Cardiovascular Disease: A Silent Threat—and What You Can Do About It
Heart disease remains the leading cause of death for both men and women in the United States. Personally, some of the people I love the most in my life have suffered from life-altering cardiac events, and I’m sure I’m not alone. Every 34 seconds, someone in the U.S. dies from cardiovascular disease (CVD), and in 2023, CVD accounted for 919,032 deaths—about 1 in every 3 deaths.¹ These are harrowing numbers. While these numbers are stark, there are many things we can do to reduce our risk of developing CVD and reduce its severity with the things we do every day.
Despite its prevalence and severity, we’ve found that most people don’t actually know what cardiovascular disease is, what causes it, and what to do about it. In this article, we’re going to cover:
What is metabolic syndrome, and how does it relate to cardiovascular disease?
How do BMI and bodyweight fit in?
The major risk factors for CVD and metabolic syndrome
Cholesterol
Blood pressure
Blood sugar and insulin resistance
Triglycerides
Visceral fat
Physical inactivity
What can you do to reduce your risk of cardiovascular disease?
The importance of fiber
How can a dietitian help?
What type of screening should you ask for from your primary care?
This is an in-depth article simply because this topic is so important. CVD risk is real, but there are incredibly effective screening and risk-reduction strategies. Especially if you or any of your loved ones have CVD, we encourage you to set aside time to read the whole thing. But if you can’t, here are some key takeaways:
Cardiovascular disease is a leading cause of early mortality (death)
There are several risk factors: cholesterol and triglyceride levels, type 2 diabetes, and physical inactivity
Early and consistent screening throughout adulthood is essential to detection
Risk of major cardiac events increases the longer risk factors go unaddressed, which is why early screening and prevention are incredibly important.
We have incredibly effective tools to reduce risk, including:
Medications: Outside the scope of this article, but they can be lifesaving
Physical activity: aerobic exercise and strength training
Nutrition: specific approaches to normalize cholesterol and blood glucose
Adequate fiber is a crucial component; at least 25 grams per day
Sleep and stress: These play a significant role and are often overlooked
Having a team around you makes all the difference. A primary care physician typically performs the screening, a registered dietitian helps with your nutritional approach, a physical therapist can help with the right approach to exercise, and a cardiologist is a specialist who is an essential part of your team if you have CVD.
What is cardiovascular disease?
Let’s first establish some common language. Cardiovascular disease is an umbrella term for conditions involving the heart and blood vessels. It includes things like:
Coronary heart disease/heart attack
Stroke
Heart failure
Atrial fibrillation and other rhythm disorders²
CVD is a broad category, but many of the most common and dangerous events—like heart attacks and many strokes—are driven by atherosclerosis, which is when plaque builds up inside the artery walls. Plaque is made up of cholesterol and fats, along with calcium and other cellular waste products. Over time, plaque can narrow arteries and make them less flexible, and contribute to higher blood pressure and reduced blood flow.
The most dangerous moments often happen when a plaque becomes unstable and ruptures. When that happens, the body forms a blood clot at the site. That clot can suddenly block blood flow. If this happens in the coronary arteries (the vessels that supply the heart muscle), it can cause a heart attack. If a clot blocks a vessel supplying the brain, it can cause an ischemic stroke—either from a clot forming in place or a clot traveling from somewhere else (like the neck arteries or the heart).
We have blood vessels throughout the body, meaning CVD can show up in different ways. It can affect the heart (heart attack, heart failure, rhythm disorders), the brain (stroke, and in some cases contribute to dementia or neurodegenerative disorders), or the limbs (peripheral artery disease, which reduces blood flow, most commonly to the legs).
When we talk about “reducing CVD risk,” we’re talking about lowering the odds of these events or conditions and improving the health of the vascular system over time.
A few other important notes:
Cardiovascular disease is typically asymptomatic for a long period of time. Without regular and thorough medical screening, most people with CVD are completely unaware until their first major event, which can be life-changing, such as a heart attack. The asymptomatic nature of CVD is a big reason why screening and prevention are essential.
