Vitamin D insufficiency in obese patients with severe mental illness taking olanzapine

  • Maria Skouroliakou
  • Ifigenia Giannopoulou
  • Stathopoulou G. Maria
  • Christina Kostara
  • Katerina Koutri
  • Christina Kakavelaki
Original Article


The purpose of the study was to assess the vitamin D status of obese patients with severe mental illness (SMI) treated with olanzapine. Fifteen obese SMI patients treated with olanzapine were pair-matched with healthy obese subjects. Another 52 overweight and obese SMI patients volunteered to participate in the study (total n = 67) and were divided into three subgroups (group A = overweight, group B = obese, group C = severely obese). Anthropometric, body composition, blood glucose, lipids, 25(OH)D, intact parathyroid hormone, and calcium measurements were performed. No differences were found between healthy and SMI subjects in any of the dependent variables (p > 0.05). The obese and severely obese patients demonstrated significantly lower levels of serum 25(OH)D concentration (p < 0.01) compared with overweight. A significant inverse correlation was found between serum 25(OH)D concentration and all anthropometric parameters (p < 0.05). The results indicate that obese SMI patients appear to be vitamin D deficient, similar to healthy obese subjects. The level of obesity seems to play a significant role in their vitamin D status: the greater the body fat of the patients the lower the serum 25(OH)D concentration. Thus, as in healthy individuals, an inverse association exists between the degree of adiposity and the serum 25(OH)D concentration in SMI patients


Vitamin D Severe mental illness Antipsychotic medications Obesity 



We would like to thank Miss Afroditi Makri for data collection and Adamantia Persidi for the final editing of the manuscript. We also thank the participants of the study and the staff of Iaso Hospital in Athens. The present study has been funded by Pharmaserve Lilly Greece, Athens, Greece.

