Open Access

Comparison of prevalence of metabolic syndrome in hospital and community-based Japanese patients with schizophrenia

  • Norio Sugawara1, 2Email author,
  • Norio Yasui-Furukori2,
  • Yasushi Sato1, 2,
  • Ikuko Kishida3, 4,
  • Hakuei Yamashita5, 6,
  • Manabu Saito2,
  • Hanako Furukori7,
  • Taku Nakagami2, 8,
  • Mitsunori Hatakeyama9 and
  • Sunao Kaneko2
Annals of General Psychiatry201110:21

DOI: 10.1186/1744-859X-10-21

Received: 2 July 2011

Accepted: 12 September 2011

Published: 12 September 2011

Abstract

Background

Lifestyle factors, such as an unbalanced diet and lack of physical activity, may affect the prevalence of metabolic syndrome (MetS) in schizophrenic patients. The aim of this study was to compare the MetS prevalence between inpatients and outpatients among schizophrenic population in Japan.

Methods

We recruited inpatients (n = 759) and outpatients (n = 427) with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis of schizophrenia or schizoaffective disorder from 7 psychiatric hospitals using a cross-sectional design. MetS prevalence was assessed using three different definitions, including the adapted National Cholesterol Education Program Adult Treatment Panel (ATP III-A).

Results

The overall MetS prevalences based on the ATP III-A definition were 15.8% in inpatients and 48.1% in outpatients. In a logistic regression model with age and body mass index as covariates, being a schizophrenic outpatient, compared to being a schizophrenic inpatient, was a significant independent factor (odds ratio = 3.66 for males, 2.48 for females) in the development of MetS under the ATP III-A definition. The difference in MetS prevalence between inpatients and outpatients was observed for all age groups in males and for females over 40 years of age.

Conclusions

Outpatients with schizophrenia or schizoaffective disorder in Japan had a high prevalence of MetS compared to inpatients. MetS in schizophrenic outpatients should be carefully monitored to minimize the risks. A change of lifestyle might improve MetS in schizophrenic patients.

Introduction

A high prevalence of metabolic syndrome (MetS) has been reported among schizophrenic patients [13]. MetS has been related to an increased risk for cardiovascular diseases [4, 5], diabetes [6] and mortality [7] and is defined as a cluster of metabolic disturbances including abdominal obesity, atherogenic dyslipidemia, hypertension and hyperglycemia [8].

Commonly used definitions for MetS are the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) MetS definition [7] and the adapted NCEP ATP III (ATP III-A) definition, proposed by the American Heart Association (AHA) following the American Diabetes Association's (ADA's) lowering of the threshold for impaired fasting glucose to 100 mg/dl [9]. Because abdominal obesity is widely recognized as a measure of metabolic abnormality, the International Diabetes Federation (IDF) established a definition that stressed the importance of waist circumference [10]. However, the small physique of the Asian population made it difficult to use the same waist circumference criterion determined for those of European descent [11]. Therefore, modified criteria for waist circumference (90 cm for males and 80 cm for females) have been proposed for Asians in the ATP III-A [12] and IDF [13] definitions. In addition, a definition established by the Japan Society for the Study of Obesity (JASSO) [14] was also used in this study. Based on an area of 100 cm2 of intra-abdominal fat, the cut-off value for waist circumference is 85 cm for males and 90 cm for females under the JASSO definition [15]. Although the Japanese Committee of the Criteria for Metabolic Syndrome established the JASSO definition, there has been controversy concerning the effective cut-off value for waist circumference [16].

Lifestyle factors, such as an unbalanced diet and lack of physical activity, could cause MetS. Patients with schizophrenia are at risk for developing obesity due to poor dietary habits or limited physical activity because of the negative symptoms of schizophrenia. In addition, Japan has the highest number of psychiatric beds per 100,000 people in the world [17]. The mean length of hospital stay is about 1.5 years [18]. Because schizophrenic inpatients have received controlled meals and occupational therapy, the lifestyles of schizophrenic patients may be different from those of outpatients.

To clarify the effect of environmental factors on MetS in the schizophrenic population, we compared the prevalence of MetS based on the type of care (inpatient vs outpatient). To the best of our knowledge, this is the first study carried out in the schizophrenic population.

