Skip to main navigation menu Skip to main content Skip to site footer

No. 3 (2025)

GENERAL THERAPY QUESTIONS AND REVIEWS

The Potential of Bioimpedance Measurements for Monitoring Metabolic Disorders in Patients with Schizophrenia

https://doi.org/10.48612/psyph/787x-859p-1v7v

Published 2025-09-30

  • A.A. Moritz
    • ,
  • D.S. Roerich
    • ,
  • M.V. Ivanov

A.A. Moritz
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology

D.S. Roerich
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology

M.V. Ivanov
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology

Abstract

Background. Metabolic disturbances, including obesity, dyslipidemia, and insulin resistance, are highly prevalent among patients with schizophrenia. These disturbances are associated both with the disease itself and with the side effects of antipsychotic therapy. Such metabolic abnormalities significantly increase the risk of cardiovascular diseases and reduce quality of life of patients.

The aim of this review is to systematically consolidate current knowledge on the potential use of bioimpedance analysis (BIA) for monitoring body composition, as well as for the early detection of risks of obesity and other metabolic complications.

Materials and Methods. This literature review was prepared in accordance with the CINAR guidelines for narrative reviews. A comprehensive analysis of scientific publications from the past 25 years was conducted using PubMed and eLIBRARY.RU databases, with searches performed using relevant keywords. Both original research and review articles were included. The final analysis encompassed 59 publications, including 17 cross-sectional studies, 8 longitudinal studies, 8 meta-analyses, and 3 systematic reviews.

Results. Regular monitoring of metabolic parameters is a critical component of the comprehensive treatment of schizophrenia. Bioimpedance analysis (BIA) represents a non-invasive, safe, and accessible method for assessing body composition, allowing to evaluate fat and muscle mass percentages, hydration levels, and basal metabolic rate. The advantages of BIA include high accuracy, the ability to perform dynamic monitoring, and ease of use in clinical practice. The results of the reviewed studies indicate significant alterations in body composition among patients with schizophrenia, including reduced muscle mass, decreased bone mineralization, and increased total body hydration.

Conclusion. The integration of bioimpedance analysis into the routine monitoring of patients with schizophrenia has the potential to improve the early detection and correction of metabolic disturbances. This approach may contribute to reducing the risk of complications and enhance long-term prognosis.

Keywords

schizophrenia, bioimpedance, body tissue composition, metabolic disorders, neuroinflammation

PDF (Русский)

