title: Association between anxiety and metabolic syndrome: A systematic review and meta-analysis of epidemiological studies.
abstract: Epidemiological studies have repeatedly investigated the association between anxiety and metabolic syndrome (MetS). However, the results have been inconsistent. We performed a meta-analysis of observational studies to summarize the evidence regarding the relation of anxiety and MetS risk.
  
  
  
  We performed a systematic literature search of all studies published in PubMed and EMBASE from its inception to June 2016. Cross-sectional and cohort studies that reported an association between the two conditions in adults were included. Data on prevalence, incidence, unadjusted or adjusted odds ratio (OR), and 95% CI were extracted or provided independently by the authors. Random effects model was used to report the pooled OR. The I2statistic was used to assess heterogeneity. Egger's test and Begger's test were used to evaluate the publication bias.
  
  
  
  The search yielded 18 cross-sectional studies and two cohort studies. The pooled finding from cross-sectional studies showed that anxiety had a significant positive association with MetS (OR 1.07, 95% CI 1.01-1.12), with moderate heterogeneity (I2=45.7%, P=0.018). Findings from two cohort studies indicated that the association between anxiety and MetS was insignificant.
  
  
  
  Our results suggest that there is an association between anxiety and MetS. In individuals with MetS anxiety should be detected and managed. Further prospective studies are needed to explore the bidirectional association between anxiety and MetS.
authors.affiliation: Health Management Center, Qianfoshan Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Tang
authors.affiliation: Department of General Surgery, The Fourth Hospital of Jinan City, Jinan, China.
authors.forename: Gangpu
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Case Administration, Qianfoshan Hospital Affiliated to Shandong University, Jinan, China. Electronic address: lianying525@sina.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Lian
mesh_terms: D001007:Anxiety / Q000453:epidemiology*; D001008:Anxiety Disorders / Q000453:epidemiology*; D015897:Comorbidity; D006801:Humans; D024821:Metabolic Syndrome / Q000453:epidemiology*; D015995:Prevalence
keywords: Anxiety; Epidemiological association; Metabolic syndrome