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Body composition in psychotic disorders: a general population survey

Published online by Cambridge University Press:  20 August 2008

S. E. Saarni ,
S. I. Saarni ,
M. Fogelholm ,
M. Heliövaara ,
J. Perälä ,
J. Suvisaari  and
J. Lönnqvist
S. E. Saarni*
Affiliation:
National Public Health Institute, Department for Mental Health and Alcohol Research, Mannerheimintie 166, 00300 Helsinki, Finland Department of Public Health, University of Helsinki, University of Helsinki, Helsinki, Finland
S. I. Saarni
Affiliation:
National Public Health Institute, Department for Mental Health and Alcohol Research, Mannerheimintie 166, 00300 Helsinki, Finland
M. Fogelholm
Affiliation:
UKK Institute for Health Promotion Research, Tampere, Finland Research Unit, Pirkanmaa Hospital District, Tampere, Finland
M. Heliövaara
Affiliation:
National Public Health Institute, Department for Mental Health and Alcohol Research, Mannerheimintie 166, 00300 Helsinki, Finland
J. Perälä
Affiliation:
National Public Health Institute, Department for Mental Health and Alcohol Research, Mannerheimintie 166, 00300 Helsinki, Finland
J. Suvisaari
Affiliation:
National Public Health Institute, Department for Mental Health and Alcohol Research, Mannerheimintie 166, 00300 Helsinki, Finland
J. Lönnqvist
Affiliation:
National Public Health Institute, Department for Mental Health and Alcohol Research, Mannerheimintie 166, 00300 Helsinki, Finland Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
*
*Address for correspondence: S. E. Saarni, M.D., B.A., Department of Public Health, PO Box 41, 00014University of Helsinki, Helsinki, Finland. (Email: suoma.saarni@helsinki.fi)
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Abstract

Background

The literature suggests an association between obesity and schizophrenia but fat mass and fat-free mass, which have been shown to be more predictive of all-cause mortality than only waist circumference and obesity [body mass index (BMI) ⩾30 kg/m2], have not been reported in psychotic disorders. We examined the detailed body composition of people with different psychotic disorders in a large population-based sample.

Method

We used a nationally representative sample of 8082 adult Finns aged ⩾30 years with measured anthropometrics (height, weight, waist circumference, fat percentage, fat-free mass and segmental muscle mass). Psychiatric diagnoses were based on a consensus procedure utilizing the Structured Clinical Interview for DSM-IV (SCID)-interview, case-notes and comprehensive register data.

Results

Schizophrenia (including schizo-affective disorder) was associated with obesity [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.5–3.6], abdominal obesity (waist circumference ⩾88 cm for women, ⩾102 cm for men) (OR 2.2, 95% CI 1.3–3.6) and with higher fat percentage (mean difference 3.8%, 95% CI 2.0–5.7%), adjusted for age and gender, than in the remaining sample. The associations between schizophrenia and low fat-free mass and decreased muscle mass on trunk and upper limbs became statistically significant after adjusting for BMI. After further adjusting for current antipsychotic medication, education, diet and smoking, schizophrenia remained associated with obesity (OR 1.9, 95% CI 1.1–3.6) and abdominal obesity (OR 3.8, 95% CI 1.5–9.4). Participants with affective psychoses did not differ from the general population.

Conclusions

Individuals with schizophrenia have metabolically unfavorable body composition, comprising abdominal obesity, high fat percentage and low muscle mass. This leads to increased risk of metabolic and cardiovascular diseases.

