European Journal of Cardiovascular Medicine

According to WHO definitions, metabolic syndrome is insulin resistance and diabetes mellitus or impaired glucose intolerance with visceral obesity, hypertension, dyslipidaemia, or microalbuminuria. This disorder is linked to insulin resistance, diabetes, ischemic heart disease, and hypertension, both alone and as part of the metabolic syndrome.1
The worldwide illness pattern is shifting toward chronic diseases like cardiovascular and diabetes mellitus and away from infectious diseases.2
The theory of "Epidemiological transition," proposed by Omran in 1971, states that morbidity and death patterns in a nation or community change in phases:
(1) Age of pestilence and famine
(2) Age of receding pandemics
(3) Age of degenerative and man-made diseases’
In this regard, a related and important concept is that of the Epidemiological Transition Level (ETL), which is based on comparison of Disability Adjusted Life Years (DALY) between Communicable and Non-Communicable diseases. ETL is defined as:

DALY due to Communicable; Maternal; Child & Nutritional cause
---------------------------------------------------------------------------------
DALY due to Non-communicable disease and injuries
A declining ratio shows epidemiological transition with a higher burden of non-communicable diseases than communicable, maternal, neonatal, and nutritional diseases. Epidemiological transition theory seems to be correct.
In 1990, the ETL for our country was 1.56, indicating a predominant role for communicable disease over noncommunicable disease in profiling morbidity and mortality. In 2016, the overall ETL for India was 0.50, indicating a major shift in the disease pattern and an overwhelming role for noncommunicable (lifestyle) diseases and injuries. In 2016, the ETL of all states in India was <1, indicating a predominance of degenerative, non-communicable diseases and injuries. Kerala, Goa, Tamil Nadu, and Punjab had particularly low ETLs, while Karnataka, Andhra Pradesh, Telangana, Maharashtra, West Bengal, Himachal Pradesh, Haryana, and Jammu & K had high ETLs.3
The National Cholesterol Education Program's Adult Treatment Panel III (NCEP: ATP III), 2001 defines metabolic syndrome as meeting three or more of the following five criteria: 4
1.Waist circumference ≥ 102 cm (male) and ≥ 88cm (female).
2.Blood Pressure≥130/≥85 mmHg,
3.Triglyceride level ≥ 150 mg/dl.
4.High-density lipoprotein cholesterol < 40 mg/dl (male) and <50 mg/dl (female).
5.High fasting blood sugar (≥110 mg/dl).
Worldwide burden
The prevalence of metabolic syndrome in adults in the United States is believed to be above 25%. The prevalence of metabolic syndrome in 7 European nations was around 23%. Approximately 20%–25% of south Asians have metabolic syndrome, and many more may be susceptible.5
Burden in India
Insulin resistance and MetS are common in India. Studies indicated that age-adjusted metabolic syndrome prevalence in urban Indian populations was 25% (31% in women and 18.5% in men). Age-related prevalence is rising in men and women.6
Another worldwide study showed that 13-15% of India's adult population has MetS, with females being more affected (8%-9% for males and 18-19% for females).4
Chhattisgarh burden
Young, rising industrial state Chhattisgarh has a western lifestyle due to urbanization, putting the people prone to cardiovascular disease.
Numerous community-based research show that METs is becoming a major public health issue, particularly in poorer nations. It was part of Madhya Pradesh before 2000. On November 1, 2000, Chhattisgarh became a state. According to 2011 census, Chhattisgarh has 2.56 crore people. The total 25,545,198 includes 12,832,895 men and 12,712,303 women.7
The community-based cross-sectional study was planned to estimate the prevalence of metabolic syndrome and distribution of associated risk factors among adult population in urban field practice area of CIMS Bilaspur Chhattisgarh since there are no published reports.

