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.
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References
Abilés V, Rodríguez-Ruiz S, Abilés J, Mellado C, García A, Pérez de la Cruz A, Fernández-Santaella MC (2010) Psychological characteristics of morbidly obese candidates for bariatric surgery. Obes Surg 20:161–167. https://doi.org/10.1007/s11695-008-9726-1
Allison DB, Mentore JL, Heo M et al (1999) Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry 156:1686–1696. https://doi.org/10.1176/ajp.156.11.1686
American Psychiatric Association (APA) (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Association, Washington
Audrain-McGovern J, Benowitz NL (2011) Cigarette smoking, nicotine, and body weight. Clin Pharmacol Ther 90:164–168. https://doi.org/10.1038/clpt.2011.105
Brömel T, Blum WF, Ziegler A, Schulz E, Bender M, Fleischhaker C, Remschmidt H, Krieg JC, Hebebrand J (1998) Serum leptin levels increase rapidly after initiation of clozapine therapy. Mol Psychiatry 3:76–80
Case M, Treuer T, Karagianis J, Hoffmann VP (2010) The potential role of appetite in predicting weight changes during treatment with olanzapine. BMC Psychiatry 10:72. https://doi.org/10.1186/1471-244X-10-72
Chao A, Grilo CM, White MA, Sinha R (2014) Food cravings, food intake, and weight status in a community-based sample. Eat Behav 15:478–482. https://doi.org/10.1016/j.eatbeh.2014.06.003
Chao AM, Jastreboff AM, White MA, Grilo CM, Sinha R (2017) Stress, cortisol, and other appetite-related hormones: prospective prediction of 6-month changes in food cravings and weight. Obesity 25:713–720. https://doi.org/10.1002/oby.21790
Chiolero A, Wietlisbach V, Ruffieux C, Paccaud F, Cornuz J (2006) Clustering of risk behaviors with cigarette consumption: a population-based survey. Prev Med 42:348–353. https://doi.org/10.1016/j.ypmed.2006.01.011
Cuerda C, Velasco C, Merchán-Naranjo J, García-Peris P, Arango C (2014) The effects of second-generation antipsychotics on food intake, resting energy expenditure and physical activity. Eur J Clin Nutr 68:146–152. https://doi.org/10.1038/ejcn.2013.253
Fernø J, Varela L, Skrede S, Vázquez MJ, Nogueiras R, Diéguez C, Vidal-Puig A, Steen VM, López M (2011) Olanzapine-induced hyperphagia and weight gain associate with orexigenic hypothalamic neuropeptide signaling without concomitant AMPK phosphorylation. PLoS One 6:e20571. https://doi.org/10.1371/journal.pone.0020571
Gendall KA, Joyce PR, Sullivan PF (1997) Impact of definition on prevalence of food cravings in a random sample of young women. Appetite 28:63–72. https://doi.org/10.1006/appe.1996.0060
Guy W (2000) Clinical Global Impression (CGI). In: Rush AJ (ed) Handbook of psychiatric measures. American Psychiatric Association, Washington, DC, pp 100–102
Haupt DW, Newcomer JW (2002) Abnormalities in glucose regulation associated with mental illness and treatment. J Psychosom Res 53:925–933
Hill AJ, Weaver CF, Blundell JE (1991) Food craving, dietary restraint and mood. Appetite 17:187–197
Ilyas S, Moncrieff J (2012) Trends in prescriptions and costs of drugs for mental disorders in England, 1998-2010. Br J Psychiatry J Ment Sci 200:393–398. https://doi.org/10.1192/bjp.bp.111.104257
Jáuregui Lobera I, Bolaños P, Carbonero R, Valero Blanco E (2010) Psychometric properties of the Spanish version of Food Craving Inventory (FCI-SP). Nutr Hosp 25:984–992
Kay SR, Fiszbein A, Opler LA (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276. https://doi.org/10.1093/schbul/13.2.261
Kluge M, Schuld A, Himmerich H, Dalal M, Schacht A, Wehmeier PM, Hinze-Selch D, Kraus T, Dittmann RW, Pollmächer T (2007) Clozapine and olanzapine are associated with food craving and binge eating. J Clin Psychopharmacol 27:662–666. https://doi.org/10.1097/jcp.0b013e31815a8872
Kroeze WK, Hufeisen SJ, Popadak BA, Renock SM, Steinberg SA, Ernsberger P, Jayathilake K, Meltzer HY, Roth BL (2003) H1-histamine receptor affinity predicts short-term weight gain for typical and atypical antipsychotic drugs. Neuropsychopharmacology 28:519–526. https://doi.org/10.1038/sj.npp.1300027
Kruger J, Bowles HR, Jones DA, Ainsworth BE, Kohl HW (2007) Health-related quality of life, BMI and physical activity among US adults (>/=18 years): national physical activity and weight loss survey, 2002. Int J Obes (2005) 31:321–327. https://doi.org/10.1038/sj.ijo.0803386
