Body mass index in adults with intellectual disability: distribution, associations and service implications: a population-based prevalence study

Background Previous studies of weight problems in adults with intellectual disability (ID) have generally been small or selective and given conflicting results. The objectives of our large‐scale study were to identify inequalities in weight problems between adults with ID and the general adult population, and to investigate factors associated with obesity and underweight within the ID population. Methods We undertook a population‐based prevalence study of 1119 adults with ID aged 20 and over on the Leicestershire Learning Disability Register who participated in a programme of universal health checks and home interviews with their carers. We performed a cross‐sectional analysis of the register data and compared the observed and expected prevalences of body mass index categories in the ID and general populations using indirect standardisation for age. We used logistic regression to evaluate the association of a range of probable demographic, physical, mental and skills attributes with obesity and underweight. Results In those aged 25 and over, the standardised morbidity ratio (SMR) for obesity was 0.80 (95% CI 0.64–1.00) in men and 1.48 (95% CI 1.23–1.77) in women. The SMR for underweight was 8.44 (95% CI 6.52–10.82) in men and 2.35 (95% CI 1.72–3.19) in women. Among those aged 20 and over, crude prevalences were 20.7% for obesity, 28.0% for overweight, 32.7% for normal weight and 18.6% for underweight. Obesity was associated with living independently/with family, ability to feed/drink unaided, being female, hypertension, Down syndrome and the absence of cerebral palsy. Underweight was associated with younger age, absence of Down syndrome and not taking medication. Conclusion Obesity in women and underweight in both men and women was more common in adults with ID than in the general population after controlling for differences in the age distributions between the two populations. The associated factors suggest opportunities for targeting high‐risk groups within the ID population for lifestyle and behaviour modification.     

Height, weight and body mass index in early adulthood and risk of schizophrenia

OBJECTIVE: To illuminate the possible associations between height, weight, and body mass index (BMI) during early adulthood and the development of schizophrenia. METHOD: This prospective study is based on an all-male sample of 3210 individuals from the Copenhagen Perinatal Cohort, comprising individuals born between 1959 and 1961. In 1999, cases of schizophrenia were identified in the Danish Psychiatric Central Register, and the cases were compared with the cohort pool of controls with respect to height, weight, and BMI from draft records. The effect of low BMI was adjusted for parental social status when the cohort members were 1 year old, birth weight, birth length, and maternal pre-pregnancy BMI. RESULTS: Forty-five cases of schizophrenia had a lower young adult mean body weight and BMI than controls. A significant inverse relationship between BMI and risk of later schizophrenia was found. For each unit increase in BMI, the adjusted odds ratio was 0.81 (95% CI, 0.70-0.93) and the risk of schizophrenia decreased by 19%. Excluding individuals who had been admitted to an in-patient facility before or within 5 years after appearing before the draft board, yielded virtually the same results. No significant differences between cases and controls were observed with respect to adult height. CONCLUSION: Independent of several possible confounders, an inverse relationship between young adult BMI and risk of later development of schizophrenia was demonstrated in this all-male sample.     

Maintenance antipsychotic medication patterns in outpatient schizophrenia patients: a naturalistic cohort study

OBJECTIVE: Newer antipsychotics are increasingly used in schizophrenia maintenance. The UK change has been slow with little known on switching patterns. We aimed to investigate antipsychotic prescribing patterns in schizophrenia patients. METHOD: A naturalistic six-site cohort sample of 600 patients were interviewed by researchers at 6-monthly intervals for 2 years to record their clinical and social functioning; use of services and medication for the preceding 6 months was obtained by structured extraction from clinical case notes. RESULTS: Alterations in antipsychotic medication were frequent in this group, mainly during periods of inpatient care. Atypical prescribing increased steadily, though slowly, across the period. Polypharmacy was less than anticipated. CONCLUSION: Inpatient care remains the main forum for switching of antipsychotics. The UK maintains a slow shift to atypical antipsychotics.     

