Sánchez-Ortí Joan Vicent, Balanzá-Martínez Vicent, Correa-Ghisays Patricia, Selva-Vera Gabriel, Vila-Francés Joan, Magdalena-Benedito Rafael, San-Martin Constanza, Victor Víctor M, Escribano-Lopez Irene, Hernández-Mijares Antonio, Vivas-Lalinde Juliana, Crespo-Facorro Benedicto, Tabarés-Seisdedos Rafael
INCLIVA - Biomedical Research Institute, Valencia, Spain.
TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Valencia, Spain.
Acta Psychiatr Scand. 2022 Sep;146(3):215-226. doi: 10.1111/acps.13433. Epub 2022 Apr 13.
Obesity and metabolic diseases such as metabolic syndrome (MetS) are more prevalent in people with type 2 diabetes mellitus (T2DM), major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SZ). MetS components might be associated with neurocognitive and functional impairments in these individuals. The predictive and discriminatory validity of MetS and its components regarding those outcomes were assessed from prospective and transdiagnostic perspectives.
Metabolic syndrome components and neurocognitive and social functioning were assessed in 165 subjects, including 30 with SZ, 42 with BD, 35 with MDD, 30 with T2DM, and 28 healthy controls (HCs). A posteriori, individuals were classified into two groups. The MetS group consisted of those who met at least three of the following criteria: abdominal obesity (AO), elevated triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL), elevated blood pressure (BP), and elevated fasting glucose (FPG); the remaining participants comprised the No-MetS group. Mixed one-way analysis of covariance and linear and binary logistic regression analyses were performed.
Cognitive impairment was significantly greater in the MetS group (n = 82) than in the No-MetS group (n = 83), with small effect sizes (p < 0.05; η²p = 0.02 - 0.03). In both groups, the most robust associations between MetS components and neurocognitive and social functioning were observed with TG and FPG (p < 0.05). There was also evidence for a significant relationship between cognition and BP in the MetS group (p < 0.05). The combination of TG, FPG, elevated systolic BP and HDL best classified individuals with greater cognitive impairment (p < 0.001), and TG was the most accurate (p < 0.0001).
Specific MetS components are significantly associated with cognitive impairment across somatic and psychiatric disorders. Our findings provide further evidence on the summative effect of MetS components to predict cognition and social functioning and allow the identification of individuals with worse outcomes. Transdiagnostic, lifestyle-based therapeutic interventions targeted at that group hold the potential to improve health outcomes.
肥胖和代谢性疾病，如代谢综合征（MetS），在2型糖尿病（T2DM）、重度抑郁症（MDD）、双相情感障碍（BD）和精神分裂症（SZ）患者中更为普遍。MetS的组成部分可能与这些个体的神经认知和功能损害有关。从前瞻性和跨诊断的角度评估了MetS及其组成部分对这些结果的预测和区分效度。
对165名受试者进行了代谢综合征组成部分、神经认知和社会功能评估，其中包括30名SZ患者、42名BD患者、35名MDD患者、30名T2DM患者和28名健康对照者（HCs）。事后，将个体分为两组。MetS组由符合以下至少三项标准的个体组成：腹型肥胖（AO）、甘油三酯（TG）升高、高密度脂蛋白胆固醇（HDL）降低、血压（BP）升高和空腹血糖（FPG）升高；其余参与者组成非MetS组。进行了混合单因素协方差分析以及线性和二元逻辑回归分析。
MetS组（n = 82）的认知障碍明显比非MetS组（n = 83）更严重，效应量较小（p < 0.05；η²p = 0.02 - 0.03）。在两组中，观察到MetS组成部分与神经认知和社会功能之间最显著的关联是与TG和FPG相关（p < 0.05）。也有证据表明MetS组中认知与BP之间存在显著关系（p < 0.05）。TG、FPG、收缩压升高和HDL的组合对认知障碍更严重的个体分类效果最佳（p < 0.001），且TG最为准确（p < 0.0001）。
特定的MetS组成部分与躯体和精神疾病中的认知障碍显著相关。我们的研究结果为MetS组成部分预测认知和社会功能的累加效应提供了进一步证据，并有助于识别预后较差的个体。针对该群体的基于跨诊断、生活方式的治疗干预措施有可能改善健康结局。
