Background: People with mental disorders have higher mortality rates in comparison with the general population. The occurrence of metabolic syndrome is greater in people with mental disorders than in the general population. A review of the research literature was carried out with regard to metabolic syndrome, its prevalence in the general population, and among those with psychiatric disorders.
Materials and methods: Literature search was conducted with the ensuing search terms, keywords, and phrases—“metabolic syndrome,” “severe mental illness,” “mental disorder,” “schizophrenia,” “bipolar disorder,” “substance use,” “prevalence,” “alcohol dependence,” and “physical activity.” The search was executed in databases such as PubMed, ProQuest, and Google Scholar.
Review results: Considerable debate exists regarding the causes for the high prevalence of metabolic disturbances in patients with mental disorders; however, gaps remain in relevant aspects, inspiring further studies in specific smaller groups of psychiatric patients to evaluate the impact of each variable on the risk for developing metabolic syndrome. From this review, we surmise that there are several factors that influence the amplified prevalence of metabolic syndrome among patients with mental disorders. Rather than a sole causative factor, there are multiple factors associated with metabolic syndrome, such as sociodemographic variables, clinical variables, and level of physical activity.
Conclusion: The research literature supports the requisite for timely identification of metabolic syndrome in people with mental disorders and initiation of suitable interventions.
Clinical significance: It is of paramount significance that guidelines pertinent to the Indian context are developed for the monitoring and screening of psychiatric patients for metabolic syndrome and physical health in general.
Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry 2015;72(4):334–341. DOI: 10.1001/jamapsychiatry.2014.2502.
Brown S. Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry J Ment Sci 1997;171(6):502–508. DOI: 10.1192/bjp.171.6.502.
Osborn DPJ, Levy G, Nazareth I, Petersen I, Islam A, King MB. Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the united kingdom's general practice research database. Arch Gen Psychiatry 2007;64(2):242–249. DOI: 10.1001/archpsyc.64.2.242.
Ganesh S, Ashok AH, Kumar CN, Thirthalli J. Prevalence and determinants of metabolic syndrome in patients with schizophrenia: a systematic review and meta-analysis of Indian studies. Asian J Psychiatry 2016;22:86–92. DOI: 10.1016/j.ajp.2016.05.006.
Vancampfort D, Stubbs B, Mitchell AJ, De Hert M, Wampers M, Ward PB, et al. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis. World Psychiatry 2015;14(3):339–347. DOI: 10.1002/wps.20252.
Kaur J. A comprehensive review on metabolic syndrome. Cardiol Res Pract 2014;2014:1–21. DOI: 10.1155/2014/943162.
KGMM Alberti, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–1645.
Povel CM, Boer JMA, Onland-Moret NC, Dollé MET, Feskens EJM, van der Schouw YT. Single nucleotide polymorphisms (SNPs) involved in insulin resistance, weight regulation, lipid metabolism and inflammation in relation to metabolic syndrome: an epidemiological study. Cardiovasc Diabetol 2012;11(1):133. DOI: 10.1186/1475-2840-11-133.
Kuppili P, Nebhinani N. Role of integrated and multidisciplinary approach in combating metabolic syndrome in patients with severe mental illness. Indian J Psychol Med 2019;41(5):466. DOI: 10.4103/IJPSYM.IJPSYM_48_19.
Shaw JE, Chisholm DJ. 1: Epidemiology and prevention of type 2 diabetes and the metabolic syndrome. Med J Aust 2003;179(7): 379–383. DOI: 10.5694/j.1326-5377.2003.tb05599.x.
Emanuela F, Grazia M, Marco DR, Maria Paola L, Giorgio F, Marco B. Inflammation as a link between obesity and metabolic syndrome. J Nutr Metab 2012;2012:1–7. DOI: 10.1155/2012/476380.
Vague J. Sexual differentiation. A determinant factor of the forms of obesity. Obes Res 1996;4(2):201–203. DOI: 10.1002/j.1550-8528.1996.tb00535.x.
Reaven GM. Banting lecture 1988 - role of insulin resistance in human disease. Diabetes 1988;37(12):1595–1607. DOI: 10.2337/diab.37.12.1595.
