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

Schizophr Res. 2019 Feb;204:96-103. doi: 10.1016/j.schres.2018.09.022. Epub 2018 Sep 22.


Objective: 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.

Method: 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).

Results: 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.

Conclusions: 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.

Keywords: Clinical high risk; Fatty acid; Metabolic; Omega 3; Oxidative stress.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / ethnology
  • Double-Blind Method
  • Dyslipidemias / epidemiology*
  • Dyslipidemias / ethnology
  • Fatty Acids, Omega-3*
  • Female
  • Humans
  • Hypertension / epidemiology*
  • Hypertension / ethnology
  • Male
  • Metabolic Syndrome / epidemiology*
  • Metabolic Syndrome / ethnology
  • Overweight / epidemiology*
  • Overweight / ethnology
  • Prediabetic State / epidemiology
  • Prehypertension / epidemiology
  • Prodromal Symptoms
  • Risk
  • Severity of Illness Index
  • Young Adult


  • Fatty Acids, Omega-3