İNCİ TÜRKOĞLU, Emine YILDIZ, Seyit M. MERCANLIGİL

Şizofreni Hastalarında Metabolik Profil ve Diyet Örüntüsü

Şizofreni, düşünce, algı, duygu ve davranışları etkileyen ve bireyin işlevlerinde önemli bozulmaya neden olan kronik bir hastalıktır. Şizofreni hastalarının sağ kalım sürelerinin genel nüfusa göre daha kısa olmasında Metabolik Sendrom (MetS) rol oynamaktadır. Ülkemizde ve dünyada şizofreni hastalarındaki MetS yaygınlığı giderek artmaktadır. Şizofrenide MetS'un etiyolojisi birçok etmenden etkilenir. Bu etkiler antipsikotik tedavi, artmış stres düzeyleri ve yetersiz beslenme gibi sağlıksız yaşam biçimlerini içerebilir. Bu derlemede, şizofreni hastalarının metabolik profil ve bunu etkileyen etmenler ile beslenme durumları arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Şizofreni hastaları artmış doymuş yağ asiti alımı, azalmış posa ve meyve alımı ile karakterize yetersiz ve dengesiz bir diyet tüketmektedirler. Bu durum hastalarda metabolik bozuklukların gelişme riskini arttırmaktadır. Şizofreni hastalarının zayıf beslenme şekli, çoğunlukla doymuş yağ asidi alımının yüksek olması, lif ve meyve tüketiminin düşük olması ile karakterizedir. Böyle bir diyetin metabolik anormallikler geliştirme riski daha yüksektir. Şizofrenide yetersiz beslenmenin olası nedenleri konusunda veriler az sayıdadır ve tutarsızdır. Şizofreni hastalarının beslenme durumu ve besin tüketiminin araştırılması, yetersiz diyet örüntüsünün altında yatan unsurların belirlenmesi, şizofreni hastalarında metabolik anormaliteleri kontrol altına almada en önemli hedeftir. Sonuç olarak şizofreni hastalarında metabolik bozuklukları kontrol altına alabilmek için beslenme durumunun, besin tüketiminin ve yetersiz diyet örüntüsüne sebep olan etmenlerin saptanması ve bu doğrultuda beslenme müdahalelerinin geliştirilmesi gereklidir

Metabolic Profile and Dietary Pattern of Patients with Schizophrenia

Schizophrenia is a chronic disease that affects thoughts, perceptions, emotions and behaviors, and causes significant deterioration in the functioning of the individual. Metabolic syndrome (MetS) plays a role in decreased survival rate of schizophrenia patients when compared to the general population. The prevalence of MetS in schizophrenia patients increases in Turkey and the world. The metabolic syndrome aetiology is multi-factorial in schizophrenia patients. These factors may involve antipsychotic treatment, high levels of stress and unhealthy lifestyle, such as poor diet. The aims of this review are to clarify metabolic profile, the factors that effect it and relationship between these factors and nutritional status of schizophrenia patients. Patients with schizophrenia have a poor diet, mainly characterized by a high intake of saturated fat and a low consumption of fibre and fruit. Such diet is more likely to increase the risk to develop metabolic abnormalities. Data about possible causes of poor diet in schizophrenia are still few and inconsistent. In conclusion, to control metabolic abnormalities in schizophrenia patients, the assessment of nutritional status and food consumption and determination of underlying factors that cause inadequate dietary pattern and the development of nutritional intervention for this direction is essential

