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Sex differences in rates of obesity in bipolar disorder: postulated mechanisms

Authors

  • Anusha Baskaran,

    1. Centre for Neuroscience Studies, Queen's University, Kingston, Canada
    2. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
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  • Danielle S Cha,

    1. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
    2. Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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  • Alissa M Powell,

    1. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
    2. Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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  • Dalya Jalil,

    1. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
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  • Roger S McIntyre

    Corresponding author
    1. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
    2. Department of Psychiatry, University of Toronto, Toronto, ON, Canada
    • Corresponding author:

      Roger S. McIntyre, M.D.

      Mood Disorders Psychopharmacology Unit

      University Health Network

      Department of Psychiatry

      University of Toronto

      399 Bathurst Street

      Toronto

      ON M5T 2S8

      Canada

      Fax: +1-416-603-5368

      E-mail: roger.mcintyre@uhn.ca

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Abstract

Objective

The increased standardized mortality ratio (SMR) from cardiovascular disease (CVD) in women with bipolar disorder (BD), relative to men with BD and individuals of both sexes in the general population, provides the impetus to identify factors that contribute to the differential association of obesity with BD in women.

Methods

We conducted a selective PubMed search of English-language articles published from September 1990 to June 2012. The key search terms were bipolar disorder and metabolic syndrome cross-referenced with gender, sex, obesity, diabetes mellitus, hypertension, and dyslipidemia. The search was supplemented with a manual review of relevant article reference lists. Articles selected for review were based on author consensus, the use of a standardized experimental procedure, validated assessment measures, and overall manuscript quality.

Results

It is amply documented that adults with BD are affected by the metabolic syndrome at a rate higher than the general population. Women with BD, when compared to men with BD and individuals of both sexes in the general population, have higher rates of abdominal obesity. The course and clinical presentation of BD manifest differently in men and women, wherein women exhibit a higher frequency of depression predominant illness, a later onset of BD, more seasonal variations in mood disturbance, and increased susceptibility to relapse. Phenomenological factors can be expanded to include differences in patterns of comorbidity between the sexes among patients with BD. Other factors that contribute to the increased risk for abdominal obesity in female individuals with BD include reproductive life events, anamnestic (e.g., sexual and/or physical abuse), lifestyle, and iatrogenic.

Conclusions

A confluence of factors broadly categorized as broad- and sex-based subserve the increased rate of obesity in women with BD. It remains a testable hypothesis that the increased abdominal obesity in women with BD mediates the increased SMR from CVD. A clinical recommendation that emerges from this review is amplified attention to the appearance, or history, of factors that conspire to increase obesity in female patients with BD.

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