References

  1. De Hert M., Correll C.U., Bobes J. et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care // World Psychiatry. – 2011. – Vol. 10 (1). – Pp. 52–77. – https://doi.org/10.1002/j.2051-5545.2011.tb00014.x
  2. Mitchell A.J., Vancampfort D., Sweers K. et al. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders. — A systematic review and meta-analysis // Schizophrenia Bulletin. – 2011. – Vol. 39 (2). – Pp. 306–318. – https://doi.org/10.1093/schbul/sbr148
  3. Correll C.U., Solmi M., Croatto G. et al. Mortality in people with schizophrenia: A systematic review and meta-analysis of relative risk and aggravating or attenuating factors // World Psychiatry. – 2022. – Vol. 21 (2). – Pp. 248–271. – https://doi.org/10.1002/wps.20994
  4. Olfson M., Gerhard T., Huang C. et al. Premature mortality among adults with schizophrenia in the United States // JAMA Psychiatry. – 2015. – Vol. 72 (12). – Pp. 1172–1181. – https://doi.org/10.1001/jamapsychiatry.2015.1737
  5. Lind L., Sundstrӧm J., Ärnlӧv J. et al. A longitudinal study over 40 years to study the metabolic syndrome as a risk factor for cardiovascular diseases // Scientific Reports. – 2021. – Vol. 11. – Art. 2978. – https://doi.org/10.1038/s41598-021-82398-8
  6. Vancampfort D., Wampers M., Mitchell A.J. et al. A meta-analysis of cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia versus general population controls // World Psychiatry. – 2013. – Vol. 12 (3). – Pp. 240–250. – https://doi.org/10.1002/wps.20069
  7. De Hert M., Schreurs V., Vancampfort D. et al. Metabolic syndrome in people with schizophrenia: A review // World Psychiatry. – 2009. – Vol. 8 (1). – Pp. 15–22. – https://doi.org/10.1002/j.2051-5545.2009.tb00199.x
  8. Miroshnikov A.B., Hadarcev A.A., Pavlov E.A. et al. Razrabotka i obosnovanie rukovodstva dlya narrativnyh obzorov literatury: kontrol’nyj spisok Cinar // Vestnik novyh medicinskih tehnologij. Elektronnoe izdanie. – 2024. – № 18 (6). – Pp. 135–146. – https://doi.org/10.24412/2075-4094-2024-6-4-2
  9. Sun M.J., Jang M.H. Risk Factors of metabolic syndrome in community-dwelling people with schizophrenia // International Journal of Environmental Research and Public Health. – 2020. – Vol. 17 (18). – Art. 6700. – https://doi.org/10.3390/ijerph17186700
  10. Alfimov P.V., Ryvkin P.V., Ladyzhenskij M.Ya., Mosolov S.N. Metabolicheskij sindrom u bol’nyh shizofreniej (obzor literatury) // Sovremennaya terapiya psikhicheskikh rasstrojstv. – 2014. – № 3. – Pp. 8–14.
  11. Sicras-Mainar A., Maurino J., Ruiz-Beato E. et al. Prevalence of metabolic syndrome according to the presence of negative symptoms in patients with schizophrenia // Neuropsychiatric Disease and Treatment. – 2015. – Vol. 11. – Pp. 51–57. – https://doi.org/10.2147/NDT.S75449
  12. Ward H.B., Beermann A., Nawaz U. et al. Evidence for schizophrenia-specific pathophysiology of nicotine dependence // Frontiers in Psychiatry. – 2022. – Vol. 13. – Art. 804055. – https://doi.org/10.3389/fpsyt.2022.804055
  13. Simonelli-Muñoz A.J., Fortea M.I., Salorio P. et al. Dietary habits of patients with schizophrenia: A self-reported questionnaire survey // International Journal of Mental Health Nursing. – 2012. – Vol. 21 (3). – Pp. 220–228. – https://doi.org/10.1111/j.1447-0349.2011.00790.x
  14. Mwebe H. Physical health monitoring in mental health settings: A study exploring mental health nurses’ views of their role // Journal of Clinical Nursing. – 2017. – Vol. 26 (19–20). – Pp. 3067–3078. – https://doi.org/10.1111/jocn.13653
  15. Huhn M., Nikolakopoulou A., Schneider-Thoma J. et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: A systematic review and network meta-analysis // The Lancet. – 2019. – Vol. 394 (10202). – Pp. 939–951. – https://doi.org/10.1016/S0140-6736(19)31135-3
