title: Bipolar disorder and metabolic syndrome: an international perspective.
abstract: BACKGROUND
  The ubiquity and hazards posed by abnormal body composition and metabolic parameters in the bipolar population are a priority research and clinical issue. Herein, we summarize and synthesize international studies describing the rate of US National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III])- and International Diabetes Federation (IDF)-defined metabolic syndrome and its criterion components in individuals with bipolar disorder.
  
  
  METHODS
  We conducted a PubMed search of all English-language articles published between January 2005 and July 2009 with the following search terms: metabolic syndrome and bipolar disorder, mania and manic-depression. Articles selected for review were based on adequacy of sample size, the use of standardized experimental procedures, validated assessment measures, and overall manuscript quality.
  
  
  RESULTS
  The rate of metabolic syndrome in individuals with bipolar disorder is increased relative to the general population. Disparate estimates are reported ranging from comparability to approximately twofold greater than the general population. The increased hazard for metabolic syndrome amongst bipolar individuals is now documented in twelve countries from Europe, Australia, Asia, North and South America. The co-occurrence of metabolic syndrome in the bipolar population is associated with a more complex illness presentation, less favourable response to treatment, and adverse course and outcome. The association between metabolic syndrome and bipolar disorder is mediated/moderated by both iatrogenic and non-iatrogenic factors.
  
  
  CONCLUSIONS
  The increased hazard for metabolic syndrome in bipolar populations is due to the clustering of traditional (and emerging) risk factors as well as iatrogenic and health systems factors. Extant data support recommendations for prioritizing, surveillance, prevention, diagnosis and management of metabolic syndrome as routine care of the bipolar patient.
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, ON, Canada. roger.mcintyre@uhn.on.ca
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.forename: Marlon
authors.initials: M
authors.lastname: Danilewitz
authors.forename: Samantha S
authors.initials: SS
authors.lastname: Liauw
authors.forename: David E
authors.initials: DE
authors.lastname: Kemp
authors.forename: Ha T T
authors.initials: HT
authors.lastname: Nguyen
authors.forename: Linda S
authors.initials: LS
authors.lastname: Kahn
authors.forename: Aaron
authors.initials: A
authors.lastname: Kucyi
authors.forename: Joanna K
authors.initials: JK
authors.lastname: Soczynska
authors.forename: Hanna O
authors.initials: HO
authors.lastname: Woldeyohannes
authors.forename: Angela
authors.initials: A
authors.lastname: Lachowski
authors.forename: Byungsu
authors.initials: B
authors.lastname: Kim
authors.forename: Jay
authors.initials: J
authors.lastname: Nathanson
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alsuwaidan
authors.forename: Valerie H
authors.initials: VH
authors.lastname: Taylor
mesh_terms: D052242:Adiponectin / Q000097:blood; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D001786:Blood Glucose / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D016000:Cluster Analysis; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D006801:Humans; D007049:Iatrogenic Disease; D008134:Long-Term Care; D024821:Metabolic Syndrome / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D001786:Blood Glucose; D002784:Cholesterol