Prof. Dr. Arjun Dev Bhatta/ Dr. Sergei Dev Bhatta

Advances in medicine and nutrition have dramatically increased life expectancy around the world. An important challenge that needs to be tackled by lawmakers and physicians in Nepal is popularisation of a “next level thinking” among general masses so as to avoid trends previously seen in other nascent economies - emerging markets and getting richer. They have also experienced an increase in prevalence of obesity similar to what is seen in developed countries.

Overweight and its more severe form, obesity, are conditions in which excess body fat has accumulated in an individual. Both are commonly discussed in popular press because their negative effects on health are well-known. By some estimates, more than 20 per cent of all adults in Nepal are overweight or obese. This problem is not limited to adults. Some reports suggest that more than 10 per cent of children and adolescents in the country are overweight, putting them at high risk of obesity in adulthood.

Improvements in the standard of living in Nepal and associated increase in consumption of energy-dense, carbohydrate-rich, nutrition coupled with physical inactivity, has been steadily contributing to increase in prevalence of one particular form of obesity called abdominal, also known as central, obesity, seen when excessive amount fat has built up in the abdominal area.

Metabolic Syndrome
While excess weight in general is a leading cause of morbidity and mortality, central obesity has been shown to be a better predictor of disease and is a component of the often-overlooked metabolic syndrome, sometimes known as Syndrome X. Metabolic syndrome is a multi-factorial disorder. According to research conducted in 2022, it causes at least three of the following five medical abnormalities observed simultaneously. Men’s waist circumference increases up to around 90 cm and women 80 cm but this varies according to countries. Other complications include elevated fasting glucose, triglycerides, blood pressure (even if it is controlled with medication) and low high density lipoprotein (HDL, a type of cholesterol-protein complex found in blood, often called “good” cholesterol.

It has been well documented that patients with metabolic syndrome are at increased risk of type 2 diabetes, cardiovascular disease, reproductive abnormalities, and many other problems, but more recent data shows that metabolic syndrome is also associated with diseases of prostate, namely BPH (benign prostate hyperplasia) and prostate cancer.

Prostate gland is an important part of the male reproductive system. Women don’t have a prostate that is located just outside the urinary bladder and surrounds urethra. Prostate anomalies can directly affect urinary flow and in the worst-case scenario, urination becomes impossible, requiring urgent help. Over 50 per cent of males older than 50 and 90 per cent of males older than 80 years of age have BPH. In simpler terms, every second man past 50, and nine out of ten men above 80 years of age suffer from BPH. BPH has been shown to be closely related to age-associated hormonal changes, and results in enlargement of prostate. BPH can be treated with medications or surgically. BPH is not related to prostate cancer and does not progress to prostate cancer.

Prostate cancer is one the most common cancers diagnosed in males. Data from the USA shows that it is the second most common cause of death due to cancer in men followed by lung cancer. In the US, approximately one in eight men will be diagnosed with it, and one man in 41 will die of prostate cancer. The word “metabolism” broadly encompasses sum of all bodily reactions at the molecular and microscopic levels that enabled individual organisms to maintain life. Metabolic changes in our bodies happen from conception until death and are a part of normal aging.

In metabolic syndrome, increased fat deposition in the abdominal viscera perturbs the normal biochemical metabolism and equilibrium necessary to maintain health, and creates a state of chronic systemic inflammation accompanied by physiological and pathological responses. This persistent metabolic aberration leads to formation of a vicious cycle, resulting in increased insulin resistance, hypertension, and dyslipidemia. The individual diagnostic characteristics that make up this syndrome have long been known to be predictive of both morbidity and mortality in the population, but what makes metabolic syndrome critically important, is that the concurrent presence of these features significantly increases the cumulative risk to patients’ well-being.

Over time, this metabolic perturbation can affect different organs and prevent them from functioning normally. A variable extent of pancreatic damage with resultant diabetes, fatty liver disease, cardiovascular disease with associated abnormalities, and other pathologic conditions have been ascribed to metabolic syndrome. Even though a large proportion of men experience prostate abnormalities at some point in their lives, association of metabolic syndrome and prostate was first documented only in 1998. The biological pathway leading to changes in prostate has not been yet elucidated, but it is easy to surmise that here too, the systemic chronic pro-inflammatory state alters the hormonal balance and acts in concert with other factors, mimicking metabolic derangements which lead to BPH or facilitate development of prostate cancer otherwise.

Correlation
Correlation between prostate volume and individual components of metabolic syndrome in men with BPH was first confirmed more than 20 years ago, and observations of larger prostate gland volumes in men with diabetes mellitus and men with obesity were independently voiced by many urologists prior to that. Given the preponderance of prostate disease among the population, it is extremely important to draw attention to this detrimental association. The number of patients suffering from lower urinary tract symptoms related to prostate abnormalities, who concurrently have obesity or diabetes, has increased substantially. Obesity’s direct contribution to cardiovascular disease incidence has been well established fact, and it’s high time to add one more reason why weight control is important: reducing those “few extra” kilogrammes along the midsection is vitally important for prostate health as well!

Diseases of prostate affect men in the second half of life, and it is increasingly recognised that they might be preventable to a certain extent. Metabolic syndrome develops over years and requires time, patient dedication, and targeted intervention to treat. It must be addressed whenever possible, as soon as possible. Lifestyle changes that incorporate both, calorie restriction and increase in physical activity have been noted to decrease the body weight and associated risk factors. Clinical evidence supports curtailing smoking and alcohol consumption. Appropriate medical or surgical treatments must be used judiciously to alter or slow the progression of disease. With increasing life expectancy, it’s never too early to start taking care of your health.

(Dr. Arjun Dev Bhatta is a consultant urologist at Medicare Hospital. Dr. Sergei Dev Bhatta is a medical teacher in the US.)