Efficacy of nutrition education for the increase of symbiotic intake on nutritional and metabolic status in schizophrenic spectrum disorders: A two-arm protocol

Alfonso Sevillano-Jiménez, Guillermo Molina-Recio, Juan Antonio García-Mellado, María García-Rodríguez, Rafael Molina-Luque, Manuel Romero-Saldaña, Alfonso Sevillano-Jiménez, Guillermo Molina-Recio, Juan Antonio García-Mellado, María García-Rodríguez, Rafael Molina-Luque, Manuel Romero-Saldaña

Abstract

Background/objectives: The microbiota plays a vital role in the two-way communication between the gastrointestinal tract and numerous neuropsychiatric disorders, such as schizophrenia. Besides, the microbiota modulation through the use of psychobiotics (prebiotics and probiotics with nutraceutical action) is related to the improvement of the physical and psychopathological health. The objective to this study was to test the efficacy of prebiotic/probiotic dietary modulation in patients diagnosed with schizophrenia, attending to the nutritional and cardio-metabolic impact.

Methods: Two-arms, double-blind, randomized in balanced blocks clinical trial of 6 months of intervention, will be developed in a group of 50 individuals. The control group will receive conventional dietary advice individually from specialized mental health nurses. In the intervention group, an individual dietetic-nutritional education program with high prebiotic and probiotic content (dairy and fermented foods, green leafy vegetables, high-fiber fruit, whole grains, etc.) will be developed by these nurses. Data will be collected on the psychopathological state, and blood test (at the beginning, at 3 and 6 months). The estimation of intestinal microbiota and the usual nutritional pattern will also be assessed at the beginning and 6 months, using a stool test. To evaluate the degree of adherence, the intervention group will fill a specific weekly record of the main dishes/food consumed. Anthropometric parameters will also be analyzed monthly.

Discussion: The study is anticipated to establish feasibility an adequate dietary modulation with a high simbiotic content, leads to a significant improvement in the nutritional status and cardio-metabolic. Furthermore, it is presumed to reach a degree of evidence that allows establishing nutritional management as an effective therapeutic intervention in the psychopathological treatment of patients with schizophrenia spectrum disorders.

Clinical trial registration: [www.ClinicalTrials.gov], identifier [NCT04366401].

Keywords: diet therapy; mental health; prebiotic; probiotic; schizophrenia spectrum and other psychotic disorders.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Sevillano-Jiménez, Molina-Recio, García-Mellado, García-Rodríguez, Molina-Luque and Romero-Saldaña.

Figures

FIGURE 1
FIGURE 1
Flow chart of the participants (CONSORT diagram).

