The key factor uniting NAFLD & Metabolic syndrome is the concept of insulin resistance. Resistance to the action of insulin at the cellular/tissue level leads to important changes in lipid and glucose metabolisms. Changes in the lipid metabolism include enhanced peripheral lipolysis, generation of triglycerides & an increased hepatic uptake of fatty acids.

The excess free fatty acids in hepatocytes trigger free radical injury in susceptible individuals. Thus, a category of patients accumulate fat in the liver but do not develop liver injury/fibrosis, whereas another category develops persistent liver cell injury/fibrosis & cirrhosis. In addition to the hepatic fat accumulation a second factor is required for progression from NAFLD to NASH.
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Introduction

A metabolic syndrome is a group of risk factors that includes high blood pressure, high blood sugar, unhealthy cholesterol levels, obesity and increased levels of abdominal fat. At present, one of the fastest-growing pandemics of chronic diseases is obesity. It carries a 39% global prevalence among children and adults. The pathophysiology of obesity is complex associated with hyperplasia and hypertrophy of the adipose tissue. The COVID-19 pandemic is associated with increased hospitalization and mortality. It is predominantly seen in the elderly population and patients with underlying conditions such as obesity and related comorbidities.
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MS includes a variety of abnormalities including obesity, hypertriglyceridemia, low HDL cholesterol, hypertension and diabetes mellitus. It is a well known fact that diabetes and high blood pressure could cause kidney disease. But the question is without these causative factors could MS by itself be the cause of proteinuria or reduced GFR?

This question was answered in a few longitudinal observational studies. A follow up of 10,000 people in Japan for more than 17 years indicated that the occurrence of CKD and body mass index increased risk to 1.273 for men, after adjusting all other components of MS(1). Similarly, over 3,00,000 people in the USA were followed for 35 years and it was proven that an increased body mass index was associated with CKD(2).
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As clinicians, we are all doing our best to obtain a full medical history, diagnose and the prognose the disease to the best of our knowledge and plan a treatment accordingly. Most of the time patients come to our outpatient clinics with a particular complaint and are treated for their symptoms. Patients improve with our treatment and are seen only at the next review. However, what we need to look into as family physicians, is the silent features of metabolic syndrome.

As the name indicates, metabolic syndrome is a constellation of signs rather than the patients’ symptoms and the earlier we diagnose metabolic syndrome, the earlier the patient can be educated about this asymptomatic medical condition.

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Metabolic Syndrome (MetS), which includes diabetes and obesity, is one of the most widespread medical conditions. It is perhaps the leading avoidable cause of premature death. It leads to multi-organ dysfunction over time. MetS has been called a global epidemic by the WHO and is considered a major public health problem.

While the causes of metabolic MetS are complex, high fat diets (HFD), inactive lifestyles, high blood pressure and genetic predispositions are important risk factors. Habitual alcohol and tobacco use also contribute to high blood pressure and to the development of other risk factors in early adulthood, which continue to act in later life. Obesity in conjunction with type 2 diabetes, hypertension, CAD, and dyslipidemia are important features of MetS, which is usually associated with hyperinsulinemia and insulin resistance.
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“Metabolic Syndrome” (MetS), refers to the clustering of abdominal obesity, impaired glucose tolerance, hypertriglyceridemia, diminished high density lipoprotein (HDL) cholesterol, and/or hypertension in an individual. MetS is consistently associated with high Cardio-Vascular event risk and high incidence of Type 2 Diabetes mellitus. Each component of the MetS is an independent risk factor for cardiovascular disease and together enhances and compounds the atherosclerotic risk in the individual. However, this complex disorder is not well understood and it is important to explain the increased CV risk.

It is now known that Central/Visceral Obesity with its Insulin Resistance and or Hyperinsulinemia is central in the pathogenesis of MetS. However, insulin resistance is not considered to be part of the definition in MetS.
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Since we are well aware of the serious impact of metabolic syndrome (DM, HT, obesity, hypercholesterolemia) on Obstetric practice, its effect on mother and fetus, pregnancy complications, need for interventions, intrapartum and postpartum period, it is now time to focus on its short term and long term implications on the reproductive health during the life span of a woman. About 30% of women presenting with gynaecological issues in day to day practice have Metabolic syndrome and its complications.

For ease of understanding, I have classified the impact of metabolic syndrome in gynaecology into the following headings.
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MetS or Metabolic syndrome is a mounting health problem. Its prevalence parallels the rising trends in childhood obesity rates. MetS is a constellation of obesity with metabolic abnormalities that are by themselves a cluster of cardiovascular risk factors (hypertension, insulin resistance, impaired glucose tolerance, dyslipidemia). Although frequently discussed in literature, MetS is a “difficult-to-define” adverse biochemical phenotype due to its fragmentary classification, racial/pubertal differences and lack of cardiovascular events in children, environmental factors and incomplete understanding of its pathogenesis. Besides cardiovascular risk and type2DM, MetS is also associated with oxidative stress, chronic inflammation, hepatic steatosis, non-alcoholic fatty liver disease, obstructive sleep apnea, hypogonadism, hyperandrogenism and polycystic ovary. Given its protean implications, it is imperative for us to understand its pathophysiology, risk factors and to identify schema for management of metabolic syndrome in childhood.
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