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Metabolic Dysfunction-Associated Steatotic Liver Disease in Schizophrenia: A Systematic Review and Meta-analysis
Marcel Camino-I-Gibernau1, Diego A Gomez2, Ramiro Manzano-Nunez3
1Departamento de psiquiatría, PARC Sanitaria Sant Joan de deu, Barcelona, Spain.
Journal of the Academy of Consultation-Liaison Psychiatry
|March 22, 2026
Summary
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 36% of individuals with schizophrenia, often overlooked. Key risk factors include metabolic syndrome, diabetes, and specific antipsychotics, highlighting a need for increased clinical awareness.
Area of Science:
- Hepatology
- Psychiatry
- Metabolic Disorders
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is the liver manifestation of metabolic syndrome.
- While cardiovascular risks in schizophrenia are known, hepatic steatosis is underrecognized.
- This study addresses the prevalence and risk factors of MASLD in schizophrenia patients.
Purpose of the Study:
- To estimate the pooled prevalence of MASLD in patients with schizophrenia.
- To identify risk factors associated with MASLD in this population.
- To raise awareness of the hepatic steatosis burden in schizophrenia.
Main Methods:
- Systematic review and meta-analysis of PubMed, Scopus, and Web of Science.
- Inclusion of observational studies on MASLD/NAFLD/MAFLD prevalence in adults with schizophrenia.
- Narrative synthesis of risk factors from multivariable analyses.
Main Results:
- Nine studies (28,702 patients) reported a pooled MASLD prevalence of 36% (95% CI: 28%-45%).
- Prevalence varied by diagnostic method (39% with imaging/biomarkers vs. 22% with administrative data).
- Independent risk factors included metabolic syndrome, type 2 diabetes, elevated BMI, dyslipidemia, antipsychotic polypharmacy, olanzapine, clozapine, quetiapine; risperidone showed a lower risk.
Conclusions:
- MASLD is prevalent (36%) in schizophrenia, with significant variation based on diagnostic modality.
- Identified risk factors underscore the need for greater clinical awareness and research.
- Current data highlight an overlooked clinical burden in schizophrenia patients.
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