de Leon J, Diaz FJ, Josiassen RC, Cooper TB, Simpson GM (2007) Weight gain during a double-blind multidosage clozapine study. J Clin Psychopharmacol 27:22–27. https://doi.org/10.1097/JCP.0b013e31802e513a
Lian J, Huang X-F, Pai N, Deng C (2016) Ameliorating antipsychotic-induced weight gain by betahistine: mechanisms and clinical implications. Pharmacol Res 106:51–63. https://doi.org/10.1016/j.phrs.2016.02.011
Lieberman J, Stroup T, McEvoy J et al (2005) Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 22:1209–1223
Martin CK, O’Neil PM, Tollefson G, Greenway FL, White MA (2008) The association between food cravings and consumption of specific foods in a laboratory taste test. Appetite 51:324–326. https://doi.org/10.1016/j.appet.2008.03.002
Meyer JM, Davis VG, McEvoy JP et al (2008) Impact of antipsychotic treatment on nonfasting triglycerides in the CATIE schizophrenia trial phase 1. Schizophr Res 103:104–109. https://doi.org/10.1016/j.schres.2008.04.023
Milano W, De Rosa M, Milano L, Capasso A (2013) Antipsychotic drugs opposite to metabolic risk: neurotransmitters, neurohormonal and pharmacogenetic mechanisms underlying with weight gain and metabolic syndrome. Open Neurol J 7:23–31. https://doi.org/10.2174/1874205X01307010023
Olfson M, Blanco C, Liu S-M, Wang S, Correll CU (2012) National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Arch Gen Psychiatry 69:1247–1256. https://doi.org/10.1001/archgenpsychiatry.2012.647
Palacios JM, Pazos A, Hoyer D (2017) A short history of the 5-HT2C receptor: from the choroid plexus to depression, obesity and addiction treatment. Psychopharmacology 234:1395–1418. https://doi.org/10.1007/s00213-017-4545-5
Rodríguez IT, Ballart JF, Pastor GC et al (2008) Validation of a short questionnaire on frequency of dietary intake: reproducibility and validity. Nutr Hosp 23:242–252
Salagre E, Vieta E, Grande I (2017) The visceral brain: bipolar disorder and microbiota. Rev Psiquiatria Salud Mental 10:67–69. https://doi.org/10.1016/j.rpsm.2017.02.001
Stunkard AJ, Messick S (1985) The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res 29:71–83. https://doi.org/10.1016/0022-3999(85)90010-8
Tardieu S, Micallef J, Gentile S, Blin O (2003) Weight gain profiles of new anti-psychotics: public health consequences. Obes Rev 4:129–138
Tecott LH, Sun LM, Akana SF, Strack AM, Lowenstein DH, Dallman MF, Julius D (1995) Eating disorder and epilepsy in mice lacking 5-HT2c serotonin receptors. Nature 374:542–546. https://doi.org/10.1038/374542a0
Teff KL, Kim SF (2011) Atypical antipsychotics and the neural regulation of food intake and peripheral metabolism. Physiol Behav 104:590–598. https://doi.org/10.1016/j.physbeh.2011.05.033
Teff KL, Rickels K, Alshehabi E, Rickels MR (2015) Metabolic impairments precede changes in hunger and food intake following short-term administration of second-generation antipsychotics. J Clin Psychopharmacol 35:579–582. https://doi.org/10.1097/JCP.0000000000000393
Theisen FM, Linden A, König IR, Martin M, Remschmidt H, Hebebrand J (2003) Spectrum of binge eating symptomatology in patients treated with clozapine and olanzapine. J Neural Transm (Vienna, Austria : 1996) 110:111–121. https://doi.org/10.1007/s00702-002-0792-6
Weiden PJ, Mackell JA, McDonnell DD (2004) Obesity as a risk factor for antipsychotic noncompliance. Schizophr Res 66:51–57
Weingarten HP, Elston D (1990) The phenomenology of food cravings. Appetite 15:231–246
White MA, Whisenhunt BL, Williamson DA, Greenway FL, Netemeyer RG (2002) Development and validation of the food-craving inventory. Obes Res 10:107–114. https://doi.org/10.1038/oby.2002.17
World Health Organization (1995) WHO Expert Committee on Physical Status : the Use and Interpretation of Anthropometry (1993 : Geneva, Switzerland) & World Health Organization. (1995). Physical status : the use of and interpretation of anthropometry, report of a WHO expert committee. World Health Organization
Zimmermann U, Kraus T, Himmerich H, Schuld A, Pollmächer T (2003) Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. J Psychiatr Res 37:193–220
Acknowledgments
The authors express gratitude to patients that voluntarily participated in this project.