Equally increased risk for metabolic syndrome in patients with bipolar disorder and schizophrenia treated with second-generation antipsychotics

Objective: Although second-generation antipsychotics (SGAs) are widely used in treating schizophrenia and bipolar disorder, their effects on dyslipidemia, glucose intolerance, metabolic syndrome (MetS), and coronary heart disease (CHD) risk are less well documented for bipolar disorder. We compared bipolar disorder and schizophrenia patients receiving SGAs to determine whether MetS prevalence is influenced by the primary psychiatric diagnosis or concomitant mood stabilizer treatment. Methods: Admission assessment of MetS criteria (abdominal obesity, fasting hypertriglyceridemia, low high-density lipoprotein cholesterol, hyperglycemia, arterial hypertension) and the calculated 10-year CHD risk in bipolar disorder and schizophrenia patients treated with SGAs and closely matched for age, sex, and race. Results: Compared to schizophrenia patients (n = 111), those with bipolar disorder (n = 74) had lower body mass index (27.1 ± 5.3 versus 29.9 ± 8.1, p = 0.0053), were more likely treated with mood stabilizers (60.8 versus 36.0, p = 0.0009), and less likely treated with clozapine (1.3% versus 15.3%, p = 0.0017) or two antipsychotics (10.8% versus 34.2%, p = 0.0003). Despite these differences, bipolar disorder and schizophrenia patients had comparable rates of MetS (43.2% versus 45.9%, p = 0.71) and predicted CHD events (10-year risk >10%: 18.9% versus 23.4%, p = 0.47). Using ≥100 mg/dL as the adapted glucose criterion, MetS rates were 54.0% in both diagnostic groups (p = 1.0). Mood stabilizer co-treatment was not associated with MetS or its individual criteria. Conclusions: Patients with bipolar disorder and schizophrenia who are treated with SGAs have similarly high rates of MetS. These findings suggest a shared susceptibility to antipsychotic-related metabolic dysregulations that is not primarily related to psychiatric diagnosis or concomitant mood stabilizer treatment.     

High prevalence of obesity in ambulatory children and adolescents with intellectual disability

Background   Obesity prevalence is unusually high among adults with intellectual disability (ID). There is limited and conflicting evidence on obesity prevalence among ambulatory children and adolescents with ID. The present study aimed to estimate obesity prevalence in this group and to compare with population prevalence.
Methods   Survey of nine schools ( n  = 206, 150 boys) for ambulatory children and adolescents with mild-moderate ID in Scotland in 2007. Obesity was defined as measured body mass index (BMI) at or above the 95th percentile relative to UK 1990 reference data, and using the international definition based on BMI. Obesity prevalence observed was compared against Scottish population data on obesity prevalence from the most recent nationally representative survey.
Results   Obesity prevalence (at or above 95th percentile for BMI) was 36%, and was significantly higher among those attending secondary schools compared with primary schools ( P  < 0.01). Prevalence of obesity was significantly higher than in the general paediatric population in both boys and girls ( P  < 0.01).
Conclusions   The present study suggests that that obesity may be very prevalent among ambulatory children and adolescents with ID, and that increased obesity risk may begin in childhood.     

Body mass index, waist circumference, waist-hip ratio and depressive symptoms in Chinese elderly: a population-based study

BACKGROUND: Studies that investigated the relationship between obesity and depressive symptoms in the elderly have generated conflicting findings, partly because of the use of body mass index (BMI) alone to measure obesity in the elderly. The use of BMI fails to account for varying proportions of muscle, fat and bone, and few studies have used other measures of central obesity, such as waist-hip ratio (WHR) and waist circumference (WC). OBJECTIVES: We examined whether individually BMI, WHR and WC were consistently associated with depressive symptoms in the elderly. METHODS: Analysis of cross-sectional data of 2604 community dwelling Chinese elderly aged 55 and above, including socio-emotional characteristics, self-rated health and functional status, anthropometric measurements and Geriatric Depression Scale (15 items, GDS-15). RESULTS: There was a negative trend in the prevalence of depressive symptoms (GDS > or =5) across increasing BMI categories: 16.9% in low BMI, 14.2% in normal weight, 12.1% in moderate to high BMI. The associations for moderate to high BMI (OR, 0.77; p = 0.04) relative to normal BMI, were statistically significant after controlling for confounding variables. However, no consistent trends in the prevalence of depressive symptoms and OR's were observed for increasing WHR and WC categories. CONCLUSION: Our results suggest that waist-hip and circumference measures of central obesity did not support an inverse relationship of obesity and depressive symptoms. An inverse relationship of BMI with depressive symptoms may indicate greater physiologic and functional reserve from greater muscle mass that protects against depressive symptoms.     

