Metabolic syndrome (MetS) also known as “insulin resistance syndrome” or “syndrome X” refers to the set of conditions that increase the likelihood of developing cardiovascular and metabolic diseases, including type 2 diabetes mellitus, hypertension, and cardiovascular disease (1). Central obesity, which can be measured through anthropometric parameters, such as waist and hip circumferences and waist-hip ratio (WHR), constitutes one of the main components of the MetS (2). In recent decades, the prevalence of obesity in adolescents has increased significantly worldwide (3), which has been associated with an increased risk of developing cardiometabolic diseases at an early age (4). In fact, since 1975, obesity rates have increased considerably and have almost tripled in the general population, and in the particular case of children and adolescents, this increase is even greater, reaching almost a five-fold increase (3). In the national context, in recent years, there has been a steady increase in the number of Peruvian adolescents at high and very high risk of cardiometabolic diseases, as measured by the WHtR (5), which, in turn, increases mortality risk. In Peru, there is a double burden of morbidity due to, on the one hand, problems associated with infectious diseases and malnutrition by deficit and/or excess, and on the other hand, a progressive increase in non-communicable diseases (6).

Social networks are online platforms that allow users to create personal profiles and establish connections with other users in their network (7). In recent years, the use of social networks has become an increasingly frequent and popular activity among adolescents (8). Social network platforms such as TikTok, Facebook, Twitter, among others, can represent a valuable opportunity to connect and engage adolescents with messages related to the adoption of healthy lifestyles, such as proper diet and physical activity, which can be a preventive element against MetS (9). However, excessive exposure to these digital platforms could have negative consequences on the physical and mental health of this population group (8). There are few studies that examine the relationship between SNA and MetS. However, we found a recent study that evaluated the link between adolescent social networks and health in adulthood, suggesting that adolescents’ social network position has lasting consequences for MetS in adulthood (10). However, most studies have focused on body mass index (BMI), pointing to a possible relationship between social media addiction, excessive use of media, and an increased risk of developing obesity in adolescents (11–13), which is related to cardiometabolic problems (1, 4).

Anxiety symptoms are one of the most prevalent psychiatric conditions in adolescence, affecting approximately 1 in 4 adolescents (14). These symptoms may represent risk factors for anxiety disorders encompassing various conditions such as agoraphobia, panic disorder, specific phobias, separation anxiety disorder, social anxiety disorder, and generalized anxiety disorder (15). Studies have shown that anxiety symptoms are associated with an increased risk of cardiovascular disease and other metabolic problems in young adults (16, 17). Although there is less research examining these connections in adolescents, a study recently found a statistically significant relationship between anxiety and some metabolic risk factors in this population (18). Another study conducted in adolescents reported a relationship between anxiety symptoms and insulin resistance (19), which may lead to worsening metabolic outcomes in at-risk youth.

Therefore, considering the above, it is important to deepen our understanding of this relationship and explore the possible clinical and public health implications. In this context, the present study aims to examine the association between SNA, anxiety symptoms, and MetS in adolescents, with the intention of contributing to a better understanding of these phenomena and to the implementation of effective preventive and therapeutic interventions.

A total of 903 schoolchildren voluntarily decided to participate in the study; of these, 56% were female. The highest proportion (68.8%) were between 12 and 15 years of age. Regarding the level of education of parents, 76.6% of mothers and 69.2% of fathers reported basic education. Most parents were married (46.4%), had a monthly income <2,149.00 (74.6%), and reported having more than two sons (57.9%). More than half of the respondents reported that they live with their parents (55.3%). The sociodemographic characteristics of the participants are shown in Table 1.

The results of the association between H/A, BMI, SNA, and anxiety symptoms are shown in Table 2. MetS was generally observed among men (67.1%, p = 0.046), in the age range of 16–18 (78.3%, p < 0.001), in those with excess body weight (90.1%, p < 0.001), SNA (85.5%, p = 0.039) and anxiety symptoms (63.2%, p = 0.007).

A binary logistic regression model was used to explore the variables that predict the probability that adolescents will present MetS and the results are shown in Table 3. In this analysis, males were more likely to present MetS than females (OR = 1.133, p = 0.028). Participants who were 16 years of age or older and those with excess body weight were 2.166, p = 0.013 and 19.414, p < 0.001 times more likely to have MetS, respectively. Furthermore, SNA (OR = 1.517, p = 0.016) and the presence of anxiety symptoms (OR = 2.596, p < 0.001) were associated with the risk of MetS.

