25
ANTHROPOMETRIC MEASUREMENTS PREDICT
LIVER STEATOSIS IN SCHIZOPHRENIC PATIENTS.
Santiago Rodríguez Villafuerte1, Roberta Goulart Rayn1, Cláudio Augusto Marroni1, Fernanda Branco2,
Luciano Selbach3, Marina Petrasi Guahnón3, Sabrina Alves Fernandes1*, Randhall Bruce Carteri4.
Abstract
Objectives
Schizophrenic patients present higher all-cause mortality when
compared to the general population, which could be associated
with an unhealthy lifestyle resulting in a high prevalence of metabolic
syndrome in these patients. Noteworthy, the metabolic effects of an
unhealthy lifestyle associated with antipsychotic drugs are risk factors
for non-alcoholic fatty liver disease development. Hence, the objective
of this study was to investigate the presence of steatosis in schizophrenic
patients under psychiatric treatment and its possible predictors.
Method
Observational study of 30 institutionalized schizophrenic patients.
Conrmation of steatosis was obtained by abdominal ultrasound
evaluation. Body composition and phase angle were obtained by
bioelectrical impedance. Anthropometric assessment and hand-grip
strength tests were also performed.
Results
A total of eleven patients (36.7 %) had diagnostic of steatosis. Most of
the patients (56.6%) were treated using between three to ve drugs,
and predominantly were using anti-psychotics (100%). The association
between body mass index and the presence of steatosis was signicant.
Steatosis patients had signicantly higher body mass index (p = 0.006),
abdominal perimeter (p = 0.012), arm perimeter (p = 0.006), and
adductor pollicis muscle (p = 0.014). No differences in hand grip strength
and other anthropometric characteristics were found.
Conclusion
This study shows a prevalence of hepatic steatosis of 36.7% in patients
with schizophrenia which was associated with body mass index. In
addition, abdominal perimeter, arm perimeter, adductor pollicis muscle,
and BMI were signicant predictors for the presence of steatosis. Future
multicentric studies could expand our results, which are important
especially for the south american population, where data is still scarce.
Revista Médica Vozandes
Volumen 34, Número 1, 2023
Keywords: hepatic diseases; non-alcoholic fatty liver disease, mental health; malnutrition..
OBSERVATIONAL STUDIES ARTÍCULO ORIGINAL
Citation: Rodríguez S, Goulart Rayn R,
Marroni CA, Branco F, Selbach L, Petrasi
Guahnón M, Alves Fernandes S, et al.
ANTHROPOMETRIC MEASUREMENTS
PREDICT LIVER STEATOSIS IN
SCHIZOPHRENIC PATIENTS. Rev Med
Vozandes. 2023; 34 (1): 25 - 31
1 Postgraduate Program in Medicine: Hepatology,
School of Medicine, Universidade Federal de Ciências
da Saúde de Porto Alegre (UFCSPA). Porto Alegre, RS,
Brazil.
2 Professor of Ultrasound in Hepatology at CETRUS
College. São Paulo, SP, Brazil.
3 Postgraduate Program in Epidemiology. Universi-
dade Federal de Rio Grande do Sul (UFRGS). Porto
Alegre, RS, Brazil.
4 Department of Nutrition. Centro Universitário Meto-
dista – IPA. Porto Alegre, RS, Brazil.
Rodríguez Villafuerte Santiago:
orcid.org/0000-0001-8610-3622
Goulart Rayn Roberta:
orcid.org/0000-0002-8492-8804
Marroni Cláudio Augusto:
orcid.org/0000-0002-1718-6548
Branco de Araújo Fernanda:
orcid.org/0000-0003-4833-5275
Selbach Luciano:
orcid.org/0000-0002-8073-9475
Petrase Guahnón Marina:
orcid.org/0000-0003-2178-314X
Alves Fernandes Sabrina:
orcid.org/0000-0001-8504-603X
Bruce Carteri Randhall:
orcid.org/0000-0003-4124-9470
*Corresponding author: Alves Fernandes Sabrina
E-mail: sabrinaafernandes@gmail.com
Este artículo está bajo una
licencia de Creative Com-
mons de tipo Reconocimien-
to – No comercial – Sin obras
derivadas 4.0 International.
Received: 18 – Apr – 2023
Accepted: 27 – Jun – 2023
Publish: 01 – Jul – 2023
Article history
Conflict of interest: The authors have full freedom
of manuscript preparation, and there were no potential
conicts of interest.
