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Schizophr Bull. 2018 Oct 17;44(6):1275-1292. doi: 10.1093/schbul/sbx162.

Nutritional Deficiencies and Clinical Correlates in First-Episode Psychosis: A Systematic Review and Meta-analysis.

Author information

NICM, School of Science and Health, University of Western Sydney, Sydney, Australia.
Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, Australia.
School of Psychiatry, University of New South Wales, Sydney, Australia.
KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
KU Leuven Department of Neurosciences, UPC KU Leuven, Leuven, Belgium.
Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, Australia.
Deakin University, School of Medicine, IMPACT Strategic Research Centre, Barwon Health, Geelong, Australia.
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.
Orygen, The National Centre of Excellence in Youth Mental Health and Orygen Youth Health Research Centre, Melbourne, Australia.
Department of Psychiatry, University of Melbourne, The Melbourne Clinic, Melbourne, Australia.



Diet is increasingly recognized as a potentially modifiable factor influencing the onset and outcomes of psychiatric disorders. Whereas, previous research has shown long-term schizophrenia is associated with various nutritional deficiencies, this meta-analysis aimed to determine the prevalence and extent of nutritional deficits in first-episode psychosis (FEP).


A search of electronic databases conducted in July 2017 identified 28 eligible studies, examining blood levels of 6 vitamins and 10 minerals across 2612 individuals: 1221 individuals with FEP and 1391 control subjects. Meta-analyses compared nutrient levels in FEP to nonpsychiatric controls. Clinical correlates of nutritional status in patient samples were systematically reviewed.


Significantly lower blood levels of folate (N = 6, n = 827, g = -0.624, 95% confidence interval [CI] = -1.176 to -0.072, P = .027) and vitamin D (N = 7, n = 906, g = -1.055, 95% CI = -1.99 to -0.119, P = .027) were found in FEP compared to healthy controls. Synthesis of clinical correlates found both folate and vitamin D held significant inverse relationships with psychiatric symptoms in FEP. There was also limited evidence for serum level reductions of vitamin C (N = 2, n = 96, g = -2.207, 95% CI = -3.71 to -0.71, P = .004). No differences were found for other vitamins or minerals.


Deficits in vitamin D and folate previously observed in long-term schizophrenia appear to exist from illness onset, and are associated with worse symptomology. Further research must examine the direction and nature of these relationships (ie, mediator, moderator, or marker) with clinical status in FEP. Future trials assessing efficacy of nutrient supplementation in FEP samples should consider targeting and stratifying for baseline deficiency.

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