Double burden of malnutrition in psychiatric disorders: a hospital-based cross-sectional study in Eastern India

Poulami Chattopadhyay; Sanchari Roy; Aparupa Mondal; Purbasha Sengupta; Sudipta Pramanik; Soumam Dutta; Sohini Roy

doi:10.18203/2394-6040.ijcmph20251386

Authors

Poulami Chattopadhyay Department of Food and Nutrition, Women’s College, Calcutta, Kolkata, West Bengal, India
Sanchari Roy Department of Psychiatry, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
Aparupa Mondal Department of Food and Nutrition, Women’s College, Calcutta, Kolkata, West Bengal, India
Purbasha Sengupta Department of Psychiatry, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
Sudipta Pramanik Department of Food and Nutrition, Women’s College, Calcutta, Kolkata, West Bengal, India
Soumam Dutta Department of Home Science, University of Calcutta, Kolkata, West Bengal, India
Sohini Roy Department of Food and Nutrition, Women’s College, Calcutta, Kolkata, West Bengal, India https://orcid.org/0000-0002-5262-6019

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20251386

Keywords:

Diet, Malnutrition, Psychiatric disorders

Abstract

Background: Psychiatric disorders are associated with nutritional impairment due to multiple reasons, including altered appetite, loss of functional abilities, and quality of life. Improving dietary intake may reduce the risk of malnutrition among psychiatric patients. However, it is not clear whether disease severity and hospitalization can impair this process. Therefore, in the present study, we intend to compare the risk of malnutrition in hospitalized patients who receive a planned diet under supervision versus community-dwelling psychiatric patients who generally have poor dietary intakes.

Methods: A cross-sectional pilot study was conducted with 48 in-patients and 50 out-patients at a tertiary hospital in Kolkata, West Bengal. The risk of malnutrition was determined using Malnutrition Universal Screening Tool (MUST). Anthropometric and blood pressure measurements were performed. Dietary intake was recorded, and nutritional value was calculated.

Results: The in-patients were at a higher risk of malnutrition than the out-patients (P<0.05). The in-patients had a significantly lower BMI, systolic blood pressure and diastolic blood pressure (P<0.001). The in-patients had both undernutrition (31.25%) and obesity (22.92%), whereas, the out-patients were predominantly obese (64%). Dietary analysis revealed that the nutritive value of hospital diet was better than the diets consumed by the out-patients.

Conclusions: Psychiatric patients had a double burden of malnutrition. The risk of malnutrition may worsen with disease severity. In spite of receiving a balanced diet, the in-patients were at a higher risk of malnutrition. Additional nutrition support is required to promote the nutritional status of psychiatric patients.

Metrics

Metrics Loading ...

References

Defar S, Abraham Y, Reta Y, et al. Health related quality of life among people with mental illness: The role of socio-clinical characteristics and level of functional disability. Front Public Health. 2023;11:1134032. DOI: https://doi.org/10.3389/fpubh.2023.1134032

Ohrnberger J, Fichera E, Sutton M. The relationship between physical and mental health: A mediation analysis. Soc Sci Med. 2017;195:42-49. DOI: https://doi.org/10.1016/j.socscimed.2017.11.008

Dutta S, Roy S, Roy S, Manna A. A Comparative Study on Nutritional Status, Functional Status and Quality of Life between Dementia Patients and Healthy Individuals in Kolkata, West Bengal. Chettinad Health City Med J. 2024;13(4):4-9. DOI: https://doi.org/10.24321/2278.2044.202454

Gautham MS, Gururaj G, Varghese M. The National Mental Health Survey of India (2016): Prevalence, socio-demographic correlates and treatment gap of mental morbidity. Int J Social Psychiatr. 2020;66(4):361-372. DOI: https://doi.org/10.1177/0020764020907941

Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. and NMHS collaborators group. National Mental Health Survey of India, 2015-16: Mental Health Systems. Bengaluru, National Institute of Mental Health and Neuro Sciences, NIMHANS Publication No. 130, 2016.

Kvamme JM, Grønli O, Florholmen J, Jacobsen BK. Risk of malnutrition is associated with mental health symptoms in community living elderly men and women: the Tromsø study. BMC Psychiatry. 2011;11:112. DOI: https://doi.org/10.1186/1471-244X-11-112

Assefa T, Seid O, Tadese F, Gebremedhin T. Nutritional Status and Associated Factors among Adult Psychiatric Patients in Dessie Referral Hospital, Northeast Ethiopia. Psychiatry J. 2020;2020:5087573. DOI: https://doi.org/10.1155/2020/5087573

Onu JU, Osuji PN. Double burden of malnutrition amongst patients with first-episode schizophrenia in a psychiatric hospital: A 1-year follow-up study. S Afr J Psychiatr. 2020;26:1564. DOI: https://doi.org/10.4102/sajpsychiatry.v26i0.1564

Firth J, Siddiqi N, Koyanagi A, The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry. 2019;6(8):675-712. DOI: https://doi.org/10.1016/S2215-0366(19)30132-4

Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry. 2015;14(2):119-36. DOI: https://doi.org/10.1002/wps.20204