CRediT – Contributor Roles Taxonomy:
Conceptualización: RG – CAM – SA , Curación de
datos: SR – RG – FB – MP , Análisis formal: RG –
CAM – SA Investigación: RG – SA Metodología: RG
– CAM – SA Administración del proyecto: CAM – SA
Supervisión: CAM – SA Validación: RG – CAM – SA,
Visualización: todos los autores, Redacción – borrador
original: SR – CAM – SA Redacción – revisión y
edición: SR – CAM – SA
STROBE 2008 Check List statement: The author has real
the STROBE 2008 Check List and the manuscript was pre-
pared and revised according to the STROBE 2008 Checklist.
Financial disclosure: The authors have no nan-
cial relationships relevant to this article to disclose.
DOI: 10.48018/rmv.v34.i1.2
26 Revista Médica Vozandes
Volumen 34, Número 1, 2023
ANTHROPOMETRIC MEASUREMENTS PREDICT LIVER
STEATOSIS IN SCHIZOPHRENIC PATIENTS Rodríguez Villafuerte S, et al.
Resumo
MEDIDAS ANTROPOMÉTRICAS PREDIZEM
ESTEATOSE HEPÁTICA EM PACIENTES
ESQUIZOFRÊNICOS
Palavras-Chave: Hepato-
patias; Hepatopatia Gordu-
rosa não Alcoólica; Saúde
Mental; Desnutrição
INTRODUCTION
Schizophrenia (SZ) is characterized by delusions, hallucinations,
disorganized speech and behavior, and other symptoms that
cause social or occupational dysfunction. For a diagnosis,
symptoms must have been present for six months and include
at least one month of active symptoms (1). The World Health
Organization (WHO) highlights the recent global increase in the
prevalence of mental disorders, including schizophrenia due to
population growth and aging, leading to a special
initiative to advance in policies and interventions
to ensure quality of care for patients with impaired
mental health conditions (2). This epidemiologic
approach aims to avoid the occurrence of these
disorders, whilst reducing disease impacts, and
mitigating further associated comorbidities (2).
Objetivo
Pacientes esquizofrênicos apresentam maior mortalidade por todas as causas quando
comparados à população geral, o que pode estar associado a um estilo de vida pouco
saudável, resultando em uma alta prevalência de síndrome metabólica nesses pacientes.
Digno de nota, os efeitos metabólicos de um estilo de vida pouco saudável associado a drogas
antipsicóticas são fatores de risco para o desenvolvimento de doença hepática gordurosa não
alcoólica. Assim, o objetivo deste estudo foi investigar a presença de esteatose em pacientes
esquizofrênicos sob tratamento psiquiátrico e seus possíveis preditores.
Métodos
Estudo observacional de 30 pacientes esquizofrênicos institucionalizados. A conrmação da
esteatose foi obtida pela avaliação ultrassonográca abdominal. A composição corporal e
o ângulo de fase foram obtidos por impedância bioelétrica. Também foram realizados testes
antropométricos e de força de preensão manual.
Resultados
Um total de onze pacientes (36,7%) apresentaram diagnóstico de esteatose. A maioria dos
pacientes (56,6%) foi tratada usando entre três a cinco drogas, e predominantemente estavam
em uso de antipsicóticos (100%). A associação entre o índice de massa corporal e a presença
de esteatose foi signicativa. Os pacientes com esteatose apresentaram índice de massa
corporal signicativamente maior (p = 0,006), perímetro abdominal (p = 0,012), perímetro do
braço (p = 0,006) e músculo adutor do polegar (p = 0,014). Não foram encontradas diferenças
na força de preensão manual e outras características antropométricas.
Conclusão
Este estudo mostra uma prevalência de esteatose hepática de 36,7% em pacientes com
esquizofrenia que foi associada ao índice de massa corporal. Além disso, o perímetro
abdominal, o perímetro do braço, o músculo adutor do polegar e o IMC foram preditores
signicativos para a presença de esteatose. Futuros estudos multicêntricos poderiam ampliar
nossos resultados, que são importantes especialmente para a população sul-americana,
onde os dados ainda são escassos.
