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Psychological underpinnings of metabolic syndrome

  • Barbara J. Stewart-Knox (a1)


Metabolic syndrome (MS) is more common among socio-economically disadvantaged individuals and is associated with certain risky lifestyle practices. MS also appears to be triggered by adverse social circumstances and chronic stress. The present paper reviews accumulating evidence to imply that individuals who have certain personality and behaviour traits are particularly predisposed to develop MS, and brings together theories that relate to possible psychological mechanisms underlying MS. It considers how such factors might interact causally to encourage the development of MS. As part of the EU-funded LIPGENE Integrated Project, multi-level modelling will be undertaken to explore potential pathways to MS, taking into consideration the interplay between a range of psycho-social, demographic, cultural and lifestyle factors thought to contribute to the development of MS. Data will be gathered for this purpose from a representative sample of >50-year-olds living in Britain (n 1000) and Portugal (n 500). It is anticipated that this information will assist in the development and targetting of future intervention to prevent and treat MS in the normal population.

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* Corresponding author: Dr Barbara J. Stewart-Knox, fax +44 2870 324 965,


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Almeras, N, Despres, JP, Villeneuve, J, Demers, MF, Roy, MA, Cadrin, C, Mottard, JP & Bouchard, RH (2004) Development of an atherogenic metabolic risk factor profile associated with the use of atypical antipsychotics. Journal of Clinical Psychiatry 65, 557564
Baptista, T (1999) Body weight gain induced by anti-psychotic drugs: mechanisms and management. Acta Psychiatrica Scandinavica 100, 316
Barefoot, JC, Peterson, BL, Dahlstrom, WG, Siegler, IC, Anderson, NB & Williams, RB (1991) Hostility patterns and health implications: correlates of Cook-Medley Hostility Scale Scores in a national survey. Health Psychology 10, 1824
Basu, R, Brar, JS, Chengappa, KNR, John, V, Parepally, H, Gershon, S, Schlicht, P & Kupfer, DJ (2004) The prevalence of metabolic syndrome in patients with schizoaffective disorder – bipolar subtype. Bipolar Disorders 6, 314318
Benetou, V, Bamia, C, Trichopoulos, D, Mountokalalakis, T, Psaltopoulou, T & Trichopoulou, A (2004) The association of body mass index and waist circumference with blood pressure depends on age and gender: A study of 10 928 non-smoking adults in the Greek EPIC cohort. European Journal of Epidemiology 19, 803809
Bjorntorp, P (1999) Neuroendocrine perturbations as a cause of insulin resistance. Diabetic Metabolism Research Reviews 15, 427441
Bjorntorp, P (2000) Do stress reactions cause abdominal obesity and comorbidities. Obesity Reviews 2, 7386
Bjorntorp, P & Rosmond, R (1999) Hypothalamic origin of the metabolic syndrome X. Annals of the New York Academy of Sciences 892, 297307
Bjorntorp, P & Rosmond, R (2000) Neuroendocrine abnormalities in visceral obesity. International Journal of Obesity 24, S80S85
Black, PH (2003) The inflammatory response is an integral part of the stress response: implications for atherosclerosis, insulin resistance, type II diabetes and metabolic syndrome X. Brain, Behaviour and Immunity 17, 350364
Brindley, DN (1995) Role of glucocorticoids and fatty acids in the impairment of lipid-metabolism observed in the metabolic syndrome. International Journal of Obesity 19, S69S75
