SCHRES-07578; No of Pages 7

Schizophrenia Research xxx (2017) xxx–xxx

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Schizophrenia Research

journal homepage: www.elsevier.com/locate/schres

Prevalence of underweight in patients with schizophrenia:

A meta-analysis
Norio Sugawara a,⁎, Kazushi Maruo a, Takuro Sugai b, Yutaro Suzuki b, Yuji Ozeki c, Kazutaka Shimoda c,
Toshiyuki Someya b, Norio Yasui-Furukori d
a
Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan
b
Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
c
Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
d
Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan

a r t i c l e i n f o a b s t r a c t

Article history: Aims: Although the relationship between body mass index and all-cause mortality is U-shaped, underweight has
Received 29 March 2017 received comparatively less attention than obesity. There is only limited evidence to date regarding underweight
Received in revised form 2 August 2017 among patients with schizophrenia. This is the first meta-analysis to address the prevalence of underweight in
Accepted 9 October 2017 these patients.
Available online xxxx
Methods: We conducted database searches (PubMed, PsycINFO) to identify studies examining underweight in
patients with schizophrenia. In total, 17 studies (18 groups) with 45,474 patients were included; data were
Keywords:
Schizophrenia
extracted independently by two authors. A meta-analysis was performed to calculate the pooled prevalence of
Japanese underweight in patients.
Underweight Results: The pooled prevalence of underweight was 6.2% (95% CI = 4.5–8.6) for the 18 groups, which included
45,474 patients with schizophrenia. The heterogeneity was I2 = 98.9% (95% Cl = 98.7–99.1%). Four studies
with 4 groups, consisting of 30,014 individuals, focused on Japanese inpatients with schizophrenia. The pooled
prevalence of underweight among inpatients in these 4 groups was 17.6% (95% CI = 15.5–20.0). Fourteen studies
were conducted with non-Japanese inpatients and included 14 groups of 15,460 patients with schizophrenia. The
pooled prevalence of underweight in non-Japanese inpatients was 4.6% (95% CI = 3.9–5.4). The proportion of un-
derweight in the 18 groups significantly varied between Japanese inpatients and other patients.
Conclusions: The results indicated that Japanese inpatients with schizophrenia have a high proportion of under-
weight. Future research should focus on evaluating interventions that target underweight.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction The life expectancy of people with schizophrenia is approximately

Underweight has received comparatively less attention than obesity,
and the evidence regarding underweight in patients with schizophrenia
remains limited. In general populations, the relationship between body
mass index (BMI) and all-cause mortality is U-shaped, with both obesity
and underweight being associated with increased mortality (Berrington
de Gonzalez et al., 2010; Nagai et al., 2010). Although several studies
have stated that obesity could increase the health risks of patients
with schizophrenia (Weiden et al., 2004; Chwastiak et al., 2009;
Sugawara et al., 2013; Li et al., 2016; Heald et al., 2017), underweight
should also receive considerable attention, especially in Asia, where
the proportion of underweight in the population is relatively high
(Moore et al., 2010).
⁎ Corresponding author at: Department of Clinical Epidemiology, Translational Medical
Center, National Center of Neurology and Psychiatry, Kodaira 187-8551, Japan.
E-mail addresses: nsuga3@yahoo.co.jp, nsuga@ncnp.go.jp (N. Sugawara).
20 years less than that of the general population, and this mortality
gap has widened (Laursen, 2011; Nielsen et al., 2013; Walker et al.,
2015). A recent study concerning patients with schizophrenia showed
that the leading causes of excess deaths can be directly attributed to
physical diseases, such as cardiovascular and respiratory diseases
(Olfson et al., 2015). While obesity has been considered a major risk fac-
tor for metabolic syndrome (Zhang et al., 2011), cardiovascular disease
(Marinou et al., 2010), and premature death (Adams et al., 2006;
Pischon et al., 2008), several studies conducted in Asian populations
have found that underweight is associated with mortality to the same
extent as obesity due to the occurrence of ischemic heart disease
(Chen et al., 2013).
Since Kitabayashi and colleagues first reported a high prevalence
(16.1%) of underweight among Japanese inpatients with schizophrenia
(Kitabayashi et al., 2006), other studies from Japan have supported this
finding (Inamura et al., 2012; Suzuki et al., 2014). However, several
studies conducted in other countries did not show similar results

https://doi.org/10.1016/j.schres.2017.10.017
0920-9964/© 2017 Elsevier B.V. All rights reserved.

