See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/330465843

Metabolic syndrome: The bane of Indian population

Article · January 2019

CITATION READS

1 258

2 authors, including:

Deepika Dhawan
Amity
7 PUBLICATIONS   9 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Metabolic syndrome View project

Food Product Development View project

All content following this page was uploaded by Deepika Dhawan on 18 January 2019.

The user has requested enhancement of the downloaded file.

 International Journal of Physiology, Nutrition and Physical Education 2019; 4(1): 58-61

ISSN: 2456-0057
IJPNPE 2019; 4(1): 58-61
© 2019 IJPNPE Metabolic syndrome: The bane of Indian population
www.journalofsports.com
Received: 18-11-2018
Accepted: 21-12-2018 Deepika Dhawan and Sheel Sharma
Deepika Dhawan
1. Ph.D., Scholar, Department of Abstract
Food science and Nutrition, Metabolic syndrome (MetS) is a cluster of risk factors for the occurrence of type 2 diabetes mellitus and
Banasthali Vidhyapith, cardiovascular diseases. It involves following interrelated biological components: abdominal obesity,
Rajasthan, India dyslipidemia, hypertension and type 2 diabetes mellitus. Indians may be susceptible to the syndrome due
2. Assistant Professor I, to foetal malnutrition and rapid post independence urbanization. This review attempts to explain the
Department of Dietetics and prevalence, risk factors and management for prevention of MetS, which may help the health authorities
Applied Nutrition, Amity and policy planners to realize the current status of MetS in Indian population.
University Haryana, Gurgaon,
India Keywords: Metabolic syndrome, type 2 diabetes mellitus, abdominal obesity, hypertension, dyslipidemia
Sheel Sharma
Professor and Head, Department 1. Introduction
of Food science and Nutrition, The rapid growth of non-communicable diseases (NCDs) is threatening the health of the
Banasthali Vidhyapith, people. India, being a developing country, is still struggling to fight infectious diseases have
Rajasthan, India another challenge i.e., to control the rise in NCDs that broadly includes diabetes mellitus,
cardiovascular diseases, cancer, chronic respiratory diseases, hypertension, obesity and mental
illness. Urbanization in India has modified people’s lifestyle and dietary habits, resulting in
increase in rate of obesity. Metabolic syndrome started as a concept rather than a diagnosis, is
a public health issue requiring immediate attention [1-3].
“A cluster of risk factors for cardiovascular diseases and type 2 diabetes mellitus occurring
together lead to a condition called metabolic syndrome” [4]. It represents a constellation of
interrelated biological factors including abdominal obesity, dyslipedemia, hypertension and
type 2 diabetes mellitus [5]. Several definitions have been given to describe metabolic
syndrome. Generally, it is agreed that a combination of three or more characteristics must be
present [6]. The definition given by IDF (International Diabetes Federation) states that “a
person is identified to have metabolic syndrome when he/she must have central obesity
specific to ethnicity values plus any of the two factors including raised triglycerides, reduced
HDL cholesterol, raised blood pressure, and raised fasting blood glucose” [7]. In 2009, Joint
Interim Statement stated that “presence of any three of the following five conditions is
essential, to be diagnosed with MetS i.e., increased waist circumference, low HDL cholesterol,
elevated blood pressure, and elevated blood sugar” [4, 6].
Barker et al. (1998) reported increased susceptibility to metabolic syndrome could be a result
of maternal nutritional deprivation leading to Intrauterine Growth Retardation (IUGR).
Programming of IUGR foetal tissues during critical periods of developments have lifelong
effects, which with affluences and urbanization manifest adult obesity and chronic
degenerative diseases [8, 9]. According to 2011 report, nearly 20% of new born have low birth
weight [10]; showing a wide prevalence of Intrauterine Growth Retardation in India. Hence,
Correspondence under nutrition at one age spectrum may bring those populations at risk of developing
Deepika Dhawan metabolic syndrome in adult life [8, 9]. So, Indians seem to be more prone to development of
1. Ph.D., Scholar, Department of MetS (metabolic syndrome); as this population has a history of foetal malnutrition and greater
Food science and Nutrition, incidence of low birth weight babies, who at present are adults, may be possible sufferers of
Banasthali Vidhyapith,
Rajasthan, India
MetS.
2. Assistant Professor I, Patients having metabolic syndrome have a 2-fold and 5-fold increased risk of developing
Department of Dietetics and cardiovascular diseases and type 2 diabetes mellitus respectively over the next 5 to 10 years [1].
Applied Nutrition, Amity Furthermore it is seen around 20-25% world’s adult population suffer from MetS and it
University Haryana, Gurgaon, confers 2- to 4- fold increased risk of stroke, a 3- to 4-fold increased risk of myocardial
India
~ 58 ~
International Journal of Physiology, Nutrition and Physical Education

