Visceral obesity in normal-weight patients suffering from chronic schizophrenia

BMC Psychiatry

Lucyna Ostrowska³  Leszek Rudzki¹  Agata Szulc⁴  Urszula Kowzan¹  Aleksandra Małus¹  Anna Golonko³  Urszula Cwalina²  Agnieszka Wendołowicz³  Ewa Stefańska³  Beata Konarzewska¹ 

[1] Department of Psychiatry, Medical University of Bialystok, Plac Brodowicza 1, Choroszcz 16-070, Poland;Department of Statistics and Medical Informatics, Medical University of Bialystok, Szpitalna 37, Białystok 15-295, Poland;Department of Dietetics and Clinical Nutrition, Medical University of Bialystok, Mieszka I-go 4B, Białystok 15-054, Poland;Department of Psychiatry, Medical University of Warsaw, Faculty of Health Sciences, ul. Partyzantow 2/4, Pruszkow 05-802, Poland

关键词: Bioelectrical impedance;    Body composition;    Normal weight;    Schizophrenia;   

Others  :  1123791
DOI  :  10.1186/1471-244X-14-35

 received in 2013-12-29, accepted in 2014-02-05,  发布年份 2014

【 摘 要 】

Background

BMI (body mass index) can be misleading regarding the level of adiposity in a normal-weight individual. Recently, a bioelectrical impedance analysis (BIA) method was developed that can measure body composition variables. The main objectives of this study were to use BIA to compare the body composition variables between chronic non-diabetic schizophrenic patients with normal weight and healthy individuals. The secondary objective was to compare the nutritional pattern of schizophrenia patients with that of matched healthy subjects, and to identify possible relationships between the content of different components of their diet and visceral adiposity.

Methods

The subjects were 52 normal-weight patients (33 males and 19 females) diagnosed with schizophrenia based on the DSM-IV and 45 (23 males and 22 females) BMI- matched controls. The patients had been receiving atypical or typical antipsychotic agents for at least one year before enrollment into the study but continuously for 3 months preceding the study and were psychiatrically stable. Body fat (kg), percent (%) body fat, fat-free mass, VAT (visceral adipose tissue) and SAT (subcutaneous adipose tissue) were measured using the bioelectrical impedance analysis (BIA) method. Daily food rations (DFR) were quantitatively evaluated by a 24-h dietary recall method covering 3 days preceding the examination.

Results

In normal-weight patients schizophrenia was significantly linked with higher VAT, VAT/SAT ratio and lower fat- free mass. Men had over 5 times and women over 2 times as much VAT as BMI matched groups. In women with schizophrenia and in their controls, the amount of magnesium, niacin and vitamin B6 in their diet inversely correlated with VAT, while in men lower zinc and vitamin C intake was related to higher visceral adiposity.

Conclusions

Our study has shown that normal-weight patients with chronic schizophrenia have higher levels of visceral fat (VAT) than controls but similar volume of subcutaneous adipose tissue (SAT). Although no clear conclusion can be made regarding cause-and-effect relationships between the dietary content of food served to our patients and visceral obesity, we suggest that schizophrenia diet should be further investigated as a possible factor related to this type of obesity.