Please cite this article as: Sugawara, N., et al., Prevalence of underweight in patients with schizophrenia: A meta-analysis, Schizophr. Res. (2017),
https://doi.org/10.1016/j.schres.2017.10.017
2 N. Sugawara et al. / Schizophrenia Research xxx (2017) xxx–xxx
(Correll et al., 2008; Chu et al., 2011; Guo et al., 2013). The prevalence of
underweight among patients with schizophrenia is still unknown.
Although the causes of underweight among patients are not fully
understood, several factors, including genetics, metabolism, drug use,
over-exercise, lack of food (frequently due to poverty), and medical
conditions, can affect weight status (Heymsfield and Wadden, 2017).
Given the aforementioned gap in the literature, we conducted a
meta-analysis of underweight in people with schizophrenia. We
aimed to (1) describe the pooled frequencies of underweight in patients
with schizophrenia, and (2) clarify the variables that account for sub-
group differences, and (3) compare the prevalence of underweight in
patients with schizophrenia and the general population. To our knowl-
edge, this is the first study to investigate the pooled prevalence of un-
derweight in patients with schizophrenia. Knowledge of underweight
in this population might help psychiatric clinicians identify patients at
risk of mortality.
2. Method
2.1. Study selection
The systematic review was reported according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
standards (a protocol used to evaluate systematic reviews) (Knobloch
et al., 2011). Electronic databases, including PubMed and PsycINFO,
were initially searched using six terms: the term ‘underweight’ or
‘BMI’ or ‘body mass index’ was paired with ‘schizophrenia’ or
‘schizoaffective disorder’ or ‘schizophreniform disorder’. We included
original studies: (1) observational studies (cross-sectional, prospective
studies) and (2) baseline data of randomized controlled trials or pro-
spective studies, regardless of clinical setting (inpatient, outpatient).
We excluded the following: (1) case reports; (2) comments, editorials,
letters; (3) studies not performed on human participants; (4) non-
English publications; (5) studies including conditions likely to signifi-
cantly affect the prevalence of underweight (e.g., retrospective studies
of deceased patients, completers-only analysis of interventions, inclu-
sion criteria limited to lower BMI, lack of BMI data, lack of classification
as underweight); (6) studies that had b100 participants with schizo-
phrenia (to avoid small-study effect) (Nüesch et al., 2010); and (7) stud-
ies including participants with other psychiatric diagnoses. Two
researchers (NS and NYF) independently searched the literature. After
all papers had been assessed, any discrepancies in the responses were
identified and discussed to reach a consensus on the best option. Data
were extracted from each article using a standardized form including
the first author, publication year and other information.
2.2. Data extraction
All authors independently extracted data on the number of total pa-
tients and those with underweight. We also extracted data regarding
the demographic and clinical characteristics of the participants in the
studies. The characteristics of the studies included in this meta-
analysis are shown in Table 1.
2.3. Statistical analysis
First, we assessed the pooled prevalence of underweight in patients
with schizophrenia who were treated at hospitals. We calculated the
pooled prevalence and its 95% confidence interval (Cl) with a fixed-
effects and a random-effects model (DerSimonian and Laird, 1986). Ad-
ditionally, we performed subgroup analysis by clinical setting
[(Japanese vs non-Japanese patients) or (Japanese inpatients vs other
patients)]. Second, we conducted meta-regression analyses including
the binary subgroup indexes above as the exploratory variables to
investigate the differences by clinical setting. Third, we calculated the
relative risk to investigate the differences in the prevalence of
