ORIGINAL ARTICLE

24 J Gandhara Med Dent Sci

January - March 2025

FREQUENCY OF METABOLIC SYNDROME IN SCHIZOPHRENIC PATIENTS IN A TERTIARY

CARE HOSPITAL, PESHAWAR, PAKISTAN

Fazle Rabbani1, Waleed Ahmad2

ABSTRACT

OBJECTIVES

This study aimed to determine the prevalence of metabolic syndrome in

schizophrenic patients in a tertiary care hospital.

METHODOLOGY

This descriptive cross-sectional study was conducted at the Department of

Psychiatry, PGMI Lady Reading Hospital Peshawar, Pakistan, from March

2023 to February 2024. A total of 196 schizophrenic patients were studied.

After obtaining permission from the hospital's ethical committee and consent

from patients included in the study, metabolic syndrome was diagnosed based

on the American Association of Clinical Endocrinology criteria (2003). All

the data, like age, gender, height, weight, BMI, smoking status, and metabolic

syndrome, were recorded in a pre-designed proforma. All the data were

analyzed in SPSS version 20. Mean and standard deviation were calculated

for numerical variables, and frequencies and percentages for qualitative

variables. The Chi-square test for categorical variables was applied with a p-

value of < 0.05 as signicant. Results were presented in the form of tables

and charts.

RESULTS

The mean and standard deviation of age, height, weight, and BMI were

35.72±13.28, 164.80±11.50, 71.87±13.60 and 27.00±6.96, respectively. Out

of 196 schizophrenic patients, 59 patients had metabolic syndrome, making

up 31.1%, while 69.9% of patients had no metabolic syndrome. Of 196

schizophrenic patients, 106 were female, and 90 were male, making 54.1%

and 45.9%, respectively, of all schizophrenic patients. Among 196 patients,

28 were from the BMI group < 18kg/m2, 71 from the BMI group 18-24kg/m2,

51 from the BMI group 25-30kg/m2, and 46 from the BMI group> 30kg/m2

making 14.3%, 36.2%, 26.0% and 23.5% respectively. Metabolic syndrome

was statistically signicant in age and BMI groups using the chi-square test

with a p-value < 0.05 as signicant.

CONCLUSION

The metabolic syndrome aects individuals with schizophrenia, particularly

among older patients and those with a high BMI. Signicant associations

were observed with age and BMI, but gender and smoking status did not

show signicant dierences.

