Like many 40-somethings, Nitin Patil (name changed on request) blamed his breathlessness on long office hours, skipped workouts, and “getting older”. He never imagined that climbing a flight of stairs was his heart quietly asking for help. Although he had no previous history of heart disease, detailed evaluation revealed obesity, high blood pressure, prediabetes, high cholesterol levels, and early-stage fatty liver.DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.“So, these were the signs of underlying metabolic dysfunction. These conditions had already begun placing excessive strain on his heart and blood vessels, increasing his risk of developing coronary artery disease, heart attack, heart failure, and stroke if left untreated,” said Dr Rahul Gupta, director, cardiologist, Gleneagles Hospital, Parel.Until a few years ago, most people had never heard the word ‘metabolic’. Today, it seems to be everywhere. Doctors now talk about metabolic syndrome, metabolic health, metabolic dysfunction, metabolic obesity, and metabolic disease, so much so that many of the familiar illnesses are even getting renamed.Fatty liver has become Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD); PCOS is now Polyendocrine Metabolic Ovarian Syndrome(PMOS), and the latest American Heart Association guidelines identify the cardiovascular-kidney-metabolic health or CKM syndrome as an urgent risk factor.Why does it matter to you and me?Metabolic health is not just about weight; it also involves factors like blood sugar control, cholesterol levels, blood pressure, body composition, physical activity, sleep, and nutrition. “Spotting metabolic dysfunction early allows us to prevent multiple chronic diseases before they advance and greatly affect long-term health,” said Dr Pranav Ghody, consultant endocrinologist and diabetologist, Wockhardt Hospitals, Mumbai Central.Millions of Indians don’t know they already have metabolic dysfunction because it often causes no pain or obvious symptoms. By the time diabetes, heart disease or kidney disease appears, the damage may have been building silently for years. Many people discover metabolic dysfunction only after a routine health check-up, or worse, after a heart attack.Story continues below this adThink of metabolism as the body’s engine. It controls how we use food for energy, store fat, regulate blood sugar, and keep our organs healthy. “When this engine starts malfunctioning, it is called metabolic dysfunction, which affects the liver, heart, kidneys, pancreas and even the brain. Long before diabetes or heart disease develops, people may have increasing belly fat, fatty liver, high blood pressure, abnormal cholesterol or insulin resistance. These problems are all connected,” asserted Dr Rajiv Kovil, diabetes and obesity specialist, Zandra Healthcare.Cardiologist Dr Susheel Kumar Malani, professor and HOD of Cardiology at DPU Super Specialty Hospital, Pimpri, Pune, described metabolic dysfunction as a “cluster of biochemical and physiological conditions that significantly increase the risk of cardiovascular disease, heart attack, brain stroke, and type 2 diabetes”.Metabolic health is closely linked to kidney health because conditions like diabetes, obesity, and high blood pressure are among the leading causes of chronic kidney disease and subsequent morbidity and mortality. “Many people are unaware that kidney damage can develop silently for years without symptoms. Understanding metabolic health helps people take steps to protect their kidneys before irreversible damage occurs,” said Dr Aditya Nayak, consultant nephrologist, Zen Annexe, Zen Multispeciality Hospital, Chembur, Mumbai.A patient with fatty liver or insulin resistance might not think they are at risk for heart disease. But these conditions often increase the chances of having heart attacks, heart failure, rhythm disorders, and vascular problems over time, reiterated Dr B C Kalmath, director and HOD, Department of Cardiac Sciences, KIMS Hospitals, Thane.Story continues below this adLooking back, Nitin now realises the breathlessness and fatigue were never isolated problems. They were all connected.With lifestyle modifications such as diet and exercise, weight-loss medications to control his blood pressure, blood sugar, and cholesterol, along with regular cardiac follow-ups, his metabolic health improved, and Nitin lost weight and felt better. “As a result, the stress on his heart was reduced, and his future risk of major cardiovascular events decreased. He doesn’t feel tired or breathless now and is doing his daily activities with ease,” Dr Gupta shared.So, how does renaming diseases help?Doctors aren’t renaming diseases to confuse patients. They are doing it because they now know these seemingly separate conditions often stem from the same underlying problem: poor metabolic health.Fatty liver is now called MASLD because it better describes that the condition is driven by metabolic problems rather than alcohol in most people. Similarly, CKM syndrome reminds us that the heart, kidneys, and metabolism are closely linked. Even PCOS is increasingly recognised as a metabolic condition because insulin resistance plays a major role, said Dr Kovil.Story continues below this ad Here’s what you should note (Photo: Getty Images/Thinkstock)Put simply, metabolic dysfunction means the body can no longer efficiently manage blood sugar, cholesterol, blood pressure, and fat storage. Over time, that silent imbalance begins damaging organs—from the liver and kidneys to the heart and brain.