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| LETTER TO EDITOR |
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| Year : 2021 | Volume
: 18
| Issue : 2 | Page : 131-133 |
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Metabolic syndrome during COVID-19: A potential public health crisis?
Jothimani Gurusamy
College of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| Date of Submission | 24-Mar-2021 |
| Date of Decision | 17-Apr-2021 |
| Date of Acceptance | 28-Apr-2021 |
| Date of Web Publication | 21-Dec-2021 |
Correspondence Address:
Dr. Jothimani Gurusamy
College of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru - 560 029, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/iopn.iopn_24_21
How to cite this article:
Gurusamy J. Metabolic syndrome during COVID-19: A potential public health crisis?. Indian J Psy Nsg 2021;18:131-3 |
| Introduction | |  |
The COVID-19 pandemic created a lot of imbalance in many people's lives. Owing to the nature of their disease, people with Schizophrenia have a greater risk of physical illness than the general population. Because of urbanization and sedentary lifestyles, metabolic syndrome has developed a significant public health issue and threat worldwide. It is characterized by abnormal glucose levels, central or abdominal obesity, dyslipidemia, and hypertension.[1] Metabolic syndrome is associated with an elevated risk of type II diabetes and cardiovascular disease. Furthermore, persons with metabolic syndrome have a 2- to 4-fold higher risk of developing stroke and myocardial infarction.[2]
In people with schizophrenia, the incidence of metabolic syndrome varies from 9% to 68%, and it is substantially higher in Schizophrenia than in healthy individuals.[3] On the other hand, poor dietary habits and unhealthy lifestyles, including smoking and lack of physical activity, are significant contributors to these patients. Individuals with severe mental illness are more vulnerable to cardio-metabolic risks to a combination of sedentary behavior, inadequate nutrition, and medication-induced weight gain. These factors lead to increased morbidity and mortality, which is a concern for health professionals.[4]
It demonstrates that people with schizophrenia have had their physical well-being neglected for years and that this neglect continues today.[5] Patients with Schizophrenia are increasingly predisposed to develop metabolic syndrome, which is associated with an elevated risk of cardiovascular disease and death. It is critical to establish and incorporate intervention strategies that can address this issue in this specific category of patients. It is also vital that healthcare workers aware of this potentially fatal disease.
To be diagnosed with metabolic syndrome, a person must have central obesity plus any two of four additional factors to the International Diabetic Federation (2006). The following are the elements:
- Central obesity: Waist circumference – ethnicity-specific (If body mass index [BMI] is >30 kg/m2, then central obesity can be expected, and waist circumference need not be measured[6])
- Fasting plasma glucose: (≥more than 100 mg/dl) or Type II diabetes earlier diagnosed
- Blood pressure: ≥130/80 mmHg or treatment of earlier diagnosed hypertension
- Elevated triglycerides: ≥(150 mg/dl) or management for this lipid abnormality
- High-density lipoprotein-cholesterol: (40 mg/dl) in men, (50 mg/dl) in women, or treatment for this lipid abnormality.
| Other Assessments | | |
Overweight and obesity can be measured using a variety of tests. The BMI is a simple measurement established on height and weight (kg/m2). Overweight is well-defined as a BMI ≥25 kg/m2, while obesity is well-defined as a BMI ≥of 30 kg/m2. Life expectancy is believed to be shortened in people with a BMI ≥30 kg/m2. However, due to evidence of higher risk of morbidity and mortality in Asian populations with BMI below 30 kg/m2, the definition of overweight in these populations has been changed to a BMI of 23 kg/m2 and the definition of obesity to a BMI of 25 kg/m2. Waist circumference is evolving as a potentially more accurate and reliable predictor of abdominal or central adiposity, cardiovascular diseases, Type 2 DM, and other metabolic risk-associated conditions.[7]
Metabolic syndrome in schizophrenia
Metabolic Syndrome is a common occurrence in Schizophrenia patients who have been treated with antipsychotic medications. The percentages differ significantly depending on the Metabolic parameters used, gender, ethnicity, region, age groups, and antipsychotic drugs (between 19.4% and 68%).[8] People with Schizophrenia, on the other hand, have a higher incidence of metabolic syndrome than the general population.[9] Metabolic Syndrome is present in 42% of patients with schizophrenia and schizoaffective disorder.[10] In addition to drug side effects, lifestyle and dietary factors (sedentary behavior, lack of physical activity) may lead to physical health issues in Schizophrenia.
| Management | | |
Managing Metabolic Syndrome in Schizophrenia patients can be complex and challenging. Obese patients are more likely than nonobese patients to ask for their antipsychotic drugs to be stopped. It's because they are worried about gaining weight and are more likely to abandon their treatment plan. Weight-loss treatments for persons with Schizophrenia should begin with regular and frequent weight monitoring and guidance on exercise and lifestyle changes. Switching antipsychotic medication to one with fewer propensities for weight gain should also be considered.
| Lifestyle Modification | | |
Intensive lifestyle modification is the most critical intervention. It should be provided by a multidisciplinary team approach in collaboration with family caregivers.
