Cardiovascular

The association between metabolic dysfunction-associated fatty liver disease and left ventricular mass index in patients with schizophrenia with long-term hospitalization.

Li J, Ma Y, Wang Y, Wu Q • Frontiers in endocrinology • 2026

PubMed 42712586 DOI 10.3389/fendo.2026.1919402

TL;DR

In long-term hospitalized patients with schizophrenia, MAFLD was prevalent in 53.7% of cases and was significantly associated with higher left ventricular mass index, with hypertension serving as a key mediator accounting for 29.8% of the total effect.

Key Findings

Results

MAFLD was identified in more than half of long-term hospitalized patients with schizophrenia.

231 of 430 patients (53.7%) were diagnosed with MAFLD via ultrasound.
The study population consisted exclusively of long-term hospitalized patients with schizophrenia.
Demographic, clinical, metabolic, and comorbidity data were collected alongside echocardiographic and ultrasound assessments.

Results

Patients with MAFLD had significantly higher left ventricular mass index compared to those without MAFLD.

Mean LVMI was 78.79 g/m² in patients with MAFLD versus 73.95 g/m² in those without MAFLD.
The mean difference was 4.84 g/m² (95% CI: 1.2–8.5, p=0.009).
LVMI was assessed using echocardiography.
Spearman correlation analysis confirmed a positive association between MAFLD and LVMI (r=0.126, p=0.009).

Results

MAFLD remained positively associated with LVMI after adjusting for age, sex, and hypertension in multivariate regression analysis.

Multivariate regression yielded β=3.53 (95% CI: 0.49–6.57, p=0.023).
Covariates adjusted for included age, sex, and hypertension.
All analyses were conducted using R with a two-tailed significance level of α=0.05.

Results

MAFLD had a significant total effect on LVMI in mediation analysis, but its direct effect was not statistically significant after accounting for hypertension as a mediator.

Total effect of MAFLD on LVMI was 4.178 (95% CI: 1.02–7.34, p=0.010).
The direct effect of MAFLD on LVMI after accounting for hypertension was β=2.618 (95% CI: -0.54–5.78, p=0.104), which was not statistically significant.
Bias-corrected bootstrap mediation analysis was used to assess mediation.
Fasting blood glucose was also examined as a potential mediator.

Results

Hypertension served as a significant mediator of the relationship between MAFLD and LVMI, accounting for 29.8% of the total effect.

The indirect effect of MAFLD on LVMI through hypertension was 1.244 (95% CI: 0.35–2.14, p=0.007).
Hypertension accounted for 29.8% of the total effect of MAFLD on LVMI.
Bias-corrected bootstrap mediation analysis was used to quantify the mediating role.
These findings suggest the association between MAFLD and cardiac structural remodeling is largely explained by hypertensive pathways.

What This Means

This research suggests that among people with schizophrenia who have been hospitalized for a long time, fatty liver disease (specifically a type called MAFLD) is very common—affecting more than half of the 430 patients studied—and is linked to changes in heart structure. Patients with fatty liver disease had measurably larger and heavier left ventricles (the heart's main pumping chamber) compared to those without the condition. An enlarged left ventricle is a known indicator of increased cardiovascular risk and can eventually lead to heart failure. The study also found that much of the connection between fatty liver disease and heart structural changes appears to work through high blood pressure (hypertension). Specifically, hypertension accounted for nearly 30% of the total relationship between MAFLD and left ventricular changes. This means that fatty liver disease may raise the risk of heart remodeling partly by contributing to or worsening high blood pressure, which then stresses the heart over time. This research suggests that for people with schizophrenia receiving long-term institutional care—a group already at elevated cardiovascular risk due to antipsychotic medications, limited physical activity, and other lifestyle factors—routine screening for fatty liver disease and high blood pressure could be especially important. Identifying and managing these conditions early may help reduce the risk of serious heart problems in this vulnerable population.

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Citation

Li J, Ma Y, Wang Y, Wu Q. (2026). The association between metabolic dysfunction-associated fatty liver disease and left ventricular mass index in patients with schizophrenia with long-term hospitalization.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1919402

Key Findings

What This Means

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