Methods

Participants

This study was conducted between January 2007 and December 2008. Subjects were 759 inpatients (355 males and 404 females) and 427 outpatients (215 males and 212 females) from 7 psychiatric hospitals in Japan who were diagnosed with either schizophrenia or schizoaffective disorder based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis. The diagnoses of the patients were recorded based on their medical charts. All subjects were previously instructed to fast from midnight prior to the assessment day. The data collection for this study was approved by the Ethics Committee of the Hirosaki University School of Medicine and all subjects provided written informed consent before participating in this study. The characteristics of the study population have been reported previously [19]. In this study, we reanalyzed the subjects based on the type of care (inpatient vs outpatient).

Measurements

The subjects' demographic data (age and sex) were obtained from their medical records. The height and weight of the subjects were measured, and body mass index (BMI) was calculated. Waist circumference to the nearest 0.1 cm was measured at the umbilical level with the subject in a standing position by a technician in the morning. Trained technicians measured blood pressure (BP) using standard mercury sphygmomanometers on the right arm of seated participants after a 5 min rest period. High-density lipoprotein (HDL) cholesterol, triglycerides and fasting blood glucose were also measured using standard analytical techniques. The presence of MetS was determined based on the definitions given by the ATP III-A for Asians, the recent IDF for Japanese populations and the JASSO (Table 1).
Table 1

Definitions of metabolic syndrome

 

ATP III-Aa

IDFb

JASSOc

Waist circumference (cm)

Male ≥ 90, female ≥ 80

Male ≥ 90, female ≥ 80

Male ≥ 85, female ≥ 90

Blood pressure (mmHg)d

≥ 130/85

≥ 130/85

≥ 130/85

HDL (mg/dl)e

Male < 40, female < 50

Male < 40, female < 50

< 40

TG (mg/dl)e

≥ 150

≥ 150

≥ 150

Glucose (mg/dl)f

≥ 100

≥ 100

≥ 110

aMetabolic syndrome if three of five criteria are met.

bMetabolic syndrome if waist circumference plus two criteria are met.

cMetabolic syndrome if waist circumference plus two of the following criteria are met: high blood pressure, reduced high-density lipoprotein (HDL) and/or raised triglyceride (TG), raised fasting hyperglycemia.

dOr specific treatment of previously diagnosed hypertension.

eOr specific treatment for this lipid abnormality.

fOr specific treatment with insulin or hypoglycemic medication.

ATP III-A = Adapted National Cholesterol Education Program Adult Treatment Panel; IDF = International Diabetes Federation; JASSO = Japan Society for the Study of Obesity.

Statistical analysis

Descriptive statistics were computed to describe the demographic and clinical variables. In order to compare the main demographic and clinical characteristics between groups, the unpaired Student's t test was performed to analyze continuous variables, and a χ2 test or Fisher's exact test was performed to analyze categorical variables. After adjusting for confounding factors (age and BMI), a multivariate logistic regression analysis was performed to assess the influence of schizophrenia as a risk factor for MetS. A value of P < 0.05 was considered significant. The data were analyzed using SPSS software for Windows (Version 12.0).

Results

Demographic and clinical characteristics

Demographic and clinical characteristics of the study population are shown in Table 2. Schizophrenic outpatients were significantly younger and taller, and had higher weight, BMI, waist circumference, systolic BP, diastolic BP, triglyceride and fasting blood glucose than schizophrenic inpatients.
Table 2

Demographic and clinical characteristics of the subjects

 

Total

Male

Female

 

Inpatients, (n = 759)

Outpatients, (n = 427)

P value

Inpatients, (n = 355)

Outpatients, (n = 215)

P value

Inpatients, (n = 404)

Outpatients, (n = 212)

P value

Age (years)

59.9 ± 12.9

45.6 ± 13.6

< 0.001

58.3 ± 13.1

45.2 ± 13.5

< 0.001

61.4 ± 12.5

46.0 ± 13.7

< 0.001

Height (cm)

