“Metabolic syndrome is a cluster of cardiovascular risk factors like hypertension, dyslipidemia, adiposity and insulin resistance,” says Dr. AK Pancholia in an interview with Dr. Manish Verma “The IDF criteria define metabolic syndrome in India as- waist circumference over 90 cm for men and 80 cm for women (obesity), triglycerides over 150, HDL less than 40 in men and less than 50 in women, blood pressure beyond 130/85 and fasting plasma glucose of 100 mg/dL.” In differentiating Indians, Dr. Pancholia says, “For the same BMI, Indians have a higher percentage of body fat then the Caucasians. The most important component of the metabolic syndrome, diabetes, is also highly prevalent in Indians along with high hepatic triglycerides and high insulin resistance.” Dr. Pancholia also points out that Indians are more prone to diabetes and metabolic syndrome because of lifestyle factors like lack of exercise, less consumption of fresh fruits and vegetables, an abnormal dietary pattern, and higher consumption of carbohydrates. Getting HDL, triglyceride and insulin resistance checked at regular intervals can warn a person of an impending attack of metabolic syndrome.

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Complete Transcript:

Dr. Manish Verma Dr. Pancholia, thank you so much for taking out time and discussing with us very important subject today. Metabolic syndrome is a very important disease which is affecting the western as well as the Indian population and we all are interested in knowing about your work on how the metabolic syndrome in Indians is different or same as compared to the western population.
Dr. AK Pancholia As you know, the metabolic syndrome is the cluster of cardiovascular risk factors like hypertension, dyslipidemia, adiposity and insulin resistance. When it is associated with other risk factors, it may lead to coronary artery disease with a high CVD and these all cause mortality. Now, there are different definitions proposed by different agencies and the most suitable related to the Indians are the IDF criteria that is central obesity on one part . When the waist circumference over 90 cm for male and more than 80 cm for female it is the obesity. When the triglycerides are more than 150, HDL less than 40 in male and less than 50 in female, blood pressure 130/85 and beyond and fasting plasma glucose of 100 mg/dL then it constitutes the metabolic syndrome and that actually fits into the Indian criteria also. Indians, in fact, have a low BMI and have a high percentage of body fat, particularly intraabdominal fat and fat at the ectopic sites also, the liver, muscles and all those. So that is the basic difference and there was a Y-Y hypothesis which has been created, the Indian Yajnik and the British Yudkin and they found that the BMI was same in both the people, but the body fat percentage of the Indian is 22% and it is only 9% to the British. So, with the similar BMI we have a high fat percentage. So that is the basic difference between Indians and the Caucasians. Apart from that, the Asian-Indians have high hepatic triglycerides also, high intramyocellular fat percentage also and they have high CRP also, inflammatory markers as compared to the Caucasians which has been reported. The most important component of the metabolic syndrome is diabetes which is also highly prevalent in Indians as compared to the Caucasians. The insulin resistance is more and then glucose disposal is more which is all related to the Indians. So that is why Indians are different from the Caucasians.
Dr. Manish Verma Thin effect. Hhow should a doctor or a patient judge actually, you said about 90 cm in male and 80 cm in female. That is one of the most important factors for abdominal obesity . Is that what you are rifting to, to be the first marker and whether the BMI should be chosen or?
Dr. AK Pancholia No, waist circumference should be chosen rather than BMI.
Dr. Manish Verma Rather than BMI because BMI may be false indicator.
Dr. AK Pancholia Yes.
Dr. Manish Verma Any other differences, you mentioned about diabetes also being very common in India as compared to the western population. So, are Indians prone to diabetes even when they are normal weight or?.
Dr. AK Pancholia Even with the normal weight, with the lean body also they have insulin resistance. Another issue is related to the thrifty genotype and phenotype related to the mal-adoption during the crisis. So that is related more to the Indians.
Dr. Manish Verma Any particular reasons why this is happening with us at this point of time?
Dr. AK Pancholia Because of several lifestyle factors which contribute more to the Indians, the lack of exercise, less consumption of the fresh fruits and vegetables, more abnormal dietary pattern also. We consume more carbohydrates as compared to the Caucasians and that is responsible for more hyperinsulinemia and postprandial hyperglycemia with lower levels of HDL and higher levels of triglycerides. So, lifestyle factor contributes more to why the diabetes is more prone in Indians and why metabolic syndrome is more prone in Indians. Another issue, why we have more fat percentage as compared to the Caucasians, because the subcutaneous area in the Caucasians is more. So they adopt adipose tissues during the positive energy balance. While in case of these Asian-Indians, they have less capacity to adopt this adipose tissue in the subcutaneous area and that spills over into the intra-abdominal area and the ectopic sites and therefore we have more fat percentage.
Dr. Manish Verma You mentioned about these patients being at risk for heart disease as well .
Dr. AK Pancholia Very high, yes.
Dr. Manish Verma Any particular age or any particular type of heart diseases which they are prone to?
Dr. AK Pancholia There is no age with metabolic syndrome. At very younger age also they are prone to get this problem and they have more severity of the coronary artery disease, more diffuse coronary artery disease with metabolic syndrome and they get early also. Indians, they are getting metabolic syndrome and all the complications 10 years early as compared to the Caucasians.
Dr. Manish Verma At what age you would recommend that doctor should start looking for metabolic syndrome?
Dr. AK Pancholia Right from the early childhood, because in India, we are now observing more childhood obesity. So why not to target right from the school age.
Dr. Manish Verma How frequently the examination should be done and what should be the preventive and treatment strategies?
Dr. AK Pancholia If we find abnormal lipids , then it should be checked every three months; otherwise it is to be at yearly interval. Same thing for the blood sugar levels also, insulin resistance also. Now HOMA-IR is being checked regularly. So HDL, triglycerides, insulin resistance all can be checked at a regular interval.
Dr. Manish Verma The theme of the conference is prevention, so any particular strategies for preventing metabolic syndrome in Indians?
Dr. AK Pancholia One is the lifestyle changes, change in the dietary pattern, regular physical exercise, less consumption of carbohydrates and fats, so that is one and then prevention of development of diabetes from impaired glucose tolerance by physical exercise and by giving drugs also, control of diabetes by anti-diabetic drugs, then control of dyslipidemia by lipid-lowering drugs and control of hypertension by anti-hypertensive drugs. Selection of the anti-hypertensive would be more in related to the RAS blockers. Because RAS blockers itself reduces weight also by distributing the fat.
Dr. Manish Verma So, pharmacotherapy also plays a role and in general, once the patient gets diagnosed with a particular condition, you mentioned about pharmacotherapy, but in past, there has been a concept of some preventive therapies as well, like the polypill ethics, any idea, or any opinion from you on that.
Dr. AK Pancholia Polypill is a new concept and a new introduction in the preventive cardiology by targeting multiple risk factors with a single capsule, targeting hypertension, targeting dyslipidemia and targeting thrombotic state also in one polypill. So that is a good concept and it is more acceptable in Indians because of the poor compliance in Indians. So compliance will be improved, adherence to the therapy will be improved with the polypill.
Dr. Manish Verma Thank you so much. Any final words on the metabolic syndrome, any final word or any message to the audience.
Dr. AK Pancholia Message to the audience is that be aware of the metabolic syndrome because it is highly responsible for the coronary artery disease, so change in lifestyle is very, very important, so go for the regular exercise, cut down you fats and carbohydrates in the diet, avoid smoking and control of your diabetes is very, very important in order to prevent coronary artery disease in the future.
Dr. Manish Verma Thank you very much.

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