European Journal of Cardiovascular Medicine

The metabolic syndrome, also known as syndrome X or insulin resistance syndrome, is a collection of metabolic disorders that significantly enhance the likelihood of developing cardiovascular disease and diabetes mellitus. The primary characteristics of the metabolic syndrome consist of central obesity, hypertriglyceridemia, reduced levels of high-density lipoprotein cholesterol, hyperglycaemia, and hypertension.[1]

The phrase "metabolic syndrome" describes a noticeable grouping of many observations in individuals, including abdominal obesity, insulin resistance (high fasting glucose levels), hypertension, and dyslipidaemia (high triglyceride levels and low levels of high-density lipoprotein cholesterol).[2] An international shift in the illness pattern has been noted, with a decreasing proportion of infectious diseases and a growing prevalence of chronic diseases such as cardiovascular conditions and diabetes mellitus.[3]

In the 2019 meta-analysis, the collective prevalence of metabolic syndrome among the adult population in India was found to be 30%. Among various states of India, Madhya Pradesh had the highest prevalence of metabolic syndrome at 50%, followed by New Delhi at 43%, Odisha at 43%, and Telangana at 42%. The lowest recorded prevalence of metabolic syndrome was observed in Jammu & Kashmir at 15%, followed by Haryana at 18% and Punjab at 21%. The prevalence of the condition rose from 13% in the age group of 18-29 years to 50% in the age group of 50-59 years. The overall prevalence of metabolic syndrome among adult females in India was 35%, whereas for males it was 26%. The combined prevalence of metabolic syndrome among the adult urban population in India was 32%, whereas in the rural population, it was 22%.[4] The current study aims to address two key research questions. Firstly, it seeks to determine the distribution of the sociodemographic profile of metabolic syndrome among the participants of the study. Secondly, it aims to estimate the prevalence of metabolic syndrome among individuals aged 20-80 years in the urban field practice area of CIMS Bilaspur Chhattisgarh.

A descriptive cross-sectional observational study was undertaken in the urban field practice area of CIMS Bilaspur, Chhattisgarh, among the population aged 20-80. The study recruited 540 people utilising systematic random sampling. The study comprised CIMS Bilaspur urban health and training centre residents aged 20–80. Study participants who rejected consent but answered the questionnaire were eliminated. The CIMS Bilaspur Scientific Review and Institutional Ethics Committees approved the study. Participants' privacy and confidentiality were ensured during data collection and release. Study participants gave written informed permission. Data was collected using an NCEP-ATP-III structured questionnaire and a semi-structured socio-demographic questionnaire. Using the NCEP ATP III definition, metabolic syndrome was identified in study participants if three or more (≥3) of the following five criteria were met: [5]

1. Waist circumference over ≥ 102 cm (male) and ≥ 88cm (female).
2. Blood pressure over ≥130/ ≥ 85 mmHg,
3. Triglyceride level ≥ 150 mg/dl.
4. High-density lipoprotein cholesterol level < 40 mg/dl (male) and <50 mg/dl (female).
5. Fasting blood sugar over ≥110 mg/dl.

A demographic profile:
Demographic data includes age, gender, caste, religion, education, occupation, work pattern, marital status, family type, and socioeconomic status. Abdominal obesity, insulin resistance (high fasting glucose), hypertension, and dyslipidaemia are assessed with the NCEP ATP III questionnaire.

Blood and anthropometric measurements. 

Body measures include weight, height, waist circumference, and systolic/diastolic blood pressure. Fasting blood glucose and lipids were taken. Weight and height were measured using calibrated digital scales. The WHO/IASO/IOTF (2000) assessed waist circumference at the halfway between the lower rib cage and the iliac crest using a flexible inch tape. Participants were instructed to sit in a chair with back support for five minutes before testing blood pressure. They were told to keep legs uncrossed and feet flat. Participants were told to be silent and lay their arm with the cuff on a table at chest height during the reading. The blood pressure cuff should be snug but not too tight and on bare skin, not over clothing.[7] Systolic and diastolic pressure were measured three times over three minutes and the lowest reading was used. After an 8-12-hour overnight fast, blood glucose and lipid profile (triglycerides and HDL) were drawn in a red tube. All measurements were done by researcher. The CIMS Bilaspur Biochemistry department laboratory analysed blood glucose and lipid profiles while a digital automatic blood pressure monitor (Dr. Morepen bp 02) assessed blood pressure. 

Table 1: The study sample population is 540, with 48% (259) males and 52% (281) females. Most participants are 20–39 years old, 49.4% (267). Caste-wise, 44.4% (240) of respondents are Other Backward Class. An overwhelming 94.8% (512) of participants are Hindu, and 19.8% (107), have completed high school. The largest occupation group is jobless, at 30% (162). Most participants (67.4%, 364) had a moderate work routine. Marital status shows that 85.2% (460) of participants are married, and 53.7% (290) are nuclear families. According to modified BG Prasad's classification, middle class (class-III) has the highest proportion at 39.4% (213).

Table 2: This study used gender-specific waist circumference cut-offs. In girls (n=281), 64.76% (182) exhibit abdominal obesity (waist circumference ≥88 cm), while in males (n=259), 58.68% (152) exceed the cut-off of ≥102 cm. In females, 57.65% (162) have high density lipoprotein levels below <50 mg/dl, while in males (n=259), 52.50% (136) have levels below 40 mg/dl. Hyperglycaemia was seen in 53.14% (287) of subjects with fasting blood sugar levels ≥110 mg/dl. Hypertriglyceridemia affects 58.52% (316) of people. Of the subjects, 52.03% (281) have normal or prehypertensive blood pressure, while 30% (162) have both systolic and diastolic hypertension (≥130/≥85 mmHg). The overall prevalence of metabolic syndrome was 55% (297), with 65% (183) of females and 44% (114) of males affected.

