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November 2015, Volume 65, Issue 11


Metabolic Syndrome: The drums are beating

Sanjay Kalra  ( Department of Endocrinology, Bharti Hospital & BRIDE, Karnal, India. )
Yashdeep Gupta  ( Department of Endocrinology, AIIMS, New Delhi, India. )

A well described medical condition, the prevalence of Metabolic Syndrome is matched by an equally large number of definitions, monikers, and acronyms. Known by various names such as the Deadly Quartet, Dysmetabolic Syndrome, hypertriglyceridaemic waist, insulin resistance syndrome, Syndrome W, Syndrome X, and Reaven\\\'s Syndrome, the concept describes a constellation of clinical features which increase the risk of cardiovascular disease.1 In some parts of the world, apronyms have been coined to facilitate understanding of these features. CHAOS, for example used in Australia, lists five characteristics of cardiovascular dysmetabolism: Coronary artery disease, Hypertension, Atherosclerosis, Obesity, and Stroke.2
Such apromyms go one step further than common-place acronyms (e.g; NASH [non-alcoholic steatohepatitis), which are routinely used in medicine. They help by providing shorter names which convey the essence of the object of description, e.g. the chaotic nature of metabolic syndrome. These apronyms illustrate the biomedical issues related to the condition, in a manner which can easily be understood by non-medical personnel.
We suggest such a term for Metabolic Syndrome in South Asia, using the basic term \\\'DHOL\\\'. The words \\\'dhol\\\', \\\'dholl\\\', \\\'dholak\\\' and \\\'dholki\\\' are used all across South Asia, to describe various types and sizes of drums. These nouns are common to most South Asian languages: Urdu, Nepali, Bengali, Sinhala, and Hindi.
The letters of this word can be used to describe the components of the metabolic syndrome (Table).

Just as the metabolic syndrome can be defined by various parameters, different variants of the \\\'dhol\\\' nomenclature can be used to match these definitions. It is co-incidental that south Asians have a high prevalence of metabolic syndrome as well.3 Recent studies from Pakistan have reported high prevalence of all five \\\'dholl\\\' features in individuals with pre-diabetes4 and with diabetes.5 In view of these findings, it becomes important to spread public awareness and stimulate action to prevent and limit the spread of metabolic syndrome in the region.
The Journal of Pakistan Medical Association has always been proactive in public health. Using the mnemonic \\\'dhol\\\', the medical profession can drum up awareness and concern about metabolic syndrome. "The drums are beating" may be used as a wake-up call for all stakeholders, including patients, the community, physician from all specialties, and policy-makers, to encourage early detection and prevention of the syndrome As ethno-specific cut offs for definition of metabolic syndrome gain universal acceptance,6 we hope that this linguo-specific apronym will achieve popularity, across South Asia, and in the South Asia diaspora. It should be able to enhance public understanding of the metabolic syndrome, and contribute to successful preventive measures for the same.


1. Parikh RM, Mohan V. Changing definitions of metabolic syndrome. Indian J Endocrinol Metab 2012; 16: 7-12.
2. Gale AE. Chronic fatigue syndrome associated with insulin resistance. Poster presented at Chronic Fatigue Syndrome Conference. Sydney. 1998. Online (Cited 2015 May 6). Available from URL:
3. Pandit K, Goswami S, Ghosh S, Mukhopadhyay P, Chowdhury S. Metabolic syndrome in South Asians. Indian J Endocrinol Metab 2012; 16: 44-55.
4. Ahsan S, Ahmed SD, Jamali SN, Imran M, Haque MS, Qasim R. Frequency and risk of metabolic syndrome in prediabetics versus normal glucose tolerant subjects - a comparative study. J Pak Med Assoc 2015; 65: 496-500.
5. Ahmed A, Khan TE, Yasmeen T, Awan S, Islam N. Metabolic syndrome in type 2 diabetes: comparison of WHO, modified ATPIII & IDF criteria. J Pak Med Assoc 2012;62:569-74.
6. Pratyush DD, Tiwari S, Singh S, Singh SK. Waist circumference cutoff and its importance for diagnosis of metabolic syndrome in Asian Indians: a preliminary study. Indian J Endocrinol Metab 2012;16:112-5.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: