Cardiovascular Kidney Metabolic (CKM) syndrome, an alarming, intricate interplay of lifestyle and the influence of globalisation on health, is fast becoming a silent, global killer. It begins insidiously, often marked by a gradual rise in body weight and waist circumference that soon escalates into obesity, setting off a chain reaction in the body. Major organs such as the heart, the kidneys, liver and blood vessels bear the brunt, leaving those affected vulnerable to a startling risk — premature death.
In Tamil Nadu, a State known for its strong public health framework, the markers of well-being, i.e., life expectancy, infant and maternal mortality, and deaths from infectious diseases, fare better than the national average. Yet, even here, a troubling transition is underway. The Global Burden of Disease (GBD) report starkly illuminates the mounting burden of non-communicable diseases (NCDs), which account for 69% of premature deaths and 68% of years lost to disability.
According to the 2020 Tamil Nadu STEPS survey (the World Health Organization’s step wise approach for NCD surveillance), 28.5% of participants were overweight. Further, 11.4% had obesity, 33.9% had hypertension and 17.6% had diabetes. This epidemic echoes the findings of the National Family Health Survey (2019-21), which places India’s diabetes prevalence at 16.1% and obesity at a staggering 40.3%. Compounded by low awareness and poor glycemic control, especially among poorer communities, the result is an alarming public health crisis. In addition, hypertension — affecting 24% of men and 21% of women —remains inadequately managed, with less than one-fourth achieving target blood pressure control.
A new paradigm is essential. Without a shift in approach, the impact of the CKM syndrome on middle-aged individuals and on the economy at large will only deepen.
Health economics, the cost of CKM
Tamil Nadu’s health expenditures tell a sobering story. Nearly ₹1,200 crore is spent annually on insurance premiums under the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), covering 1.4 crore families. Topping the list of claims are coronary angioplasty and dialysis, which are both stark outcomes of the CKM syndrome. Meanwhile, the private sector has seen insurance premiums soar, tracking the rise in NCD cases over the past decade. While the aim of the UN’s Sustainable Development Goals is also to reduce NCD deaths by one-third by 2030, the current trends of rising obesity, diabetes, and hypertension rates threaten not only those goals but also the health budget and the economy as a whole.
Need for integrated clinics
The American Heart Association recently laid emphasis on the importance of integrated care for CKM calling for a shift from segmented care to unified, simultaneous management of risk factors. Rather than isolating diabetes, hypertension, heart disease, and kidney disease, the association argues that health professionals should view them as symptoms of a broader metabolic condition.
Today’s management models miss key opportunities for optimal, holistic risk assessment. Patients with multiple affected organs may see separate specialists for each issue, leading to fragmented care, drug interactions, repeated visits, and, ultimately, a loss in wages and productivity. An integrated clinic could address these issues, with a multidisciplinary team of a diabetologist, cardiologist, nephrologist, dietician and physiotherapist working together. Public health teaching hospitals could make this a reality, acting as centres for training medical students and expanding the model to secondary- and primary-care levels.
Tamil Nadu’s health efforts begin early. For pregnant mothers, the State’s Muthu Lakshmi Reddy scheme provides direct cash transfers and nutrition kits, a step toward addressing low birth weight (a known precursor to future diabetes, hypertension, and kidney disease). Could the inclusion of protein-rich foods such as two eggs a day for mothers from the fourth month of pregnancy, further improve outcomes? For the next generation — preschool through secondary schoolchildren — regular weight and obesity screenings could identify high-risk individuals early.
Since the 1960s, rice, which is a high glycemic food, has been widely accessible through the Public Distribution System (PDS), transforming the nutrition landscape. But this staple, while sustaining the population, has also contributed to obesity. In response, partial replacement of rice in the PDS with millets is essential.
In addition, replacement of common salt with low sodium salt can be considered as a pilot project as there is enough evidence for reduction of hypertension with low sodium salt in clinical trials. But there must be caution in people with heart or kidney ailments and where common salt is preferred.
Globalisation and CKM
The lifestyle of today, which is marked by long work hours and night shifts, has been called “the gift of globalisation”, for better or worse. As Alex Soojung-Kim Pang writes in his book Rest, the global economy demands that we ignore our need for rest, idolising workaholism and dismissing rest as a weakness. In reality, rest is essential for productivity and creativity. Long working hours and frequent night shifts lead to brain fatigue and reduced secretion of happy hormones, often counterbalanced by eating super-palatable foods which are rich in salt, sugar and butter. Our physiology, however, tells a different story. Extended work hours disrupt hormone levels, with cortisol (the “stress hormone”) driving unhealthy carbohydrate and lipid metabolism. The result is obesity.
Regulation of work hours and shifts, many argue, is as essential a public health measure as any medical intervention. In the end, the goal is simple. Not only does an economy grow, but there is also a a society that lives longer, healthier and happier. We must pause and ponder over this today, which is also World Diabetes Day (November 14).
Dr. Sakthirajan Ramanathan is Assistant Professor of Nephrology at the Madras Medical College. Dr. Tanuj Moses Lamech is Assistant Professor of Nephrology, SRM Medical College
Published – November 14, 2024 12:08 am IST