PDF

___

1. Buchanan RW, Carpenter WT. Schizophrenia and other psychotic disorders. In: Sadock BJ, Sadock VA editors. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. Eight Ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 1329-1558.
2. McGrath JJ, Susser ES. New directions in the epidemiology of schizophrenia. Med J Aust 2009;190(4 Suppl):7-9.
3. World Health Organization. Schizophrenia and Public Health. Available at: 15 Haziran http://www.who.int/ mental_health/media/en/55.pdf Accessed June 15, 2017.
4. Ruschena D, Mullen PE, Burgess P, Cordner SM, Barry-Walsh J, Drummer OH, et al. Sudden death in psychiatric patients. Br J Psychiatry 1998;172:331-336.
5. Auquier P, Lançon C, Rouillon F, Lader M. Mortality in schizophrenia. Pharmacoepidemiol Drug Saf 2007;16(12):1308-1312.
6. Ertuğrul A. Şizofreninin Etiyolojisi. Türkiye Klinikleri J Int Med Sci 2005;1(12):6-14.
7. Mc Guffin P, Owen MJ, Farmer AE. Genetic basis of schizophrenia. Lancet 1995;346:678-682.
8. Keshavan MS, Tandon R, Boutros N, Nasrallah HA. Schizophrenia,“just the facts”. What we know in 2008. Part 3: Pathophysiology. Schizophr Res 2008;106:89- 107.
9. Amerikan Psikiyatri Birliği, DSM-5 Tanı Ölçütleri Başvuru El Kitabı. (E. Köroğlu, Çev.) HYB Yayıncılık, İstanbul, 2013.
10. Yağcıoğlu EA. Antipsikotik İlaçların Etki Mekanizmaları: Şizofreni Tedavisinde “Atipiklik” Bir Üstünlük mü?” Türk Psikiyatri Dergisi 2007;18(4):364- 374.
11. Jibson, MD, Tandon R. New atypical antipsychotic medications. J Psychiatr Res 1998;32(3-4):215-228.
12. Green AI, Patel JK, Goisman, RM, Allison DB, Blackburn G. Weight gain from novel antipsychotic drugs: need for action. Gen Hosp Psychiatry 2000;22:224-235.
13. Baptista T, Hernandez L, Hoebel BG. Systemic sulpiride increases dopamine metabolites in the lateral hypothalamus. Pharmacol Biochem Behav 1990;37(2):227-229.
14. Fadel J, Bubser M, Deutch AY. Differential activation of orexin neurons by antipsychotic drugs associated with weight gain. J Neurosci 2002;22(15):6742-6746.
15. Wirshing DA, Wirshing WC, Kysar L, Berisford MA, Goldstein D, Pashdag J, et al. Novel antipsychotics: comparison of weight gain liabilities. J Clin Psychiatry 1999;60:358-363.
16. Ryan MC, Collins P, Thakore JH. Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia. Am J Psychiatry 2003;160:284- 289.
17. Chintoh AF, Mann SW, Lam L, Giacca A, Fletcher P, Nobrega J, et al. Insulin resistance and secretion in vivo: Effects of different antipsychotics in an animal model. Schizophr Res 2009;108:127-133.
18. Casey DE, Zorn SH. The pharmacology of weight gain with antipsychotics. J Clin Psychiatry 2001;62(Suppl7):4-10.
19. Gilles M, Wilke A, Kopf D, Nonell A, Lehner H, Deuschle M. Antagonism of the serotonin (5-HT)-2 receptor and insulin sensitivity: implications for atypical antipsychotics. Psychosom Med 2005;67:748-751.
20. Baker GF, Rogers, HJ. Effects of psychotropic drugs on the erythrocyte permeability to glucose and ethylidene glucose. Biochem Pharmacol 1972;21:1871-1878.
21. Dwyer DS, Pinkofsky HB, Liu Y, Bradley RJ. Antipsychotic drugs affect glucose uptake and the expression of glucose transporters in PC12 cells. Prog Neuropsychopharmacol Biol Psychiatry 1999;23:69- 80.
22. Melkersson KI, Dahl M. 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;170:157-166.
23. Hennekens CH, Hennekens AR, Hollar D, Casey DE. Schizophrenia and increased risks of cardiovascular disease. Am Heart J 2005;150:1115-1121.
24. Woo YS, Kim W, Chae CH, Yoon BH, Bahk W. Blood pressure changes during clozapine or olanzapine treatment in Korean schizophrenic patients. World J Biol Psychiatry 2009;10(4):420-425.
25. Reaven GM. Banting lecture: Role of insulin resistance in human disease. Diabetes 1988;37:1595-1607.
26. Ervin, R.B. Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003- 2006. National Health Statistical Report 2009;5(13):1- 7.
27. Kozan O, Oguz A, Abaci A, Erol C, Ongen Z, Temizhan A, et al. Prevalence of the metabolic syndrome among Turkish adults. Eur J Clin Nutr 2007;61(4):548-553.
28. Newcomer JW, Hennekens CH. Severe mental illness and risk of cardiovascular disease. JAMA 2007;298:1794-1796.
29. McEvoy JP, Meyer JM, Goff DC, Nasrallah HA, Davis SM, Sullivan L, et al. 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. Schizophr Res 2005;80(1):19-32.
30. De Hert M, Mauri M, Shaw K, Wetterling T, Doble A, Giudicelli A, et al. The METEOR study of diabetes and other metabolic disorders in patients with schizophrenia treated with antipsychotic drugs. I. Methodology. Int J Methods Psychiatr Res 2010;19(4):195-210.
31. Öyekcin DG. The frequency of metabolic syndrome in patients with schizophrenia and schizoaffective disorder. Anadolu Psikiyatri Derg 2009;10:26-33.
32. Kaya MC, Virit O, Altindag A, Selek S, Bulbul F, Bulut M, et al. Prevalence of metabolic syndrome, characteristics of metabolic syndrome and relationship with the antipsychotics used in schizophrenia. Noropsikiyatri Ars 2009;46:13-18.
