Dietary Intake in Body Mass Index Differences in Community-Based Japanese Patients with Schizophrenia.

IntroductionAn increase in overweight and obesity is an important problem to be addressed in public health. In particular, patients with schizophrenia are well known to be prone to be overweight (1-3). Conventional and atypical antipsychotics are associated with weight gain (4). Obesity and being overweight increase the risks of dyslipidemia, hypertension, cardiovascular disease, insulin-resistant diabetes, and type 2 diabetes mellitus (5, 6). Furthermore, the psychological effect of obesity in patients with schizophrenia have been suggested, particularly its association with depressive symptoms (7). Previous studies have indicated that one of the causes of obesity in patients with schizophrenia is a poor choice of diet. According to surveys in the U.K., patients with schizophrenia showed a higher fat intake and lower intakes of fiber and vitamins than the general population and reference population (8, 9). In a survey in Iran, patients with schizophrenia showed higher intakes of hydrogenated fats, full-fat cream, and carbonated drinks than individuals without mental disorder (10). It has been reported that patients with schizophrenia are likely to die early due to cardiovascular disease, which may be related to the low intake of fruit and vegetables (11). These findings suggest that a poor dietary intake has a major effect on obesity and physical health in patients with schizophrenia.Obesity and overweight are generally known to result from nutritional excess and decreased physical activities, and the body mass index (BMI) is mainly used as an indicator of overweight and obesity. In a nutrition survey in the general population, the BMI closely related with the dietary intake and individuals with protein, fat, carbohydrate and fiber (12). Therefore, even in patients with schizophrenia, the intake of individual nutrient may differ depending on their BMIs. In previous nutrition surveys in patients with schizophrenia, differences in gender and races and comparison with the general population have been mainly studied, (10, 11, 13) and no surveys have clarified or discussed the characteristics of their dietary intake focusing on the BMI.In this study, we investigated the characteristics of the dietary intake in patients with schizophrenia in Japan, comparing them between BMI strata. There is shortage of nutrition surveys in Japan where patients with schizophrenia. This study aimed to obtain helpful suggestions for supporting their dietary life from the comparison between patients with schizophrenia and the general population.Materials and MethodsStudy Area and SubjectsSubjects were chosen diagnosed with schizophrenia by psychiatrists and correspond to criteria from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). It was a cross-sectional study carried out from October to December 2011. This survey was conducted at the hospital daycare and workshops in Aomori, Japan. Subjects of age 20 years and above who had Schizophrenia of at least one year living in the community were included in the study. We obtained informed consent before the survey from 60 community-based Japanese patients with schizophrenia who received the explanation about the survey verbally and in writing before consent. Among them, 51 subjects (25 men and 26 women) for whom there were no flaws in the questionnaire and photography for the nutrition survey were i ncl ud ed in the analysis. T h i s study w as ap pr oved by the Ethical Review Board of Aomori University of Health and Welfare before implementation (Approval No. 08078).Data CollectionA self-completed questionnaire was distributed to each subject. Demographic variables collected were age, gender, age of onset, and anthropometric indices including BMI, height, and weight. Height was assessed using a handle-type height meter. With shoes removed (in socks), back and buttocks were measured standing upright with the heel touching the pillars of the height gauge. …