Kaplan NM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med 1989;149(7):1514–1520. DOI: 10.1001/archinte.1989.00390070054005.
Alberti KGMM, Zimmet PZ. WHO consultation. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabet Med 1998;15(7):539–553. DOI: 10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S.
World Health Organization. WHO expert committee on diabetes mellitus: second report. Geneva, Switzerland: World Health Organization. World Health Organ Tech Rep Ser 1980;646:9–14.
National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979;28(12):1039–1057. DOI: 10.2337/diab.28.12.1039.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). J Am Med Assoc 2001;285(19): 2486–2497. DOI: 10.1001/jama.285.19.2486.
Alberti KGM, Zimmet P, Shaw J. The metabolic syndrome—a new worldwide definition. The Lancet 2005;366(9491):1059–1062. DOI: 10.1016/S0140-6736(05)67402-8.
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an american heart association/national heart, lung, and blood institute scientific statement. Circulation 2005;112(17):2735–2752. DOI: 10.1161/CIRCULATIONAHA.105.169404.
Grover S, Aggarwal M, Chakrabarti S, Dutt A, Avasthi A, Kulhara P, et al. Prevalence of metabolic syndrome in bipolar disorder: an exploratory study from North India. Prog Neuropsychopharma Biol Psychiatry 2012;36(1):141–146. DOI: 10.1016/j.pnpbp.2011.10.013.
Grover S, Malhotra N, Chakrabarti S, Kulhara P. Metabolic syndrome in bipolar disorders. Indian J Psychol Med 2012;34(2):110–118. DOI: 10.4103/0253-7176.101767.
Grover S, Malhotra N, Chakrabarti S, Nebhinani N, Avasthi A, Subodh BN, et al. Metabolic syndrome in adolescents with severe mental disorders: retrospective study from a psychiatry inpatient unit. Asian J Psychiatry 2015;14:69–70. DOI: 10.1016/j.ajp.2015.01.012.
Grover S, Aggarwal M, Dutt A, Chakrabarti S, Avasthi A, Kulhara P, et al. Prevalence of metabolic syndrome in patients with schizophrenia in India. Psychiatry Res 2012;200(2–3):1035–1037. DOI: 10.1016/j.psychres.2012.03.043.
Grover S, Nebhinani N, Chakrabarti S, Avasthi A, Basu D, Kulhara P, et al. Cardiovascular risk factors among bipolar disorder patients admitted to an inpatient unit of a tertiary care hospital in India. Asian J Psychiatry 2014;10:51–55. DOI: 10.1016/j.ajp.2014.03.004.
Misra A, Misra R, Wijesuriya M, Banerjee D. The metabolic syndrome in South Asians: continuing escalation & possible solutions. Indian J Med Res 2007;125(3):345.
Deepa M, Farooq S, Datta M, Deepa R, Mohan V. Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai urban rural epidemiology study (CURES-34). Diabetes Metab Res Rev 2007;23(2):127–134. DOI: 10.1002/dmrr.658.
Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003-2012. JAMA 2015;313(19):1973–1974. DOI: 10.1001/jama.2015.4260.
Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Metabolic syndrome in urban Asian Indian adults--a population study using modified ATP III criteria. Diabetes Res Clin Pract 2003;60(3): 199–204. DOI: 10.1016/s0168-8227(03)00060-3.
Prasad DS, Kabir Z, Dash AK, Das BC. Prevalence and risk factors for metabolic syndrome in Asian Indians: a community study from urban Eastern India. J Cardiovasc Dis Res 2012;3(3):204–211. DOI: 10.4103/0975-3583.98895.
Prasad DS, Kabir Z, Dash AK, Das BC. Abdominal obesity, an independent cardiovascular risk factor in Indian subcontinent: a clinico epidemiological evidence summary. J Cardiovasc Dis Res 2011;2(4):199–205. DOI: 10.4103/0975-3583.89803.
Sawant A, Mankeshwar R, Shah S, Raghavan R, Dhongde G, Raje H, et al. Prevalence of metabolic syndrome in urban India. Cholesterol 2011;2011:e920983. DOI: 10.1155/2011/920983.