27
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Volumen 34, Número 1, 2023
Nevertheless, the considerable discrepancy of all-cause
mortality between schizophrenic patients compared to the
general population has worsened in recent decades. Hence,
it is important to investigate all aspects of metabolic health,
avoiding several associated comorbidities which could be
related to behavioral changes of patients with mental disorders
(3). Furthermore, the associated behavioral disturbances in
schizophrenia are associated with an unhealthy lifestyle due
to inappropriate dietary intake and decreased physical
activity levels resulting in a high prevalence of metabolic
syndrome in these patients (4). Also, the use of antipsychotic
drugs is also associated with the development of several
comorbidities such as obesity, hypertension, hyperlipidemia,
and insulin resistance (5). Noteworthy, the metabolic effects of
an unhealthy lifestyle associated with antipsychotic drugs are
risk factors for non-alcoholic fatty liver disease development (6).
Among liver diseases, Non-Alcoholic Fatty liver disease
(NAFLD) is the second most common, characterized by the
accumulation of triglycerides (TG) in liver cells, when this is
not caused by alcohol consumption, hepatitis C infection,
hereditary liver disease, or drug-induced liver disease (7).
Notably, NAFLD presents a wide spectrum, ranging from simple
steatosis to nonalcoholic steatohepatitis (NASH) which can
culminate in cirrhosis. Hepatic steatosis initially occurs when
the liver metabolizes the excess of free fatty acids which leads
to several mechanisms associated with hepatocyte damage
and brosis such as oxidative stress, increased inammatory
mediators, and dysregulated apoptosis (8). Hence, early
detection of steatosis is pivotal to ensure appropriate treatment
and improve the associated outcomes in schizophrenic
patients, considering the increased risk and pharmacological
treatments (9). Nevertheless, to the best of our knowledge,
only a few studies have aimed to analyze the prevalence of
NAFLD in schizophrenic patients. The prevalence of NAFLD
in young schizophrenic patients is higher than in the general
population (10). A recent robust observational study conducted
in Chinese schizophrenic patients showed a prevalence of 22%,
which is similar to the prevalence reported in a study in veterans
with schizophrenia (11, 12). Given together the links between
schizophrenia, unhealthy lifestyle habits, metabolic risk, and
NAFLD development, we aimed to investigate the presence of
steatosis in schizophrenic patients under psychiatric treatment
and its possible predictors.
METHODS
Population
This is an observational study, comprising a non-probabilistic
sample of patients diagnosed with schizophrenia from
AGAFAPE (Associação Gaúcha de Familiares de Pacientes
Esquizofrênicos), located at Porto Alegre, Brazil. The sample was
composed by convenience, including patients diagnosed with
schizophrenia, with no sex or age restrictions, whose alcohol
intake was limited to 40g/day, and which family signed an
informed consent form allowing participation. Following the
clinical evaluation, patients were divided in two groups: control
(n = 19) and steatosis (n = 11).
Clinical Evaluation
All patients underwent the evaluation of
steatosis performed by a qualied physician,
using a standardized abdominal ultrasound
(13). Body composition (fat-free mas an fat
max percentage) and phase angle (AF) were
obtained by bioelectrical impedance (BIA),
placing electrodes on the extremities of the
body (hand, wrist, foot and ankle), using the
Biodynamics® device, model 450 (14). Using a
plicometer (Cerscorf®) and anthropometric tape,
the triceps skinfold thickness (TST), arm perimeter
(AP), abdomen perimeter (ABP) and calf
perimeter (CP) were obtained. Adductor pollicis
muscle thickness was obtained with the Cerscorf®
brand plicometer, exerting continuous pressure
to pinch the adductor muscle at the apex of an
imaginary triangle formed by the extension of the
thumb and index nger of the patient’s dominant
hand, with three repetitions, using the average of
measurements (15). Also, the hand-grip strength was
obtained with a mechanical grip dynamometer
with an adjustable handle (Baseline® brand,
model Smedley Spring) after three measurements
separated by 30-second intervals. The result was
the highest registered value (15).
Statistical analysis
Quantitative variables were described by
the mean ± SD, and categorical variables by
absolute and relative frequencies. Associations
of categorical variables were assessed with the
Chi-square test and intergroup comparisons
were performed with the independent samples
t-test. Also, logistic regressions were performed
to evaluate the relationship of presence of
steatosis with several predictive variables. The
signicance level adopted was 5% (p ≤ 0.05)
and the analyses were performed using the SPSS
program version 22.0.
