Metabolic comorbidity, the new enemy. Metabolic syndrome and steatohepatitis.

Abstract

55 doi: 10.18176/resp.00010 In recent decades we have observed a progressive increase in the prevalence of non-communicable chronic diseases worldwide. This trend is more notable in developed countries and has been attributed to (amongst other factors) a gradual ageing of the population, unhealthy lifestyles and to healthcare advances that have increased life expectancy. The prison population is also afectted by these global socio-demographic changes. The prison population in Spain has been ageing progressively in recent years, mainly due to an increased imprisonment of older people and longer sentences. At present, the average age of inmates in Spain is 39 years and almost 30% of inmates are over 45 years of age1,2. One non-communicable chronic disease that has recently come under the spotlight is metabolic syndrome. The incidence of this condition has increased exponentially in recent years to become one of the main public health concerns of this century and is now a high priority health objective at international level. Metabolic syndrome is made up of a spectrum of diseases (obesity, higharterial hypertension, diabetes mellitus and dyslipidemia), and their importance rests on their role as risk factors for high morbimortality diseases, such as cardiovascular, respiratory and hepatic diseases, etc3,4. National studies in general population shows a prevalence of metabolic syndrome in Spain around 22-32%, but unfortunately there are very few studies evaluating the presence and impact of metabolic syndrome in prison population. The prevalence of arterial hypertensión in Spanish prisons is estimated to be 25%; while levels of dyslipidemia are estimated at 18% and diabetes mellitus at 10% in persons over 45 years of age, while 20% of such patients are obese (defined as a body mass index of over 30 kg/m2)5,6 Such numbers contradict the stereotypical perceptions held in experts circles outside prison, since they are not very different from those observed amongst the general population. One factor that could help to explain the increase of metabolic pathology amongst inmates is that the prison population is ageing, as we commented above. Another probable explanation is that particular factors of this population are contributing towards the increase in prevalence. On the one hand, we know that the prevalence of metabolic syndrome increases by up to 70% in patients with mental illnesses in the general population. These patients often take second-generation antipsychotic drugs, which are linked to weight gain and the risk of dyslipidemia or diabetes mellitus. This factor takes on even greater importance in prison, where the prevalence of severe mental illness is four times that of the general population, and almost half of the patients that go to psychiatric consultations in prison receive treatment with neuroleptic medication7. It has also been documented that the prison population is more likely to fall ill than the general public, when compared by age and sex, probably because of their origins (many are from the Third or Fourth World), their high risk behaviours and lifestyles. Likewise, higher levels of prison morbidity and mortality have been recorded in recent years that are related to non-communicable diseases and in particular to metabolic issues, (mainly cardiovascular events), at the expense of deaths attributed to infectious diseases. One of the chronic pathologies associated with metabolic syndrome that merits special attention is the metabolic (dysfunction) associated fatty liver disease “MAFLD”, previusly named non alcoholic Editorial