Association of Serum Adiponectin, Sleep Quality, and Health-promoting Lifestyle with Metabolic Syndrome in Patients with Schizophrenia

Background: Metabolic syndrome (MS) significantly contributes to premature mortality in schizophrenia, which is driven by multiple biological and behavioral factors. While individual risk factors are known, comprehensive studies examining the combined influence of biological markers (adiponectin) and behavioral factors (sleep, lifestyle) in the Indian context are limited. Methods: In this cross-sectional, observational study, 130 patients diagnosed with schizophrenia were assessed for MS using modified National Cholesterol Education Program Adult Treatment Panel III criteria. We evaluated symptom severity using the Brief Psychiatric Rating Scale, Sleep quality using the Pittsburgh Sleep Quality Index, and lifestyle behaviors using the Health-Promoting Lifestyle Profile-II. Blood samples were analyzed for serum adiponectin and metabolic profiles to diagnose MS. Results: The MS rate was 24.6%. Bivariate analyses revealed that patients with MS had a significantly longer time spent in exacerbation ( p = .03), a longer treatment duration ( p = .01), lower serum adiponectin levels ( p = .02), poorer sleep quality ( p = .001), and lower physical activity and nutritional habit scores ( p = .01). In the multivariable logistic regression model, poorer sleep quality (OR = 1.17, 95% CI = 1.06–1.30, p = .002) and a lower physical activity and nutritional habit score (OR = 0.92, 95% CI = 0.86–0.98, p = .01) emerged as significant predictors of MS. Conclusions: One-fourth of the patients with schizophrenia had MS in this cohort. Notably, modifiable behavioral factors—specifically sleep quality and lifestyle—were stronger predictors of metabolic risk. This signifies the vital need to integrate routine screening for cardiometabolic risk factors and to apply therapeutic strategies into the standard of care for schizophrenia.