Please cite this article as: Sugawara, N., et al., Prevalence of underweight in patients with schizophrenia: A meta-analysis, Schizophr. Res. (2017),
https://doi.org/10.1016/j.schres.2017.10.017
underweight between patients with schizophrenia and members of
the general population. We used the I2 statistic and its 95% Cl to estimate
heterogeneity. The I2 statistic was considered high when it was 75% or
more (Higgins et al., 2003). The significance level was set at p b 0.05.
The meta-analysis and related statistical analyses were performed
with meta package version 4.8-2 in R version 3.3.0 (Schwarzer, 2017;
Venables et al., 2016).
3. Results
3.1. Search results and included participants
After excluding duplicates and non-relevant hits, our search yielded
17 publications (18 groups) that met the inclusion criteria (Fig. 1). All
included studies adopted a cross-sectional design. The final sample
comprised 45,474 patients with schizophrenia but no matched controls.
The sample sizes of groups ranged from 100 to 15,171 patients, with a
median sample size of 303. At the group level, the mean age of patients
with schizophrenia ranged from 23.6 to 60.0 years, and 55.7% (25,336/
45,474) were male. More details of the included studies and participants
are presented in Table 1.
3.2. Prevalence of underweight and subgroup analyses
The pooled prevalence of underweight based on the random-effects
model was 6.2% (95% CI = 4.5–8.6) for the 18 groups, which included
45,474 patients with schizophrenia (Supplementary Fig. S1). The het-
erogeneity was I2 = 98.9% (95% Cl = 98.7–99.1%).
Under the same model, the 5 groups, including 35,455 Japanese pa-
tients, showed a pooled prevalence of underweight of 13.0% (95% CI =
8.8–18.7) (Fig. 2). The heterogeneity was I2 = 99.4%. Thirteen studies
(13 groups), which were conducted in non-Japanese patients, included
10,019 patients with schizophrenia. The pooled prevalence of under-
weight in non-Japanese patients with schizophrenia was 4.6% (95% CI
= 3.7–5.7) for the 13 groups. The heterogeneity was I2 = 65.3%. The
prevalence of underweight in the 18 groups significantly varied (Q
value = 20.65, p b 0.001) between Japanese and non-Japanese patients.
We identified 4 groups focusing on Japanese inpatients with schizo-
phrenia that included 30,014 individuals. In the random-effects model,
the pooled prevalence of underweight in Japanese inpatients with
schizophrenia in the 4 groups was 17.6% (95% CI = 15.5–20.0) (Fig.
3). The heterogeneity was I2 = 93.2%. Fourteen studies (14 groups)
conducted in non-Japanese inpatients included 15,460 patients with
schizophrenia. Under the same model, the pooled prevalence of
underweight in non-Japanese patients with schizophrenia was 4.6%
(95% CI = 3.9–5.4) for the 14 groups. The heterogeneity was I2 =
63.0%. The pooled prevalence of underweight was significantly higher
among Japanese inpatients than in other patients (Q value = 154.54,
p b 0.001).
The meta-regression analysis revealed that setting had a significant
effect on the prevalence of underweight in Japanese patients (regres-
sion coefficient: 1.16, 95% CI: 0.64, 1.69, p b 0.001) and in Japanese inpa-
tients (regression coefficient: 1.48, 95% CI: 1.26, 1.71, p b 0.001).
Among studies that included healthy controls (Supplementary
Table 1), pooling data from 35,555 people with schizophrenia and
36,374 controls yielded a significant RR of 2.13 (95% CI = 1.65–2.76).
Of these studies, an analysis restricted to studies conducted in Japan
showed a significant RR of 2.18 (95% CI = 1.66–2.86). Furthermore, an
analysis restricted to studies of Japanese inpatients showed a significant
RR of 2.33 (95% CI = 2.08–2.60) (Fig. 4).
4. Discussion
To the authors' knowledge, this is the first meta-analysis concerning
the prevalence of underweight in people with schizophrenia. Approxi-
mately one in 16 individuals with schizophrenia was underweight,
 N. Sugawara et al. / Schizophrenia Research xxx (2017) xxx–xxx 3