158.3 ± 9.8

162.6 ± 9.9

< 0.001

165.1 ± 7.2

168.5 ± 6.6

< 0.001

152.3 ± 7.7

156.4 ± 8.9

< 0.001

Weight (kg)

55.7 ± 11.8

69.3 ± 14.4

< 0.001

60.8 ± 11.6

75.2 ± 11.9

< 0.001

51.2 ± 10.1

63.2 ± 14.2

< 0.001

BMI (kg/m2)

22.1 ± 4.0

26.5 ± 11.4

< 0.001

22.2 ± 4.0

26.5 ± 3.9

< 0.001

22.0 ± 4.0

26.6 ± 15.7

< 0.001

Waist circumference (cm)

82.9 ± 10.7

90.3 ± 12.4

< 0.001

82.9 ± 10.3

92.8 ± 10.7

< 0.001

83.0 ± 11.0

87.5 ± 13.4

< 0.05

Systolic BP (mmHg)

117.8 ± 16.1

127.9 ± 20.0

< 0.001

119.6 ± 16.5

131.4 ± 19.8

< 0.001

116.2 ± 15.5

124.4 ± 18.8

< 0.001

Diastolic BP (mmHg)

73.3 ± 11.6

78.7 ± 13.1

< 0.001

75.2 ± 12.1

80.9 ± 12.9

< 0.001

71.7 ± 10.8

76.5 ± 13.0

< 0.001

HDL-C (mg/dl)

55.0 ± 15.3

53.8 ± 16.1

NS

49.8 ± 12.5

49.3 ± 15.3

NS

59.5 ± 16.1

58.4 ± 15.6

NS

Triglyceride (mg/dl)

96.7 ± 56.5

167.8 ± 126.1

< 0.001

99.1 ± 63.6

202.3 ± 148.4

< 0.001

94.6 ± 49.5

133.2 ± 86.2

< 0.001

Fasting glucose (mg/dl)

90.6 ± 18.6

115.7 ± 52.2

< 0.001

91.0 ± 20.9

118.1 ± 53.2

< 0.001

90.3 ± 16.3

113.3 ± 51.2

< 0.001

Data are expressed as mean ± SD. These data were analyzed using Student's t test between the reference group and the schizophrenic patients.

BP = blood pressure; BMI = body mass index; HDL-C = high-density lipoprotein cholesterol; NS = not significant.

MetS and criteria prevalence among subjects

The data in Table 3 shows significant patterns of MetS criteria prevalence by type of care (inpatients vs outpatients). The unadjusted MetS prevalences among schizophrenic outpatients (inpatients) using the ATP III-A, IDF and JASSO definitions were 48.1% (15.8%), 44.1% (14.7%) and 33.2% (9.1%), respectively. The prevalence of all the criteria is significantly higher in the outpatient group than in the inpatient group. Among schizophrenic inpatients, an association between gender and MetS prevalence was significant based on the JASSO and IDF definitions (JASSO: χ2 = 16.03, df = 1, P < 0.001, IDF: χ2 = 4.04, df = 1, P < 0.05) but was not significant based on the ATP III-A definition (χ2 = 1.49, df = 1, P = 0.22). Schizophrenic outpatients showed an association between gender and MetS prevalence that was significant based on the JASSO and ATP III-A definitions (JASSO: χ2 = 31.19, df = 1, P < 0.001, ATP III-A: χ2 = 9.94, df = 1, P < 0.01), but was not significant based on the IDF definition (χ2 = 3.60, df = 1, P = 0.058).
Table 3

Prevalence of metabolic syndrome (MetS) and its criteria among subjects

 

All

Male

Female

 

Inpatients

Outpatients

P value

Inpatients

Outpatients

P value

Inpatients

Outpatients

P value

MetS prevalence:

         

ATP III-A

15.8

48.1

< 0.001

14.1

55.8

< 0.001

17.3

40.6

< 0.001

IDF

14.7

44.1

< 0.001

11.9

48.6

< 0.001

17.1

39.4

< 0.001

JASSO

9.1

33.2

< 0.001

13.6

45.8

< 0.001

5.1

20.2

< 0.001

MetS criteria prevalence:

         

Waist circumference

         

