Clinical and inflammatory markers associated with metabolic dysfunction-associated fatty liver disease in a cohort of individuals with chronic schizophrenia (FACE-SZ)

Abstract

Aims: Recent studies on Metabolic dysfunction-associated fatty liver (MAFLD) in schizophrenia show inconsistent findings, often based on small or specific samples. This study aims to assess the prevalence of MAFLD and its sociodemographic, clinical, and treatment-related risk factors in a large cohort of chronic patients with schizophrenia. A secondary goal is to identify an immuno-inflammatory signature associated with MAFLD.

Methods: 1009 stable outpatients with schizophrenia were included in the cross-sectional analysis. Individuals with liver disease, hepatitis B/C, or current alcohol use disorder were excluded. MAFLD was screened using the Fatty Liver Index (FLI), with FLI > 60 indicating MAFLD. Risk factors were assessed using multivariate logistic regression, and inflammatory markers were analysed with penalized logistic regression.

Results: In a sample of 1009 individuals with schizophrenia, MAFLD prevalence was 36.6 %, higher in men than in women (38.3 % vs 32.0 %, p < 0.0001). Multivariate analysis identified male gender, older age, current smokers, mood stabilizers, antidepressant, clozapine, olanzapine and quetiapine as risk factors for MAFLD. The use of risperidone was associated with a lower risk of MAFLD (0.63 (0.42-0.94). Elevated levels of inflammatory markers such as TNF-α, CRP, and IL-12/IL-23p40 were also linked to a higher likelihood of MAFLD.

Conclusion: Although not generalizable to all patients with schizophrenia, this study confirms the high prevalence of MAFLD in individuals with schizophrenia. Psychiatrists should promote healthy lifestyle changes, such as weight control, improved diet, better sleep, and increased physical activity, to improve both physical health and quality of life in these patients.

Keywords: Inflammation; Inflammatory markers; Liver diseases; MAFLD; Metabolic abnormalities; NAFLD; Non-alcoholic fatty liver disease; Schizophrenia.