Pooling eight observational studies covering 21,708 Nepalese adults, this systematic review estimates metabolic syndrome prevalence at 21.3% (95% CI: 11.6–35.9%). The finding is severely undermined by extreme statistical heterogeneity (I² = 99.4%), with the 95% prediction interval spanning 2.0% to 78.6% — meaning the true burden in any given Nepalese population could be negligible or near-epidemic. Component-level data are more actionable: low HDL cholesterol affects 64.5% of those with metabolic syndrome, abdominal obesity 59.5%, and hypertriglyceridemia 47.0%. GRADE certainty for the overall prevalence estimate is rated very low.
This preprint, not yet peer-reviewed, highlights a tension increasingly visible across South Asian epidemiology: national-level pooled estimates for metabolic syndrome often obscure vast rural-urban, ethnic, and dietary divides that make averages nearly meaningless for policy. Nepal's geographic and demographic fragmentation — from Himalayan highland communities to Terai plains populations — likely explains much of this variance, yet the eight included studies lacked sufficient granularity to disentangle these factors. The strikingly high prevalence of low HDL and hypertriglyceridemia mirrors patterns across South Asia, where refined carbohydrate diets and physical inactivity drive atherogenic dyslipidemia independent of obesity. For public health practitioners, these component rates — not the headline 21.3% — should anchor intervention design. The eight-study sample is a major limitation; expanding surveillance with standardized diagnostic criteria across Nepal's ecological zones is the essential next step before clinical or policy conclusions can be drawn with confidence.