Correspondence Renal Consequences of Metabolic Syndrome Sir, Obesity has become a major public health problem worldwide, as a result of abundant food, sedentary lifestyle and Thrifty gene phenotype. The study by Gupta et al in a large group of randomly selected adults has shown a continuous positive relationship of all markers of obesity (body-mass index, waist size and waist hip ratio) with major coronary risk factors- hypertension, diabetes and metabolic syndrome.1 Recent studies have shown that Metabolic Syndromes (MetS) has harmful effects on the kidney also. Chagnac has demonstrated the renal pathological changes in obese Zucker rats.2 These rats develop hyper-filtration, proteinuria, glomerulomegaly and focal segmental glomerulosclerosis. Studies in obese humans have confirmed these findings.3,4 Higher the body mass index, more the prevalence of end-stage renal disease after adjustment of blood pressure and presence of diabetes.5 In another study of 10,000 non-diabetic USA subjects with a normal baseline glomerular filtration rate, who were followed for nine years, the adjusted risk of developing chronic kidney disease (CKD) was 43% higher in subjects with the MetS.6 The pathophysiological factors contributing to renal disease include insulin resistance, adipocytokines, endothelial resistance, renin-angiotensin-aldosterone-system activation and oxidative stress. The problem often starts in childhood. The popular myth ‘A chubby child is a healthy child’ is proving to be a bane for public health. Majority of obese children grow up to become obese adults. They are exposed to the metabolic consequences of obesity for a far more prolonged period, and hence are more likely to develop the renal complications. Mehta et al in a study of affluent Delhi schoolgirls has shown that the prevalence of obesity and overweight is 5.3% and 15.2% respectively.7 More than half of these obese children have central obesity. It is likely that in the coming years they may pose a huge burden on the already fragile renal health delivery system including dialysis facilities. The main utility of the concept of MetS is that it is a powerful public education tool. The cluster of clinical features, its complications and treatment, which essentially consists of life-style changes, can be easily explained and impressed upon the minds of the lay public. Hence it should become a part of the school health and other public education programmes, so that the epidemic of MetS can be nipped in the bud and its serious consequences in adulthood averted. So far there are no Indian studies on the renal consequences of MetS. We hope that future studies in India will be more comprehensive and also include the renal effects of MetS. D Bhowmik*, SC Tiwari** *Asociate Professor; **Professor and Head, Department of Nephrology All India Institute of Medical Sciences, New Delhi. REFERENCES 1. Gupta R, Rastogi P, Sarna M, Gupta VP, Sharma SK, Kothari K. Body-mass index, waist-size, waist-hip ratio and cardiovascular risk factors in urban subjects. J Assoc Physicians India 2007;55:621-7 2. Chagnac A, Weinstein T, Korzets A, Ramadan E, Hirsch J, Gafter U. Glomerular hemodynamics in severe obesity. Am J Physiol Renal Physiol 2000;278:F817-F822. 3. Kambham N, Markowitz GS, Valeri AM, Lin J, D’Agati VD. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int 2001;59:1498-1509. 4. Chen J, Muntner P, Hamm L, Jones DW,
Batuman V, Fonseca V, Whelton PK, He J. The metabolic syndrome and chronic
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disease in a screened cohort. Kidney Int 2004;65: 6. Kurella M, Lo JC, Chertow GM. Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. J Am Soc Nephrol 2005;16:2134-40. 7. Mehta M, Bhasin SK, Agarwal K, Dwivedi S. Obesity amongst affluent adolescent girls. Indian J Pediatr 2007;74:619-22.
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