Metabolic syndrome--emerging clusters of the Indian phenotype.

Some 250 years ago, JB Morgagni with the help of only a knife for anatomical dissection, an acute mind, and an observational skillfulness was able to identify the intraabdominal and mediastinal fat accumulation in android obesity. 1 He clearly described the association between visceral obesity, hypertension, hyperuricemia, atherosclerosis and obstructive sleep apnea syndrome, long before the modern recognition of this syndrome. The concept of insulin resistance is more than 250 years old and was first described in the 20th century by Himsworth, when in Lancet he wrote about subdivision of diabetes into insulin sensitive and insulin resistance in 1936. Yet it needed Prof. Gerald Raeven who delivered the famous Banting Oration in 1988 to introduce the concept of Insulin Resistance. Several terms are used for the same entity namely, Insulin Resistance Syndrome, Reaven’s Syndrome, Metabolic Syndrome, Deadly Quartet, CHAOS, New World Syndrome, Civilization Syndrome, Syndrome ‘X’ etc. The latest term used is ‘Metabolic Syndrome’ as per ATP III and WHO. 2 Metabolic Syndrome is now being increasing recognised as an emerging threat which will invade desktops of public health policy planners in the decades to come. The clusters which make this syndrome and its etiopathogensis will keep getting varied in different ethnic populations, regions and countries. Factors like migration, socioeconomic status, lifestyle, nutrition habits play important role. Therefore research in Metabolic Syndrome provides an interdisciplinary forum to explore the pathophysiology, recognition, and treatment of the cluster of conditions associated with the evolving entity of metabolic syndrome. These include but are not limited to: central obesity, endothelial dysfunction, insulin resistance, dyslipidemia, glucose intolerance, type 2 diabetes, prethrombosis and pro-inflammatory states, hyperinsulinemia, hyperuricemia, hypertension, cardiovascular disease, and polycystic ovarian syndrome (PCOS). The individual conditions are only parts of a more generalized problem that requires more than simply correcting a single lab value. For a majority of those affected, inappropriate or poor or defective nutritional status and lack of physical activity are the root causes in the disease process. Metabolic syndrome is estimated to affect more than one in five adults, and its prevalence is growing in the adult and pediatric populations. Metabolic Syndrome and Related Disorders will be pertinent to the practice of the general physician as well as the endocrinologist, the cardiologist, the diabetologist and other specialists. Metabolic Syndrome always lacked a structure and has different facets seen by different specialists. Diabetologists see it as insulin resistance, cardiologists see it as dyslipidemia and syndrome X, it is polycystic ovarian syndrome for the adolescent physicians and ob-gyn specialists. However both auxological/ anthropometric variables as well as lipid levels need more Asian Indian validation. Each component of cluster has variations based on several factors including migration status, socio-economic class, rural-urban subclass etc. The body fat pattern and lipids are particularly making the Asian Indians coronary prone. Unfortunately the Asian Indian studies outside India outnumber the studies from India. 3 In this issue two groups form North West India report two different but relevant clusters which eventually will be used later to qualify the real Indian criteria for both lipids and may be even Metabolic Syndrome; namely lipid cluster form Chandigarh 4 and low socioeconomic cluster form Jaipur. 5 The group from PGI Chandigarh reports ;Isolated lipid abnormalities in 47 to 51 % in rural-urban non diabetic cohort