Body mass index effect on common nerve conduction study measurements

This study was performed to determine whether there is a difference in nerve conduction study (NCS) measures based on body fat (body mass index; BMI). Two hundred fifty-three subjects had the following NCS tests performed on them: median, ulnar, peroneal, and tibial motor studies; median, ulnar, radial, and sural sensory studies; median and ulnar mixed nerve studies; and H-reflex studies. BMI was calculated as weight (kg) divided by height (m) squared. A repeated measures analysis of variance was run adjusting for age, sex, and height and using BMI as both a continuous variable and by dividing BMI into upper, middle, and lower thirds. The sensory and mixed nerve amplitudes correlated significantly (P ⩽ 0.01) with BMI for all nerves tested, with means being approximatly 20–40% lower in the obese than in the thin subjects. No correlation was noted between BMI and nerve conduction velocity, H-reflex latency, or most of the other motor/sensory/mixed measures. The correlation between increased BMI and lower sensory/mixed nerve amplitudes should be taken into account in clinical practice. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21: 1398–1404, 1998     

Weight development in patients treated with risperidone: a 5-year naturalistic study

OBJECTIVE: To examine annual weight-development in a sample of 215 psychotic patients treated with risperidone over 5 years. METHOD: Naturalistic longitudinal study. RESULTS: The sample was more obese than the general population at baseline, but also increased much more in mean body mass index over approximately the same time period, while patients off medication seemed to remain weight stable. Excessive weight gain (>7%) was experienced by 40.2% and was weakly associated with weight at baseline (beta = -0.2%; P = 0.02), while independent of gender, symptoms, years of illness, prolactin levels and nicotine consumption. In patients with complete weight data (n = 87), approximately 72% (3.4 +/- 8.3 kg) of the observed 5 years weight gain (4.7 +/- 11.6 kg) had been accumulated after 2 years. CONCLUSION: Antipsychotic drug treatment resulted in significant weight gain, which levelled off over time. Unfortunately, few significant predictors of adverse weight development could be identified, leaving little guidance for clinical decision making regarding this specific side-effect.     

Body composition and body mass index in Duchenne muscular dystrophy: Role of dietary intake

Introduction: In Duchenne muscular dystrophy (DMD) muscle is replaced by adipose tissue. The role of dietary intake (DI) in DMD has not been evaluated. In this study we examined body composition, body mass index (BMI), and adequacy of DI in patients with DMD and evaluated the influence of DI on body composition. Methods: Patients (n = 101; age 3–18 years; BMI 11.8–29.5 kg/m²) completed a dietary recall to determine DI and then underwent dual-energy X-ray absorptiometry to determine body composition. Results: Preschool-age and school-age boys with DMD had high total energy intake. Protein intake per kilogram exceeded recommendations. As age increased, the percentage of boys with abnormal BMI and fat mass increased, while lean mass decreased. Dietary intake did not predict body fat or lean mass. Discussion: Age-dependent changes in BD in boys with DMD may be due to endogenous metabolic factors related to the underlying disease process and to disease-related mobility impairments. Muscle Nerve 59 :295–302, 2019     

Body mass index in patients with Multiple Sclerosis: a meta-analysis

ABSTRACT

Background: The impact of nutrition and diet on the etiology of Multiple Sclerosis (MS) has been evaluated through a number of studies. Only a limited number reported findings on the association between body mass index (BMI) and MS. We systematically assessed whether BMI differs between MS patients and healthy individuals.

Methods: The PubMed database was searched for available studies assessing the relationship between BMI and MS until April 2018. Random effects models were applied for evaluating the association of mean BMI between MS, relapsing-remitting MS (RRMS) patients, females, or males with MS, and their respective healthy control groups.

Results: We included 25 studies. The mean BMI of MS patients during the course of the disease and RRMS patients was significantly different from the mean BMI of their healthy counterpart individuals [standardized mean difference (SMD) (95% confidence interval (CI)): ?0.25 (?0.44, ?0.06), P_Z = 0.01 and SMD (95%): ?0.27 (?0.54, ?0.01), P_Z = 0.04, respectively]. The mean BMI of females with MS was significantly differentfrom that of corresponding healthy females [SMD (95% CI): ?0.52 (?0.96, ?0.07), P_Z = 0.02]. Moreover, the mean BMI was significantly different between males with MS and healthy males [SMD (95% CI): ?0.75 (?1.33, ?0.18), P_Z = 0.01].

Conclusions: Statistically significantly lower mean BMI was revealed in the overall MS patients’ group during the MS course than in healthy controls. The same difference was revealed in all parts of the meta-analysis demonstrating a significantly lower BMI in patients with RRMS, in females, and in males with MS, when compared to their respective healthy individuals.     

