Clinical Correlates of Vitamin D Deficiency in Established Psychosis

J. Lally; P. Gardner-Sood; M. Firdosi; C. Iyegbe; B. Stubbs; K. Greenwood; R. Murray; S. Smith; O. Howes; F. Gaughran

BMC Psychiatry. 2016;16(76)

Abstract

Background: Suboptimal vitamin D levels have been identified in populations with psychotic disorders.

We sought to explore the relationship between vitamin D deficiency, clinical characteristics and cardiovascular disease risk factors among people with established psychosis.

Methods: Vitamin D levels were measured in 324 community dwelling individuals in England with established psychotic disorders, along with measures of mental health, cardiovascular risk and lifestyle choices. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25-OHD) levels below 10 ng/ml (equivalent to <25 nmol/L) and "sufficient" Vitamin D as above 30 ng/ml (>50 nmol/L).

Results: The mean 25-OHD serum level was 12.4 (SD 7.3) ng/ml, (range 4.0–51.7 ng/ml). Forty nine percent (n = 158) were vitamin D deficient, with only 14 % (n = 45) meeting criteria for sufficiency. Accounting for age, gender, ethnicity and season of sampling, serum 25-OHD levels were negatively correlated with waist circumference (r = −0.220, p < 0.002), triglycerides (r = −0.160, p = 0.024), total cholesterol (r = −0.144, p = 0.043), fasting glucose (r = −0.191, p = 0.007), HbA1c (r = −0.183, p = 0.01), and serum CRP levels (r = −0.211, p = 0.003) and were linked to the presence of metabolic syndrome.

Conclusions: This is the largest cross sectional study of serum 25-OHD levels in community dwelling individuals with established psychosis, indicating a high level of vitamin D deficiency. Lower vitamin D levels are associated with increased cardiovascular disease risk factors and in particular metabolic syndrome. Further research is needed to define appropriate protocols for vitamin D testing and supplementation in practice to see if this can improve cardiovascular disease risk.

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Table 1. Clinical/demographic characteristics and differences in mean vitamin D by season of sampling, age categories, ethnicity & diagnoses
	Total (n = 324)	Male (n = 193)	Female (n = 131)
Mean age (SD)	43.8 (10.1)	43.2 (10.1)	44.7 (10.2)
Mean Duration of illness (SD)	16.5 (10.4)	17.1 (10.5)	15.6 (10.4)
Mean Vitamin D levels	12.4 (7.3)	12.2 (7.0)	12.6 (7.8)
	Mean 25-OHD levels (ng/ml) ± SD				T	df	P Value
Age categories	Age ≤ 44 (n = 172)		Age > 44 (n = 152)
Age categories	12.1 ± 7.1		12.7 ± 7.5		−0.724	322	0.663
Diagnosis	Non affective psychosis (i.e. Schizophrenia) (n = 218)		Affective psychosis (Schizoaffective disorder, BPAD, psychotic depression) (n = 96)
	11.5 ± 6.7		14.3 ± 8.1		3.099	312	0.061
	Mean 25-OHD levels (ng/ml) ± SD/Vitamin D deficiency %				F	df	p Value
Season of sampling	Autumn (n = 96)/38 %	Winter (n = 70)/69 %	Spring (n = 70)/60 %	Summer (n = 88)/36 %	12.977	3	<0.001*
Season of sampling	14.3 ± 7.3^1,2	9.4 ± 5.9	9.8 ± 4.8²	14.7 ± 8.5^1,2	12.977	3	<0.001*
Ethnicity	Black (n = 104)	White (n = 183)	Asian (n = 12)	Mixed/Others (n = 24)	2.707	3	0.008*
	10.6 ± 5.9³	13.5 ± 8.1³	10.7 ± 8.4	12.4 ± 4.9	2.707	3	0.008*

Student-t tests and analysis of variance (ANOVA) were conducted to assess for differences in serum 25-OHD between groups. The *values represent the significant difference with p <0.05
^1,2Mean serum 25-hydroxyvitamin D (25-OHD) levels were significantly decreased in those who had blood sampling in Winter compared to Summer or Autumn (p < 0.001) and were significantly decreased in Spring compared to Summer or Autumn (p < 0.001)
³Mean 25-OHD levels were significantly decreased in those of black ethnicity compared to those of white ethnicity (p = 0.002)

Table 2. Significant bivariate and partial correlations between serum levels of 25-Hydroxyvitamin D (25-OHD) and cardiometabolic risk factors among patients with psychosis
	Bivariate r for 25-OHD level	Partial r for 25-OHD level
Waist	−0.188**	−0.220**
BMI	−0.149*	−0.163*
Type 2 DM	−0.147*	−0.128
MetS	−0.117*	−0.151*
Fasting glucose	−0.135*	−0.191**
HbA1c	−0.146**	−0.183**
Serum triglyceride	−0.133*	−0.160*
Serum total cholesterol	−0.128*	−0.144*
Systolic blood pressure	−0.084	−0.134
Diastolic blood pressure	−0.151**	−0.128
CRP level	−0.206**	−0.211**

Bivariate and partial correlations (r) between serum 25-OHD levels and cardiometabolic risk factors were examined using Pearson's coefficients, with controlling for age, gender, ethnicity and season of 25-OHD blood sampling. The *values represent the significant difference with p <0.05, **with p < 0.01 and ***with p < 0.001

Authors and Disclosures

J. Lally^1,2, P. Gardner-Sood¹, M. Firdosi³, C. Iyegbe¹, B. Stubbs^4,5, K. Greenwood⁶, R. Murray⁷, S. Smith⁷, O. Howes^1,8 and F. Gaughran^1,2*

¹Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK. ²National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK. ³South London and Maudsley NHS Foundation Trust, London, UK. ⁴Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. ⁵Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK. ⁶Honorary Senior Research Fellow, School of Psychology, University of Sussex, Brighton and Early Intervention in Psychosis Service, Sussex Partnership NHS Foundation Trust, West Sussex, UK. ⁷Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London and Honorary Consultant, National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK. ⁸Department of Psychosis Studies, MRC Clinical Sciences Centre, Imperial College- Hammersmith Hospital Campus, London, W12 0NN, UK, London, UK.

*Correspondence
Fiona.p.gaughran@kcl.ac.uk

Competing interests
RMM has received payment for lectures including service on speakers' bureaus for BMS, Janssen, AZ.
Dr Howes has received investigator-initiated research funding from and/or participated in advisory/speaker meetings organised by Astra-Zeneca, Autifony, BMS, Eli Lilly, Heptares, Jansenn, Lundbeck, Lyden-Delta, Otsuka, Servier, Sunovion, Rand and Roche. Neither Dr Howes or his family have been employed by or have holdings/a financial stake in any biomedical company.
FG has received honoraria for advisory work and lectures from Roche, BMS, Lundbeck, Otsuka and Sunovion and has a family member with professional links to Lilly and GSK;
The other authors, JL, PGS, MF, CI, BS, KG and SS have no conflict of interest to declare.
We affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Authors' contributions
All authors (JL, PGS, MF, CI, BS, KG, RMM, SS, OH and FG) made substantial contributions to the conception and design of the work. JL, PGS, MF, SS, OH and FG were involved in the acquisition and analysis of the data, and JL, PGS, MF, CI, BS, KG, RMM, SS, OH and FG in the interpretation of data for the work; JL and FG created the first draft of the work and all, JL, PGS, MF, CI, BS, KG, RMM, SS, OH and FG were involved in the revision and completion of the work; All authors gave final approval of the version to be submitted and published and are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Clinical Correlates of Vitamin D Deficiency in Established Psychosis

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