Funding
Funding for this study was provided by the Spanish Ministry of Economy and Competitiveness (PI14/00753) integrated into the State Plan of Scientific and Technical Research and Innovation 2013–2016 and co-financed by the ISCIII-General Evaluation Branch and the European Regional Development Fund (FEDER), Instituto de SaludCarlos III through a ‘Rıo Hortega’ contract (CM17/00102, to Dr. Garriga), FEDER, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Government of Catalonia, Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017SGR1355 and 2017SGR1365), FI-DGR-2013 Contract of the Agència de Gestió d’Ajuts Universitaris i de Recerca, Esther Koplowitz Center-Barcelona (Dr. Bernardo), and the CERCA Programme/Generalitat de Catalunya.
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MG: conception and design of the article, acquisition, analyses, and interpretation of data, and drafting the manuscript. AM: conception and design of the article, acquisition, and interpretation of data, revising critically for contents. LS: conception and design of the article, acquisition, and interpretation of data, revising critically for contents. JR: analyses, interpretation of data, and revising critically for contents. MS: analyses, interpretation of data, and revising critically for contents. EP: revising the manuscript critically for intellectual content and approved the final version of the manuscript. MGR: analyses, interpretation of data, and revising critically for contents. CO: revising the manuscript critically for intellectual content and approved the final version of the manuscript. SA: acquisition and interpretation of data, revising critically for contents. EV: revising the manuscript critically for intellectual content and approved the final version of the manuscript. MB: revising the manuscript critically for intellectual content and approved the final version of the manuscript. CGR: conception and design of the article, revising the manuscript critically for intellectual content, and approved the final version of the manuscript.
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The protocol was approved by the local Ethical Committee and conducted in conformity with the Declaration of Helsinki.
Conflict of interest
Marina Garriga has received grants and served as consultant or advisor for Ferrer, Lundbeck, Janssen, Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III through a ‘Rıo Hortega’ contract (CM17/00102), FEDER, and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM).
Marta Gómez-Ramiro has received grant/research/travel support from Alter, Janssen, Lundbeck, Otsuka, Pfizer, Sanofi-Aventis.
Eduard Parellada has received honoraria and/or research grants from the Fondo de Investigación Sanitaria of the Spanish Ministry of Science and Innovation, MINECO, Pons Balmes Grant, Fundació la Marató de TV3 of Catalonia, Janssen-Cilag, GlaxoSmithKline, Ferrer and ADAMED.
Eduard Vieta has received grants, CME-related honoraria, or consulting fees from Alexza, Almirall, AstraZeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly, Ferrer, Forest Research Institute, Gedeon Richter, GlaxoSmith-Kline, Janssen, Janssen-Cilag, Jazz, Johnson & Johnson, Lundbeck, Merck, Novartis, Organon, Otsuka, Pfizer, Pierre-Fabre, Qualigen, Roche, Sanofi-Aventis, Schering-Plough, Servier, Shire, Solvay, Takeda, Teva, CIBERSAM, the Seventh European Framework Programme (ENBREC), the Stanley Medical Research Institute, United Biosource Corporation, and Wyeth.
Miquel Bernardo has been a consultant for, received grant/research support and honoraria from, and been on the speakers/advisory board of ABBiotics, Adamed, Angelini, Casen Recordati, Eli Lilly, Janssen-Cilag, Lundbeck, Otsuka, Somatics, Takeda and has obtained research funding from the Ministry of Education, Culture and Sport, the Spanish Ministry of Economy, Industry and Competitiveness (CIBERSAM), by the Government of Catalonia, Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017SGR1355), Foundation European Group for Research In Schizophrenia (EGRIS), and the 7th Framework Program of the European Union.
Clemente García-Rizo has received honoraria/travel support from Janssen-Cilag, Lundbeck and Ferrer.
The other authors do not declare any conflict of interest.
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Garriga, M., Mallorquí, A., Serrano, L. et al. Food craving and consumption evolution in patients starting treatment with clozapine. Psychopharmacology 236, 3317–3327 (2019). https://doi.org/10.1007/s00213-019-05291-3
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DOI: https://doi.org/10.1007/s00213-019-05291-3