CVD risk is not evenly distributed. In the United States, race and ethnicity are associated with differences in rates of hypertension, diabetes, and heart disease outcomes. This isn’t because of the color of our skin but is driven largely by structural factors like access to care, food access, chronic stress, environmental exposures, and the cumulative impact of discrimination.¹ The takeaway isn’t “biology,” it’s that context matters—and risk reduction needs to be practical, culturally relevant, and rooted in systemic change and improving access to healthcare.
The “perfect storm”: Metabolic syndrome
Like most things, CVD doesn’t exist in isolation. Many of the biggest drivers of cardiovascular risk cluster together, creating a condition called metabolic syndrome (MetS).
To meet criteria for metabolic syndrome, you typically have 3 out of 5 of the following:³
Low HDL cholesterol
Men: <40 mg/dL
Women: <50 mg/dL³
Elevated blood pressure (or on blood pressure medication)
Elevated fasting blood sugar (or on glucose medication)
Elevated triglycerides (or on TG medication)
Elevated waist circumference (a marker that often correlates with visceral adipose tissue)³
>40 inches for men
>35 inches for women
Metabolic syndrome is associated with:
~2× risk of developing cardiovascular disease over the next 5–10 years
~5× risk of developing type 2 diabetes⁷
Key takeaway: The metabolic syndrome criteria essentially outline the measurable risk factors of cardiovascular disease. If you don’t meet the criteria for diagnosis (3 of 5 factors), just one or two can significantly increase cardiovascular disease risk.
A quick note on weight and BMI
It’s important to note what’s not in the criteria: body weight and BMI. Waist circumference is included as one marker, but MetS is fundamentally defined by cardiometabolic physiology—not by the number on the scale.³
This matters because our medical system is often weight-centric, meaning weight loss is promoted as the gold standard for reducing chronic disease risk. While weight change can correlate with improvements, it’s not due to the decrease in weight alone. It’s the health-promoting behaviors (nutrition quality, movement and exercise, sleep, stress support, medication access, and consistent care) that are the main drivers of physiological change.
When healthcare focuses on weight alone, it can backfire, and when it does, it’s the patients who suffer. Weight stigma and discrimination are associated with worse health outcomes and can function as a barrier to care (people delay or avoid appointments, screenings, and follow-ups).⁴ When we lose weight, we don’t simply lose fat— we also lose lean mass from our organs, bones, and muscle tissue. This alone puts us at risk for falls and the development of metabolic syndrome. Repeated cycles of restrictive dieting and regain (“weight cycling” or “yo-yo” dieting) are also associated with adverse cardiometabolic patterns in many studies, regardless of weight or BMI.⁵
“Normal weight” doesn’t automatically mean low risk
Another reason I’m so adamant about disconnecting weight or BMI from health and cardiovascular health is that blaming one’s body size or weight for everything is lazy medicine. When clinicians focus solely on weight and body size, they can overlook risks in individuals who “look healthy.” (Note: Health doesn’t actually have a specific appearance. I’m using the term here to refer to what society typically considers healthy, which is thin.) This leads to:
Delayed screening
Clinical bias when someone in a normal BMI category has markers of MetS but is dismissed due to “looking healthy,” which is often associated with being thin.
A 2020 analysis using a large population dataset called NHANES (N=12,047) found that while adults in the “normal BMI” category had a lower prevalence of metabolic syndrome than higher BMI categories, those with a normal BMI with MetS had the highest mortality across all BMI categories.
I’ll say that again: Individuals who are “normal weight” 1) Can and do have metabolic syndrome; and 2) Are at higher risk of death as a result than those in higher weight categories. This is why focusing on BMI alone can overlook people who need earlier intervention and treatment.⁶ When providers overlook this, it has real consequences because, as mentioned above, we cannot turn back the clock, and in this case, bias kills.
