|Year : 2021 | Volume
| Issue : 1 | Page : 20-25
Prevalence of metabolic syndrome in elderly patients with depression
Sandeep Grover, Rahul Chakravarty, Aseem Mehra, Subho Chakrabarti
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||28-Feb-2021|
|Date of Decision||28-Apr-2021|
|Date of Acceptance||22-May-2021|
|Date of Web Publication||05-Aug-2021|
Dr. Sandeep Grover
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh . 160 012
Source of Support: None, Conflict of Interest: None
Aim: To assess the prevalence of metabolic syndrome (MetS) in elderly patients with depressive disorder. Methodology: By using retrospective study design, the treatment records of all the elderly patients (aged ≥60 years) diagnosed with depressive disorders diagnosed as per the International Classification of Diseases, 10th Revision, were reviewed and data of patients for fasting blood glucose levels, lipid profile, and anthropometry (height, weight, waist circumference, and blood pressure [BP]) were extracted. The diagnosis of MetS was made as per the consensus criteria. Results: Data of 93 patients were included in the study. The mean age of the study participants was 65.65 (standard deviation [SD]: 5.61) years and the mean number of years of education was 8.33 (SD: 6.65) years. The mean duration of illness was 70.93 (SD: 107.39) months, with the mean duration of the current episode at the time of collection of data as 5.38 (SD: 3.54) months. More than half (57%) of the patients fulfilled the criteria for MetS. Besides more than half of the patients fulfilling the criteria for MetS, about one-tenth (9.7%) fulfilled one criterion, and one-third (32.3%) fulfilled 2 criteria for the MetS. The most common criteria of MetS which was fulfilled included abnormal waist circumference, followed by raised blood pressure, abnormal triglyceride levels, and abnormal high-density lipoprotein. Fasting blood glucose level was the least common abnormality. The presence of MetS was associated with a higher level of education, higher income, and presence of physical comorbidity. Conclusions: Considering that more than half of elderly patients with depressive illness also suffer from MetS, it is important to monitor elderly with depression for MetS, to reduce the risk of future cardiovascular morbidity and mortality.
Keywords: Depression, elderly, metabolic syndrome
|How to cite this article:|
Grover S, Chakravarty R, Mehra A, Chakrabarti S. Prevalence of metabolic syndrome in elderly patients with depression. J Geriatr Ment Health 2021;8:20-5
|How to cite this URL:|
Grover S, Chakravarty R, Mehra A, Chakrabarti S. Prevalence of metabolic syndrome in elderly patients with depression. J Geriatr Ment Health [serial online] 2021 [cited 2021 Dec 9];8:20-5. Available from: https://www.jgmh.org/text.asp?2021/8/1/20/323114
| Introduction|| |
Depression is one of the most common psychological morbidities among the elderly. Community-based studies from India suggest that 8.9%–62.16% of persons raised blood pressure, from depression. The clinic-based studies have reported the prevalence of depression in the outpatient setting ranging from 42.4% to 72%. Depression is one of the leading causes of disability and disability-adjusted life years. It has also been shown that, compared to healthy subjects, persons with depression have reduced life expectancy by 10–20 years and depression is associated with higher mortality rates. Premature mortality is attributed to cardiovascular disorders and other metabolic abnormalities. [4,5] Hence, several attempts have been made to identify the risk factors for cardiovascular diseases and metabolic abnormalities. One such entity is metabolic syndrome (MetS), which is a constellation of risk factors such as hypertension, diabetes mellitus, and dyslipidemia that contributes to cardiovascular morbidity and mortality. Studies suggest that the presence of MetS is associated with a three-time higher risk of developing myocardial infarction or stroke.
Some of the studies have evaluated the association of MetS with depression and suggest that persons with depression have a two-fold higher risk of harboring MetS. [7,8] The prevalence figure for MetS in persons with depression among those attending general hospitals or those recruited from community-based populations ranges from 11.7% to 57%. [4,8-23] A systematic review and meta-analysis estimated the pooled prevalence of MetS in persons with depression to be 31.3% with a comparatively lower prevalence of MetS (22.7%) when the analysis was limited to community-based studies. However, one of the important facts to note is that most of these studies are limited to mixed age group participants.
