稳定型精神分裂症住院患者中肌肉减少性肥胖与认知功能之间的关系。

The relationship between sarcopenic obesity and cognitive functionality among inpatients with stable schizophrenia.

作者信息

Guo Yan, Wu Jianfei, Lei Xiuping, Zhang Hongli, Wang Binyou, Liu Yu, Xu Maoya, Wang Yilin, Tan Youguo

机构信息

Department of Psychiatry, the Zigong Affiliated Hospital, Southwest Medical University, Zigong, Sichuan, China.

Zigong Institute of Brain Science, Zigong Mental Health Center, the Zigong Affiliated Hospital, Southwest Medical University, Zigong, Sichuan, China.

出版信息

PLoS One. 2025 Aug 18;20(8):e0330453. doi: 10.1371/journal.pone.0330453. eCollection 2025.

DOI:10.1371/journal.pone.0330453

PMID:40824937

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12360547/

Abstract

BACKGROUND AND OBJECTIVES

Patients with schizophrenia face an elevated risk of sarcopenic obesity (SO) due to antipsychotic-induced metabolic dysfunction, physical inactivity, and nutritional deficiencies. Although recent studies suggest an association between SO and cognitive decline, its specific impact on cognitive function in schizophrenia remains to be fully elucidated. This study aimed to evaluate the diagnostic concordance between the European Society for Clinical Nutrition and Metabolism/European Association for the Study of Obesity (SOESPEN) criteria and its modified version (SOESPEN-M), and to examine their respective associations with cognitive function in inpatients with stable schizophrenia.

METHODS

In this cross-sectional analysis, 228 adults with stable schizophrenia were recruited. SO was diagnosed using two definitions: SOESPEN (excess adiposity, low muscle mass-to-weight ratio, and reduced handgrip strength) and SOESPEN-M (BMI-adjusted muscle mass threshold). Cognitive function was assessed using the Montreal Cognitive Assessment-Chinese version (MoCA-C). Multivariate linear regression models were employed to evaluate associations between SO and MoCA-C scores, adjusting for relevant demographic, clinical, and comorbidity-related variables.

RESULTS

SO prevalence was 17.1% under both diagnostic criteria, with moderate inter-criteria agreement (κ = 0.660). Sex-stratified analyses revealed divergent diagnostic trends: in males, SO prevalence increased from 15.9% (SOESPEN) to 22.5% (SOESPEN-M; κ = 0.698); in females, prevalence decreased from 18.9% to 8.9% (κ = 0.590). Across both criteria, SO groups demonstrated significantly lower MoCA-C scores (males: 16 vs 20, p = 0.045 for SOESPEN; 13 vs 21, p < 0.001 for SOESPEN-M; females: 11 vs 17, p = 0.009 for SOESPEN; 10.5 vs 17, p = 0.036 for SOESPEN-M). Multivariate analysis confirmed that SOESPEN-M-defined SO was independently associated with lower MoCA-C scores in males (β = -2.71, 95% CI: -5.08 to -0.33, p = 0.027).

CONCLUSION

Our results demonstrate that SO defined by SOESPEN-M criteria is significantly associated with cognitive impairment in male inpatients with stable schizophrenia.

摘要

背景与目的

由于抗精神病药物引起的代谢功能障碍、身体活动不足和营养缺乏，精神分裂症患者患肌少症性肥胖（SO）的风险升高。尽管最近的研究表明SO与认知功能下降之间存在关联，但其对精神分裂症患者认知功能的具体影响仍有待充分阐明。本研究旨在评估欧洲临床营养与代谢学会/欧洲肥胖研究协会（SOESPEN）标准及其修订版（SOESPEN-M）之间的诊断一致性，并研究它们与稳定期精神分裂症住院患者认知功能的各自关联。

方法

在这项横断面分析中，招募了228名稳定期精神分裂症成年患者。使用两种定义诊断SO：SOESPEN（肥胖、低肌肉质量与体重比以及握力降低）和SOESPEN-M（BMI调整后的肌肉质量阈值）。使用蒙特利尔认知评估中文版（MoCA-C）评估认知功能。采用多变量线性回归模型评估SO与MoCA-C评分之间的关联，并对相关人口统计学、临床和合并症相关变量进行调整。

结果

两种诊断标准下的SO患病率均为17.1%，标准间一致性中等（κ = 0.660）。按性别分层分析显示出不同的诊断趋势：在男性中，SO患病率从15.9%（SOESPEN）增加到22.5%（SOESPEN-M；κ = 0.698）；在女性中，患病率从18.9%降至8.9%（κ = 0.590）。在两种标准下，SO组的MoCA-C评分均显著较低（男性：SOESPEN时为16分对20分，p = 0.045；SOESPEN-M时为13分对21分，p < 0.001；女性：SOESPEN时为11分对17分，p = 0.009；SOESPEN-M时为10.5分对17分，p = 0.036）。多变量分析证实，SOESPEN-M定义的SO与男性较低的MoCA-C评分独立相关（β = -2.71，95%CI：-5.08至-0.33，p = 0.027）。