   Male ≥ 90 cm, female ≥ 80 cm

46.2

64.2

< 0.001

27.8

61.7

< 0.001

62.4

66.8

NS

   Male ≥ 85 cm, female ≥ 90 cm

34.9

59.0

< 0.001

42.3

73.8

< 0.001

28.4

43.8

< 0.001

BP (≥ 130/85 mmHg)

30.7

46.7

< 0.001

37.2

55.5

< 0.001

25.1

37.5

< 0.01

HDL (male < 40 mg/dl, female < 50 mg/dl)

25.5

31.8

< 0.05

22.7

28.9

NS

28.0

34.8

NS

Triglyceride (≥ 150 mg/dl)

11.2

40.6

< 0.001

13.2

50.2

< 0.001

9.4

31.0

< 0.001

HDL (< 40 mg/dl) and TG (≥ 150 mg/dl)

20.8

46.1

< 0.001

28.2

58.1

< 0.001

14.4

34.0

< 0.001

Glucose (≥ 100 mg/dl)

17.5

50.9

< 0.001

16.6

56.0

< 0.001

18.4

45.5

< 0.001

Glucose (≥ 110 mg/dl)

9.5

35.3

< 0.001

9.9

36.8

< 0.001

9.2

33.7

< 0.001

All prevalences are expressed as a percentage (%) and were analyzed using the χ2 test comparing the reference group and the schizophrenic patients.

ATP III-A = Adapted National Cholesterol Education Program Adult Treatment Panel; BP = blood pressure; IDF = International Diabetes Federation; JASSO = Japan Society for the Study of Obesity; HDL = high-density lipoprotein; NS = not significant.

Male inpatients with schizophrenia showed higher prevalences of criteria for waist circumference (JASSO: χ2 = 15.65, df = 1, P < 0.001), BP (ATP III-A, IDF, JASSO: χ2 = 12.98, df = 1, P < 0.001) and TG and/or HDL (JASSO: χ2 = 21.71, df = 1, P < 0.001) than female inpatients. However, more female inpatients with schizophrenia met the criteria for waist circumference (ATP III-A, IDF: χ2 = 88.17, df = 1, P < 0.001) than male inpatients. No significant differences were seen in HDL (ATP III-A, IDF: χ2 = 2.69, df = 1, P = 0.10), TG (ATP III-A, IDF: χ2 = 2.75, df = 1, P = 0.097) and fasting plasma glucose levels (ATP III-A, IDF: χ2 = 3.96, df = 1, P = 0.529, JASSO: χ2 = 0.10, df = 1, P = 0.751).

Male outpatients with schizophrenia showed higher prevalences of criteria for waist circumference (JASSO: χ2 = 39.46, df = 1, P < 0.001), BP (ATP III-A, IDF, JASSO: χ2 = 13.57, df = 1, P < 0.001), TG (ATP III-A, IDF: χ2 = 15.53, df = 1, P < 0.001), TG and/or HDL (JASSO: χ2 = 23.80, df = 1, P < 0.001) and fasting plasma glucose levels (ATP III-A, IDF: χ2 = 4.48, df = 1, P < 0.05) than female outpatients. No significant difference was seen in waist circumference (ATP III-A, IDF: χ2 = 1.22, df = 1, P = 0.270), HDL (ATP III-A, IDF: χ2 = 1.49, df = 1, P = 0.22) and fasting plasma glucose levels (JASSO: χ2 = 0.46, df = 1, P = 0.50)

The effect of type of care on the odds ratio for MetS

To examine the independent effect of type of care for schizophrenia on the odds ratio of for MetS, two logistic regression models were developed with MetS status as the binary dependent variable (Table 4). Due to the differences in the criteria for MetS by gender, these models were constructed in a gender-specific manner. In model 1, the odds ratios of having MetS were greater for male schizophrenic outpatients (ATP III-A: odds ratio = 7.57, 95% CI = 4.83 to 11.86, P < 0.001, IDF: odds ratio = 6.72, 95% CI = 4.19 to 10.78, P < 0.001, JASSO: odds ratio = 6.07, 95% CI = 3.80 to 9.71, P < 0.001), and female schizophrenic outpatients (ATP III-A: odds ratio = 4.24, 95% CI = 2.70 to 6.67, P < 0.001, IDF: odds ratio = 3.95, 95% CI = 2.50 to 6.24, P < 0.001, JASSO: odds ratio = 5.66, 95% CI = 2.92 to 10.94, P < 0.001) when analyzed with illness and age as covariates. In the second model, the odds ratios for both male and female schizophrenic outpatients were also statistically significant when BMI was added as a covariate.
Table 4

