CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Metabolic syndrome (MS) has become one of the major challenges to public health worldwide due to its significant association with an increased risk of developing type 2 diabetes and cardiovascular disease among children, adolescents, and adults. A diagnosis of MS is defined as the presence of abdominal obesity with two or more risk factors, such as high fasting triglycerides (TG), low high-density lipoprotein (HDL) cholesterol, elevated blood pressure (BP), and high fasting plasma glucose (FPG) . For example, an individual with abdominal obesity, along with elevated blood pressure and high FPG has an increased risk of cardiovascular disease (CVD) because of the combination of the risk factors than any factor presenting alone. A prospective cohort study including 6255 subjects indicated that those having one or two MS risk factors were at increased risk for mortality from coronary heart disease (CHD) and (CVD). The study also indicated that MS strongly predicts CHD, CVD, and total mortality as compared to its individual components.
India is a major contributor to the global increase in cardiovascular disease through the increased mortality and prevalence of metabolic syndrome (MetS). MetS is a constellation of physiological and biochemical abnormalities characterized by diabetes or high fasting glucose, central obesity, abnormal cholesterol and triglyceride (TG) levels, and hypertension. This clustering of abnormalities is frequently seen and attributed to people’s dietary habits. One in approximately every 4 or 5 adults has developed MetS depending on the environmental conditions and daily lifestyle habits of the country where he or she resides.
The incidence of this syndrome has been estimated to increase with age for individuals over 50 years of age. MetS affects 27% of the population in India, nearly 30% in Europe, and more than 40% in the US. MetS has been accepted worldwide as a clinical marker for earlier detection of cardiovascular disease and type 2 diabetes. People with MetS are estimated to have twice the risk of developing cardiovascular disease compared to healthy individuals and a five-fold increased risk of type 2 diabetes. However, the underlying pathophysiological processes leading to its development are unclear and there is confusion over its conceptual definitions and criteria, allowing the medical controversy over MetS to continue. An increase in total body fatness and preferential upper body accumulation of fat is independently related to insulin resistance (IR). Obese women with a greater proportion of upper body fat tend to be more insulin-resistant, hyperinsulinemic, glucose-intolerant, and dyslipidemic than obese women with a greater proportion of lower body fat. Therefore, the distribution of body fat is an important correlate of MetS. The term “metabolic” refers to the biochemical processes involved in the body’s normal functioning. Risk factors are behaviors or conditions that increase a disease.