Why do the risk factors of metabolic syndrome matter?
Why do altered cholesterol levels, blood pressure, fasting glucose levels, triglycerides, and waist circumference matter? Each of these factors affects the body differently, but in related ways that increase the risk of atherosclerotic plaque buildup. Let’s go through them one by one.
1) Cholesterol, lipoproteins, and atherogenic particle burden
Cholesterol is a central risk factor for CVD because abnormal cholesterol levels are central to the development of atherosclerosis. But cholesterol is confusing and nuanced. This section walks through some cholesterol basics. If we lose you, just skip down to the key takeaway and trust your physician’s advice on cholesterol management.
First, what is it? Cholesterol is a waxy, fat-like molecule used to build cell membranes, make steroid hormones (testosterone/estrogen/cortisol), make vitamin D, and produce bile acids for fat digestion.
Your body makes most of its cholesterol internally—primarily in the liver (and also in the intestines and other tissues). And yes, your diet matters, but for many people, dietary cholesterol has less impact than their overall dietary pattern, the types of fat eaten regularly, genetics, and liver metabolism.
Lipoproteins are the particles that carry cholesterol and triglycerides through the bloodstream. Cholesterol can’t travel through the body on its own, so it’s packaged inside these lipoproteins. There are various types of lipoproteins, and when they’re out of balance, they can drive plaque buildup and CVD risk. So, the clinically useful question isn’t just “how much cholesterol exists,” but “how much is being carried, and by which particles?” This is why bloodwork often reports numbers related to lipoproteins. There are many types, including:
LDL is often called “bad cholesterol” because higher LDL levels are associated with a higher risk of heart disease and stroke.⁸
HDL is often called “good cholesterol” because it helps carry cholesterol back to the liver for processing/removal.⁸
VLDL is produced by the liver and carries triglycerides; as VLDL is remodeled in the bloodstream, it can ultimately contribute to LDL formation.
Lp(a) (lipoprotein[a]) is a genetically influenced LDL-like particle that independently increases cardiovascular risk for some people.
ApoB (apolipoprotein B) is what’s called a key “particle number” marker. It reflects the number of atherogenic (plaque-promoting) particles—lipoproteins that can contribute to atherosclerosis. Remember, atherosclerosis is a primary driver of CVD.
One ApoB ≈ one atherogenic particle (such as LDL, VLDL, Lp(a), and others).
ApoB can help clarify risk when LDL looks “okay.” There can still be a high number of total atherogenic particles (a common pattern in insulin resistance).⁹
There are several other types of lipoproteins that you don’t have to memorize. The overarching idea is that while these lipoproteins play important roles in the body, they need to be in balance—both with each other and in total amount. If they circulate at abnormal levels for long enough, the development of atherosclerosis becomes much more likely.
Because cholesterol is complex, it’s difficult to give one-size-fits-all dietary advice. However, for most people, limiting saturated fat intake is a good place to start.
The physiology gets even more complicated here, but essentially, different types of fat we eat change how the liver packages and clears lipoproteins from the body. Higher saturated fat intake tends to raise LDL and other atherogenic particles, while mono- and polyunsaturated fats tend to lower LDL by helping your body clear it from the blood more efficiently.
There is considerable debate about this on the internet, but like many nutrition topics, these conversations often have little grounding in peer-reviewed science—and even less nuance. Replacing saturated fat with mono- and polyunsaturated fats has been shown time and time again in well-controlled human studies to improve cholesterol profiles. Enough said. Even if you didn’t understand everything in this section, we hope it gives you a sense of how nuanced cholesterol is and why it’s worth relying on trusted sources for cholesterol management.
Key takeaway: Abnormal cholesterol levels are central to the plaque buildup that defines atherosclerosis. Cardiovascular disease risk drops significantly when these markers are in a healthier range and in better balance.
