Saarni S E, Saarni S I, Fogelholm M, Heliövaara M, Perälä J, Suvisaari J, Lönnqvist J
National Public Health Institute, Department for Mental Health and Alcohol Research, Mannerheimintie 166, 00300 Helsinki, Finland.
Psychol Med. 2009 May;39(5):801-10. doi: 10.1017/S0033291708004194. Epub 2008 Aug 20.
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.
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.
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.
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.
文献表明肥胖与精神分裂症之间存在关联，但脂肪量和去脂体重比仅腰围和肥胖（体重指数[BMI]≥30kg/m²）更能预测全因死亡率，而在精神障碍患者中尚未有关于这两者的报道。我们在一个基于大规模人群的样本中研究了不同精神障碍患者的详细身体组成情况。
我们使用了一个具有全国代表性的样本，其中包括8082名30岁的芬兰成年人，测量了他们的人体测量学指标（身高、体重、腰围、脂肪百分比、去脂体重和节段性肌肉量）。精神疾病诊断基于采用《精神疾病诊断与统计手册》第四版（DSM-IV）的结构化临床访谈（SCID）、病例记录和综合登记数据的共识程序。
精神分裂症（包括精神分裂情感性障碍）与肥胖相关（比值比[OR]2.3，95%置信区间[CI]1.5 - 3.6）、腹部肥胖（女性腰围≥88cm，男性腰围≥102cm）（OR 2.2，95% CI 1.3 - 3.6），且在调整年龄和性别后，与较高的脂肪百分比相关（平均差异3.8%，95% CI 2.0 - 5.7%），高于其余样本。在调整BMI后，精神分裂症与低去脂体重以及躯干和上肢肌肉量减少之间的关联具有统计学意义。在进一步调整当前抗精神病药物治疗、教育程度、饮食和吸烟因素后，精神分裂症仍与肥胖（OR 1.9，95% CI 1.1 - 3.6）和腹部肥胖（OR 3.8，95% CI 1.5 - 9.4）相关。患有情感性精神病的参与者与一般人群无差异。
精神分裂症患者具有代谢不利的身体组成，包括腹部肥胖、高脂肪百分比和低肌肉量。这导致代谢和心血管疾病风险增加。