Compared to the adult population, elderly persons with depression are known to have a higher prevalence of physical comorbidities and many of these patients suffer from multimorbidity. A multicentric study from India suggests that about three-fourth (78.7%) of the elderly with depression have at least one comorbid physical illness and one-third (36.7%) have at least three comorbid physical illnesses. Among the various physical illnesses, hypertension (47.3%) was the most common followed by diabetes mellitus (29%). Considering the high prevalence of these physical abnormalities, it is expected that elderly patients with depression may have a higher prevalence of MetS. However, only a limited number of studies have evaluated the prevalence of MetS in elderly patients with depression.
Studies that have evaluated MetS in the general population suggest that MetS in the elderly is associated with depressive symptoms. Only one study has evaluated the prevalence of MetS among elderly with depression and has estimated the same to be 51%. Studies that have evaluated MetS in elderly patients with depression suggest that the presence of MetS is associated with a higher risk of treatment resistance and a longer time to achieve remission. All these findings suggest that there is a need to evaluate the prevalence and risk factors for MetS in elderly patients with depression.
Although there are few Indian studies on the prevalence of MetS in adult patients with depression, there are no similar studies on the evaluation of the prevalence of MetS among elderly patients with depression. In this background, this study aimed to evaluate the prevalence of MetS in elderly patients with depression attending the outpatient services of a tertiary care hospital.
| Methodology|| |
This retrospective study was conducted in the outpatient setting of a tertiary care hospital. The study was approved by the ethics committee of the institute.
The Department of Psychiatry runs a geriatric clinic, in which all the elderly patients (aged ≥60 years) are initially evaluated by a senior resident and/or consultant. The diagnosis is made as per the International Classification of Diseases, 10th Revision (ICD-10). After the initial evaluation, the patients are started on treatment and are given an appointment for detailed evaluation. The detailed workup is done by a Junior Resident, who collects information from all available sources and reviews the available treatment records including all investigations. The clinical details are then reviewed by the consultant for any further clarifications. Based on all the available information, a final diagnosis is made with an appropriate treatment plan.
The geriatric clinic proforma has the provision of recording all the available investigations and the anthropometry.
For the present study, the treatment records of all the patients diagnosed with depressive disorders, as per the ICD-10, were reviewed and data of patients for fasting blood glucose levels, lipid profile, and anthropometry were extracted.
For the present study, the diagnosis of MetS was made as per the Consensus criteria. The five components of consensus criteria include abdominal obesity (also known as central obesity) (≥90cm in males and ≥80 cm in females), raised blood pressure (systolic BP ≥130 mmHg and/or diastolic BP ≥85 mmHg), or diagnosis of hypertension, low high-density lipoprotein cholesterol (HDL-C) (<40 mg/dL in males, <50 mg/dL in females) or diagnosis of dyslipidemia, elevated triglycerides (≥150 mg/dL) or diagnosis of dyslipidemia, and increase serum blood glucose levels (≥100 mg/dL) or diagnosis of diabetes mellitus. A diagnosis of MetS is considered if the patient fulfills three out of the five criteria.
| Results|| |
Data of 93 patients were extracted. The mean age of the study participants was 65.65 (standard deviation [SD]: 5.61) years and the mean number of years of education was 8.33 (SD: 6.65) years. Males outnumbered the females. The majority of the patients were married and belonged to non-nuclear families. There was equal representation of participants from the urban and rural background; similar distribution was also seen between those who were on the paid job and those who were not on paid job [Table 1].
More than half (57%) of the patients fulfilled the criteria for MetS.
When the demographic profile of those with MetS was compared with those without Mets, the former group had a significantly higher duration of education and family income [Table 1]. No significant differences emerged for other demographic variables.
The mean duration of illness was 70.93 (SD: 107.39) months, with the mean duration of a current episode at the time of collection of data as 5.38 (SD: 3.54) months. The mean number of episodes in the lifetime in the study sample was 3.22 (SD: 5.1). About one-eighth of the patients had psychotic symptoms and one-fourth of the participants had a history of substance use. At least one comorbid physical illness was present in more than two-thirds (71%) of the participants, with dyslipidemia (65.6%) being the most common, followed by hypertension (49.5%) and diabetes mellitus (19.4%) [Table 2]. When participants with MetS were compared with those without MetS, it was seen that a higher proportion of those with MetS had severe depression and most of them had the presence of physical comorbidity [Table 2].
