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Schizophr Res. 2018 Sep 21. pii: S0920-9964(18)30580-2. doi: 10.1016/j.schres.2018.09.022. [Epub ahead of print]

Metabolic abnormalities and low dietary Omega 3 are associated with symptom severity and worse functioning prior to the onset of psychosis: Findings from the North American Prodrome Longitudinal Studies Consortium.

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University of California San Diego, La Jolla, CA, United States. Electronic address:
Department of Psychiatry, University of Oxford, UK.
University of California San Diego, La Jolla, CA, United States; San Diego State University/University of California-San Diego Joint Doctoral Program in Clinical Psychology, United States.
Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
University of California Los Angeles, Los Angeles, CA, United States.
Yale University, New Haven, CT, United States.
The Zucker Hillside Hospital, New York, NY; Hofstra North Shore-LIJ School of Medicine, Hempstead, New York; The Feinstein Institute for Medical Research, Manhasset, NY, United States.
University of California San Francisco, San Francisco, CA, United States.
University of North Carolina, Chapel Hill, NC, United States.
Harvard, Boston, MA, United States.
University of California San Diego, La Jolla, CA, United States.
Emory University, Atlanta, GA, United States.
VA Pittsburgh Healthcare System and University of Pittsburg School of Medicine, Pittsburgh, PA, United States.



Patients with schizophrenia have a high prevalence of metabolic disorders and cardiovascular mortality. It is possible that a vulnerability to metabolic abnormalities is associated with risk for psychosis, symptoms and functionality. In this study, we evaluate demographic information, cardiometabolic indices, symptoms and functioning in an antipsychotic free cohort at Clinical High Risk (CHR) for psychosis from the NAPLS Omega 3 fatty acid clinical trial.


Subjects received physical exams and metabolic monitoring prior to randomization into the Omega 3 versus Placebo trial. Anthropometrical measures, vital signs, glucose, and lipids were assessed along with symptoms, functioning, dietary Omega 3 fatty acids, erythrocyte polyunsaturated fatty acid content and a measure of lipid peroxidation (TBARS, Thiobarbituric acid-reactive substances).


The sample included 113 CHR subjects (42.1% female; 17.5% Latino) ages 12-29. The mean BMI was 24.3 with a trend toward higher BMI and a higher incidence of metabolic syndrome in Latino subjects; 36% of the sample was obese/overweight; 37.6% met criteria for prehypertension/hypertension; 4.2% met criteria for prediabetes/diabetes; 9.6% showed evidence of insulin resistance and 44.7% had dyslipidemia. The TBARS was elevated at 9.8 μM ± 6.1 (normal 1.86-3.94 μM). Metabolic parameters and a diet low in Omega 3 rich foods were significantly associated with prodromal symptoms and poor functioning.


CHR subjects show a high percentage of metabolic abnormalities prior to exposure to antipsychotic medication. These findings reinforce that early detection of metabolic disturbances and food insecurity is crucial since these factors are modifiable with the potential for significant gains in terms of quality of life, physical and mental health.


Clinical high risk; Fatty acid; Metabolic; Omega 3; Oxidative stress

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