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Letter to the Editor: Obesity as a risk factor for greater severity of COVID-19 in patients with metabolic associated fatty liver disease
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“Of note, aging, obesity and inflammation-related diseases such as diabetes and cardiovascular diseases have been shown to be risk factors for the severity of COVID-19 (293, 371–373).”
From IL-6 in inflammation, autoimmunity and cancer (2021) · cites this paper as [371]
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Cites
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
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“[2] Patients with metabolic associated fatty liver disease (MAFLD),[3] formerly known as non-alcoholic fatty liver disease, are often obese and have additional metabolic risk factors which may translate to a greater risk from respiratory diseases.”
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“[13] In MAFLD patients, particularly those with obesity, increased inflammatory activity in the liver and visceral fat is independently correlated with increased levels of IL-6,[14] which might have an additive/synergistic role in promoting greater severity of COVID-19.”
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Feng, G., Zheng, K. I., Yan, Q., Rios, R. S., Targher, G., Byrne, C. D., Poucke, S. V., Liu, W., & Zheng, M. (2020) · Journal of Clinical and Translational Hepatology · doi:10.14218/jcth.2020.00018 · Cited by 422 · cited 1×
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BackgroundSelf-citationObesity Is a Risk Factor for Greater COVID-19 Severity
Gao, F., Zheng, K. I., Wang, X.-B., Sun, Q.-F., Pan, K.-H., Wang, T.-Y., Chen, Y.-P., Targher, G., Byrne, C., George, J., et al. (2020) · Diabetes Care · doi:10.2337/dc20-0682 · Cited by 376 · cited 1×
“for severe COVID-19 with a dose-effect relationship between increasing BMI and the proportion of patients with severe illness.[11] In the current analysis, the risk of severe illness in MAFLD patients with co-existing obesity was more than 6-fold greater after adjustment for confounders.”
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“[4] [5] [6] [7] It is currently not known whether MALFD patients are also more likely to have greater COVID-19 severity of illness.”
Nonalcoholic fatty liver disease is associated with decreased lung function
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“[4] [5] [6] [7] It is currently not known whether MALFD patients are also more likely to have greater COVID-19 severity of illness.”
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IL-6 in inflammation, autoimmunity and cancer
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Risk factors for severe and critically ill COVID‐19 patients: A review
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COVID-19 in people with diabetes: understanding the reasons for worse outcomes
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Obesity in patients with COVID-19: a systematic review and meta-analysis
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de Almeida-Pititto, B., Dualib, P. M., Zajdenverg, L., Dantas, J. R., de Souza, F. D., Rodacki, M., Bertoluci, M. C., & Brazilian Diabetes Society Study Group (SBD) (2020) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-020-00586-4 · Cited by 391
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RETRACTED: Obesity and mortality of COVID-19. Meta-analysis
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RetractedObesity aggravates COVID‐19: A systematic review and meta‐analysis
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Neutrophils and Neutrophil Extracellular Traps Drive Necroinflammation in COVID-19
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Acute Pulmonary Embolism and COVID-19
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“Our study, in conjunction with recent and future studies, may prompt early evaluation with pulmonary CT angiography in patients with coronavirus disease 2019 who are at increased risk for developing pulmonary embolism based on demographic, clinical, and laboratory variables (6,7,10).”
BackgroundResultCommentary: Obesity: The “Achilles heel” for COVID-19?
Muscogiuri, G., Pugliese, G., Barrea, L., Savastano, S., & Colao, A. (2020) · Metabolism · doi:10.1016/j.metabol.2020.154251 · Cited by 230
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“Noteworthy, our results are in line with a previous report suggesting that ectopic fat depositionwithin the liver is strongly associated to COVID-19 clinical severity among obese subjects [30].”
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“Apart from overall obesity, body fat distribution is an important risk factor for cardiometabolic outcome [1,2].”
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Extrapulmonary complications of COVID‐19: A multisystem disease?
