Diet, exercise and the metabolic syndrome in schizophrenia: A cross-sectional study

Heald, Adrian; Sein, Kyaw; Anderson, Simon; Pendlebury, John; Guy, Mark; Narayan, Vinesh; Gibson, Martin; Haddad, Peter M.; Livingston, Mark

doi:10.1016/j.schres.2015.10.043

Cited by 14 publications

(11 citation statements)

References 8 publications

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“… 4 Although previous research has focused on common mental disorders, 1 , 5 recent attention has been drawn to the food intake of people with schizophrenia—who may have the worst diet, poorest metabolic health, and greatest premature mortality across all severe mental illnesses. 6–8 …”

Section: Introductionmentioning

confidence: 99%

Nutritional Deficiencies and Clinical Correlates in First-Episode Psychosis: A Systematic Review and Meta-analysis

Firth

Carney

Stubbs

et al. 2017

Schizophrenia Bulletin

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ObjectiveDiet is increasingly recognized as a potentially modifiable factor influencing the onset and outcomes of psychiatric disorders. Whereas, previous research has shown long-term schizophrenia is associated with various nutritional deficiencies, this meta-analysis aimed to determine the prevalence and extent of nutritional deficits in first-episode psychosis (FEP).MethodA search of electronic databases conducted in July 2017 identified 28 eligible studies, examining blood levels of 6 vitamins and 10 minerals across 2612 individuals: 1221 individuals with FEP and 1391 control subjects. Meta-analyses compared nutrient levels in FEP to nonpsychiatric controls. Clinical correlates of nutritional status in patient samples were systematically reviewed.ResultsSignificantly lower blood levels of folate (N = 6, n = 827, g = −0.624, 95% confidence interval [CI] = −1.176 to −0.072, P = .027) and vitamin D (N = 7, n = 906, g = −1.055, 95% CI = −1.99 to −0.119, P = .027) were found in FEP compared to healthy controls. Synthesis of clinical correlates found both folate and vitamin D held significant inverse relationships with psychiatric symptoms in FEP. There was also limited evidence for serum level reductions of vitamin C (N = 2, n = 96, g = −2.207, 95% CI = −3.71 to −0.71, P = .004). No differences were found for other vitamins or minerals.ConclusionsDeficits in vitamin D and folate previously observed in long-term schizophrenia appear to exist from illness onset, and are associated with worse symptomology. Further research must examine the direction and nature of these relationships (ie, mediator, moderator, or marker) with clinical status in FEP. Future trials assessing efficacy of nutrient supplementation in FEP samples should consider targeting and stratifying for baseline deficiency.

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Section: Introductionmentioning

confidence: 99%

Nutritional Deficiencies and Clinical Correlates in First-Episode Psychosis: A Systematic Review and Meta-analysis

Firth

Carney

Stubbs

et al. 2017

Schizophrenia Bulletin

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“…Many people with schizophrenia vary in insight with regards to their illness (Aleman et al, 2006), dietary intake habits (Heald et al, 2015), social support (Buchanan, 1995), and everyday functioning (Sabbag et al, 2012). For dietary interventions in schizophrenia patient populations to be successful, the combined support from scientists, dieticians, family members, and neuropsychiatric clinicians who have been successful in implementing behavioral modifications will be necessary.…”

Section: Discussionmentioning

confidence: 99%

“…A lower intake of ω-6, phytosterols, vitamin A, and vitamin E (α-tocopherol) has also been reported in relation to BMI and demographically matched comparison subjects (Nunes et al, 2014). In addition, consumption of fruit and vegetable portions is significantly lower that the recommended daily allowance (Heald et al, 2015). However, other reports indicate that it is primarily the overall, rather than specific type of, caloric intake that is increased in schizophrenia (Strassnig et al, 2003).…”

Section: Schizophrenia Obesity and Unhealthy Dietary Intakementioning

confidence: 99%

Modified Mediterranean Diet for Enrichment of Short Chain Fatty Acids: Potential Adjunctive Therapeutic to Target Immune and Metabolic Dysfunction in Schizophrenia?