Table 1
Details of the included studies.

First author Country Setting Design Participants Underweight

(year) prevalence

Coodin (2001) Canada Outpatients Cross-sectional 120 males and 63 females; Mean age 39.6 years 3.3 (6/183)
Kitabayashi et al. (2006) Japan Inpatients Cross-sectional 141 males and 132 females; Mean age 55.8 years; Mean length of hospital 16.1 (44/273)
stay 11.6 years
Leitão-Azevedo et al. Brazil Outpatients Cross-sectional 95 males and 26 females; Mean age 34.5 years; Use of clozapine 43.8% 1.7 (2/121)
(2006)
Limosin et al. (2008) France Inpatients & Baseline data 3694 males and 2268 females; Mean age 37.1 years; Use of second generation 4.1 (235/5765)
outpatients antipsychotic drugs 52.0%
Correll et al. (2008) US Outpatients Cross-sectional 54 males and 57 females; Mean age 44.3 years; White race 83.5%; Smoking 1.8 (2/111)
52.2%; Positive history of diabetes 15.3%, coronary heart disease 9.1%;
Antipsychotic polypharmacy 34.2%
Huang et al. (2009) Taiwan Outpatients Cross-sectional 352 males and 298 females; Mean age 45.9 years; Mean length of hospital 4.6 (30/650)
stay 11.6 years; Antipsychotic polypharmacy 20.2%; Use of second generation
antipsychotic drugs 60.5%
Chu et al. (2011) Taiwan Inpatients Cross-sectional 649 males and 229 females; Mean age 50.6 years; Mean length of hospital 4.3 (38/878)
stay 8.4 years; Use of second generation antipsychotic drugs 59.3%
Inamura et al. (2012) Japan Inpatients Cross-sectional 7897 males and 7274 females; 50 (25, 75) percentile of age 61.0 (51.0, 69.0) 20.2 (3071/15171)
years; Length of hospital stay N12 months 77.1%
Lee et al. (2012) Singapore Inpatients & Cross-sectional 66 males and 34 females; Mean age 36.6 years; Chinese 84.0%, Indian 8.0%; 9.0 (9/100)
outpatients Smoking 31.0%; Use of second generation antipsychotic drugs 61.0%; Mean
dose of CP equivalence 295.8 mg
Said et al. (2012) Malaysia Outpatients Cross-sectional 174 males and 96 females; Mean age 40.0 years; Smoking 71.9%; Use of 5.2 (14/270)
second generation antipsychotic drugs 70.4%
Guo (2013) China Outpatients Cross-sectional 603 males and 505 females; Mean age 27.5 years; Use of second generation 6.1 (68/1108)
antipsychotic drugs 70.3%
Correll et al. (2014) US Inpatients & Baseline data 288 males and 106 females; Mean age 50.6 years; White race 54.6%, Black 2.1 (8/394)
outpatients race 36.6%; Antipsychotic polypharmacy 9.4%; Use of first generation
antipsychotic drugs 6.6%
Kheng Yee et al. (2014) Malaysia Outpatients Cross-sectional 111 males; Mean age 37.8 years; Malay 73.9%; Smoking 48.6% 3.6 (4/111)
Suzuki et al. (2014) Japan Inpatients Cross-sectional 176 males and 157 females; Mean age 23.6 years; Smoking 35.4%; Mean 14.1 (47/333)
length of hospital stay 2.9 months
Norlelawati et al. (2015) Malaysia Outpatients Cross-sectional 148 males and 75 females; Mean age 38.3 years; Malay 76.7%, Chinese 18.8%; 3.6 (8/220)
Smoking 69.4%; Use of second generation antipsychotic drugs 64.5%
Sugai et al. (2015) Japan Outpatients Cross-sectional 3147 males and 2294 females; Mean age 52.2 years; Smoking 36.2%; 4.3 (232/5441)
Prevalence of diabetes 16.8%, hypertension 30.5%, lipid Abnormality 46.6%;
Antipsychotic polypharmacy 44.4%; Use of second generation antipsychotic
drugs 73.3%; Mean dose of CP equivalence 532.0 mg
Inpatients Cross-sectional 7527 males and 6710 females; Mean age 60.0 years; Smoking 24.0%; 17.4 (2481/14237)
Prevalence of diabetes 7.1%, hypertension 19.9%, lipid abnormality 27.8%;
Antipsychotic polypharmacy 52.4%; Use of second generation antipsychotic
drugs 75.8%; Mean dose of CP equivalence 691.1 mg
Seow et al. (2017) Singapore Inpatients Cross-sectional 94 males and 14 females; Mean age 56.1 years; Mean length of hospital stay 11.1 (12/108)
8.8 years; Chinese 80.6%, Malay 14.8%; Smoking 69.4%; Prevalence of diabetes
11.1%, hypertension 19.9%, lipid abnormality 30.6%; Use of second generation
antipsychotic drugs 53.7%; Mean dose of CP equivalence 755.3 mg