Keywords

Abdominal obesitybioimpedancemental disorderobesityschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 5 , May 2009 , pp. 801 - 810
Copyright
Copyright © Cambridge University Press 2008

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References

Ader, M, Kim, SP, Catalano, KJ, Ionut, V, Hucking, K, Richey, JM, Kabir, M, Bergman, RN (2005). Metabolic dysregulation with atypical antipsychotics occurs in the absence of underlying disease: a placebo-controlled study of olanzapine and risperidone in dogs. Diabetes 54, 862–871.CrossRefGoogle ScholarPubMed
Alexandersen, P, Tanko, LB, Bagger, YZ, Jespersen, J, Skouby, SO, Christiansen, C (2006). Associations between aortic calcification and components of body composition in elderly men. Obesity 14, 1571–1578.CrossRefGoogle ScholarPubMed
Allison, DB, Mentore, JL, Heo, M, Chandler, LP, Cappelleri, JC, Infante, MC, Weiden, PJ (1999). Antipsychotic-induced weight gain: a comprehensive research synthesis. American Journal of Psychiatry 156, 1686–1696.CrossRefGoogle ScholarPubMed
Amani, R (2007). Is dietary pattern of schizophrenia patients different from healthy subjects? BMC Psychiatry 2, 15.CrossRefGoogle Scholar
Anonymous (2001). 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). Journal of the American Medical Association 285, 2486–2497.CrossRefGoogle Scholar
Anonymous (2004). Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 27, 596–601.CrossRefGoogle Scholar
Bergman, RN, Ader, M (2005). Atypical antipsychotics and glucose homeostasis. Journal of Clinical Psychiatry 66, 504–514.CrossRefGoogle ScholarPubMed
Bigaard, J, Frederiksen, K, Tjonneland, A, Thomsen, BL, Overvad, K, Heitmann, BL, Sorensen, TI (2005). Waist circumference and body composition in relation to all-cause mortality in middle-aged men and women. International Journal of Obesity 29, 778–784.CrossRefGoogle ScholarPubMed
Bigaard, J, Tjonneland, A, Thomsen, BL, Overvad, K, Heitmann, BL, Sorensen, TI (2003). Waist circumference, BMI, smoking, and mortality in middle-aged men and women. Obesity Research 11, 895–903.CrossRefGoogle ScholarPubMed
Björntorp, P, Rosmond, R (2000). Obesity and cortisol. Nutrition 16, 924–936.CrossRefGoogle ScholarPubMed
Bobes, J, Arango, C, Aranda, P, Carmena, R, Garcia-Garcia, M, Rejas, J (2007). Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: results of the CLAMORS Study. Schizophrenia Research 90, 162–173.CrossRefGoogle ScholarPubMed
Brown, S, Birtwistle, J, Roe, L, Thompson, C (1999). The unhealthy lifestyle of people with schizophrenia. Psychological Medicine 29, 697–701.CrossRefGoogle ScholarPubMed
Cohn, T, Prud'homme, D, Streiner, D, Kameh, H, Remington, G (2004). Characterizing coronary heart disease risk in chronic schizophrenia: high prevalence of the metabolic syndrome. Canadian Journal of Psychiatry 49, 753–760.CrossRefGoogle ScholarPubMed
Correll, CU, Frederickson, AM, Kane, JM, Manu, P (2006). Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs. Journal of Clinical Psychiatry 67, 575–583.CrossRefGoogle ScholarPubMed
De Hert, MA, van Winkel, R, Van Eyck, D, Hanssens, L, Wampers, M, Scheen, A, Peuskens, J (2006). Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophrenia Research 83, 87–93.CrossRefGoogle ScholarPubMed
