title: Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis.
abstract: Metabolic syndrome (MetS) and its components are highly predictive of cardiovascular diseases. The primary aim of this systematic review and meta-analysis was to assess the prevalence of MetS and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder, comparing subjects with different disorders and taking into account demographic variables and psychotropic medication use. The secondary aim was to compare the MetS prevalence in persons with any of the selected disorders versus matched general population controls. The pooled MetS prevalence in people with severe mental illness was 32.6% (95% CI: 30.8%-34.4%; N = 198; n = 52,678). Relative risk meta-analyses established that there was no significant difference in MetS prevalence in studies directly comparing schizophrenia versus bipolar disorder, and in those directly comparing bipolar disorder versus major depressive disorder. Only two studies directly compared people with schizophrenia and major depressive disorder, precluding meta-analytic calculations. Older age and a higher body mass index were significant moderators in the final demographic regression model (z = -3.6, p = 0.0003, r(2)  = 0.19). People treated with all individual antipsychotic medications had a significantly (p<0.001) higher MetS risk compared to antipsychotic-naïve participants. MetS risk was significantly higher with clozapine and olanzapine (except vs. clozapine) than other antipsychotics, and significantly lower with aripiprazole than other antipsychotics (except vs. amisulpride). Compared with matched general population controls, people with severe mental illness had a significantly increased risk for MetS (RR = 1.58; 95% CI: 1.35-1.86; p<0.001) and all its components, except for hypertension (p = 0.07). These data suggest that the risk for MetS is similarly elevated in the diagnostic subgroups of severe mental illness. Routine screening and multidisciplinary management of medical and behavioral conditions is needed in these patients. Risks of individual antipsychotics should be considered when making treatment choices.
authors.affiliation: UPC KU Leuven, Campus Kortenberg, Department of Neurosciences, KU Leuven - University of Leuven, Kortenberg, Belgium.|Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.
authors.forename: Davy
authors.initials: D
authors.lastname: Vancampfort
authors.affiliation: School of Health and Social Care, University of Greenwich, Eltham, London, UK.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: Department of Psycho-oncology, Leicestershire Partnership NHS Trust, Leicester, UK.|Department of Cancer and Molecular Medicine, University of Leicester, Leicester, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.affiliation: UPC KU Leuven, Campus Kortenberg, Department of Neurosciences, KU Leuven - University of Leuven, Kortenberg, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: De Hert
authors.affiliation: UPC KU Leuven, Campus Kortenberg, Department of Neurosciences, KU Leuven - University of Leuven, Kortenberg, Belgium.
authors.forename: Martien
authors.initials: M
authors.lastname: Wampers
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Philip B
authors.initials: PB
authors.lastname: Ward
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Rosenbaum
authors.affiliation: Zucker Hillside Hospital, Glen Oaks, NY, USA.|Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
keywords: Metabolic syndrome; antipsychotics; bipolar disorder; major depressive disorder; schizophrenia; severe mental illness