  16. Pillinger T., McCutcheon R.A., Vano L. et al. Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: A systematic review and network meta-analysis // The Lancet Psychiatry. – 2020. – Vol. 7 (1). – Pp. 64–77. – https://doi.org/10.1016/S2215-0366(19)30416-X
  17. Mosolov S.N., Ryvkin P.V., Serditov O.V. et al. Metabolicheskie pobochnye jeffekty sovremennoj antipsihoticheskoj farmakoterapii // Social’naja i klinicheskaja psihiatrija. – 2008. – № 18 (3). – Pp. 75–90.
  18. Jeong S.H., Lee N.Y., Kim S.H. et al. Long-term evolution of metabolic status in patients with schizophrenia stably maintained on second-generation antipsychotics // Psychiatry Investigation. – 2018. – Vol. 15 (6). – Pp. 628–637. – https://doi.org/10.30773/pi.2018.01.18.1
  19. Sosin D.N., Hasanova A.K., Moshhevitin S.Yu., Mosolov S.N. Farmakogeneticheskie prediktory metabolicheskih narushenij pri primenenii klozapina // Sovremennaya terapiya psikhicheskikh rasstrojstv. – 2024. – № 4. – Pp. 30–40. – https://doi.org/10.21265/PSYPH.2024.88.88.004
  20. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) // JAMA. – 2001. – Vol. 285. – Pp. 2486–2497. – https://doi.org/10.1001/jama.285.19.2486
  21. Prusova T.I., Lepik O.V., Kosterin D.N. et al. Metabolicheskij sindrom u podrostkov s psihicheskimi rasstrojstvami: voprosy diagnostiki, profilaktiki i korrekcii // Obozrenie psihiatrii i medicinskoj psihologii imeni V.M. Behtereva. – 2024. – № 58 (4–2). – Pp. 47–64. – https://doi.org/10.31363/2313-7053-2024-1039
  22. Unamuno X., Gómez-Ambrosi J., Rodríguez A. et al. Adipokine dysregulation and adipose tissue inflammation in human obesity // European Journal of Clinical Investigation. – 2018. – Vol. 48 (9). – Art. 12997. – https://doi.org/10.1111/eci.12997
  23. Fahed G., Aoun L., Bou Zerdan M. et al. Metabolic syndrome: Updates on pathophysiology and management in 2021 // International Journal of Molecular Sciences. – 2022. – Vol. 23 (2). – Art. 786. – https://doi.org/10.3390/ijms23020786
  24. de Oliveira Dos Santos A.R., de Oliveira Zanuso B., Miola V.F.B. et al. Adipokines, myokines, and hepatokines: Crosstalk and metabolic repercussions // International Journal of Molecular Sciences. – 2021. – Vol. 22 (5). – Art. 2639. – https://doi.org/10.3390/ijms22052639
  25. Moritz A.A., Terebova P.S., Ivanov M.V. Rol’ immunovospalitel’nyh faktorov v razvitii negativnoj simptomatiki pri shizofrenii // Zhurnal nevrologii i psihiatrii imeni S.S. Korsakova. – 2024. – № 124 (11). – Pp. 42–48. – https://doi.org/10.17116/jnevro202412411142
  26. Emre S., Asli S., Sener M. et al. Antipsychotic-treated schizophrenia patients develop inflammatory and oxidative responses independently from obesity: However, metabolic disturbances arise from schizophrenia-related obesity // Human Psychopharmacology. – 2024. – Vol. 39 (6). – e2913. – https://doi.org/10.1002/hup.2913
  27. Molina J.D., Avila S., Rubio G. et al. Metabolomic connections between schizophrenia, antipsychotic drugs and metabolic syndrome: A variety of players // Current Pharmaceutical Design. – 2021. – Vol. 27 (39). – Pp. 4049–4061. – https://doi.org/10.2174/1381612827666210804110139
  28. Ayerbe L., Forgnone I., Addo J. et al. Hypertension risk and clinical care in patients with bipolar disorder or schizophrenia; A systematic review and meta-analysis // Journal of Affective Disorders. – 2018. – Vol. 225. – Pp. 665–670. – https://doi.org/10.1016/j.jad.2017.09.002
  29. Ward L.C., Brantlov S. Bioimpedance basics and phase angle fundamentals // Reviews in Endocrine and Metabolic Disorders. – 2023. – Vol. 24 (2). – Pp. 381–391. – https://doi.org/10.1007/s11154-022-09780-3
  30. Rigaud B., Morucci J.P., Chauveau N. Bioelectrical impedance techniques in medicine. Part I: Bioimpedance measurement. Second section: Impedance spectrometry // Critical Reviews in Biomedical Engineering. – 1996. – Vol. 24 (4–6). – Pp. 257–351. – PMID: 9196884