Topiramate mitigates weight gain in antipsychotic-treated patients with schizophrenia: meta-analysis of randomised controlled trials

Objective: Weight gain is one of the most challenging issues in patients with schizophrenia treated with antipsychotics. Several meta-analyses have been conducted to review the efficacy of topiramate in reducing weight, however, several issues regarding the methodology had arisen of which make the results remain ambiguous.

Methods: We conducted a meta-analysis of randomised controlled trials about the use of topiramate in patients with schizophrenia for weight reduction. Ten double-blinded randomised placebo-controlled trials and seven open-label randomised controlled trials included 905 patients.

Results: Patients treated with topiramate experienced a greater reduction in body weight and BMI. Patients in countries of the lower overweight population showed more significant BMI reduction. Besides, studies from the Middle East and South Asia showed the greatest effect in body weight change, followed by East Asia, then Europe/America. Topiramate group was outperformed control group with significant psychopathology improvement. No difference between two groups regarding the overall side effects.

Conclusions: Topiramate was significantly superior to control group in mitigating weight gain and psychopathology in antipsychotic-treated patients with schizophrenia. The effects of topiramate augmentation need further investigations in larger definitive studies using methodological rigor and thorough assessments.     

Poor maternal care and high maternal body mass index in pregnancy as a risk factor for schizophrenia in offspring

OBJECTIVE: We investigated whether antenatal factors in mothers would increase the risk of schizophrenia in the offspring, and also examined any relationship between these factors and histories of obstetric complications (OCs). METHOD: Using the Mother and Child Health Handbooks of 52 patients with schizophrenia and 284 healthy subjects, we evaluated the risk-increasing effects of the frequency of antenatal care visits and mothers' body mass index (BMI) at both early and late pregnancy. RESULTS: In logistic regression analysis, there was a significant association between the number of antenatal care visits and the risk of the disorder; an increase in a unit of visits corresponds to a reduction of the risk by 12%. We also found a 24% increase in the risk with a one-unit increase of BMI at the early pregnancy, and a 19% increase at the late pregnancy. These antenatal factors were found to contribute, in part, to an excess of OCs in individuals with schizophrenia. CONCLUSION: Poor maternal care during pregnancy and comparatively high maternal BMI especially at early pregnancy may cause a predisposition to schizophrenia in the offspring.     

药源性肥胖患者血清同型半胱氨酸水平研究

目的：了解抗精神病药所致药源性肥胖患者的血清同型半胱氨酸（Hcy）水平及其可能的影响因素。方法：调查60例药源性肥胖住院患者,用酶免疫法测定其血清Hcy水平,用化学发光法测定其血清叶酸、VitB12水平。以28名健康者为对照。结果1患者组血清Hey水平明显高于对照组（P〈0．001）,而血清叶酸、VitB12水平则显著低于对照组（P〈0．001及〈0．005）。单因素相关分析显示其血清Hcy与叶酸、VitB12呈负相关（r＝-0．520,P〈0．01;r：-0．372,P〈0．01）,多元逐步回归示叶酸是影响血清Hcv水平的因子（标准回归系数-0．490,t＝-5．16,P〈0．01）。结论：药源性肥胖患者多存在高同型半胱氨酸血症（HHcy）,其血清Hcy水平主要受叶酸的影响。     

Body mass index and its impact on migraine prevalence and severity in female patients: Preliminary results

Background and purposeA strikingly increasing number of obese patients causes a great interest in potential medical problems resulting from abnormal body weight. Many conditions are associated with obesity. The severity and risk of migraine may be connected with a body weight. We would like to assess a correlation between body mass index (BMI) and frequency and duration of migraine.Materials and methodsWe collected data of 53 female patients with migraine and 36 healthy persons (25 women) as a control group. Mean duration of migraine attacks and their mean frequency were based on patients’ diaries. The patients reported their height. Weight was measured by the authors. We consequently calculated BMI and performed statistics on SAS 9.2.ResultsThe mean BMI of the migraine group was 24.27 ± 4.47. Forty-nine percent of patients had normal BMI (18.5–25), 30% patients were overweight (>25) and 13% were obese (>30). The mean BMI among controls was 22.69 ± 2.96. Eighty-four percent of the control group had normal BMI, 12% was overweight and 5% was obese. An association of BMI in women with frequency of migraine episodes per month occurred remarkable when adjusted for age. Difference of a mean BMI value between the migraine and the control group was nearly statistically significant. Body mass index and duration of the episodes revealed similarly strong correlation.ConclusionsIncreased BMI correlates with frequency of migraine. Its influence on a risk of the headaches and their duration remains to be specified.