References

    1. Balanzá V. Nutritional supplements in psychotic disorders. Actas Esp Psiquiatr. (2017) 45(Suppl. 1):16–25.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Madrid: Editorial Médica Panamericana; (2014).
    1. Gómez AE. Nutrition and mental illness. Schizophrenia and omega 3 fatty acids. Farmacia Profesional. (2007) 21:60–3.
    1. Bernardo M, Cañas F, Herrera B, García M. Adherence predicts symptomatic and psychosocial remission in schizophrenia: naturalistic study of patient integration in the community. Rev Psiquiatr Salud Ment. (2017) 10:149–59. 10.1016/j.rpsm.2016.04.001
    1. Tandon R, Nasrallah HA, Keshavan MS. Schizophrenia, “just the facts” 4. Clinical features and conceptualization. Schizophr Res. (2009) 110:1–23.
    1. Godoy JF, Caballero M, Godoy-Izquierdo D, Vázquez ML, Muela JA. Relapse prevention in schizophrenia: proposal for an intervention programme during the prodromal phase. Rei Do Crea. (2016) 5:56–8.
    1. Soria V, Uribe J, Salvat N, Palao D, Menchón JM, Labad J. Psychoneuroimmunology of mental disorders. Rev Psiquiatr Salud Ment (Barc). (2018) 11:115–24. 10.1016/j.rpsm.2017.07.006
    1. Egerton A, Grace AA, Stone J, Bossong MG, Sand M, McGuire P. Glutamate in schizophrenia: neurodevelopmental perspectives and drug development. Schizophr Res. (2020) 223:59–70. 10.1016/j.schres.2020.09.013
    1. Stahl SM. Beyond the dopamine hypothesis of schizophrenia to three neural networks of psychosis: dopamine, serotonin, and glutamate. CNS Spectr. (2018) 23:187–91. 10.1017/S1092852918001013
    1. Cepeda V, Mondragón A, Lamas A, Miranda JM, Cepeda A. Use of prebiotics and probiotics in the management of anxiety. Farmaceut Comunit. (2019) 11:30–40. 10.5672/FC.2173-9218
    1. Icaza ME. Gut microbiota in health and disease. Rev Gastroenterol Mex. (2013) 78:240–8. 10.1016/j.rgmx.2013.04.004
    1. Castillo F, Marzo ME. Role of the gut microbiota in the development of various neurological diseases. Neurol Sci. (2019) S0213-4853(19)30082-9. 10.1016/j.nrl.2019.03.017
    1. Rodríguez A, Solano M. Nutrition and mental health: a literature review. Rev Post Psiquiat UNAH. (2008) 1:1–5.
    1. Salagre E, Vieta E, Grande I. The visceral brain: bipolar disorder and microbiota. Rev Psiquiatr Salud Ment. (2017) 10:67–9. 10.1016/j.rpsm.2017.02.001
    1. Wang HX, Wang YP. Gut microbiota-brain axis. Chin Med J. (2016) 129:2373–80. 10.4103/0366-6999.190667
    1. Mariño A, Núñez M, Barreto JM. Microbiota, probiotics, probiotics, prebiotics and symbiotics. Pediatr Integral. (2015) 19:337–54.
    1. Andreo P, García N, Sánchez EP. The gut microbiota and its relation to mental illnesses through the microbiota-gut-brain axis. Rev Dis Cli Neuro. (2017) 4:52–8.
    1. Kim YK, Shin C. The microbiota-gut-brain axis in neuropsychiatric disorders: pathophysiological mechanisms and novel treatments. Curr Neuropharmacol. (2018) 16:559–73. 10.2174/1570159X15666170915141036
    1. Patra S. Psychobiotics: a paradigm shift in psychopharmacology. Indian J Pharmacol. (2016) 48:469–70.
    1. Sarkar A, Lehto SM, Harty S, Dinan TG, Cryan JF, Burnet P. Psychobiotics and the manipulation of bacteria–gut–brain signals. Trends Neurosci. (2016) 39:763–81. 10.1016/j.tins.2016.09.002
    1. Kali A. Psychobiotics: an emerging probiotic in psychiatric practice. Biomed J. (2016) 3:223–4. 10.1016/j.bj.2015.11.004
    1. Forsythe P, Kunze W, Bienestock J. Moody microbes or fecal phrenology: what do we know about the microbiota-gutbrain axis? BMC Med. (2016) 14:58. 10.1186/s12916-016-0604-8
    1. Galletero JM. Nutrition and mental illness. Biochemical markers in bipolar disorder. Zainak. (2011) 34:323–34.
    1. Franch CM, Molina V, Franch JI. Determinants of metabolic risk in atypical antipsychotic treatment. Rev Psiquiatr Salud Ment. (2016) 23:87–130. 10.1016/j.psiq.2016.08.001
    1. Franch CM, Molina V, Franch JI. Metabolic syndrome and atypical antipsychotics: possibility of prediction and control. Rev Psiquiatr Salud Ment. (2017) 10:38–44. 10.1016/j.rpsm.2016.09.003
    1. Sánchez ML, González J, Martínez MC. Metabolic control and prolactin in severe mental illness. Nursing interventions. Rev Enferm Salud Ment. (2018) 9:24–8. 10.5538/2385-703X.2018.9.24
    1. Pringsheim T, Kelly M, Urness D, Teehan M, Ismail Z, Gardner D. Physical health and drug safety in individuals with schizophrenia. Can J Psychiatry. (2017) 62:673–83. 10.1177/0706743717719898
    1. Pina L, Díaz MC, Saiz PA, Bobes J, Corripio I, Grasa E, et al. Pharmacogenetic study of second-generation antipsychotic long-term treatment metabolic side effects (the SLiM Study): rationale, objectives, design and sample description. Rev Psiquiatr Salud Ment. (2014) 7:166–78. 10.1016/j.rpsm.2014.05.004
    1. Severi E, Ferrara M, Tedeschini E, Vacca F, Mungai F, Amendolara R, et al. Assessment of cardiovascular risk in an Italian psychiatric outpatient sample: a chart review of patients treated with second-generation antipsychotics. Int J Ment Health Nurs. (2018) 27:1002–8. 10.1111/inm.12407
