title: Determinants of overweight and obesity in patients with bipolar disorder.
abstract: OBJECTIVE
  To examine lifestyle-related determinants of the excess adiposity observed in patients with bipolar disorder.
  
  
  METHODS
  Eighty-nine male and female patients with DSM-IV bipolar disorder who were attending a specialist bipolar clinic or another psychiatric outpatient clinic (19% with body mass index [BMI] > or = 30) and 445 age- and sex-matched reference subjects (12% with BMI > or = 30) participated in a cross-sectional study of nutrient intake and physical activity. Main outcome measures included macronutrient intakes (assessed with 24-hour recall), percentage of energy derived from various food sources, and physical activity levels (assessed with the Life in New Zealand Questionnaire).
  
  
  RESULTS
  Mean total energy intake was higher in female patients than in reference subjects: 8468 kJ compared with 6980 kJ (95% confidence interval [CI] = 583 to 2392 kJ). Total daily sucrose and percentage of energy from carbohydrate were higher in patients than in reference subjects; for women, 73 g and 49% (95% CI = 20 to 56 g, 3% to 10) and for men, 89 g and 47% (95% CI = 15 to 59 g, 3% to 9%). Total fluid intake and intake of sweetened drinks were higher in patients than in reference subjects (ratio of geometric means: women, 1.2 and 2.3, respectively [95% CI = 1.1 to 1.4, 1.9 to 2.8]; men, 1.1 and 2.1, respectively [95% CI = 1.0 to 1.23, 1.8 to 2.41). Patients reported fewer episodes of low- to moderate-intensity and high-intensity physical activity as compared with reference subjects (p < or = .05).
  
  
  CONCLUSIONS
  This study confirms that drug-induced changes in food preference can lead to an excessive energy intake largely as a result of a high intake of sucrose. Dietary advice regarding the use of energy-rich beverages along with encouragement to increase levels of physical activity may help prevent weight gain in bipolar patients. The findings also have some bearing on dietary advice aimed at avoiding overweight and obesity in the general population.
authors.affiliation: Department of Human Nutrition, University of Otago, Dunedin, New Zealand. jane.elmslie@xtra.co.nz
authors.forename: J L
authors.initials: JL
authors.lastname: Elmslie
authors.forename: J I
authors.initials: JI
authors.lastname: Mann
authors.forename: J T
authors.initials: JT
authors.lastname: Silverstone
authors.forename: S M
authors.initials: SM
authors.lastname: Williams
authors.forename: S E
authors.initials: SE
authors.lastname: Romans
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001628:Beverages; D001714:Bipolar Disorder / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004326:Drinking; D004435:Eating; D004734:Energy Metabolism; D015444:Exercise / Q000523:psychology; D005260:Female; D005518:Food Preferences / Q000187:drug effects; D006801:Humans; D008019:Life Style; D008094:Lithium / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D009765:Obesity / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D013395:Sucrose / Q000008:administration & dosage; D015430:Weight Gain
chemical_list: D014150:Antipsychotic Agents; D004040:Dietary Carbohydrates; D013395:Sucrose; D008094:Lithium