Logistic regression models of metabolic syndrome (MetS) status in subjects

 

Model 1

Model 2

 

Covariate

OR (95% CI)

P value

Covariate

OR (95% CI)

P value

Male:

      

ATP III-A

Outpatients

7.569 (4.829 to 11.863)

< 0.001

Outpatients

3.664 (2.187 to 6.139)

< 0.001

 

Age

1.000 (0.985 to 1.015)

NS

Age

1.015 (0.998 to 1.036)

NS

    

BMI

1.479 (1.365 to 1.602)

< 0.001

IDF

Outpatients

6.717 (4.188 to 10.7765)

< 0.001

Outpatients

2.506 (1.397 to 4.496)

< 0.01

 

Age

0.998 (0.983 to 1.014)

NS

Age

1.018 (0.996 to 1.040)

NS

    

BMI

1.677 (1.517 to 1.855)

< 0.001

JASSO

Outpatients

6.071 (3.795 to 9.711)

< 0.001

Outpatients

2.599 (1.505 to 4.488)

< 0.01

 

Age

1.011 (0.995 to 1.027)

NS

Age

1.034 (1.014 to 1.055)

< 0.01

    

BMI

1.467 (1.354 to 1.589)

< 0.001

Female:

      

ATP III-A

Outpatients

4.243 (2.699 to 6.671)

< 0.001

Outpatients

2.477 (1.474 to 4.161)

< 0.01

 

Age

1.017 (1.002 to 1.032)

< 0.05

Age

1.032 (1.013 to 1.050)

< 0.01

    

BMI

1.332 (1.253 to 1.416)

< 0.001

IDF

Outpatients

3.952 (2.497 to 6.254)

< 0.001

Outpatients

2.842 (1.738 to 4.647)

< 0.001

 

Age

1.015 (1.000 to 1.030)

NS

Age

1.021 (1.004 to 1.038)

< 0.05

    

BMI

1.143 (1.090 to 1.198)

< 0.001

JASSO

Outpatients

5.655 (2.923 to 10.940)

< 0.001

Outpatients

4.137 (2.047 to 8.361)

< 0.001

 

Age

1.010 (0.989 to 1.031)

NS

Age

1.012 (0.990 to 1.035)

NS

    

BMI

1.089 (1.027 to 1.154)

< 0.01

ATP III-A = Adapted National Cholesterol Education Program Adult Treatment Panel; BMI = body mass index; IDF = International Diabetes Federation; JASSO = Japan Society for the Study of Obesity; OR = odds ratio; NS = not significant.

Age-specific prevalence of metabolic syndrome

Figure 1 shows the age-specific prevalences of MetS (ATP III-A) for both genders. In all age groups, MetS prevalence for male schizophrenic outpatients was greater than inpatients. For female schizophrenic outpatients, the prevalence was statistically higher in the over 40 age group. The age-specific prevalences of MetS using the IDF and JASSO definitions showed similar tendencies (data not shown).
https://static-content.springer.com/image/art%3A10.1186%2F1744-859X-10-21/MediaObjects/12991_2011_Article_1300_Fig1_HTML.jpg
Figure 1

The age-specific prevalence of metabolic syndrome (Adapted National Cholesterol Education Program Adult Treatment Panel (ATP III-A)) among Japanese outpatients and inpatients with schizophrenia. * Indicates a statistically significant (P < 0.05) difference from control.

Discussion

Control of diet and physical activity may affect the development of MetS. The services provided for patients differ based on the type of care, such as hospital or community-based care. The type of care could be a large environmental factor. However, there have been few studies that compare the prevalence of MetS among patients receiving different types of care. In this study, we reported the prevalence of MetS in inpatients and outpatients diagnosed with schizophrenia. Compared to inpatients, outpatients were found to be at a higher risk of developing MetS.