  31. Sharpe J.K., Byrne N.M., Stedman T.J. et al. Bioelectric impedance is a better indicator of obesity in men with schizophrenia than body mass index // Psychiatry Research. – 2008. – Vol. 159 (1–2). – Pp. 121–126. – https://doi.org/10.1016/j.psychres.2007.08.010
  32. Marra M., Scalfi L., Covino A. et al. Assessment of body composition in health and disease using Bioelectrical Impedance Analysis (BIA) and Dual Energy X-Ray Absorptiometry (DXA): A critical overview // Contrast Media & Molecular Imaging. – 2019. – Vol. 2019. – Art. 3548284. – https://doi.org/10.1155/2019/3548284
  33. Ortega R.M., Pérez-Rodrigo C., López-Sobaler A.M. Dietary assessment methods: Dietary records // Nutrición Hospitalaria. – 2015. – Vol. 31 (Suppl. 3). – Pp. 38–45. – https://doi.org/10.3305/nh.2015.31.sup3.8749
  34. Garlini L.M., Alves F.D., Ceretta L.B. et al. Phase angle and mortality: A systematic review // European Journal of Clinical Nutrition. – 2019. – Vol. 73. – Pp. 495–508. – https://doi.org/10.1038/s41430-018-0159-1
  35. Earthman C.P. Body composition tools for assessment of adult malnutrition at the bedside: A tutorial on research considerations and clinical applications // JPEN Journal of Parenteral and Enteral Nutrition. – 2015. – Vol. 39 (7). – Pp. 787–822. – https://doi.org/10.1177/0148607115595227
  36. Wysokiński A., Kłoszewska I. Assessment of body composition using bioelectrical impedance in patients with schizophrenia – preliminary report // Archives of Psychiatry and Psychotherapy. – 2014. – Vol. 16 (1). – Pp. 31–37. – https://doi.org/10.12740/APP/23278
  37. Böhm A., Heitmann B. The use of bioelectrical impedance analysis for body composition in epidemiological studies // European Journal of Clinical Nutrition. – 2013. – Vol. 67 (Suppl. 1). – Pp. S79–S85. – https://doi.org/10.1038/ejcn.2012.168
  38. Schoenfeld B., Nickerson B., Wilborn C. et al. Comparison of multifrequency bioelectrical impedance vs. Dual-energy X-ray absorptiometry for assessing body composition changes after participation in a 10-week resistance training program // Journal of Strength and Conditioning Research. – 2020. – Vol. 34 (3). – Pp. 678–688. – https://doi.org/10.1519/JSC.0000000000002708
  39. Boneva-Asiova Z., Boyanov M.A. Body composition analysis by leg-to-leg bioelectrical impedance and dual-energy X-ray absorptiometry in non-obese and obese individuals // Diabetes, Obesity and Metabolism. – 2008. – Vol. 10 (11). – Pp. 1012–1018. – https://doi.org/10.1111/j.1463-1326.2008.00851.x
  40. Norman K., Stobäus N., Pirlich M. et al. Bioelectrical phase angle and impedance vector analysis — clinical relevance and applicability of impedance parameters // Clinical Nutrition. – 2012. – Vol. 31 (6). – Pp. 854–861. – https://doi.org/10.1016/j.clnu.2012.05.008
  41. Marthoenis M., Martina M., Alfiandi R. et al. Investigating body mass index and body composition in patients with schizophrenia: A case-control study // Schizophrenia Research and Treatment. – 2022. – Vol. 2022. – Art. 1381542. – https://doi.org/10.1155/2022/1381542
  42. Sugawara N., Yasui-Furukori N., Tsuchimine S. et al. Body composition in patients with schizophrenia: Comparison with healthy controls // Annals of General Psychiatry. – 2012. – Vol. 11 (1). – Art. 11. – https://doi.org/10.1186/1744-859X-11-11
  43. Kishi T., Okuya M., Sakuma K. et al. Body composition in Japanese patients with psychiatric disorders: A cross-sectional study // Neuropsychopharmacology Reports. – 2021. – Vol. 41 (1). – Pp. 117–121. – https://doi.org/10.1002/npr2.12160
  44. Smith E., Singh R., Lee J. et al. Adiposity in schizophrenia: A systematic review and meta-analysis // Acta Psychiatrica Scandinavica. – 2021. – Vol. 144 (6). – Pp. 524–536. – https://doi.org/10.1111/acps.13365