    1. Ocando L, Roa A, León M, González R. Atypical antipsychotics and their role in the development of metabolic disease. Rev Iberoam Hipert. (2018) 13: 44–51.
    1. Gurusamy J, Gandhi S, Damodharan D, Ganesan V, Palaniappan M. Exercise, diet and educational interventions for metabolic syndrome in persons with schizophrenia: a systematic review. Asian J Psychiatr. (2018) 36:73–85. 10.1016/j.ajp.2018.06.018
    1. Cortés B. Metabolic syndrome and second generation antipsychotic agents. Rev Asoc Esp Neuropsiq. (2011) 31:303–20. 10.4321/S0211-57352011000200009
    1. González E. Obesity: etiologic and pathophysiological analysis. Endocrinol Nutr. (2013) 60:17–24. 10.1016/j.endonu.2012.03.006
    1. Chee GL, Wynaden D, Heslop K. Improving metabolic monitoring rate for young people aged 35 and younger taking antipsychotic medications to treat a psychosis: a literature review. Arch Psychiatr Nurs. (2017) 31:624–33. 10.1016/j.apnu.2017.09.002
    1. Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, et al. The lancet psychiatry commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry. (2019) 6:675–712. 10.1016/S2215-0366(19)30132-4
    1. Firth J, Teasdale SB, Allott K, Siskind D, Marx W, Cotter J, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry. (2019) 18:308–24. 10.1002/wps.20672
    1. Teasdale SB, Ward PB, Rosenbaum S, Samaras K, Stubbs B. Solving a weighty problem: systematic review and meta-analysis of nutrition interventions in severe mental illness. Br J Psychiatry. (2017) 210:110–8. 10.1192/bjp.bp.115.177139
    1. Teasdale SB, Ward PB, Samaras K, Firth J, Stubbs B, Tripodi E, et al. Dietary intake of people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry. (2019) 214:251–9. 10.1192/bjp.2019.20
    1. Sánchez V, Romero D, Abad MJ, Descalzo MA, Alonso S, Salazar J, et al. Metabolic syndrome and cardiovascular risk in people treated with long-acting injectable antipsychotics. Endocr Metab Immune Disord Drug Targets. (2018) 18:379–87. 10.2174/1871530317666171120151201
    1. Firth J, Solmi M, Wootton RE, Vancampfort D, Schuch FB, Hoare E, et al. A meta-review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry. (2020) 19:360–80. 10.1002/wps.20773
    1. Pérez BY, Jasso JA, López MM. Assessment of nutritional status in patients with psychiatric disorders in a hospital unit. Nutr Clín Diet Hosp. (2017) 37:24–33. 10.12873/371brendayadira
    1. Curtis J, Watkins A, Rosenbaum S, Teasdale S, Kalucy M, Samaras K, et al. Evaluating an individualized lifestyle and life skills intervention to prevent antipsychotic-induced weight gain in first-episode psychosis. Early Interv Psychiatry. (2016) 10:267–76. 10.1111/eip.12230
    1. Andalusian Regional Ministry of Health. Dietary advice in Primary Care. Plan for the Promotion of Physical Health and Balanced Diet 2004-2008. Andalusian Health Service. Andalusian Regional Ministry of Health. (2010). Available online at: (accessed November 20, 2019).
    1. Andalusian Regional Ministry of Health. Guide to Intensive Dietetic Counselling in Primary Health Care. Plan for the Promotion of Physical Health and Balanced Diet 2004-2008. Andalusian Health Service. Andalusian Regional Ministry of Health. (2007). Available online at: (accessed November 23, 2019).
    1. Andalusian Health Service, Andalusian Regional Ministry of Health. Assessment Instrument No. 8: Early Detection and Intervention in Psychosis. Positive and Negative Schizophrenia Syndrome Scale (PANSS). Andalusian Health Service. (2010). Available online at: (accessed November 5, 2019).
    1. García MP, Alejandra P, Bousoño M, Bascarán MT, Guzmán C, Bobes J. Validation of the Spanish personal and social performance scale (PSP) in outpatients with stable and unstable schizophrenia. Rev Psiquiatr Salud Ment (Barc). (2011) 4:9–18. 10.1016/j.rpsm.2010.11.003
    1. Martín JM, Boyle P, Gorgojo L, Maisonneuve P, Fernández JC, Salvini S, et al. Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol. (1993) 22:512–9. 10.1093/ije/22.3.512
    1. Sugawara N, Sagae T, Yasui-Furukori N, Yamakazi M, Shimoda K, Mori T, et al. Effects of nutritional education on weight change and metabolic abnormalities among patients with schizophrenia in Japan: a randomized controlled trial. J Psychiatr Res. (2018) 97:77–83. 10.1016/j.jpsychires.2017.12.002
    1. Carmenate L, Moncada FE, Borjas WE. Manual of Anthropometric Measurements. 1st ed. Costa Rica: SALTRA; (2014).
    1. Shrestha B, Dunn L. The declaration of helsinki on medical research involving human subjects: a review of seventh revision. J Nepal Health Res Counc. (2020) 17:548–552. 10.33314/jnhrc.v17i4.1042
    1. Dommel FW, Alexander D. The convention on human rights and biomedicine of the council of europe. Kennedy Inst Ethics J. (1997) 7:259–76. 10.1353/ken.1997.0023
    1. UNESCO: universal declaration on the human genome and human rights. J Med Philos. (1998) 23:334–41. 10.1076/jmep.23.3.334.2578

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