Association between sedentary behavior and metabolic syndrome in adolescents: a systematic review and meta-analysis

To synthesize the available evidence on the association between sedentary behavior (SB) and metabolic syndrome (MetS) in adolescents. PubMed, Embase, CINAHL, SPORTDiscus, LILACS, and Web of Science were searched up to February 20, 2026. Risk of bias was assessed using the AXIS tool, and certainty of evidence was evaluated using the GRADE approach. For the meta-analysis, pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Seventeen studies (49,307 participants) were included in the systematic review, and 16 studies were included in the meta-analysis (49,028 participants), all rated as having low risk of bias. There was moderate certainty of evidence that adolescents with moderate/high SB (screen time ≥ 2 h/day or sitting time ≥ 8 h/day) had higher odds of MetS compared to those with low SB (OR = 1.59 [95% CI 1.42–1.78]). No significant difference was observed between studies assessing SB by screen time or total sitting time (p = 0.74). Subgroup analyses further demonstrated a dose–response pattern, with high SB (screen time ≥ 5 h/day) associated with nearly twofold higher odds of MetS (OR = 1.95 [95% CI 1.52–2.48]). There is moderate certainty of evidence that adolescents with moderate/high SB have approximately 59% higher odds of MetS, with high SB associated with nearly twofold higher odds. These findings support the development of intervention strategies aimed at monitoring and reducing SB in this population.