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T-Cell Hyperactivation and Paralysis in Severe COVID-19 Infection Revealed by Single-Cell Analysis
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Obesity and COVID-19: what makes obese host so vulnerable?
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“SARS-COV- 2: Severe acute respiratory syndrome coronavirus 2; COVID19: Coronavirus disease; BMI: Body Mass Index; IMV: Intermittent Mandatory Ventilation; ICU: Intensive Care Unit; MAFLD: Metabolic associated fatty liver disease; H1N1: Influenza A virus subtype H1N1; ACE-2: Angiotensinconverting enzyme 2; Th cells: T…”
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“It may also be a determinant of disease severity, independent of age and hypertension [14, 19].”
BackgroundTwo important controversial risk factors in SARS-CoV-2 infection: Obesity and smoking
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“Of these studies, fourwere performed in Asia [24,26,28,34], including China (n=3) and Kuwait (n=1); Nine in America [8,21,23,25,27,31–33,35], including USA (n=7) andMexico (n = 2); and three in Europe [22,29,30], including Italy (n = 2) and France (n=1).”
InfluentialCOVID‐19 and non‐alcoholic fatty liver disease: Two intersecting pandemics
Portincasa, P., Krawczyk, M. J., Smyk, W., Lammert, F., & Ciaula, A. D. (2020) · European Journal of Clinical Investigation · doi:10.1111/eci.13338 · Cited by 141
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Cardiac Involvement of COVID-19: A Comprehensive Review
Chang, W., Toh, H. S., Liao, C., & Yu, W. (2020) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2020.10.002 · Cited by 165
COVID-19 in pregnant women: A systematic review and meta-analysis
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Are we equal in adversity? Does Covid-19 affect women and men differently?
Rozenberg, S., Vandromme, J., & Martin, C. (2020) · Maturitas · doi:10.1016/j.maturitas.2020.05.009 · Cited by 123
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a review
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Self-citationImpact of obesity on hospitalizations and mortality, due to COVID-19: A systematic review
de Siqueira, J. V. V., Almeida, L. G., Zica, B. O., Brum, I. B., Barceló, A., & Galil, A. G. D. S. (2020) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2020.07.005 · Cited by 120
COVID-19 and Preexisting Comorbidities: Risks, Synergies, and Clinical Outcomes
Bigdelou, B., Sepand, M. R., Najafikhoshnoo, S., Negrete, J. A. T., Sharaf, M., Ho, J. Q., Sullivan, I., Chauhan, P. S., Etter, M. M., Shekarian, T., et al. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.890517 · Cited by 126
COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist
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Impact of obesity on COVID-19 patients
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“Several studies found that obesity was a critical predictor of severe COVID-19 [73].”
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Liver injury in COVID-19: clinical features and treatment management
Yu, D., Du, Q., Yan, S., Guo, X., He, Y., Zhu, G., Zhao, K., & Ouyang, S. (2021) · Virology Journal · doi:10.1186/s12985-021-01593-1 · Cited by 97
“Patients with metabolically related fatty liver disease have additional metabolic risk factors, which may be associated with more severe disease phenotype [25].”
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Maddaloni, E., D’Onofrio, L., Alessandri, F., Mignogna, C., Leto, G., Pascarella, G., Mezzaroma, I., Lichtner, M., Pozzilli, P., Agrò, F. E., et al. (2020) · Cardiovascular Diabetology · doi:10.1186/s12933-020-01140-2 · Cited by 108
“While measures of visceral adiposity were not available in our study, BMI was found to be higher in patients with the primary outcome, consistent with previous reports in other populations [4, 39].”
ResultObesity in COVID-19: A Systematic Review and Meta-analysis
Ho, J. S. Y., Fernando, D. I., Chan, M. Y., & Sia, C. (2020) · Annals of the Academy of Medicine Singapore · doi:10.47102/annals-acadmedsg.2020299 · Cited by 93
A systematic review and meta-analysis of obesity and COVID-19 outcomes
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Pasquarelli-do-Nascimento, G., Braz-de-Melo, H. A., Faria, S. S., Santos, I. D. O., Kobinger, G., & Magalhães, K. G. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.00530 · Cited by 103
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“In another study, the presence of obesity in NAFLD patients was associated with a sixfold increased risk of severe COVID-19 illness after adjusting for other major co-morbidities [24].”
