Premorbid obesity and metabolic disturbances as promising clinical targets for the prevention and early screening of bipolar disorder.

Recent evidence shows an important relationship between metabolic disturbances and bipolar disorder (BD). However, it is still unclear whether such metabolic disturbances are only a consequence or to some extent the precipitating factors for health problems and maladaptive behaviors observed in BD. Because both metabolic disturbances and BD are medical conditions sharing common alterations in multiple biomarkers, it is plausible to hypothesize that metabolic disturbances may be considered to some extent as a major vulnerability factor in the latent phase of BD for some young adults. In line with this hypothesis, obesity may be regarded as a major driving force for prevalent cardio-metabolic disorders encountered within the early stages of BD. Likewise, premorbid metabolic disturbances as a whole may be considered as a potential source for vulnerability to develop BD. In addition, a synergistic relationship between obesity and metabolic disturbances associated with a premorbid disruption of biological rhythms may also lead to BD. Therefore, we postulate that metabolic disturbances may serve as a specific marker of premorbid illness activity in some people at risk for BD. Future prospective studies should focus on validating metabolic disturbances as vulnerability factors within the staging model of BD.