The move to community care means that most schizophrenic patients now live outside hospital. Patients in the community are supported in various ways—for example, through drugs and nursing support. However, schizophrenic patients die early, especially from cardiovascular disease, which is promoted by an inappropriate diet.1 Are schizophrenic patients making faulty dietary choices?
Subjects, methods, and results
The study took place in Nithsdale, south west Scotland. It focused on schizophrenic patients living in accommodation provided by the Dumfries and Galloway Mental Health Association. Their position in the community had been assessed by social services as sufficiently precarious for them to need additional support. The residents, however, are encouraged to be responsible for their own domestic chores, including shopping and cooking. Each patient was matched with a normal control for sex, age, smoking status (smoker v non-smoker), and employment status—variables that affect a person’s diet. All patients were unemployed.
Patients and controls were interviewed by a psychiatrist. The current average weekly food intake was obtained through a modified version of an established food frequency questionnaire.2 Also recorded were patients’ and controls’ height and weight. Patients’ mental state was examined using the positive and negative syndrome scale for schizophrenia. A blood sample was taken to measure serum concentrations of cholesterol and vitamin E.3
We studied 30 patients (17 men; mean age 44 (SD 15, range 20-79) years). Twenty three patients smoked. More patients (20) than controls (11) were overweight or obese, as assessed by body mass index (weight (kg)/(height(m)2)); McNemar’s test, χ2=4.27; P=0.04). The patients consumed significantly less energy, total fibre, retinol, carotene, vitamin C, vitamin E, and alcohol (table). In all, 83% of the patients consumed less fibre, 71% of the male and 69% of the female patients consumed less vitamin E, and 70% of the patients and 73% of the controls consumed more energy from saturated fats than the suggested UK estimated average requirements (the amounts that any stated group of people will, on average, need).4 The patients, when compared with the controls, consumed fewer fruit portions (median weekly intake 2.3 (range 0-20) v 7.0 (range 0-33); Wilcoxon matched pairs signed rank test, median difference 3.5 (95% confidence interval 0.5 to 7.5); P=0.03) and vegetable portions (10.0 (1-23) v 19.0 (4-34); 8.5 (4.0 to 12.0); P=0.001).
Fewer patients than controls (8 v 18; McNemar’s test, χ2=6.7; P=0.01) had a ratio of serum vitamin E concentration to cholesterol concentration of over 5 (said to be necessary to protect against cardiovascular disease).
Where dietary measurements in the patients differed significantly from those in the controls, correlations between these measurements and scores in the positive, negative, and total symptom scales were measured. In female patients, a positive correlation was found between positive symptoms and alcohol intake (rho=0.75, P=0.006).
Comment
Most patients smoked and were overweight or obese; their intake of saturated fat was higher than recommended; and antioxidant intake and ratios of serum vitamin E concentration to cholesterol concentration were low. These factors are associated with cardiovascular disease.1 Patients on average consumed only 12 fruit and vegetable portions a week; the recommended intake is five portions a day.5
There was an association in female patients between mental state and alcohol intake. This association may have arisen by chance as, in all, 36 correlations were calculated. Also, association does not imply causality. Does a high alcohol intake worsen the mental state? Or does a disturbed mental state lead women to drink more?
We conclude that the schizophrenic patients we studied are making poor dietary choices. Assertive programmes to improve diet are necessary.
Table.
Daily median (range) intake of various substances and estimated average requirements
| Intake/day | Men
|
Women
|
All
|
Wilcoxon signed ranks test
|
Estimated average requirements
|
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Patients (n=17) | Controls (n=17) | Patients (n=13) | Controls (n=13) | Patients (n=30) | Controls (n=30) | Median difference (95% CI) | P | Men | Women | |||||
| Energy (MJ) | 11.84 (7.67-17.93) | 14.19 (6.94-23.22) | 8.87 (5.07-13.02) | 9.99 (5.25-16.25) | 9.71 (5.07-17.94) | 11.98 (5.25-23.22) | 2.06 (0.26-4.23) | 0.04 | 9.40*† | 8.11*† | ||||
| Protein (g) | 92.5 (65.1-157.4) | 114.2 (74-633) | 68.7 (38.4-104.2) | 82.5 (40.5-142.2) | 84.5 (38.4-157.4) | 96.0 (40.5-633.0) | 15.9 (−1.1 to 32.8) | 0.07 | 44.4‡ | 36.0‡ | ||||
| Total fibre (g) | 13.0 (8.5-20.8) | 22.0 (8.7-86.2) | 10.7 (7.3-18.0) | 15.5 (10.7-22.9) | 12.6 (7.3-20.8) | 18.9 (8.7-86.2) | 7.0 (3.6 to 10.6) | 0.0001 | 18‡ | 18‡ | ||||
| Retinol (μg) | 647 (294-1498) | 817 (134-12 341) | 533 (288-7556) | 817 (201-11 585) | 590 (288-7556) | 817 (134-12 341) | 310 (93 to 1269) | 0.02 | 500§ | 400§ | ||||
| Carotene (μg) | 783 (219-3638) | 2510 (523-11 313) | 2048 (550-4657) | 3079 (956-6188) | 1443 (219-4657) | 2798 (523-11 313) | 1376 (549 to 2452) | 0.004 | — | — | ||||
| Vitamin C (mg) | 41.0 (4.0-204) | 81.0 (14.0-262) | 40.0 (3-165) | 61.0 (27.0-291.0) | 40.5 (3.0-204) | 80.5 (14.0-219) | 33.5 (2.0 to 64.0) | 0.03 | 25§ | 25§ | ||||
| Vitamin E (mg) | 4.8 (3.4-18.0) | 10.26 (2.23-32.0) | 4.5 (2.3-6.0) | 5.38 (3.6-14.7) | 4.7 (2.3-18.0) | 7.8 (2.2-32.0) | 2.9 (1.45 to 5.35) | 0.0002 | 7† | 5† | ||||
| Alcohol (g) | 3.8 (0-19.4) | 11.7 (0-80) | 0 (0-5.6) | 1.8 (0-12) | 0 (0-19.4) | 5.7 (0-80) | 5.4 (1.2 to 9.9) | 0.009 | — | — | ||||
Based on values in kilocalories (men 2250, women 1940). †Age 19-49 years. ‡Adults. §Age ⩾15.
Acknowledgments
We thank the patients and staff of the Dumfries and Galloway Mental Health Association and the control subjects for their cooperation; Joan Brown, area dietician, for advice on dietary assessment and provision of training; Heather Barrington for statistical advice; and Mary Muirhead for secretarial help.
Footnotes
Funding: None.
Conflict of interest: None.
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