Skip to main content
SpringerLink
Log in

Liver disease prevalence and severity in people with serious mental illness: a cross-sectional analysis using non-invasive diagnostic tools

Hepatology International volume 15, pages 812–820 (2021)Cite this article

Abstract

Background/purpose of the study

Little is known about all-cause liver disease in people with serious mental illness (SMI), despite heightened risk factors. We, therefore, prospectively assessed liver disease by etiology and severity in a cross-sectional cohort of people with SMI at a tertiary health service.

Methods

We recruited 255 people with SMI between August 2019 and March 2020. Liver disease data were derived from structured interview, medical records, biochemical and BBV serological analyses, and vibration-controlled transient elastography (VCTE). Steatosis was determined using a threshold of ≥ 248 db/m via the controlled attenuation parameter (CAP) on VCTE. Liver disease prevalence was assessed descriptively, and predictors of metabolic-dysfunction associated fatty liver disease (MAFLD) analyzed using linear regression and multivariable analysis. Best fit modeling of non-invasive screening tests for MAFLD was also assessed.

Results

Valid VCTE was obtained for 252 (98.9%) participants. Median age was 40 years (IQR 31–49) with male predominance (65.9%). Hepatitis C Virus (HCV) seroprevalence was 14.7% (37/252), with four new viremic cases identified. Hepatic steatosis was diagnosed in 61.5% (155/252) of participants, with MAFLD criteria met in 59.9% (151/252) of cases. Clozapine and paliperidone were associated with hepatic steatosis (CAP + 23.3 db/m, p 0.013 and CAP + 25.5, p 0.037, respectively). Advanced liver disease, defined by LSM ≥ 8.2 kPa, was identified in 26 individuals (10.3%). MAFLD compared to no MAFLD was associated with more advanced liver disease (5.3 kPa, 4.3–6.5 versus 4.9 kPa, 3.9–5.6, p < 0.001).

Conclusion

Liver disease is common in people with SMI and should be screened for as part of standard physical health assessment.

Graphic abstract

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

Data availability

Deidentified data will be provided to authorized academic partners upon written request.

References

  1. Hughes E, Bassi S, Gilbody S, Bland M, Martin F. Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness: a systematic review and meta-analysis. Lancet Psychiatry 2016;3(1):40–48

    Article  Google Scholar 

  2. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990;264(19):2511–2518

    Article  CAS  Google Scholar 

  3. Carrier P, Debette-Gratien M, Girard M, Jacques J, Nubukpo P, Loustaud-Ratti V, et al. Liver illness and psychiatric patients. Hepat Mon 2016;16(12):e41564

    Article  Google Scholar 

  4. Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol 2015;62(1 Suppl):S47–S64

    Article  Google Scholar 

  5. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M, et al. Global epidemiology of nonalcoholic fatty liver disease—meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64(1):73–84

    Article  Google Scholar 

  6. Sokal J, Messias E, Dickerson FB, Kreyenbuhl J, Brown CH, Goldberg RW, et al. Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services. J Nerv Ment Dis 2004;192(6):421–427

    Article  Google Scholar 

  7. Piatt EE, Munetz MR, Ritter C. An examination of premature mortality among decedents with serious mental illness and those in the general population. Psychiatr Serv 2010;61(7):663–668

    Article  Google Scholar 

  8. Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut 2017;66(6):1138–1153

    Article  Google Scholar 

  9. Parabiaghi A, Bonetto C, Ruggeri M, Lasalvia A, Leese M. Severe and persistent mental illness: a useful definition for prioritizing community-based mental health service interventions. Soc Psychiatry Psychiatr Epidemiol 2006;41(6):457–463

    Article  Google Scholar 

  10. Bedogni G, Bellentani S, Miglioli L, Masutti F, Passalacqua M, Castiglione A, et al. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 2006;6:33

    Article  Google Scholar 

  11. Eslam M, Newsome PN, Anstee QM, Targher G, Gomez MR, Zelber-Sagi S, et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol 2020;73(1):202–209

    Article  Google Scholar 

  12. Karlas T, Petroff D, Sasso M, Fan JG, Mi YQ, de Lédinghen V, et al. Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol 2017;66(5):1022–1030

    Article  Google Scholar 

  13. Eddowes PJ, Sasso M, Allison M, Tsochatzis E, Anstee QM, Sheridan D, et al. Accuracy of fibroscan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology 2019;156(6):1717–1730

    Article  Google Scholar 

  14. Australian Institute of Health and Welfare. Canberra: AIHW. 2019. https://www.aihw.gov.au/reports-data/australias-welfare/australias-welfare-snapshots. Accessed Aug 2020

  15. Australian Bureau of Statistics [website]. Migration, Australia. 2019. https://www.abs.gov.au/statistics/people/population/migration-australia/2018-19. Accessed 12 July 2020

  16. De Hert M, Cohen DA, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei DM, et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 2011;10(2):138–151

    Article  Google Scholar 

  17. Farrell A, Magliano D, Shaw J, Thompson A, Croagh C, Ryan M, et al. Non-alcoholic fatty liver disease is a big problem in Australia: analysis from the AusDiab cohort [Abstract]. J Gastroenterol Hepatol 2020;35(Suppl. 1):34–104

    Google Scholar 

  18. Petta S, Di Marco V, Pipitone RM, Grimaudo S, Buscemi C, Craxì A, et al. Prevalence and severity of nonalcoholic fatty liver disease by transient elastography: genetic and metabolic risk factors in a general population. Liver Int 2018;38(11):2060–2068