Dickerson, FB, Brown, CH, Kreyenbuhl, JA, Fang, L, Goldberg, RW, Wohlheiter, K, Dixon, LB (2006). Obesity among individuals with serious mental illness. Acta Psychiatrica Scandinavica 113, 306–313.CrossRefGoogle ScholarPubMed
Fagiolini, A, Frank, E, Scott, JA, Turkin, S, Kupfer, DJ (2005). Metabolic syndrome in bipolar disorder: findings from the Bipolar Disorder Center for Pennsylvanians. Bipolar Disorders 7, 424–430.CrossRefGoogle ScholarPubMed
Flegal, KM, Carroll, MD, Ogden, CL, Johnson, CL (2002). Prevalence and trends in obesity among US adults, 1999–2000. Journal of the American Medical Association 288, 1723–1727.CrossRefGoogle ScholarPubMed
Fogelholm, M, van Marken Lichtenbelt, W (1997). Comparison of body composition methods: a literature analysis. European Journal of Clinical Nutrition 51, 495–503.CrossRefGoogle ScholarPubMed
Goldbacher, EM, Matthews, KA (2007). Are psychological characteristics related to risk of the metabolic syndrome? A review of the literature. Annals of Behavioral Medicine 34, 240–252.CrossRefGoogle ScholarPubMed
Graham, TE, Yang, Q, Bluher, M, Hammarstedt, A, Ciaraldi, TP, Henry, RR, Wason, CJ, Oberbach, A, Jansson, PA, Smith, U, Kahn, BB (2006). Retinol-binding protein 4 and insulin resistance in lean, obese, and diabetic subjects. New England Journal of Medicine 354, 2552–2563.CrossRefGoogle ScholarPubMed
Hägg, S, Lindblom, Y, Mjörndal, T, Adolfsson, R (2006). High prevalence of the metabolic syndrome among a Swedish cohort of patients with schizophrenia. International Clinical Psychopharmacology 21, 93–98.CrossRefGoogle ScholarPubMed
Hakko, H, Komulainen, MT, Koponen, H, Saari, K, Laitinen, J, Jarvelin, MR, Lindeman, S (2006). Are females at special risk of obesity if they become psychotic? The longitudinal Northern Finland 1966 Birth Cohort Study. Schizophrenia Research 84, 15–19.CrossRefGoogle ScholarPubMed
Heilä, H, Haukka, J, Suvisaari, J, Lönnqvist, J (2005). Mortality among patients with schizophrenia and reduced psychiatric hospital care. Psychological Medicine 35, 725–732.CrossRefGoogle ScholarPubMed
Heiskanen, T, Niskanen, L, Lyytikäinen, R, Saarinen, PI, Hintikka, J (2003). Metabolic syndrome in patients with schizophrenia. Journal of Clinical Psychiatry 64, 575–579.CrossRefGoogle ScholarPubMed
Heitmann, BL (1994). Impedance: a valid method in assessment of body composition? European Journal of Clinical Nutrition 48, 228–240.Google ScholarPubMed
Homel, P, Casey, D, Allison, DB (2002). Changes in body mass index for individuals with and without schizophrenia, 1987–1996. Schizophrenia Research 55, 277–284.CrossRefGoogle ScholarPubMed
Joukamaa, M, Heliövaara, M, Knekt, P, Aromaa, A, Raitasalo, R, Lehtinen, V (2001). Mental disorders and cause-specific mortality. British Journal of Psychiatry 179, 498–502.CrossRefGoogle ScholarPubMed
Kato, MM, Currier, MB, Gomez, CM, Hall, L, Gonzalez-Blanco, M (2004). Prevalence of metabolic syndrome in Hispanic and non-Hispanic patients with schizophrenia. Primary Care Companion to the Journal of Clinical Psychiatry 6, 74–77.Google ScholarPubMed
Koskinen, S, Aromaa, A (eds.) (2002). Health and Functional Capacity in Finland. Baseline Results of the Health 2000 Health Examination Survey. National Public Health Institute: Helsinki.Google Scholar
Malavolti, M, Mussi, C, Poli, M, Fantuzzi, AL, Salvioli, G, Battistini, N, Bedogni, G (2003). Cross-calibration of eight-polar bioelectrical impedance analysis versus dual-energy X-ray absorptiometry for the assessment of total and appendicular body composition in healthy subjects aged 21–82 years. Annals of Human Biology 30, 380–391.CrossRefGoogle ScholarPubMed
