Childhood maltreatment is associated with increased body mass index and increased C-reactive protein levels in first-episode psychosis patients

Background. The high incidence of the metabolic syndrome in patients with psychosis is mainly attributed to antipsychotic treatment. However, it is also possible that psychological stress plays a role, inducing a chronic inflammatory process that may predispose to the development of metabolic abnormalities. We investigated the association between childhood maltreatment and inflammatory and metabolic biomarkers in subjects with first-episode psychosis and healthy controls.

Method. Body mass index (BMI), weight and waist circumference were measured in 95 first-episode psychosis patients and 97 healthy controls. Inflammatory and metabolic markers were measured in a subsample of 28 patients and 45 controls. In all the subjects we collected information on childhood maltreatment and recent stressors.

Results. Patients with childhood maltreatment had higher BMI [25.0 (S.E. = 0.6) kg/m(2)] and C-reactive protein (CRP) levels [1.1 (S.E. = 0.6) mg/dl] when compared with healthy controls [23.4 (S.E. = 0.4) kg/m(2), p = 0.030 and 0.2 (S.E. = 0.1) mg/dl, p = 0.009, respectively]. In contrast, patients without childhood maltreatment were not significantly different from healthy controls for either BMI [24.7 (S.E. = 0.6) kg/m(2), p = 0.07] or CRP levels [0.5 (S.E. = 0.2) mg/dl, p = 0.25]. After controlling for the effect of BMI, the difference in CRP levels across the three groups remained significant (F-2,F-58 = 3.6, p = 0.035), suggesting that the increase in inflammation was not driven by an increase in adipose tissue.

Conclusions. Childhood maltreatment is associated with higher BMI, and increased CRP levels, in patients with a first-episode psychosis. Further studies need to confirm the mechanisms underlying the putative causal relationship between childhood maltreatment and higher BMI, and whether this is indeed mediated by increased inflammation.