The effect of lifestyle intervention on cardiometabolic risk factors in mental health rehabilitation hostel residents at-risk: a cluster-randomized controlled 15-month trial.

OBJECTIVE: Cardiometabolic disorders contribute to morbidity and mortality in people with severe mental illnesses (SMI), yet lifestyle-intervention efficacy in patients with SMI is unclear. Israel's unique mental-health rehabilitation hostels (MHRHs) provide housing to subjects with SMI. We tested how multi-component lifestyle intervention affects cardiometabolic risk-factors in at-risk SMI populations residing in MHRHs. METHODS: In a prospective, cluster-randomized, controlled study, six MHRHs, paired by residents' functioning level, were randomized to lifestyle intervention (nutrition education, physical education), or usual care. Subjects recruited included those with ≥1 of: BMI > 25 kg/m2; plasma triglycerides ≥150 mg/dL; HbA1c ≥ 5.7%; fasting plasma glucose ≥ 100 mg/dL and plasma HDL < 40(men)/ 50(women) mg/dL. Primary outcome was BMI change after 15 months; other outcomes were plasma lipids levels and glycemic control. Low cooperation in one MHRH pair led to their exclusion, the others were assigned to intervention or control. RESULTS: Eighty residents were enrolled to intervention groups and 74 to control. Compared to baseline, intervention-arm participants experienced improvements in BMI (-0.83 kg/m2 [-1.36, -0.29] 95%CI), triglycerides (-30.60 mg/dL [-49.39, -11.82]95%CI) and LDL (-15.51 mg/dL [-24.53, -6.50]95%CI) (all P ≤ 0.003). BMI improvement correlated with number of dietitian consultations (r = -0.30; P = 0.001). No significant differences were found between treatment arms in BMI (-0.46 kg/m2 [-1.11, 0.18]95%CI;P = 0.189), triglycerides (-24.70 mg/dL [-57.66, 8.25]95%CI), LDL (-9.24 mg/dL [-20.50, 2.03]95%CI), HDL and glycemic control. CONCLUSIONS: Lifestyle intervention significantly improved BMI, LDL and triglycerides compared to baseline in at-risk MHRHs residents with SMI, yet compared to usual care the differences did not reach statistical significance. The association between the number of dietitian's consultations and BMI improvement suggests that programs should highlight participants' adherence.

[Nutritional assessment of inpatients with schizophrenia].

BACKGROUND: No thorough examination of the actual nutritiornal composition of the diet of schizophrenia patients in Israel has been carried out. We performed a cross-sectional study evaluating the nutritional assessment and dietary intake of inpatients with schizophrenia treated with antipsychotic drugs, based on the first National Health and Nutrition Examination Survey [MABAT]. METHODS: Sixty inpatients completed a face-to-face interview. The questionnaire included details on health status, alcohol intake, exercise, smoking habits, eating and dieting habits and food supplementation use, knowledge and attitudes regarding nutrition, sources of nutrition knowledge and a 24-hour food recall to gather information on total caloric intake and total fat, protein, carbohydrate, cholesterol, and fiber content. The hospital's menu is according to the requirements of the Ministry of Health (MoH), based on Dietary Reference Intakes. Weight, height, waist and hip measurements were recorded and body mass index and waist/hip ratio were calculated. Data were subsequently compared to data for the general population collected in the MABAT survey. RESULTS: Schizophrenia patients as a group did not eat more food when compared to MABAT subjects, but the relative percentages of calories derived from protein was higher and fiber intake was lower. The schizophrenia patients exercised less, but were not significantly more obese, thodgh there was more abdominal obesity. CONCLUSION: The schizophrenic patients make poor dietary choices, which likely contribute to the adverse metabolic side effects of antipsychotic treatment, thereby promoting the risk of morbidity and mortality. Proactive programmes to improve dietary habits and related nutritional status are necessary.