2) Blood pressure (hypertension)
Blood pressure is the force of blood pushing against the artery walls. It’s regulated moment-to-moment to ensure your brain and organs get enough blood flow.
Your body regulates blood pressure primarily through:
Nervous system (stress response, heart rate, vascular tone)
Kidneys (sodium/water balance → blood volume)
Hormones (RAAS: renin → angiotensin → aldosterone)
Endothelial function (blood vessel lining health)
When blood pressure remains consistently elevated over time, it imposes increased mechanical stress on the entire cardiovascular system. While the stress induced by exercise is adaptive and advantageous, an extended period of elevated stress can lead to adverse effects.
This also increases the likelihood for a blood clot caused by atherosclerosis breaking loose, and raising the risk of stroke, heart failure, kidney disease, and vascular damage (often silently for years). Furthermore, atherosclerotic buildup can contribute to high blood pressure due to the narrowing of vessels, creating a negative feedback loop.
Key takeaway: High blood pressure is both a cause and effect of CVD.
3) Blood sugar and insulin resistance
Glucose is the main fuel your body uses for energy—especially for the brain and working muscles. After you eat carbs, it’s broken down into glucose. This glucose enters the bloodstream, and the pancreas releases insulin to move glucose into cells.
Your body regulates blood glucose largely by:
Insulin secretion (moves glucose into cells)
Cortisol and glucagon (raise glucose when it’s too low)
Liver glycogen storage/release
Muscle activity (muscles can take up glucose during and after movement)
Insulin resistance means cells don’t respond to insulin effectively. The pancreas compensates by producing more insulin, and over time, this can lead to higher fasting glucose, higher post-meal glucose spikes, and eventually type 2 diabetes. While type 2 diabetes is diagnosed based on insulin and blood sugar patterns, the damage it causes is primarily to the cardiovascular system.
It’s normal for blood glucose to rise after we eat, and then be processed or delivered throughout the body appropriately. However, if insulin becomes less effective, blood glucose levels can become too high for an extended period, causing damage to blood vessels. Additionally, the disease process worsens lipid and cholesterol patterns, leading to the buildup of plaque.
Meal timing can matter here too: A 2022 review found that skipping meals (especially breakfast) is commonly associated with worse metabolic outcomes (including higher cardiometabolic risk markers) across many studies.¹¹
Additionally, athletes who have Relative Energy Deficiency in Sport (RED-S) can have altered insulin sensitivity, fasting glucose, and lipid levels as well, despite being incredibly active and eating “well”.This is due to not eating enough calories to support normal physiological functions.
Key takeaway: Insulin resistance and type-2 diabetes contribute to CVD risk. Blood sugar matters, but skipping meals or just “not eating carbs” is not the fix.
4) Triglycerides
Triglycerides are the main form of fat your body uses to store energy. They circulate mainly in VLDL (from the liver) and a particle called chylomicrons (from the gut after meals).
Like cholesterol, they play a role, but can be problematic at high levels. High triglycerides often reflect underlying metabolic dysfunction—especially insulin resistance—and are often associated with low HDL and higher ApoB particle burden.
Key Takeaway: Triglycerides levels, like cholesterol, affect CVD risk.
5) Waist circumference (as a marker—not a verdict)
Waist circumference is used as one of the criteria for metabolic syndrome because it often correlates with visceral adipose tissue. The best way to measure visceral fat is with a DEXA scan, because it is not simply abdominal fat or appearance, but rather fat in and around organs that poses a risk to our hearts. Visceral fat influences metabolic risk because it affects how the liver processes and produces cholesterol. It is also associated with elevated triglycerides and insulin resistance – the body is essentially storing fat around the organs.
The main drivers of visceral fat accumulation are regular and heavy alcohol intake, low muscle mass, untreated sleep apnea, insulin resistance/type 2 diabetes, and physical inactivity.