infarction and 2- fold risk of dying compared to people that “the measure for central obesity there should not be an
without syndrome [1, 7]. Age, heredity, lifestyle factors and obligatory component, but that waist measurement would
socioeconomic status have a major impact on its pathogenesis [7]. continue to be a useful preliminary screening tool” [17].
Prevalence of MetS worldwide ranges from <10% to as much
as 84%, depending on various demographic factors: region, 3. Materials & Methods
urban/rural environment, composition (sex, age, race, and A literature review was done to obtain relevant information,
ethnicity) of the patient, and the definition used. While in searching the online databases PubMed, Medline, Google
India the prevalence of MetS has been documented to be from scholar and NCBI and related books. Research articles such as
11% to 41% across the country with socio-cultural variations cross-sectional, prospective and longitudinal studies and
[11]
. Surveys in large cities of India show that one-third of the reviews were identified. Following keywords: ‘Non-
urban population suffers from MetS while prevalence in rural communicable diseases’, ‘Metabolic syndrome’, ‘History’,
population is comparatively low. ‘Definitions’, ‘Pathophysiology’, ‘Risk factors’,
Determining and controlling various components of MetS at ‘Cardiovascular diseases’, Type2 Diabetes’, ‘Prevalence’, ‘In
population level is complex and requires multi-sectoral policy utero malnutrition’, ‘Chronic Degenerative Disease’, ‘Diet’
approach focused on delivering balanced nutrition, lifestyle and ‘Exercise’ were used in search strategy. This review
modification and environment to improve physical activity highlights prevalence, components and consequences of
[12]
. metabolic syndrome in Indians, with an attempt made to
retrieve relevant concepts and studies on Indian population.
2. Historical Background
The concept of MetS dates back to as early as 250 years ago, 4. Definitions
Morgagni identified association between abdominal obesity, Many expert groups from international organizations like
arterial hypertension, atherosclerosis, high level of uric acid in WHO, EGIR, NCEP ATP III, AHA/NHLBI and IDF have
the blood and frequent respiratory disorders during sleep (the come up with definitions to describe MetS [18]. However,
obstructive sleep apnea) [13]. In 1923, Kylin demonstrated obesity, insulin resistance, dyslipidemia and hypertension
association of hypertension, hyperglycemia and gout as a have been the main components of MetS in all of the
syndrome. While in 1940s, Vague stated that abdominal definitions [14]. However, a harmonized definition was given
obesity was commonly linked with metabolic abnormalities in 2009, as improvement in previous definitions stating that
found in cardiovascular diseases and diabetes. Later on, at “presence of any three of the following five conditions is
European Association for the study of Diabetes in an annual essential, to be diagnosed with MetS i.e., increased waist
meeting held in 1965, Avogaro and Crepaldi presented an circumference (males: ≥90 cm and for females: ≥80 cm),
abstract describing a syndrome including obesity, hypertriglyceredimia ≥150 mg/dl (1.7 mmol/l), low HDL
hypertension and hyperglycemia [14, 1]. The term ‘metabolic (Males <40 mg/dl (1 mmol/l) and for females <50 mg/dl (1.3
syndrome’ was first time coined in 1981, Hanefield and mmol/l), elevated blood pressure (systolic blood pressure