Conflict of interest



  1. 1.
    Abel KM, Heatlie HF, Howard LM, Webb RT (2008) Sex- and age-specific incidence of fractures in mental illness: a historical, population-based cohort study. J Clin Psychiatry 69:1398–1403CrossRefGoogle Scholar
  2. 2.
    Allison DB, Mentore JL, Heo M, Chandler LP, Cappelleri JC, Infante MC et al (1999) Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry 156:1686–1696Google Scholar
  3. 3.
    Allison DB, Newcomer JW, Dunn AL, Blumenthal JA, Fabricatore AN, Daumit GL (2009) Obesity among those with mental disorders: a National Institute of Mental Health meeting report. Am J Prev Med 36:341–350CrossRefGoogle Scholar
  4. 4.
    Arunabh S, Pollack S, Yeh J, Aloia JF (2003) Body fat content and 25-hydroxyvitamin D levels in healthy women. J Clin Endocrinol Metab 88(1):157–161CrossRefGoogle Scholar
  5. 5.
    Bailey KR (2003) Atypical psychotropic medications and their side effects: a review for the African-American primary care physician. J Natl Med Assoc 95:137–144Google Scholar
  6. 6.
    Barger-Lux MJ, Heaney RP, Hayes J, DeLuca HF, Johnson ML, Gong G (1995) Vitamin D receptor gene polymorphism, bone mass, body size, and vitamin D receptor density. Calcif Tissue Int 57(2):161–162CrossRefGoogle Scholar
  7. 7.
    Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S (1985) Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest 76(1):370–373CrossRefGoogle Scholar
  8. 8.
    Bertone-Johnson ER (2009) Vitamin D and the occurrence of depression: causal association or circumstantial evidence? Nutr Rev 67:481–492CrossRefGoogle Scholar
  9. 9.
    Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28Google Scholar
  10. 10.
    Buffington C, Walker B, Cowan GS Jr, Scruggs D (1993) Vitamin D deficiency in the morbidly obese. Obes Surg 3(4):421–424CrossRefGoogle Scholar
  11. 11.
    Citrome L, Holt RI, Walker DJ, Hoffmann VP (2011) Weight gain and changes in metabolic variables following olanzapine treatment in schizophrenia and bipolar disorder. Clin Drug Investig. 31:455–482CrossRefGoogle Scholar
  12. 12.
    Compston JE, Vedi S, Ledger JE, Webb A, Gazet JC, Pilkington TR (1981) Vitamin D status and bone histomorphometry in gross obesity. Am J Clin Nutr 34(11):2359–2363Google Scholar
  13. 13.
    Fields DA, Goran MI, McCrory MA (2002) Body-composition assessment via air-displacement plethysmography in adults and children: a review. Am J Clin Nutr 75:453–467Google Scholar
  14. 14.
    Goff DC (2007) Integrating general health care in private community psychiatry practice. J Clin Psychiatry 68:49–54CrossRefGoogle Scholar
  15. 15.
    Grundberg E, Brändström H, Ribom EL, Ljunggren O, Mallmin H, Kindmark A (2004) Genetic variation in the human vitamin D receptor is associated with muscle strength, fat mass and body weight in Swedish women. Eur J Endocrinol 150(3):323–328CrossRefGoogle Scholar
  16. 16.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281CrossRefGoogle Scholar
  17. 17.
    Lips P (2006) Vitamin D physiology. Prog Biophys Mol Biol 92:4–8CrossRefGoogle Scholar
  18. 18.
    McGill AT, Stewart JM, Lithander FE, Strik CM, Poppitt SD (2008) Relationships of low serum vitamin D3 with anthropometry and markers of the metabolic syndrome and diabetes in overweight and obesity. Nutr J 7:4CrossRefGoogle Scholar
  19. 19.
    McCloughen A, Foster K (2011) Weight gain associated with taking psychotropic medication: an integrative review. Int J Ment Health Nurs. 20(3):202–222CrossRefGoogle Scholar
  20. 20.
    Minet-Ringuet J, Even PC, Valet P, Carpéné C, Visentin V, Prévot D et al (2007) Alterations of lipid metabolism and gene expression in rat adipocytes during chronic olanzapine treatment. Mol Psychiatry 12:562–571CrossRefGoogle Scholar
  21. 21.
    Newcomer JW, Sernyak MJ (2007) Identifying metabolic risks with antipsychotics and monitoring and management strategies. J Clin Psychiatry 68:e17CrossRefGoogle Scholar
  22. 22.
    Pouwels S, van Staa TP, Egberts AC, Leufkens HG, Cooper C, de VF (2009) Antipsychotic use and the risk of hip/femur fracture: a population-based case–control study. Osteoporos Int 20(9):1499–1506Google Scholar
  23. 23.
    Schmitt LH, Harrison GA (1998) Patterns in the within-population variability of stature and weight. Ann Hum Biol 15(5):353–364CrossRefGoogle Scholar
  24. 24.
    Scragg R, Holdaway I, Singh V, Metcalf P, Baker J, Dryson E (1995) Serum 25-hydroxyvitamin D3 levels decreased in impaired glucose tolerance and diabetes mellitus. Diabetes Res Clin Pract 27(3):181–188CrossRefGoogle Scholar
  25. 25.
    Souza RP, De Luca V, Muscettola G, Rosa DV, de Bartolomeis A, Romano Silva M et al (2008) Association of antipsychotic induced weight gain and body mass index with GNB3 gene: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 32:1848–1853CrossRefGoogle Scholar
  26. 26.
    Speer G, Cseh K, Winkler G, Vargha P, Braun E, Takács I et al (2001) Vitamin D and estrogen receptor gene polymorphisms in type 2 diabetes mellitus and in android type obesity. Eur J Endocrinol 144(4):385–389CrossRefGoogle Scholar
  27. 27.
    Tschoner A, Engl J, Laimer M, Kaser S, Rettenbacher M, Fleischhacker WW et al (2007) Metabolic side effects of antipsychotic medication. Int J Clin Pract 61:1356–1370CrossRefGoogle Scholar
  28. 28.
    Vestergaard P, Rejnmark L, Mosekilde L (2006) Anxiolytics, sedatives, antidepressants, neuroleptics and the risk of fracture. Osteoporos Int 17:807–816CrossRefGoogle Scholar
  29. 29.
    Vestri HS, Maianu L, Moellering DR, Garvey WT (2007) Atypical antipsychotic drugs directly impair insulin action in adipocytes: effects on glucose transport, lipogenesis, and antilipolysis. Neuropsychopharmacology 32:765–772CrossRefGoogle Scholar
  30. 30.
    Vreeland B (2007) Bridging the gap between mental and physical health: a multidisciplinary approach. J Clin Psychiatry 68:26–33CrossRefGoogle Scholar
  31. 31.
    Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF (2003) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 77:1342Google Scholar
  32. 32.
    Ye WZ, Reis A, Dubois-Laforgue D, Bellanne-Chantelot C, Timsit J, Velho G (2001) Vitamin D receptor gene polymorphisms are associated with obesity in type II diabetic subjects with early age of onset. Eur J Endocrinol 145:181–186CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Maria Skouroliakou
    • 1
    • 3
  • Ifigenia Giannopoulou
    • 2
  • Stathopoulou G. Maria
    • 1
  • Christina Kostara
    • 3
  • Katerina Koutri
    • 3
  • Christina Kakavelaki
    • 1
  1. 1.Department of Nutrition and DieteticsHarokopio UniversityAthensGreece
  2. 2.Department of Physical Education and Exercise ScienceUniversity of AthensAthensGreece
  3. 3.Dietetic DepartmentIaso HospitalAthensGreece

Personalised recommendations