Brown, ES, Varghese, FP & McEwan, BS (2004) Association of depression with mental illness: does cortisol play a role. Biological Psychiatry 55, 19
Brunner, EJ, Hemmingway, H, Walker, BR, Page, M, Clarke, P, Juneja, M et al. . (2002) Adrenocortical, autonomic and inflammatory causes of the metabolic syndrome. Circulation 106, 26592665
Brunner, EJ, Marmot, MG, Nanchahal, K, Shipley, MJ, Stansfeld, SA, Juneja, M & Alberti, KGMM (1997) Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II study. Diabetologia 40, 13411349
Buttriss, J (2003) Metabolic syndrome: new research underway. Nutrition Bulletin 28, 381385
Chen, W, Bao, W, Begum, S, Elkasabany, A & Srinivasan, SR (2000) Age-related patterns of the clustering of cardio-vascular risk variables of Syndrome X from childhood to young adulthood in a population made up of black and white subjects. The Bogalusa Heart Study. Diabetes 49, 10421048
Cook, WW & Medley, DM (1954) Proposed hostility and parasisaic-virtue scales for the MMPI. Journal of Applied Psychology 38, 414418
Danesh, HB (1977) Anger and fear. American Journal of Psychiatry 134, 11091112
Diamond, EL (1982) The role of anger and hostility in essential hypertension and coronary heart disease. Psychological Bulletin 92, 410433
Drapeau, V, Therrien, F, Richard, D & Tremblay, A (2003) Is visceral obesity a physiological adaptation to stress. Panminerva Medica 45, 189195
Eikelis, N, Lambert, G, Weisner, G, Kaye, D, Schlaich, M, Morris, M, Hastings, J, Socratous, F & Esler, M (2004) Extra-adipocyte leptin release in human obesity and its relation to symphathoadrenal function. American Journal of Physiology 286, E744E752
Esler, M, Rumantir, M, Wiesner, G, Kaye, D, Hastings, J & Lambert, G (2001) Sympathetic nervous system and insulin resistance: form obesity to diabetes. American Journal of Hypertension 14, S304S309
Feldman, PJ & Steptoe, A (2003) Psychosocial and socioeconomic factors associated with glycated hemoglobin in non-diabetic middle-aged men and women. Health Psychology 22, 398405
Friedman, M & Rosenman, RH (1959) Association of a specific overt behaviour pattern with increases in blood cholesterol, blood clotting time, incidence of arcus senilis and clinical coronary artery disease. Journal of the American Medical Association 169, 12861296
Frost, A, Eachus, J, Sparrow, J, Peters, TJ, Hopper, C, Davey-Smith, G & Frankel, S (2001) Vision-related quality of life impairment in an elderly population: associations with age, sex, social class and material deprivation. Eye 15, 739744
Gigolini, M, Seidell, JC, Targher, G, Deslypere, JP, Ellsinger, BM, Charzewska, J, Cruz, A & Bjorntorp, P (1995) Fasting serum-insulin in relation to components of the metabolic syndrome in European healthy men – the European fat distribution study. Metabolism: Clinical and Experimental 44, 3540
Halford, JCG (2001) Pharmacology of appetite suppression: implication for the treatment of obesity. Current Drug Targets 2, 353370
Haynes, SG, Levine, S, Scotch, N, Feinleib, M & Kannel, WB (1980) The relationship of psychological factors to coronary heart disease in the Frammington Study: I. Methods and risk factors. American Journal of Epidemiology 107, 362383
Hidvegi, T, Hetyesi, K, Biro, L & Jermendy, G (2001) Education level and clustering of clinical characteristics of metabolic syndrome. Diabetes Care 24, 20132016
Ho, SC, Chen, YM, Woo, JLF, Leung, SSF, Lam, TH & Janus, ED (2001) Association between simple anthropometric indices and cardiovascular risk factors. International Journal of Obesity 25, 16891697
