Forest plot of the association between frequency of alcohol consumption and metabolic syndrome

Discussion

This study found a positive relationship between use of alcohol and metabolic syndrome in cohort and cross-sectional studies. However, no statistically significant relationship was shown between the dose of alcohol and metabolic syndrome. The study also found that drinking alcohol 1 to 2 times a week reduced the risk of metabolic syndrome.

Many studies have shown that alcohol consumption increased the risk of metabolic syndrome [18–21] and excessive alcohol consumption is also a known risk factor for metabolic syndrome [22, 23]. Drinking alcohol increases blood pressure, which is one of the components of metabolic syndrome [24, 25]. The results of an autopsy show that drinking too much alcohol causes blood vessels to clog [26]. Excessive alcohol consumption leads to acute inhibition of fibrinolysis, which creates the conditions for atherosclerosis and increases mortality from cardiovascular diseases [27]. The increase in HDLC in connection with high alcohol consumption can have a protective effect on cardiovascular disease to some extent [28, 29]. But, a study showed that the inverse relationship between HDLC and mortality from coronary artery diseases is less clear as a result of high alcohol consumption [30]. So, as a result, alcohol consumption and the protective effects of cardiovascular diseases should be reevaluated. However, the risk of metabolic syndrome increases with increasing alcohol consumption. Increasing alcohol consumption causes blood pressure and increases HDLC, which causes great damage to the liver. A review of different studies shows that the relationship between alcohol consumption and metabolic syndrome is not consistent. It may be because mild to moderate consumption has a positive effect on lipid metabolism and abdominal obesity and glucose regulation, but it increases blood pressure and hypertriglyceridemia [31–33]. A recent study conducted in Japan showed that consumption of more than 60 g of alcohol per day increased the risk of metabolic syndrome and consumption of less than 20 g of alcohol per day had a lower risk of metabolic syndrome [34]. Wanki’s study shows that alcohol consumption is not related to metabolic syndrome, this result may be because the type or form of alcohol consumption is not taken into account [35]. The results of the previous meta-analysis study are consistent with the present study. In a previous meta-analysis study, it has been mentioned that in healthy people, alcohol consumption of less than 40 g per day in men and 20 g per day in women significantly reduces the prevalence of metabolic syndrome [36]. In the current study, it has been shown that consumption of 1 to 2 alcoholic drinks per week reduces metabolic syndrome. A study was published in 2017 [37] that showed that moderate consumption of beer and wine reduces metabolic syndrome. This may be because insulin resistance is low in moderate drinkers and high in nondrinkers or heavy drinkers [32, 38, 39].

One of the strengths of our study could be pointed out as extensive and up-to-date searches have been done in this field. Unlike the previous study, the duration of alcohol consumption is also mentioned in this study. Also, we included studies in the meta-analysis that considered and adjusted possible confounders such as sex, age and etc.

The present study had limitations. One of them was a significant heterogeneity, which could be due to heterogeneous populations, different settings in these populations, change in exposure dose, the limited number of studies on the dose and duration of alcohol consumption and the risk of metabolic syndrome. Due to the fact that the type of drink (wine, beer, etc.) was not analyzed in previous studies, we also could not analyze the type of drink. After that, we only included studies published in English because we believed that high-quality studies would be published in English. Also, we included studies published after 2000. Finally, in cross-sectional studies, due to lack of temporality, a causal association between alcohol consumption and metabolic syndrome may not be observed.

Conclusion

This study showed a positive relationship between alcohol consumption and metabolic syndrome. Therefore, it is recommended that educational and prevention programs be promoted to reduce alcohol consumption and increase public awareness about the harmful effects of alcohol consumption on health. It is also suggested that further studies be conducted to accurately evaluate alcohol consumption and metabolic syndrome components, and for evaluate reducing or stopping alcohol consumption on metabolic syndrome, it is better to conduct clinical trial studies in the future.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1 (32.7KB, docx)
Supplementary Material 2 (71.7KB, docx)

Author contributions

MA. Conducted research, EMY. provided essential reagents or provided essential materials. FKH. Performed the statistical analysis. MA., EMY., FKH., MK., EKH., ZB., and HA wrote the paper. FKH had primary responsibility for final content; FKH and MA had responsibility for all parts of the manuscript. All authors have approved the final article should be true and included in the disclosure.

Funding

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Competing interests

The authors declare no competing interests.

Ethical approval

Not applicable.

Conflict of interests

The authors declare that they have no conflict of interest.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1 (32.7KB, docx)
Supplementary Material 2 (71.7KB, docx)

Data Availability Statement

No datasets were generated or analysed during the current study.

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