Metabolic Dysfunction-Associated Steatotic Liver Disease in Schizophrenia: A Systematic Review and Meta-analysis
Abstract
Background: 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.
Objective: 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.
Methods: 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.
Results: 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…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 28,702 participants or records.
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