Impact of lifestyle modification on some components of metabolic syndrome in persons with severe mental disorders: A meta-analysis Vinit Kumar Singh b , Sneha Karmani a , Palash Kumar Malo c , Virupaksha H.G. b , Daliboina Muralidhar b , Ganesan Venkatasubramanian a , Kesavan Muralidharan a, ⁎ a Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India b Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India c Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India. abstract article info Article history: Received 21 March 2018 Received in revised form 28 June 2018 Accepted 30 June 2018 Available online xxxx Background: Metabolic syndrome (MS) is reportedly associated with high mortality from mostly cardiovascular causes in patients with severe mental disorders (SMD). Lifestyle interventions augment effective management of MS in patients with SMD. The present meta-analysis aims at updating the recent evidence on the effectiveness of lifestyle intervention for MS in patients with SMD. Method: A literature search for English Language publications of randomized controlled trials (RCTs) from 2001 to 2016 comparing lifestyle modification (LM) with treatment as usual (TAU) in the management of MS were identified. Using PRISMA guidelines, 19 RCTs reporting data on 1688 SMD and MS patients and providing data on change in Body Weight, Body Mass Index (BMI) and waist circumference (WC) were included. Using random effects model, standardized mean difference between LM and TAU for the mean baseline-to-endpoint change in body weight, BMI and WC was calculated with a 95% confidence limit, on RevMan 5.3. The study was registered with PROSPERO (CRD42016046847). Results: LM had significantly superior efficacy in the reducing weight (-0.64, 95% CI -0.89, -0.39, Z = 5.03, overall effect p b 0.00001), BMI (-0.68, 95% CI -1.01, -0.35, Z = 4.05, overall effect p b 0.0001), and WC (-0.60, 95% CI -1.17, -0.03, Z = 2.06; overall effect p = 0.04), compared to TAU. LM was significantly more effective than TAU even in short duration (p = 0.0001) and irrespective of the treatment setting. Conclusion: Interventions targeting LM in persons with SMD and MS are effective in reducing body weight, BMI and WC. It must be routinely recommended to all patients with SMD, ideally during commencement stage of sec- ond generation antipsychotic treatment. © 2018 Published by Elsevier B.V. Keywords: Metabolic syndrome Weight gain Body Mass Index Waist circumference Severe mental disorder Lifestyle modification 1. Introduction Severe mental disorders (SMD) like Bipolar Affective Disorder, Schizophrenia and Major Depressive Disorder have a higher risk of Metabolic Syndrome (MS; previously syndrome X) which contributes to higher mortality, mainly due to cardiovascular diseases (Murray et al., 2017; Kritharides et al., 2017). Metabolic syndrome is reportedly 2–3 times more common in persons with SMD as compared to general population (Ohaeri and Akanji, 2011). Individual components of MS like obesity, diabetes, raised blood pressure, dyslipidemia, etc., are also significantly deranged in SMD. Further, obesity has emerged as a serious problem which leads to poor treatment adherence, poor quality of life and increased death rate (Malhotra et al., 2016). The possible causes of MS in SMD are multifactorial and include biological factors (genetic vulnerability, endocrinological factors), psychosocial factors (emotional disturbances, motivational factors, and stressful life events), unhealthy lifestyle including poor eating be- havior, nicotine dependence, and psychotropic medication like antipsy- chotics and mood stabilizers (Correll et al., 2008; Heald et al., 2017). In recent years, the importance of physical health in SMD is being increasingly acknowledged. It has been documented that lifestyle inter- ventions like weight management by physical exercise, healthy dietary practices, and smoking cessation can bolster effective management of MS (Chacón et al., 2011; Brar et al., 2005; Vreeland et al., 2003). There are three systematic reviews and meta-analyses till date on MS in SMD. One meta-analysis done by Bruins et al. (2014) assessed the impact of lifestyle modifications on MS, using body weight and waist circumference as the primary outcome measures and reported that the interventions had a significant, beneficial effect on weight loss (p b 0.00001). The intervention groups in the weight loss intervention studies showed a higher reduction of the mean body weight than the Schizophrenia Research xxx (2018) xxx–xxx ⁎ Corresponding author at: National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India. E-mail address: drmuralidk@gmail.com (K. Muralidharan). SCHRES-07945; No of Pages 9 https://doi.org/10.1016/j.schres.2018.06.066 0920-9964/© 2018 Published by Elsevier B.V. Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres Please cite this article as: Singh, V.K., et al., Impact of lifestyle modification on some components of metabolic syndrome in persons with severe mental disorders: A meta-analysis, Schizophr. Res. (2018), https://doi.org/10.1016/j.schres.2018.06.066