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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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Citations
Cites
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30183-5 · Cited by 48,884 · cited 1×
“Systemic inflammatory response syndrome, a common complication in severe COVID-19 [12], is promoted by the activation of CD14+ and”
Clinical characteristics of coronavirus disease 2019 in China
Guan, W.-J., Ni, Z.-Y., Hu, Y., Liang, W.-H., Ou, C.-Q., He, J.-X., Liu, L., Shan, H., Lei, C.-L., Hui, D. S. C., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2002032 · Cited by 30,246 · cited 1×
“Preliminary data suggests that obesity may aggravate the severity of respiratory diseases and of COVID-19 [2].”
Self-citationAlberti, K. G. M. M., Zimmet, P., & Shaw, J. (2006) · Diabetic Medicine · doi:10.1111/j.1464-5491.2006.01858.x · Cited by 6,597 · cited 1×
“hypertension and dyslipidemia were diagnosed based on established criteria.[10] All patients denied a history of chronic obstructive or restrictive pulmonary disease.”
BackgroundEslam, M., Newsome, P. N., Sarin, S. K., Anstee, Q. M., Targher, G., Romero-Gomez, M., Zelber-Sagi, S., Wai-Sun Wong, V., Dufour, J.-F., Schattenberg, J. M., et al. (2020) · Journal of Hepatology · doi:10.1016/j.jhep.2020.03.039 · Cited by 4,472 · cited 2×
“[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.”
BackgroundMethodSelf-citationvan der Poorten, D., Milner, K., Hui, J. M., Hodge, A. D., Trenell, M. I., Kench, J. G., London, R. M., Peduto, T., Chisholm, D. J., & George, J. (2008) · Hepatology · doi:10.1002/hep.22350 · Cited by 611 · cited 2×
“[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.”
BackgroundSelf-citationCOVID-19 and Liver Dysfunction: Current Insights and Emergent Therapeutic Strategies
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×
“This suggests IL-6 is a key proinflammatory factor that triggers the inflammatory “storm” in patients.[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/synerg…”
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.”
BackgroundSelf-citationLean NAFLD: A Distinct Entity Shaped by Differential Metabolic Adaptation
Chen, F., Esmaili, S., Rogers, G. B., Bugianesi, E., Petta, S., Marchesini, G., Bayoumi, A., Metwally, M., Azardaryany, M. K., Coulter, S., et al. (2019) · Hepatology · doi:10.1002/hep.30908 · Cited by 338
Self-citationNseir, W., Mograbi, J., Amara, A., Abu-Elheja, O., & Mahamid, M. (2018) · QJM : monthly journal of the Association of Physicians · doi:10.1093/qjmed/hcy227 · Cited by 47 · cited 1×
“[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
Lee, C.-H., Choi, S.-H., Chung, G., Park, B., & Kwak, M.-S. (2018) · Liver international (Print) · doi:10.1111/liv.13860 · Cited by 36 · cited 1×
“[4] [5] [6] [7] It is currently not known whether MALFD patients are also more likely to have greater COVID-19 severity of illness.”
Obesity and Overweight in Asian People.
Goda, A., & Masuyama, T. (2016) · Circulation Journal · doi:10.1253/circj.cj-16-1087 · Cited by 34 · cited 1×
“Obesity was defined as BMI N25 kg/m(2) [9].”
Association Between Pulmonary Function and Nonalcoholic Fatty Liver Disease in the NHANES III Study
Peng, T.-C., Kao, T., Wu, L.-W., Chen, Y.-J., Chang, Y.-W., Wang, C.-C., Tsao, Y.-T., & Chen, W.-L. (2015) · Medicine · doi:10.1097/md.0000000000000907 · Cited by 25 · cited 1×
“[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.[4-7] It is currently not known whether MALFD patients are also more lik…”
BackgroundSelf-citationArias, M., Fábrega, E., López‐Hoyos, M., & Crespo, J. (2015) · BioMed Research International · doi:10.1155/2015/319745 · Cited by 17 · cited 1×
“[4] [5] [6] [7] It is currently not known whether MALFD patients are also more likely to have greater COVID-19 severity of illness.”
Cited by
Sorted by citations
IL-6 in inflammation, autoimmunity and cancer
Hirano, T. (2021) · International Immunology · doi:10.1093/intimm/dxaa078 · Cited by 1,453
Risk factors for severe and critically ill COVID‐19 patients: A review
Gao, Y., Ding, M., Dong, X., Zhang, J., Azkur, A. K., Azkur, D., Gan, H. K., Sun, Y., Fu, W., Li, W., et al. (2020) · Allergy · doi:10.1111/all.14657 · Cited by 1,453
Popkin, B. M., Du, S., Green, W. D., Beck, M. A., Algaith, T., Herbst, C. H., Alsukait, R. F., Alluhidan, M., Alazemi, N., & Shekar, M. (2020) · Obesity Reviews · doi:10.1111/obr.13128 · Cited by 1,150
Beyerstedt, S., Casaro, E. B., & Rangel, É. B. (2021) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-020-04138-6 · Cited by 897
COVID-19 in people with diabetes: understanding the reasons for worse outcomes
Apicella, M., Campopiano, M. C., Mantuano, M., Mazoni, L., Coppelli, A., & Prato, S. D. (2020) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(20)30238-2 · Cited by 949
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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