A simple screening tool for metabolic syndrome risk in the psychiatric patient treated with antipsychotic medication

Abstract

Objective: This study sought to determine whether waist to height ratio (WhtR) can be used to identify psychiatric patients at risk for metabolic syndrome (MetS). Body mass index (BMI) is most often used as the primary determinant for MetS in current screening protocols. There is currently no defined range of values of BMI that determine the level of risk. Psychiatric patients have twice the risk of dying from cardiovascular events than the general population. Cardiovascular disease has been a consequence of metabolic dysregulation that is common to MetS which involves abnormalities in at least three of the following biometric parameters: increase waist circumference, decreased high density lipids (HDL), increased triglycerides (TRG), elevated fasting blood sugar (FBS) and elevated blood pressure (BP). It is well documented that antipsychotic medication is a risk factor for developing MetS.  

Methods: A retrospective record review (n = 48), evaluated the clinic records of psychiatric patients treated with antipsychotic medication. Data from these records compared the relationship between the WhtR and BMI. The association between WhtR and BMI was analyzed through a Pearson correlation analysis and their respectively sensitivity and specificity for predicting risk for MetS was analyzed using a Receiver Operating Characteristic (ROC) curve. Confounding of the relationships between WhtR and risk of MetS by other risk factors was examined using generalized linear models.

Results: Pearson coefficients of BMI and WhtR revealed a strong positive correlation r = 0.935, p = .01. Furthermore, WhtR was evaluated utilizing a ROC curve and demonstrated maximum sensitivity between 0.52 and 0.58 with the maximum specificity at 78%. Both WhtR and BMI showed robust measures in determining metabolic syndrome risk. The relationship between WhtR and risk of MetS existed even when controlling for other factors.

Conclusions: The ratio of waist circumference to height, can provide a reliable low-cost, non-invasive form of measurement that can be performed in any setting, to monitor the progression of metabolic involvement.