Leonhardt gave first definition of metabolic syndrome, ≥130 mmHg and/or diastolic blood pressure ≥85 mmHg or
describing it as “simultaneous occurrence of hyper- drug treatment for hypertension), and elevated blood sugar
dyslipoproteinemia, hyperglycemia, hypertension, gout and (fasting blood sugar ≥100 mg/ dl (5.6 mmol/l) or drug
obesity in combination with an increased risk of treatment for diabetes mellitus)”.
cardiovascular diseases, fatty liver and cholelithiasis in
overfed, physically inactive and genetically predisposed 5. Components
people” [15]. Further in 1988, the phrase ‘Syndrome X’ was Studies reveal association between obesity and insulin
first time used by Reavan to describe metabolic syndrome as a resistance underlying pathophysiology of MetS. It becomes
constellation of risk factors for diabetes and cardiovascular difficult to understand which one causes pathogenesis and
diseases creating clinical significance though excluding progression of MetS [13]. Several other risk factors constitute
obesity. He introduced the concept of insulin resistance but the syndrome including: age, ethnicity/race, diet, physical
missed out very important feature of obesity from the inactivity, genetic susceptibility, dyslipidemia, elevated blood
definition later added as a crucial abnormality [14, 1]. Kaplan in pressure, imbalances in hormone levels, drugs and chronic
1989, renamed metabolic syndrome as ‘The Deadly Quartet’ stress making it very complex [14, 1].
and described syndrome as presence of obesity, hypertension,
hypertriglyceridemia and glucose intolerance as commonly 5.1 Abdominal Obesity
coexisting components [16]. While in 1991, Defronzo and High consumption of cheap, calorie dense foods along with
Ferrannini represented syndrome X as ‘Insulin Resistance sedentary lifestyle has lead to increased incidence of obesity
Syndrome11. Several agencies have described diagnostic globally [1]. Studies estimate that about 50% of adults
criteria for MetS. WHO (World Health Organization) diabetes worldwide are expected to be obese by 2030. Obesity may be
group made first attempt in 1998 to define MetS, later was defined by BMI (Body Mass Index) being 30 or above, but
modified by European Group for the study of Insulin central obesity may not always occur with an elevated BMI.
Resistance (EGIR) in 1999. National Cholesterol Education Presence of excess visceral fat deposits on abdomen is a
Programme Adult Treatment Panel (NCEP/ATP) also major risk factor for systematic inflammation, hyperlipidemia,
released definition of MetS in 2001. In 2003 American insulin resistance and cardiovascular disease. Abdominal
Association of Clinical Endocrinologists also expressed its obesity may be measured by taking anthropometric
views regarding the syndrome. Understanding the need of measurements such as waist circumference or waist: hip ratio
[19]
unified definition IDF gave a worldwide definition of MetS in . Abdominal obesity is defined by large waist
April 20051. In 2009, harmonized definition was given by circumference according to the ethnicity specific values. For
IDF and the American Heart Association/ National Heart, Asian Indians, waist circumference for males≥90cm and
Lung and Blood Institute (AHA/NHLBI) with an agreement female≥80cm is considered to have abdominal obesity [4].
~ 59 ~
International Journal of Physiology, Nutrition and Physical Education