Waist circumference is perhaps the least reliable marker, compared to cholesterol and triglyceride levels, blood pressure, and diabetes risk, because it doesn’t measure visceral fat directly. People can have metabolic syndrome and high visceral fat levels at many body sizes, and people can have larger waists without major metabolic disease. It’s one signal among many—not a moral judgment.
Key Takeaway: Visceral fat around organs affects risk, and weight circumference may be correlated with visceral fat.
6) Additional risk factors: physical inactivity and sarcopenia
In our opinion, checklists for metabolic syndrome and CVD risk underemphasize two big factors: physical inactivity and sarcopenia, which is the gradual loss of muscle mass, strength, and function.
Low aerobic fitness and sarcopenia are independent risk factors for CVD: even in the absence of metabolic syndrome, high blood pressure, or abnormal cholesterol, low activity levels (and declining strength/muscle with age) are linked to higher cardiovascular risk.
Regular physical activity and maintaining muscle mass have far-reaching and significant effects on the entire body. The muscular system functions as a metabolic sink, storing glucose, triglycerides, and cholesterol for energy rather than allowing them to accumulate in the bloodstream. Consequently, more active muscle tissue enhances blood sugar regulation, blood pressure, lipid levels, inflammation, and reduces visceral fat.
So, regular aerobic exercise and strength training affect risk directly—and they’re a core part of treatment.
(Side note: Things can get complicated for endurance athletes, as not eating enough to support training can throw off cholesterol and blood glucose levels. Click here for a detailed article on this topic.)
What can I do to improve my cardiovascular disease risk?
Luckily, there’s a lot that we can do to improve cardiovascular disease risk. Here are the top behaviors that can significantly move the needle:
If you are prescribed medications for blood pressure, cholesterol, or type 2 diabetes. Take them as prescribed. Roughly 1 in 5 people don’t take their medications as prescribed. If your medication doesn’t agree with you, explore other options with your physician, as there are many options available. If you were prescribed a medication, it means that we know you are at risk, and there is something do about it. Nutrition, exercise, and other lifestyle choices play a significant role in preventing the development of high cholesterol, type 2 diabetes, and hypertension. While we may not be able to completely reverse these conditions, especially if the risk factors have been present for a long time, making daily changes and taking medication can help reduce the rate of progression and lower the risk of premature death.
Get regular screening from your primary care provider, including bloodwork and blood pressure (more on that below). CVD prevalence goes up the longer that you have any of the risk factors, so early detection and prevention are key.
Eat enough fiber! (more on that below). Fiber is a key nutrient that can lower CVD risk.
Consider working with a Registered Dietitian to fine-tune your approach to nutrition, including how to get enough fiber, manage blood sugar, support exercise, identify any allergies or intolerances, promote recovery, and eat foods you enjoy. Expert dietitians (like those at EVOLVE) can go deep into your bloodwork and help you use nutrition to your advantage.
Regular exercise, both cardiovascular or aerobic exercise, as well as strength training. Click here for an in-depth article on aerobic exercise. If you need help with strength training, we have classes, semi-private training, and personal training programs for you. We specialize in working with adults who have never set foot in a gym. If you are struggling to exercise due to pain or other factors, consider working with a physical therapist to design a routine that’s right for you.
Work to manage stress levels. We don’t have a miracle fix here. It’s stressful to be alive in 2026. As we learned above, chronic stress increases blood pressure, which affects your risk of developing CVD and major adverse events. If you’re always stressed out, it’s worth exploring ways to manage that, potentially with a mental health therapist.
Get enough high-quality sleep, and potentially get screened for sleep apnea and other sleep disorders. Insufficient sleep, or an untreated sleep disorder, impairs our body’s ability to heal and recover, alters our blood glucose levels, increases blood pressure, can contribute to how we respond to stress, and can make it harder to eat in ways that support the body and exercise consistently.
The importance of fiber and the fiber gap
Now for a bit more practical guidance, focused on adding rather than subtracting. Fiber.