Ethical aspects
This study was approved by a local research
ethics committee and registered at
Plataforma Brasil (Registered Protocol number:
76641317.6.0000.5308) and was performed in
accordance with the ethical standards of the 2000
Declaration of Helsinki and followed the guidelines
for the publication of observational studies (16).
RESULTS
A total of thirty patients participated in the
study, with a mean age of 43.13 and with a
mean of 20 year of diagnostic conrmation of
schizophrenia. A total of eleven patients (36.7 %)
had diagnostic of steatosis. Most of the patients
(56.6%) were treated using between 3 to 5 drugs,
and all patients were using anti-psychotics
OBSERVATIONAL STUDIES ARTÍCULO ORIGINAL
28 Revista Médica Vozandes
Volumen 34, Número 1, 2023
(100%). The association between the use of antipsychotics and
the presence of steatosis tended towards signicance (x2 =
5.562, p = 0.06; Likelihood Ratio = 6.481, p = 0.03; Cramer’s V =
0.43, p = 0.62).
Table 1. Sample characteristics (n = 30)
n %
Sex Male 21 70.0
Female 930.0
Steatosis diagnostic 019 63.3
1 11 36.7
Number of medications 1 3 10.0
25 16.7
3 7 23.3
4 4 13.3
5 6 20.0
626.7
726.7
81 3.3
Antipsychotics 120 66.7
2 8 26.7
326.7
Antidepressants 0 17 56.7
1 11 36.7
2 2 6.7
Anticonvulsants 019 63.3
1930.0
2 2 6.7
Anxiolytics 020 66.7
1930.0
21 3.3
Other medications 012 40.0
1930.0
23 10.0
3 6 20.0
Source: Authors
The evaluated variables are shown in Table 2. Steatosis patients
had signicantly higher body mass index (p = 0.006), abdominal
perimeter (p = 0.012), arm perimeter (p = 0.006), and adductor
pollicis muscle (p = 0.014). No differences in hand grip strength
and other anthropometric characteristics were found.
Regarding the relationship of the selected variables with the
presence of steatosis, the logistic regression results is showed
in Table 3. The odds ratio indicated that each unitary gain in
abdominal perimeter, arm perimeter, adductor
pollicis muscle, and BMI increases the chances of
the presence of steatosis in schizophrenic patients.
DISCUSSION
The main objective of the present study was to
investigate the presence of hepatic steatosis in
schizophrenic patients undergoing treatment.
The results indicate a prevalence of hepatic
steatosis in 36.7% of the evaluated patients.
In addition, the association of antipsychotic
drug use with the presence of hepatic steatosis
tended to be signicant. Also, each unitary gain
in the abdominal perimeter, arm perimeter,
adductor pollicis muscle, and BMI increases
the chances of the presence of steatosis in
schizophrenic patients.
The nonalcoholic fatty liver disease (NAFLD)
represents the most common chronic liver disease
in the world, it is a complex metabolic-inammatory
disease associated with poor health outcomes
and decreased quality of life (17, 18). Further, NAFLD
represents the hepatic manifestation of metabolic
syndrome – a group of cardiometabolic
components present in an important portion
of patients with NAFLD (18). Moreover, recent
evidence suggests that patients with psychiatric
disorders have some predisposition to the
development of NAFLD, among the mechanisms
implicated in the development of the disease we
can indicate: dysregulation of the hypothalamic-
pituitary-adrenal axis, metabolic syndrome, as
well as metabolic side effects of antipsychotic
medication - hyperglycemia and dyslipidemia –
components of metabolic syndrome, especially
with clozapine and olanzapine (17, 19).
Importantly, the prevalence of diagnosed
mental disorders is 13% of the estimated world
population, and Brazil is the second country with
the highest prevalence of mental disorders (20). In
addition, mental disorders account for 21% of all
disability-adjusted life years in Brazil (21), and recent
epidemiological analysis indicates a higher
occurrence of schizophrenia compared to other
mental disorders in the whole population, and
more specically in male patients (22). Similarly,
epidemiological data indicate that NAFLD
affects about 25% of the world’s population, and
is more prevalent in Western countries; however,
a signicant increase in prevalence is observed
among countries in other parts of the world, such
as the Asian continent (12).
Nevertheless, the present study showed a
prevalence of 36.7% of hepatic steatosis in
schizophrenic patients. Considering data from
different studies, only a few studies evaluated
ANTHROPOMETRIC MEASUREMENTS PREDICT LIVER
STEATOSIS IN SCHIZOPHRENIC PATIENTS Rodríguez Villafuerte S, et al.