5.2 Dyslipidemia increased risk of long term cardiovascular complications

Dyslipidemia is characterized by high plasma triglycerides along with long term diabetic complications [26].
and free fatty acid levels due to alterations in atherogenic and Studies also reveal that MetS has a strong association with
antiatherogenic lipoproteins due to abnormal lipid renal and chronic kidney disease. Incidence of other health
metabolism. The condition may be due to increased levels of problems like osteoarthritis, gout, and renal stones with
atherogenic lipoproteins or increased production of very low- addition of MetS traits also increases. Further it may also be
density lipoproteins (VLDL) and low-density lipoproteins associated with various cancers. Major factors of MetS like
(LDL) and decreased levels of high-density lipoproteins obesity, diabetes and dyslipidemia increases the risk of breast,
(HDL). It may also result from decreased clearance of colon/colorectal, liver, pancreatic, bladder and endometrial
triglyceride-rich-lipoprotein due to deficiency of enzyme cancers. In addition to this; it has also been linked to cognitive
insulin-sensitive lipoprotein lipase. This condition is and psychiatric issues leading to sleep apnea, vascular and
important feature of MetS which increases risk of type2 Alzheimer’s dementia [27].
diabetes and cardiovascular diseases [20]. According to
harmonized definition, raised triglycerides ≥150mg/dl and 7. Prevention and Management
reduced HDL cholesterol <40mg/dl in males and <50mg/dl in The most effective treatment of MetS has not been
females lead to atherogenic dyslipidemia [4]. established. However long-term life style modification may
be possible treatment in controlling and preventing major
5.3 Hypertension components of MetS. Long term dietary alterations may help
Hypertension also becomes associated with insulin resistance, in weight reduction, managing blood glucose, blood pressure
obesity and dyslipidemia being common risk factors. Recent and cholesterol levels. Studies show improvements in MetS
data show conditions like hyperglycemia and criteria by following various types of diet like low-fat,
hyperinsulinemia activate renin angiotensin pathway causing mediterranean, ketogenic, high-protein, DASH (Dietary
increased expression of angiotensinogen, Angiotensinogen II, Approaches to Stop Hypertension) and Nordic diet. Apart
AT1 receptors. All these processes lead to elevated blood from diet, improved physical activity level can also prove to
pressure in patients with insulin resistance. Symathetic be beneficial for patients with MetS. Exercise and increased
nervous system is activated when there is a persistent elevated physical activity level may reduce abdominal fat, risk of
level of glucose and insulin in blood which causes increased cardiovascular diseases and diabetes [28, 19].
sodium reabsorption by the kidneys, increased cardiac output People with metabolic syndrome have an increased risk of
and then, hypertension. Recent studies show that adipocytes developing diabetes, myocardial infarction, cardiovascular
produce aldosterone in response to Angiotensin II causing diseases and dying from heart stroke1. Following healthy
sodium retention and raised blood pressure. According to dietary patterns and lifestyle modification can improve status
recent guidelines, systolic BP≥130mmHg or diastolic of MetS. The protective effect of energy-restricted diets
BP≥85mmHg is diagnosed with hypertension [4, 21]. seems to be beneficial as it may help to make small changes
in the individual components rather than a large effect on any
5.4 Type 2 Diabetes Mellitus single component of MetS. Thus treatment for MetS should
Insulin resistance is a condition in which cells of various be focused on weight-loss and increased physical activity in
organs become insensitive and resistant to insulin hormone order to achieve significant improvements for the betterment
and glucose cannot be absorbed by the body causing rise in of the people [28, 19].
blood glucose, eventually type 2 diabetes [7]. This may
become a potential risk factor for MetS as seen in majority of 8. Conclusion
subjects diagnosed with MetS in studies. Diabetic patients This review article intends to clarify, how MetS may become
have increased risk of developing hypertension, dyslipidemia, a possible threat on Indian population. Looking back at its
cardiovascular diseases and obesity [22]. According to the history, organizations and researchers have described the
harmonization definition raised fasting plasma glucose of syndrome as interlinked biological factors such as obesity,
≥100mg/dl is a characteristic feature of MetS [4]. raised blood pressure, blood glucose, triglycerides and
cholesterol levels. These factors may give rise to various
6. Prevalence in India health problems like cardiovascular diseases, type 2 diabetes,
Recent data show MetS is a major contributing risk factor for kidney diseases, cholelithiasis, and fatty liver diseases. These
various diseases. A cross-sectional study was conducted in consequences of MetS have been reported in various studies
Kerala, South India with around 5000 subjects revealed in India.
prevalence of MetS to be 33% and is associated with the Health education programs should be planned to control MetS
presence of coronary artery disease and increased to help reduce its burden. Multi-sectoral approach to control
cardiovascular mortality in the state [23]. Another study of MetS in Indian population may help to control its unsavoury
North India in rural districts of Haryana with 1700 subjects, repercussions.
prevalence of MetS was 26.6% and showed increased risk for
progression of type2 diabetes and heart diseases [23]. Processes 9. References
of MetS may begin at a very early age of life during 1. Kaur J. A Comprehensive Review on Metabolic
childhood to young adulthood and reach to 50% prevalence in Syndrome. Cardiol Res Pract, 2014, 1-21.
obese youngsters. In a study of Gujarati asymptomatic young 2. Bansal S, Paliwal A, Verma V, Chauhan J. A study on
population on 1500 subjects, prevalence was found to be prevalence of metabolic syndrome in general population
16%. It also showed increased incidence of diabetes, in Western Uttar Pradesh, India. Int J Res Med Sci. 2017;
hypertension, dyslipidemia and atheroscelerosis in subjects 5(6):2641-2643.
with advance in age [25]. Another study in Central India, in the 3. Pathania D, Bunger R, Mishra P, Pathak R, Arora A. A
area of Chambal in Madhya Pradesh on 700 type 2 diabetic study to assess prevalence of metabolic syndrome and its
patients showed prevalence of MetS to be 57.7% stated socio demographic risk factors in rural area of district
~ 60 ~
International Journal of Physiology, Nutrition and Physical Education

