Adiposity in schizophrenia: A systematic review and meta‐analysis

Objective 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. Methods 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. Results 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 to 5.44), SAT (MD = 24.29 cm2 ; 95%CI: 2.97 to 45.61) and VAT (MD = 33.73 cm2 , 95%CI: 4.19 to 63.27) compared to healthy controls. AP treatment was found to increase SAT (MD = 31.98 cm2 ; 95%CI: 11.33 to 52.64) and VAT (MD = 16.30 cm2 ; 95%CI: 8.17 to 24.44) with no effect on %BF. However, change in %BF was higher for AP-free/AP-naive patients compared to treated patients. Conclusion Our findings indicate that patients with SCZ spectrum disorders have greater adiposity than healthy controls, which is increased by AP treatment. Young, AP-naive 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.