Teixeira PJR, Rocha FL. The prevalence of metabolic syndrome among psychiatric inpatients in Brazil. Rev Bras Psiquiatr São Paulo Braz 2007;29(4):330–336. DOI: 10.1590/S1516-44462007000400007.
Mattoo SK, Singh SM. Prevalence of metabolic syndrome in psychiatric inpatients in a tertiary care centre in north India. Indian J Med Res 2010;131:46–52.
Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders—a systematic review and meta-analysis. Schizophr Bull 2013;39(2):306–318. DOI: 10.1093/schbul/sbr148.
Bermudes RA, Keck PE, Welge JA. The prevalence of the metabolic syndrome in psychiatric inpatients with primary psychotic and mood disorders. Psychosomatics 2006;47(6):491–497. DOI: 10.1176/appi.psy.47.6.491.
Grover S, Nebhinani N, Chakrabarti S, Avasthi A, Kulhara P, Basu D, et al. Comparative study of prevalence of metabolic syndrome in bipolar disorder and schizophrenia from North India. Nord J Psychiatry 2014;68(1):72–77. DOI: 10.3109/08039488.2012.754052.
Solia F, Rosso G, Maina G. Metabolic syndrome in acute psychiatric inpatients: clinical correlates. J Psychopathol 2015;21(3):246–253.
Heiskanen T, Niskanen L, Lyytikäinen R, Saarinen PI, Hintikka J. Metabolic syndrome in patients with schizophrenia. J Clin Psychiatry 2003;64(5):575–579. DOI: 10.4088/jcp.v64n0513.
Padmavati R, McCreadie RG, Tirupati S. Low prevalence of obesity and metabolic syndrome in never-treated chronic schizophrenia. Schizophr Res 2010;121(1–3):199–202. DOI: 10.1016/j.schres.2010.05.010.
Mattoo SK, Chakraborty K, Basu D, Ghosh A, Vijaya Kumar KG, Kulhara P. Prevalence & correlates of metabolic syndrome in alcohol & opioid dependent inpatients. Indian J Med Res 2011;134:341–348.
Vancampfort D, Hallgren M, Mugisha J, De Hert M, Probst M, Monsieur D, et al. The prevalence of metabolic syndrome in alcohol use disorders: a systematic review and meta-analysis. Alcohol Alcohol 2016;51(5):515–521. DOI: 10.1093/alcalc/agw040.
John AP, Koloth R, Dragovic M, Lim SCB. Prevalence of metabolic syndrome among Australians with severe mental illness. Med J Aust 2009;190(4):176–179. DOI: 10.5694/j.1326-5377.2009. tb02342.x.
Bajaj S, Varma A, Srivastava A, Verma AK. Association of metabolic syndrome with schizophrenia. Indian J Endocrinol Metab 2013;17(5):890–895. DOI: 10.4103/2230-8210.117238.
Carrà G, Bartoli F, Carretta D, Crocamo C, Bozzetti A, Clerici M, et al. The prevalence of metabolic syndrome in people with severe mental illness: a mediation analysis. Soc Psychiatry Psychiatr Epidemiol 2014;49(11):1739–1746. DOI: 10.1007/s00127-014-0835-y.
Malhotra N, Kulhara P, Chakrabarti S, Grover S. A prospective, longitudinal study of metabolic syndrome in patients with bipolar disorder and schizophrenia. J Affect Disord 2013;150(2):653–658. DOI: 10.1016/j.jad.2013.03.010.
Saloojee S, Burns JK, Motala AA. Metabolic syndrome in South African patients with severe mental illness: prevalence and associated risk factors. PLoS ONE 2016;11(2):e0149209. DOI: 10.1371/journal.pone.0149209.
Alosaimi FD, Abalhassan M, Alhaddad B, Alzain N, Fallata E, Alhabbad A, et al. Prevalence of metabolic syndrome and its components among patients with various psychiatric diagnoses and treatments: a cross-sectional study. Gen Hosp Psychiatry 2017;45:62–69. DOI: 10.1016/j.genhosppsych.2016.12.007.
