OBJECTIVE:To investigate visceral fat distribution in patients with schizophrenia. DESIGN: Cross sectional study using CT scanning in patients with drug-naive and drug-free schizophrenia. SUBJECTS: Fifteen (13 men and two women) subjects with schizophrenia (mean age 33.7 y; mean body mass index (BMI) ¼ 26.7 kg=m 2 ), and 15 age-and sex-matched controls (mean age 30.5 y; mean BMI ¼ 22.8 kg= 2 ). MEASUREMENTS: Various fatness and fat distribution parameters (by CT scanning and anthropometry) and 16:00 h plasma cortisol. RESULTS: In comparison to controls, patients with schizophrenia had central obesity and had significantly higher levels of plasma cortisol. Furthermore, previous neuroleptic exposure did not appear to influence these findings as both drug-naive and drug-free patients had equally high levels of visceral fat deposition. CONCLUSION: Central obesity is a well recognized risk factor in developing certain general medical conditions. This study shows that patients with schizophrenia have increased intra-abdominal fat which may provide one explanation for why they die prematurely. International Journal of Obesity (2002 Keywords: schizophrenia; cortisol; imaging IntroductionReduced life expectancy is a well recognized feature of psychiatric illness. 1 -3 With respect to schizophrenia, the precise reasons underlying this excessive mortality are as yet unknown. 4,5 However, it is clear that suicide cannot fully account for these findings. 6,7 A meta-analysis of the relevant literature by Harris and Barraclough found that 'unnatural' causes of death such as suicide and accidents were far more likely to occur than expected in patients with schizophrena. 8 However, the standardized mortality ratios for 'natural causes', such as cardiovascular illness, was also significantly increased, a finding which was supported by Allbeck 9 and Ruschena et al. 3 A number of reasons may explain the excessive death rate due to 'natural causes' observed in schizophrenia; these include psychosocial deprivation, an unhealthy lifestyle and psychotropic medication. 10 -12 Yet, the general medical illnesses which tend to occur in those suffering from schizophrenia form a cluster which is termed the metabolic syndrome. 13 Hypertension, type 2 diabetes mellitus and dyslipidaemias are the primary constituents of this syndrome and are associated with increased intra-abdominal fat deposition. 14,15 Abdominal fat distribution consists of two discrete depots, subcutaneous and visceral (intra-abdominal) and numerous variables can account for the pattern of body fat deposition observed in the general population. 16,17 Of note is the fact that cortisol has a marked effect on regional fat distribution, in that patients with Cushing's syndrome who have marked hypercortisolaemia, have increased visceral fat distribution as measured by computerized axial tomography (CT) scanning. 18,19 Indeed, reduction of plasma cortisol in this subgroup of patients leads to a decrease in intra-abdominal fat stores 20 and also a normalization of certain features...
Fat is stored around the abdomen in both subcutaneous and intra abdominal (visceral) sites. Visceral fat is associated in its own right with a set of metabolic abnormalities, including non insulin dependent diabetes, hypertension and dyslipidaemias. States of marked hypercortisolaemia, for example Cushing's syndrome, lead to the preferential accumulation of visceral fat. Since melancholic depression is known to be associated with elevated plasma Cortisol levels, this review explores whether depressed patients are prone to excess visceral fat storage, with the subsequent risk of developing the associated metabolic disturbances. Though the literature is limited, there is evidence that intra abdominal fat is increased in major depression. There is also evidence that depression is associated with increased risk of death from cardiovascular disease. Is visceral fat and its association with metabolic abnormalities the link between depression and physical illness?
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