Prevalence of metabolic syndrome in childhood cancer survivors: a systematic review and meta-analysis

Childhood cancer survivors (CCS) encounter elevated long-term health risks, including metabolic syndrome (MetS), which significantly contributes to cardiovascular disease. The prevalence, geographic distribution, and risk factors associated with MetS among CCS are not fully understood. A systematic search was conducted using PubMed, Embase, and the Cochrane Library up to August 23, 2025, for studies reporting the prevalence of MetS in CCS. Data extraction and analysis were performed independently by three reviewers. A random-effects model was applied, and heterogeneity was assessed. Of the studies retrieved, 61 met the inclusion criteria, encompassing a total of 33,313 CCS. The pooled prevalence of MetS was found to be 14.2% (95% CI 10.8–18.1). The prevalence was higher in males (16.4%) compared to females (14.4%) and varied by cancer type, with the highest prevalence observed among survivors of brain tumors (27.4%) and the lowest among those with hematologic malignancies (12.4%). Substantial geographic variability was noted, ranging from 8.5% in Southeast Asia to 20.5% in the Americas. Temporal and age-related analyses indicated an increasing prevalence with older age at diagnosis and longer follow-up, although rates decreased during the most recent study periods. Variations in prevalence were also influenced by the diagnostic criteria utilized. MetS is relatively common among CCS, with prevalence estimates varying by sex, cancer type, geographic region, age-related factors, and diagnostic definitions. Given its relevance to long-term cardiovascular risk, routine screening, timely risk assessment, and targeted preventive strategies may help reduce future cardiometabolic morbidity in this vulnerable population.