Previous studies of inpatients with schizophrenia have reported that the prevalence of MetS ranged from 27 to 29% using the ATP III definition [20, 21]. With the same definition, the prevalence of MetS among outpatients with schizophrenia ranged from 25% to 35% [3, 22]. Although there have been some reports of the prevalence of MetS in patients undergoing inpatients or outpatient care, we could not compare the prevalence of MetS because the patients in these studies were treated under different systems of medical care.

In this study, outpatients with schizophrenia were found to be at a higher risk of developing MetS than inpatients with schizophrenia. Using the ATP III-A and JASSO definitions, male outpatients have a higher prevalence of MetS than female outpatients. Among inpatients with schizophrenia, female inpatients showed a higher prevalence of MetS than male inpatients using the IDF definition, while male inpatients showed a higher prevalence of MetS than female inpatients using the JASSO definition.

The prevalence rates of MetS reported in previous studies have varied considerably due to the different definitions of the syndrome used in each study. In this study, the prevalence rate of MetS (5.1%) among female schizophrenic inpatients using the JASSO definition seems to be extremely low compared to those obtained using the ATP III-A (17.3%) and IDF (17.1%) definitions. This difference may be due to the influence of increasing the waist circumference criterion to 90 cm [14]. The specific values of waist circumference used to assess MetS in the Japanese population have changed in the IDF definition: the current specific values for Japanese are 90 cm for men and 80 cm for women [13], as in the ATP III-A definition. Though the effective cut-off value for waist circumference is still controversial, the ATP III-A or IDF criteria may be suitable for making international comparisons because of the availability of data in several different ethnic groups.

As mentioned earlier, no significant difference in MetS prevalence between inpatients and outpatients was observed in females aged 39 years and younger. The results using the IDF and JASSO definitions were similar. One possible explanation is that this study failed to find a difference in MetS prevalence in females aged 39 years and younger due to smaller sample sizes. Another possible explanation is that the later age at onset of female schizophrenic patients compared to schizophrenic male patients [23, 24] might cause differences in duration of treatment between genders.

The reason for this increased prevalence among outpatients has not been entirely elucidated. However, schizophrenic inpatients have received controlled diets and occupational therapy. Schizophrenic inpatients in Japan typically have long hospital stays, and the above-mentioned treatment might influence the lower prevalences of MetS in this study. Previous studies [25, 26] have suggested that long-term programs that incorporate nutrition, exercise, and behavioral interventions can prevent weight gain among schizophrenic patients. An effective intervention program could reduce the high risk for developing MetS among male outpatients.

The current study also has some limitations. Firstly, it was a cross-sectional study. It is necessary to carry out a follow-up survey to clarify the reason for not finding a difference in the MetS prevalence between inpatients and outpatients among female subjects aged 39 and younger. Secondly, patient recruitment was restricted to hospitals where outpatients and inpatients presented for a review of their health problems. No other population groups were included, such as children, adolescents or unmedicated patients. Thirdly, some patients, who were diagnosed with schizophrenia may have had metabolic disturbances prior the use of antipsychotics [27]. Lastly, some parameters that may contribute to MetS were not included in this study, such as dietary habits, physical activity levels, duration of illness and treatment, length of the current stay in hospital among inpatients, schizophrenic symptoms and medications. Antipsychotic medications may be especially important factors. The use of first-generation or second-generation antipsychotics might confound the results. Stratification by drug use is needed in further studies.

Conclusions

This study has shown that the prevalence of MetS in Japanese outpatients with schizophrenic and schizoaffective disorders was higher than in inpatients and was considerably higher in male outpatients. Therefore, metabolic abnormalities in schizophrenic patients should be monitored carefully and treated in an appropriate manner.

Declarations

Acknowledgements

The authors would like to thank all their coworkers on this study for their skillful contributions to the data collection and management.