KEYWORDS: Metabolic syndrome, schizophrenia, Anti-Psychotics, BMI,

Smoking

How to cite this article

Rabbani F, Ahmad W. Frequency of

Metabolic Syndrome in Schizophrenic

Patients in A Tertiary Care Hospital,

Peshawar, Pakistan. J Gandhara Med

Dent Sci. 2025;12(1):24-27.doi:10.37762

Date of Submission: 08-10-2024

Date Revised: 03-12-2024

Date Acceptance: 12-12-2024

1Assistant Professor, Department of

Psychiatry, Lady Reading Hospital,

MTI, Peshawar

Correspondence

2Waleed Ahmad, Assistant Professor,

Department of Psychiatry, L

Reading Hospital, MTI, Peshawar

dr.waleed@outlook.com

INTRODUCTION

Schizophrenia is one of the psychiatric illnesses

affecting about 1% of the population of the world.1 It is

a severe mental illness causing morbidity and mortality

globally. The lifetime risk of schizophrenia in

developing countries is about 4.0 per 1000 population.2

It is more common in males than females, forming a

ratio of 1.4:1.3 The age of onset of schizophrenia is

usually early adulthood. For males, the peak age of

onset of schizophrenia is <25 years, and for females,

the peak age for onset of schizophrenia is <35 years.4

The prevalence of schizophrenia in Pakistan is 1.5%,

causing premature mortality due to the disease and

drug’s side eects and associated other risk factors.5

Schizophrenic patients are at risk of cardiovascular

events due to the prevalence of cardio-metabolic

disorders related to schizophrenia.6 Metabolic

syndrome is a collection of clinical and metabolic

disorders, including insulin resistance, impaired glucose

tolerance, hypertension, obesity, and dyslipidemia.7

Different criteria are used for diagnosing metabolic

syndrome, i.e., WHO criteria.8 European Group for the

Study of Insulin Resistance criteria, National

Cholesterol Education Program Adult Treatment Panel

111(NCEP/ATP111) criteria, American Association of

/jgmds.12-1.632

J Gandhara Med Dent Sci

January - March 2025

Clinical Endocrinology criteria, and International

Diabetes Federation (IDF) criteria.9 The American

Association of Clinical Endocrinology criterion for

metabolic syndrome is based on impaired glucose

tolerance, BMI, dyslipidemia, and hypertension.10 The

metabolic syndrome causes morbidity and mortality due

to cardiovascular diseases. Metabolic syndrome

includes a disease of old age aecting 42% of the

population above 70 years old and aects both males

and females equally. The overall prevalence of

metabolic syndrome ranges from 8% to 63%,

depending on age, race, and geographical location.11

Schizophrenic patients have an increased risk of

developing metabolic syndrome due to unhealthy

lifestyles, poor diet, sedentary behavior, and side eects

of drugs. The prevalence of metabolic syndrome in

schizophrenic patients varies, as shown in dierent

studies. The prevalence of metabolic syndrome in a

study was 37%.12 Another study showed the prevalence

of metabolic syndrome as 50%, while another study

showed a 44.6% prevalence of metabolic syndrome in

schizophrenic patients.13,14 This study aimed to

determine the prevalence of metabolic syndrome in

schizophrenic patients in a tertiary care hospital. This

study will help us to know the association of age,

gender, BMI, and smoking with metabolic syndrome in

schizophrenic patients.

METHODOLOGY

This descriptive cross-sectional study was conducted at

the Department of Psychiatry, Lady Reading Hospital

Peshawar, Pakistan, from March 2023 to February

2024. The sample size was calculated using the WHO

sample size calculator, keeping a 50% proportion of

metabolic syndrome in schizophrenic patients, a 95%

confidence interval, and a 7 % margin error. The

sample size was 196. Sampling was done using a

consecutive non-probability sampling technique. All the

patients presenting with schizophrenia were diagnosed

based on the Diagnostic and Statistical Manual of

Mental Disorders-IV-Text Revision (DSM-IV-TR)

diagnostic criteria with ages 20 or less to 50 or more

years included in the study. Patients having a history of

other psychiatric illnesses, hypothyroidism, pregnancy,

malignancies, and secondary hypertension due to

endocrine causes were excluded. Exclusion criteria

were strictly followed to control the confounders and to

exclude bias in the study results. After obtaining

permission from the hospital's ethical committee and

consent from patients included in the study, metabolic

syndrome was diagnosed based on the American

Association of Clinical Endocrinology criteria (2003).

A patient was labeled as having metabolic syndrome if

they had impaired fasting glucose plus any of the

following, i.e., BMI ≥ 25kg/m2 or serum triglycerides ≥

150mg/dl and HDL-cholesterol <40mg/dl in men and

<40mg/dl in women or Blood pressure 130/85mmHg or

greater. The body mass index of all the patients was

calculated. 10 ml of blood was taken from all the

patients and sent to the hospital laboratory to detect

impaired fasting glucose and dyslipidemia. A patient

was labeled as having impaired fasting glucose if the

fasting blood sugar was > 100mg/dl. A patient was

labeled dyslipidemia if the serum triglycerides were≥

150mg/dl and HDL-cholesterol <40mg/dl in men and

<40mg/dl in women. All the investigations were done

in the same laboratory by a technician with more than

five years of experience. Blood pressure was calculated

manually. Certeza Aneroid Sphygmomanometer (CR

1006). All the data, such as age, gender, height, weight,

BMI, smoking status, and metabolic syndrome, were

recorded in a pre-designed proforma. All the data were

analyzed in SPSS version 20. Mean and standard

deviation were calculated for numerical variables, and

frequencies and percentages were calculated for

qualitative variables. The Chi-square test for categorical

variables was applied with a p-value of < 0.05 as

signicant.

The mean and standard deviation of age, height, weight,

and BMI were 35.72 ± 13.28, 164.80 ± 11.50,

71.87 ± 13.60 and 27.00 ± 6.96 respectively. (Table1).