Penninx BWJH, Lange SMM. Metabolic syndrome in psychiatric patients: overview, mechanisms, and implications. Dialogues Clin Neurosci. 2018;20(1):63-73. DOI: https://doi.org/10.31887/DCNS.2018.20.1/bpenninx

Dalvi T, Kalghatgi S. A 2023 Update of Kuppuswamy Socioeconomic Status Classification Scale for the Indian Population. Journal of Indian Association of Public Health Dentistry. 2023;21(3):282-283. DOI: https://doi.org/10.4103/jiaphd.jiaphd_173_23

Karsegard VL, Ferlay O, Maisonneuve N. Outil de dépistage simplifié de la dénutrition: Malnutrition Universal Screening Tool (MUST) [Simplified malnutrition screening tool: Malnutrition Universal Screening Tool (MUST)]. Rev Med Suisse Romande. 2004;124(10):601-5.

Longvah T, An-antan I, Bhaskarachary K, Venkaiah K. Indian food composition tables. Hyderabad: ICMR-National Institute of Nutrition; 2017.

Risch L, Hotzy F, Vetter S. Assessment of Nutritional Status and Risk of Malnutrition Using Adapted Standard Tools in Patients with Mental Illness and in Need of Intensive Psychiatric Treatment. Int J Environ Res Public Health. 2022;20(1):109. DOI: https://doi.org/10.3390/ijerph20010109

Correia J, Ravasco P. Weight changes in Portuguese patients with depression: which factors are involved?. Nutr J. 2014;13(1):117. DOI: https://doi.org/10.1186/1475-2891-13-117

Shawel S, Baraki N, Alemeshet Y, Abebe DS, Egata G. Undernutrition and associated factors among adults with mental and neurological disorders in public health hospitals, Eastern Ethiopia, 2019: a cross-sectional study. BMC Psychiatry. 2023;23(1):617. DOI: https://doi.org/10.1186/s12888-023-05117-9

Tesfa H, Jara D, Woyiraw W, Bogale EK, Asrat B. Prevalence of undernourishment and associated factors among adults with major depressive disorder at two public hospitals in Northwest Ethiopia: a cross-sectional study. BMJ Open. 2022;12(11):e065108. DOI: https://doi.org/10.1136/bmjopen-2022-065108

Hadley C, Tegegn A, Tessema F, Cowan JA, Asefa M, Galea S. Food insecurity, stressful life events and symptoms of anxiety and depression in east Africa: evidence from the Gilgel Gibe growth and development study. J Epidemiol Community Health. 2008;62(11):980-6. DOI: https://doi.org/10.1136/jech.2007.068460

Sugai T, Suzuki Y, Yamazaki M. High prevalence of underweight and undernutrition in Japanese inpatients with schizophrenia: a nationwide survey. BMJ Open. 2015;5(12):e008720. DOI: https://doi.org/10.1136/bmjopen-2015-008720

Asma A, Tuncer Ö. Risks of undernutrition and depression in hospitalized patients: A cross-sectional study. Medicine (Baltimore). 2023;102(36):e35133. DOI: https://doi.org/10.1097/MD.0000000000035133

Dutta S, Roy S, Roy S, Manna A. A comparative study on dietary diversity and nutritional adequacy between dementia patients and healthy individuals in Kolkata, West Bengal. Int J Community Med Public Health. 2021;8(3):1177-85. DOI: https://doi.org/10.18203/2394-6040.ijcmph20210541

Boulos C, Salameh P, Barberger-Gateau P. Social isolation and risk for malnutrition among older people. Geriatr Gerontol Int. 2017;17(2):286-94. DOI: https://doi.org/10.1111/ggi.12711

Rogers GB, Keating DJ, Young RL, Wong ML, Licinio J, Wesselingh S. From gut dysbiosis to altered brain function and mental illness: mechanisms and pathways. Mol Psychiatry. 2016;21(6):738-48. DOI: https://doi.org/10.1038/mp.2016.50

Safadi JM, Quinton AMG, Lennox BR, Burnet PWJ, Minichino A. Gut dysbiosis in severe mental illness and chronic fatigue: a novel trans-diagnostic construct? A systematic review and meta-analysis. Mol Psychiatry. 2022;27(1):141-53. DOI: https://doi.org/10.1038/s41380-021-01032-1

Mahnic A, Breskvar M, Dzeroski S, Skok P, Pintar S, Rupnik M. Distinct Types of Gut Microbiota Dysbiosis in Hospitalized Gastroenterological Patients Are Disease Non-related and Characterized With the Predominance of Either Enterobacteriaceae or Enterococcus. Front Microbiol. 2020;11:120. DOI: https://doi.org/10.3389/fmicb.2020.00120

Masterton G, Main CJ, Lever AF, Lever RS. Low blood pressure in psychiatric inpatients. Br Heart J. 1981;45(4):442-46. DOI: https://doi.org/10.1136/hrt.45.4.442

Main CJ, Masterton G. The influence of hospital environment on blood pressure in psychiatric in-patients. J Psychosom Res. 1981;25(3):157-63. DOI: https://doi.org/10.1016/0022-3999(81)90028-3