Most Americans simply aren’t getting much fiber. General guidance often translates to about 14 g per 1,000 calories, which is roughly 25 g/day for many women and 38 g/day for many men (depending on age and energy needs).¹² A USDA dietary data brief reports a recommended intake of around ~16 g/day in U.S. adults—well below typical recommendations.¹³
You don’t need to count grams for this to matter, and we don’t recommend counting calories, but being aware of ways to add dietary fiber and knowing the sources of fiber-rich foods can be incredibly beneficial. The takeaway is: there’s a big fiber opportunity for most people, and you can approach it by adding foods you already enjoy.
What fiber does (beyond “being regular”)
Dietary fiber is found in carbohydrate foods, including grains, vegetables, fruits, and legumes, and is the part of plant foods you don’t fully digest. It changes how digestion works, feeds gut microbes, and influences metabolic processes. Benefits that show up consistently with adequate fiber intake:
1) Cholesterol support (especially soluble fiber)
Soluble fibers found in foods like oats, barley, beans, lentils, chia, and psyllium can support lipid patterns by binding bile acids. Bile acids are involved in the production of new cholesterol. When bile acids are bound by fiber, they are then excreted through feces, and this nudges the body to use more circulating cholesterol. A well-known example is a fiber called oat beta-glucan: a meta-analysis found that adding ≥3 g/day of oat beta-glucan reduced LDL and total cholesterol.¹⁵
2) Blood sugar support
Fiber can slow gastric emptying and carbohydrate absorption, which supports glycemic regulation by reducing how quickly your blood sugar rises after a meal. This matters directly for diabetes risk and indirectly for vascular health.
3) GI and gut microbiome support
Fiber supports bowel regularity and stool consistency and promotes the elimination of bile acids, reducing cholesterol levels. Additionally, some fibers are fermented by gut bacteria into short-chain fatty acids that support gut barrier function and inflammation regulation.¹⁴
4) Colon health and colorectal cancer risk
Higher fiber intake is associated with lower colorectal cancer risk. AICR notes that each 10 g/day increase in dietary fiber is linked with about a 7% lower risk of colorectal cancer.¹⁶
How to add fiber in real life (without overhauling your diet)
If you currently don’t eat enough fiber, increase gradually over 1–3 weeks and drink enough fluids. Going from 10 g/day to 30 g/day overnight can cause bloating/cramping.
Here are several “Add-on” options. Start by choosing 1-2 per day, and go up from there as tolerated:
Breakfast additions:
Add berries to yogurt, cereal, oatmeal, or smoothies
Stir 1–2 Tbsp chia or ground flax into oats or yogurt
Choose oatmeal or overnight oats a few days/week
Add a banana or apple alongside whatever breakfast you already eat
Lunch/dinner additions:
Add ½–1 cup beans or lentils to tacos, bowls, salads, soups, chili, or pasta sauce
Add 1–2 cups of frozen vegetables to a meal you already make
Use whole grains you like (brown rice, quinoa, barley, whole-wheat pasta, corn tortillas)
Add a side fruit (orange, apple, grapes) with lunch
Snack additions:
Fruit and nuts/nut butter
Popcorn with yogurt/cheese/edamame
Hummus and crackers with carrots or cucumbers
Trail mix with nuts, seeds, and dried fruit
How can a dietitian help?
Registered Dietitians are the most qualified health professionals to help you make dietary changes. A qualified dietitian can work with you and your primary care physician to understand your bloodwork and cholesterol levels. They can work with you to better understand your nutritional needs, relationship with food, and how to make sustainable changes to support your long-term health.
Most nutrition advice is either too general, too biased, or simply inaccurate. Registered Dietitians have years of schooling and understand the science behind nutrition. When you hear “Dietitian,” don’t think “meal plans and no cookies.” Instead, think, “An essential member of my team who can help cut through the noise, eat what I love, and stay healthy long term.”
What type of screening tests should I ask for?
