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Obesity and the Metabolic Syndrome in Developing Countries
Anoop Misra and Lokesh Khurana J. Clin. Endocrinol. Metab. 2008 93: s9-s30, doi: 10.1210/jc.2008-1595

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Obesity and the Metabolic Syndrome in Developing Countries
Anoop Misra and Lokesh Khurana
Center for Diabetes, Obesity, and Cholesterol Disorders (A.M., L.K.), Diabetes Foundation (India), New Delhi 110016, India; and Department of Diabetes and Metabolic Diseases (A.M.), Fortis Hospital, New Delhi 110070

Context:Prevalence of obesity and the metabolic syndrome is rapidly increasing in developing countries, leading to increased morbidity and mortality due to type 2 diabetes mellitus (T2DM) and cardiovascular disease. Evidence Acquisition: Literature search was carried out using the terms obesity, insulin resistance, the metabolic syndrome, diabetes, dyslipidemia, nutrition, physical activity, anddeveloping countries, from PubMed from 1966 to June 2008 and from web sites and published documents of the World Health Organization and Food and Agricultural Organization. Evidence Synthesis: With improvement in economic situation in developing countries, increasing prevalence of obesity and the metabolic syndrome is seen in adults and particularly in children. The main causes are increasing urbanization,nutrition transition, and reduced physical activity. Furthermore, aggressive community nutrition intervention programs for undernourished children may increase obesity. Some evidence suggests that widely prevalent perinatal undernutrition and childhood catch-up obesity may play a role in adult-onset metabolic syndrome and T2DM. The economic cost of obesity and related diseases in developingcountries, having meager health budgets is enormous. Conclusions: To prevent increasing morbidity and mortality due to obesity-related T2DM and cardiovascular disease in developing countries, there is an urgent need to initiate large-scale community intervention programs focusing on increased physical activity and healthier food options, particularly for children. International health agencies andrespective government should intensively focus on primordial and primary prevention programs for obesity and the metabolic syndrome in developing countries. (J Clin Endocrinol Metab 93: S9 –S30, 2008)

utritional, demographic, epidemiological, and socioeconomic transitions are occurring in many developing countries. Continuing undernutrition and escalating over nutrition has created double jeopardyof communicable and noncommunicable diseases (NCDs) (1, 2). This double burden poses apparently insurmountable health and economic challenges in resource-constrained populations. Obesity is a natural consequence of over nutrition and sedentary lifestyle. Persistent obesity dysregulates metabolic processes including action of insulin on glucose-lipid-free fatty acid metabolism and severely affectsprocesses controlling blood glu0021-972X/08/$15.00/0 Printed in U.S.A. Copyright © 2008 by The Endocrine Society doi: 10.1210/jc.2008-1595 Received July 23, 2008. Accepted September 11, 2008.

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cose, blood pressure, and lipids. Thus begins a cluster of conditions; dysglycemia, dyslipidemia, hypertension, and procoagulant state, known as the metabolic syndrome (3). Data suggest that theobesity and the metabolic syndrome are immediate precursors of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) (4 –7). Increasing burden of obesity, the metabolic syndrome, T2DM, and CVD in developing countries has created an urgent need to strategize health policies and mass intervention programs to tackle nutrition and continue efforts to manage undernutrition. Clearly these...