Horsten, M, Mittleman, MA, Wamala, SP, Schenck-Gustafsson, K, Orth-Gomer, K (1999) Social relations and the metabolic syndrome in middle-aged Swedish women. Journal of Cardio-Vascular Risk 6, 391397
Katzmarzyk, PT, Perusse, L, Bergeron, J, Despres, JP & Bouchard, C (2001) Stability of indicators of the metabolic syndrome from childhood and adolescence into young adulthood: the Quebec Family Study. Journal of Clinical Epidemiology 54, 190195
Kiecolt-Glaser, JK, McGuire, L, Robles, TF & Glaser, R (2002) Emotions, morbidity and mortality: New perspectives. Psychoneuroimmunology 53, 8392
Kerenyi, Z, Tabac, AG, Stella, P, Bosyak, Z, Simon, K, Karadi, I & Tamas, G (2000) Association between socioeconomic factors and the metabolic syndrome in women with prior gestational diabetes mellitus. Diabetes Care 23, 14441446
Kinder, LS, Carnethon, MR, Palaniappan, LP, King, AC & Fortmann, SP (2004) Depression and the metabolic syndrome in young adults: findings from the third national health and nutrition examination survey. Psychosomatic Medicine 66, 316322
Laaksonen, DE, Lakka, HM, Lynch, J, Lakka, TA, Niskanen, L, Rauramaa, R, Salonen, JT & Kauhanen, J (2003) Cardiorespiratory fitness and vigorous leisure-time physical activity modify the association of small size at birth with the metabolic syndrome. Diabetes Care 26, 21562164
Laaksonen, DE, Lakka, HM, Salonen, JT, Niskanen, LK, Rauramaa, R & Lakka, TA (2002) Low levels of leisure-time physical activity and cardio-respiratory fitness predict development of the metabolic syndrome. Diabetes Care 25, 16121619
Landen, M, Baghaei, F, Rosmond, R, Holm, G, Bjorntorp, P & Eriksson, E (2004) Dystipiclemia and high waist-hip ratio in women with self reported social anxiety. Psychoneuroendocrinology 29, 10371046
Lawlor, DA, Ebrahim, S, Davey-Smith, G (2004) The metabolic syndrome and coronary heart disease in older women: findings from the British Women's Heart and Health Study. Diabetic Medicine 21, 906913
Lidfeldt, J, Nyberg, P, Nerbrand, C, Samsioe, G, Schersten, B & Agardh, CD (2003) Socio-demographic and psychosocial factors are associated with features of the metabolic syndrome. The women's health in the Lund Area (WHILA) study. Diabetes, Obesity and Metabolism 5, 106
McCaffery, JM, Niaura, R, Todaro, JF, Swan, GE & Carmelli, D (2003) Depressive symptoms and metabolic risk in adult male twins enrolled in the national heart, lung and blood institute twin study. Psychosomatic Medicine 65, 409497
McElroy, SL, Kotwal, R, Malhotra, S, Nelson, EB, Keck, PE & Nemeroff, CB (2004) Are mood disorders and obesity related? A review for the mental health professional. Journal of Clinical Psychiatry 65, 634651
Martins, IS & Marinho, SP (2003) The potential of central obesity anthropometric indicators as diagnostic tools. Revista de Saude Publica 37, 760767
Meigs, JB, D'Agostino, RB, Wilson, PW & Cupples, LA (1997) Risk variable clustering in the insulin resistance syndrome. Diabetes 46, 15941601
Muldoon, MF, Mackey, RH, Williams, KV, Korytkowski, MT, Flory, JD & Manuck, SB (2004) Low central nervous system serotonergic responsivity is associated with the metabolic syndrome and physical inactivity. Journal of Clinical Endocrinology and Metabolism 89, 266271
Niaura, R (2002) Heart disease; high hostility may be more predictive than other factors. Heart Disease Weekly 29 December issue 7
Niaura, R, Banks, SM, Ward, KD, Stonay, CM, Spiro, A, Aldwin, CM, Landsberg, L & Weiss, ST (2000) Psychosomatic Medicine 62, 716
Nonogaki, K (2000) New insights into sympathetic regulation of glucose and fat metabolism. Diabetologia 43, 533549
