Prevalence of Metabolic Syndrome and Metabolic Abnormalities in Schizophrenia and Related Disorders—A Systematic Review and Meta-Analysis

Abstract

Individuals with schizophrenia have high levels of medical comorbidity and cardiovascular risk factors. The presence of 3 or more specific factors is indicative of metabolic syndrome, which is a significant influence upon future morbidity and mortality. We aimed to clarify the prevalence and predictors of metabolic syndrome (MetS) in adults with schizophrenia and related disorders, accounting for subgroup differences. A PRISMA systematic search, appraisal, and meta-analysis were conducted of 126 analyses in 77 publications (n = 25,692). The overall rate of MetS was 32.5% (95% CI = 30.1%-35.0%), and there were only minor differences according to the different definitions of MetS, treatment setting (inpatient vs outpatient), by country of origin and no appreciable difference between males and females. Older age had a modest influence on the rate of MetS (adjusted R(2) = .20; P < .0001), but the strongest influence was of illness duration (adjusted R(2) = .35; P < .0001). At a study level, waist size was most useful in predicting high rate of MetS with a sensitivity of 79.4% and a specificity of 78.8%. Sensitivity and specificity of high blood pressure, high triglycerides, high glucose and low high-density lipoprotein, and age (>38 y) are shown in supplementary appendix 2 online. Regarding prescribed antipsychotic medication, highest rates were seen in those prescribed clozapine (51.9%) and lowest rates of MetS in those who were unmedicated (20.2%). Present findings strongly support the notion that patients with schizophrenia should be considered a high-risk group. Patients with schizophrenia should receive regular monitoring and adequate treatment of cardio-metabolic risk factors.

Proteomic pathway analysis of the hippocampus in schizophrenia and bipolar affective disorder implicates 14-3-3 signaling, aryl hydrocarbon receptor signaling, and glucose metabolism: Potential roles in GABAergic interneuron pathology

“…These findings are in support of accumulating evidence indicating that there could be an intrinsic link between disturbances of glucose metabolism in psychotic disorders (Calkin et al, 2013;Mitchell et al, 2013) The hippocampus is a brain region vulnerable to disturbed glucose metabolism (Auer, 1986;Biessels et al, 2002), and GABAergic interneurons appear particularly sensitive. In rodents with streptozotosin (STZ)-induced chronic hyperglycemia, hippocampal immunoreactivity of calbindin and parvalbumin is reduced (Yi, 2013).…”

Total white blood cell count, liver enzymes, and metabolic syndrome in schizophrenia

“…For example, in the United States the frequency of MetS is 25%-34% in the general population above the age of 20, and it is 23%-24% in Europe for the same age group (14,15). A recent systematic review reported that 32.5% of individuals with schizophrenia also have MetS (6). In the Turkish Adult Risk Factor Study conducted in 2000, the frequency of MetS was 28% in men and 45% in women (16).…”

Altered reward anticipation: Potential explanation for weight gain in schizophrenia?

“…They typically concentrate on i) dysregulation of neuroendocrinological circuits (e.g., hormonal regulation by the hypothalamus; Sharma et al, 2014); ii) dysregulation of peripheral hormones (e.g., leptin and ghrelin) implicated in weight homeostasis and in regulation of glucose (De Hert et al, 2009;Mitchell et al, 2013;Sentissi et al, 2008); and iii) the effect of antipsychotic medication on weight (Bak et al, 2014;Deng et al, 2010;Sharma et al, 2014). All of these factors are important.…”