Metabolic syndrome in youth with bipolar spectrum disorders treated with second-generation antipsychotics: baseline results from the community-based pragmatic MOBILITY Trial.

Metabolic syndrome (MetS) in obese youth in the general population is about 29%. The aim of this study is to identify the baseline prevalence and clinical characteristics of MetS in a sample of overweight/obese youth with bipolar spectrum disorders treated with second-generation antipsychotics (SGAs). The MOBILITY trial enrolled overweight/obese youth 8-19 years of age with a lifetime diagnosis of a bipolar spectrum disorder who were continuing or starting treatment with an SGA (November/2015-December/2022). Baseline height, weight, body mass index (BMI), blood pressure, fasting lipid profile, glucose, hemoglobin A1c, and insulin were collected. Logistic regression was used to estimate the odds of MetS and each of its component criteria and correlations with demographic factors. Of 1565 randomized patients mean age = 13.9 ± 2.8 years, males = 53%, White = 65.4%, Black/African American = 18.5%, multiracial = 9.6%, obese = 65.7%, overweight = 34.3%, MetS status could be determined for 996 patients (63.6%). The overall prevalence of MetS was 32.8% (males = 49.5%, females = 26.0%, p < 0.001), being higher in obese than overweight youth (41.1% vs 4.1%, p < 0.001). The odds of MetS increased rapidly with age in boys (p < 0.001); no association with age was evident among girls. White patients having significantly higher frequency of MetS than Black/African American patients (35.5% vs 24.9%, OR = 1.75, p = 0.003). The prevalence of MetS in this enriched sample was about one-third higher than the MetS prevalence in the general population of obese youth. Over one third of participants had missing metabolic data. These data highlight the need for increased identification and targeted interventions for MetS in youth. Clinical Trial Registration: NCT02515773, https://clinicaltrials.gov/study/NCT02515773.