Okosun, S, Cooper, RS, Rotimi, CN, Osotimehin, B & Forrester, T (1998) Association of waist circumference with risk of hypertension and type 2 diabetes in Nigerians, Jamaicans and African Americans. Diabetes Care 21, 18361839
Okosun, S, Liao, YL, Rotimi, CN, Prewitt, TE & Cooper, S (2000) Abdominal adiposity and clustering of multiple metabolic syndrome in white, black and Hispanic Americans. Annals of Epidemiology 10, 263270
Onat, A, Avci, GS, Barlan, MM, Uyarel, H, Uzunlar, B & Sansoy, V (2004) Measures of abdominal obesity assessed for visceral adiposity and relation to coronary risk. International Journal of Obesity and Related Metabolic Diseases 28, 10181025
Oppert, JM, Lahlou, N, Laferrere, B, Roger, M, Basdevant, A & GuyGrand, B (1997) Plasma leptin and acute serotonergic stimulation of the corticotropic axis in women who are normal weight or obese. Obesity Research 5, 410416
Paffenbarger, RS, Wing, AL & Hyde, RT (1978) Physical activity as an index of heart attack risk in college alumni. American Journal of Epidemiology 108, 161175
Plutchik, R (1980) Emotion: A Psychoevolutionary Synthesis New York Harper & Row
Puttonen, S, Keltikangas-Jarvinen, L, Ravaja, N & Viikari, J (2003) Affects and autonomic cardiac reactivity during experimentally-induced stress as related to precursors of insulin resistance syndrome. International Journal of Behavioural Medicine 10, 106124
Raikkonen, K, Keltikangas-Jarvinen, L, Ladlercreutz, H & Hautanen, A (1996) Psychosocial stress and the insulin resistance syndrome. Metabolism 45, 15331538
Raikkonen, K, Matthews, KA & Kuller, LH (1999a) Anthropometric and psychosocial determinants of visceral obesity in healthy postmenopausal women. International Journal of Obesity 23, 775782
Raikkonen, K, Matthews, KA & Kuller, LH (2002) The relationship between psychological risk attributes and the metabolic syndrome in healthy women: antecedent or consequence. Metabolism 51, 15731577
Raikkonen, K, Matthews, KA, Kuller, LH, Reiber, C & Bunker, CH (1999b) Anger, hostility and visceral adipose tissue in healthy post-menopausal women. Metabolism 48, 11461151
Raikkonen, K, Matthews, KA & Salomon, K (2003) Hostility predicts metabolic syndrome risk factors in children and adolescents. Health Psychology 22, 279286
Ravaja, N, Keltikangas-Jarvinen, L & Viikari, J (1996) Life changes, locus of control and metabolic syndrome precursors in adolescents and young adults: a three-year follow-up. Social Science and Medicine 43, 5161
Rennie, KL, McCarthy, N, Yazdgerdi, S, Marmot, M & Brunner, E (2003) Association of metabolic syndrome with both vigorous and moderate physical activity. International Journal of Epidemiology 32, 600
Riserus, U, Arnlov, J, Brismar, K, Zethelius, B, Berglund, L & Vessby, B (2004) Sagittal abdominal diameter is a strong anthropometric marker of insulin resistance and hyperproinsulinemia in obese men. Diabetes Care 27, 20412046
Rosmond, R, Holm, G & Bjorntorp, P (2000) Food-induced cortisol secretion in relation to anthropometric, metabolic and haemodynamic variables in men. International Journal of Obesity 24, 416422
Roth, JL, Mobarhan, S & Clohisy, M (2002) The metabolic syndrome: where are we where do we go. Nutrition Reviews 60, 335337
Roy, S, Rink, C, Khanna, S, Phillips, C, Bagchi, D, Bagchi, M & Sen, CK (2004) Bodyweight and abdominal fat gene expression profile in response to a novel hydroxycitric acid-based dietary supplement. Gene Expression 11, 251262