i.e., 6.2% (95% CI = 4.5–8.6%); however, the heterogeneity between
studies was high. When restricting the pooled prevalence of under-
weight to non-Japanese studies, the prevalence was one in 22, or 4.6%
(95% CI = 3.7–5.7%), which might be a more accurate estimate of the
prevalence worldwide. A meta-regression analysis revealed that the
setting of Japanese inpatients with schizophrenia had a significant effect
on the prevalence of underweight, and the pooled prevalence of under-
weight among inpatients was 17.6% (95% CI = 15.5–20.0). Furthermore,
compared with the general population, Japanese inpatients with schizo-
phrenia showed a significantly higher risk of being underweight.
Many studies have reported on the prevalence of underweight in the
general population. The National Health and Nutrition Examination Sur-
vey in Japan showed that the proportion of underweight among partic-
ipants was 7.9%. The proportion of underweight did not exceed 10%,
except among participants aged b40 years. Among participants aged
30 years and older, the proportion of overweight was more than double
that of underweight (Health Service Bureau, Ministry of Health, Labour
and Welfare, 2014). Data from the 2011 Behavioral Risk Factor Surveil-
lance System (BRFSS) in the US demonstrated that the proportions of
underweight, overweight, and obesity were 1.9%, 35.9%, and 27.4%, re-
spectively (Mukherjee, 2013). Previous large-scale investigations of
United Christian Nethersole Community Health Service in Hong Kong
showed that 7.8%, 25.2%, and 3.8% of participants from the community
were underweight, overweight, and obese, respectively (Ko and Tang,
2006). Although the prevalence of underweight reported in previous
studies varied in different backgrounds, the countries that were includ-
ed in our analysis showed a relatively lower prevalence of underweight
compared to those of obesity or overweight.
Two studies have shown a relatively higher prevalence of under-
weight among patients with schizophrenia. One study from the US re-
ported that the proportion of underweight among patients with a
mean age of 48.6 years was 27.3% (35/128). That study assessed
deceased patients using a retrospective design (Conley et al., 2005).
Another study from India demonstrated that the proportion of
underweight (defined as BMI b 18 kg/m2) among patients with a
mean age of 45.8 years was 45.1% (23/51). These patients had never re-
ceived antipsychotic drug treatment, and the mean duration of illness
was 127 (12–480) months (Padmavati et al., 2010). Although the
abovementioned studies indicated a higher prevalence of underweight,
the characteristics of the study population, which included deceased or
never-treated patients, were not representative of general patients with
schizophrenia.
Our results demonstrated that Japanese inpatients with schizophre-
nia had an odds ratio of 4.4 (calculated from a meta-regression coeffi-
cient of 1.48) for being underweight. Although we could not establish
why there was a high prevalence of underweight in Japanese inpatients

Please cite this article as: Sugawara, N., et al., Prevalence of underweight in patients with schizophrenia: A meta-analysis, Schizophr. Res. (2017),
https://doi.org/10.1016/j.schres.2017.10.017
4 N. Sugawara et al. / Schizophrenia Research xxx (2017) xxx–xxx

Fig. 1. A flow chart of the study selection process.

Fig. 2. Prevalence of underweight in (A) Japanese and (B) non-Japanese patients with schizophrenia.

Please cite this article as: Sugawara, N., et al., Prevalence of underweight in patients with schizophrenia: A meta-analysis, Schizophr. Res. (2017),
https://doi.org/10.1016/j.schres.2017.10.017
 N. Sugawara et al. / Schizophrenia Research xxx (2017) xxx–xxx 5

Fig. 3. Prevalence of underweight in (A) Japanese inpatients and (B) other patients with schizophrenia.

with schizophrenia, long-term hospitalization could affect physical
health. The number of psychiatric beds in institutions decreased in the
1970s and 1980s in most developed countries. However, in Japan, the
mental health system is still hospital-based and has the largest number
of psychiatric beds per person worldwide. In addition, the mean length
of a hospital stay in Japan is approximately 1.5 years, which is the lon-
gest in developed countries (Statistics and Information Department,
Ministry of Health, Labour and Welfare, 2014). Japanese inpatients
with schizophrenia receive controlled meals, and the overall prevalence
of MetS among Japanese inpatients is less than half of that in outpatients
(Sugawara et al., 2011; Sugai et al., 2016). Several hypotheses could ex-
plain the development of underweight among inpatients with long-
term intake of a controlled diet. First, inpatients with schizophrenia
might be inclined to not seek help for symptoms of physical illness

Fig. 4. Relative risk of being underweight for patients with schizophrenia compared with the general population.

