Severe mental illness is marked by an average 20-year lower life expectancy due to cardiometabolic disease. Poor diet is one key – and modifiable – risk factor in this.
Standard treatment for psychotic illness includes long-term antipsychotic medications, but these medications can lead to rapid weight gain particularly during the first 12 weeks.
The average increase during this period is 8 kg, climbing to 12 kg over the first two years and 18 kg over the first four years of treatment.
Prevelance of obesity and being overweight is far higher in this vulnerable population as a result and rates of diabetes and hypercholesterolaemia are twice and five times higher, respectively, than in the general population.
This group is also more likely to eat energy-dense, highly processed, high-salt diets, have higher rates of smoking and substance use and exercise less.
In 2013 leaders of the UK's National Health Service (NHS) called for action on this so-called mortality gap. According to the national newspaper the Guardian, Martin McShane, director for patients with long-term conditions, said: "The 'mortality gap' we see today is shocking. It is not acceptable people with mental health conditions die younger. For too long, physical and mental health problems have been treated separately and people do not get the services they need every time … We must act to ensure mental health is on a par with physical health."
The researchers behind the study published in the British Journal of Nutrition said nutrition interventions early on in young people with first-episode psychosis just after starting antipsychotic medication could help close this gap.
Feasible and effective
They said such early intervention was “feasible, acceptable and effective” in young people aged 15–25, and delivered far greater returns on clinician efforts compared to the current practice of addressing poor metabolic health at a later stage.
“The integration of dietetic services into community early psychosis programmes is feasible and acceptable to youth with FEP [first-episode psychosis] with high attendance rates over a short-term period of 12 weeks,” they wrote.
Two-thirds of the participants completed the 12-week nutrition intervention.
While five people stopped because they were unable to be contacted, three discontinued treatment with the mental healthcare service, one was re-admitted to inpatient care and one was incarcerated during the intervention period.
The researchers said these rates were promising given this group was typically difficult to engage.
“The results of the intensive 12-week intervention suggest that overall intake of food in this target group can be improved, with poor-quality, energy-dense, discretionary foods replaced by core foods such as vegetables. The reduction in energy intake provides a means to attenuate antipsychotic-induced weight gain.”
The 12-week intervention saw a 47% reduction in discretionary food intake, and 24% reduction in daily energy and 26% reduction in sodium intakes.
The study was conducted by researchers at the Bondi Community Centre, University of New South Wales, Ingham Institute of Applied Medical Research, University of Technology Sydney, St Vincent’s Hospital and Garvan Institute of Medical Research in Australia.
Source: British Journal of Nutrition
Published online ahead of print, doi:10.1017/S0007114516001033
“A nutrition intervention is effective in improving dietary components linked to cardiometabolic risk in youth with first-episode psychosis”
Authors: S. B. Teasdale, P. B. Ward, S. Rosenbaum, A. Watkins, J. Curtis, M. Kalucy and K. Samaras