Eating behavior of schizophrenic patients
Keywords:
Eating, Feeding behavior, Food consuption, Metabolome, SchizophreniaAbstract
Objective
To assess the eating behavior, food practices, nutritional and metabolic profiles of patients with schizophrenia undergoing treatment.
Methods
Cross-sectional exploratory descriptive qualitative study used a semi-structured questionnaire on the eating behavior, food practices, and perception of changes after the initiation of drug therapy and a quantitative method using anthropometric and body composition measurements, metabolic parameters, and 5-day dietary records to analyze nutrient ingestion of patients with schizophrenia in an outpatient clinic at a tertiary hospital (n=33). The qualitative data were analyzed and coded by three researchers and quantitative data were analyzed using descriptive exploratory statistics.
Results
The results of this study showed that schizophrenic patients presented high prevalence of excess weight (71.0%), metabolic syndrome (42.0%), dyslipidemia (62.0%), changes in appetite (76.0%), and increase in energy intake (74.2%), associated with important irregularities in eating behavior and food practices (such as irregularity of meals, emotional intake, high carbohydrate and fat intake, and low energy expenditure) and lifestyle (changes in social and work routines).
Conclusion
This eating profile may interact synergistically with psychotropic drugs to contribute to weight gain and metabolic changes in schizophrenia. Nutrition education may prevent and monitor the risk of metabolic and nutrition problems, irrespective of the medications used.
References
Bushe CJ, Slooff CJ, Haddad PM, Karagianis JL. Weight change by baseline BMI from three-year observational data: Findings from the Worldwide Schizophrenia Outpatient Health Outcomes Database. J Psychopharmacol. 2013;27(4):358-65.
Young SL, Taylor M, Lawrie SM. First do no harm: A systematic review of the prevalence and management of antipsychotic adverse effects. J Psychopharmacol. 2015;29(4):353-62.
Ramacciotti CE, Paoli RA, Catena M, Ciapparelli A, Dell’Osso L, Schulte F, et al. Schizophrenia and binge-eating disorders. J Clin Psychiatry. 2004;65(7):1016-7.
Smith RC, Lindenmayer J-P, Hu Q, Kelly E, Viviano TF, Cornwell J, et al. Effects of olanzapine and risperidone on lipid metabolism in chronic schizophrenic patients with long-term antipsychotic treatment: A randomized five month study. Schizophr Res. 2010;120(1-3):204-9.
Kim B-J, Sohn J-W, Park C-S, Hahn G-H, Koo J, Noh Y-D, et al. Body weight and plasma levels of ghrelin and leptin during treatment with olanzapine. J Korean Med Sci. 2008;23(4):685-90.
Chen VC-H, Wang T-N, Lu M-L, Chou J-Y, Ju P-C, Wu J-Y, et al. Weight gain and ghrelin level after olanzapine monotherapy. Prog NeuroPsychopharmacol Biol Psychiatry. 2011;35(2):632-5.
Goncalves P, Araujo JR, Martel F. Antipsychoticsinduced metabolic alterations: Focus on adipose tissue and molecular mechanisms. Eur Neuropsychopharmacol. 2015;25(1):1-16.
Elman I, Borsook D, Lukas SE. Food intake and reward mechanisms in patients with schizophrenia: Implications for metabolic disturbances and treatment with second-generation antipsychotic agents. Neuropsychopharmacology. 2006;31(10):2091-120.
Nilsson BM, Forslund AH, Olsson RM, Hambraeus L, Wiesel FA. Differences in resting energy expenditure and body composition between patients with schizophrenia and healthy controls. Acta Psychiatr Scand. 2006;114(1):27-35.
Araujo FS, Petribu K, Bastos O. Depression in schizophrenia. Rev Bras Psiquiatr. 2002;24(2):86-93.
Miyamoto S, Duncan GE, Marx CE, Lieberman JA. Treatments for schizophrenia: A critical review of pharmacology and mechanisms of action of antipsychotic drugs. Mol Psychiatry. 2005;10(1):79-104.
Allison DB, Mentore JL, Heo M, Chandler LP, Cappelleri JC, Infante MC, et al. Antipsychoticinduced weight gain: A comprehensive research synthesis. Am J Psychiatry. 1999;156(11):1686-96.
Wirshing DA. Schizophrenia and obesity: Impact of antipsychotic medications. J Clin Psychiatry. 2004;65 Suppl 18:13-26.
Draper A, Swift JA. Qualitative research in nutrition and dietetics: Data collection issues. J Human Nutr Diet. 2011;24(1):3-12.
Weingarten HP, Elston D. Food cravings in a college population. Appetite. 1991;17(3):167-75.
Macedo DM, Diez-Garcia RW. Sweet craving and ghrelin and leptin levels in women during stress. Appetite. 2014;80:264-70.
Cleeman JI, Grundy SM, Becker D, Clark LT, Cooper RS, Denke MA, et al. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Jama. 2001;285(19):2486-97.