Authors’ Affiliations

(1)
Department of Psychiatry, Hirosaki-Aiseikai Hospital
(2)
Department of Neuropsychiatry, Hirosaki University School of Medicine
(3)
Department of Psychiatry, Fujisawa Hospital
(4)
Department of Psychiatry, Yokohama City University School of Medicine
(5)
Department of Psychiatry, Moro Hospital
(6)
Department of Neuropsychiatry, Saitama Medical University
(7)
Department of Psychiatry, Kuroishi-Akebono Hospital
(8)
Department of Psychiatry, Odate Municipal General Hospital
(9)
Department of PsychiatryHigashidai Hospital

References

  1. Cohn T, Prud'homme D, Streiner D, Kameh H, Remington G: Characterizing coronary heart disease risk in chronic schizophrenia: high prevalence of the metabolic syndrome. Can J Psychiatry. 2004, 49: 753-760.PubMedGoogle Scholar
  2. Meyer JM, Nasrallah HA, McEvoy JP, Goff DC, Davis SM, Chakos M, Patel JK, Keefe RS, Stroup TS, Lieberman JA: The Clinical Antipsychotic Trials Of Intervention Effectiveness (CATIE) Schizophrenia Trial: clinical comparison of subgroups with and without the metabolic syndrome. Schizophr Res. 2005, 80: 9-18. 10.1016/j.schres.2005.07.015.View ArticlePubMedGoogle Scholar
  3. Bobes J, Arango C, Aranda P, Carmena R, Garcia-Garcia M, Rejas J: CLAMORS Study Collaborative Group. Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: results of the CLAMORS study. Schizophr Res. 2007, 90: 162-173. 10.1016/j.schres.2006.09.025.View ArticlePubMedGoogle Scholar
  4. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001, 24: 683-689. 10.2337/diacare.24.4.683.View ArticlePubMedGoogle Scholar
  5. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002, 288: 2709-2716. 10.1001/jama.288.21.2709.View ArticlePubMedGoogle Scholar
  6. Wilson PW, D'Agostino RB, Parise H, Sullivan L, Meigs JB: Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005, 112: 3066-3072. 10.1161/CIRCULATIONAHA.105.539528.View ArticlePubMedGoogle Scholar
  7. Expert Panel on Detection, Evaluation and Treatmentof High Blood Cholesterol in Adults: Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001, 285: 2486-2497. 10.1001/jama.285.19.2486.View ArticleGoogle Scholar
  8. Grundy SM: Hypertriglyceridemia, insulin resistance, and the metabolic syndrome. Am J Cardiol. 1999, 83: 25F-29F.View ArticlePubMedGoogle Scholar
  9. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC, Spertus JA, Costa F: Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005, 112: 2735-2752. 10.1161/CIRCULATIONAHA.105.169404.View ArticlePubMedGoogle Scholar
  10. Alberti KG, Zimmet P, Shaw J: Metabolic syndrome-a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006, 23: 469-480. 10.1111/j.1464-5491.2006.01858.x.View ArticlePubMedGoogle Scholar
  11. Lear SA, Toma M, Birmingham CL, Frohlich JJ: Modification of the relationship between simple anthropometric indices and risk factors by ethnic background. Metabolism. 2003, 52: 1295-1301. 10.1016/S0026-0495(03)00196-3.View ArticlePubMedGoogle Scholar
  12. Tan CE, Ma S, Wai D, Chew SK, Tai ES: Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians?. Diabetes Care. 2004, 27: 1182-1186. 10.2337/diacare.27.5.1182.View ArticlePubMedGoogle Scholar
  13. International Diabetes Federation: The IDF consensus worldwide definition of the metabolic syndrome. [http://www.idf.org/webdata/docs/MetSyndrome_FINAL.pdf]
  14. Examination Committee of the Criteria for Metabolic Syndrome in Japan: Definition and criteria of the metabolic syndrome in Japan [in Japanese]. Japan Intern Med. 2005, 94: 188-201.Google Scholar
