Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Acta Psychiatr Scand. 2021 Dec;144(6):524-536. doi: 10.1111/acps.13365. Epub 2021 Sep 16.
Although a relationship between schizophrenia (SCZ), antipsychotic (AP) medication, and metabolic dysregulation is now well established, the effect of adiposity is less well understood. By synthesizing findings from imaging techniques that measure adiposity, our systematic review and meta-analysis (PROSPERO CRD42020192977) aims to determine the adiposity-related effects of illness and treatment in this patient population.
We searched MEDLINE, EMBASE, PsychINFO and Scopus for all relevant case-control and prospective longitudinal studies from inception until February 2021. Measures of adiposity including percent body fat (%BF), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) were analyzed as primary outcomes.
Our search identified 29 articles that used imaging methods to quantify adiposity among patients with SCZ spectrum disorders. Analyses revealed that patients have greater %BF (mean difference (MD) = 3.09%; 95% CI: 0.75-5.44), SAT (MD = 24.29 cm ; 95% CI: 2.97-45.61) and VAT (MD = 33.73 cm , 95% CI: 4.19-63.27) compared to healthy controls. AP treatment was found to increase SAT (MD = 31.98 cm ; 95% CI: 11.33-52.64) and VAT (MD = 16.30 cm ; 95% CI: 8.17-24.44) with no effect on %BF. However, change in %BF was higher for AP-free/AP-naïve patients compared to treated patients.
Our findings indicate that patients with SCZ spectrum disorders have greater adiposity than healthy controls, which is increased by AP treatment. Young, AP-naïve patients may be particularly susceptible to this effect. Future studies should explore the effect of specific APs on adiposity and its relation to overall metabolic health.
虽然精神分裂症（SCZ）、抗精神病药物（AP）和代谢失调之间的关系现在已经得到充分证实，但肥胖的影响还不太清楚。通过综合评估肥胖的影像学技术研究结果，我们的系统评价和荟萃分析（PROSPERO CRD42020192977）旨在确定该患者群体中疾病和治疗的肥胖相关影响。
我们检索了 MEDLINE、EMBASE、PsychINFO 和 Scopus 数据库，以获取从成立到 2021 年 2 月期间所有相关的病例对照和前瞻性纵向研究。身体脂肪百分比（%BF）、皮下脂肪组织（SAT）和内脏脂肪组织（VAT）等肥胖指标被分析为主要结局。
我们的检索共确定了 29 篇使用影像学方法来量化 SCZ 谱系障碍患者肥胖的文章。分析显示，患者的 %BF（平均差值（MD）=3.09%；95%置信区间：0.75-5.44）、SAT（MD=24.29cm；95%置信区间：2.97-45.61）和 VAT（MD=33.73cm；95%置信区间：4.19-63.27）均大于健康对照组。抗精神病药物治疗被发现会增加 SAT（MD=31.98cm；95%置信区间：11.33-52.64）和 VAT（MD=16.30cm；95%置信区间：8.17-24.44），但对 %BF 没有影响。然而，与接受治疗的患者相比，AP 无/AP 初治患者的 %BF 变化更高。
我们的研究结果表明，SCZ 谱系障碍患者的肥胖程度高于健康对照组，而这种肥胖程度会因抗精神病药物治疗而增加。年轻、AP 初治的患者可能特别容易受到这种影响。未来的研究应该探索特定抗精神病药物对肥胖的影响及其与整体代谢健康的关系。