World Health Organization. Defining the problem of overweight and obesity. In: World Health Organization. Obesity: Preventing and managing the global epidemic: Report of a WHO Consultation. Geneva: WHO; 2000. p.241-3. WHO Technical Report Series, 894.
International Diabetes Federation. Clinical Guidelines Task force: Global guideline for Type 2 diabetes. Brussels: International Diabetes Federation; 2005.
Pollock WL, Wilmore JH. Exercícios na saúde e na doença: avaliação e prescrição para prevenção e reabilitação. 2a ed. Rio de Janeiro: MEDSI; 1993.
Kohlmann S, Rief W, Westermann S. Emotion regulation, overeating and obesity. J Psychosom Res. 2012;72(6):489.
Kishi T, Elmquist JK. Body weight is regulated by the brain: A link between feeding and emotion. Mol Psychiatry. 2005;10(2):132-46.
Myin-Germeys I, van Os J. Stress-reactivity in psychosis: Evidence for an affective pathway to psychosis. Clin Psychol Rev. 2007;27(4):409-24.
Cerimele JM, Katon WJ. Associations between health risk behaviors and symptoms of schizophrenia and bipolar disorder: A systematic review. Gen Hosp Psychiatry. 2013;35(1):16-22.
Ziedonis D, Hitsman B, Beckham J, Zvolensky M, Adler L, Audrain-McGovern J, et al. Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report. Nicotine Tob Res. 2008;10(12):1691-715.
Vancampfort D, Probst M, Scheewe T, De Herdt A, Sweers K, Knapen J, et al. Relationships between physical fitness, physical activity, smoking and metabolic and mental health parameters in people with schizophrenia. Psychiatry Res. 2013;207(1-2):25-32.
Kristiansen CB, Juel A, Hansen MV, Hansen AM, Kilian R, Hjorth P. Promoting physical health in severe mental illness: Patient and staff perspective. Acta Psychiatr Scand. 2015;132(6):470-8.
Thorp AA, Owen N, Neuhaus M, Dunstan DW. Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011. Am J Prev Med. 2011;41(2):207-15.
Vancampfort D, Probst M, Knapen J, Carraro A, De Hert M. Associations between sedentary behaviour and metabolic parameters in patients with schizophrenia. Psychiatry Res. 2012;200(2-3):73-8.
Brown S, Birtwistle J, Roe L, Thompson C. The unhealthy lifestyle of people with schizophrenia. Psychol Med. 1999;29(3):697-701.
Scagliusi FB, Lancha Júnior AH. Underreporting of energy intake in dietary assessment methods. Rev Nutr. 2003;16(4):471-81. http://dx.doi.org/10.1590/S1415-52732003000400010
Dipasquale S, Pariante CM, Dazzan P, Aguglia E, McGuire P, Mondelli V. The dietary pattern of patients with schizophrenia: A systematic review. J Psychiatr Res. 2013;47(2):197-207.
Ratliff JC, Palmese LB, Reutenauer EL, Liskov E, Grilo CM, Tek C. The effect of dietary and physical activity pattern on metabolic profile in individuals with schizophrenia: A cross-sectional study. Comp Psychiatry. 2012;53(7):1028-33.
Monteiro CA, Levy RB, Claro RM, Ribeiro de Castro IR, Cannon G. Increasing consumption of ultra-processed foods and likely impact on human health: Evidence from Brazil. Public Health Nutr. 2011;14(1):5-13.
Moubarac JC, Martins APB, Claro RM, Levy RB, Cannon G, Monteiro CA. Consumption of ultra-processed foods and likely impact on human health: Evidence from Canada. Public Health Nutr. 2013;16(12):2240-8.
Weltens N, Zhao D, Van Oudenhove L. Where is the comfort in comfort foods? Mechanisms linking fat signaling, reward, and emotion. Neurogastroenterol Motil. 2014;26(3):303-15.
Ministério da Saúde (Brasil). Secretaria de Vigilância em Saúde. Vigitel Brasil 2013: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde; 2014.
Zortea K, Bock PM, Moreno DB, Belmonte de Abreu PS. Anthropometric and biochemical assessment of schizophrenic patients taking clozapine. Rev Nutr. 2009;22(5):697-705. http://dx.doi.org/10.1590/S14 15-52732009000500010
Levy RB, Claro RM, Monteiro CA. Sugar and total energy content of household food purchases in Brazil. Public Health Nutr. 2009;12(11):2084-91.
Monteiro CA, Levy RB, Claro RM, Ribeiro de Castro IR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saúde Pública. 2010;26(11):2039-49.
Sachs GS, Guille C. Weight gain associated with use of psychotropic medications. J Clin Psychiatry. 1999;60 Supl 21:16-9.
Allison DB, Casey DE. Antipsychotic-induced weight gain: A review of the literature. J Clin Psychiatry. 2001;62 Supl 7:22-31.