    Article  CAS  Google Scholar 

  19. Teeratorn N, Piyachaturawat P, Thanapirom K, Chaiteerakij R, Sonsiri K, Komolmit P, et al. Screening for non-alcoholic fatty liver disease in community setting: a cohort study using controlled attenuation parameter-transient elastography. JGH Open 2020;4(2):245–250

    Article  Google Scholar 

  20. Yan J, Hou C, Liang Y. The prevalence and risk factors of young male schizophrenics with non-alcoholic fatty liver disease. Neuropsychiatr Dis Treat 2017;13:1493–1498

    Article  CAS  Google Scholar 

  21. Mahady SE, Gale J, Macaskill P, Craig JC, George J, et al. Prevalence of elevated alanine transaminase in Australia and its relationship to metabolic risk factors: a cross-sectional study of 9,447 people. J Gastroenterol Hepatol 2017;32(1):169–176

    Article  CAS  Google Scholar 

  22. Soliman HM, Wagih HM, Algaidi SA, Hafiz AH. Histological evaluation of the role of atypical antipsychotic drugs in inducing non-alcoholic fatty liver disease in adult male albino rats (light and electron microscopic study). Folia Biol (Praha) 2013;59(5):173–180

    CAS  Google Scholar 

  23. Weston-Green K, Babic I, De Santis M, Pan B, Montgomery MK, Mitchell T, et al. Disrupted sphingolipid metabolism following acute clozapine and olanzapine administration. J Biomed Sci 2018;25(1):40

    Article  Google Scholar 

  24. Morlán-Coarasa MJ, Arias-Loste MT, de la Foz VO, Martínez-García O, Alonso-Martín C, Crespo J, et al. Incidence of non-alcoholic fatty liver disease and metabolic dysfunction in first episode schizophrenia and related psychotic disorders: a 3-year prospective randomized interventional study. Psychopharmacology 2016;233(23–24):3947–3952

    Article  CAS  Google Scholar 

  25. Teff KL, Rickels MR, Grudziak J, Fuller C, Nguyen HL, Rickels K, et al. Antipsychotic-induced insulin resistance and postprandial hormonal dysregulation independent of weight gain or psychiatric disease. Diabetes 2013;62(9):3232–3240

    Article  CAS  Google Scholar 

  26. MacLachlan J, Thomas L, Cowie C. Hepatitis C Mapping Project: estimates of geographic diversity in chronic hepatitis C prevalence, diagnosis, monitoring and treatment—National Report 2016. Sydney: ASHM, 2018. https://ashm.org.au/products/product/Viral-Hepatitis-Mapping-Project-2017. Accessed May 2020

  27. Australian Institute of Health and Welfare. Alcohol, tobacco & other drugs in Australia. 2020. https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia. Accessed 25 Sept 2020

  28. Lin S, Huang J, Wang M, Kumar R, Liu Y, Liu S, et al. Comparison of MAFLD and NAFLD diagnostic criteria in real world. Liver Int 2020;40(9):2082–2089

    Article  Google Scholar 

  29. Dulai PS, Singh S, Patel J, Soni M, Prokop LJ, Younossi Z, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology 2017;65(5):1557–1565

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Road, Clayton, VIC, 3168, Australia

    Michael Rudi Braude, Anouk Dev & William Sievert

  2. Department of Gastroenterology and Hepatology, Eastern Health, 5 Arnold Street, Box Hill, VIC, 3128, Australia

    Danny Con

  3. Department of Gastroenterology and Hepatology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia

    John Lubel

  4. Department of Mental Health, Monash Health, 126-128 David Street, Dandenong, VIC, 3175, Australia

    Hoang-Thy Nguyen, Shipra Sharmamiglani & David Clarke

  5. School of Clinical Sciences, Monash University, Wellington Road, Clayton, VIC, 3800, Australia

    John Lubel, Anouk Dev & William Sievert

  6. Psychological Medicine, Monash University, Wellington Road, Clayton, VIC, 3800, Australia

    David Clarke

Authors
  1. Michael Rudi Braude
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Danny Con
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Lubel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abhijit Bidwai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hoang-Thy Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shipra Sharmamiglani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anouk Dev
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. William Sievert
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualisation: MRB and AD; Methodology: MRB; Recruitment: MRB, AB, SSand T-HN; Formal analysis and investigation: MRB and DC; Writing—original draft preparation: MRB; Writing—review and editing: MRB, JL and WS; Funding acquisition: N/A; Resources: N/A; Supervision: JL, AD and WS; Project oversight: DC, AD and WS.

Corresponding author

Correspondence to Michael Rudi Braude.

Ethics declarations

Conflict of interest

Michael Rudi Braude, Danny Con, John Lubel, Abhijit Bidwai, Hoang-Thy Nguyen, Shipra Sharmamiglani, David Clarke, Anouk Dev and William Sievert declares that they have nil financial or institution disclosures or conflicts of interest.

Ethical approval

The study was approved by the Monash Health Human Research and Ethics Committee (RES-19-0000208A, HREC 52541) and was conducted in accordance with the Australian National Statement on Ethical Conduct in Human Research.

Consent to participate

Written consent was obtained from all recruited participants in accordance with the ethics-approved study protocol.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Braude, M.R., Con, D., Lubel, J. et al. Liver disease prevalence and severity in people with serious mental illness: a cross-sectional analysis using non-invasive diagnostic tools. Hepatol Int 15, 812–820 (2021). https://doi.org/10.1007/s12072-021-10195-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-021-10195-6

Keywords

search

Navigation