title: Trajectories of body mass index change in first episode of mania: 3-year data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM).
abstract: Overweight/obesity is common in patients with bipolar disorder (BD). However, little is known about longitudinal trends in body mass index (BMI) in patients with BD. Furthermore, most studies on the association between BMI and clinical outcomes are restricted by retrospective and cross-sectional designs. This study uses prospectively-gathered data from a first episode mania (FEM) cohort to examine the trajectories of BMI change and analyze their association with clinical outcomes during a 3-year period.
  
  
  
  A total of 110 FEM patients receiving maintenance treatment and 57 healthy subjects were included. The comparisons of BMI trajectories were examined using linear mixed-effects models. The effects of BMI on time to any mood episode were assessed by Cox proportional-hazards models.
  
  
  
  The estimated mean BMI in FEM patients significantly increased from 24.0kg/m2to 25.4kg/m2within 6 months. FEM patients had a significant BMI increase trend over the entire 3 years follow-up, which was not observed in the control group. No significant difference in BMI trajectory between patient subgroups (baseline normal-weight vs. overweight/obese; male vs. female) was observed. BMI increase predicted an increased risk of recurrence during follow-up visits (HR=1.50, 95% CI: 1.06-2.13; p=0.02).
  
  
  
  Naturalistic design does not allow the accurate assessments of the impact of pharmacologic treatments on BMI.
  
  
  
  FEM patients showed a significantly increased BMI trajectory compared to healthy subjects. Furthermore, BMI increase is independently associated with an increased risk of recurrence to a new mood episode during 3-year follow-up. Thus, weight control prevention is needed in the early course of BD.
authors: Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada; Mood Disorders Centre, Beijing Anding Hospital, Capital Medical University, Beijing, China.
authors: Chen
authors: C
authors: Hu
authors: Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada.
authors: Ivan J
authors: IJ
authors: Torres
authors: Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.
authors: Hong
authors: H
authors: Qian
authors: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors: Hubert
authors: H
authors: Wong
authors: Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada.
authors: Priyanka
authors: P
authors: Halli
authors: Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada.
authors: Taj
authors: T
authors: Dhanoa
authors: Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada.
authors: Sharon
authors: S
authors: Ahn
authors: Mood Disorders Centre, Beijing Anding Hospital, Capital Medical University, Beijing, China.
authors: Gang
authors: G
authors: Wang
authors: Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA.
authors: David J
authors: DJ
authors: Bond
authors: Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada.
authors: Raymond W
authors: RW
authors: Lam
authors: Mood Disorders Centre of Excellence, University of British Columbia, 2255, Wesbrook Mall, Vancouver, BC, Canada. Electronic address: yatham@mail.ubc.ca.
authors: Lakshmi N
authors: LN
authors: Yatham
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications / Q000503:physiopathology*; D050177:Overweight / Q000150:complications / Q000503:physiopathology*; D012008:Recurrence; D012737:Sex Factors; D055815:Young Adult
keywords: Bipolar disorder; Body mass index; Clinical outcomes; First episode mania; Longitudinal; Recurrence