29
Revista Médica Vozandes
Volumen 34, Número 1, 2023
OBSERVATIONAL STUDIES ARTÍCULO ORIGINAL
hepatic health in schizophrenic patients, focusing on NAFLD.
For example, an observational study including patients with
schizophrenia and other common mental disorders showed
an overall NAFLD prevalence of 17.63%, which was higher in
schizophrenic patients (22.44%) when compared to other
disorders, indicating that schizophrenia is a risk factor for NAFLD,
alongside antipsychotics use, hypertension, diabetes, and
dyslipidemia (12). Likewise, a study with 145 patients diagnosed
with schizophrenia, presenting mean age of 42.2 years and 14.8
years since diagnostic conrmation reported a prevalence
of 21.4%, and the association between the steatosis with the
presence of metabolic syndrome, albeit it was
not associated with BMI or other variables (23).
Furthermore, in the present study the association
between body mass index and the presence
of steatosis was signicant, and steatosis
patients had signicantly higher body mass
index, abdominal perimeter, arm perimeter,
and adductor pollicis muscle. Notably, simple
anthropometric parameters, such as BMI and
waist circumference, are useful for predicting
Table 2. Evaluated variables comparison between groups
Total (n = 30) Control (n = 19) Steatosis (n = 11) p value
Age 43.13 ± 10.7 41.53 ± 11.4 45.91 ± 9.1 0.286
Time since SZ diagnostic (years) 20.79 ± 12.4 18.56 ± 12.2 24.64 ± 12.3 0.199
Height (cm) 167.83 ± 9.4 169.05 ± 9.6 165.73 ± 9.0 0.359
Weight (kg) 75.22 ± 14.2 71.45 ± 14.0 81.75 ± 12.8 0.055
Abdominal perimeter 97.08 ± 12.0 93.00 ± 11.9 104.14 ± 8.8 0.012*
Triceps Skinfold thickness 16.63 ± 5.9 15.37 ± 5.5 18.82 ± 6.2 0.126
Arm perimeter 30.47 ±4.3 28.92 ± 4.1 33.14 ± 3.1 0.006*
Hand Grip Strength 61.33 ± 27.6 62.63 ± 29.1 59.09 ± 26.0 0.741
Adductor Pollicis Muscle 12.0 ± 3.1 10.97 ± 2.9 13.77 ± 2.7 0.014*
Fat-free mass (%) 67.58 ± 7.6 68.04 ± 8.5 66.80 ± 6.0 0.674
Fat mass (%) 32.4 ± 7.6 31.96 ± 8.5 33.15 ± 5.9 0.685
Body Mass index 26.75 ± 5.0 24.93 ± 4.1 29.90 ± 4.9 0.006*
Phase Angle 5.98 ± 1.2 5.68 ± 1.3 6.50 ± 0.9 0.079
Data are represented as Mean ± Standard Deviation; * Signicant difference comparing control to steatosis
(independent-samples t-test, p ≤ 0.05).
Source: Authors
Table 3. Logistic Regression regarding variables and the presence of steatosis
p value 95% C.I. for EXP(B) Odds (%) Ratio
Abdominal perimeter 0,023* 1,014 1,201 10,4
Triceps Skinfold thickness 0,129 0,97 1,268 10,9
Arm perimeter 0,022* 1,053 1,923 42,3
Hand Grip Strength 0,731 0,968 1,023 -0,5
Adductor Pollicis Muscle 0,025* 1,046 1,946 42,7
Fat-free mass (%) 0,662 0,885 1,081 -2,2
Fat mass (%) 0,673 0,924 1,13 2,2
Body Mass index 0,017* 1,044 1,546 27
Phase Angle 0,089 0,907 3,995 90,3
C.I. = Condence Interval; p value of Wald test
Source: Authors
NAFLD in adults from different countries (24-26), and the present
results indicated that not only body mass index predicts
steatosis, but also abdominal perimeter, arm perimeter, and
adductor Pollicis Muscle showed a signicant relationship with
the presence of steatosis. Correspondingly, the importance
of BMI in the prediction of metabolic disturbances led to its
inclusion in the National Cholesterol Education Program
Adult Treatment Panel III criteria for diagnosis of metabolic
syndrome (27). Even when considering multiple factors and
using advanced methodologies, BMI still prevails as the most
important predictor of steatosis and NAFLD (28). Importantly,
NAFLD is associated with insulin resistance, hypertension,
and dyslipidemia, and is currently considered the hepatic
manifestation of the metabolic syndrome (29), triggering a
proposal for a new nomenclature of the disease, changing it
from NAFLD to MAFLD - Metabolic Associated Fatty Liver Disease
(30). Strikingly, the aforementioned metabolic impairments
associated with NAFLD explain the increased risks of cancer,
cardiovascular and cerebrovascular events, reinforcing the
need to evaluate hepatic health in schizophrenic patients.