In terms of metabolic parameters, the most commonly met criteria of MetS was abnormal waist circumference, followed by abnormal BP, abnormal triglyceride levels, abnormal HDL. Fasting blood glucose level was the least common abnormality. More than half (57%) of the patients fulfilled the criteria of MetS [Table 3].
| Discussion|| |
The present retrospective study estimated the prevalence of MetS among elderly patients with depression to be 57%, which is comparable to the figure of 51% reported in a previous study involving elderly patients with depression. This finding suggests that the prevalence of MetS in elderly patients with depression is high in India and the same is comparable with studies from other parts of the world. Previous studies on the prevalence of MetS in adult or mixed age group patients with depression have estimated the prevalence to range from 11.7% to 57%,,,,,, in India, with a pooled prevalence of 31.3%. The prevalence of MetS involving the adult or mixed age group in clinic attending patients with depression is estimated to range from 20.8% to 43.6%.,, On comparing the findings of the present study with this data, it is apparent that the prevalence of MetS is significantly higher in elderly patients compared to adult patients with depression. Accordingly, it can be said that elderly patients with depression require closer monitoring of MetS.
The present study also suggests that a significant proportion (42%) of elderly patients with depression also fulfill one to two criteria of MetS and hence are at risk of developing MetS in near future. This finding suggests that these patients should be more closely monitored and interventions should be initiated to prevent the development of full-blown MetS.
In terms of factors associated with MetS in patients with depression, the present study suggested a lack of significant difference for most of the demographic variables, except for years of education and family income, both being higher for those with MetS. Previous studies have also suggested similar associations. [36,37] The association with these variables may be a reflection of dietary patterns, which might be influenced by income. In terms of clinical variables, the present study suggested a lack of association of MetS with the number of episodes and absence of any significant difference between those with the first episode and those with recurrent depressive disorder. The existing data in this regard is inconclusive, with some of the studies suggesting a higher prevalence of MetS in those with multiple episodes [7,38] while others suggest a lack of significant difference in the prevalence of MetS with single or multiple episodes of depression. The present study also suggests the association of MetS with the presence of physical comorbidity. This could be because some of the comorbidities are a part and parcel of MetS per se.
In terms of various components of MetS, the most commonly met criteria of MetS in the present study was abnormal waist circumference, followed by abnormal BP, abnormal triglyceride levels, and abnormal HDL while fasting blood glucose level was the least common abnormality. When this profile is compared with studies involving adult patients, [26, 27, 38] certain similarities are apparent such as waist circumference being the most common abnormality and raised fasting glucose level being the least common abnormality in previous as well as the present study. However, unlike the studies involving adult patients which suggest low HDL level to be the second most common abnormality, [34,39] in the present study, raised BP was the second most common abnormality. Considering that increased waist circumference was the most common abnormality, it can be used to screen patients for MetS, in the absence of other laboratory parameters. It can also be used for longitudinal monitoring and advising lifestyle and dietary modifications.
The present study has certain limitations in the form of retrospective study design, evaluating the data of patients attending the psychiatry outpatient services, and lack of assessment of the severity of depression. The sample size for the study was relatively small, and no sample size calculation was done. The data also comes from a single center. Due to the retrospective study design, no data were available for assessing the level of physical activity and dietary patterns. This study also did not evaluate the association of MetS with medications and treatment response. In future, attempts must be made to overcome these limitations.
The present study suggests that 57% of the elderly patients with depressive disorders fulfill the criteria for MetS, which is higher than that seen in adult patients. Among the various abnormalities, abnormal waist circumference is the most common abnormality followed by raised BP, while abnormal fasting blood glucose is the least common abnormality. The presence of MetS in the elderly is associated with a higher level of education, higher income, and presence of physical comorbidity. These findings suggest that there is a need to monitor the elderly with depression for MetS to reduce the risk of future cardiovascular abnormality. Patients with depression should be routinely monitored for MetS and should be advised dietary measures and physical activity to reduce the risk of developing cardiovascular morbidity and mortality. If the laboratory parameters cannot be done routinely, then at least anthropometry should be monitored.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]