In this cross-sectional study, we determined the association between SNA and anxiety symptoms with the risk of MetS in Peruvian adolescents aged 12 to 18 years. The main findings were as follows: Male sex, participants who were 16 years of age or older and those who had excess body weight were more likely to present MetS. Furthermore, it is highlighted that SNA and anxiety symptoms were associated with MetS.

Previous studies have documented the influence of sex and age on the anthropometric profile, more precisely MetS, measured through the WHtR (4, 41–43). The results of the logistic regression analysis of the current study revealed that men were more likely to have MetS compared to females; furthermore, we found that a higher proportion of men had MetS. It should be noted that the current study used WHtR to determine MetS. Similarly, the findings of the research conducted in Brazilian adolescents showed that boys had a higher mean WHtR and a higher WHtR at the 95^th percentile (41). Similarly, other studies in adolescents reported that boys were more likely to report MetS factors, such as high blood pressure, elevated cholesterol, glucose, and triglyceride levels (42, 43). Although in some studies MetS patterns do not differ in both sexes (44), however, there are mechanisms that support evidence of sex differences (42, 43, 45, 46). In general, it has been found that men have higher visceral adipose tissue, intramyocellular and intrahepatic lipids than women, which could partly explain why they have a higher MetS (46). On the other hand, males tend to have higher blood pressure and cholesterol levels than women from puberty onward, which can also contribute to a higher cardiovascular risk (42, 43). In hormonal terms, it has been found that testosterone levels in men can negatively affect glucose metabolism and increase the risk of insulin resistance and type 2 diabetes, which are considered cardiometabolic complications (45).

Chronological age remains one of the strongest predictors of cardiometabolic events (47). In the present study, we found that participants who were 16 or older tended to report MetS; furthermore, an age ≥ 16 years was significantly associated with MetS. These findings are similar to the results reported in a recent study conducted in Peruvian adolescents where the highest proportion of those with MetS, measured by WHtR, were aged 15 to 17 years vs. 12 to 14 years (4). In addition, these results confirm the findings of research that measured waist circumference and WHtR in US children and adolescents (48). This study showed that the relative changes in WHtR increased with increasing age, and that the greatest relative change was observed in men and women between 18 and 19 years of age (48). Chronological age is an important determinant of health, since it coincides with the critical moments of increasing body fat and, therefore, of the development of diseases (49). In fact, as age increases, the risk of developing various chronic cardiometabolic diseases and conditions increases (48, 50). In addition, the physical and mental changes that occur with age can affect the quality of life and a person’s ability to perform daily activities (51). However, it is important to note that the premature onset of age-related diseases in younger people suggests a discrepancy between chronological and biological age, pointing out that chronological age is not always representative of true biological age, because several disease/morbidity factors may be related to biological age (50). Beyond this discrepancy, it is important to consider age as an important factor in assessing adolescent health and in planning long-term disease prevention and treatment strategies.

Global obesity and MetS, measured using WHtR, are two anthropometric factors that are associated with the onset and development of noncommunicable diseases (1). The measurement of both factors is particularly important in adolescents, since adolescence is a high-risk stage and one of the most critical periods of life, due to constant changes in lifestyle (52). Evidence for the association between global obesity and MetS has been demonstrated in both adolescents and the general population (4, 49, 53, 54). In our study, we found that those who had excess body weight were more likely to present MetS. These results are consistent with the findings of a study conducted in Spanish schoolchildren aged 6 to 15 years, showing a relationship between excess body weight and abdominal obesity, a metabolic risk factor (49). Similarly, the results of a recent study conducted in 506 adolescents aged 10 to 19 years of age from different schools in Brazil reported that normal weight obesity, which is defined as excess body fat in normal weight individuals, is associated with MetS, assessed through waist circumference (53). Some possible justification why obesity is related to increased waist circumference in adolescents is the fact that excess body fat accumulates predominantly in the abdominal region (1). It is worth mentioning that abdominal fat, also known as visceral fat, is metabolically active and can release pro-inflammatory fatty acids and adipokines, which contribute to the development of insulin resistance, dyslipidemia and other MetS factors (53, 54). Therefore, assessment of MetS measured through WHtR in obese and normal weight adolescents can be useful to identify those with a higher risk of developing cardiovascular and metabolic diseases.