Ambala, Haryana. J Community Med Health Educ. 2013; 22. Marjani A. Metabolic syndrome and diabetes: a review.
3(5):1-4. JCBR. 2017; 1(2):36-43.
4. Prasad DS, Kabir Z, Dash AK, Das BS. Prevalence and 23. Harikrishnan S, Sarma S, Sanjay G, Jeemon P, Krishnan
risk factors for metabolic syndrome in Asian Indians: A MN, Venugopal K et al. Prevalence of metabolic
community study from urban Eastern India. J Cardiovasc syndrome and its risk factors in Kerala, South India:
Dis Res. 2012; 3:204-11. Analysis of a community based cross-sectional study.
5. Ranasinghe P, Mathangasinghe Y, Jayawardena R, Hills PLoS ONE. 2018; 13(3):1-16.
AP, Misra A. Prevalence and trends of metabolic 24. Singh J, Rajput M, Rajput R, Bairwa M. Prevalence and
syndrome among adults in the asia-pacific region: a Predictors of Metabolic Syndrome in a North Indian
systematic review. BMC Public health. 2017; 17:101. Rural Population: A Community Based Study. J Glob
6. Nolan PB, Ranson GC, Stinear JW, Reading SA, Dalleck Diabetes Clin Metab. 2016; 1(2):1-5.
LC. Prevalence of metabolic syndrome and metabolic 25. Jain SR, Shah KH, Acharya HN, Barot K, Sharma KH.
syndrome components in young adults: A pooled Prevalence and Predictors of Metabolic Syndrome in
analysis. Prev Med Rep. 2017; 7:211-215. Young Asymptomatic Gujarati Population. Int J Chronic
7. Quick dissolving tablets. https://www.idf.org/e- Dis, 2015, 1-7.
library/consensus-statement.html. 17 august, 2018. 26. Yadav D, Mahajan S, Subramanian SK, Bisen PS, Chung
8. Bamji MS, Rao NP, Reddy V. Textbook of Human CH, Prasad GBKS. Prevalence of Metabolic Syndrome in
Nutrition. IBH publishing Co Pvt. Ltd, New Delhi, India, Type 2 Diabetes Mellitus Using NCEP-ATPIII, IDF and
1996, 1-16. WHO Definition and Its Agreement in Gwalior Chambal
9. Barker DJP. In utero programming of chronic disease- Region of Central India. Glob J Health Sci. 2013;
review. Clin Sci. 1998; 95(2):115-28. 5(6):142-155.
10. Bharati P, Pal M, Bandyopadhyay M, Bhakta A, 27. Watt KD. Extrahepatic Implications of Metabolic
Chakraborty S. Prevalence and causes of low birth weight Syndrome. Liver Transpl. 2013; 19(11):S56-S61.
in India. Malays J Nutr. 2011; 17(3):301-13. 28. Barquero CS, Leon RAM, Sadurní M, Estruch R, Casas
11. Khan Y, Lalchandani A, Gupta AC, Khadanga S, Kumar R. Dietary Strategies for Metabolic Syndrome: A
S. Prevalence of metabolic syndrome crossing 40% in Review. J Obes Ther. 2017; 1(2):1-5.
Northern India: Time to act fast before it runs out of
proportions. J Family Med Prim Care. 2018; 7(1):118-
123.
12. Pandit K, Goswami S, Chowdhury S. Metabolic
syndrome in South Asians. Indian J Endocr Metab. 2012;
16(1):44-55.
13. Kaur B, Aeri BT. Metabolic syndrome-concept and
criterias: a review. IFJANS. 2017; 6(3):61-74.
14. Kumar NGV, Pullaiah CP, Dhanunjaya S, Reddy DG.
Metabolic syndrome: a rising epidemic: comprehensive
review. Int J Res Ayurveda Pharm. 2017; 8(3):36-41.
15. Hanefeld M, Pistrosch F, Schulze J, Roth U. The
metabolic syndrome and cardiovascular Diseases: an
update of medical treatment. J Metabolic Synd. 2014;
3(4):1-9.
16. Kaplan NM. The Deadly Quartet. Arch Intern Med. 1989;
149:1514-1520.
17. Milici N. A short history of the metabolic syndrome
definitions. Proc Rom Acad. 2010; 1:13-20.
18. McCracken E, Monaghan M, Sreenivasan S.
Pathophysiology of metabolic syndrome. Clin Dermatol.
2018; 36:14-20.
19. Paley CA, Johnson MI. Abdominal obesity and metabolic
syndrome: exercise as medicine?. BMC Sports Sci Med
Rehabil. 2018; 10(7):1-8.
20. Iqbal J, Qarni AA, Hawwari A, Alghanem AF, Ahmed G.
Metabolic syndrome, dyslipidemia and regulation of
lipoprotein metabolism. Curr Diabetes Rev. 2017; 13:1-6.
21. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins
KJ, Dennison Himmelfar BC et al. 2017
ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC
/NMA/PCNA guideline for the prevention, detection,
evaluation, and management of high blood pressure in
adults: a report of the American College of
Cardiology/American Heart Association Task Force on
Clinical Practice Guidelines. Hypertension. 2018; 71:e13-
e115.

~ 61 ~

View publication stats