metabolic syndrome X

Sweet disease

Your Health
DR GITA MATHAI

A waist-hip ratio (the narrowest part of your waist divided by the widest part of your hips) greater than 1 in men and 0.8 in women is risky
Vellore recently hosted an endocrinology conference that was attended by almost 1,000 physicians. The experts discussed health issues linked to various hormones, but more than half the conference was devoted to diabetes. This was not surprising. After all, we are in the midst of a global epidemic. The physicians talked about new issues, the latest advances, pancreatic islet cell transplant surgery and hopes of an eventual cure. Exciting new developments were discussed. An eminent professor has actually managed to modify insulin so that it can be injected just once a month for good sugar control. Of course, only mice have benefitted thus far, but everyone is hopeful of successful human trials in the near future.

Diabetes has affected 11 per cent of India’s urban population and 3 per cent of the rural population above the age of 15. This may be an underestimation as 30 to 40 per cent of diabetics in India go undiagnosed until complications set in.

But why do we have this predisposition to diabetes? One theory is that India survived several famines, and in the process we evolved genetically and developed a “thrifty” gene. This conserves calories and converts food into fat which is then deposited in various parts of the body. That is why Indians, even thin individuals, tend to have a “tummy”. The first place we put on weight is around the middle.

Metabolic syndrome usually occurs in people who have a close relative like a parent or sibling with diabetes. Women at risk may have polycystic ovarian syndrome (PCOS) or develop diabetes during pregnancy (gestational diabetes).

It is possible to determine if a person is at risk for developing diabetes by recording certain biometric criteria. Such an individual has elevated fasting blood sugar levels of more than 125mg/dL or a random sugar value of more than 200mg/dL. The glucose tolerance test may be impaired. The lipid profile is deranged with triglycerides greater than 150 mg/dL, and HDL cholesterol less than 40mgdL in men and 50 mg/dL in women. The blood pressure is also higher than 135/85. Those who exhibit these abnormalities are said to suffer from “metabolic syndrome” or “syndrome X”.

It is also possible to evaluate yourself using a weighing scale and measuring tape. Risk factors are a BMI (body mass index) more than 30 (BMI = weight in kilogram divided by height in metre squared), a waist to hip ratio greater than 1 in men and 0.8 in women (this is the narrowest part of your waist divided by the widest part of your hips), and a waist measurement greater than 102cm in men and 88 cm in women. These anthropometric measurements do not require medical expertise.

If three or more of the above criteria are present, the person suffers from metabolic syndrome. When checking a cross section of the population, a staggering 40 per cent of those above the age of 15 were found to be affected.

Does this mean the majority of us are doomed to become diabetic?

To prevent syndrome X, and later its progression to diabetes, first the biochemical abnormalities have to be corrected. The abnormalities occur because of insulin resistance. Normally, the food we eat is converted into glucose which enters the cells of the body to provide them with energy. In people with syndrome X, the cells are resistant to insulin. Higher amounts of insulin have to be secreted to force the glucose to enter the cells. Eventually, the body is unable to produce enough insulin to do this and diabetes sets in.

Tackling the insulin resistance attacks the beginning of syndrome X. The most effective way to do this is to achieve and maintain the ideal body weight or a BMI of 23.

Aerobic activities like walking as little as 30 minutes every day will reduce insulin resistance. This has to be at a brisk pace, fast enough to prevent conversation except in short bursts. Ideally a pace of 4km/hr should be maintained. Although this is just about sufficient for fitness, an hour of walking, combined with caloric restriction (1,500 calories), is ideal. Cycling or swimming can be done instead.

If time is a constraint, climb stairs for 20 minutes. Weight lifting and other gym exercises increase strength and flexibility but do not help control syndrome X unless they are combined with aerobic activity. Also, exercises for spot reduction of abdominal fat alone, attempting to correct an abnormal waist-hip ratio, without overall weight loss do not work.

Caloric restriction can be achieved by reducing the amount eaten during each meal by 25 per cent. Reading, watching television and other mind diverting activities during meal times increases caloric intake. Also, fill up on fruits and vegetables and avoid snacking. Oils add hidden calories to food. Consumption should be restricted to 500 ml per person a month.

Healthy eating and the habit of regular exercise should be ingrained in children by parents.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in