Objective:To assess the metabolic side effects of the following atypical antipsychoties head-to-head:amisulpride,olanzapine,aripiprazole,quetiapine,risperidone,ziprasidone.Methods:We searched the MED-LINE,EMBASE,Cochrane Library,PubMed,CNKI,Web of science,Sinomed,WANGFANG DATA databases for randomized,blineded studies comparing the above mentioned atypical antipsychoties in the treatment of schizophre-nia or related disorders.At last three reviewers extracted the data independently.All the data would be analysed with meta ananlysis and the analysis software of the RevMan 5.1 provided by Cochrane network.Results:There were 49 studies in which 45 were written in English and 4 were written in Chinese included in the review.Olanzapine pro-duced statistically significantly more weight gain than all other second-generation antipsychotics.Risperidone pro- duced significantly more weight gain than amisulpride.Olanzapine produced statistically significantly more increase in glucose levels from baseline to endpoint than all other second-genetation antipsychotics.Risperidone produced statistically significantly more increase in glucose levels from baseline to endpoint than aripiprazole,quetiap-ine.Olanzapine produced statistically significantly more increase in cholesterol than aripiprazole,risperidone and zi-prasidone.Quetiapine produced significantly more increase in cholesterol than risperidone and ziprasi-done.Risperidone produced significantly more increase in cholesterol compared to aripiprazole and ziprasidone.Conclusion:Some atypical antipsychoties lead to substantially more metabolic side effects than other a-typical antipsychoties.When choosing an atypical antipsychotic agent for an individual patient these side effects with their potential cause of secondary diseases should be weighed against efficacy and characteristics of the individual patient.