Marina Garriga1,2,3,4, Andrea Mallorquí5, Lourdes Serrano5, José Ríos6,7, Manel Salamero5, Eduard Parellada8,9,10,11, Marta Gómez-Ramiro11, Cristina Oliveira11, Silvia Amoretti8,9,10,11, Eduard Vieta12,8,9,10, Miquel Bernardo8,9,10,11, Clemente García-Rizo8,9,10,11. 1. Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Catalonia, Spain. magarriga@clinic.cat. 2. Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. magarriga@clinic.cat. 3. Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain. magarriga@clinic.cat. 4. Department of Medicine, University of Barcelona, Barcelona, Spain. magarriga@clinic.cat. 5. Department of Psychiatry, Institute of Neuroscience, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Catalonia, Spain. 6. Medical Statistics Core Facility, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain. 7. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. 8. Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. 9. Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain. 10. Department of Medicine, University of Barcelona, Barcelona, Spain. 11. Barcelona Clinic Schizophrenia Unit (BCSU), Institute of Neuroscience, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain. 12. Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Catalonia, Spain.
Abstract
BACKGROUND: Antipsychotic-induced weight gain has been especially related to clozapine and olanzapine. Underlying mechanisms in relation to food preferences with an increased food craving and consumption of specific nutrients have not been extensively studied in patients with serious mental illness (SMI). We aim to describe specific food preferences (craving) and subsequent food consumption in SMI patients starting clozapine, as well as their possible relation to weight and body mass index (BMI). METHODS: An observational prospective follow-up study (18 weeks) was conducted in a cohort of 34 SMI patients who started clozapine due to resistant-psychotic symptoms. Anthropometric measures, Food Craving Inventory (FCI), and a food consumption frequency questionnaire were evaluated at baseline, weeks 8 and 18 of treatment. Statistical analysis included generalized estimating equations models with adjustment for potential confounding factors. RESULTS: No longitudinal changes over time were found across the different food craving scores after 18 weeks of treatment. However, adjusted models according to BMI status showed that the normal weight (NW) group presented an increased score for the "complex carbohydrates/proteins" food cravings (- 0.67; 95% CI [- 1.15, - 0.19]; P = 0.010), while baseline scores for "fast-food fats" cravings were significantly higher in the overweight/obese (OWO) group in comparison with NW patients (NW, 2.05; 95% CI [1.60, 2.49]; OWO, 2.81, 95% CI [2.37, 3.25]; P = 0.016). When considering if food craving could predict weight gain, only increments in "fast-food fats" cravings were associated (β = - 5.35 ± 1.67; 95% CI [- 8.64, - 2.06]; P = 0.001). CONCLUSIONS: No longitudinal differences were found for any of the food craving scores evaluated; however, in the NW group, food craving for "complex carbohydrates/proteins" changed. Thus, changes in "fast-food fats" cravings predicted weight increase in this sample. Interventions targeting food preferences may help to mitigate weight gain in patients starting treatment with clozapine.
BACKGROUND: Antipsychotic-induced weight gain has been especially related to clozapine and olanzapine. Underlying mechanisms in relation to food preferences with an increased food craving and consumption of specific nutrients have not been extensively studied in patients with serious mental illness (SMI). We aim to describe specific food preferences (craving) and subsequent food consumption in SMI patients starting clozapine, as well as their possible relation to weight and body mass index (BMI). METHODS: An observational prospective follow-up study (18 weeks) was conducted in a cohort of 34 SMI patients who started clozapine due to resistant-psychotic symptoms. Anthropometric measures, Food Craving Inventory (FCI), and a food consumption frequency questionnaire were evaluated at baseline, weeks 8 and 18 of treatment. Statistical analysis included generalized estimating equations models with adjustment for potential confounding factors. RESULTS: No longitudinal changes over time were found across the different food craving scores after 18 weeks of treatment. However, adjusted models according to BMI status showed that the normal weight (NW) group presented an increased score for the "complex carbohydrates/proteins" food cravings (- 0.67; 95% CI [- 1.15, - 0.19]; P = 0.010), while baseline scores for "fast-food fats" cravings were significantly higher in the overweight/obese (OWO) group in comparison with NW patients (NW, 2.05; 95% CI [1.60, 2.49]; OWO, 2.81, 95% CI [2.37, 3.25]; P = 0.016). When considering if food craving could predict weight gain, only increments in "fast-food fats" cravings were associated (β = - 5.35 ± 1.67; 95% CI [- 8.64, - 2.06]; P = 0.001). CONCLUSIONS: No longitudinal differences were found for any of the food craving scores evaluated; however, in the NW group, food craving for "complex carbohydrates/proteins" changed. Thus, changes in "fast-food fats" cravings predicted weight increase in this sample. Interventions targeting food preferences may help to mitigate weight gain in patients starting treatment with clozapine.
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