et al. 2017

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Growing interest in gut and digestive processes and their potential link to brain and peripheral based inflammation or biobehavioral phenotypes has led to an increasing number of basic and translational scientific reports focused on the role of gut microbiota within the context of neuropsychiatric disorders. However, the effect of dietary modification on specific gut metabolites, in association with immune, metabolic, and psychopathological functioning in schizophrenia spectrum disorders has not been well characterized. The short chain fatty acids (SCFA) acetate, butyrate, and propionate, major metabolites derived from fermentation of dietary fibers by gut microbes, interact with multiple immune and metabolic pathways. The specific pathways that SCFA are thought to target, are dysregulated in cardiovascular disease, type II diabetes, and systemic inflammation. Most notably, these disorders are consistently linked to an attenuated lifespan in schizophrenia. Although, unhealthy dietary intake patterns and increased prevalence of immune and metabolic dysfunction has been observed in people with schizophrenia; dietary interventions have not been well utilized to target immune or metabolic illness. Prior schizophrenia patient trials primarily focused on the effects of gluten free diets. Findings from these studies indicate that a diet avoiding gluten benefits a limited subset of patients, individuals with celiac disease or non-celiac gluten sensitivity. Therefore, alternative dietary and nutritional modifications such as high-fiber, Mediterranean style, diets that enrich the production of SCFA, while being associated with a minimal likelihood of adverse events, may improve immune and cardiovascular outcomes linked to premature mortality in schizophrenia. With a growing literature demonstrating that SCFA can cross the blood brain barrier and target key inflammatory and metabolic pathways, this article highlights enriching dietary intake for SCFA as a potential adjunctive therapy for people with schizophrenia.

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“…Several factors can explain the increased mortality risk such as the effect of antipsychotic medications and the high prevalence of the traditional coronary heart disease (CHD) risk factors, mainly obesity and an unhealthy lifestyle [1,6–8]. In fact, patients with schizophrenia have been shown to have sedentary behaviors [ 9 – 11 ], lower activity and exercise levels, and unhealthy dietary habits compared with the general population. It is well known that a low level of physical activity and a high calorie diet reduce life expectancy and increase the risk of both the metabolic syndrome and CHD in the general population, as well as in patients with schizophrenia [ 9 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, patients with schizophrenia have been shown to have sedentary behaviors [ 9 – 11 ], lower activity and exercise levels, and unhealthy dietary habits compared with the general population. It is well known that a low level of physical activity and a high calorie diet reduce life expectancy and increase the risk of both the metabolic syndrome and CHD in the general population, as well as in patients with schizophrenia [ 9 – 12 ]. Furthermore, smoking is much more prevalent in patients with schizophrenia than in the general population or in patients with other mental disorders [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Coronary Heart Disease Risk in Patients with Schizophrenia: A Lebanese Cross-Sectional Study

Haddad¹,

Hallit²,

Salameh

et al. 2017

J Comorb

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Background:Coronary heart disease (CHD) is a leading cause of premature death in patients with schizophrenia. CHD risk in Lebanese patients with schizophrenia remains unknown.Objectives:To (i) evaluate CHD risk of patients with schizophrenia in Lebanon; and (ii) detect the modifiable and non-modifiable factors affecting this risk.Methods:Cross-sectional study of 329 patients with schizophrenia aged 20–75 years. Ten-year hard CHD risk was calculated using the Framingham risk score. A logistic regression was conducted taking the dichotomous hard CHD (<10% and ≥10%) as the dependent variable.Results:Ten-year hard CHD risk was low (<10%) in 60.8% of patients, intermediate (10–20%) in 31.6%, and high (>20%) in 7.6%. Multivariate analysis showed that the mean 10-year hard CHD risk was 8.76±6.92 (10.82±6.83 in men and 3.18±2.90 in women). Ten-year hard CHD risk was higher in patients with the metabolic syndrome (odds ratio [OR] 2.67, confidence interval [CI] 1.54–4.64), a longer duration of schizophrenia (OR 1.03, CI 1.01–1.05), a history of other medical illnesses (OR 2.02, CI 1.18–3.47), and in those participating in art therapy (OR 2.13, CI 1.25–3.64) or therapeutic education (OR 1.93, CI 0.93–4.01). Ten-year hard CHD risk was lower in patients receiving risperidone (OR 0.23, CI 0.08–0.68), any anti-epileptic (OR 0.41, CI 0.24–0.73), or any benzodiazepine (OR 0.33, CI 0.17–0.66) medication.Conclusion:CHD is prevalent in patients with schizophrenia in Lebanon. Physicians are recommended to monitor the components of the metabolic syndrome to identify patients with increased risk of cardiovascular diseases.

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Diet, exercise and the metabolic syndrome in schizophrenia: A cross-sectional study

Cited by 14 publications

References 8 publications

Nutritional Deficiencies and Clinical Correlates in First-Episode Psychosis: A Systematic Review and Meta-analysis

Nutritional Deficiencies and Clinical Correlates in First-Episode Psychosis: A Systematic Review and Meta-analysis

Modified Mediterranean Diet for Enrichment of Short Chain Fatty Acids: Potential Adjunctive Therapeutic to Target Immune and Metabolic Dysfunction in Schizophrenia?

Coronary Heart Disease Risk in Patients with Schizophrenia: A Lebanese Cross-Sectional Study

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