Association between perceived stress and metabolic parameters: a systematic review and meta-analysis

BACKGROUND: Metabolic syndrome (MetS) is a major global public health problem associated with cardiovascular disease, type 2 diabetes mellitus (T2D), and increased mortality. Chronic psychological stress has been proposed as a contributor to metabolic dysfunction; however, evidence linking perceived stress to MetS and its individual components remains inconsistent. The Perceived Stress Scale (PSS) is a widely validated instrument for assessing subjective stress, yet its association with metabolic outcomes has not been systematically synthesised. AIMS: The objective of this study was to systematically review the evidence and evaluate the association between perceived stress, measured using the PSS, and metabolic parameters related to MetS. METHODS: A systematic search of peer-reviewed literature identified studies assessing perceived stress using the PSS-10 or PSS-14 and reporting metabolic outcomes in adults. Associations between perceived stress and metabolic parameters were examined using random-effects meta-regression models, with stress scores standardised to allow comparability across PSS versions. Outcomes included anthropometric measures, blood pressure, glycaemic markers, lipid profile, and insulin resistance. RESULTS: Thirty studies comprising 12,491 participants were included. Most metabolic parameters, including body mass index, waist circumference, blood pressure, fasting glucose, and triglycerides, showed no significant association with perceived stress. In contrast, insulin resistance assessed by HOMA-IR was positively associated with perceived stress (β = 0.463, 95% CI: 0.159-0.767). Borderline associations were observed for high-density lipoprotein cholesterol and total cholesterol. Although substantial heterogeneity was present across analyses, the HOMA-IR association was exploratory and sensitive to the inclusion of individual studies. CONCLUSIONS: Higher perceived stress may be associated with insulin resistance (HOMA-IR) but not with traditional anthropometric, glycaemic, or blood pressure measures; this finding is exploratory and causal inferences cannot be established. These results highlight the potential relevance of psychosocial stress as a contributor to metabolic vulnerability; stress assessment may be considered in preventive and clinical strategies pending higher-certainty evidence.