Although the association between the use of antipsychotics
and the presence of steatosis only tended to be signicant, it is
important to access schizophrenic patients for the development
of this condition. Notwithstanding, the use of medication is
associated with increased risk for NAFLD, as demonstrated in
a study of 191 subjects showing a 25.1% prevalence of NAFLD
at the third-year follow-up. In this study, there were associations
of the brosis score with body mass index, waist circumference,
and other biochemical parameters (9).
Similarly, a cross-sectional study with 253 patients diagnosed
with schizophrenia showed a prevalence of NAFLD of 42.7%.
Of the 108 patients diagnosed with NAFLD, 13 had signs
of fibrosis on ultrasound. Also, in the univariate analysis,
the total dose of antipsychotic drugs was significantly
associated with the presence of steatosis, whereas in
the multivariate analysis, the dose of drugs with a known
risk of metabolic syndrome and hyperprolactinemia was
significantly associated with NAFLD (31).
Some limitations of our findings should be addressed. The
sample size was limited to a single institution and needs
reevaluation in future multicentric studies. Also, we used
ultrasonography to diagnose liver steatosis, and although
ultrasonography is accurate when compared with nuclear
magnetic resonance spectroscopy and liver biopsy, the
identification of fatty infiltration of the liver occurs above
a threshold of 30%, which could have gendered our final
analysis and underestimated the prevalence of steatosis
(32). Additionally, the present study lacks blood biomarker
data. For instance, a cohort of Chinese cases and controls
indicated a prevalence comparatively higher,
where the authors compared 202 men aged
18-5 years diagnosed with schizophrenia
in treatment of at least one month with
antipsychotics with 149 healthy controls. The
clinical evaluation included the Positive and
Negative Syndrome Scale (PANSS), disease-
related information, and laboratory tests:
fasting blood glucose, total cholesterol,
triglyceride, alanine aminotransferase (ALT),
and aspartate aminotransferase (AST). The
authors showed that the prevalence of NAFLD
in the study group was 50% when compared
to 20% in the control group. In the univariate
analysis, NAFLD correlated significantly with
BMI, triglycerides, medications, and dose as
well as with the PANSS score.(33). Moreover,
a prospective Spanish study with a 3-year
follow-up (9) included 191 patients with a
recent diagnosis of schizophrenia – first event
– (94% of patients were naïve for psychiatric
treatment and none of them had a diagnosis
of steatosis evaluated by NAFLD fibrosis score
or FIB-4 score). On admission, at 3 months and
annually until 3 years the NAFLD fibrosis score,
FIB-4 score, and fatty liver index (FLI) were
calculated. At the end of the follow-up period,
25% of the patients had an FLI score ≥ 60, a
good predictor of steatosis. When comparing
patients with FLI ≥ 60 with patients with FLI ≤
60 the authors found that patients with FLI ≥ 60
had statistically higher values of triglycerides (≥
150 P 0.000), waist circumference (≥ 102 men
and ≥88 women P 0.000) and presence of the
metabolic syndrome.
CONCLUSION
This study shows a prevalence of hepatic steatosis
of 36.7% in patients with schizophrenia which was
associated with body mass index. In addition,
abdominal perimeter, arm perimeter, adductor
pollicis muscle, and BMI were signicant predictors
for the presence of steatosis. Future multicentric
studies could expand our results, which are
important, especially for the south american
population, where data is still scarce.
30 Revista Médica Vozandes
Volumen 34, Número 1, 2023
ANTHROPOMETRIC MEASUREMENTS PREDICT LIVER
STEATOSIS IN SCHIZOPHRENIC PATIENTS Rodríguez Villafuerte S, et al.
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Revista Médica Vozandes
Volumen 34, Número 1, 2023
OBSERVATIONAL STUDIES ARTÍCULO ORIGINAL
