COVID‐19 and non‐alcoholic fatty liver disease: Two intersecting pandemics

• Published in: European journal of clinical investigation Vol. 50; no. 10; pp. e13338 - n/a
• Main Authors: Portincasa, Piero, Krawczyk, Marcin, Smyk, Wiktor, Lammert, Frank, Di Ciaula, Agostino
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.10.2020; John Wiley and Sons Inc
• Subjects: Abnormalities; Asthma; Betacoronavirus; Cardiovascular diseases; Chronic obstructive pulmonary disease; Coronavirus Infections - epidemiology; Coronavirus Infections - immunology; Coronavirus Infections - metabolism; COVID-19; Cytokine Release Syndrome - immunology; Damage; Diabetes mellitus (non-insulin dependent); Emphysema; Fatty liver; Fibrosis; Humans; Hypertension; Illnesses; Infections; Inflammation; Inflammation - immunology; Insulin; Insulin Resistance; Lethality; Liver; Liver - immunology; Liver - metabolism; Liver diseases; Lung diseases; Metabolic disorders; Metabolic syndrome; Metabolic Syndrome - epidemiology; Metabolic Syndrome - immunology; Metabolic Syndrome - metabolism; mitochondria; nitrosative stress; Non-alcoholic Fatty Liver Disease - epidemiology; Non-alcoholic Fatty Liver Disease - immunology; Non-alcoholic Fatty Liver Disease - metabolism; Obstructive lung disease; oxidative stress; Pandemics; Pneumonia, Viral - epidemiology; Pneumonia, Viral - immunology; Pneumonia, Viral - metabolism; Review; Reviews; Risk analysis; Risk factors; SARS-CoV-2; Subgroups; Viral diseases; Viruses; SARS-CoV-2; nitrosative stress; fatty liver; mitochondria; oxidative stress
• ISSN: 0014-2972; 1365-2362; 1365-2362
• DOI: 10.1111/eci.13338

Background Initial evidence from China suggests that most vulnerable subjects to COVID‐19 infection suffer from pre‐existing illness, including metabolic abnormalities. The pandemic characteristics and high‐lethality rate of COVID‐19 infection have raised concerns about interactions between virus pathobiology and components of the metabolic syndrome. Methods We harmonized the information from the recent existing literature on COVID‐19 acute pandemic and mechanisms of damage in non‐alcoholic fatty liver disease (NAFLD), as an example of chronic (non‐communicable) metabolic pandemic. Results COVID‐19‐infected patients are more fragile with underlying metabolic illness, including hypertension, cardiovascular disease, type 2 diabetes, chronic lung diseases (e.g. asthma, chronic obstructive pulmonary disease and emphysema) and metabolic syndrome. During metabolic abnormalities, expansion of metabolically active fat ('overfat condition') parallels chronic inflammatory changes, development of insulin resistance and accumulation of fat in configuring NAFLD. The deleterious interplay of inflammatory pathways chronically active in NAFLD and acutely in COVID‐19‐infected patients, can explain liver damage in a subgroup of patients and might condition a worse outcome in metabolically compromised NAFLD patients. In a subgroup of patients with NAFLD, the underlying liver fibrosis might represent an additional and independent risk factor for severe COVID‐19 illness, irrespective of metabolic comorbidities. Conclusions NAFLD can play a role in the outcome of COVID‐19 illness due to frequent association with comorbidities. Initial evidences suggest that increased liver fibrosis in NAFLD might affect COVID‐19 outcome. In addition, long‐term monitoring of post‐COVID‐19 NAFLD patients is advisable, to document further deterioration of liver damage. Further studies are required in this field.