RESULTS

Table 1: Demographic variables of schizophrenic patients

f (%)

Age < 20 years 62(31.6)

21-30 years 32(16.3)

31-40 years 33(16.8)

41-50 years 51 (26.0)

> 50 years 18(9.2)

Gender Female 106 (54.1)

Male 90 (45.9)

BMI < 18kg/m2 28 (14.3)

18-24kg/m2 71 (36.2)

25-30kg/m2 51 (26.0)

> 30kg/m2 46 (23.5)

Metabolic Syndrome in

Schizophrenic Patients

Present 59 (30.1)

Absent 137 (69.9)

: Table 2 Prevalence of Metabolic Syndrome among Age groups

Age Metabolic syndrome in schizophrenic

patients

P-value

Present Absent

< 20 years 04 (6.8) 58 (42.3) <0.001

21-30 years 06 (10.2) 26 (19.0)

31-40 years 14 (23.7) 19 (13.9)

41-50 years 22 (37.3) 29 (21.2)

> 50 years 13 (22.0) 05 (3.6)

Frequency of Metabolic Syndrome in Schizophrenic Patients

26 J Gandhara Med Dent Sci

January - March 2025

Table 3: Gender-wise metabolic syndrome distribution in

schizophrenic patients

Gender Metabolic syndrome in schizophrenic

patients

P-value

Present Absent

Female 30 (50.8) 76 (55.5) 0.551

Male 29 (49.2) 61 (44.5)

Table 4: Prevalence of Metabolic Syndrome among BMI groups

BMI Metabolic syndrome in schizophrenic

patients

P-value

Present Absent

< 18kg/m2 03 (5.1%) 25 (18.2%) 0.004

18-24kg/m2 16 (27.1%) 55 (40.1%)

25-30kg/m2 19 (32.2%) 32 (23.4%)

> 30kg/m2 21 (35.6%) 25 (18.2%)

DISCUSSION

Metabolic syndrome is one of the metabolic disorders

causing mortality and morbidity worldwide. It is more

prevalent in schizophrenic patients as compared to non-

schizophrenic patients. The metabolic syndrome was

more prevalent in schizophrenic patients as compared

to normal people of the same population.15 The

prevalence of metabolic syndrome was 46% in people

with schizophrenia and 18.3% in normal individuals in

that population. The prevalence of metabolic syndrome

was 19.4%, while in another survey, the prevalence of

metabolic syndrome in schizophrenic patients was

53.3%.16,17 In our present study, the prevalence of

metabolic syndrome in schizophrenic patients was

31.1% presenting in tertiary care hospitals. The

prevalence of metabolic syndrome in schizophrenic

patients increases with the increase of age. It was

shown in many studies that metabolic syndrome had a

significant association with age. The studies showed

that the prevalence of metabolic syndrome in

schizophrenic patients increased with the increase of

age, signicantly aecting the patients i n the 3rd, 4th,

and 5th decades more as compared to the young

patients.11,18 Our present study showed that metabolic

syndrome was more prevalent in the 4th decade and

affected patients of old age. Schizophrenia is present in

both genders equally. Studies have shown that

metabolic syndrome in schizophrenic patients is present

more in women as compared to women.15,19 The present

study showed that metabolic syndrome was more

common in women but was not statistically signicant.

Smoking is one of the risk factors for cardiovascular

diseases. It is more prevalent in males.20,21,22 in our

study, the prevalence of smoking was higher in male

patients, and no female in our research used to smoke.

BMI is one of the predictors of metabolic syndrome in

patients with schizophrenia.23 A literature search

showed that patients having high BMI had more

Frequency of Metabolic Syndrome in Schizophrenic Patients

chances of developing metabolic syndrome than

24,25

schizophrenic patients. Our present study showed

that BMI is associated with metabolic syndrome in

patients with schizophrenic patients and was

statistically signicant.

LIMITATIONS

This study has an ethnicity, diet, and the drug eects on

metabolic syndrome in schizophrenic patients were not

determined.