This cross-sectional observational study was undertaken in the urban field practise area of Chhattisgarh Institute of Medical Sciences Bilaspur to evaluate metabolic syndrome prevalence using NCEP ATP III criteria in 20-80-year-olds. Waist circumference, blood pressure/or on anti-hypertensive medication, triglyceride level, high-density lipoprotein, cholesterol level, and fasting blood sugar/or on anti-diabetic medication are the NCEP ATP III criteria for metabolic syndrome. The prevalence of metabolic syndrome in our sample was 55% (n=297), with women (65%; n=183) having a considerably higher rate than men (44%, n=114). Past studies in metropolitan south India found prevalence between 22.1% to 41%.which is lower than our 55%. The prevalence of metabolic syndrome was 35% in eleven significant Indian cities from 2006 to 2010.Other studies found frequency of 19.52% in urban western India, which is much lower than ours. An international study estimated that 13-15% of Indian adults have metabolic syndrome, with females being more affected (8%-9% among adult males and 18-19% among adult females). A combination of factors contributed to the greater metabolic syndrome prevalence in our community-based investigation. Rapid urbanisation in Bilaspur, Chhattisgarh's second largest city, has led to sedentary lifestyles, increased consumption of processed and calorie-dense foods, and stressful urban environments, which increase the risk of obesity, insulin resistance, and dyslipidaemia, which are key components of metabolic syndrome. The prevalence rate of metabolic syndrome may vary due to different diagnostic components, criteria, geography, and age group. 

Waist Circumference is more common in women (n=281), with 64.76% having waist circumference ≥88 cm. Among males (n=259), 58.68% have abdominal obesity (waist circumference ≥102 cm). Obesity/waist circumference was more common in women (15.6%) than men (13.3%), according to Misra A et al.[11].

Yi-Lin Ma et al.[12] found increased waist circumference in 82.6% women and 68.3% males. 
High Density lipoprotein level: 57.65% of females in this study have blood lipid levels below 50 mg/dl. 52.50% of men (n=259) have serum lipids ≤ 40 mg/dl. According to D. S. Prasad et al. [8], low high-density lipoprotein (84.5%) was the most prevalent anomaly in women. Our study found that women with low high-density lipoprotein had more central adiposity than men. Lower HDL cholesterol is on the rise. According to the WHO, just 4% of Asian Indian men and 5% of women have adequate HDL-C values.[13]

Fasting glucose: Out of the whole sample, 53.14% (287) have hyperglycaemia (≥110 mg/dl). A research by Kayo Kurotani et al.[14] found that impaired fasting glucose is associated with diabetes (8.8%), a risk factor for metabolic syndrome. Number of metabolic syndrome components increased risk, especially impaired fasting glucose. In the Framingham offspring research, Wilson et al.[15] found that metabolic syndrome components with impaired fasting glucose had a 2-fold greater risk of diabetes than other combinations. Also, Merlit James et al.[16] found that 92.85% of the population had increased fasting blood sugar levels according to NCEP ATP III criteria for metabolic syndrome.

Triglyceride level: In this study, 58.52% (316) had hypertriglyceridemia (≥150 mg/dl). Triglycerides correlated positively with metabolic syndrome in another long-term investigation by Li-Xin Tao et al.[17].

Blood pressure: 10.92% (59) had isolated systolic hypertension (≥130 mmHg), 7.03% (38 individuals) had isolated diastolic hypertension (≥85 mmHg), and 30% (162 individuals) had elevated blood pressure in both tests (≥130/≥85 mmHg). Other research by Roshali Senarathne et al.[18] found that hypertensives had a higher rate of metabolic syndrome. Elevated blood pressure (69.3%) was the most common anomaly in men, according to D. S. Prasad et al. 

Strengths: The study's large urban community-based sample size of 540 participants will boost generalizability.
 Limitations: This study is a cross-sectional, one-time examination of surface data, therefore causal conclusions cannot be drawn. Metabolic syndrome risk factors and mediators must be identified through longitudinal follow-up research.

Metabolic syndrome is a multifactorial disorder, and this study found that females (65%) have a higher prevalence than males (44%). Overall prevalence is (55%), indicating a significant health risk, but gender differences must be addressed. The findings suggest metabolic syndrome mitigation requires gender-specific treatments and health initiatives. Customising preventative strategies to address discrepancies can improve public health and well-being.

1. Harrison’s principles of internal medicine. 20th ed. McGraw-Hill Education/Medical; 2018.
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3. Borch-Johnsen K. The metabolic syndrome in a global perspective. The public health impact--secondary publication. Dan Med Bull. 2007;54(2):157–9.  
4. Yuvaraj K, Sathish R, Sharan M, Tanveer R, Jayaprakash S, Sitanshu Sekhar K. Prevalence of metabolic syndrome among adult population in India: A systematic review and meta-analysis. PLoS One [Internet]. 2020;15(10):e0240971. Available from: http://dx.doi.org/10.1371/journal.pone.0240971
5. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet [Internet]. 2005 [cited2024Feb2];365(9468):1415–28.