  45. Chouinard V.A., Henderson D.C., Dalla Man C. et al. Impaired insulin signaling in unaffected siblings and patients with first-episode psychosis // Molecular Psychiatry. – 2019. – Vol. 24 (10). – Pp. 1513–1522. – https://doi.org/10.1038/s41380-018-0045-1
  46. Tian Y., Wang D., Wei G. et al. Prevalence of obesity and clinical and metabolic correlates in first-episode schizophrenia relative to healthy controls // Psychopharmacology. – 2021. – Vol. 238 (3). – Pp. 745–753. – https://doi.org/10.1007/s00213-020-05727-1
  47. Liang J., Cai Y., Xue X. et al. Does Schizophrenia Itself Cause Obesity? // Frontiers in Psychiatry. – 2022. – Vol. 13. – Art. 934384. – https://doi.org/10.3389/fpsyt.2022.934384
  48. Li X., Shi X., Tan Y. et al. Metabolic indexes of obesity in patients with common mental disorders in stable stage // BMC Psychiatry. – 2022. – Vol. 22 (1). – Art. 91. – https://doi.org/10.1186/s12888-022-03752-2
  49. Correll C., Detraux J., De Lepeleire J. et al. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder // World Psychiatry. – 2015. – Vol. 14 (2). – Pp. 119–136. – https://doi.org/10.1002/wps.20204
  50. Kowalchuk C., Castellani L.N., Chintoh A. et al. Antipsychotics and glucose metabolism: how brain and body collide // American Journal of Physiology: Endocrinology and Metabolism. – 2019. – Vol. 316 (1). – Pp. E1–E15. – https://doi.org/10.1152/ajpendo.00164.2018
  51. Goossens G.H. The metabolic phenotype in obesity: Fat mass, body fat distribution, and adipose tissue function // Obesity Facts. – 2017. – Vol. 10 (3). – Pp. 207–215. – https://doi.org/10.1159/000471488
  52. Saarni S.E., Saarni S.I., Fogelholm M. et al. Body composition in psychotic disorders: A general population survey // Psychological Medicine. – 2009. – Vol. 39 (5). – Pp. 801–810. – https://doi.org/10.1017/S0033291708004194
  53. Kornetova E.G., Kornetov A.N., Mednova I.A. et al. Changes in body fat and related biochemical parameters associated with atypical antipsychotic drug treatment in schizophrenia patients with or without metabolic syndrome // Frontiers in Psychiatry. – 2019. – Vol. 10. – Art. 803. – https://doi.org/10.3389/fpsyt.2019.00803
  54. Tseng P.T., Chen Y.W., Yeh P.Y. et al. Bone mineral density in schizophrenia: An update of current meta-analysis and literature review under guideline of PRISMA // Medicine (Baltimore). – 2015. – Vol. 94 (47). – e1967. – https://doi.org/10.1097/MD.0000000000001967
  55. Chen C.Y., Lane H.Y., Lin C.H. Effects of antipsychotics on bone mineral density in patients with schizophrenia: gender differences // Clinical Psychopharmacology and Neuroscience. – 2016. – Vol. 14 (3). – Pp. 238–249. – https://doi.org/10.9758/cpn.2016.14.3.238
  56. Mercurio M., Spina G., Galasso O. et al. The association between antipsychotics and bone fragility: An updated comprehensive review // Diagnostics. – 2024. – Vol. 14 (23). – Art. 2745. – https://doi.org/10.3390/diagnostics14232745
  57. Marinho Esteves Pereira M., dos Santos Campello Queiroz M., Masiero Cavalcanti de Albuquerque N. et al. Phase angle and nutritional status in individuals with advanced cancer in palliative care // Revista Brasileira de Cancerologia. – 2019. – Vol. 65 (1). – e02272. – https://doi.org/10.32635/2176-9745.RBC.2019v65n1.272
  58. Barrera Ortega S., Redondo Del Río P., Carreño Enciso L. et al. Phase angle as a prognostic indicator of survival in institutionalized psychogeriatric patients // Nutrients. – 2023. – Vol. 15 (9). – Art. 2139. – https://doi.org/10.3390/nu15092139
  59. Kornetova E.G., Galkin S.A., Kornetov A.N. et al. Sravnitel’noe issledovanie metabolicheskih narushenij u statsionarnyh pacientov s shizofreniej i affektivnymi rasstrojstvami // Social’naja i klinicheskaja psihiatrija. – 2024. – Vol. 34, № 2. – Pp. 5–12.

Downloads

Download data is not yet available.