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The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.
We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.
This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.
Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).
Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.
To examine the association between cardiorespiratory fitness and dietary patterns in adolescents.
Food choice was assessed using the validated New Zealand Adolescent FFQ. Principal components analysis was used to determine dietary patterns. Trained research assistants measured participants’ height and body mass. Cardiorespiratory fitness was assessed in a subset of participants using the multistage 20 m shuttle run. The level and stage were recorded, and the corresponding VO2max was calculated. Differences in mean VO2max according to sex and BMI were assessed using t tests, while associations between cardiorespiratory fitness and dietary patterns were examined using linear regression analyses adjusted for age, sex, school attended, socio-economic deprivation and BMI.
Secondary schools in Otago, New Zealand.
Students (n 279) aged 14–18 years who completed an online lifestyle survey during a class period.
Principal components analysis produced three dietary patterns: ‘Treat Foods’, ‘Fruits and Vegetables’ and ‘Basic Foods’. The 279 participants who provided questionnaire data and completed cardiorespiratory fitness testing had a mean age of 15·7 (sd 0·9) years. Mean VO2max was 45·8 (sd 6·9) ml/kg per min. The ‘Fruits and Vegetables’ pattern was positively associated with VO2max in the total sample (β=0·04; 95 %CI 0·02, 0·07), girls (β=0·06; 95 % CI 0·03, 0·10) and boys (β=0·03; 95 % CI 0·01, 0·05).
These results indicate that increase in cardiorespiratory fitness was associated with a healthier dietary pattern, suggesting both should be targeted as part of a global lifestyle approach. Longitudinal studies are needed to confirm this association in relation to health outcomes in New Zealand adolescents.
To examine the potential associations between diet quality and multiple measures of body composition in a sample of New Zealand adolescents aged 14–18 years.
Cross-sectional survey of eleven high schools in Otago, New Zealand. Each participant completed an online FFQ and a New Zealand Diet Quality Index for Adolescents (NZDQI-A) score was calculated based on variety and adequacy of intake for five major food groups. Besides height and waist circumference measurements, body composition was assessed using segmental bio-impedance analysis. Generalized estimating equations were used to examine associations between diet quality and body composition in models adjusted for sex, age, ethnicity and socio-economic status.
High schools in Otago, New Zealand.
High-school students (n 681, 56 % male, mean age 16·1 (sd 1·5) years) participating in the Otago School Students Lifestyle Survey Two.
Higher NZDQI-A scores were significantly associated with lower body fat percentage (β=−0·19; 95 % CI −0·35, −0·04; P=0·014), fat-to-lean mass ratio (β=−0·26; 95 % CI −0·46, −0·05; P=0·016) and lower fat mass index (β=−0·23; 95 % CI −0·45, −0·004; P=0·046) after multivariate adjustment. No association was found between NZDQI-A and BMI, waist circumference or waist-to-height ratio.
Diet quality, as measured by NZDQI-A, was associated only with measures of body fat, not measures of overall body size. Measures specific to body fat should be used for more accurate ascertainment of body composition in examining the diet–body composition associations in this age group.
There is increasing pressure for adolescents to be thin and this may not always be acted upon in healthy ways; for example, certain foods or food groups may be restricted or meals skipped. As foods are not eaten in isolation it is useful to examine dietary patterns and associated psychosocial factors to better understand eating behaviour. The aim of the present study was to identify correlates of ‘dieting’ in adolescents from Otago, New Zealand.
A web-based survey was conducted in 2009, collecting information on food consumption and factors potentially associated with food consumption. Principal components analysis was used to investigate dietary patterns. Correlates were examined in 1329 students using multiple logistic regression analysis.
Nineteen secondary schools in the province of Otago, New Zealand.
Students from school years 9 and 10 (mean age 14·1 (sd 0·7) years).
There was no relationship between dieting and dietary patterns. Those not dieting were 17 % (95 % CI 7, 26 %) more likely to eat lunch and 22 % (95 % CI 3, 37 %) more likely to eat an evening meal on one more weekday than those who were dieting. Those who reported dieting were more likely to report healthiness (OR = 2·18, 95 % CI 1·11, 4·26) as an important factor when choosing food and that eating fruit and vegetables makes you better looking. No sex by dieting interaction was found.
In this cohort, while there was no difference in actual food consumption between dieters and non-dieters, there were significant differences in attitudes to food.
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