Hepatic Steatosis, Hepatic Fibrosis, and Metabolic Dysfunction–Associated Steatotic Liver Disease in Schizophrenia Patients

BACKGROUND: Although there is a large amount of data on the prevalence of metabolic syndrome, there are limited data on the prevalence of hepatic steatosis, hepatic fibrosis, and metabolic dysfunction-associated steatotic liver disease (MASLD) in schizophrenia patients. The present study aimed to evaluate the prevalence of MASLD, hepatic steatosis, hepatic fibrosis, and metabolic syndrome in a group of patients with schizophrenia. METHODS: This cross-sectional study included 80 patients with schizophrenia spectrum disorder, with 40 patients receiving clozapine and 40 receiving other second-generation antipsychotics. Hepatic steatosis and fibrosis were quantified noninvasively using transient elastography (Fibroscan) to measure the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. The participants were also evaluated for anthropometry and metabolic abnormalities. RESULTS: In the whole study sample, the prevalence was 37.5%, 33.75%, 33.75%, and 28.75% for metabolic syndrome, hepatic steatosis, MAFLD, and hepatic fibrosis, respectively. Compared with other antipsychotics, patients receiving clozapine had a higher prevalence of hepatic fibrosis and MAFLD. CONCLUSION: The present study suggests that about one-third of the schizophrenia patients on antipsychotics have hepatic steatosis and MAFLD and slightly more than one-fourth have hepatic fibrosis. These findings underscore the critical need for hepatic monitoring, including steatosis assessment, in patients receiving high-metabolic-risk antipsychotics.