Incidence of non-alcoholic fatty liver disease and metabolic dysfunction in first episode schizophrenia and related psychotic disorders: a 3-year prospective randomized interventional study.
RATIONALE
Patients with schizophrenia spectrum disorders have increased morbidity and mortality, largely due to cardiovascular disease, which is associated with antipsychotic treatment.


OBJECTIVES
Because of the link between cardiometabolic risk, non-alcoholic fatty liver disease (NAFLD), and antipsychotics, we aimed to investigate the development of NAFLD during the first 3 years of antipsychotic treatment in first episode non-affective psychosis patients.


RESULTS
A sample of 191 subjects was included in final analyses, randomly assigned to aripiprazole (N = 83), risperidone (N = 12), quetiapine (N = 46), and ziprasidone (N = 50). At intake, 180 patients were antipsychotic naïve. The NAFLD fibrosis score, FIB-4 score, and the fatty liver index (FLI) were calculated at baseline, at 3 months, and then yearly for 3 years. None of the patients showed significant liver fibrosis according to the mentioned scores at baseline, prior to randomization. At 3 years follow-up, 25.1 % individuals showed a FLI score ≥60, which is a predictor of steatosis. Of the individuals considered indeterminate at baseline, 64.7 % developed a FLI score ≥60 and only 16.6 % who had a FLI score <30 at baseline, showed a FLI score predictor of steatosis at endpoint. The FLI score ≥60 at endpoint was associated with an increase of more than 7 % of the body mass index (FLI score ≥ 60, 91.7 %; FLI < 60, 55.9 %; p < 0.001), increased triglyceride levels (FLI score ≥ 60, 54.2 %; FLI < 60, 5.6 %; p < 0.001), decreased HDL levels (FLI score ≥ 60, 41.7 %; FLI < 60, 17.5 %; p = 0.001), hypertension (FLI score ≥ 60, 19.5 %; FLI < 60, 4.5 %; p = 0.002), and waist circumference increase (steatosis 68.8 %; FLI < 60, 14.0 %; p < 0.001).


CONCLUSIONS
Our results support the importance of assessing the potential development of NAFLD in schizophrenia spectrum patients receiving antipsychotic medication.
['Morlán-Coarasa|María José|MJ|', 'Arias-Loste|María Teresa|MT|', 'Ortiz-García de la Foz|Víctor|V|', 'Martínez-García|Obdulia|O|', 'Alonso-Martín|Carmen|C|', 'Crespo|Javier|J|', 'Romero-Gómez|Manuel|M|', 'Fábrega|Emilio|E|', 'Crespo-Facorro|Benedicto|B|']
D000328:Adult D014150:Antipsychotic Agents D000068180:Aripiprazole D005260:Female D006801:Humans D015994:Incidence D008297:Male D008659:Metabolic Diseases D008875:Middle Aged D065626:Non-alcoholic Fatty Liver Disease D010879:Piperazines D011446:Prospective Studies D011618:Psychotic Disorders D000069348:Quetiapine Fumarate D018967:Risperidone D012559:Schizophrenia D013844:Thiazoles D055815:Young Adult
Antipsychotics Cardiometabolic risk Psychosis Hepatic steatosis Lipids Metabolic syndrome