Cannabis use and liver steatosis

Increased incidence of obesity and excess weight lead to an increased incidence of non-alcoholic fatty liver disease (NAFLD). Recent evidence indicates a protective effect of cannabis consumption on weight gain and related metabolic alterations in psychosis patients. Overall, patients are at greater risk of presenting fatty diseases, such as NAFLD, partly due to lipid and glycemic metabolic disturbances. However, there are no previous studies on the likely effect of cannabis on liver steatosis. We aimed to explore if cannabis consumption had an effect on hepatic steatosis, in a sample of first-episode (FEP) non-affective psychosis.
Material and methods: A total of 390 patients were evaluated at baseline and after 3 years of initiating the antipsychotic treatment. Anthropometric measurements and liver, lipid, and glycemic parameters were obtained at both time points. All but 6.7% of patients were drug-naïve at entry, and they self-reported their cannabis use at both time points. Liver steatosis and fibrosis were evaluated through validated clinical scores (Fatty Liver Index [FLI], Fibrosis-4 [FIB-4], and NAFLD).
Main results: At 3-year follow-up, cannabis users presented significantly lower FLI scores than non-users (F = 13.874; p < .001). Moreover, cannabis users less frequently met the criteria for liver steatosis than non-users (X2 = 7.97, p = .019). Longitudinally, patients maintaining cannabis consumption after 3 years presented the smallest increment in FLI over time, which was significantly smaller than the increment in FLI presented by discontinuers (p = .022) and never-users (p = .016). No differences were seen in fibrosis scores associated with cannabis.

肥胖及超重之发病率上升，导致非酒精性脂肪性肝病（NAFLD）发病率亦随之增加。近期研究表明，大麻消费对精神分裂症患者体重增加及相关代谢改变具有一定的保护作用。总体而言，患者罹患脂肪性疾病，如NAFLD的风险较高，部分原因在于脂质和血糖代谢紊乱。然而，目前尚无关于大麻对肝脏脂肪变性可能影响的先前研究。本研究旨在探讨大麻消费是否对首次发作（FEP）的非情感性精神分裂症患者肝脏脂肪变性产生影响。

材料与方法：共有390名患者在基线及开始抗精神病药物治疗3年后进行了评估。在两个时间点均获取了人体测量学、肝脏、脂质和血糖参数。除6.7%的患者外，其余患者均为药物初用者，并在两个时间点自行报告了大麻使用情况。通过验证的临床评分（脂肪肝指数[FLI]、纤维化-4[FIB-4]和NAFLD）对肝脏脂肪变性及纤维化进行了评估。

主要结果：在3年随访中，使用大麻的患者FLI评分显著低于非使用者（F=13.874；p＜.001）。此外，使用大麻的患者中，符合肝脏脂肪变性标准的人数显著少于非使用者（X2=7.97，p＝.019）。纵向分析显示，在3年后仍持续使用大麻的患者，FLI评分随时间增加的幅度最小，这一增幅显著小于停止使用者（p＝.022）和从未使用者（p＝.016）的增幅。与大麻相关的纤维化评分未见差异。