Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease

Zheng, Kenneth I.; Gao, Feng; Wang, Xiao-Bo; Sun, Qing-Feng; Pan, Ke-Hua; Wang, Ting-Yao; Ma, Hong-Lei; Liu, Wen-Yue; George, Jacob; Zheng, Ming-Hua

Abstract Background & Aims. Coronavirus disease 2019 (COVID-19) has been declared a pandemic in 2020. Patients with metabolic associated fatty liver disease (MAFLD) are often obese and have additional metabolic risk factors which may aggravate the severity of respiratory diseases and of COVID-19. This study aims to investigate the association between MAFLD and COVID-19 severity. Methods 214 patients with laboratory-confirmed COVID-19 aged between 18 and 75 years from three hospitals in Wenzhou, China were consecutively enrolled. Sixty-six patients with MAFLD were included in the final analysis. COVID-19 was diagnosed as a positive result by high-throughput sequencing or real-time reverse transcriptase-polymerase chain reaction assay of oropharyngeal swab specimens. COVID-19 severity was assessed during hospitalization and classified as severe and non-severe based on the current management guideline. All patients were screened for fatty liver by computed tomography and subsequently diagnosed as MAFLD according to a recent set of consensus diagnostic criteria. Obesity was defined as BMI >25 kg/m2. Results The presence of obesity in MAFLD patients was associated with a ~ 6-fold increased risk of severe COVID-19 illness (unadjusted-OR 5.77, 95% CI 1.19–27.91, p = .029). Notably, this association with obesity and COVID-19 severity remained significant (adjusted-OR 6.32, 95% CI 1.16–34.54, p = .033) even after adjusting for age, sex, smoking, diabetes, hypertension, and dyslipidaemia. Conclusions Our data demonstrate that the risk of obesity to COVID-19 severity is greater in those with, than those without MAFLD.