【 授权许可】

   
2014 Konarzewska et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Ruderman N, Chisholm D, Pi-Sunyer X, Schneider S: The metabolically obese, normal-weight individual revisited. Diabetes 1998, 47:699-713.
• [2]Björntorp P: Abdominal obesity and the development of noninsulin-dependent diabetes mellitus. Diabetes Metab Rev 1988, 4:615-622.
• [3]Carey VJ, Walters EE, Colditz GA, et al.: Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses’ health study. Am J Epidemiol 1997, 145:614-619.
• [4]Wang J, Liu EY, Freudenreich O, Goff D, Henderson DC, Fan X: Phenotypic characteristics in metabolically obese but normal weight non-diabetic patients with schizophrenia. Schizophr Res 2010, 124(1–3):49-53.
• [5]Dickerson FB, Brown CH, Kreyenbuhl JA, Fang L, Goldberg RW, Wohlheiter K, Dixon LB: Obesity among individuals with serious mental illness. Acta Psychiatr Scand 2006, 113:306-313.
• [6]Susce MT, Villanueva N, Diaz FJ, de Leon J: Obesity and associated complications in patients with severe mental illnesses: a cross-sectional survey. J Clin Psychiatry 2005, 66:167-173.
• [7]Amani R: Is dietary pattern of schizophrenia patients different from healthy subjects? BMC Psychiatry 2007, 7:1-5. BioMed Central Full Text
• [8]Peet M: Nutrition and schizophrenia: beyond omega-3 fatty acids. Prostaglandins Leukot Essent Fat Acids 2004, 70:417-422.
• [9]Pate RR, O’Neill JR, Lobelo F: The evolving defınition of “sedentary”. Exerc Sport Sci Rev 2008, 36:173-178.
• [10]Sharpe JK, Stedman TJ, Byrne NM, Wishart C, Hills AP: Energy expenditure and physical activity in clozapine use: implications for weight management. Aust N Z J Psychiatry 2006, 40(12):810-814.
• [11]Vancampfort D, Probst M, Knapen J, Carraro A, De Hert M: Associations between sedentary behaviour and metabolic parameters in patients with schizophrenia. Psych Res 2012, 200(2/3):73-78.
• [12]Ryan M, Flanagan S, Kinsella U, Keeling F, Thakore J: The effects of atypical antipsychotics on visceral fat distribution in first episode, drug-naive patients with schizophrenia. Life Sci 2004, 74(16):1999-2008.
• [13]Saarni SE, Saarni SI, Fogelholm M, Heliövaara M, Perälä J, Suvisaari J, Lönnqvist J: Body composition in psychotic disorders: a general population survey. Psychol Med 2009, 39:801-810.
• [14]Thakore JH, Mann JN, Vlahos I, Martin A, Reznek R: Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia. Int J Obes Relat Metab Disord 2002, 26:137-141.
• [15]Sharpe J, Byrne N, Stedman T, Hills A: Bioelectric impedance is a better indicator of obesity in men with schizophrenia than body mass index. Psychiatry Res 2008, 159(1/2):121-126.
• [16]Boneva-Asiova Z, Boyanov MA: Body composition analysis by leg-to-leg bioelectrical impedance and dual-energy X-ray absorptiometry in non-obese and obese individuals. Diabetes Obes Metab 2008, 10:1012-1018.
• [17]Ellis KJ: Human body composition: in vivo methods. Psychol Rev 2000, 80(2):649-680.
• [18]Kitano T, Kitano N, Inomoto T, Futatsuka M: Evaluation of body composition using dual-energy X-ray absorptiometry, skinfold thickness and bioelectrical impedance analysis in Japanese female college students. J Nutr Sci Vitaminol 2001, 47:122-125.
• [19]Meng-Yueh C, Hsu-Ko K, Ying-Tai W: Sarcopenia, cardiopulmonary fitness, and physical disability in community-dwelling elderly people. Phys Ther 2010, 90(9):1277-1287.
• [20]Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI: Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr 1985, 41:810-817.
• [21]Segal KR, Van Loan M, Fitzgerald PI, et al.: Lean body mass estimation by bioelectrical impedance analysis: a four-site cross-validation study. Am J CIin Nutr 1988, 47:7-14.
• [22]Jackson AS, Pollock ML, Graves JE, Mahar MT: Reliability and validity of bioelectrical impedance in determining body composition. J Appl Physiol 1988, 64:529-534.
• [23]Rychlik E: Album fotografii produktów i potraw. Warszawa: Instytut Żywności i Żywienia; 2000.