Sargent, PA, Sharpley, AL, Williams, C, Goodall, EM & Cowen, PJ (1997) 5-HT2C receptor activation decreases appetite and body weight in obese subjects. Psychopharmacology 133, 309312
Seematter, G, Binnert, C, Martin, JL & Tappy, L (2004) Relationship between stress, inflammation and metabolism. Current Opinion in Clinical Nutrition and Metabolic Care 7, 169173
Siani, A, Cappuccio, FP, Barba, G, Trevisan, M, Farinaro, E, Iacone, R, Russo, O, Russo, P, Mancini, M & Strazzullo, P (2002) The relationship of waist circumference to blood pressure: the Olivetti Heart Study. American Journal of Hypertension 15, 780786
Snijder, MB, Zimmet, PZ, Visser, M, Dekker, JM, Seidell, JC & Shaw, JE (2004) Independent and opposite associations of waist and hip circumferences with diabetes, hypertension and dyslipidemia: the AusDiab Study. International Journal of Obesity 28, 402409
Spielberger, CD (1983) Manual for the State-Trait Anger Scale (STAS) Palo Alto, CA Consulting Psychologist's Press
Steptoe, A & Marmot, M (2003) Burden of psychological adversity and vulnerability in middle age: associations with biobehavioural risk factors and quality of life. Psychosomatic Medicine 65, 10291037
Vanhala, MJ, Vanhala, PT, Keinanen-Kiukaanniemi, SM, Kumpusalo, EA & Takala, JK (1999) Relative weight gain and obesity as a child predict metabolic syndrome as an adult. International Journal of Obesity 23, 656659
Vieta, E (2004) Olanzapine in bipolar disorder. Expert Opinion on Pharmacotherapy 5, 16131619
Vitaliano, PP, Scanlan, JM, Zhang, JP, Savage, MV, Hirsch, IB & Siegler, IC (2002) Heart disease; role of chronic stress clarified Heart Disease Weekly 16 June issue 16
Waldstein, SR, Burns, HO, Toth, MJ & Poehlman, ET (1999) Cardiovascular reactivity and central adiposy in older African Americans. Health Psychology 18, 221228
Wallerius, S, Rosmond, R, Ljung, T, Holm, G & Bjorntorp, P (2003) Rise in morning saliva cortisol is associated with abdominal obesity in men: a preliminary report. Journal of Endocrinological Investigation 26, 616619
Wamala, SP, Lynch, J, Horsten, M, Mittleman, MA, Schenck-Gustafsson, K, Orth-Gomer, K (1999) Education and the metabolic syndrome in women. Diabetes Care 22, 19992003
Ward, AMV, Syddall, HE, Wood, PJ, Dennison, EM & Phillips, DIW (2004) Central hypothalamic-pituitary-adrenal activity and the metabolic syndrome: studies using the corticotrophin-releasing hormone test. Metabolism: Clinical and Experimental 53, 720726
Weber-Hamann, B, Hentschel, F, Kniest, A, Deuschle, M, Colla, M, Lederbogen, F & Heuser, I (2002) Hypercolesterolemic depression is associated with increased intra-abdominal fat. Psychosomatic Medicine 54, 274277
Wellman, PJ, Jones, SL & Miller, DK (2003) Effects of preexposure to dexfenfluramine, phentermine, dexfenfluramine-phentennine or fluoxetine on sibutramine-induced hypophagia in the adult rat. Pharmacology Biochemistry and Behavior 75, 103114
Woodall, KL & Matthews, KA (1993) Change in and stability of hostile characteristics: results form a 4-year longitudinal study of children. Journal of Personality and Social Psychology 64, 491499
Zimmermann, U, Kraus, T, Himmerich, H, Schuld, A & Pollmacher, T (2003) Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. Journal of Psychiatric Research 37, 193220
Yarbrough, DE, Barrett-Connor, E, Kritz-Silverstein, D & Wingard, DL (1998) Birth weight, adult weight and girth as predictors of the metabolic syndrome in postmenopausal women. Diabetes Care 21, 16521659


Psychological underpinnings of metabolic syndrome

  • Barbara J. Stewart-Knox (a1)


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