Arjun Sharma is an IT professional in his mid-40s, working in Bangalore. He used to play squash and tennis but in the last few years the long hours at work have made it difficult for him to play a sport regularly. In the last five years he had put on 20kg, and his wife insisted he get a full medical check-up in December.
His medical reports showed his blood sugar levels were too high, the HDL (high-density lipoprotein or good cholesterol) levels were too low and the triglycerides were too high. The doctor diagnosed him with Metabolic Syndrome and said he was in danger of developing diabetes and/or cardiovascular heart disease if he didn’t lose at least 20kg. Sharma, who weighed 85kg, immediately joined a gym and started working out regularly for an hour every day. He also started eating home-cooked food so he could have a healthy diet low in fat and rich in fresh vegetables. In a year he lost over 15kg and his blood report after the weight loss showed blood sugar, HDL and triglyceride levels were normal. The doctor told him he should get his blood test done every year, but as long as he stayed on course with his exercise and diet, and didn’t regain the weight, there should be no cause for concern.
Life cycle: Weight around the middle is a major risk factor for the Metabolic Syndrome.
The mystery behind Metabolic Syndrome
The Metabolic Syndrome is a constellation of health markers that include high blood pressure, high cholesterol levels, high blood sugar and most importantly a large amount of fat around the waist. It is sometimes also called Syndrome X and Insulin Resistance Syndrome. A study of 177 men working in an industrial unit in Chennai, conducted in June by P. Kaur, et al, at the National Institute of Epidemiology of the Indian Council of Medical Research, found the prevalence of Metablic Syndrome in men in the age group of 20 years and above was 41.3%, using International Diabetes Federation (IDF) criteria. A study of 2,225 men and women over the age of 20 years in Chandigarh, by Ravikiran M., et al, at the department of endocrinology in the Postgraduate Institute of Medical Education and Research, released findings in August that suggested the rate was 39.5%, again by the IDF criteria.
Five other small studies over the last decade have shown a similar prevalence in cities. Anoop Misra, director, department of diabetes, obesity and metabolic diseases at Fortis Hospital, New Delhi, published a review in 2009 of the published medical research on the Metabolic Syndrome, estimating that about one-third of all adults living in large cities have Metabolic Syndrome.
A person suffering from the syndrome may not feel the effects immediately but it puts that person at grave risk of developing both Type 2 diabetes mellitus and cardiovascular heart disease later in life. It depends on family history, and the marker levels. You can get diabetes mellitus Type 2 in your 30s and heart disease in your 40s. If you’ve got Metabolic Syndrome, the risk of diabetes is 9-30 times more than for the normal population—defined as those whose blood pressure, cholesterol and blood sugar levels are within range. The risk of cardiovascular heart disease too is two-four times higher than for the normal population.
“It’s unfortunate these days, one sees 35-year-olds dying of cardiac arrests,” says Suman Bhandari of Escorts Heart Institute and Research Centre, New Delhi. Such deaths could be prevented if the person had been screened for the syndrome and made the necessary lifestyle changes with or without medication.
There are no symptoms. Interestingly, a Chennai study of 358 subjects in November found a correlation between snoring and the Metabolic Syndrome, even after the results were adjusted for factors such as age, sex, level of physical activity, smoking and drinking. The research was carried out by Roopa M., et al, in collaboration with the World Health Organization, to estimate the prevalence of sleep abnormalities and their association with Metabolic Syndrome.
The best thing to do is to get your blood sugar level checked and take it from there, says Dr Misra. Particularly if there is a history of diabetes, heart disease and/or obesity in the family, you should get your blood sugar levels checked every year, especially after the age of 40. If the levels are high the doctor will recommend other tests (See Take these Tests).
The susceptibility factor
A large body of medical evidence suggests weight around the middle is a major risk factor for developing the syndrome. Being apple-shaped, in other words, puts you at risk. Unfortunately, Indians are predisposed to putting on weight around their midriffs. We are also unfortunately endowed with the ability to turn energy-giving foods into fat more efficiently than Caucasians or the Chinese. Put another way, the percentage of fat in our bodies at a particular weight is much higher when compared with our Caucasian friends of the same weight. It was perhaps an evolutionary blessing to help survive droughts, but it now puts us at risk of developing both heart disease and diabetes.
Modern sedentary life is one where food is aplenty, exercise limited and stress unlimited. Increased stress only adds to our susceptibility. Stress cannot be eliminated, but we have to learn to cope with it better. Regular exercise can help manage both weight and stress.
The prevention guide
Dr Bhandari believes prevention starts early. Teach your children to make healthy food choices and exercise part of their daily life. They should be taught to avoid aerated soft drinks and fried snacks and encouraged to play sports. Schools should have annual height and weight checks. They should teach a class on nutrition and physical fitness and keep fried snacks and aerated soft drinks out of the school cafeteria.
“Diet and fitness education should be a part of higher (college) education,” he says emphatically. For young people aged 20-30, he recommends regular exercise, 45-60 minutes a day, every single day, coupled with a healthy diet. The importance of regular exercise cannot be overstated, because exercise is beneficial for blood pressure, cholesterol levels and blood sugar, whether weight loss is achieved or not. After the age of 35, diet control, regular exercise and yearly medical check-ups are recommended.
TAKE THESE TESTS
Get these checks done regularly
• Fasting blood sugar test
• Blood pressure measurement
• HDL cholesterol level
• LDL cholesterol level
• Triglyceride level
If with high fasting blood sugar levels you also have low HDL and high triglyceride levels, that is considered a clear diagnosis of the syndrome. There are differing diagnostic criteria but generally speaking, if you have three or more of the following signs then you’ll be diagnosed with MS:
• Blood pressure equal to or more than 130/85mm Hg
• Fasting blood glucose equal to or more than 100mg/dl
• In Indians, waist measurement that is greater than 35 inches in men and 31 inches in women
• HDL cholesterol under 40mg/dl in men, and 50mg/dl in women
•Triglyceride levels that are
150mg/dl or more
Sujata Kelkar Shetty, PhD, writes regularly on public health issues and is a research scientist trained at the National Institutes of Health in Bethesda, US.
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