The prevalence of metabolic syndrome and its associated factors in long-term patients in a specialist psychiatric hospital in South Africa

Abstract

Objective: The aims of this study were to determine the prevalence of metabolic disorders in long-term psychiatric patients, and the relationship between known risk factors and these metabolic disorders. Method: All psychiatric in-patients ≥18 years, who had been admitted ≥six months were invited to participate. Eighty-four patients participated. They were interviewed, examined, measured and blood tests conducted to determine several demographic and clinical variables including age, gender, weight, blood pressure and fasting blood glucose. Results: The prevalence of the metabolic disorders were: metabolic syndrome 32%, hypertension 32%, diabetes mellitus 8%, cholesterol dyslipidaemia 32%, triglyceride dyslipidaemia 29%, low density lipoprotein (LDL) dyslipidaemia 50%, overweight 37%, and obesity 24%. Black African and female patients were more likely to have metabolic syndrome. Female patients were more likely to have cholesterol dyslipidaemia and obesity. Hypertension was associated with age. Ninety-six percent of patients with dyslipidaemia were newly diagnosed during the study. Three out of the seven previously diagnosed diabetic patients had raised fasting blood glucose levels. Conclusion: The prevalence of metabolic syndrome falls towards the lower limits of the expected prevalence rate. Race and gender showed a moderate statistical association with metabolic syndrome. There is a lack of screening for dyslipidaemia in this setting. Diabetic patients should be referred to specialist diabetic clinics for better monitoring and control. developing countries. 20,21 Therefore, the first aim of the study was to determine the local prevalence of these metabolic disorders in long-term psychiatric patients.Many studies like CATIE have found a significant association between some second-generation antipsychotics (SGA) and weight gain, diabetes mellitus and dyslipidaemia. [22][23][24][25][26][27][28] However, the contribution of other variables including first-generation antipsychotics (FGA), mood stabilisers and antidepressants in the development of metabolic disorders has also been recognised. [29][30][31][32][33][34] Unmodifiable risk factors (age, ethnicity, gender and family history) and modifiable ones (level of functioning, smoking history, dietary intake and obesity) in psychiatric patients have also been associated with metabolic disorders. [35][36][37] Therefore, the second aim of the study was to determine whether these risk factors could be associated with metabolic disorders in long-term psychiatric patients.Although screening guidelines for these disorders have been recommended due to the significance of metabolic disorders in causing CVD, the guidelines are still not widely applied, even in developed countries. 38,39 Clinicians tend to rely on a patient's presentation of worrying symptoms/signs or in the case of inpatients, routine monthly blood pressure checking before investigating or treating these disorders. As a result, opportunities to detect and treat metabolic disorders may be missed. The...

High risk of metabolic syndrome among black South African women with severe mental illness

“…A higher prevalence of MetS in women with SMI has been reported in individual studies, 6 but a recent meta-analysis that included men and women of different ethnicities from diverse geographical regions reported no gender differences in the prevalence of MetS. 4 A higher prevalence in women was also reported from South Africa, 13 but that study comprised patients of multiple ethnicities with no control group.…”

Metabolic Syndrome in South African Patients with Severe Mental Illness: Prevalence and Associated Risk Factors

“…The meta—analysis by Mitchell et al[ 13 ] did not include any studies from Africa; also, only 0.001% of the patients enrolled in schizophrenia trials throughout the world are recruited from Africa [ 14 ]. Data for South Africa are limited to three studies [ 15 – 17 ]. A study of 84 long term in patients that included patients with cognitive and personality disorders reported a MetS prevalence of 32% [ 15 ] while the other two reported on the prevalence of MetS in patients taking a single antipsychotic [ 16 , 17 ].…”

“…Data for South Africa are limited to three studies [ 15 – 17 ]. A study of 84 long term in patients that included patients with cognitive and personality disorders reported a MetS prevalence of 32% [ 15 ] while the other two reported on the prevalence of MetS in patients taking a single antipsychotic [ 16 , 17 ]. From population studies in South Africa, the reported prevalence of MetS is 22.1% in rural [ 18 ] and 31.7% in urban black South African communities [ 19 ].…”

Metabolic syndrome in patients with severe mental illness in Gorgan

“…SMI show 2-3 times the incidence of higher type 2 diabetes mellitus and CVDs than the general population. [ 25 ] A recent study in the USA indicated that all CVDs risk factors such as central obesity, hypertension, dyslipidemia, and hyperglycemia were higher in SMI than in the general population. [ 40 ] Study of Lozano et al .…”

“…[ 17 ] Individuals with severe mental illnesses (SMI) show a higher prevalence of metabolic syndrome than those who do not a metabolic syndrome. [ 24 25 ] These people indicate an important social and/or occupational dysfunction. [ 26 ] The elevated prevalence of metabolic syndrome in these subjects may be related to the disease itself, treatment with the antipsychotic drug, obesity, consumption of high-fat diets, low physical activity, and active smoking.…”