McElroy, SL, Kotwal, R, Malhotra, S, Nelson, EB, Keck, PE, Nemeroff, CB (2004). Are mood disorders and obesity related? A review for the mental health professional. Journal of Clinical Psychiatry 65, 634–651.CrossRefGoogle ScholarPubMed
McEvoy, JP, Meyer, JM, Goff, DC, Nasrallah, HA, Davis, SM, Sullivan, L, Meltzer, HY, Hsiao, J, Scott, ST, Lieberman, JA (2005). Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia Research 80, 19–32.CrossRefGoogle ScholarPubMed
McGee, DL (2005). Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Annals of Epidemiology 15, 87–97.CrossRefGoogle ScholarPubMed
Mokdad, AH, Marks, JS, Stroup, DF, Gerberding, JL (2004). Actual causes of death in the United States, 2000. Journal of the American Medical Association 291, 1238–1245.CrossRefGoogle ScholarPubMed
Must, A, Spadano, J, Coakley, EH, Field, AE, Colditz, G, Dietz, WH (1999). The disease burden associated with overweight and obesity. Journal of the American Medical Association 282, 1523–1529.CrossRefGoogle ScholarPubMed
Nasrallah, HA, Meyer, JM, Goff, DC, McEvoy, JP, Davis, SM, Stroup, TS, Lieberman, JA (2006). Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophrenia Research 86, 15–22.CrossRefGoogle ScholarPubMed
Nilsson, BM, Forslund, AH, Olsson, RM, Hambraeus, L, Wiesel, FA (2006). Differences in resting energy expenditure and body composition between patients with schizophrenia and healthy controls. Acta Psychiatrica Scandinavica 114, 27–35.CrossRefGoogle ScholarPubMed
Ogden, CL, Carroll, MD, Curtin, LR, McDowell, MA, Tabak, CJ, Flegal, KM (2006). Prevalence of overweight and obesity in the United States, 1999–2004. Journal of the American Medical Association 295, 1549–1555.CrossRefGoogle ScholarPubMed
Osby, U, Brandt, L, Correia, N, Ekbom, A, Sparen, P (2001). Excess mortality in bipolar and unipolar disorder in Sweden. Archives of General Psychiatry 58, 844–850.CrossRefGoogle ScholarPubMed
Pariante, CM, Vassilopoulou, K, Velakoulis, D, Phillips, L, Soulsby, B, Wood, SJ, Brewer, W, Smith, DJ, Dazzan, P, Yung, AR, Zervas, IM, Christodoulou, GN, Murray, R, McGorry, PD, Pantelis, C (2004). Pituitary volume in psychosis. British Journal of Psychiatry 185, 5–10.CrossRefGoogle ScholarPubMed
Perälä, J, Suvisaari, JM, Saarni, SI, Kuoppasalmi, K, Isometsä, E, Pirkola, S, Partonen, T, Tuulio-Henriksson, A, Hintikka, J, Kieseppä, T, Härkänen, T, Koskinen, S, Lönnqvist, J (2007). Lifetime prevalence of psychotic and bipolar I disorders in a general population. Archives of General Psychiatry 64, 19–28.CrossRefGoogle ScholarPubMed
Pirkola, SP, Isometsä, E, Suvisaari, J, Aro, H, Joukamaa, M, Poikolainen, K, Koskinen, S, Aromaa, A, Lönnqvist, JK (2005). DSM-IV mood-, anxiety- and alcohol use disorders and their comorbidity in the Finnish general population – results from the Health 2000 Study. Social Psychiatry and Psychiatric Epidemiology 40, 1–10.CrossRefGoogle ScholarPubMed
Räikkönen, K, Matthews, KA, Kuller, LH (2007). Depressive symptoms and stressful life events predict metabolic syndrome among middle-aged women: a comparison of World Health Organization, Adult Treatment Panel III, and International Diabetes Foundation definitions. Diabetes Care 30, 872–877.CrossRefGoogle ScholarPubMed
