Metabolic Syndrome: The Forerunner of Diabetes and Cardiovascular Disease

Metabolic syndrome is the name given to a cluster of medical problems which when present for a prolonged period of time leads to the development of Type 2 Diabetes mellitus, heart problems and stroke.

Metabolic disarrangement grows into a syndrome when the person suffers from any 3 of the below-mentioned conditions.

Metabolic Syndrome: The Forerunner of Diabetes and Cardiovascular Disease
  • Waist measures in excess of 40 inches for men and 35 inches for women
  • Triglyceride level is 150 mg/dL or more than that
  • HDL level drops to 40 mg/dL or lower in men and 50 mg/dL or lower in women
  • Fasting sugar readings are 100 mg/dL or more
  • BP readings are (or are more than) 130/85 mm Hg

The world-wide prevalence of metabolic syndrome is on the increase, with the overall global prevalence estimated to be 20%-25% of the adult population. In our country, various epidemiological studies have consistently shown a high prevalence, which is likely to be as much as one-quarter of the adult population, with increasing age and female gender being at higher risk. The occurrence has also been recorded among adolescents. The events which initiate the cardio-metabolic problems can be classified under four categories.

1. Excess Weight Gain

The first event which initiates metabolic syndrome is excess weight gain. In a majority of our population, the reason for excess weight gain is usually a combination of genetic factors (family history of diabetes, obesity, etc.) and environmental factors (sedentary lifestyle, excess calorie intake, psychological stress, etc.).

It is the belly fat or abdominal obesity which increases the risk of metabolic syndrome. For Indians, a unique and worrisome feature is that we develop belly fat even with a normal body mass index (BMI) which is generally measured with our weight and height. So, Indians are prone for the phenomenon called “Thin Fat Phenotype”. Hence, it’s very important that we not only should be conscious of our weight but also take care that we don’t cross the waist circumference limit suggested for our population. Waist circumference (WC) (< 90 cm for Indian men and < 80 cm for Indian women) or waist hip ratio (WHR) would be a more appropriate measure of obesity than BMI for Indians.

2. Insulin Resistance

The second event which occurs due to abdominal obesity is called “insulin resistance”. All of us are aware that the insulin hormone is secreted from the pancreas and its main function is to control our blood glucose levels. Increase in belly fat makes insulin dysfunctional and consequently, the pancreas secretes more and more insulin to overcome this dysfunction. Prolonged resistance to the action of insulin initiates a cascade of events.

3. Endothelial Damage

Our body has several blood vessels which supply blood to all the organs. Insulin resistance causes damage to the innermost layer (endothelium) of these blood vessels. This is similar to the damage to the inner layer of a smooth pipe through which water flows. Endothelial damage causes an altered blood flow pattern which leads to hypertension in the long run. Presence of hypertension and diabetes in turn cause further endothelial damage and it becomes a “vicious cycle”.

4. Atherosclerosis

The circulating blood cholesterol gets trapped at the places of endothelial damage which causes a “fatty streak”. This is the starting point of a problem called “atherosclerosis”. Over the next few years, the fatty streak becomes a “plaque” followed by calcium deposition (calcification) and blood clot formation (thrombus). The final result of the long-term atherosclerotic process is the critical occlusion of the blood vessels supplying blood to heart and brain. Consequently, patients develop coronary artery disease, stroke and other heart and brain related diseases.

“Metabolic syndrome” is just a terminology which represents all the above-mentioned events in a chronological order. Hence, it can be called as the “tip of the iceberg”.

How Can I Prevent Metabolic Syndrome?

Metabolic syndrome is an easily preventable problem provided we understand its long-term consequences and start acting at the right time. For people who have a strong genetic risk, the initiative should start from early childhood itself. There are certain steps which should be followed by all of us as we are prone for this cardio-metabolic risk at a younger age and with more severity.

1. All the family members should take steps to follow healthy eating habits so that children inculcate this as part of their way of life.

2. A regular structured physical activity should be followed as a part of our daily routine.

3. Restrict the “screen time” for yourself and your family members. The number of hours one spends in using mobile, laptop, TV or other gadgets is directly related to excess weight gain.

4. Make sure that you get adequate and quality sleep at night. Disturbed sleep wake cycle is associated with altered “circadian rhythm” i.e., the rhythm which controls our hormone secretion.

5. Prolonged sitting is considered as the “new avatar of smoking”. Being a “couch potato” is as injurious to one’s health as smoking cigarettes. Even during busy office hours, make sure that you do some stretches in between so that you get energised and stay active.

6. Try to avoid or reduce the “stressors”. Often, a continuous psychological stress is one of the un-addressed risk factors for metabolic syndrome. Get professional help from a psychologist or counsellor if you are unable to cope up with stress.

Dr. Bharath Ramji

Dr. Bharath Ramji
Consultant Endocrinologist
Kauvery Hospital Chennai


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