• [24]Jarosz M: Normy żywienia dla populacji polskiej — nowelizacja. Warszawa: Instytut Żywności i Żywienia; 2012.
• [25]Ottoson M, Vikman-Adolfson K, Enerback S, Olivecrona G, Bjorntorp P: The effects of cortisol on the regulation of lipoprotein lipase activity in human adipose tissue. J Clin Endocrinol Metabol 1994, 79:820-825.
• [26]Sugawara N, Yasui-Furukori N, Tsuchimine S, Fujii A, Sato Y, Saito M, Kaneko S: Body composition in patients with schizophrenia: Comparison with healthy controls. Annals Of General Psychiatry 2012, 11(1):11-15. BioMed Central Full Text
• [27]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, 114:27-35.
• [28]Zhang ZJ, Yao ZJ, Liu W, et al.: Effects of antipsychotics on fat deposition and changes in leptin and insulin levels. Magnetic resonance imaging study of previously untreated people with schizophrenia. Br J Psychiatry 2004, 184:58-62.
• [29]Swaminathan R: Magnesium metabolism and its disorders. Clin Biochem Rev 2003, 24(2):47-66.
• [30]Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004, 27(5):1047-1053.
• [31]Nadler JL, Buchanan T, Natarajan R, Antonipillai I, Bergman R, Rude R: Magnesium deficiency produces insulin resistance and increased thromboxane synthesis. Hypertension 1993, 21:1024-1029.
• [32]Huang ES, Liu JY, Moffet HH, John PM, Karter AJ: Glycemic control, complications, and death in older diabetic patients the diabetes and aging study. Diabetes Care 2011, 34(6):1329-1336.
• [33]de Boer IH, Katz R, Cao JJ, Fried LF, Kestenbaum B, Mukamal K, et al.: Cystatin C, albuminuria, and mortality among older adults with diabetes. Diabetes Care 2009, 32(10):1833-1838.
• [34]Nielsen FH, Milne DB, Klevay LM, Gallagher S, Johnson L: Dietary magnesium deficiency induces heart rhythm changes, impairs glucose tolerance, and decreases serum cholesterol in postmenopausal women. J Am Coll Nut 2007, 26(2):121-132.
• [35]Barragan-Rodriguez L, Rodriguez-Moran M, Guerrero-Romero F: Depressive symptoms and hypomagnesemia in older diabetic subjects. Arch Med Res 2007, 38(7):752-756.
• [36]Dong JY, Xun P, He K, Qin LQ: Magnesium intake and risk of type 2 diabetes: meta-analysis of prospective cohort studies. Diabetes Care 2011, 34(9):2116-2122.
• [37]Kamanna VS, Kashyap ML: Mechanism of action of niacin on lipoprotein metabolism. Curr Atheroscler Rep 2000, 2:36-46.
• [38]Canner PL, Berge KG, Wenger J, Stamler L, Friedman L, Prineas RJ, Friedewald W: Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. Am Coll Cardiol 1986, 8:1245-1255.
• [39]Brown BG, Zhao XQ, Chait A, Fisher LD, Cheung MC, Morse JS, Dowdy AA, Marino E, Bolson E, Alaupovic PJ, Frohlich J, Albers JJ: Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001, 345:1583-1592.
• [40]Young SN, Gauthier S: Effect of tryptophan administration on tryptophan, 5-hydroxyindoleacetic acid, and indoleacetic acid in human lumbar and cisternal cerebrospinal fluid. J Neurol Neurosurg Psychiatry 1981, 44:323-327.
• [41]Wurtman RJ, Wurtman JJ: Brain serotonin, carbohydrate-craving, obesity and depression. Obes Res 1995, 4:477-480.
• [42]Chen MD, Lin PY, Lin WH, Cheng V: Zinc in hair and serum of obese individuals in Taiwan. Am J Clin Nutr 1988, 48:1307-1309.
• [43]Liuzzi JP, Lichten LA, Rivera S, Blanchard SK, Aydemir TB, Knutson MD, Ganz T, Cousins RJ: Interleukin-6 regulates the zinc transporter Zip14 in liver and contributes to the hypozincemia of the acute-phase response. Proc Natl Acad Sci USA 2005, 102:6843-6848.
• [44]Gariballa , et al.: Oxidative damage and inflammation in obese diabetic Emirati subjects supplemented with antioxidants and B-vitamins: a randomized placebo-controlled trail. Nutr Metab 2013, 10:21. BioMed Central Full Text
• [45]Puchau B, Zulet A, Gonzalez A, Hermsdorff H, Martinez J: Dietary total antioxidant capacity is negatively associated with some metabolic syndrome features in healthy young men. Nutrition 2010, 26:534-541.