The Intersection of COVID-19 and Metabolic-Associated Fatty Liver Disease: An Overview of the Current Evidence

Abstract

The global population is currently experiencing the impact of the SARS-CoV-2 coronavirus, which has caused the Coronavirus Disease 2019 (COVID-19) pandemic. With our profound comprehension of COVID-19, encompassing the involvement sequence of the respiratory tract, gastrointestinal system, and cardiovascular apparatus, the multiorgan symptoms of this infectious disease have been discerned. Metabolic-associated fatty liver disease (MAFLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a pervasive public health concern intricately linked with metabolic dysregulation and estimated to afflict one-fourth of the global adult population. The burgeoning focus on the association between COVID-19 and MAFLD is justified by the potential role of the latter as a risk factor for both SARS-CoV-2 infection and the subsequent emergence of severe COVID-19 symptoms. Investigations have suggested that changes in both innate and adaptive immune responses among MAFLD patients may play a role in determining the severity of COVID-19. The remarkable similarities observed in the cytokine pathways implicated in both diseases imply the existence of shared mechanisms governing the chronic inflammatory responses characterizing these conditions. The effect of MAFLD on the severity of COVID-19 illness remains uncertain, as indicated by conflicting results in cohort investigations.

Exploring Paxlovid Efficacy in COVID-19 Patients with MAFLD: Insights from a Single-Center Prospective Cohort Study

“…T2DM can also influence the immune system, potentially affecting the host response to COVID-19 [ 38 ]. The interaction between T2DM, MAFLD, and the immune response to COVID-19 may lead to nuanced and interconnected effects that are difficult to disentangle [ 14 ].…”

“…Existing hepatic steatosis and MAFLD have been identified as influencers of COVID-19 disease severity, Intensive Care Unit (ICU) admission rates, and the necessity for invasive mechanical ventilation. Conversely, COVID-19 contributes to the exacerbation of hepatic injury and the progression of disease severity in MAFLD and other liver disorders [ 14 ]. However, it is essential to acknowledge that MAFLD frequently coexists with additional entities such as obesity and DM within the broader spectrum of metabolic syndrome.…”

“…Meta-analyses have postulated that the presence of MAFLD heightens the risk of severe progression of COVID-19 and augments the likelihood of patients requiring admission to intensive care units [ 1 , 6 , 11 , 12 , 13 ]. However, its impact on the development of critical COVID-19 or mortality remains equivocal [ 14 ].…”

Genetic Predictors of Comorbid Course of COVID-19 and MAFLD: A Comprehensive Analysis

“…While the relationship remains contentious, initial reports during the COVID-19 pandemic suggested that patients with MAFLD may face an elevated risk of experiencing a more severe disease course [ 35 , 36 , 37 , 38 , 39 , 40 ]. However, it remains unclear whether MAFLD merely associates with adverse outcomes or whether it plays a causal role [ 41 ]. Furthermore, it is crucial not only to acknowledge the potential impact of MAFLD on the course of COVID-19 but also to recognize the effects of the COVID-19 pandemic itself on patients with MAFLD and the overall epidemiology of the disease [ 41 , 42 ].…”

“…However, it remains unclear whether MAFLD merely associates with adverse outcomes or whether it plays a causal role [ 41 ]. Furthermore, it is crucial not only to acknowledge the potential impact of MAFLD on the course of COVID-19 but also to recognize the effects of the COVID-19 pandemic itself on patients with MAFLD and the overall epidemiology of the disease [ 41 , 42 ].…”