CONCLUSIONS

It was concluded that the prevalence of metabolic

syndrome in schizophrenia was 31.1%, and metabolic

syndrome was more prevalent in patients having high

BMI and old age. According to age and BMI, the

metabolic syndrome in patients with schizophrenia was

statistically signicant, while gender distribution and

smoking status in schizophrenic patients with metabolic

syndrome were not statistically signicant.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

REFERENCES

1. Prabhakaran S, Nagarajan P, Varadharajan N, Menon V.

Relationship Between Quality of Life and Social Support

Among Patients with Schizophrenia and Bipolar Disorder: A

Cross-Sectional Study. J Psychosoc Rehabil Ment Health

2021;8(2):137-45.doi:10.1007/s40737-020-00211-7.

2. Baranne ML, Falissard B. Global burden of mental disorders

among children aged 5-14 years. Child Adolesc Psychiatry

Ment Health . 2018 Apr 12;12:19.

3. Velligan DI, Rao S. The Epidemiology and Global Burden of

Schizophrenia. J Clin Psychiatry.2023;84(1).doi:10.4088

/jcp.ms21078com5.

4. Häfner H. From Onset and Prodromal Stage to a Life-Long

Course of Schizophrenia and Its Symptom Dimensions: How

Sex, Age, and Other Risk Factors Inuence Incidence and

Course of Illness. Psychiatry J . 2019 Apr 16;2019

:9804836.

5. Ayub M, Arsalan A, Khan S ud DA, Bajwa S, Hussain F, Umar

M, et al. Self-reported health and smoking status, and body

mass index: a case-control comparison based on GEN SCRIP

(GENetics of SChizophRenia In Pakistan) data. BMJ Open

2021;11(4):e042331.doi:10.1136/bmjopen-2020-042331.

6. Balõtšev R, Koido K, Vasar V, Janno S, Kriisa K, Mahlapuu R,

et al. Inammatory, cardio-metabolic and diabetic proling of

chronic schizophrenia. European Psychiatry.2017;39:1-10.

doi.10.1016/j.eurpsy.2016.05.010.

7. Gluvic Z, Zaric B, Resanovic I, Obradovic M, Mitrovic A,

Radak D, et al. Link between Metabolic Syndrome and Insulin

Resistance. Curr Vasc Pharmacol [Internet]. 2016;15(1):30–9.

doi:10.2174/1570161114666161007164510.

8. Nilsson PM, Tuomilehto J, Rydén L. The metabolic syndrome –

What is it and how should it be managed? Eur J Prev Cardiol

2019;26(2_suppl):33-46.doi:10.1177/2047487319886404.

J Gandhara Med Dent Sci

January - March 2025

LICENSE: JGMDS publishes its articles under a Creative Commons Attribution Non-Commercial Share-Alike license (CC-BY-NC-SA 4.0).

COPYRIGHTS: Authors retain the rights without any restrictions to freely download, print, share and disseminate the article for any lawful purpose.

It includes scholarlynetworks such as Research Gate, Google Scholar, LinkedIn, Academia.edu, Twitter, and other academic or professional networking sites.

9. Ulaganathan V, Kandiah M, Mohd Shari Z. A case-control

study of the association between metabolic syndrome and

colorectal cancer: a comparison of International Diabetes

Federation, National Cholesterol Education Program Adults

Treatment Panel III, and World Health Organization denitions.

J Gastrointest Oncol. 2018 Aug;9(4):650-63.

10. Al-Hamad D, Raman V. Metabolic syndrome in children and

adolescents. Transl Pediatr . 2017 Oct;6(4):397-407.

11. Yoca G, Anıl Yağcıoğlu AE, Eni N, Karahan S, Türkoğlu İ,

Akal Yıldız E, et al. A follow-up study of metabolic syndrome

in schizophrenia. Eur Arch Psychiatry Clin Neurosci.2019;270

(5):611-8.doi:10.1007/s00406-019-01016-x.

12. Sneller MH, de Boer N, Everaars S, Schuurmans M, Guloksuz

S, Cahn W, et al. Clinical, Biochemical and Genetic Variables

Associated With Metabolic Syndrome in Patients With

Schizophrenia Spectrum Disorders Using Second-Generation

Antipsychotics: A Systematic Review. Front Psychiatry.

