Clinical and metabolic associations of obesity and body mass index in antipsychotic-na?ve first-episode schizophrenia patients and nonadherent chronic patients

Aim: We investigated the association between obesity and body mass index (BMI) with Positive and Nega-tive Syndrome Scale (PANSS) psychopathology, age at disease onset, and parameters linked to the metabol-ic syndrome (fasting plasma lipid and glucose levels), among antipsychotic-naive first-episode schizophrenia (AN-FES) patients and nonadherent chronic schizophrenia individuals. Patients and methods: We recruited a total of 187 AN-FES patients or nonadherent chronic individuals who were treated at the Department of Psychiatry in the University Hospital Centre Sestre milosrdnice, Zagreb, Croatia, in 2015-2021. Clinical and anthropometric data together with plasma lipid and glucose parameters were collected immediately after patients' admission to the hospital. Patients were classified as obese with body mass index (BMI) >= 30, or as non-obese if overweight (BMI: 25 - 29.9) or of normal body weight (BMI: 18.5 - 24.9).Results: After controlling for the possible confounders we found that only BMI significantly predicted clinical and metabolic variables. Among AN-FES patients, higher BMI values predicted lower levels of HDL cholesterol (HDL-c), and higher ratios for LDL cholesterol (LDL-c)/HDL-c and triglyceride/HDL-c, while among nonadher-ent individuals, higher BMI values predicted higher number of psychotic episodes, and lower PANSS general psychopathology scores. The contribution of BMI ranged from approximately 5.8% to 29.4%, with the lowest contribution observed for number of psychotic episodes, and the highest contribution for the LDL-c/HDL-c ratio.Conclusion: Higher BMI contributes to an increased risk for dyslipidemia among AN-FES patients and to the higher number of psychotic episodes, and less severe clinical psychopathology among nonadherent chron-ic schizophrenia individuals.