It can include: A weight reduction of 5%–10% of the preintervention weight should be achieved over four to 6 months. The amount of sodium consumed should be decreased.
Diet
Diet should be high in vegetables and fruits, low in total fat and saturated fat, and low in cholesterol. Consider foods with a low glycemic index, soluble fibers, unrefined carbohydrates, a protein consumption of 10%–35% of total calories, and total fat consumption of 25%–35% of calories.
Exercise
On most days of the week, engage in moderate-intensity physical activity for at least 30 min. Sixty min of brisk walking with moderate intensity, accompanied by other workouts, should be prioritized.
Behaviour therapy
Can be planned to provide the patients with a fixed or set of principles and methods to alter their eating and physical activity levels. The importance on behavioral modification should comprise the advantage of stress management, the value of a regular exercise regimen, social support and an improvement in eating habits.
Therapeutic management of metabolic syndrome
It is being a cluster of diseases, has no single drug employed in its direction. Hence, each condition should be treated with specific medications.
| The Future Care During COVID-19 | | |
In determining what to do with Schizophrenia's poor physical health, we must first understand the perspectives of patients and family members. Many people prioritize physical fitness, and the more physical conditions they have, the less satisfied they are with their physical and mental health.
In Schizophrenia, death from natural causes can be linked to an unhealthy lifestyle and may be amenable to health-promoting treatments. However, suggesting a transition could be difficult. The degree to which the disorder (positive, negative, or cognitive symptoms) and any biological predisposition play a role is unknown. Furthermore, the additional threats to physical health posed by the complex interaction of medications and particular metabolic predispositions should not be ignored. Persons with Schizophrenia may be unable to identify the early symptoms of physical illness.
As a result, in addition to expected psychiatric results by frequent follow-up interventions, the future outlook should concentrate on detailed evaluations of physical health and future risk predictions. Mental health nurses must make sure that patients at risk of developing severe physical morbidity receive the proper assessment and investigation. They should collaborate closely with general practitioners and other specialists as needed. The benefits of atypical medications are apparent, but when choosing antipsychotics, mental health professionals should consider the effects of metabolic disturbance and its possible impact on patients' future cardiovascular risk.
A systematic medical history should be collected. Weight, BMI, and other metabolic parameters such as glucose and lipid profile should be monitored regularly. This data will support the treating team in weighing the costs and benefits of a particular procedure for a specific patient. The challenge is to ensure that the physical health of Schizophrenia is prioritized. Further, it also enables them to face the future with low morbidity and mortality as possible due to physical health issues.
| Conclusion | | |
In severe mental illnesses like Schizophrenia, physical health problems are more common. In addition to modifiable lifestyle factors and psychotropic drug side effects, individuals with Schizophrenia should resolve issues such as insufficient access to and quality of health care obtained. Physical disorders can wreak havoc on mental health, medication adherence, and life expectancy, as well as the quality of life. In people with Schizophrenia, health practitioners should actively and consistently screen, monitor symptoms, and potential complications related to comorbid physical health problems.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 3. | Malhotra N, Kulhara P, Chakrabarti S, Grover S. Lifestyle related factors & impact of metabolic syndrome on quality of life, level of functioning & self-esteem in patients with bipolar disorder & schizophrenia. Indian J Med Res 2016;143:434-42. [ PUBMED] [Full text] |
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| 5. | Nasrallah HA, Meyer JM, Goff DC, McEvoy JP, Davis SM, Stroup TS, et al. Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: Data from the CATIE schizophrenia trial sample at baseline. Schizophr Res 2006;86:15-22. |
| 6. | The IDF consensus worldwide definition of the Metabolic Syndrome:The IDF Communications:Avenue Emile De Mot 19,Brussels, Belgium,2006. |
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| 8. | Yahia N, Brown C, Rapley M, Chung M. Assessment of college students' awareness and knowledge about conditions relevant to metabolic syndrome. Diabetol Metab Syndr 2014;6:111. |
| 9. | Meyer JM, Stahl SM. The metabolic syndrome and schizophrenia. Acta Psychiatr Scand 2009;119:4-14. |
| 10. | Basu R, Brar JS, Chengappa KN, John V, Parepally H, Gershon S, et al. The prevalence of the metabolic syndrome in patients with schizoaffective disorder – bipolar subtype. Bipolar Disord 2004;6:314-8. |
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