2021 Mar 29;12:625935.

13. Pillinger T, McCutcheon RA, Vano L, Mizuno Y, Arumuham

A, Hindley G, et al. Comparative effects of 18 antipsychotics on

metabolic function in patients with schizophrenia, predictors of

metabolic dysregulation, and association with psychopathology:

a systematic review and network meta-analysis. Lancet

Psychiatry. 2019/12/17. 2020 Jan;7(1):64-77.

14. Piras M, Ranjbar S, Laaboub N, Grosu C, Gamma F, Plessen

KJ, et al. Evolutions of Metabolic Parameters Following

Switches of Psychotropic Drugs: A Longitudinal Cohort Study.

Schizophr Bull . 2023 Jan 3;49(1):24-33.

15. Challa F, Getahun T, Sileshi M, Geto Z, Kelkile TS, Gurmessa

S, et al. Prevalence of metabolic syndrome among patients with

schizophrenia in Ethiopia. BMC Psychiatry. 2021 Dec11;21(1):

620.

16. Nebhinani N, Tripathi S, Suthar N, Pareek V, Purohit P, Sharma

P. Correlates of Metabolic Syndrome in Patients with

Schizophrenia: An Exploratory Study. Indian J Clin Biochem.

2020/07/06. 2022 Apr;37(2):232-7.

17. Xing M, Sheng J, Cui M, Su Y, Zhang C, Chen X, et al.

Differing Prevalence and Correlates of Metabolic Syndromes

Between Chlorpromazine and Clozapine: A 10-year

Retrospective Study of a Male Chinese Cohort. Curr

Neuropharmacol. 2022;20(10):1969-77.

18. Sahpolat M, Ari M. Higher prevalence of metabolic syndrome

and related factors in patients with rst-episode psychosis and

schizophrenia: a cross-sectional study in Turkey. Nord J

Psychiatry. 2020;75(1):73-8. doi:10.1080/08039488.2020.1815

080.

19. Bowo-Ngandji A, Kenmoe S, Ebogo-Belobo JT, Kenfack-

Momo R, Takuissu GR, Kengne-Ndé C, et al. Prevalence of the

metabolic syndrome in African populations: A systematic

review and meta-analysis. PLoS One. 2023 Jul 27;18(7):

e0289155-e0289155.

20. Rosenthal T, Touyz RM, Oparil S. Migrating Populations and

Health: Risk Factors for Cardiovascular Disease and Metabolic

Syndrome. Curr Hypertens Rep. 2022/06/15.2022 Sep;24(9):

325-40.

21. Teo KK, Raq T. Cardiovascular Risk Factors and Prevention:

A Perspective From Developing Countries. Canadian Journal of

Cardiology [Internet]. 2021;37(5):733-43.doi:10.1016.j.cjca.

2021.02.009.

22. Farahbakhsh M, Faramarzi E, Fakhari A, Sadeghi M, Barzegar

H, Norouzi S, et al. The PERSIAN Cohort: Prevalence of

Psychiatric Disorders Among Employees. Arch Iran Med

2024 Feb 1;27(2):72-8.

23. Şahin B, İlgün G. Risk factors of deaths related to

cardiovascular diseases in World Health Organization (WHO)

member countries. Health & Social Care in the Community

2020;30(1):73-80.doi:10.1111/hsc.13156.

24. Poojari PG, Khan SA, Shenoy S, Acharya LD, Shetty S, Bose S,

et al. Identication of risk factors and metabolic monitoring

practices in patients on antipsychotic drugs in South India.

Asian J Psychiatr. 2020;53:102186.doi:10.1016/j.ajp.2020.1021

86.

25. Saccaro LF, Aimo A, Panichella G, Sentissi O. Shared and

unique characteristics of metabolic syndrome in psychotic

disorders: a review. Front Psychiatry. 2024 Mar 4;15:134

3427.

CONTRIBUTORS

1. Fazle Rabbani - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript;

Critical Revision; Supervision; Final Approval

Waleed Ahmad - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript;

Critical Revision; Supervision; Final Approval

Frequency of Metabolic Syndrome in Schizophrenic Patients