33. Yazıcı MK, Anıl Yağcıoğlu AE, Ertuğrul A, Eni N, Karahan S, Karaağaoğlu E, et al. The prevalence and clinical correlates of metabolic syndrome in patients with schizophrenia: findings from a cohort in Turkey. Eur Arch Psychiatry Clin Neurosci 2011;261(1):69-78.
34. De Hert M, Schreurs V, Vancampfort D, Winkel RV. Metabolic syndrome in people with schizophrenia: a review. World Psychiatry 2009;8:15-22.
35. Barnett AH, Mackin P, Chaudhry I, Farooqi A, Gadsby R, Heald A, et al. Minimising metabolic and cardiovascular risk in schizophrenia: diabetes, obesity and dyslipidemia. J Psychopharmacol 2007;21(4):357- 373.
36. Bermudes RA, Keck PE.Jr, Welge JA. The prevalence of the metabolic syndrome in psychiatric inpatients with primary psychotic and mood disorders. Psychosomatics 2006;47(6):491-497.
37. Saddichha S, Manjunatha N, Ameen S, Akhtar S. Metabolic syndrome in first episode schizophrenia. A randomized double-blind controlled, short-term prospective study. Schizophr Res 2008;101:266-272.
38. Stahl SM, Mignon L, Meyer JM. Which comes first: atypical antipsychotic treatment or cardiometabolic risk? Acta Psychiatr Scand 2009;119(3):171-179.
39. Brown S, Birtwistle J, Roe L, Thompson C. The unhealthy lifestyle of people with schizophrenia. Psychol Med 1999;29(3):697-701.
40. Fusar-Poli P, De Marco L, Cavallin F, Bertorello A, Nicolasi M, Politi P. Lifestyles and cardiovascular risk in individuals with functional psychoses. Perspect Psychiatr Care 2009:45(2):87-99.
41. Wallace B, Tennant C. Nutrition and obesity in the chronic mentally ill. Aust N Z J Psychiatry 1998;32(1):82-85.
42. Henderson DC, Borba CP, Daley TB, Boxill R, Nguyen DD, Culhane MA, et al. Dietary intake profile of patients with schizophrenia. Ann Clin Psychiatry 2006;18(2):99-105.
43. Osborn DP, Nazareth I, King MB. Physical activity, dietary habits and Coronary Heart Disease risk factor knowledge amongst people with severe mental illness: a cross sectional comparative study in primary care. Soc Psychiatry Psychiatr Epidemiol 2007;42(10):787-793.
44. Henderson DC, Sharma B, Fan X, Copeland PM, Borba CP, Freudenreich O, et al. Dietary saturated fat intake and glucose metabolism impairments in nondiabetic, nonobese patients with schizophrenia on clozapine or risperidone. Ann Clin Psychiatry 2010;22(1):33-42.
45. McCreadie R, Macdonald E, Blacklock C, TilakSingh D, Wiles D, Halliday J, et al. Dietary intake of schizophrenic patients in Nithsdale, Scotland: casecontrol study. BMJ 1998;317(7161):784-785.
46. McCreadie RG. Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study. Br J Psychiatry 2003;183:534-539.
47. Amani R. Is dietary pattern of schizophrenia patients different from healthy subjects? BMC Psychiatry 2007;7:15.
48. Strassnig M, Brar JS, Ganguli R. Nutritional assessment of patients with schizophrenia: a preliminary study. Schizophr Bull 2003;29:393-397.
49. 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. Compr Psychiatry 2012;53(7):1028-1033.
50. Ito H, Kumagai T, Kimura M, Koike S, Shimizu T. Dietary intake in body mass index differences in community-based Japanese patients with schizophrenia. Iran J Public Health 2015;44(5):639-645.
51. Nunes D, Eskinazi B, Camboim Rockett F, Delgado VB, Schweigert Perry ID. Nutritional status, food intake and cardiovascular disease risk in individuals with schizophrenia in southern Brazil: a case-control study. Rev Psiquiatr Salud Ment 2014;7(2):72-79.
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):268-276.
53. Bobes J, Arango C, Garcia-Garcia M, Rejas J. Healthy lifestyle habits and 10-year cardiovascular risk in schizophrenia spectrum disorders: an analysis of the impact of smoking tobacco in the CLAMORS schizophrenia cohort. Schizophr Res 2010;119(1- 3):101-109.
54. Gothelf D, Falk B, Singer P, Kairi M, Phillip M, Zigel L, et al. Weight gain associated with increased food intake and low habitual activity levels in male adolescent schizophrenic inpatients treated with olanzapine. Am J Psychiatry 2002;159(6):1055-1057.
55. Henderson DC, Cagliero E, Copeland PM, Borba CP, Evins E, Hayden D, et al. Glucose metabolism in patients with schizophrenia treated with atypical antipsychotic agents: a frequently sampled intravenous glucose tolerance test and minimal model analysis. Arch Gen Psychiatry 2005;62(1):19-28.
56. Ellingrod VL, Taylor SF, Brook RD, Evans SJ, Zollner SK, Grove TB, et al. Dietary, lifestyle and pharmacogenetic factors associated with arteriole endothelialdependent vasodilatation in schizophrenia patients treated with atypical antipsychotics (AAPs). Schizophr Res 2011;130(1-3):20-26.
57. Arango C, Bobes J, Aranda P, Carmena R, GarciaGarcia M, Rejas JA comparison of schizophrenia outpatients treated with antipsychotics with and without metabolic syndrome: findings from the CLAMORS study. Schizophr Res 2008;104(1-3):1-12