Meltzer HY, Perry E, Jayathilake K. Clozapineinduced weight gain predicts improvement in psychopathology. Schizophr Res. 2003;59(1):19-27.
Nihalani N, Schwartz TL, Siddiqui UA, Megna JL. Obesity and Psychotropics. CNS Neurosci Ther. 2012;18(1):57-63.
Melkersson KI, Dahl ML. Relationship between levels of insulin or triglycerides and serum concentrations of the atypical antipsychotics clozapine and olanzapine in patients on treatment with therapeutic doses. Psychopharmacology. 2003;170(2):157-66.
Parsons B, Allison DB, Loebel A, Williams K, Giller E, Romano S, et al. Weight effects associated with antipsychotics: A comprehensive database analysis. Schizophr Res. 2009;110(1-3):103-10.
Citrome L, Holt RIG, Walker DJ, Hoffmann VP. Weight gain and changes in metabolic variables following olanzapine treatment in schizophrenia and bipolar disorder. Clin Drug Invest. 2011;31(7):455-82.
Leitão-Azevedo CL, Abreu MGB, Guimarães LR, Moreno D, Lobato MI, Gama CS, et al. Overweight and obesity in schizophrenic patients taking clozapine compared to the use of other antipsychotics. Rev Psiquiatr Rio Gd Sul. 2006;28(2):120-8.
Dickerson FB, Brown CH, Kreyenbuhl JA, Fang L, Goldberg RW, Wohheiter K, et al. Obesity among individuals with serious mental illness. Acta Psychiatr Scand. 2006;113(4):306-13.
Gurpegui M, Maria Martinez-Ortega J, GutierrezRojas L, Rivero J, Rojas C, Jurado D. Overweight and obesity in patients with bipolar disorder or schizophrenia compared with a non-psychiatric sample. Prog Neuropsychopharmacol Biol Psychiatry. 2012;37(1):169-75.
Fagiolini A, Frank E, Scott JA, Turkin S, Kupfer DJ. Metabolic syndrome in bipolar disorder: Findings from the Bipolar Disorder Center for Pennsylvanians. Bipolar Disord. 2005;7(5):424-30.
Almeida KM, de Macedo-Soares MB, Issler CK, Amaral JA, Caetano SC, Dias RDS, et al. Obesity and metabolic syndrome in Brazilian patients with bipolar disorder. Acta Neuropsychiatr. 2009;21(2):84-8.
Salvi VA, Albert U, Chiarle A, Soreca I, Bogetto F, Maina G. Metabolic syndrome in Italian patients with bipolar disorder. Gen Hosp Psychiat. 2008;30(4):318-23.
van Winkel R, De Hert M, Van Eyck D, Hanssens L, Wampers M, Scheen A, et al. Prevalence of diabetes and the metabolic syndrome in a sample of patients with bipolar disorder. Bipolar Disord. 2008;10(2):342-8.
Chang HH, Chou CH, Chen PS, Gean PW, Huang HC, Lin CY, et al. High prevalence of metabolic disturbances in patients with bipolar disorder in Taiwan. J Affective Disord. 2009;117(1-2):124-9.
Salaroli LB, Barbosa GC, Mill JG, Molina MCB. Prevalence of metabolic syndrome in populationbased study, Vitoria, ES - Brazil. Arq Bras Endocrinol Metabol. 2007;51(7):1143-52.
Roick C, Fritz-Wieacker A, Matschinger H, Heider D, Schindler J, Riedel-Heller S, et al. Health habits of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2007;42(4):268-76.
Strassnig M, Brar JS, Ganguli R. Nutritional assessment of patients with schizophrenia: A preliminary study. Schizophr Bull. 2003;29(2):393-7.
Kilbourne AM, Rofey DL, McCarthy JF, Post EP, Welsh D, Blow FC. Nutrition and exercise behavior among patients with bipolar disorder. Bipolar Disord. 2007;9(5):443-52.
Bensenor IM, Brunoni AR, Pilan LA, Goulart AC, Busatto GF, Lotufo PA, et al. Cardiovascular risk factors in patients with first-episode psychosis in São Paulo, Brazil. Gen Hosp Psychiat. 2012;34(3):268-75.
Simonelli-Munoz AJ, Fortea MI, Salorio P, GallegoGomez JI, Sanchez-Bautista S, Balanza S. Dietary habits of patients with schizophrenia: A self-reported questionnaire survey. Int J Ment Health Nurs. 2012;21(3):220-8.
Amani R. Is dietary pattern of schizophrenia patients different from healthy subjects? BMC Psychiat. 2007;7:1-5.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Ana Carolina AGUIAR-BLOEMER, Rosina Gabriela AGLIUSSI, Thiago Maehara Pereira PINHO, Erikson Felipe FURTADO, Rosa Wanda DIEZ-GARCIA
This work is licensed under a Creative Commons Attribution 4.0 International License.