  15. Examination Committee of the Criteria for "Obesity Disease" in Japan, Japan Society for the study of Obesity: New criteria for 'obesity disease' in Japan. Circ J. 2002, 66: 987-992. 10.1253/circj.66.987.View ArticleGoogle Scholar
  16. Lee JS, Kawakubo K, Mori K, Akabayashi A: Effective cut-off values of waist circumference to detect the clustering of cardiovascular risk factors of metabolic syndrome in Japanese men and women. Diab Vasc Dis Res. 2007, 4: 340-345. 10.3132/dvdr.2007.062.View ArticlePubMedGoogle Scholar
  17. Oshima I, Mino Y, Inomata Y: How many long-stay schizophrenia patients can be discharged in Japan?. Psychiatry Clin Neurosci. 2007, 61: 71-77. 10.1111/j.1440-1819.2007.01613.x.View ArticlePubMedGoogle Scholar
  18. Statistics and Information Department Minister's Secretariat, Ministry of Health, Labour and Welfare: Patient Survey. 2008, Tokyo, Japan: Ministry of Health, Labour and WelfareGoogle Scholar
  19. Sugawara N, Yasui-Furukori N, Sato Y, Umeda T, Kishida I, Yamashita H, Saito M, Furukori H, Nakagami T, Hatakeyama M, Nakaji S, Kaneko S: Prevalence of metabolic syndrome among patients with schizophrenia in Japan. Schizophr Res. 2010, 123: 244-250. 10.1016/j.schres.2010.08.030.View ArticlePubMedGoogle Scholar
  20. Rezaei O, Khodaie-Ardakani MR, Mandegar MH, Dogmehchi E, Goodarzynejad H: Prevalence of metabolic syndrome among an Iranian cohort of inpatients with schizophrenia. Int J Psychiatry Med. 2009, 39: 451-462. 10.2190/PM.39.4.i.View ArticlePubMedGoogle Scholar
  21. Teixeira PJ, Rocha FL: The prevalence of metabolic syndrome among psychiatric inpatients in Brazil. Rev Bras Psiquiatr. 2007, 29: 330-336.View ArticlePubMedGoogle Scholar
  22. Huang MC, Lu ML, Tsai CJ, Chen PY, Chiu CC, Jian DL, Lin KM, Chen CH: Prevalence of metabolic syndrome among patients with schizophrenia or schizoaffective disorder in Taiwan. Acta Psychiatr Scand. 2009, 120: 274-280. 10.1111/j.1600-0447.2009.01401.x.View ArticlePubMedGoogle Scholar
  23. Takahashi S, Matsuura M, Tanabe E, Yara K, Nonaka K, Fukura Y, Kikuchi M, Kojima T: Age at onset of schizophrenia: gender differences and influence of temporal socioeconomic change. Psychiatry Clin Neurosci. 2000, 54: 153-156. 10.1046/j.1440-1819.2000.00651.x.View ArticlePubMedGoogle Scholar
  24. Tang YL, Gillespie CF, Epstein MP, Mao PX, Jiang F, Chen Q, Cai ZJ, Mitchell PB: Gender differences in 542 Chinese inpatients with schizophrenia. Schizophr Res. 2007, 97: 88-96. 10.1016/j.schres.2007.05.025.View ArticlePubMedGoogle Scholar
  25. Menza M, Vreeland B, Minsky S, Gara M, Radler DR, Sakowitz M: Managing atypical antipsychotic-associated weight gain: 12-month data on a multimodal weight control program. J Clin Psychiatry. 2004, 65: 471-477.View ArticlePubMedGoogle Scholar
  26. Poulin MJ, Chaput JP, Simard V, Vincent P, Bernier J, Gauthier Y, Lanctôt G, Saindon J, Vincent A, Gagnon S, Tremblay A: Management of antipsychotic-induced weight gain: prospective naturalistic study of the effectiveness of a supervised exercise programme. Aust N Z J Psychiatry. 2007, 41: 980-989. 10.1080/00048670701689428.View ArticlePubMedGoogle Scholar
  27. Fernandez-Egea E, Bernardo M, Donner T, Conget I, Parellada E, Justicia A, Esmatjes E, Garcia-Rizo C, Kirkpatrick B: Metabolic profile of antipsychotic-naive individuals with non-affective psychosis. Br J Psychiatry. 2009, 194: 434-438. 10.1192/bjp.bp.108.052605.PubMed CentralView ArticlePubMedGoogle Scholar

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