Another relevant finding of this study is the fact that SNA is associated with MetS. This connection is especially relevant in the current times since the use of social networks has become a widespread and popular activity among adolescents (8). Although there is a paucity of research analyzing the relationship between SNA and MetS, our findings are in line with a recent study that evaluated the relationship between adolescents’ social networks and their health in adulthood suggesting that their position in their social network during adolescence has lasting implications for MetS in adulthood (10). It should be noted that most studies have focused on BMI, pointing to a possible relationship between SNA and excessive media use with an increased risk of developing obesity in children and adolescents (11–13, 55), which is related to cardiometabolic problems (1, 4). Therefore, it is important to highlight that excessive exposure to digital platforms could have negative effects on the cardiovascular health of this population group through the onset of obesity (56). This suggests that the effect of SNA on MetS could be mediated by obesity. Although it is important to note that structural equation modeling was not used in this study to explore these relationships in depth, our findings provide a clear picture of how cardiometabolic disease is influenced by SNA and obesity. This sets the groundwork for future research using mediation models, which will help to better understand these relationships. The mechanism for this association may be that excessive and sedentary use of social networks reduces the time that would be devoted to physical activities (57). Studies that have provided evidence to support this theory show that when the amount of time adolescents spend in front of screens is reduced, their level of physical activity increases (12). Another reason for this relationship is the fact that it has been suggested that the consumption of hypercaloric foods can increase in parallel with the time spent on the media and social networks (58, 59). This hypothesis is supported by research showing that high use of social networks among adolescents is associated with unhealthy dietary behaviors (60), and that energy intake in adolescents decreases when sedentary behaviors are reduced (59).

Finally, in this study, we found that anxiety symptoms are associated with MetS. Although little research has been done on the relationship between anxiety and metabolic risk factors in adolescents, however, a recent study has found a significant association between anxiety and some metabolic risk factors in this population group (18). Similarly, another study conducted in adolescents reported a relationship between anxiety symptoms and insulin resistance (19), which may lead to worsening metabolic outcomes in at-risk youth. Furthermore, studies have shown that anxiety symptoms are associated with an increased risk of cardiovascular disease and other metabolic problems in young adults (16, 17). Anxiety is a common affective disorder in children and adolescents, affecting approximately 1 in 12 children and 1 in 4 adolescents, and is one of the most common mental health problems in these populations (14). One of the possible reasons why anxiety symptoms are associated with MetS is that this disorder can contribute to increased intake of unhealthy foods and decreased physical activity (61). In particular, it is possible that people with anxiety are more likely to have a sedentary lifestyle, increasing the risk of obesity and cardiovascular disease (61). Furthermore, anxiety symptoms can increase the release of stress hormones, such as cortisol, which can promote abdominal fat gain and insulin resistance (19, 62).

The findings of this cross-sectional study suggest that men were more likely to have MetS compared to females; furthermore, we found that a higher proportion of men had higher MetS. Furthermore, it is notable that participants 16 years or older tended to report a higher level of MetS; furthermore, an age ≥ 16 years was significantly associated with the risk of MetS. Similarly, excess body weight, SNA, and anxiety symptoms were associated with the risk of MetS. Given the impact of MetS on health, more efforts are needed to better understand the associated factors for the implementation of effective preventive and therapeutic interventions.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by Research Ethics Committee of the Universidad Señor de Sipán (Registration and reference number: 0085-17052022-CIEI). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.

JS: Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Visualization, Writing – original draft, Writing – review & editing. SO-G: Conceptualization, Data curation, Funding acquisition, Investigation, Project administration, Resources, Writing – original draft. GL-T: Conceptualization, Methodology, Project administration, Resources, Visualization, Writing – original draft. IL-D-M: Conceptualization, Data curation, Funding acquisition, Writing – original draft. FB-C: Funding acquisition, Investigation, Methodology, Writing – original draft. EL-L: Conceptualization, Funding acquisition, Methodology, Project administration, Writing – review & editing. YC-M: Conceptualization, Data curation, Investigation, Project administration, Visualization, Writing – original draft, Writing – review & editing. AS-B: Investigation, Methodology, Validation, Visualization, Writing – review & editing. CR-V: Formal Analysis, Investigation, Methodology, Supervision, Visualization, Writing – review & editing.