Gender Differences in Prevalence and Clinical Correlates of Initial-Treatment and Drug-Naïve Bipolar Disorder Patients With Metabolic Syndrome: A Cross-Sectional Study

Alpha Psychiatry. 2025 Oct 21;26(5):39112. doi: 10.31083/AP39112. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: Bipolar disorder (BD) has been studied extensively. However, no studies have investigated gender differences in the prevalence of metabolic syndrome (MetS) in initial-treatment and drug-naïve (ITDN) patients with BD. Therefore, the aim of this study was to investigate gender differences and correlates of MetS in ITDN patients with BD.

METHODS: A cross-sectional study of 671 ITDN patients with BD was conducted. Demographic and clinical data were collected. Patients underwent routine serum tests including fasting blood glucose, lipid profile, thyroid function and prolactin tests. Manic, depressive and psychotic symptoms and severity of illness were measured using the Youth Mania Rating Scale (YMRS), the Hamilton Depression Scale (HAMD), the Positive Symptom Scale of the Positive and Negative Symptom Scale (PSS, items P1-P7) and the Clinical Global Impression Scale-Severity of Illness (CGI-SI), respectively.

RESULTS: There was no gender difference in the prevalence of MetS in ITDN patients with BD. Two-way analysis of covariance (ANCOVA) revealed an interaction effect between MetS status and gender for total thyroxine (TT₄) levels (p = 0.005). In addition, multivariable logistic regression analysis revealed that TT₄ level (odds ratio, OR = 1.426, 95% CI = 1.120-1.817, p = 0.004) and PSS score (OR = 1.401, 95% CI = 1.270-1.545, p < 0.001) were significantly associated with the MetS in male BD patients; moreover, the low-density lipoprotein cholesterol (LDL-C) level (OR = 2.008, 95% CI = 1.274-3.165, p = 0.003) and PSS score (OR = 1.447, 95% CI = 1.316-1.591, p < 0.001) were significantly associated with the MetS in female BD patients.

CONCLUSION: TT₄ levels and psychotic symptoms were significantly associated with male BD patients with MetS. Furthermore, LDL-C levels and psychotic symptoms were significantly associated with female BD patients with MetS. Particular attention should be given to the early metabolic detection and intervention in male BD patients with high TT₄ levels and in female BD with high LDL-C levels.

PMID:41209495 | PMC:PMC12593734 | DOI:10.31083/AP39112