This Community-based cross-sectional observational study was conducted in Department of Community Medicine CIMS, Bilaspur from November 2021 to October 2022, to estimates metabolic syndrome prevalence and risk variables in 20-80-year-olds in CIMS Bilaspur Chhattisgarh's urban field practice region. Institutional scientific review and ethical committee clearance was obtained before the project. A total 540 systematic random samples was taken. Statical analysis was done using Microsoft excel sheet 2019. Data was analysed using frequencies and percentages and Positive and negative METs were created.

Subjects were characterized by NCEP-ATP-III guideline as-
1.Subjects with ≥ 3 positive MET components were indicated as having metabolic syndrome.
2.Participants with any of the 3 criteria (WC >102 cm in men and ≥88 cm in women, BP ≥ 130/ ≥85 mmHg or on HTN treatment, FBS ≥110 mg/dL or on Diabetes treatment) except changed triglyceride and HDL levels will undergo lipid profile estimate and blood sample collection.
Study tools: semi-structured pre-tested proforma, anthropometric assessment, blood pressure, fasting blood sugar, lipid profile.
Study technique- Self-administered questionnaire.
Inclusion criteria
1. Who turned 20.
2. Study volunteers (20–80).
Exclusion conditions
1. Woman pregnant.
2. Bedridden, unwell patients.
Study variables:-
Dependent variables- Lifestyle, BMI, Smoking, Alcohol, Dietary patterns, Physical Activity, Anthropometric measures
Independent variables:- Age, Sex, Socio-economic status, Education level.

Bjørn Hildrum et al(2006)8 found that the highest number of participants were aged 40-59 (24%), followed by 20-39 (20%). According to Sanjib Sharma et al.,(2011)9 the majority of participants were 20–40 years old (7729), followed by 41–60 years old (4880).
Hye Soon Park10 2003 found 3937 (45.5%) men and 4713 (54.5%) women. Male 590 (50.1%) and female 588 (49.9%) in Prasad11 (2001) study.
Table 1 shows most participants attended primary 114 (21.1%), then high school. 107 (19.8%), 91 (16.9%), and 102 (18.9%) study participants were illiterate. Shabana Tharkar 12(2008) found 249 (62.1%) high school graduates and 126 (31.4%) graduates.
Okubatsion Tekeste Okube13 (2019) found 307 (76%) married, 69 (17.1%) unmarried, while Eyitayo Omolara Owolabi14 (2017) found 637 (63.9%) single, 300 (30.1%) married.
In Table 1, the majority of participants (39.4%) were from class-III socioeconomic status, followed by class-II SES (23.3%), and least from class-I. SES 42 (7.8%) According to Vinayagamoorthy Venugopal15 (2017)high SES participants were 151 (30.9%), lower
SES participants 142 (29%), and upper SES participants 19 (3.9%).

EUROPEAN JOURNAL OF CARDIOVASCULAR MEDICINE Volume:14 Issue:2
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Table 2A indicates 174 (32.2%) vegetarians and 366 (67.8) non-vegetarians. Table 2B reveals that 456 (84.4%) people have normal salt intake, 37 (6.9%) add more salt, and 47 (8.7%) eat minimal salt.Table 2C demonstrates that 367 (68%) of individuals didn't eat packed food, whereas 173 (32%) did.
Table No. 3 Physical activity and substance abuse of study participant (n=540)
Table 3A reveals 334 (61.9%) participants exercise regularly, while 206 (38.1%) do not. Hyo Kyung Lim16 (2018) et al. found that exercise lowers METs.
Table 3B reveals that 69 (42.59%) people used smokeless substances, 46 (28.40%) multiple substance abusers, 24 (14.81%) smokers, and 23 (28.40%) alcoholics. Alcohol users have increased METs prevalence, according to Inkyung Baik17 et al. (2008). Drinkers also had significant METs component prevalence, according to Vasilios G. Athyros18 et al. (2007).
In a similar study by Abdulbari Bener 19 et al. (2013), 470 (30.3%) participants had a positive family history of METs and 1082 (69.7%) had a negative history. In Table 4B, 33 (29.20%) have hypertension and 25 (22.12%) have diabetes. 25 (22.12) have dyslipidemia and 30 (26.55%) have various illnesses. Das et al 20. (2012) found 107 (23.88%) have diabetic family histories.
Table 4C reveals that 94 (17.4%) participants were taking medicine, 54 (5.445%) for less than 5 years and 40 (42.55%) for more than 5 years.

