Metabolic Dysfunction-Associated Steatotic Liver Disease in Schizophrenia: A Systematic Review and Meta-analysis

Metabolic dysfunction-associated steatotic liver disease (MASLD) constitutes the hepatic manifestation of metabolic syndrome. While cardiovascular risk is well-documented in schizophrenia, the burden of hepatic steatosis remains underrecognized.

The primary aim of this systematic review and meta-analysis was to estimate the pooled prevalence of MASLD in patients with schizophrenia and to systematically identify risk factors associated with the condition in this population.

A systematic review and meta-analysis was conducted by searching PubMed, Scopus, and Web of Science from inception to November 28, 2025. Observational studies reporting MASLD prevalence (including definitions of nonalcoholic fatty liver disease and Metabolic-Associated Fatty Liver Disease) in adults with schizophrenia were included. Data were pooled using a random-effects model. Risk factors were synthesized narratively from multivariable analyses.

Nine studies comprising 28,702 patients were included. The pooled prevalence of MASLD was 36% (95% confidence interval: 28%-45%), with high heterogeneity (I2 = 97.96%). Prevalence estimates varied by diagnostic modality, ranging from 39% in studies using ultrasonography or biomarkers to 22% in administrative datasets relying on ICD-10 coding. Independent risk factors included metabolic syndrome, type 2 diabetes, elevated body mass index, and dyslipidemia. Regarding psychopharmacology, antipsychotic polypharmacy and treatment with olanzapine, clozapine, or quetiapine were associated with increased risk, whereas risperidone was associated with a lower risk profile.

Our study reports an observed MASLD prevalence of 36%-with estimates varying according to diagnostic modality-and identifies several associated risk factors, suggesting that this condition is frequent but often overlooked in schizophrenia. While these data do not establish a definitive global prevalence or justify changes to current screening protocols, they point to a clinical burden that warrants greater awareness and further research.