Prevalence of nonalcoholic fatty liver disease in mental disorder inpatients in China: an observational study

Abstract

Background and Purpose Non-alcoholic fatty liver disease (NAFLD) is becoming the most common liver disease in China. However, the understanding of NAFLD prevalence among Chinese mental disorder inpatients remains insufficient. We aim to investigate the prevalence of NAFLD among mental disorder inpatients in Beijing, China. Methods In this observational study, we included 66,273 mental disorder inpatients between 2014 and 2018, including inpatients with schizophrenia, bipolar disorder, depressive disorder and other mental disorders. Data were obtained from electronic health records of 19 specialized psychiatric hospitals in Beijing. NAFLD was defined by ICD-10 code, excluding other causes of liver disease. We calculated the overall and annual prevalence rates of NAFLD from 2014 to 2018, and compared NAFLD prevalence between sexes, age groups, mental disorders types, antipsychotics use, and comorbidities. Multivariable logistic regression was used to examine risk factors associated with NAFLD. Subgroup analysis was performed in different mental disorder types. Results The prevalence of NAFLD was 17.63% (95% CI 17.34–17.92%) in mental disorder inpatients, increasing from 16.88% in 2014 to 19.07% in 2018. The NAFLD prevalence in participants with schizophrenia (22.44%) was higher than that in participants with bipolar disorder (17.89%), depressive disorder (12.62%), and other mental disorders (12.99%). Women had similar or even higher NAFLD prevalence than men after 50 years. Men, 50–59 years (aOR = 1.71), schizophrenia (aOR = 1.56), bipolar disorder (aOR = 1.47), antipsychotics use (aOR = 1.46), hypertension (aOR = 1.50), diabetes (aOR = 1.83), dyslipidemia (aOR = 2.50) were risk factors for NAFLD in mental disorder inpatients. Conclusion NAFLD was common among Chinese mental disorder inpatients, and increased over years. The prevalence of NAFLD was higher among men, old women, inpatients with schizophrenia, bipolar disorder, antipsychotics, hypertension, diabetes, and dyslipidemia. Fatty liver disease among mental disorder population warrants the attention of psychiatric specialists and health policy-makers.

Is Fatty Liver Associated With Depression? A Meta-Analysis and Systematic Review on the Prevalence, Risk Factors, and Outcomes of Depression and Non-alcoholic Fatty Liver Disease

“…While studies have been conducted to describe the relationship between depression and NAFLD, previous literature has reported conflicting results, varying from a strong association ( 17 , 18 ) to no association ( 19 , 20 ). A study involving a database of 567 patients with biopsy-proven NAFLD estimated that 67.5% of patients had depressive symptoms and showed that they were associated with histological severity of NAFLD ( 21 ).…”

Gastrointestinal and liver disease in patients with schizophrenia: A narrative review

“…49.5% (100/202) of the schizophrenia group had steatosis on AUSS, compared with 20.1% (30/149) of the control group. Although NAFLD prevalence amongst inpatients with schizophrenia was not as high (22.44%) as in the aforementioned studies, in another 2021 Chinese study[ 19 ] comprising 66,273 patients with “mental disorders”, it was still higher than amongst those with bipolar affective disorder (17.89%), depressive disorder (12.62%) and other mental disorders (12.99%) and was demonstrated to be associated with antipsychotic treatment.…”

The development of the Metabolic-associated Fatty Liver Disease during pharmacotherapy of mental disorders - a review

“…However, after 50-60 years of age, NAFLD occurs at a higher rate in women [15,16]. In the Ma et al study, concerning the Asian population, a higher incidence of NAFLD was associated with schizophrenia and bipolar disorder to a greater extent than with other psychiatric disorders and also, like the above mental disorders, was correlated with the components of MetS [17]. In the population-cohort study, also in relation to the Asian population, Hsu et al observed, that patients with schizophrenia showed significantly higher morbidity and incidence of chronic liver disease than general population, and diabetes was a risk factor for developing chronic liver disease in patients with schizophrenia [1].…”

“…Almost ¾ of them were treated with neuroleptics. The use of antipsychotic drugs was associated with a 1.46 times higher incidence of NAFLD compared to no use of neuroleptic [17].…”

“…Jednakże, po 50-60 roku życia, NAFLD częściej występuje u kobiet [15,16]. W badaniu Ma i wsp., dotyczącym populacji azjatyckiej, wyższa częstość NAFLD wiązała się w większym stopniu ze schizofrenią i chorobą afektywną dwubiegunową niż z innymi zaburzeniami psychicznymi, a także, podobnie jak powyższe zaburzenia psychiczne, była skorelowana ze składowymi MetS [17]. W badaniu populacyjno-kohortowym Hsu i wsp., również w odniesieniu do populacji azjatyckiej, chorzy na schizofrenię wykazywali istotnie większą chorobowość i zapadalność na przewlekłą chorobę wątroby niż populacja ogólna, zaś czynnikiem ryzyka rozwoju przewlekłej choroby wątroby u pacjentów ze schizofrenią była cukrzyca [1].…”