Table 5 shows that 261 (48.3%) participants had normal BMI, 168 (31.1%) were overweight, 73 (13.5%) were obese, and 38 (7%) were underweight. Antonella Agodi et al 21. (2018) found 937 (48.5%) participants had normal BMI. 632 (33%) were overweight, 58 (2.95) underweight. Another study by Basma Damiri et al 22. (2015) found 191 (58.1%) overweight subjects and 126 (38.3%) normal BMI.

In Table 6, 49 (9.1%) male participants have WC >102cm and 17 (32.7%) females have WC >88cm, meeting ATP-III diagnostic criteria for METs. A similar study by Jose P. Lopez-Lopez et al 23 (2021) found 858 (50.3%) males in the 3rd quartile and 488 (28.6%) females in the same level.

In 55% (297) of participants, metabolic syndrome is more common in women than males (Table 7). Specifically, 65% (183) of female and 44% (114) of male individuals were affected. Strengths: This study's large urban community-based sample size of 540 participants will boost generalizability. Limitations: This cross-sectional study is a one-time examination of surface data, therefore causal conclusions cannot be drawn. Identifying metabolic syndrome risk factors and mediators requires longitudinal follow-up research

Metabolic syndrome is a complex problem, and 28% of research respondents had METs, but only a handful were aware of their condition and sought therapy. This study found that low education, bad diet, and obesity (BMI) were key contributing variables for males and low SES and unemployment for females. Diet, obesity, and education are key to preventing METs and improving quality of life. Community awareness should be prioritized.
Recommendations
Ongoing METs issues in India are a major difficulty. Few MET studies have been done in Chhattisgarh, despite many elsewhere in India. Increased prevalence of METs in the research area and their relationship to risk variables discovered by this study suggest numerous areas for focus. Despite India's National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) addressing all major concerns, the current study suggests the following effective actions are still needed:

Individual targets include regular physical activity, improved diet, health check-ups, medication compliance and stopped addiction. 1. Engage in regular physical activity (e.g., walking, running, gym) to reduce weight, abdominal obesity, and BMI. 2. Improving diet by reducing sugar, salt, and fat consumption, particularly saturated and trans fats. 3. Regular health check-ups and follow-ups for blood pressure and sugar. 4. Patients with METs components should take medication regularly to prevent additional damage and advancement. 5. Quitting alcohol, smoking, and other addictions.
At the community level, "sensitization sessions" are necessary to educate locals about METs in their native language and promote awareness. 2. Organize "wellness activities" to promote health, educate, and raise awareness about the long-term consequences of bad eating habits, addictions, salt intake, and sedentary lives. These activities should include anganwadi staff, school instructors, local leaders, preachers, and others. 3. Encourage adequate follow-up, medicine, and knowledge of long-term complications about loss to follow-up. 4. Healthcare providers should educate the public to increase healthcare system usage and improve health-seeking behaviour. 5. Lack of necessary drugs and diagnostic kits in health care institutions might lead to community distrust and undermine health-seeking behaviour.
At Government level:
1.Governments should guarantee necessary medicines and testing kits reach the grassroots level. 2. Despite theoretical differences in population and health care facility ratios, more facilities are needed in the community. 3. Provide adequate room for wellness activities in healthcare facilities. 4. The state government could optimize "De-addiction centers" at district levels to aid in quitting smoking and drinking. Later, block-level de-addiction centres should be constructed. 5. Large-scale study is necessary to discover all population risk variables

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