If you’ve made it this far, then you probably care about your CVD risk and want to do something about it. At your next primary care visit, you should ask for:
A thorough blood pressure screening (this is often not screened correctly due to incorrect cuff sizes or rushed office visits; read more here).
Routine blood work:
Comprehensive metabolic panel
Comprehensive lipid and triglyceride panel
Complete blood count
An advanced lipid panel or nuclear magnetic resonance (NMR) panel with ApoB and Lp(a) may be recommended if you:
Have a strong family history of high cholesterol, CVD, or if someone in your family has had a premature cardiac-related event, such as a heart attack, before 55 for men and 65 in women.
Are high risk and have MetS
C-reactive protein
While not fully discussed above, this is a marker for overall inflammation and can be an indicator of how at risk you are for developing CVD.
Hemoglobin A1c
If possible, you should also ask family members, particularly your parents and siblings, about their cardiac health history and cardiovascular disease and metabolic syndrome risk factors.
Family history is a strong predictor of your risk. Understanding it can help your healthcare team better understand your risk and take appropriate action.
Conclusion: CVD Risk is Real, But There’s Much You Can Control
CVD remains a massive public health burden in the U.S. (919,032 deaths in 2023; one death every 34 seconds).¹ CVD includes more than “heart attacks”—it spans heart disease, stroke, heart failure, and arrhythmias.² Metabolic syndrome reflects the real-world overlap of blood pressure, lipids, and blood glucose that drives risk.³,⁷
In addition to appropriate screening, regular physical activity, and managing sleep and stress, dietary fiber is one of the most practical, weight-neutral levers to support GI health, metabolic regulation, cholesterol patterns, and colon health—especially because average intake is so low.¹² The most effective strategy is also the simplest: add fiber-rich foods you already like, in ways that fit your life.
If you’re not ready to schedule an appointment, but want more information about what it looks like to work with one of our providers, fill out the form below and we will be in touch!
Centers for Disease Control and Prevention. Heart Disease Facts. Updated October 24, 2024. Accessed February 3, 2026. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html
CDC. About Heart Disease. Updated May 15, 2024. Accessed February 3, 2026. https://www.cdc.gov/heart-disease/about/index.html
American Heart Association. Symptoms and Diagnosis of Metabolic Syndrome. Updated October 17, 2023. Accessed February 3, 2026. https://www.heart.org/en/health-topics/metabolic-syndrome/symptoms-and-diagnosis-of-metabolic-syndrome
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Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640-1645. doi:10.1161/CIRCULATIONAHA.109.192644
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Carroll MD, Kruszon-Moran D, Tolliver E. Trends in apolipoprotein B, non–high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol for adults aged 20 and over, 2005–2016. Natl Health Stat Report. 2019;(127):1-15.
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Alkhulaifi F, Darkoh C. Meal Timing, Meal Frequency and Metabolic Syndrome. Nutrients. 2022;14(9):1719. doi:10.3390/nu14091719
U.S. Department of Agriculture; U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020–2025. 9th ed. December 2020. Accessed February 3, 2026. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf
Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: National Academies Press; 2005. doi:10.17226/10490
Hoy MK, Goldman JD. Dietary Fiber Intake of the U.S. Population: What We Eat in America, NHANES 2009–2010. Dietary Data Brief No. 12. Beltsville, MD: U.S. Department of Agriculture, Agricultural Research Service, Food Surveys Research Group; September 2014. Accessed February 3, 2026. https://www.ars.usda.gov/arsuserfiles/80400530/pdf/dbrief/12_fiber_intake_0910.pdf
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Whitehead A, Beck EJ, Tosh S, Wolever TMS. Cholesterol-lowering effects of oat β-glucan: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2014;100(6):1413-1421.
American Institute for Cancer Research. Ask the Dietitian: Get Your Facts Right on Fiber and Whole Grains. Published September 21, 2018. Accessed February 3, 2026. https://www.aicr.org/resources/blog/ask-the-dietitian-get-your-facts-right-on-fiber-and-whole-grains/