Reaven, GM (1988). Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 37, 1595–1607.CrossRefGoogle ScholarPubMed
Roubenoff, R (2003). Sarcopenia: effects on body composition and function. Journals of Gerontology: Biological Sciences and Medical Sciences 58, 1012–1017.Google ScholarPubMed
Ryan, MC, Collins, P, Thakore, JH (2003). Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia. American Journal of Psychiatry 160, 284–289.CrossRefGoogle ScholarPubMed
Saari, KM, Lindeman, SM, Viilo, KM, Isohanni, MK, Jarvelin, MR, Lauren, LH, Savolainen, MJ, Koponen, HJ (2005). A 4-fold risk of metabolic syndrome in patients with schizophrenia: the Northern Finland 1966 Birth Cohort study. Journal of Clinical Psychiatry 66, 559–563.CrossRefGoogle ScholarPubMed
Salmi, JA (2003). Body composition assessment with segmental multifrequency bioimpedance method. Journal of Sports Science and Medicine 2 (Suppl. 3), 1–29.Google Scholar
Salmi, JA, Pekkarinen, H (2004). Segmental assessments of fat-free mass by bioimpedance in relation to DXA. International Journal of Obesity and Related Metabolic Disorders 28, 127.Google Scholar
Samele, C, Patel, M, Boydell, J, Leese, M, Wessely, S, Murray, R (2007). Physical illness and lifestyle risk factors in people with their first presentation of psychosis. Social Psychiatry and Psychiatric Epidemiology 42, 117–124.CrossRefGoogle ScholarPubMed
Sartorio, A, Malavolti, M, Agosti, F, Marinone, PG, Caiti, O, Battistini, N, Bedogni, G (2005). Body water distribution in severe obesity and its assessment from eight-polar bioelectrical impedance analysis. European Journal of Clinical Nutrition 59, 155–160.CrossRefGoogle ScholarPubMed
Satoh, M, Sakuda, H, Kobayashi, T, Kataoka, T, Nakao, F, Turale, S (2007). Comparison of the body fluid levels in healthy individuals and those with schizophrenia in Japan: using the bioelectrical impedance method. Nursing and Health Science 9, 177–184.CrossRefGoogle ScholarPubMed
Susce, MT, Villanueva, N, Diaz, FJ, de Leon, J (2005). Obesity and associated complications in patients with severe mental illnesses: a cross-sectional survey. Journal of Clinical Psychiatry 66, 167–173.CrossRefGoogle ScholarPubMed
Suvisaari, JM, Perälä, J, Saarni, SI, Härkänen, T, Pirkola, S, Joukamaa, M, Koskinen, S, Lönnqvist, J, Reunanen, A (2008). Type 2 diabetes among persons with schizophrenia and other psychotic disorders in a general population survey. European Archives of Psychiatry and Clinical Neuroscience 258, 129–136.CrossRefGoogle Scholar
Suvisaari, JM, Saarni, SI, Perälä, J, Suvisaari, JVJ, Härkönen, T, Lönnqvist, J, Reunanen, A (2007). Metabolic syndrome among persons with schizophrenia and other psychotic disorders in a general population survey. Journal of Clinical Psychiatry 66, 1045–1055.CrossRefGoogle Scholar
Thakore, JH (2004). Metabolic disturbance in first-episode schizophrenia. British Journal of Psychiatry 47 (Suppl.), S76–S79.CrossRefGoogle ScholarPubMed
Thakore, JH, Mann, JN, Vlahos, I, Martin, A, Reznek, R (2002). Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia. International Journal of Obesity and Related Metabolic Disorders 26, 137–141.CrossRefGoogle ScholarPubMed
Visscher, TL, Seidell, JC (2001). The public health impact of obesity. Annual Review of Public Health 22, 355–375.CrossRefGoogle ScholarPubMed