Phytochemicals from medicinal plants as alternative therapeutics for metabolic syndrome: A review of randomized controlled trials

Metabolic syndrome (MetS) constitutes a constellation of interrelated cardiometabolic risk factors, including central obesity, dyslipidemia, hypertension, and impaired glucose regulation, that collectively drive systemic inflammation and elevate cardiovascular morbidity and mortality. Conventional pharmacotherapies often face challenges related to limited efficacy, adverse effects, and patient adherence, particularly in geriatric cohorts. This narrative review critically appraises the clinical utility of phytochemicals derived from medicinal plants as complementary or alternative interventions in MetS management, exclusively synthesizing evidence from randomized controlled trials (RCTs). Key bioactive compounds such as curcumin, quercetin, genistein, and hesperidin consistently demonstrated statistically and clinically significant improvements in lipid metabolism, glycemic indices, blood pressure regulation, inflammatory biomarkers, and adipokine profiles. Emerging data also highlight their epigenetic modulation capacity, underscoring mechanistic plausibility. Despite methodological heterogeneity and predominantly short trial durations limiting long-term efficacy assessments, the current clinical evidence substantiates the integration of select phytochemicals as adjunctive agents within MetS therapeutic paradigms. Future rigorously designed, large-scale RCTs with standardized formulations and extended follow-ups are imperative to validate these findings and optimize dosing strategies.