Metabolic syndrome

How is metabolic syndrome related to schizophrenia?

Metabolic syndrome is a risk factor for diabetes and cardiovascular diseases. It is defined as a clustering of at least three abnormalities including obesity, high blood pressure, high blood triglycerides, low levels of high-density lipoprotein (HDL) cholesterol and insulin resistance.

What is the evidence for metabolic syndrome in people with schizophrenia?

Moderate quality evidence finds an overall prevalence of metabolic syndrome in people with schizophrenia of around 32%. Compared to age and gender-matched population controls, there are increased rates of abdominal obesity, hypertension, hypertriglyceridemia, and low HDL cholesterol in people with schizophrenia, with no differences when compared to people with bipolar disorder or major depression.

Compared to people in their first-episode of psychosis and compared to drug-naive patients, medicated patients have increased rates of metabolic syndrome, diabetes, obesity, high triglycerides, low HDL cholesterol, and hyperglycaemia > 100 mg/dl. There were also increased rates of high blood pressure in first-episode patients compared to unmedicated patients, and increased waist size in unmedicated patients compared to first-episode patients.

Compared to controls, moderate to high quality evidence finds small effects of reduced total and LDL cholesterol, and increased triglycerides in people with first-episode psychosis, with no changes in HDL cholesterol or leptin levels. There was a large effect of more impaired glucose tolerance and more insulin resistance in people with first-episode psychosis, with no differences in fasting plasma glucose.

High quality evidence finds small effects of more impaired processing speed and executive functioning in people with schizophrenia and metabolic syndrome compared to patients without metabolic syndrome.Moderate to high quality evidence also finds medium-sized effects of more impaired memory and attention, and a small effect of more impaired global cognition in patients with metabolic syndrome.

Moderate to high quality evidence finds benefits of lifestyle interventions for improving cardiometabolic parameters of weight, triglycerides, fasting glucose and insulin.

May 2019

Last updated at: 6:04 am, 5th May 2019
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