Metabolic syndrome in bipolar disorder and schizophrenia: dietary and lifestyle factors compared to the general population

Abstract

Objective Since a poor diet is often cited as a contributor to metabolic syndrome for subjects diagnosed with bipolar disorder and schizophrenia, we sought to examine dietary intake, cigarette smoking, and physical activity in these populations and compare them with the general population. Methods Individuals diagnosed with bipolar disorder (n = 116) and schizophrenia (n = 143) were assessed for dietary intake, lifestyle habits and metabolic syndrome and compared to age, gender, and race matched subjects from the National Health and Nutrition Examination Survey (NHANES) 1999-2000. Additionally, matched subgroups within the patient populations were compared to elicit any differences. Results As expected, the metabolic syndrome rate was higher in the bipolar (33%) and schizophrenia (47%) samples compared to matched NHANES controls (17% and 11%, respectively), and not different between the patient groups. Surprisingly, both bipolar disorder and schizophrenia subjects consumed fewer total calories, carbohydrates and fats, as well as more fiber (p< 0.03), compared to NHANES controls. No dietary or activity differences between patient participants with and without metabolic syndrome were found. Schizophrenia subjects had significantly lower total and low density cholesterol levels (p< 0.0001) compared to NHANES controls. Bipolar disorder subjects smoked less (p = 0.001), exercised more (p = 0.004), and had lower BMIs (p = 0.009) compared to schizophrenia subjects. Conclusions Counter to predictions, few dietary differences could be discerned between schizophrenia, bipolar disorder, and NHANES control groups. The bipolar subjects exhibited healthier behaviors than the schizophrenia patients. Additional research regarding metabolic syndrome mechanisms, focusing on non-dietary contributions, is needed.

Polygenic risk for type 2 diabetes mellitus among individuals with psychosis and their relatives

“…One interpretation of the findings is that among Caucasians with chronic psychotic disorders, lifestyle risk factors and antipsychotic medication use primarily account for their higher prevalence of diabetes, rather than any difference in genetic liability. These lifestyle factors include diminished physical activity, poor diet, and smoking (Bly et al, 2014). Antipsychotic medication is associated with T2D (Cross-Disorder Group of the Psychiatric Genomics et al, 2013, Nielsen et al, 2010) perhaps because of the effect of these medications on weight gain (Bak et al, 2014), insulin release (Teff et al, 2013), glucose transport (Dwyer et al, 1999), and muscarinic receptor signaling (Weston-Green et al, 2012).…”

Sitting time, physical fitness impairments and metabolic abnormalities in people with bipolar disorder: An exploratory study

“…In the general population there is evidence that physical activity and exercise are broadly as effective as pharmacological interventions in preventing cardio-metabolic diseases and consequently premature mortality (Naci and Ioannidis, 2013). Data in people with bipolar disorder are however inconsistent with some studies finding a strong association between the level of physical activity participation and the risk for cardio-metabolic diseases (Salvi et al, 2011), while others in a mixed study including people with bipolar disorder and schizophrenia did not (Bly et al, 2014). Physical activity guidelines and recommendations for preventing and treating cardiovascular diseases have historically emphasized moderate-vigorous physical activity, or physical activity at an intensity greater than 45% of the maximum oxygen uptake (Garber et al, 2011).…”

Altered metabolic parameters in association with antipsychotic medication use in diabetes: A population based case-control study

“…In addition total cholesterol was marginally lower in the antipsychotic groups despite no difference in statin prescriptions (average -0.1mmol/l less). Significantly lower cholesterol level in schizophrenia patients have been described in other studies, although this finding has not been explained Deborah Wake 13 (Bly et al, 2014), and the wider literature suggests that second generation antipsychotics generally induce hypertension and dyslipidaemia most likely through weight gain (which this study matches for) over time (O'Donoghue et al, 2014;Roohafza et al, 2013;RummelKluge et al, 2010). A role for statins and anti-hypertensive medications is suggested in patients prescribed antipsychotics long term (Tse et al, 2014;Vincenzi et al, 2013).…”