The lifestyle of patients with severe mental illness, receiving treatment in mental care facilities in Asker, Norway

Introduction: The life expectancy of patients with severe mental illness (SMI) is shortened by 15-20 years compared to the average population. This is mainly due to cardiovascular disease (CVD). Many modifiable risk factors for CVD such as diabetes type 2 (DMT2) and the metabolic syndrome (MetS) are prevalent in SMI patients. Anti-psychotic medication is also known to increase appetite and promote weight gain. SMI patients have previously been found to lead unhealthy lifestyles with little exercise, unhealthy dietary habits, frequent smoking, and high alcohol consumption. Food based dietary guidelines (FBDG) in Norway have been developed to promote a healthy diet and avoid premature death and morbidity. A previous assessment in Asker experienced barriers regarding somatic screening and dietary assessment of SMI patients, and knowledge of Norwegian SMI patient’s lifestyle is still limited. In this study we hypothesized low compliance to FBDG and recommendations for exercise, high prevalence of metabolic syndrome (MetS) and deviant biomarkers for liver enzymes and micronutrients. Methods: Adult SMI-patients (schizophrenia spectrum-/bipolar disorder) receiving treatment in Asker, Norway was included in this study. Anthropometric measures and blood samples relevant to assess risk for CVD were collected from all participants. Compliance to FBDG were assessed with an online FFQ. Lifestyle related statements were documented for qualitative nuancing. New data was merged with the assessment from 2022 and analyzed together. Results: Forty-two SMI-patients (male=23, female=18) were assessed between 2021 and 2023. Mean age was 41.5 years (SD 12.1), and obesity (BMI  30 kg/m2) were highly prevalent with the median BMI being 29.9 kg/m2 (SD 5,4). In 42 participants, 67% were deemed abdominally obese, and the mean waist circumference (WC) was 106.2 cm (12.8). MetS was present in 50% of the participants, and serum total cholesterol, LDL- and non-HDL cholesterol exceeded the treatment goals for high-risk individuals. Vitamin D deficiency was identified in 17.3% of the subjects, but the median (nmol/L) of 79.7 (SD 38.3) in men and 75.8 (SD 17.1) in women indicated that serum concentration of vitamin D was too low. The median Diet Score was 7.5, corresponding to low/moderate compliance to FBDG. Reported exercise was below the recommended amount but might be even lower due to recall- and social desirability bias. Smoking was more prevalent than in average Norwegians, while reported alcohol intake was lower than expected. Conclusion: Obesity and MetS was highly prevalent, posing the SMI-patients at high risk for CVD. Compliance to FBDG was low, and physical activity level was below recommended. SMI-patients in Norway are thought to benefit from lifestyle-based interventions led by dietary professionals.