“Over time, these abnormalities damage the tiny blood vessels in the kidneys, reducing their filtering ability and increasing the risk of chronic kidney disease and even kidney failure. Early detection is essential because kidney damage is often preventable in its initial stages,” described Dr Nayak.That is why doctors are changing the way they look at diseases.“The heart should no longer be viewed in isolation. A patient with obesity, diabetes, fatty liver, or kidney disease is also at increased cardiovascular risk, even before symptoms appear. Looking at metabolic health as a whole allows earlier intervention and better long-term outcomes,” stressed Dr Nayak.Story continues below this adThis is a landmark shift because doctors are no longer treating fatty liver, diabetes, kidney disease, or heart disease as separate illnesses. They increasingly see them as different warning signs of the same metabolic problem, which means catching one early could prevent several others.Dr Nayak said that patients with obesity, diabetes, fatty liver, or heart disease should also be “assessed” for kidney health, even if they have no symptoms. “A holistic approach to metabolic health allows doctors to identify kidney problems earlier and slow down the disease progression,” said Dr Nayak.Self-check: Could you already have metabolic dysfunction?*Waistline getting larger?*Fatty liver on ultrasound?*Blood pressure above 130/80 mmHg?*Prediabetes?*High triglycerides?*Poor sleep?*Constant fatigue after meals?If you answered yes to more than one, experts recommend getting evaluated.Story continues below this adWhy are so many people suddenly metabolically unhealthy?Dr Malani said that one of the foremost reasons is insulin resistance, or the condition where the body’s cells do not respond effectively to insulin, causing the pancreas to produce more. “Lifestyle factors, including physical inactivity, poor diet, and being overweight or obese, are the primary drivers. Family history and genetics play a major role in a person’s risk for insulin resistance,” said Dr Malani.Combine it with long sitting hours, poor sleep, chronic stress, ultra-processed foods, loss of muscle mass after 35, and less movement.In fact, experts highlight the following “surprising” facts:* Belly fat is more dangerous than overall weight.* You can have fatty liver without drinking alcohol.* You don’t need diabetes to develop kidney damage.* Even people with ‘normal’ BMI can have metabolic dysfunction, said Dr Malani.Can thin people get metabolic dysfunction?Dr Ghody said that even those who seem thin can have insulin resistance, fatty liver, abnormal cholesterol levels, or prediabetes. “This is particularly relevant among South Asians, who can develop excess fat around internal organs even if they have a normal body weight. Therefore, a person can appear healthy on the outside while silently developing metabolic issues,” said Dr Ghody.Story continues below this adSo, what should we do now?The common person should stop treating diseases as separate problems. “High blood sugar, excess weight, fatty liver, high blood pressure and heart disease often share the same root cause—poor metabolic health,” said Dr Kovil. How is heart health connected to metabolic health? (Photo: Getty Images/Thinkstock)The good news is that metabolic dysfunction can often be improved, and sometimes even reversed, through healthy eating, regular exercise, good sleep, stress management, and, when needed, the right medications, Dr Kovil said.The key is prevention through regular health check-ups, including blood pressure monitoring, blood sugar testing, kidney function tests, and urine protein screening in high-risk individuals.If you’re above 35, ask your doctor about waist circumference, blood pressure, HbA1c, lipid profile, liver function, and kidney function.Story continues below this adThe biggest lesson from metabolic health is this: your body doesn’t wait for diabetes or a heart attack before it starts getting damaged. It whispers first—through belly fat, rising blood pressure, fatty liver, abnormal cholesterol, or unexplained fatigue. “Listening to those whispers may prevent a lifetime of disease. Instead of waiting for diabetes or a heart attack, we should focus on improving our metabolic health early. Prevention is always easier, cheaper and far more effective than treating complications later,” said Dr Kovil.