Researchers urge metabolic screening in psychiatric care regardless of BMI

A— new hospital study of 1,072 adults with bipolar disorder found that metabolic dysfunction–associated fatty liver disease (MAFLD) shows up not only in patients with excess weight but also in those who are lean, with clear clinical risk markers that doctors can track.

Researchers at Anhui Medical University and Anhui Mental Health Center reviewed inpatient records from adults ages 18 to 60 and sorted them by body mass index. Patients with BMI under 24 kg/m² were classified as lean; those 24 or higher were overweight or obese. 

The team then compared liver ultrasound findings and metabolic measures to determine who had MAFLD and which factors were linked to it. The paper was published July 30, 2025, in Frontiers in Endocrinology.

The gap was stark across weight groups. Among lean patients with bipolar disorder, 10.5% had MAFLD. In the overweight/obese group, 76.3% had the disease (p<0.001). While obesity remained the strongest signal, the lean subgroup still showed a meaningful burden, suggesting clinicians should not rely on weight alone to rule out fatty liver in psychiatric settings.

In the analyses, several routine blood markers stood out. Higher fasting blood glucose, elevated triglycerides, and higher gamma-glutamyl transferase (GGT)—a liver enzyme—were associated with greater odds of MAFLD. High-density lipoprotein (HDL) cholesterol, by contrast, appeared protective. Female sex and diabetes status also tracked with higher risk. These are all tests commonly available in standard panels, making the findings practical for day-to-day screening.

The study is retrospective and cannot prove cause and effect. But its size and focus on hospitalized patients with bipolar disorder—who often face sleep disruption, medication side effects, and lifestyle stressors that raise metabolic risk—add weight to the results. 

Fatty liver disease tied to metabolic dysfunction can progress silently for years, moving from simple fat buildup to inflammation and scarring. 

In people with serious mental illness, that trajectory can be accelerated by insulin resistance, dyslipidemia, and irregular routines. The simple takeaway here: if a patient has bipolar disorder, check the labs—even if the patient looks thin.

The paper’s novelty lies in quantifying how often MAFLD appears in lean inpatients with bipolar disorder and in mapping a short list of lab-based predictors that are easy to monitor. Think of HDL as a “shield,” while fasting glucose, triglycerides, and GGT act like “red flags.” That frame can help non-specialists prioritize who needs imaging, counseling, or medication review.

The authors call for prospective studies to test whether targeted interventions—dietary counseling, exercise programs geared to psychiatric units, and careful selection of mood stabilizers and antipsychotics—can reduce MAFLD rates.

For now, they recommend routine metabolic screening in bipolar disorder, with special attention to fasting glucose, triglycerides, GGT, HDL, and diabetes history, regardless of body size.

Source: Lei W., Li J., Liu Y., Wang Y., Wu Q. “Prevalence and risk factors of metabolic associated fatty liver disease in patients with bipolar disorder: a retrospective cross-sectional study.” Frontiers in Endocrinology, published July 30, 2025.