BackgroundMethodNAFLD and COVID-19: a Pooled Analysis
Sachdeva, S., Khandait, H., Kopel, J., Aloysius, M., Desai, R., & Goyal, H. (2020) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-020-00631-3 · Cited by 78
“32 in obese NAFLD patients than in non-obese patients with NAFLD [14].”
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Machine Learning and AI for Healthcare: Big Data for Improved Health Outcomes
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“COVID-19 made it acceptable for everyone to perform tasks in their own time—moving expectancy from time based to task based.”
BackgroundInfluentialLiver injury in the era of COVID-19
Cichoż‐Lach, H., & Michalak, A. (2021) · World Journal of Gastroenterology · doi:10.3748/wjg.v27.i5.377 · Cited by 94
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Karuppan, M. K. M., Devadoss, D., Nair, M. G., Chand, H. S., & Lakshmana, M. K. (2021) · Molecular Neurobiology · doi:10.1007/s12035-020-02245-1 · Cited by 79
“Another recent study in China reported that obesity in metabolic-associated fatty liver disease (MAFLD) has ~ 6-fold increased risk for COVID-19 in the age group of 18 to 75 [52].”
BackgroundMahamid, M., Nseir, W., Khoury, T., Mahamid, B., Nubania, A., Sub-Laban, K., Schifter, J., Mari, A., Sbeit, W., & Goldin, E. (2020) · European Journal of Gastroenterology and Hepathology · doi:10.1097/meg.0000000000001902 · Cited by 66
Should patients with obesity be more afraid of COVID‐19?
Rychter, A. M., Zawada, A. E., Ratajczak, A. E., Dobrowolska, A., & Krela‐Kaźmierczak, I. (2020) · Obesity Reviews · doi:10.1111/obr.13083 · Cited by 102
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“A characteristic of COVID-19 patients is obesity [5] and this condition can lead to a dangerous paradox [6].”
BackgroundDalamaga, Μ., Christodoulatos, G. S., Karampela, Ι., Vallianou, N. G., & Apovian, C. M. (2021) · Current Obesity Reports · doi:10.1007/s13679-021-00436-y · Cited by 74
The COVID-19, Obesity, and Food Insecurity Syndemic
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Self-citation
Metadata
- Authors
- Zheng, K. I., Gao, F., Wang, X.-B., Sun, Q.-F., Pan, K.-H., Wang, T.-Y., Ma, H.-L., Chen, Y.-P., Liu, W.-Y., George, J., & Zheng, M.-H.
- Affiliations
- First Affiliated Hospital of Wenzhou Medical University (CN)
- The University of Sydney (AU)
- Wenzhou Medical University (CN)
- Corresponding author
- George, Jacob
- Zheng, Ming-Hua
- Venue
- Metabolism
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 108
- Pages
- 154244
- ISSN
- 0026-0495 (ISSN-L)
- PMC
- PMC7166301
- OpenAlex
- W3016610783
- Cited by
- 332
- References
- 14
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 10 · 2023: 28 · 2022: 44 · 2021: 101 · 2020: 140
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
- Funders
- National Natural Science Foundation of China (81500665)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- obesity, COVID-19 severity, metabolic-associated fatty liver disease, non-alcoholic fatty liver disease, comorbidities, SARS-CoV-2, disease severity risk factors, metabolic risk factors, respiratory disease risk, hypoxia, innate immunity, lung function, SARS-CoV-2 viral load, SARS-CoV-2 variants
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Obesity, Pneumonia, Viral, Risk Factors, Coronavirus Infections, Young Adult, Pandemics, Non-alcoholic Fatty Liver Disease
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