Metabolic syndrome and cardiometabolic index among patients with anxiety disorders: a cross-sectional clinical study

Q: What are the key findings of this study?

Poorer sleep quality (OR 1.250, 95% CI 1.152-1.356) and older age (OR 1.061) were independently associated with higher odds of metabolic syndrome (prevalence 51.5%) in anxiety disorder patients.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Anxiety disorders (n=375). Intervention: Poorer sleep quality (per unit increase in PSQI score) vs. Lower PSQI score (better sleep quality). Primary outcome: Metabolic syndrome (NCEP ATP III criteria) (OR 1.250, 95% CI 1.152-1.356, p=<0.001).

Q: What does this research mean for the field?

Metabolic syndrome has a high prevalence among patients with anxiety disorders and is independently associated with older age and poorer sleep quality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the prevalence and determinants of metabolic syndrome and evaluate the diagnostic accuracy of the cardiometabolic index in outpatients diagnosed with anxiety disorders.

Parnian Khalkhali; Mohammadrasoul Khalkhali; Hassan Farrahi; Mojtaba Mehrdad; Zahra Atrkar Roushan

doi:10.1186/s12888-026-08769-5

October 20, 2026BMC PsychiatryOpen Access

Metabolic syndrome and cardiometabolic index among patients with anxiety disorders: a cross-sectional clinical study

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Key result

Poorer sleep quality linked to ~25% higher odds of metabolic syndrome in anxiety disorder patients.

OR 1.250
95% CI 1.152-1.356
P<0.001
n=375

Why the study?

Metabolic dysregulation and cardiometabolic risk frequently accompany anxiety disorders, prompting an evaluation of metabolic syndrome (MetS) and the cardiometabolic index (CMI) in this patient population.

Key Points

To assess the prevalence and determinants of metabolic syndrome and evaluate the diagnostic accuracy of the cardiometabolic index in outpatients diagnosed with anxiety disorders.
Conducted a cross-sectional study of 375 outpatients with anxiety disorders at two psychiatric clinics in Rasht, Iran, between 2024 and 2025.
Assessed sleep quality using the Pittsburgh Sleep Quality Index, physical activity using the International Physical Activity Questionnaire, and metabolic syndrome via NCEP ATP III criteria.
Evaluated the cardiometabolic index (derived from the triglyceride-to-HDL cholesterol ratio and waist-to-height ratio) using multivariable regression and receiver operating characteristic curve analysis.
Metabolic syndrome was identified in 51.5% of participants (median cardiometabolic index, 0.90; Q1–Q3: 0.55–1.35).
Older age (OR = 1.061, 95% CI: 1.034–1.088, p < 0.001) and poorer sleep quality (OR = 1.250, 95% CI: 1.152–1.356, p < 0.001) were associated with higher odds of metabolic syndrome, whereas higher education reduced the odds (OR = 0.408, 95% CI: 0.204–0.818, p = 0.012).
The cardiometabolic index demonstrated strong discriminative capacity for metabolic syndrome (AUC = 0.839, 95% CI: 0.798–0.881, p < 0.001), achieving 82.4% sensitivity and 75.8% specificity at a cutoff of 0.845.

Study Design

Type

Cross-Sectional (n=375)

Multicenter

Yes

Structured PICO

P

Population

375 adult outpatients with anxiety disorders (mean age 49.0 years, 79.2% female) receiving SSRI or SNRI monotherapy for at least 6 months, excluding those with bipolar or schizophrenia spectrum disorders.

O

Outcome

Prevalence and factors associated with metabolic syndrome (MetS, defined by NCEP ATP III criteria) and the cardiometabolic index (CMI, calculated from triglyceride-to-HDL cholesterol ratio and waist-to-height ratio), as well as the discriminative ability of CMI for MetS.surrogate

Main Result

Odds Ratio: 1.25 (95% CI 1.152–1.356)

p-value: p=<0.001

Limitations

Cross-sectional design precludes causal or temporal inferences
Structural overlap between CMI components and MetS diagnostic criteria inflates discriminative performance
Predominantly female sample (79.2%) limits conclusions regarding sex differences
Small subgroup sizes for eating disorders and specific psychiatric comorbidities limited statistical power
Antidepressant exposure was modeled only at the class level without accounting for specific drugs, dosages, or cumulative exposure
Overlap between CMI components and MetS criteria
Individual antidepressant medications and dosages were not included as separate predictors due to small subgroups and risk of model overfitting
Need for further longitudinal and external validation studies

Implication

Metabolic syndrome is present in over half of outpatients treated for anxiety disorders, with older age and poorer sleep quality independently associated with higher cardiometabolic risk.

Abstract

Metabolic dysregulation and cardiometabolic risk frequently accompany anxiety disorders. This study evaluated metabolic syndrome (MetS) and the cardiometabolic index (CMI) among patients with anxiety disorders. This cross-sectional study included 375 outpatients with anxiety disorders attending two psychiatric clinics in Rasht, Iran, during 2024–2025. Sleep quality and physical activity were assessed using the Pittsburgh Sleep Quality Index and International Physical Activity Questionnaire, respectively. MetS was defined according to NCEP ATP III criteria, and CMI was calculated using the triglyceride-to-HDL cholesterol ratio and waist-to-height ratio. Hierarchical logistic and linear regression analyses examined factors associated with MetS and CMI, respectively. ROC analysis evaluated the discriminative ability of CMI for MetS. Among 375 participants (mean age, 49.0 ± 13.5 years; 79.2% female), MetS prevalence was 51.5%, and median CMI was 0.90 (Q1–Q3: 0.55–1.35). Older age (OR = 1.061, 95% CI: 1.034–1.088) and poorer sleep quality (OR = 1.250, 95% CI: 1.152–1.356) were associated with higher odds of MetS, whereas higher education was associated with lower odds (OR = 0.408, 95% CI: 0.204–0.818). Higher FBG (β = 0.190, p = 0.001) and poorer sleep quality (β = 0.122, p = 0.028) were associated with higher CMI. CMI showed good discriminative ability for MetS (AUC = 0.839, 95% CI: 0.798–0.881), with a Youden-derived cutoff of 0.845 (sensitivity, 82.4%; specificity, 75.8%). MetS was common among patients with anxiety disorders and was associated with older age and poorer sleep quality. CMI showed good discriminative ability for MetS, although this finding should be interpreted considering the overlap between CMI components and MetS criteria. Further longitudinal and external validation studies are warranted.

Discussion

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Cite This Study

Khalkhali et al. (2026) conducted a cross-sectional in Anxiety disorders (n=375). Poorer sleep quality (per unit increase in PSQI score) vs. Lower PSQI score (better sleep quality) was evaluated on Metabolic syndrome (NCEP ATP III criteria) (OR 1.250, 95% CI 1.152-1.356, p=<0.001). Poorer sleep quality (OR 1.250, 95% CI 1.152-1.356) and older age (OR 1.061) were independently associated with higher odds of metabolic syndrome (prevalence 51.5%) in anxiety disorder patients.

synapsesocial.com/papers/6ad9e562f67b53d0945659a8 https://doi.org/10.1186/s12888-026-08769-5

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Metabolic syndrome and cardiometabolic index among patients with anxiety disorders: a cross-sectional clinical study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Metabolic syndrome and cardiometabolic index among patients with anxiety disorders: a cross-sectional clinical study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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