De Hert M, Schreurs V, Sweers K, Van Eyck D, Hanssens L, Šinko S, et al. Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: a retrospective chart review. Schizophr Res 2008;101(1):295–303. DOI: 10.1016/j.schres.2008.01.028.
Vancampfort D, Vansteelandt K, Correll CU, Mitchell AJ, De Herdt A, Sienaert P, et al. Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators. Am J Psychiatry 2013;170(3):265–274. DOI: 10.1176/appi.ajp.2012.12050620.
Papanastasiou E. The prevalence and mechanisms of metabolic syndrome in schizophrenia: a review. Ther Adv Psychopharmacol 2013;3(1):33–51. DOI: 10.1177/2045125312464385.
Peter K, Praveenlal K, Saibunnisa K. View of incidence of metabolic syndrome in patients treated with clozapine in a tertiary care center in central Kerala. Kerala J Psychiatr 2019.
Saddichha S, Ameen S, Akhtar S. Incidence of new onset metabolic syndrome with atypical antipsychotics in first episode schizophrenia: a six-week prospective study in Indian female patients. Schizophr Res 2007;95(1–3):247. DOI: 10.1016/j.schres.2007.05. 036.
Saddichha S, Manjunatha N, Ameen S, Akhtar S. Metabolic syndrome in first episode schizophrenia — a randomized double-blind controlled, short-term prospective study. Schizophr Res 2008;101(1–3): 266–272. DOI: 10.1016/j.schres.2008.01.004.
Srisurapanont M, Likhitsathian S, Boonyanaruthee V, Charnsilp C, Jarusuraisin N. Metabolic syndrome in Thai schizophrenic patients: a naturalistic one-year follow-up study. BMC Psychiatry 2007;7(1):14. DOI: 10.1186/1471-244X-7-14.
Brown S, Birtwistle J, Roe L, Thompson C. The unhealthy lifestyle of people with schizophrenia. Psychol Med 1999;29(3):697–701. DOI: 10.1017/s0033291798008186.
Nyboe L, Lund H. Low levels of physical activity in patients with severe mental illness. Nord J Psychiatry 2013;67(1):43–46. DOI: 10.3109/08039488.2012.675588.
Newcomer JW. Metabolic syndrome and mental illness. Am J Manag Care 2007;13(7 Suppl):S170–S177.
Nishanth K, Chadda R, Sood M, Biswas A, Lakshmy R. Metabolic syndrome and its impact on functioning in participants with schizophrenia: a hospital-based cross-sectional study. Indian J Soc Psychiatry 2019;35(3):179. DOI: 10.4103/ijsp.ijsp_64_18.
Vancampfort D, Sweers K, Probst M, Maurissen K, Knapen J, Minguet P, et al. Association of the metabolic syndrome with physical activity performance in patients with schizophrenia. Diabetes Metab 2011;37(4):318–323. DOI: 10.1016/j.diabet.2010.12.007.
Katano S, Nakamura Y, Nakamura A, Murakami Y, Tanaka T, Nakagawa H, et al. Relationship among physical activity, smoking, drinking and clustering of the metabolic syndrome diagnostic components. J Atheroscler Thromb 2010;17(6):644–650. DOI: 10.5551/jat.3699.
Nguyen TH, Tang HK, Kelly P, van der Ploeg HP, Dibley MJ. Association between physical activity and metabolic syndrome: a cross sectional survey in adolescents in ho Chi Minh city, Vietnam. BMC Public Health [Internet] 2010;10(1): Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-10-141.
Bo S, Ciccone G, Pearce N, Merletti F, Gentile L, Cassader M, et al. Prevalence of undiagnosed metabolic syndrome in a population of adult asymptomatic subjects. Diabetes Res Clin Pract 2007;75(3): 362–365. DOI: 10.1016/j.diabres.2006.06.031.
World Health Organization. WHO | Global Physical Activity Surveillance [Internet]. WHO. [cited 2016 Oct 14]. Available from: http://www.who.int/chp/steps/GPAQ/en/.
Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health 2009;6(6):790–804. DOI: 10.1123/jpah.6.6.790.