Please cite this article as: Sugawara, N., et al., Prevalence of underweight in patients with schizophrenia: A meta-analysis, Schizophr. Res. (2017),
https://doi.org/10.1016/j.schres.2017.10.017
6 N. Sugawara et al. / Schizophrenia Research xxx (2017) xxx–xxx
due to their severe and refractory psychotic symptoms, including nega-
tive symptoms, cognitive impairment and social isolation (De Hert et al.,
2011; Crump et al., 2013). Clinicians might overlook physical illnesses
causing weight loss in patients with schizophrenia in long-term hospi-
talization. Additionally, schizophrenia and underweight may share
common genetic or nutritional risk factors in their causal pathways. Pre-
vious studies have shown that lower BMI per se could be a risk factor of
developing schizophrenia (Sørensen et al., 2006; Zammit et al., 2007).
Second, negative symptoms of schizophrenia might cause underweight
(Chen et al., 2014) due to insufficient dietary intake. In Japan, inpatients
demonstrated more severe negative symptoms (Nakanishi et al., 2007)
than outpatients, and approximately 12.9% of inpatients reported that
they consumed 80% or less of three meals a day (Sugawara et al.,
2016). Third, long-term hospitalization might lead to a lack of exercise,
which could result in a loss in bone mass (Carter and Hinton, 2014).
Being underweight has also been reported to be related to low bone
density (Pines, 2012). Therefore, the factors associated with long-term
hospitalization may affect weight loss in patients with schizophrenia.
Fourth, protein-energy wasting (PEW), in which loss of protein and en-
ergy stores is caused by reduced nutrient intake or oxidative stress
(Fouque et al., 2008), might mediate the development of underweight
(Tsai et al., 2017) among patients with schizophrenia. Even in obese pa-
tients, PEW could exist and be associates with a poor clinical outcome
(Honda et al., 2007).
Several limitations of this meta-analysis should be acknowledged.
First, there was considerable heterogeneity between studies, indicating
a variation in prevalences between studies. To address the heterogene-
ity, random-effect modeling was used throughout the analyses, as this
approach provides a more conservative estimate of the prevalence and
is better suited to address extreme differences between studies. Second,
a number of studies were not included due to the stringent inclusion/
exclusion criteria. Third, several potential confounding factors, such as
the mean duration of illness, length of hospital stay, dose of chlorprom-
azine equivalents, and use of second-generation antipsychotics, were
not included in our study. Indeed, it is important to note that duration
of illness is often a proxy for duration of medication exposure and is re-
lated to patient age, both of which may influence underweight. In addi-
tion, there were inadequate data on individuals prescribed specific
antipsychotics, particularly first-generation antipsychotic drugs. Finally,
there was marked variation in the quality of studies, particularly in sam-
ple size. Although the incidence rates are valuable for prevention and
screening measures, the discrepancy introduced with the incidence
and prevalence rates did not allow for studies that only reported inci-
dence rates to be included in the current study.
This was the first meta-analysis of the pooled prevalence of under-
weight among patients with schizophrenia. Underweight is highly prev-
alent in Japanese inpatients with schizophrenia. Psychiatrists in Japan
should be aware of underweight and its potential health risks. Treating
psychiatrists should also be responsible for providing the necessary nu-
tritional interventions. Future research should focus on evaluating inter-
ventions that target underweight.
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.schres.2017.10.017.
Acknowledgments
We would like to thank Ms. Naomi Natsume for her kind support. Funding for this
study was provided by the Hirosaki Research Institute for the neurosciences.
Conflict of interest
The authors declare that they have no competing interests.
Contributors
Dr. Sugawara and Dr. Yasui-Furukori conceived and designed the study, searched liter-
atures, interpreted the data, and wrote the initial draft of the manuscript. Dr. Yasui-Furukori
had full access to all of the data in the study. Dr. Maruo conducted the statistical analyses.
Dr. Sugai, Dr. Suzuki and Dr. Someya contributed to the study design and the development
of research question. Dr. Shimoda, and Dr. Ozeki contributed to development of research
question and the interpretation of the results. All of authors approved the manuscript.
Please cite this article as: Sugawara, N., et al., Prevalence of underweight in patients with schizophrenia: A meta-analysis, Schizophr. Res. (2017),
https://doi.org/10.1016/j.schres.2017.10.017
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