title: Metabolic syndrome in bipolar disorder: a cross-sectional assessment of a Health Management Organization database.
abstract: OBJECTIVE
  To estimate the prevalence of metabolic syndrome (MS) in patients with bipolar disorder (BD) included in a Health Management Organization (HMO) database.
  
  
  METHODS
  A cross-sectional analysis of the administrative claim database of Badalona Serveis Assistencials (BSA) was performed. All patients of either sex over 16 years of age and receiving treatment for BD for more than three weeks were included in the study group. The reference group comprised the rest of patients in the BSA database without BD. MS was defined according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III modified criteria and required fulfillment of at least three of the following five components: body mass index (BMI) >or=28.8 kg/m(2), triglycerides >or=150 mg/dL, high-density lipoprotein (HDL) cholesterol <40 mg/dL (males)/<50 mg/dL (females), blood pressure >or=130/85 mmHg, and fasting glucose >or=110 mg/dL. Descriptive statistics, bivariate analysis, and logistic regression models were applied.
  
  
  RESULTS
  We identified 178 patients with BD out of 86,028 subjects (50.5% women; 45.5 +/- 17.8 years, mean +/- SD) included in the BSA database. MS prevalence was significantly higher in BD: 24.7% [95% confidence interval (CI): 18.6-31.7] versus 14.4% (CI: 14.2-14.7) with no statistically significant differences between genders; age-adjusted odds ratio (OR) = 1.65 (1.11-2.44, p = 0.013). All MS components were higher in the BD group, particularly BMI >28.8 kg/m(2) [33.1% (26.3-40.6) versus 17.9% (17.7-18.2), adjusted OR = 2.05 (1.46-2.87, p < 0.001)], high triglyceride levels [23.0% (17.1-29.9) versus 11.3% (11.1-11.5), adjusted OR = 2.09 (1.45-3.02, p < 0.001)], and low HDL cholesterol levels [54.5% (46.9-62.0) versus 29.4% (29.1-29.7), adjusted OR = 2.77 (2.02-3.80, p < 0.001)]. Furthermore, patients with BD showed a significantly higher frequency of obesity [41.4% (32.3-50.9) versus 27.1% (26.6-27.5); adjusted OR = 1.83 (1.24-2.68, p = 0.002)].
  
  
  CONCLUSIONS
  Compared with the general population managed by the BSA, the prevalence of MS was significantly higher in patients with BD, mainly due to a higher prevalence of obesity, high triglyceride levels, and low HDL cholesterol levels. These findings strongly support the development of health policies addressing this problem in BD patients.
authors.affiliation: Badalona Serveis Assistencials, Badalona, Barcelona, Spain. asicras@bsa.gs
authors.forename: Antoni
authors.initials: A
authors.lastname: Sicras
authors.forename: Javier
authors.initials: J
authors.lastname: Rejas
authors.forename: Ruth
authors.initials: R
authors.lastname: Navarro
authors.forename: Josep
authors.initials: J
authors.lastname: Serrat
authors.forename: Milagrosa
authors.initials: M
authors.lastname: Blanca
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000097:blood / Q000453:epidemiology*; D008078:Cholesterol, LDL / Q000097:blood; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000706:statistics & numerical data; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain; D014280:Triglycerides / Q000097:blood
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D008078:Cholesterol, LDL; D014280:Triglycerides