This study investigates the cardiometabolic effects of second-generation antipsychotics (SGAs) in children and adolescents who are antipsychotic-naïve. The SATIETY cohort study, conducted from 2001 to 2007, enrolled 505 pediatric patients aged 4 to 19 years with ≤1 week of antipsychotic exposure. Of these, 272 patients completed the study, with 205 completing the full 12-week treatment period. The primary outcomes were weight changes, and secondary outcomes included body composition and metabolic parameters. Key findings include: - Significant weight gain was observed with all four SGAs: olanzapine (19.0 lbs, 15.2% weight gain), quetiapine (13.5 lbs, 10.4% weight gain), risperidone (11.9 lbs, 10.4% weight gain), and aripiprazole (9.9 lbs, 8.1% weight gain). - Weight gain ≥7% occurred in 84.4% of patients on olanzapine, 64.4% on risperidone, 58.4% on aripiprazole, and 55.6% on quetiapine. - Metabolic changes varied among the SGAs. Olanzapine significantly increased cholesterol, triglycerides, non-HDL-cholesterol, triglyceride/HDL ratio, glucose, insulin, and HOMA-IR. Quetiapine significantly increased cholesterol, triglycerides, non-HDL cholesterol, and triglyceride/HDL ratio. Risperidone significantly increased triglycerides. Aripiprazole and the comparison group showed no significant metabolic changes. - Dyslipidemia developed in 28.9%, 19.4%, 8.8%, and 7.3% of youth on olanzapine, risperidone, quetiapine, and aripiprazole, respectively, compared to 6.7% in the comparison group. - Insulin resistance and metabolic syndrome were relatively rare, with 8.6% and 1.6% of patients developing insulin resistance and metabolic syndrome, respectively. The study concludes that first-time use of SGAs is associated with significant weight gain and varied metabolic changes, highlighting the need for careful monitoring and management of cardiometabolic risks in pediatric patients.This study investigates the cardiometabolic effects of second-generation antipsychotics (SGAs) in children and adolescents who are antipsychotic-naïve. The SATIETY cohort study, conducted from 2001 to 2007, enrolled 505 pediatric patients aged 4 to 19 years with ≤1 week of antipsychotic exposure. Of these, 272 patients completed the study, with 205 completing the full 12-week treatment period. The primary outcomes were weight changes, and secondary outcomes included body composition and metabolic parameters. Key findings include: - Significant weight gain was observed with all four SGAs: olanzapine (19.0 lbs, 15.2% weight gain), quetiapine (13.5 lbs, 10.4% weight gain), risperidone (11.9 lbs, 10.4% weight gain), and aripiprazole (9.9 lbs, 8.1% weight gain). - Weight gain ≥7% occurred in 84.4% of patients on olanzapine, 64.4% on risperidone, 58.4% on aripiprazole, and 55.6% on quetiapine. - Metabolic changes varied among the SGAs. Olanzapine significantly increased cholesterol, triglycerides, non-HDL-cholesterol, triglyceride/HDL ratio, glucose, insulin, and HOMA-IR. Quetiapine significantly increased cholesterol, triglycerides, non-HDL cholesterol, and triglyceride/HDL ratio. Risperidone significantly increased triglycerides. Aripiprazole and the comparison group showed no significant metabolic changes. - Dyslipidemia developed in 28.9%, 19.4%, 8.8%, and 7.3% of youth on olanzapine, risperidone, quetiapine, and aripiprazole, respectively, compared to 6.7% in the comparison group. - Insulin resistance and metabolic syndrome were relatively rare, with 8.6% and 1.6% of patients developing insulin resistance and metabolic syndrome, respectively. The study concludes that first-time use of SGAs is associated with significant weight gain and varied metabolic changes, highlighting the need for careful monitoring and management of cardiometabolic risks in pediatric patients.